Characteristics of referrals and admissions to a medium secure ASD unit

2014 ◽  
Vol 5 (3) ◽  
pp. 138-146
Author(s):  
Therese O' Donoghue ◽  
John Shine ◽  
Olufunto Orimalade
Keyword(s):  
Autism Spectrum ◽  
Response To Treatment ◽  
Diagnostic Tools ◽  
Treatment Pathway ◽  
Content Type ◽  
Therapeutic Engagement ◽  
Starting Point ◽  
Wide Range ◽  
History Of

Purpose – The purpose of this paper is to present preliminary data on a cohort of patients referred to a specialist forensic medium-secure autism spectrum disorder (ASD) service during its first two years of opening and to identify variables associated with admission to the service. Design/methodology/approach – Data on all referrals to the service (n=40) was obtained from clinical files on demographics, offending history, psychiatric history and levels of therapeutic engagement. The sample was divided into two groups: referred and admitted (n=23) and referred and not admitted (n=17). Statistical analysis compared the two groups on all variables. Findings – Totally, 94 per cent of all individuals assessed had a diagnosis of autism, however, structured diagnostic tools for ASD were used in a small minority of cases. About half the sample had a learning disability, almost four-fifths had at least one additional mental disorder and almost three-quarters had a history of prior supervision failure or non-compliance with treatment. The sample had a wide range of previous offences. No significant differences were found between the groups on any of the variables included in the study. Research limitations/implications – The present study presents a starting point to follow up in terms of response to treatment and characteristics associated with treatment outcome. Practical implications – The sample had a wide range of clinical and risk-related needs. Both groups shared many similarities. Originality/value – This highlights the need for comprehensive assessment looking at risk-related needs so that individuals are referred to an optimal treatment pathway.

Catatonia in individuals with Autism Spectrum Disorder and intellectual disability: a discussion of four cases

2019 ◽  
Vol 13 (5) ◽  
pp. 182-193
Author(s):  
Huw Morgan Dunstall ◽  
Catherine Walton ◽  
Lance Vincent Watkins ◽  
Andrew Bhasker Isaac ◽  
Mohamed El Tahir
Keyword(s):  
Autism Spectrum Disorder ◽  
Intellectual Disability ◽  
Rating Scales ◽  
Autism Spectrum ◽  
Stressful Events ◽  
Spectrum Disorder ◽  
Response To Treatment ◽  
Diagnostic Tools ◽  
Content Type ◽  
High Index Of Suspicion

Purpose Catatonia is increasingly recognised as a comorbid syndrome of Autism Spectrum Disorder (ASDs). The assessment and management of individuals with comorbid ASD and intellectual disability (ID) adds a further dimension to this already complex presentation, with few cases identified in the literature. The paper aims to discuss these issues. Design/methodology/approach This paper presents four cases of catatonia in individuals with comorbid ASD and ID. The diagnostic challenges, response to treatment and prognosis are discussed whilst comparing with the existing literature. Findings A high index of suspicion is required to recognise the subtle catatonic features seen in patients with ASD and ID. Clinicians should be particularly vigilant following stressful events in young adults. The assessment of catatonia in ASDs and ID requires a pragmatic approach given the lack of suitable diagnostic tools and difficulties completing investigations. Caution is advised when using rating scales as they are not validated in ID. The mainstay of treatment is lorazepam, although responses vary. Originality/value The discussion of these four cases strengthens the existing literature, and highlights the implications a comorbid diagnosis of ID has on the assessment and management of catatonia in ASDs.

