Genetic determinants of psychic resilience after a diagnosis of cancer

2017 ◽  
Vol 41 (S1) ◽  
pp. S596-S596
Author(s):  
M. Christensen ◽  
A. Drago
Keyword(s):  
At Risk ◽  
Psychiatric Disorders ◽  
Depressive Disorders ◽  
Adjustment Disorder ◽  
Genetic Determinants ◽  
Co Morbidity ◽  
Patients At Risk ◽  
Diagnosis Of Cancer ◽  
Competing Interest ◽  
Definition Of

IntroductionCo-morbidity between cancer and psychiatric disorders including adjustment disorder, depressive disorders or angst can seriously influence the prognosis and the quality of life of patients.AimThe identification of the psychological and biological profile of patients at risk for such co-morbidity is not yet available. Classical candidate genes such as the BDNF, the 5-HTLPR and genes whose products are involved in inflammatory events have received some attention, but results are inconclusive.Object and methodsIn the present review the association between cancer and psychiatric disorders is reviewed, a focus on the investigation of the Gene X environment and the epigenetic control over the activation of the HPA axis is proposed as a tool to refine the definition of the biologic profile at risk for co-morbidity between psychiatry and cancer.Results and conclusionA number of genes and socio-demographic variables that may influence risk to suffer from a psychiatric disorder after a diagnosis of cancer is identified and discussed. The identification of such biologic and socio-demographic profile is instrumental in the identification of subjects at risk of a double diagnosis, both somatic and psychiatric. An early identification of such profile risk would pave the way to the implementation of early intervention strategies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Emotion Dysregulation: A Review of the Concept and Implications for Clinical Practice

2016 ◽  
Vol 33 (S1) ◽  
pp. S528-S529
Author(s):  
A. D’Agostino ◽  
S. Covanti ◽  
M. Rossi Monti ◽  
V. Starcevic
Keyword(s):  
Clinical Practice ◽  
Psychiatric Disorders ◽  
Emotion Dysregulation ◽  
Emotional Reactivity ◽  
Emotional Awareness ◽  
Future Research ◽  
Competing Interest ◽  
Expression Of Emotions ◽  
Psychology Literature ◽  
Definition Of

IntroductionOver the past decade, emotion dysregulation has become a very popular term in the psychiatric and clinical psychology literature and it has been described as a key component in a range of mental disorders. For this reason, it has been recently called the “hallmark of psychopathology” (Beauchaine et al., 2007). However, many issues make this concept controversial.ObjectivesTo explore emotion dysregulation, focusing on problems related to its definition, meanings and role in many psychiatric disorders.AimsTo clarify the psychopathological core of emotion dysregulation and to discuss potential implications for clinical practice.MethodsA literature review was carried out by examining articles published in English between January 2003 and June 2015. A search of the databases PubMed, PsycINFO, Science Direct, Medline, EMBASE and Google Scholar was performed to identify the relevant papers.ResultsAlthough, there is no agreement about the definition of emotion dysregulation, the following five overlapping, not mutually exclusive dimensions were identified: decreased emotional awareness, inadequate emotional reactivity, intense experience and expression of emotions, emotional rigidity and cognitive reappraisal difficulty. These dimensions characterise a number of psychiatric disorders in different proportions, with borderline personality disorder and eating disorders seemingly more affected than other conditions.ConclusionsThis review highlights a discrepancy between the widespread clinical use of emotion dysregulation and inadequate conceptual status of this construct. Better understanding of the various dimensions of emotion dysregulation has implications for treatment. Future research needs to address emotion dysregulation in all its multifaceted complexity.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Complicated grief: Is there a place in psychiatry?

