scholarly journals A Pilot Study of the Swedish Sexual Offender Treatment Program

2021 ◽  
pp. 104973152110363
Author(s):  
Stina Lindegren
Keyword(s):  
Risk Factors ◽  
Treatment Program ◽  
Effect Size ◽  
Attachment Styles ◽  
Behavioral Treatment ◽  
Rating Scale ◽  
Medium Effect ◽  
Offender Treatment ◽  
Treatment Needs ◽  
Increased Risk

Purpose: The aim was to test whether dynamic criminogenic risk factors change after participation in a new cognitive-behavioral treatment program adhering to the Risk-Need-Responsivity (RNR) model, within a group of adult men convicted of a sexual offense in Sweden. Methods: Three psychometric tests from approximately 26 participants were completed. Therapists rated 46 participants using the Therapist Rating Scale-2 (TRS-2). Results: Participants reported a significant decrease in hypersexuality, small to medium effect size, a non-significant, increased, internal locus of control, but no change regarding attachment styles, posttreatment. Therapists rated significant decrease in all treatment needs posttreatment, medium to large effect size. Conclusions: The significant reduction of several criminogenic risk factors posttreatment indicates the treatment program may reduce problems related to increased risk of recidivism, especially hypersexuality. Moreover, treatment did not appear to have negative effects, motivating further implementation. However, to evaluate the effectiveness, more research is necessary.

scholarly journals Approach to Management of Wandering in Dementia: Ethical and Legal Issue

2021 ◽  
pp. 025371762110309
Author(s):  
Adesh Kumar Agrawal ◽  
Mahesh Gowda ◽  
Umesh Achary ◽  
Guru S. Gowda ◽  
Vijaykumar Harbishettar
Keyword(s):  
Behavioral Treatment ◽  
Comprehensive Evaluation ◽  
Mental Healthcare ◽  
Legal Issues ◽  
Legal Issue ◽  
Clear Understanding ◽  
Treatment Needs ◽  
People With Dementia ◽  
Increased Risk ◽  
Ethical And Legal Issues

Wandering behavior is one of the most important and challenging management aspects in persons with dementia. Wandering behavior in people with dementia (PwD) is associated with an increased risk of falls, injuries, and fractures, as well as going missing or being lost from a facility. This causes increased distress in caregivers at home and in healthcare facilities. The approach to the comprehensive evaluation of the risk assessment, prevention, and treatment needs more strengthening and effective measures as the prevalence of wandering remains high in the community. Both the caregiver and clinicians need a clear understanding and responsibility of ethical and legal issues while managing and restraining the PwD. Ethical and legal issues especially in the light of the new Indian Mental Healthcare Act of 2017, related to confinement by family members in their homes by family caregivers, seclusion, physical or chemical restraints, other pharmacological and behavioral treatment, highlighting their effectiveness as well as adverse consequences are discussed. This article attempts to address an approach in managing wandering behavior in PwD in light of MHCA, 2017

scholarly journals Levetiracetam as an Adjunctive Treatment for Mania: A Double-Blind, Randomized, Placebo-Controlled Trial

2022 ◽  
pp. 1-12
Author(s):  
Amir Keshavarzi ◽  
Aziz Sharifi ◽  
Leila Jahangard ◽  
Alireza Soltanian ◽  
Annette Beatrix Brühl ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Cognitive Performance ◽  
Effect Size ◽  
Rating Scale ◽  
Medium Effect ◽  
Large Effect Size ◽  
Placebo Condition ◽  
Double Blind ◽  
Subjective Sleep ◽  
Over Time

<b><i>Background:</i></b> Levetiracetam is an anticonvulsant with a low side effect profile and favorable properties for individuals with bipolar I disorder during their manic phase. Despite initial promising results until about 2008, it appears that this track of research has not been followed-up. To counter this, we tested the influence of adjuvant levetiracetam on acute mania, compared to placebo. More specifically, we performed a randomized, double-blind, placebo-controlled clinical trial among inpatients with bipolar disorder I during their acute phase of mania. <b><i>Methods:</i></b> A total of 72 inpatients (mean age: 33.98 years; 23.6% females) with diagnosed bipolar disorder I and during their acute manic phase were randomly assigned either to the adjuvant levetiracetam (250 mg to a maximum of 1,500 mg) or to the placebo condition. Standard medication was lithium at therapeutic dosages. At baseline, participants completed a series of self-rating questionnaires covering sociodemographic information and subjective sleep. Subjective sleep was re-assessed 24 days later at the end of the study. Experts rated participants’ acute state of mania with the Young Mania Rating Scale at baseline and at day 12 and day 24. Participants’ cognitive performance was assessed at baseline and at day 24 at the end of the study. <b><i>Results:</i></b> Over time, mania scores significantly decreased (large effect size), but more so in the levetiracetam condition, compared to the placebo condition (medium effect size). Likewise, over time, subjective sleep improved (large effect size), but more so in the levetiracetam condition, compared to the placebo condition (large effect size). Over time, cognitive performance improved (large effect size), irrespective of the study condition. <b><i>Conclusions:</i></b> Compared to placebo, adjuvant levetiracetam to lithium improved symptoms of mania, as rated by experts, and subjective sleep quality. Adjuvant levetiracetam had no further favorable (or detrimental) impact on cognitive performance.

