Tourette and Trichotillomania

2021 ◽  
pp. 260-294
Author(s):  
Jennifer R. Alexander ◽  
Jordan T. Stiede ◽  
Douglas W. Woods
Keyword(s):  
Treatment Strategies ◽  
Additional Treatment ◽  
Reversal Training ◽  
Diagnostic Categories ◽  
Habit Reversal Training ◽  
Efficacy Research ◽  
Key Features ◽  
Hair Pulling Disorder ◽  
And Function ◽  
Tourette Disorder

This chapter explores the treatment of trichotillomania (TTM; also referred to as hair pulling disorder) and Tourette disorder (TD). TTM and TD exist in separate diagnostic categories but exhibit functional similarities and respond to similar treatments. The chapter reviews the characteristics of each disorder. It then describes habit reversal training (HRT) and function-based interventions, which serve as core therapeutic elements in the treatment of both TTM and TD. The chapter also discusses additional treatment strategies that occur as part of standard protocols for both disorders, before looking at the treatment efficacy research. It considers the key features of the manual-based treatments (behavior therapy protocols), as well as ways these protocols can be flexibly implemented for those with TTM and TD. Finally, consistent with the call for “flexibility within fidelity,” the chapter provides an example of a flexible implementation of these treatments.

scholarly journals When Cells Suffocate: Autophagy in Cancer and Immune Cells under Low Oxygen

2011 ◽  
Vol 2011 ◽  
pp. 1-13 ◽  
Author(s):  
Katrin Schlie ◽  
Jaeline E. Spowart ◽  
Luke R. K. Hughson ◽  
Katelin N. Townsend ◽  
Julian J. Lum
Keyword(s):  
Tumor Microenvironment ◽  
Cancer Cells ◽  
Immune Cells ◽  
Immune Cell ◽  
Treatment Strategies ◽  
Patient Treatment ◽  
Low Oxygen ◽  
Tumor Environment ◽  
And Function ◽  
The Impact

Hypoxia is a signature feature of growing tumors. This cellular state creates an inhospitable condition that impedes the growth and function of all cells within the immediate and surrounding tumor microenvironment. To adapt to hypoxia, cells activate autophagy and undergo a metabolic shift increasing the cellular dependency on anaerobic metabolism. Autophagy upregulation in cancer cells liberates nutrients, decreases the buildup of reactive oxygen species, and aids in the clearance of misfolded proteins. Together, these features impart a survival advantage for cancer cells in the tumor microenvironment. This observation has led to intense research efforts focused on developing autophagy-modulating drugs for cancer patient treatment. However, other cells that infiltrate the tumor environment such as immune cells also encounter hypoxia likely resulting in hypoxia-induced autophagy. In light of the fact that autophagy is crucial for immune cell proliferation as well as their effector functions such as antigen presentation and T cell-mediated killing of tumor cells, anticancer treatment strategies based on autophagy modulation will need to consider the impact of autophagy on the immune system.

Outcomes Following Surgical Treatment of Hamate Arthrosis Lunotriquetral Ligament Injuries

Hand ◽  
2021 ◽  
pp. 155894472110432
Author(s):  
Jesse Meaike ◽  
Joshua Meaike ◽  
Sanjeev Kakar
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Combined Treatment ◽  
Additional Treatment ◽  
Ligament Injuries ◽  
Interosseous Ligament ◽  
Institutional Review ◽  
Lunotriquetral Ligament ◽  
Treatment Plans ◽  
And Function

Background: An institutional review board–approved study of the functional outcomes of patients after surgical treatment of hamate arthrosis lunotriquetral ligament tear (HALT) lesions was conducted. Methods: In all, 21 wrists in 19 patients underwent arthroscopic, open, or combined treatment of HALT lesions. Seven patients underwent isolated hamate debridement and 14 had concomitant procedures to address lunotriquetral pathology. Nineteen wrists underwent procedures to address additional pathology, including triangular fibrocartilage complex, ulnotriquetral ligament split, and scapholunate ligament injuries. Results: Mayo wrist scores increased from 54 to 71. Sixteen patients had no or mild pain postoperatively, compared with none preoperatively. When stratified by lunotriquetral interosseous ligament management, 75% of the limited treatment group (none or debridement) and 78% of the additional treatment group reported improved pain. Three patients underwent additional surgeries for persistent pain. Conclusion: Resection of the proximal pole of the hamate can improve pain and function for patients with ulnar-sided wrist pain secondary to a HALT lesion. Concomitant wrist pathologies should be considered when determining treatment plans.

