Psychiatric disorders in individuals diagnosed with infantile autism as children: a case control study

The objective of this study was to compare the prevalence and types of psychiatric disorders in a clinical sample of 118 individuals diagnosed as children with infantile autism (IA) with psychiatric disorders in 336 matched controls from the general population using data from the nationwide Danish Psychiatric Central Register. The average observation time was 32.5 years, and mean age at follow-up was 40.6 years (range 25-55 years). Of the 118 individuals with IA, 57 (48.3%) had been in contact with psychiatric hospitals (inpatient hospitalization or outpatient visits) during the follow-up period, compared with 20/336 (6.0%) in the control group (p < 0.0001). This observation should alert general psychiatrists to the possibility of additional treatable psychiatric disorders occurring in individuals with IA. Of the 118 individuals in the IA group, 20 individuals (17%) had been given a comorbid psychiatric diagnosis during the observation period, compared with 9 individuals (2.7%) in the control group. Of the subjects with IA, 3.4% had received a diagnosis of schizophrenia (F20) at least once since the index admission in childhood, 0.8% had been diagnosed with delusional disorder (F22), 0.8% with acute psychotic disorder (F23), and 1.6% with unspecified non-organic psychosis (F29). In the control group, 0.9% had been diagnosed with schizophrenia (p = 0.08). In the group with IA, 3.4% had received a diagnosis in the broad category of affective disorders compared with 1.2% in the control group (p = 0.21). Issues associated with using registers in the ascertainment of co-occurring psychiatric disorders in IA are discussed.     

Paternal depression in the postnatal period assessed with traditional and male depression scales

Background

The occurrence of postnatal depression in fathers has begun to receive attention in the international research literature. The Edinburgh Postnatal Depression Scale (EPDS) assessment tool has been validated for men. However, identification of such men has been hindered by the use of assessment tools that may not be sensitive to the particular depressive symptoms experienced by men. So far the problem of male depressive symptoms has not been included in research on men's postnatal depressions.

Methods

As part of a fatherhood research programme, the EPDS and the Gotland Male Depression Scale (GMDS) were administered to 607 fathers 6 weeks after the birth of their child.

Results

549 (90.4%) fathers were assessed for the presence of depressive symptoms. The prevalence was 5.0% with EPDS (cut-off ≥10) and 3.4% with GMDS (cut-off ≥13). While 2.1% of the fathers had scores above the cut-off on both scales, 3.1% were assessed using only the EPDS and 1.3% with only the GMDS.

Conclusion

Our findings indicate that better methods for identifying men with postnatal depression need to be developed and should consist of assessment scales that also include male depressive symptoms.     

Dopamine natriuresis in salt-repleted, water-loaded humans: a dose-response study

Aims The purpose of the present study was to define the dose-response relationship between exogenous dopamine and systemic haemodynamics, renal haemodynamics, and renal excretory function at infusion rates in the range 0 to 12.5 μg kg⁻¹ min⁻¹ in normal volunteers. Methods While undergoing water diuresis, eight subjects were infused with 0, 1, 2, 3, 5, 7.5, 10 or 12.5 μg of dopamine kg⁻¹ min⁻¹ over 2 h in a randomized and double-blind fashion. On each study day, renal clearance studies were performed during a 1 h baseline period and subsequently during the second 1 h infusion period. Lithium clearance (CL_Li ) was used to estimate proximal tubular outflow. Results Cardiac output increased with the four highest doses. Mean arterial pressure followed a biphasic pattern with a decrease during the two lowest doses and a dose-dependent increase from the 7.5 μg kg⁻¹ min⁻¹ dose onwards. Effective renal plasma flow increased with all doses of dopamine, but peaked with the 3 μg kg⁻¹ min⁻¹ infusion rate [ from 617 (585–649) ml min⁻¹ with placebo to 915 (824–1006) ml min⁻¹ (means with 95% CI, P<0.001)]. None of the doses changed glomerular filtration rate (GFR). Sodium clearance (CL_Na ) and CL_Li were elevated with the four lowest doses but increased further from 7.5 μg kg⁻¹ min⁻¹ onwards. Compared with placebo, the percentage increase in CL_Na with increasing dose was 77 (5–159), 93 (13–172), 107 (24–190), 121 (60–181), 253 (65–441), 284 (74–494), and 212 (111–312) %, respectively. There were only small, inconsistent decreases in absolute proximal reabsorption rate (APR=GFR-CL_Li ). Fractional distal reabsorption of sodium (FDR_Na=(CL_Li-CL_Na )/CL_Li ) decreased with all doses, reaching its nadir with 7.5 μg kg⁻¹ min⁻¹ [from 95.9 (94.6–97.2) % with placebo to 91.5 (90.0–93.0) % (P<0.01)] whereafter a flat dose-response curve was observed. Conclusions In conclusion, the renal vasodilating effect of dopamine was maximal with 3 μg kg⁻¹ min⁻¹. The dose-dependent attenuation seen with higher doses is consistent with an increased α-adrenergic stimulation opposing the effect on dopaminergic receptors. The present CL_Li studies confirm that dopamine increases proximal tubular outflow. The results suggest that the natriuretic effect of depressor doses of dopamine was primarily caused by attenuation of the increase in distal sodium reabsorption normally seen after an increase in proximal tubular outflow. Pressor doses further increased sodium excretion, indicating the presence of pressure natriuresis at these high doses.     

Embodied relational research: How can researchers' competences in exploring existential aspects be enhanced?

Background

This methodological essay discusses the following question: How can researchers' competences in exploring existential aspects related to healthcare be enhanced? Exploring this novel perspective on caring practice may help us better understand and communicate about experiences and issues that matter to others (e.g. patients/users). Two things are needed: firstly, a vocabulary mirroring an “aesthetic-holistic” research approach allowing us to capture the essence of “what it is like” and secondly, the development of skills and competences allowing us to understand complex aspects of caring that are embodied, ethically sensitive and sustainable.

Aim

To identify personal competences and approaches underpinning research exploring “what it is like”—understanding human existence.

Discussion

The discussion addresses three questions: (A) What does human science exploring human existence search for? (B) Which researcher competences are required? (C) Which theoretical and practical approaches and dimensions may enhance the researchers' competences? We argue that we should find “ourselves” not only grasped through language and a qualitative research-methodological approach but also in what is reflected in the relation between self, language (dialogue) and the other. It is crucial to listen to the world in an ontological way. Emotions, feelings and bodily sensed understandings can, in some situations, bar us from stepping further into meta-physical listening and from adopting a being-in-the-world stance. In this relational perspective, the researcher may adopt an attentive pace and aesthetical attunement that transcend what cannot be reached through the language of logical, rigorous, precise and rational words, tuning into the ontological mood that exists as the tacit backdrop of our existence. This approach we dub “Embodied Relational Research.”

Conclusion

Researchers who explore humanity may benefit from cultivating awareness, sensitivity and understanding while displaying openness towards the other (the patients' or users' experiences). In this context, contemplative and creative dimensions are important to apply.