2017 ◽  
Vol 41 (S1) ◽  
pp. S458-S458
Author(s):  
S.L. Azevedo Pinto ◽  
J. Soares ◽  
A. Silva ◽  
R. Curral
Keyword(s):  
Depressive Disorders ◽  
Complicated Grief ◽  
Adjustment Disorder ◽  
Classification Systems ◽  
Post Traumatic Stress ◽  
Adequate Treatment ◽  
Psychiatric Syndrome ◽  
Persistent Complex Bereavement ◽  
Competing Interest ◽  
Persistent Complex Bereavement Disorder

IntroductionGrief is as normal reactive to a significant personal loss. It is characterized by affective, cognitive, behavioural and physiological symptoms. The grieving process is usually divided in five different stages, but in most cases presents a benign course, with decreased suffering and better adaptation to the new context. However, when high levels of emotional suffering or disability persist over a long time period, it becomes a case of complicated grief (CG), which should be adequately addressed.ObjectivesTo review the characteristics of CG, the evidence that supports it as an individual pathological entity, and its place in current classification systems.MethodsWe performed a bibliographic search in Pubmed and PsychInfo, of articles written in English, Portuguese and Spanish, containing the key words: grief, bereavement, psychiatry, classification.ResultsThe main issue regarding grief is the degree to which it is reasonable to interfere with a usually benign process. Since DSM-III bereavement has been referred to as an adaptive reaction to an important loss, which should not be diagnosed as major depressive disorder or adjustment disorder. However, DSM-5 has stated persistent complex bereavement disorder as an independent entity. In fact, CG fulfils the general criteria of every psychiatric syndrome, namely regarding specific diagnosis criteria, differential diagnosis from depressive disorders and post-traumatic stress disorder, and improvement with adequate treatment.ConclusionIt is important to correctly approach CG, since it presents with characteristic diagnosis features and much improvement may be achieved once adequate treatment is provided.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Subjective quality of life and its changes in patients at-risk for psychosis results of the EPOS study

2011 ◽  
Vol 26 (S2) ◽  
pp. 2039-2039
Author(s):  
R. Salokangas ◽  
T. Svirskis ◽  
M. Heinimaa ◽  
J. Klosterkötter ◽  
S. Ruhrmann ◽  
...  
Keyword(s):  
Quality Of Life ◽  
At Risk ◽  
Depressive Disorders ◽  
Familial Risk ◽  
Young Patients ◽  
Point Of View ◽  
Psychotic Symptoms ◽  
Subjective Quality Of Life ◽  
Patients At Risk

ObjectivesIn the European Prediction of Psychosis Study (EPOS) a large sample of young patients at high risk of psychosis (HR) were examined and their conversion rate to psychosis during 18 months follow-up was estimated. This presentation describes quality of life (QoL) and its changes in patients at risk of psychosis who did or did not convert to psychosis.MethodsIn all, 245 young HR patients were recruited and followed for 9 and 18 months. Risk of psychosis was defined by occurrence of basic symptoms (BS), attenuated psychotic symptoms (ATP), brief, limited or intermittent psychotic symptoms (BLIPS) or familial risk plus reduced functioning (FR-RF). QoL was assessed at baseline and at 9 and 18 months’ follow-ups, and analysed in the HR-patients who converted (HR-P; n = 40) or did not converted to psychosis (HR-NP; n = 205).ResultsThere were no differences in the course of QoL between the HR-P and HR-NP patients. Of the inclusion criteria, only BS associated with poor QoL at baseline. Among HR-NP subjects, depressive symptoms associated with QoL at baseline and predicted poor QoL at 9 and 18 month follow-ups.ConclusionsQoL of the HR-NP patients is as poor as that of the HR-P. From the QoL point of view, all HR patients require intensive treatment intervention from the first contact on. Especially, depressive disorders need to be treated vigorously.

Role of psychopathology in elucidating the underlying neural mechanisms

2016 ◽  
Vol 33 (S1) ◽  
pp. S65-S65
Author(s):  
F. Oyebode
Keyword(s):  
Psychiatric Disorders ◽  
Subjective Experience ◽  
Right Hemisphere ◽  
Neural Mechanisms ◽  
Subjective Experiences ◽  
Precise Description ◽  
Competing Interest ◽  
Definition Of ◽  
Misidentification Syndromes

IntroductionPsychopathology is the systematic study of abnormal subjective experience and behaviour and it aims to give precise description, categorisation and definition of abnormal subjective experiences.AimI aim to demonstrate that the most appropriate approach to elucidating the biological origins of psychiatric disorders is firstly to identify elementary abnormal phenomena and then to relate these to their underlying neural mechanisms. I will exemplify this by drawing attention to studies of Delusional Misidentification Syndromes (DSM).ResultsI will show that there are impairments in face recognition memory in individuals with DSM without impairments in the recognition of emotion and that there are abnormalities of right hemisphere function and of the autonomic recognition pathways that determine sense of familiarity.ConclusionsBasic psychopathological phenomena are more likely to throw light on the basic neural mechanisms that are important in psychiatric disorders than studying disease level categories.Disclosure of interestThe author has not supplied his declaration of competing interest.