scholarly journals The role of RDoC in future classification of mental disorders

2020 ◽  
Vol 22 (1) ◽  
pp. 81-85 ◽  
Keyword(s):  
Mental Health ◽  
Affective Behavior ◽  
Research Domain Criteria ◽  
Computational Approaches ◽  
Diagnostic Categories ◽  
Key Features ◽  
Study Designs ◽  
Research Domain

The Research Domain Criteria (RDoC) project constitutes a translational framework for psychopathology research, initiated by the National Institute of Mental Health in an attempt to provide new avenues for research to circumvent problems emerging from the use of symptom-based diagnostic categories in diagnosing disorders. The RDoC alternative is a focus on psychopathology based on dimensions simultaneously defined by observable behavior (including quantitative measures of cognitive or affective behavior) and neurobiological measures. Key features of the RDoC framework include an emphasis on functional dimensions that range from normal to abnormal, integration of multiple measures in study designs (which can foster computational approaches), and high priority on studies of neurodevelopment and environmental influences (and their interaction) that can contribute to advances in understanding the etiology of disorders throughout the lifespan. The paper highlights key implications for ways in which RDoC can contribute to future ideas about classification, as well as some of the considerations involved in translating basic behavioral and neuroscience data to psychopathology.

scholarly journals Effectiveness of behaviour therapy for children and adolescents with Tourette syndrome and chronic tic disorder in a real-world setting

2020 ◽  
Author(s):  
Per Andrén ◽  
Vera Wachtmeister ◽  
Julia Franzé ◽  
Caroline Speiner ◽  
Lorena Fernández de la Cruz ◽  
...  
Keyword(s):  
Young People ◽  
Tourette Syndrome ◽  
Real World ◽  
Post Treatment ◽  
Reversal Training ◽  
Behaviour Therapy ◽  
Tic Disorder ◽  
Chronic Tic Disorder ◽  
Habit Reversal Training ◽  
Tic Severity

Background: Treatment guidelines recommend behaviour therapy (BT) as the first-line intervention for patients with Tourette syndrome (TS) and chronic tic disorder (CTD). The efficacy of BT has been documented in randomised controlled trials (RCTs), but it is unclear to what extent these results are generalisable to real-world clinical settings, and whether the therapeutic gains are maintained long-term.Methods: In this naturalistic study, 74 young people with TS/CTD (aged 6 to 17) received BT (including psychoeducation, exposure with response prevention, habit reversal training or a combination of these treatments) at a specialist clinic in Stockholm, Sweden. Data were routinely collected at baseline, post-treatment, and at 3-, 6-, and 12-month follow-ups. Measures included the clinician-rated Yale Global Tic Severity Scale (YGTSS) and the Clinical Global Impression – Improvement scale (CGI-I), amongst others.Results: Tic severity and tic-related impairment (as measured by the YGTSS) improved significantly after treatment, with large within-group effect sizes (d=1.03 for the YGTSS Total Tic Severity Score, and d=1.37 for the YGTSS Impairment Score). At post-treatment, 57% of the participants were classified as treatment responders according to the CGI-I. Both tic severity and tic-related impairment continued to improve further through the follow-up, with 75% of the participants being rated as responders 12 months after the end of treatment. Significant improvements were also observed across a range of secondary measures.Conclusions: BT is an effective and durable treatment for young people with TS/CTD in a real-world clinical setting, with effects comparable to those reported in RCTs.

scholarly journals The Efficacy of Endovascular Treatment of Ruptured Blood Blister-Like Aneurysms Using Stent-Assisted Coil Embolization

2012 ◽  
Vol 18 (4) ◽  
pp. 432-441 ◽  
Author(s):  
Y.K. Ihn ◽  
S.H. Kim ◽  
J.H. Sung ◽  
T-G. Kim
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Coil Embolization ◽  
Internal Carotid ◽  
Treatment Strategies ◽  
Additional Treatment ◽  
Stent Insertion ◽  
Supraclinoid Internal Carotid Artery