scholarly journals 108 Lurasidone in Children and Adolescents With Bipolar Depression Presenting With Mixed Features

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 70-70
Author(s):  
Cynthia Siu ◽  
Andrei Pikalov ◽  
Michael Tocco ◽  
Antony Loebel
Keyword(s):  
Children And Adolescents ◽  
Effect Size ◽  
Repeated Measures ◽  
Mixed Model ◽  
Rating Scale ◽  
Bipolar Depression ◽  
Depression Score ◽  
Double Blind ◽  
Increased Risk ◽  
Mixed Features

AbstractObjectiveTo evaluate the efficacy and safety of lurasidone in the treatment of children and adolescents with bipolar depression presenting with mixed features.MethodsPatients 10 to 17 years of age, inclusive, with a DSM-IV-TR diagnosis of bipolar I depression, were randomized to 6 weeks of double-blind treatment with once-daily, flexible doses of lurasidone 20-80 mg or placebo. The presence of mixed features (subthreshold hypomanic symptoms) was defined as a YMRS score > 5 at study baseline. Efficacy analyses included change from baseline to week 6 in Children Depression Rating Scale, Revised (CDRS-R) score (the primary outcome), and Clinical Global Impressions, Bipolar Severity of Depression Score (CGI-BP-S), using mixed model for repeated measures (MMRM) analysis.ResultsAt baseline, mixed features were present in 54.2% of patients (lurasidone, n=97/173; placebo, n=89/170). Treatment with lurasidone (vs placebo) was associated with significantly greater reductions in CDRS-R scores at week 6 in the mixed features group (-21.5 vs -15.9; P<0.01; effect size, 0.45), and in the group without mixed features (-20.4 vs -14.8; P<0.01; effect size, 0.45). Likewise, lurasidone was associated with greater effect size (vs placebo) for reductions inCGI-BP-S scores at week 6 in the mixed features group (-1.6 vs -1.1; P<0.001; effect size 0.57), and in the group without mixed features (-1.3 vs -1.0; P=0.05; effect size 0.30). Rates of protocol-defined treatment-emergent hypomania or mania were similar for lurasidone and placebo in patients with mixed features(lurasidone 8.2% vs. placebo 9.0%) and without mixed features (lurasidone 1.3% vs. placebo 3.7%).ConclusionsIn this post-hoc analysis, lurasidone was found to be efficacious for treating child and adolescent patients with bipolar depression presenting with mixed features(assessed cross-sectionally at study baseline). There was no increased risk of treatment-emergent mania observed in patients with or without mixed features.Funding AcknowledgementsSunovion Pharmaceuticals Inc.

Risk factors for cognitive impairment in amyotrophic lateral sclerosis: a systematic review and meta-analysis

2021 ◽  
pp. jnnp-2020-325701
Author(s):  
Tianmi Yang ◽  
Yanbing Hou ◽  
Chunyu Li ◽  
Bei Cao ◽  
Yangfan Cheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Amyotrophic Lateral Sclerosis ◽  
Cognitive Impairment ◽  
Family History ◽  
Rating Scale ◽  
Or Education ◽  
Increased Risk ◽  
Bulbar Onset ◽  
History Of ◽  
Lateral Sclerosis