The assessment of autism spectrum disorders in adults

2016 ◽  
Vol 2 (1) ◽  
pp. 31-40
Author(s):  
Anastasios Galanopoulos ◽  
Dene Robertson ◽  
Emma Woodhouse
Keyword(s):  
Needs Assessment ◽  
National Health System ◽  
Autism Spectrum ◽  
Comprehensive Assessment ◽  
Diagnostic Tools ◽  
Diagnostic Process ◽  
Content Type ◽  
Wide Range ◽  
Physical Health Problems ◽  
Personal Functioning

Purpose – The purpose of this paper is to explore and highlight the main elements of an autism spectrum disorder assessment in adults. It features significant challenges for the clinical teams responsible to undertake the assessment. This paper aims to explain the importance of the wider needs assessment in accordance to the Autism Act and Autism Strategy. Design/methodology/approach – The paper describes the main symptom domains for an ASD diagnosis, according to the two basic diagnostic manuals. It provides compendious summary of the available diagnostic tools and the significant comorbidities people with ASD present with including other neurodevelopmental disorders, mental or physical health problems, challenging behaviour and risk issues. Findings – The paper proposes that all National Health System professionals should be able to recognise possible signs of ASD and accordingly refer individuals for a comprehensive assessment to secondary services. It highlights the importance of a wider needs assessment as part of a broader approach to addressing the needs of those with suspected ASD. Practical implications – The paper aims to improve the gaps which remain in the referral and diagnostic process of people affected by ASD. Social implications – Through a comprehensive assessment the paper aims to improve the educational, social and personal functioning of people with ASD as well as the quality of life of their parents and carers. Originality/value – The paper assembles a wide range of relevant considerations in regards to potential ASD in one place, and can be used to inform a comprehensive understanding of the assessment/diagnosis process.

Efficacy of local treatments in Prurigo Pigmentosa after Bariatric surgery

2021 ◽  
Vol 07 (02) ◽  
pp. 01-03
Author(s):  
Mezoun Almuhaimeed
Keyword(s):  
Bariatric Surgery ◽  
Clinical Presentation ◽  
Response To Treatment ◽  
Single Female ◽  
Provisional Diagnosis ◽  
Patient Response ◽  
Medical City ◽  
History Of ◽  
Multivitamin Supplements

A 22-year-old single female presented to primary care Wazarat Health Center at Prince Sultan Military Medical City in Riyadh, with a 3 weeks history of itchy erythematous papules and vesicles and papulo-vesicles over the neck, chest, and upper back and face, which started 4 to 5 days after bariatric surgery. The patient on daily multivitamin supplements, vitamin D (50,000 IU, weekly / 2 months). The patient has lost 4kg since the operation, family history of atopy was positive regarding the mother physical examination shows erythematous papules and vesicles and papulo-vesicles over the neck with crust, chest, and upper back, Based on medical history and clinical presentation a provisional diagnosis was Prurigo Pigmentosa. The patient was prescribed topical mometasone furoate cream (BID for one week). Two -week follow-up showed improvement of the eruption. The course of the disease was shorter than usual in such cases the patient response to treatment was reactive to the topical mometasone without taking the oral minocyline, which major of such cases need in the late course of the disease The patient starts to improve within 2 weeks compared to others who need an average of 6 weeks to improve in such cases

scholarly journals Employing neo-Durkheimian institutional theory in cross-cultural accounting research

2016 ◽  
Vol 29 (8) ◽  
pp. 1270-1293 ◽  
Author(s):  
Philip Mark Linsley ◽  
Alexander Linsley ◽  
Matthias Beck ◽  
Simon Mollan
Keyword(s):  
Institutional Theory ◽  
Cultural Change ◽  
Cross Cultural ◽  
Content Type ◽  
Accounting Research ◽  
Mary Douglas ◽  
The Social ◽  
Wide Range ◽  
History Of ◽  
The Uk

Purpose The purpose of this paper is to propose Neo-Durkheimian institutional theory, developed by the Durkheimian institutional theory, as developed by anthropologist Mary Douglas, as a suitable theory base for undertaking cross-cultural accounting research. The social theory provides a structure for examining within-country and cross-country actions and behaviours of different groups and communities. It avoids associating nations and cultures, instead contending any nation will comprise four different solidarities engaging in constant dialogues. Further, it is a dynamic theory able to take account of cultural change. Design/methodology/approach The paper establishes a case for using neo-Durkheimian institutional theory in cross-cultural accounting research by specifying the key components of the theory and addressing common criticisms. To illustrate how the theory might be utilised in the domain of accounting and finance research, a comparative interpretation of the different experiences of financialization in Germany and the UK is provided drawing on Douglas’s grid-group schema. Findings Neo-Durkheimian institutional theory is deemed sufficiently capable of interpreting the behaviours of different social groups and is not open to the same criticisms as Hofstede’s work. Differences in Douglasian cultural dialogues in the post-1945 history of Germany and the UK provide an explanation of the variations in the comparative experiences of financialization. Originality/value Neo-Durkheimian institutional theory has been used in a wide range of contexts; however, it has been little used in the context of accounting research. The adoption of the theory in future accounting research can redress a Hofstedian-bias in accounting research.