Role of Computed Tomography in the Management of Vasospasm after Subarachnoid Hemorrhage

Neurosurgery ◽  
1984 ◽  
Vol 15 (3) ◽  
pp. 344-353 ◽  
Author(s):  
Alberto Pasqualin ◽  
Luisa Rosta ◽  
Renato Da Pian ◽  
Paolo Cavazzani ◽  
Renato Scienza
Keyword(s):  
Computed Tomography ◽  
At Risk ◽  
Subarachnoid Hemorrhage ◽  
Subsequent Development ◽  
Blood Collection ◽  
Therapeutic Modalities ◽  
Patients At Risk ◽  
Definition Of ◽  
Subarachnoid Blood

Abstract The role of computed tomography (CT) in the management of vasospasm from subarachnoid hemorrhage was evaluated in 242 consecutive cases with CT performed within 7 days after hemorrhage. Only 20% of these cases did not show a detectable subarachnoid hemorrhage on CT. Subsequent angiograms showed vessel narrowing in 56% of the cases; associated clinical deterioration was noted in 34% of the cases. On later CT, clear ischemic areas were detected in 20% of the cases. A strict correlation between the amount of cisternal blood and the subsequent development of vasospasm was observed: although absent or thin cisternal depositions were rarely associated with vasospasm, consistent or thick depositions were frequently linked to vasospasm (72% of the cases) and to ischemic disturbances (51% of the cases), as well as to clear ischemic areas on later CT (30% of the cases). Regarding the morphology of the cisternal blood collection, the risk of developing vasospasm was at its lowest (42%) for depositions only in the frontal interhemispheric fissure and was at its highest (79%) for depositions in multiple cisterns. The site of cisternal deposition corresponded closely to the area of ischemia on later CT. The persistence of subarachnoid blood more than 72 hours after hemorrhage probably increases the risk of vasospasm, although our data are not conclusive. The definition of a CT scan “at risk” for vasospasm—based on the previous findings—gives practical advantages: proper selection of patients in regard to timing of operation, closer observation and the possibility of prophylactic treatment in patients “at risk,” and more adequate evaluation of different therapeutic modalities for vasospasm. With regard to the last point, the incidence of vasospasm was not statistically different between two groups of patients uniformly “at risk”: the first group submitted to early operation and the second awaiting operation.

scholarly journals Predicting readmission and death after hospital discharge: a comparison of conventional frailty measurement with an electronic health record-based score

2021 ◽  
Author(s):  
Yong Yong Tew ◽  
Juen Hao Chan ◽  
Polly Keeling ◽  
Susan D Shenkin ◽  
Alasdair MacLullich ◽  
...  
Keyword(s):  
At Risk ◽  
Electronic Health Record ◽  
Hospital Discharge ◽  
Risk Score ◽  
Primary Outcome ◽  
Risk Scores ◽  
Health Record ◽  
Co Morbidity ◽  
Patients At Risk ◽  
Electronic Health

Abstract Background frailty measurement may identify patients at risk of decline after hospital discharge, but many measures require specialist review and/or additional testing. Objective to compare validated frailty tools with routine electronic health record (EHR) data at hospital discharge, for associations with readmission or death. Design observational cohort study. Setting hospital ward. Subjects consented cardiology inpatients ≥70 years old within 24 hours of discharge. Methods patients underwent Fried, Short Physical Performance Battery (SPPB), PRISMA-7 and Clinical Frailty Scale (CFS) assessments. An EHR risk score was derived from the proportion of 31 possible frailty markers present. Electronic follow-up was completed for a primary outcome of 90-day readmission or death. Secondary outcomes were mortality and days alive at home (‘home time’) at 12 months. Results in total, 186 patients were included (79 ± 6 years old, 64% males). The primary outcome occurred in 55 (30%) patients. Fried (hazard ratio [HR] 1.47 per standard deviation [SD] increase, 95% confidence interval [CI] 1.18–1.81, P < 0.001), CFS (HR 1.24 per SD increase, 95% CI 1.01–1.51, P = 0.04) and EHR risk scores (HR 1.35 per SD increase, 95% CI 1.02–1.78, P = 0.04) were independently associated with the primary outcome after adjustment for age, sex and co-morbidity, but the SPPB and PRISMA-7 were not. The EHR risk score was independently associated with mortality and home time at 12 months. Conclusions frailty measurement at hospital discharge identifies patients at risk of poorer outcomes. An EHR-based risk score appeared equivalent to validated frailty tools and may be automated to screen patients at scale, but this requires further validation.

