480 research outputs found
Drug history taking and the identification of drug related problems in an accident and emergency department
No full textObjective - To determine the incidence of drug related problems that fail to be noted on casualty cards in patients subsequently admitted, and to compare medication histories as recorded by accident and emergency (A&E) senior house officers (SHOs) and a pharmacist.Methods - An initial retrospective survey of 1459 acute inpatient admissions through A&E over a three month period was followed by a prospective study of 33 elderly patients. Results - In the retrospective survey, 52 medication related problems were confirmed after examination of the medical records, of which only 16 were identified in A&E. In the prospective study, 125 currently prescribed items were identified by the pharmacist compared to 77 by A&E SHOs; 66% of the missed information was clinically relevant. Of 17 previous adverse drug reactions identified by the pharmacist only six were also recorded by the A&E officer. Only four over the counter medicines were identified by the A&E SHOs compared to 30 by the pharmacist. Conclusions - More accurate recording of drug history on casualty cards should be undertaken, particularly in respect of over the counter medication and the identification of drug related problems
Abnormal anatomical connectivity between the amygdala and orbitofrontal cortex in conduct disorder
No full textObjective: previous research suggested that structural and functional abnormalities within the amygdala and orbitofrontal cortex contribute to the pathophysiology of Conduct Disorder (CD). Here, we investigated whether the integrity of the white-matter pathways connecting these regions is abnormal and thus may represent a putative neurobiological marker for CD.Methods: diffusion Tensor Imaging (DTI) was used to investigate white-matter microstructural integrity in male adolescents with childhood-onset CD, compared with healthy controls matched in age, sex, intelligence, and socioeconomic status. Two approaches were employed to analyze DTI data: voxel-based morphometry of fractional anisotropy (FA), an index of white-matter integrity, and virtual dissection of white-matter pathways using tractography.Results: adolescents with CD displayed higher FA within the right external capsule relative to controls (T?=?6.08, P<0.05, Family-Wise Error, whole-brain correction). Tractography analyses showed that FA values within the uncinate fascicle (connecting the amygdala and orbitofrontal cortex) were abnormally increased in individuals with CD relative to controls. This was in contrast with the inferior frontal-occipital fascicle, which showed no significant group differences in FA. The finding of increased FA in the uncinate fascicle remained significant when factoring out the contribution of attention-deficit/hyperactivity disorder symptoms. There were no group differences in the number of streamlines in either of these anatomical tracts.Conclusions: these results provide evidence that CD is associated with white-matter microstructural abnormalities in the anatomical tract that connects the amygdala and orbitofrontal cortex, the uncinate fascicle. These results implicate abnormal maturation of white-matter pathways which are fundamental in the regulation of emotional behavior in C
Corrigendum: Mutualistic Coupling Between Vocabulary and Reasoning Supports Cognitive Development During Late Adolescence and Early Adulthood
No full textCorrection to: Kievit, R. A., Lindenberger, U., Goodyer, I. M., Jones, P. B., Fonagy, P., Bullmore, E. T., the Neuroscience in Psychiatry Network, & Dolan, R. J. (2017). Mutualistic coupling between vocabulary and reasoning supports cognitive development during late adolescence and early adulthood. Psychological Science, 28, 1419–1431. doi:10.1177/095679761771078
Cortisol diurnal rhythm and stress reactivity in male adolescents with early-onset or adolescence-onset conduct disorder
No full textBackground: Previous studies have reported lower basal cortisol levels and reduced cortisol responses to stress in children and adolescents with conduct disorder (CD). It is not known whether these findings are specific to early-onset CD. This study investigated basal and stress-induced cortisol secretion in male participants with early-onset and adolescence-onset forms of CD.Methods: Forty-two participants with early-onset CD, 28 with adolescence-onset CD, and 95 control subjects participated in the study. They collected saliva across the day to assess their cortisol awakening response and diurnal rhythm. Subsequently, salivary cortisol was measured before, during, and after a psychosocial stress procedure designed to elicit frustration. Cardiovascular activity and subjective mood states were also assessed during stress exposure.Results: There were no group differences in morning cortisol levels or the size of the cortisol awakening response. Basal cortisol levels in the evening and at 11 am during the laboratory visit were higher in both CD subgroups relative to control subjects. In contrast, cortisol and cardiovascular responses to psychosocial stress were reduced in both CD subgroups compared with control subjects. All groups reported similar increases in negative mood states during stress.Conclusions: Our findings suggest that group differences in cortisol secretion are most pronounced during stress exposure, when participants with CD show cortisol hyporeactivity compared with control subjects. There was no evidence for reduced basal cortisol secretion in participants with CD, but rather increased secretion at specific time points. The results do not support developmentally sensitive differences in cortisol secretion between CD subtypes
Early British botanists and their gardens, based on unpublished writings of Goodyer, Tradescant, and others
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Cortical thickness, surface area, and folding alterations in male youths with conduct disorder and varying levels of callous–unemotional traits
No full textPurpose: Previous studies have reported changes in gray matter volume in youths with conduct disorder (CD), although these differences are difficult to interpret as they may have been driven by alterations in cortical thickness, surface area (SA), or folding. The objective of this study was to use surface-based morphometry (SBM) methods to compare male youths with CD and age and sex-matched healthy controls (HCs) in cortical thickness, SA, and folding. We also tested for structural differences between the childhood-onset and adolescence-onset subtypes of CD and performed regression analyses to assess for relationships between CD symptoms and callous–unemotional (CU) traits and SBM-derived measures.
