Content and correlates of checking related to symptoms of obsessive compulsive disorder and generalized anxiety disorder

In addition to the central role of compulsive behaviors in obsessive compulsive disorder (OCD), recent data have documented the presence of compulsive behaviors in individuals with generalized anxiety disorder (GAD). However, there is a lack of information about potential similarities and differences with regard to the quality, or content, of checking associated with worry and obsessions. The two studies presented herein are an initial step towards gathering this information. Findings of Study 1, from a large unselected undergraduate sample, showed that symptoms of OCD and GAD were both significantly associated with checking behaviors. However, while OCD symptoms were associated with checking related to both objects and interpersonal situations, GAD symptoms were only significantly associated with interpersonal checking. Findings of Study 2, using a separate sample, suggest links between interpersonal checking and features characteristic of GAD, namely emotion regulation difficulties, and between object checking and a cognitive feature of OCD, namely thought-action fusion. In summary, the current studies add to a growing body of literature suggesting that checking may be important in numerous forms of psychopathology, while also suggesting that the nature and function of checking may differ for various symptom profiles.     

Seizures triggered by July 4th fireworks in an 8-year-old girl with perinatal stroke

Warnings regarding fireworks displays as a possible seizure-producing stimulus have been around for several years, but there is a lack of well-documented cases. This case describes photic- and/or pattern-induced seizures that appeared to be triggered by July 4 fireworks. This 8-year-old girl with hemiplegic cerebral palsy and known seizure disorder because of perinatal right middle cerebral artery stroke had a cluster of seizures within minutes of the onset of a professional fireworks display. The seizures stopped when the child's eyes were covered and she was taken away from the scene. The importance of photic- and pattern-induced seizures in children is discussed.     

Higher prevalence of bipolar I disorder among Asian and Latino compared to Caucasian patients receiving treatment

Introduction: There are limited data regarding relationships between race/ethnicity and bipolar disorder. This study assessed such relationships in patients receiving treatment in a university clinic. Methods: Demographic, illness characteristics, symptom severity, treatment, and care utilization data were collected from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP‐BD) Affective Disorders Evaluation, Mini‐International Neuropsychiatric Interview, and the STEP‐BD Clinician Rated Packet. Data were compared among 51 Asian, 35 Latino, and 86 Caucasian patients in treatment at the Stanford University Bipolar Disorders Clinic. χ² tests and analyses of variance were used to assess between‐group differences. Results: Asian and Latino compared to Caucasian patients had significantly higher prevalence of bipolar I disorder (58.8% and 60.0% versus 37.2%, respectively). Asian and Latino patients also had a higher prevalence of history of psychosis, but this was related to the excess of bipolar I disorder, becoming non‐significant after controlling for bipolar subtype. The racial/ethnic difference in bipolar subtype prevalence did not appear to be secondary to demographic or socioeconomic differences. Discussion: The higher prevalence of bipolar I disorder and thus lower prevalence of bipolar II disorder and bipolar disorder not otherwise specified in Asian and Latino patients may be related to under‐diagnosis, misdiagnosis, or care underutilization of patients with milder forms of bipolar disorders. Additional research and public health efforts are warranted to further understand the effects of race and ethnicity on the management of bipolar disorders and to enhance timely and accurate diagnosis, culturally sensitive treatment, and optimal care utilization.     

Challenging issues in surgical critical care, trauma, and acute care surgery: a report from the Critical Care Committee of the American Association for the Surgery of Trauma

Critical care workforce analyses estimate a 35% shortage of intensivists by 2020 as a result of the aging population and the growing demand for greater utilization of intensivists. Surgical critical care in the U.S. is particularly challenged by a significant shortfall of surgical intensivists, with only 2586 surgeons currently certified in surgical critical care by the American Board of Surgery, and even fewer surgeons (1204) recertified in surgical critical care as of 2009. Surgical critical care fellows (160 in 2009) represent only 7.6% of all critical care trainees (2109 in 2009), with the largest number of critical care fellowship positions in internal medicine (1472, 69.8%). Traditional trauma fellowships have now transitioned into Surgical Critical Care or Acute Care Surgery (trauma, surgical critical care, emergency surgery) fellowships. Since adult critical care services are a large, expensive part of U.S. healthcare and workforce shortages continue to impact our healthcare system, recommendations for regionalization of critical care services in the U.S. is considered. The Critical Care Committee of the AAST has compiled national data regarding these important issues that face us in surgical critical care, trauma and acute care surgery, and discuss potential solutions for these issues.     

Interosseous membrane reconstruction for forearm longitudinal instability

Forearm longitudinal instability results from an axial load to the forearm with fracture or dislocation of the radial head and disruption of the interosseous membrane and that of the distal radioulnar joint. Patients may present in the acute or chronic setting with radioulnar instability as manifested by persistent or new forearm discomfort and wrist and elbow pain. Reconstruction of the interosseous membrane has been described to restore longitudinal forearm stability. We describe reconstruction of the central band of the interosseous membrane with a bone-patellar tendon-bone graft. This procedure may be carried out in conjunction with radial head fixation or replacement and TFCC repair in the acute setting or ulnar shortening osteotomy in late presenting cases.