ObjectiveCognitive impairment is a common, far-reaching but imperceptible manifestation in patients with amyotrophic lateral sclerosis (ALS). We aimed to identify the risk factors for cognitive impairment in ALS.MethodsWe searched PubMed and EMBASE for cross-sectional, case–control and cohort studies that reported predictors of cognitive impairment in ALS. The obtained data were meta-analysed to generate overall ORs and 95% CIs.ResultsTwenty-seven eligible articles reporting on 6799 individuals were included out of 20 501 records. Nine predictors were identified: C9orf72 (OR 3.62, 95% CI 1.76 to 7.45), dysarthria (OR 2.25, 95% CI 1.20 to 4.22), family history of ALS (OR 1.76, 95% CI 1.18 to 2.61), predominant upper motor neuron (PUMN) phenotype (OR 1.73, 95% CI 1.09 to 2.73) and bulbar onset (OR 1.54, 95% CI 1.28 to 1.87) increased risk factors for cognitive impairment in ALS. ALS Functional Rating Scale-Revised scores, sex, age or education level were not significantly associated with cognitive impairment in ALS. In addition, C9orf72 (OR=5.94) and bulbar onset (OR=2.08) were strong predictors of ALS-frontotemporal dementia. Female sex conferred more susceptibility to executive cognitive impairment than male sex (OR=1.82).ConclusionsPatients with C9orf72 repeat expansion, dysarthria, family history of ALS, PUMN phenotype and bulbar onset had a high risk for cognitive impairment in ALS. These associations may contribute to understanding the heterogeneity of ALS.PROSPERO registration numberCRD42020201085.

scholarly journals Prevalence of Neuropathic Pain Varies in Patients With Knee Osteoarthritis in Different Treatment Stages

2021 ◽  
Author(s):  
Li Li ◽  
Zhaohui Zeng ◽  
Hanle Zhang ◽  
Yuanyuan Lin ◽  
Linghui Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Neuropathic Pain ◽  
Knee Osteoarthritis ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Nociceptive Pain ◽  
Womac Pain ◽  
Increased Risk ◽  
Outpatient Group ◽  
Paindetect Questionnaire

Abstract Background: Pain is the main symptom of knee osteoarthritis (KOA) and can be classified as nociceptive pain and neuropathic pain (NP). However, the prevalence and risk factors of NP in patients with KOA at different treatment stages vary in countries and are still unclear in China.Methods: Patients in this retrospective study were divided into three groups according to treatment stage, including outpatient stage, preoperative total knee arthroplasty (pre-TKA) stage and postoperative TKA stage (post-TKA). A numeric rating scale (NRS) and PainDETECT questionnaire were used to evaluate nociceptive pain and NP. Patient demographics, radiological assessments using Kellgren-Lawrence (K-L) grades, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were analyzed.Results: Of the 921 patients, the prevalence of possible and likely NP was 17.5% (56/320) and 2.5% (8/320) in the pre-TKA group compared with 3.4% (8/233) and 0.4% (1/233) in the outpatient group and 1.4% (5/368) and 0.5% (2/368) in the post-TKA group, respectively. In the pre-TKA group, higher NRS (NRS>3; OR=10.65, 95% CI: 3.25-34.92, p<0.001) and WOMAC pain (WOMAC>10; OR=4.88, 95% CI: 2.38-10.01, p<0.001) scores conferred an increased risk of unclear pain. Age, gender, BMI and K-L grade showed no significant differences among the unlikely, possible and likely NP groups.Discussion: Different prevalence of NP occur in KOA patients at different treatment stages. Due to the low prevalence of NP in the outpatient and post-TKA groups, we suggest not regularly screening for NP in these patients, while it may be essential to screen for NP in patients waiting for TKA. In the latter group, higher NRS and WOMAC pain scores are important risk factors of NP.

scholarly journals Elevated fecal calprotectin is linked to psychosocial complexity in pediatric functional abdominal pain disorders

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Erin L. Moorman ◽  
Michael Farrell ◽  
Neha Santucci ◽  
Lee Denson ◽  
Christine Le ◽  
...  
Keyword(s):  
Risk Factors ◽  
Abdominal Pain ◽  
Functional Disability ◽  
Rating Scale ◽  
Child Anxiety ◽  
Risk Groups ◽  
Fecal Calprotectin ◽  
Numeric Rating Scale ◽  
Functional Abdominal Pain ◽  
Increased Risk

Abstract Objective Children with functional abdominal pain disorders (FAPD) and clinical elevations in three risk areas (anxiety, functional disability, and pain) have been found to be at increased risk for persistent disability. We evaluated if the presence of these three risk factors corresponded with greater gastrointestinal inflammation (measured via fecal calprotectin; FC) compared to those with no risk factors. FC concentration differences between children with three risk factors and those with one and two risk factors were explored. Results Fifty-six children with FAPD (Mage = 12.23) completed measures of anxiety (Screen for Child Anxiety Related Disorders), disability (Functional Disability Inventory), and pain intensity (Numeric Rating Scale). Participants were stratified into risk groups (range: 0–3). Fisher’s exact tests were conducted to determine if children with three versus fewer risk factors were more likely to have elevated FC (≥ 50 µg/g) versus normal levels. Children with three risk factors (MFC = 86.04) were more likely to have elevated FC compared to children with zero (MFC = 25.78), one (MFC = 38.59), and two risk factors (MFC = 45.06; p’s < 0.05). Those with three risk factors had borderline elevated FC concentrations whereas those with fewer had normal FC concentrations. Findings suggest the importance of a biopsychosocial approach to help elucidate a FAPD phenotype.