scholarly journals External validation of two prediction tools for patients at risk for recurrent Clostridioides difficile infection

2021 ◽  
Vol 14 ◽  
pp. 175628482097738
Author(s):  
Tessel M. van Rossen ◽  
Laura J. van Dijk ◽  
Martijn W. Heymans ◽  
Olaf M. Dekkers ◽  
Christina M. J. E. Vandenbroucke-Grauls ◽  
...  
Keyword(s):  
At Risk ◽  
Validation Cohort ◽  
Characteristic Curve ◽  
External Validation ◽  
Risk Scores ◽  
Prediction Tools ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Patients At Risk ◽  
Definition Of

Background: One in four patients with primary Clostridioides difficile infection (CDI) develops recurrent CDI (rCDI). With every recurrence, the chance of a subsequent CDI episode increases. Early identification of patients at risk for rCDI might help doctors to guide treatment. The aim of this study was to externally validate published clinical prediction tools for rCDI. Methods: The validation cohort consisted of 129 patients, diagnosed with CDI between 2018 and 2020. rCDI risk scores were calculated for each individual patient in the validation cohort using the scoring tools described in the derivation studies. Per score value, we compared the average predicted risk of rCDI with the observed number of rCDI cases. Discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUC). Results: Two prediction tools were selected for validation (Cobo 2018 and Larrainzar-Coghen 2016). The two derivation studies used different definitions for rCDI. Using Cobo’s definition, rCDI occurred in 34 patients (26%) of the validation cohort: using the definition of Larrainzar-Coghen, we observed 19 recurrences (15%). The performance of both prediction tools was poor when applied to our validation cohort. The estimated AUC was 0.43 [95% confidence interval (CI); 0.32–0.54] for Cobo’s tool and 0.42 (95% CI; 0.28–0.56) for Larrainzar-Coghen’s tool. Conclusion: Performance of both prediction tools was disappointing in the external validation cohort. Currently identified clinical risk factors may not be sufficient for accurate prediction of rCDI.

Causal Thinking in Developmental Disorders

2011 ◽  
Author(s):  
E. Jane Costello ◽  
Adrian Angold
Keyword(s):  
Psychiatric Disorders ◽  
Developmental Disorders ◽  
Genetic Determinants ◽  
Developmental Approach ◽  
Developmental Processes ◽  
Essential Components ◽  
Definite Structure ◽  
Normal Human ◽  
Definition Of ◽  
The Individual

In this chapter we (1) lay out a definition of development as it relates to psychopathology; (2) make the case that nearly all psychiatric disorders are ‘‘developmental’’; and (3) examine, with some illustrations, methods from developmental research that can help to identify causal mechanisms leading to mental illness. The philosopher Ernst Nagel (1957, p. 15) defined development in a way that links it to both benign and pathological outcomes: . . . The concept of development involves two essential components: the notion of a system possessing a definite structure and a definite set of pre-existing capacities; and the notion of a sequential set of changes in the system, yielding relatively permanent but novel increments not only in its structure but in its modes of operation. . . . As summarized by Leon Eisenberg (1977, p. 220), "the process of development is the crucial link between genetic determinants and environmental variables, between individual psychology and sociology." It is characteristic of such systems that they consist of feedback and feedforward loops of varying complexity. Organism and environment are mutually constraining, however, with the result that developmental pathways show relatively high levels of canalization (Angoff, 1988; Cairns, Gariépy, & Hood, 1990; Gottlieb & Willoughby, 2006; Greenough, 1991; McGue, 1989; Plomin, DeFries, & Loehlin, 1977; Scarr & McCartney, 1983). Like individual ‘‘normal’’ development, diseases have inherent developmental processes of their own—processes that obey certain laws and follow certain stages even as they destroy the individual in whom they develop (Hay & Angold, 1993). A developmental approach to disease asks what happens when developmental processes embodied in pathogenesis collide with the process of ‘‘normal’’ human development. The progression seen in chronic diseases (among which we categorize most psychiatric disorders) has much in common with this view of development. It is "structured" by the nature of the transformation of the organism that begins the process, and in general, it follows a reasonably regular course, although with wide variations in rate.