We report our experience with endovascular treatment and follow-up results of a ruptured blood blister-like aneurysm (BBA) in the supraclinoid internal carotid artery. We performed a retrospective review of ruptured blood blister-like aneurysm patients over a 30-month period. Seven patients (men/women, 2/5; mean age, 45.6 years) with ruptured BBAs were included from two different institutions. The angiographic findings, treatment strategies, and the clinical (modified Rankin Scale) and angiographic outcomes were retrospectively analyzed. All seven BBAs were located in the supraclinoid internal carotid artery. Four of them were ≥ 3 mm in largest diameter. Primary stent-assisted coiling was performed in six out of seven patients, and double stenting was done in one patient. In four patients, the coiling was augmented by overlapping stent insertion. Two patients experienced early re-hemorrhage, including one major fatal SAH. Complementary treatment was required in two patients, including coil embolization and covered-stent placement, respectively. Six of the seven BBAs showed complete or progressive occlusion at the time of late angiographic follow-up. The clinical midterm outcome was good (mRS scores, 0–1) in five patients. Stent-assisted coiling of a ruptured BBA is technically challenging but can be done with good midterm results. However, as early regrowth/re-rupture remains a problem, repeated, short-term angiographic follow-up is required so that additional treatment can be performed as needed.

Contribution of SOS Genes to H2O2-induced Apoptosis-like Death in Escherichia Coli

2021 ◽  
Author(s):  
Heesu Kim ◽  
Dong Gun Lee
Keyword(s):  
Oxidative Stress ◽  
Escherichia Coli ◽  
Treatment Strategies ◽  
Sos Response ◽  
Bacterial Dna ◽  
E Coli ◽  
New Treatment ◽  
Induced Apoptosis ◽  
And Function ◽  
The Relationship

Abstract Hydrogen peroxide (H2O2) is a debriding agent that damages the microbial structure and function by generating various reactive oxygen species (ROS). H2O2-produced hydroxyl radical (OH∙) also exert oxidative stress on microorganisms. The spread of antibiotic resistance in bacteria is a serious issue worldwide, and greater efforts are needed to identify and characterize novel antibacterial mechanisms to develop new treatment strategies. Therefore, this study aimed to clarify the relationship between H2O2 and Escherichia coli and to elucidate a novel antibacterial mechanism(s) of H2O2. Following H2O2 exposure, increased levels of 8-hydroxyldeoxyguanosine and malondialdehyde indicated that H2O2 accelerates oxidation of bacterial DNA and lipids in E. coli. As oxidative damage worsened, the SOS response was triggered. Cell division arrest and resulting filamentation were identified in cells, indicating that LexA was involved in DNA replication. It was also verified that RecA, a representative SOS gene, helps self-cleavage of LexA and acts as a bacterial caspase-like protein. Our findings also showed that dinF is essential to preserve E. coli from H2O2-induced ROS, and furthermore, demonstrated that H2O2-induced SOS response and SOS genes participate differently in guarding E. coli from oxidative stress. As an extreme SOS response is considered apoptosis-like death (ALD) in bacteria, additional experiments were performed to examine the characteristics of ALD. DNA fragmentation and membrane depolarization appeared in H2O2-treated cells, suggesting that H2O2 causes ALD in E. coli. In conclusion, our investigations revealed that ALD is a novel antibacterial mode of action(s) of H2O2 with important contributions from SOS genes.

Radiofrequency Ablation of Spine Metastases: A Clinical and Technical Approach

2021 ◽  
Vol 25 (06) ◽  
pp. 795-804
Author(s):  
Steven Yevich ◽  
Stephen Chen ◽  
Zeyad Metwalli ◽  
Joshua Kuban ◽  
Stephen Lee ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Multidisciplinary Treatment ◽  
Treatment Algorithm ◽  
Treatment Strategies ◽  
Clinical Work ◽  
Additional Treatment ◽  
Vertebral Compression Fractures ◽  
Tumor Control ◽  
Technical Approach ◽  
Spine Metastases

AbstractPercutaneous radiofrequency ablation (RFA) is an integral component of the multidisciplinary treatment algorithm for both local tumor control and palliation of painful spine metastases. This minimally invasive therapy complements additional treatment strategies, such as pain medications, systemic chemotherapy, surgical resection, and radiotherapy. The location and size of the metastatic lesion dictate preprocedure planning and the technical approach. For example, ablation of lesions along the spinal canal, within the posterior vertebral elements, or with paraspinal soft tissue extension are associated with a higher risk of injury to adjacent spinal nerves. Additional interventions may be indicated in conjunction with RFA. For example, ablation of vertebral body lesions can precipitate new, or exacerbate existing, pathologic vertebral compression fractures that can be prevented with vertebral augmentation. This article reviews the indications, clinical work-up, and technical approach for RFA of spine metastases.

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