Risk factors for falls in multiple sclerosis: an observational study

2013 ◽  
Vol 19 (14) ◽  
pp. 1913-1922 ◽  
Author(s):  
Hilary Gunn ◽  
Siobhan Creanor ◽  
Bernhard Haas ◽  
Jonathan Marsden ◽  
Jennifer Freeman
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Rating Scale ◽  
Demographic Data ◽  
Predictive Ability ◽  
Final Analysis ◽  
C Statistic ◽  
Increased Risk ◽  
And Performance ◽  
Risk Factors For Falls

Background: People with multiple sclerosis (MS) experience frequent falls, which are associated with impairments and limitations to activities and participations. Objective: The objective of this paper is to evaluate falls risk factors using robust clinical measures. Methods: A total of 150 individuals (confirmed MS diagnosis, Expanded Disability Status Scale (EDSS) 3.5–6.5) were recruited, with 148 participants included in the final analysis. Demographic data were collected and performance assessed in eight predictor measures (Physiological Profile Assessment (PPA), Brief Ataxia Rating scale, Ashworth scale (Ashworth), Modified Falls Efficacy scale, Symbol Digit Modalities Test, dual-task interference, lying/standing blood pressure, static/dynamic visual acuity). Participants prospectively recorded falls over three months using a daily diary. People were classified as “fallers” based on reports of ≥ two falls. Results: A total of 104 participants recorded 672 falls; 78 (52.7%) reported ≥ two falls. Continence issues, previous falls history and use of prescribed medications were each associated with increased risk of being a “faller”. Ashworth and PPA risk score contributed significantly to a logistic regression model predicting faller/non-faller classification. The reduced model (Ashworth, PPA, EDSS) showed fair-to-good predictive ability (ROC c-statistic 0.73, sensitivity 70%, specificity 69%). Conclusion: This study confirms the high prevalence of falls in ambulant people with MS. Important potentially modifiable risk factors are identified, suggesting aspects to target in falls interventions.

Biopsychosocial risk factors of depression during menopause transition in southeast China

2021 ◽  
Author(s):  
Ketan Chu ◽  
Jing Shui ◽  
Linjuan Ma ◽  
Yizhou Huang ◽  
Fan Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postmenopausal Women ◽  
Rating Scale ◽  
Severe Depression ◽  
Reproductive Period ◽  
Depression Symptoms ◽  
Southeast China ◽  
Increased Risk ◽  
Ordinal Logistic Regression Analysis ◽  
Menopause Transition

Abstract Objective More than 2 billion women experiencing menopause transition in China and some of them suffered depression; while the risk factors of depression are still unclearin China. We aimed to investigate the risk factors in mid-life women in Southeast China. Method This study included 1748 Chinese women aged 40 to 65 years who visit gynecology outpatient department of Women’s hospital School of Medicine, Zhejiang University during 2010 to 2018. Demographic information was collected, and the modified Kupperman Menopausal Index (mKMI) and Hamilton Rating Scale for Depression were assessed. Circulating levels of sex hormones were obtained. Ordinal logistic regression analysis was performed to identify risk factors for depression. Results The prevalence of depression symptoms was 47.43%. The majority of women had mild (38.56%) or moderate depression symptoms (8.00%); only 0.86% had severe depression. Compared with perimenopausal women, postmenopausal women had increased risks of depression. The associations between menopausal syndromes and depression were strongly positive (OR 6.69, 95% CI 5.39–8.29). Women with older age, higher follicle stimulating hormone levels, lower estradiol levels, and fewer parity had increased risk of depression. Among postmenopausal women, underweight, mKMI > 14, earlier age at menopause, shorter reproductive period, and longer duration after menopause were risk factors for depression. Conclusions The results demonstrated a high proportion of depression in women complaining of menopause. Menopausal symptoms were strongly related to the risk of depression. In postmenopausal women, estrogen related events are associated with depression. Gynecological endocrinologists in China should consider screening for depression in high-risk women.