scholarly journals Future vision

2015 ◽  
Vol 13 (3/4) ◽  
pp. 346-360 ◽  
Author(s):  
Simon Rogerson
Keyword(s):  
Action Plan ◽  
Information And Communications Technology ◽  
Ethical Challenges ◽  
Content Type ◽  
Funded Research ◽  
Starting Point ◽  
Global Action ◽  
History Of ◽  
Ict Ethics ◽  
Future Vision

Purpose – The purpose of this paper is to review the world of information and communications technology (ICT) from its early days to the near future. The aim is to consider how successfully academia, industry and government have worked together in delivering ethically acceptable ICT which is accessible to those who might benefit from such advances. The paper concludes with suggestions of a fresh approach for the future. Design/methodology/approach – The paper draws upon evidence from the history of computers, funded research projects, professional bodies in the field, the ETHICOMP conference series and reported ICT disasters. The author uses his experience as both an ICT practitioner and an academic in the ICT ethics field to synthesise the evidence so providing a foundation on which to build an outline global action plan. Findings – The paper lays out the findings that there has been much detailed observation and analysis of the ethical challenges surrounding ICT but the transformation of this into widespread practical positive action remains elusive. It explores why progress has been difficult. Originality/value – This review of the interconnecting landscapes of practical ICT, funded research and the ICT ethics community is new. The attempt to demonstrate what progress has been made and to identify the underlying factors which influence progress are valuable to future generations working in this area. The concluding suggestions for action offer a starting point for entering the next phase of ICT ethics.

Surgical treatment of laterally ruptured cervical disc

1973 ◽  
Vol 38 (6) ◽  
pp. 679-683 ◽  
Author(s):  
Francis Murphey ◽  
James C. H. Simmons ◽  
Bruce Brunson
Keyword(s):  
Nerve Root ◽  
Cervical Disc ◽  
Root Pressure ◽  
Content Type ◽  
Arm Pain ◽  
Follow Up Study ◽  
History Of ◽  
Neurosurgical Operation ◽  
Better Than

✓ From the analysis of 648 patients operated on for ruptured cervical discs between 1939 and March of 1972 and a follow-up study of 380 of these patients, the following conclusions seem justified. Osteophytes or hypertrophic spurs rarely produced the classical clinical picture or deficits. Ninety per cent of the patients awakened in the morning with pain in the neck and rhomboid region. Ten per cent had a history of injury, but there was no characteristic pattern as in lumbar discs. Only one patient had a typical hyperextension injury. Anterior chest pain occurred in one-fifth of the cases. Pain in the neck, rhomboid region, and anterior chest was referred from the discs, while the arm pain was usually the result of nerve root compression; however, in a few cases the degenerating disc caused referred pain to the arm without any nerve root pressure. Since accurate diagnosis can be made on clinical grounds, myelography is not necessary in most cases. In our experience conservative treatment was usually unsuccessful while the surgical results were better than in almost any other neurosurgical operation. The nerve root syndromes associated with extruded lateral cervical discs are outlined and the indications and contraindications for myelography discussed.

scholarly journals Scorpion Venom Antimicrobial Peptides Induce Siderophore Biosynthesis and Oxidative Stress Responses in Escherichia coli

mSphere ◽  
2021 ◽  
Vol 6 (3) ◽  
Author(s):  
Mohamed M. Tawfik ◽  
Magnus Bertelsen ◽  
Mohamed A. Abdel-Rahman ◽  
Peter N. Strong ◽  
Keith Miller
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Peptides ◽  
Antimicrobial Agents ◽  
Venom Gland ◽  
Cation Transport ◽  
Content Type ◽  
Starting Point ◽  
Wide Range ◽  
Initial Starting ◽  
Increased Susceptibility