Psychology feminine holiness

2017 ◽  
Vol 41 (S1) ◽  
pp. S329-S329
Author(s):  
J. Garcia-albea ◽  
M. Navas
Keyword(s):  
Psychiatric Disorders ◽  
Mental State ◽  
Mystical Experience ◽  
Social Aspects ◽  
Religious Women ◽  
States Of Consciousness ◽  
Competing Interest ◽  
Definition Of ◽  
Female Saints ◽  
Rule Out

Feminine holiness is a subject as complex as it is interesting–not least because of the very definition of the term–, in many occasions extraordinary and many others bitter, which has sparked interest throughout history, especially after the progress made on modernity.ObjectiveThe main objective is less to show whether there is a psychiatric, infectious, neurological or any other form of pathological disorder linked to the behaviour of female saints, rather to evaluate all the psychological and social aspects that result in holiness as a mental state being largely a female attribute.Material and methodsFor this, we have tested from birth to death, in what is possible, the lives of sixty religious women, through biographies and autobiographies since they were servants, pious or holy according to ecclesiastical terminology. This set was unavoidable to select twelve cases, which are set out exhaustively in this study.Results and discussionLimiting ourselves to a purely psychiatric view, we can show the presence of psychopathology associated with exceptional states of consciousness, as would be ecstatic and mystical experience itself, present in most cases. We also found common psychological profiles, out of the sixty biographies and autobiographies of religious women analyzed: e.g. pain is used as a means of atonement and a way of removing the guilt of sin. We rule out major psychiatric disorders in the Santas we have analyzed. The behaviors they presented, even sometimes excessive, cannot be included in any of the current major psychiatric disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals An algorithm for the clinical assessment of nutritional status in hospitalized patients

2003 ◽  
Vol 90 (4) ◽  
pp. 829-836 ◽  
Author(s):  
J. Th. C. M. de Kruif ◽  
A. Vos
Keyword(s):  
At Risk ◽  
Nutritional Status ◽  
Nursing Staff ◽  
Clinical Assessment ◽  
Early Stage ◽  
Hospitalized Patients ◽  
Nutritional Screening ◽  
Patients At Risk ◽  
Two Phases ◽  
Definition Of

Upon admission to hospital, 30–50% of patients either are or become malnourished. There is no generally accepted definition of malnutrition or guidelines on the best way to establish nutritional status. We consider it self-evident that the nursing staff have an important role in screening patients at risk of malnutrition on admission and thereafter at regular times. This is why we developed the nursing nutritional screening form (NNSF). The NNSF was tested by nurses, dietitians and clinicians, in pairs, to establish the extent of agreement in two phases on sixty-nine and forty patients. Later, the form was used in practice by nursing staff on five wards (334 patients). Based on the results of the NNSF, patients were referred to a dietitian. The dietitian established whether the patient was indeed at risk, or was actually malnourished, using a complete nutritional history. The degree of concurrence within pairs was reasonable to good. The same applied to the concurrence between nursing staff and dietitians, but concurrence between clinicians and nursing staff was less. In total, 334 patients were screened and sixty-nine of them were referred to the dietitian. It was established that 86% of the referred patients were potentially at risk of malnutrition or were malnourished. Without the NNSF, 39% (n 27) of the patients referred to the dietitian would not have been referred, or would have been referred much later. The NNSF makes it possible for nurses to detect malnourished patients or patients at risk of malnutrition at an early stage of their hospitalization.

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