Persistent Incisional Pain after Noncardiac Surgery: An International Prospective Cohort Study

2021 ◽  
Vol 135 (4) ◽  
pp. 711-723
Author(s):  
James S. Khan ◽  
Daniel I. Sessler ◽  
Matthew T. V. Chan ◽  
C. Y. Wang ◽  
Ignacio Garutti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Rating Scale ◽  
Noncardiac Surgery ◽  
Persistent Pain ◽  
Increased Risk ◽  
History Of ◽  
Incisional Pain

Background The purpose of this study was to determine the incidence, characteristics, impact, and risk factors associated with persistent incisional pain. The hypothesis was that patient demographics and perioperative interventions are associated with persistent pain. Methods This was a secondary analysis of an international prospective cohort study from 2012 to 2014. This study included patients who were 45 yr of age or older who underwent major inpatient noncardiac surgery. Data were collected perioperatively and at 1 yr after surgery to assess for the development of persistent incisional pain (pain present around incision at 1 yr after surgery). Results Among 14,831 patients, 495 (3.3%; 95% CI, 3.1 to 3.6) reported persistent incisional pain at 1 yr, with an average pain intensity of 3.6 ± 2.5 (0 to 10 numeric rating scale), with 35% and 14% reporting moderate and severe pain intensities, respectively. More than half of patients with persistent pain reported needing analgesic medications, and 85% reported interference with daily activities (denominator = 495 in the above proportions). Risk factors for persistent pain included female sex (P = 0.007), Asian ethnicity (P &lt; 0.001), surgery for fracture (P &lt; 0.001), history of chronic pain (P &lt; 0.001), coronary artery disease (P &lt; 0.001), history of tobacco use (P = 0.048), postoperative patient-controlled analgesia (P &lt; 0.001), postoperative continuous nerve block (P = 0.010), insulin initiation within 24 h of surgery (P &lt; 0.001), and withholding nonsteroidal anti-inflammatory medication or cyclooxygenase-2 inhibitors on the day of surgery (P = 0.029 and P &lt; 0.001, respectively). Older age (P &lt; 0.001), endoscopic surgery (P = 0.005), and South Asian (P &lt; 0.001), Native American/Australian (P = 0.004), and Latin/Hispanic ethnicities (P &lt; 0.001) were associated with a lower risk of persistent pain. Conclusions Persistent incisional pain is a common complication of inpatient noncardiac surgery, occurring in approximately 1 in 30 adults. It results in significant morbidity, interferes with daily living, and is associated with persistent analgesic consumption. Certain demographics, ethnicities, and perioperative practices are associated with increased risk of persistent pain. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Therapeutic options in male osteoporosis

2013 ◽  
Vol 22 (04) ◽  
pp. 271-276 ◽  
Author(s):  
P. Farahmand ◽  
J. D. Ringe
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Public Health Problem ◽  
Male Osteoporosis ◽  
Individual Risk ◽  
Modes Of Action ◽  
Increased Risk ◽  
Study Results ◽  
Long Term Treatment ◽  
Male Patients

SummaryOsteoporosis in men is increasingly recognized as an important public health problem but affected patients are still under-diagnosed and -treated. As in women the diagnostic and therapeutic strategy has to be adapted to the individual case. In the practical management it is very important to detect possible causes of secondary osteoporosis, to explain the possibilities of basic therapy counteracting individual risk factors and communicate that osteoporosis is a chronic disease and adherence to a long-term treatment is crucial. In established severe osteoporosis a careful analgesic therapy is important to avoid further bone loss related to immobility. In elderly men with increased risk of falling insufficient Vitamin D supply or impaired activation of Vitamin D due to renal insufficiency must be taken into consideration. Specific medications available today for the treatment of male osteoporosis comprise among antiresorptive drugs the bis phosphonates alendronate, risedronate and zoledronic acid. Denosumab, the first biological therapy is approved for men with androgen deprivation therapy for prostate cancer. An important advantage of this potent antiresorptive drug is the increased adherence due to the comfortable application by sixmonthly subcutaneous injections. Study results from the 2-year multi-center randomized controlled ADAMO-Study will very soon allow the use of denosumab in all types of male osteoporosis. Teriparatide, the 34 N-terminal amino acid sequence of parathyroid hormone was approved for men with osteoporosis as an anabolic agent based on proven efficacy by different studies. Among drugs with other modes of action the D-hormone pro-drug alfacalcidol can be used in men alone or in combination with the advantage of pleiotropic effects on calcium absorption, parathyroids, bone and muscle. Recently also Strontium-ranelate was approved for male patients with the limitation to exclude men with clinical relevant cardiovascular risk factors. In general the possibilities to treat male osteoporosis have considerably improved during recent years. Today there is a choice of a spectrum of drugs from mild to strong potency with different modes of action on bone turnover to design strategies for individual male patients.

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