ABSTRACT The increasing development of microbial resistance to classical antimicrobial agents has led to the search for novel antimicrobials. Antimicrobial peptides (AMPs) derived from scorpion and snake venoms offer an attractive source for the development of novel therapeutics. Smp24 (24 amino acids [aa]) and Smp43 (43 aa) are broad-spectrum AMPs that have been identified from the venom gland of the Egyptian scorpion Scorpio maurus palmatus and subsequently characterized. Using a DNA microarray approach, we examined the transcriptomic responses of Escherichia coli to subinhibitory concentrations of Smp24 and Smp43 peptides following 5 h of incubation. Seventy-two genes were downregulated by Smp24, and 79 genes were downregulated by Smp43. Of these genes, 14 genes were downregulated in common and were associated with bacterial respiration. Fifty-two genes were specifically upregulated by Smp24. These genes were predominantly related to cation transport, particularly iron transport. Three diverse genes were independently upregulated by Smp43. Strains with knockouts of differentially regulated genes were screened to assess the effect on susceptibility to Smp peptides. Ten mutants in the knockout library had increased levels of resistance to Smp24. These genes were predominantly associated with cation transport and binding. Two mutants increased resistance to Smp43. There was no cross-resistance in mutants resistant to Smp24 or Smp43. Five mutants showed increased susceptibility to Smp24, and seven mutants showed increased susceptibility to Smp43. Of these mutants, formate dehydrogenase knockout (fdnG) resulted in increased susceptibility to both peptides. While the electrostatic association between pore-forming AMPs and bacterial membranes followed by integration of the peptide into the membrane is the initial starting point, it is clear that there are numerous subsequent additional intracellular mechanisms that contribute to their overall antimicrobial effect. IMPORTANCE The development of life-threatening resistance of pathogenic bacteria to the antibiotics typically in use in hospitals and the community today has led to an urgent need to discover novel antimicrobial agents with different mechanisms of action. As an ancient host defense mechanism of the innate immune system, antimicrobial peptides (AMPs) are attractive candidates to fill that role. Scorpion venoms have proven to be a rich source of AMPs. Smp24 and Smp43 are new AMPs that have been identified from the venom gland of the Egyptian scorpion Scorpio maurus palmatus, and these peptides can kill a wide range of bacterial pathogens. By better understanding how these AMPs affect bacterial cells, we can modify their structure to make better drugs in the future.

scholarly journals MON-073 Hyperinsulinemic Hypoglycemia Responsive to Diazoxide Due to a Previously Unknown ABCC8 Dominant Mutation

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Veronica M Figueredo ◽  
Alejandro Diaz ◽  
Pedro Pagan Banchs
Keyword(s):  
Brain Mri ◽  
Poor Response ◽  
White Matter Injury ◽  
Response To Treatment ◽  
Hyperinsulinemic Hypoglycemia ◽  
Dominant Mutation ◽  
Suspected Sepsis ◽  
Intravenous Glucose ◽  
History Of