Methods: We acquired structural neuroimaging data from 20 HCs and 36 CD participants (18 with childhood-onset CD and 18 with adolescence-onset CD) and analyzed the data using FreeSurfer.
Results: Relative to HCs, youths with CD showed reduced cortical thickness in the superior temporal gyrus, reduced SA in the orbitofrontal cortex (OFC), and increased cortical folding in the insula. There were no significant differences between the childhood-onset and adolescence-onset CD subgroups in cortical thickness or SA, but several frontal and temporal regions showed increased cortical folding in childhood-onset relative to adolescence-onset CD participants. Both CD subgroups also showed increased cortical folding relative to HCs. CD symptoms were negatively correlated with OFC SA whereas CU traits were positively correlated with insula folding.
Conclusions: Cortical thinning in the superior temporal gyrus may contribute to the social cognitive impairments displayed by youths with CD, whereas reduced OFC SA may lead to impairments in emotion regulation and reward processing in youths with CD. The increased cortical folding observed in the insula may reflect a maturational delay in this region and could mediate the link between CU traits and empathy deficits. Altered cortical folding was observed in childhood-onset and adolescence-onset forms of CD
Changes in General and Specific Psychopathology Factors Over a Psychosocial Intervention
No full textOBJECTIVE: Recent research suggests that comorbidity among child and adolescent psychiatric symptoms can be explained by a single general psychopathology ('p') factor, as well as more specific factors summarizing clusters of symptoms. We investigated within- and between-person changes in the general and specific psychopathology factors over a psychosocial intervention. METHOD: We ran a secondary analysis of the Systemic Therapy for At-Risk Teens study, a pragmatic randomized controlled trial that compared the effects of multisystemic therapy to management-as-usual for reducing antisocial behavior in 684 adolescents (82% male; 11-18 at baseline) over an 18-month period. The general p factor, as well as specific antisocial, attention, anxiety, and mood factors, were estimated from a symptom-level analysis of a set of narrow-band symptom scales measured repeatedly over the study. General and specific psychopathology factors were assessed for reliability, validity, and within- and between-person change using a parallel process multilevel growth model. RESULTS: A revised bifactor model that included a general p factor and specific anxiety, mood, antisocial, and attention factors with cross-loadings fit the data best. While the factor structure was multidimensional, p accounted for most of the variance in total scores. The p, anxiety, and antisocial factors predicted within-person variation in external outcomes. p and antisocial factors showed within-person reductions, while anxiety showed within-person increases over time. Despite individual variation in baseline factor scores, adolescents showed similar rates of change. CONCLUSION: The bifactor model is useful for teasing apart general and specific therapeutic changes which are conflated in standard analyses of symptom scores. CLINICAL TRIAL REGISTRATION INFORMATION: START (Systemic Therapy for At Risk Teens): A National Randomised Controlled Trial to Evaluate Multisystemic Therapy in the UK Context. http://www.isrctn.com; ISRCTN77132214
Stress, Risk and Resilience in Children and Adolescents: Process, Mechanisms and Interventions Edited by R. J. Haggerty, L. R. Sherrod, N. Garmezy, <i>et al.</i> Cambridge: Cambridge University Press. 1997. 417 pp. £15.95. ISBN 0-521-4-4146-3
No full textEarly British botanists and their gardens, based on unpublished writings of Goodyer, Tradescant, and others
No full textHelp Starts Here. The Maladjusted Child in the Ordinary School. By I. Kolvin, R. F. Garside, A. R. Nicol, A. Macmillan, F. Wolstenholme and I. M. Leitch Andover: Associated Book Publishers. 1981. Pp 436. £9.95.
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