Abstract Background: Hyperinsulinism is the most common cause of persistent hypoglycemia. It results from different genetic defects, the most common being recessive and dominant mutations in the ABCC8/KCNJ11 genes. The majority of recessive mutations have a poor response to Diazoxide, while dominant mutations are highly variable in both clinical presentation and response to treatment. Prompt recognition and management is critical to avoid irreversible brain damage. Clinical case: A 38-week gestation male, born via emergent c-section due to decreased fetal movement, presented with neonatal hypoglycemia. Pregnancy was uncomplicated and mother had a normal OGTT. Patient had a history of suspected sepsis, seizures, pulmonary hypertension and respiratory distress requiring intubation. Blood glucose was undetectable at birth and required multiple dextrose 10% boluses. A critical sample with a glucose of 47 mg/dL showed an elevated insulin at 30.3 m IU/mL with undetectable ketone levels. Lactic acid, ammonia, cortisol, GH, plasma amino acids, acylcarnitine profile and uric organic acids where all normal for a hypoglycemic state. He required intravenous glucose infusion with GIR up to 17 mg/kg/min to maintain normoglycemia. A brain MRI at 11 days of life showed findings of white matter injury. Subsequent genetic testing identified a heterozygous c.4051G>A (p.Val1351Met) variant in ABCC8, classified as “of uncertain significance”. However, an entry in the ClinVar database (RCV000714711.1) exists from a research lab and was classified as likely pathogenic. Analysis of parental samples showed that the mother was heterozygous for the same genetic variant. She did not have a history of hypoglycemia. Patient was started on diazoxide (8 mg/kg/day) and chlorothiazide with resolution of hypoglycemia. At a follow up visit at 5 months of age, there was no history of hypoglycemia, and no need for adjustments of the diazoxide dose by weight (dose at that time of 7.4 mg/kg/day). Conclusion: The ABCC8 reported here is a dominant mutation causing hyperinsulinemic hypoglycemia responsive to diazoxide with a milder phenotype later in infancy. Longitudinal follow up of the case is warranted to understand the long term progress in patients with this particular mutation. Reference: Adam MP, Ardinger HH, Pagon RA, Wallace SE, et al. None. 1993. Familial hyperinsulinism.

The EMDR DeTUR protocol for the treatment of self-injury in a patient with severe personality disorder: a case report

2019 ◽  
Vol 5 (1) ◽  
pp. 27-38
Author(s):  
Phyllis Annesley ◽  
Adedayo Alabi ◽  
Laura Longdon
Keyword(s):  
Case Report ◽  
Factitious Disorder ◽  
Content Type ◽  
Self Injury ◽  
Life Threatening ◽  
History Of ◽  
Mental Health Difficulties ◽  
Healthcare Interventions ◽  
Therapy Sessions

Purpose The purpose of this paper is to describe the Eye movement desensitisation and reprocessing (EMDR) treatment of an adult female patient detained within a high secure hospital with complex mental health difficulties, including complex trauma, factitious disorder, self-injury and a history of offending. The EMDR treatment addressed the patient’s urges to engage in severe and sometimes life-threatening self-injury, a primary motive of which was to access physical healthcare interventions within a general hospital. The paper describes the wide-ranging benefits of the treatment and incorporates feedback from the patient and clinicians within her multi-disciplinary team (MDT). Design/methodology/approach Four triggers for self-injury were processed during the therapy using the DeTUR Protocol (Popky, 2005, 2009) and the Constant Installation of Present Orientation and Safety (CIPOS, Knipe, 2009a) method. In total, 18 one hour therapy sessions were delivered plus three follow-up sessions to continue to offer support and complete the post-treatment evaluation. Findings The level of urge for each trigger was reduced to 0 which the patient defined as “no urge to self-injure”. Benefits went well beyond self-injury with reported positive impacts on mood, thinking, sleep, concentration, memory and experience of flashbacks. Practical implications This case report demonstrates that the EMDR DeTUR Protocol together with the CIPOS method can be extremely valuable in the treatment of patients who self-injure. Originality/value The case report offers an important contribution to an area that requires much further research.

A Follow-up Study of Psychiatric Disturbance in a Cape Coloured Community

1973 ◽  
Vol 123 (574) ◽  
pp. 279-283 ◽  
Author(s):  
L. S. Gillis ◽  
G. L. Stone
Keyword(s):  
Mental Disorders ◽  
Natural History ◽  
Psychiatric Disorders ◽  
Longitudinal Studies ◽  
Response To Treatment ◽  
Psychiatric Disturbance ◽  
Follow Up Study ◽  
History Of

Longitudinal studies of psychiatric disturbance in communities are important in order to determine the natural history of mental disorders. Most studies have focused on the prevalence of known psychiatric disorders and response to treatment, but only a few on the follow up of a population not previously recognized as psychiatrically ill (Beiser (1), Hagnell (5), Helgason (6), Myers and Bean (10)). The present study is an attempt to do this, and also to follow up untreated disorder within a community.

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