scholarly journals Pathological gambling: an overview of assessment and treatment

2005 ◽  
Vol 11 (6) ◽  
pp. 450-456 ◽  
Author(s):  
Sanju George ◽  
Vijaya Murali
Keyword(s):  
Pathological Gambling ◽  
Psychiatric Comorbidity ◽  
Treatment Strategies ◽  
Appropriate Treatment ◽  
Assessment And Treatment ◽  
Scant Attention ◽  
Assessment Techniques ◽  
The Individual ◽  
The Uk

Pathological gambling has so far received scant attention in the psychiatric literature. It has a prevalence rate of about 1% in most countries, and with the deregulation of gambling in the UK the prevalence is set to rise here. Pathological gambling can adversely affect the individual, family and society, and also carries high rates of psychiatric comorbidity. Early identification and appropriate treatment can limit the long-term adverse consequences and improve outcome. This article reviews assessment techniques and tools, and treatment strategies for pathological gambling.

Dental care for children with selective mutism

2021 ◽  
Vol 12 (2) ◽  
pp. 72-77
Author(s):  
Mona Agel ◽  
Gino Hipolito
Keyword(s):  
Selective Mutism ◽  
Behavioural Therapy ◽  
Dental Care For Children ◽  
Routine Examination ◽  
Dental Visits ◽  
Social Settings ◽  
The Individual ◽  
The Uk ◽  
Dental Appointments

Selective mutism (SM) is an anxiety disorder that is characterised by a consistent failure to speak in certain social settings where the individual is expected to speak while in other situations, speech is normal. It often starts in childhood and is thought to affect around 1 in 140 children in the UK. If recognised and treated early, SM can be overcome but left untreated, it can lead to long-term problems. It is thought to be caused by a complex interaction between various vulnerabilities such as genetics, temperament, environment and neurodevelopmental factors. Treatment methods are variable and can include non-medication-based therapies (eg behavioural therapy) or pharmacotherapy. This paper specifically addresses the child with SM. Few professionals are trained in dealing with SM and many have little knowledge of the condition. SM awareness for parents and professionals along with appropriate information and intervention techniques are vital. For children with SM, dental visits can prove challenging. Each child is unique in how they present with their difficulties. A child attending the dentist for a dental problem or a routine examination may not yet be diagnosed with SM, and so knowledge of the condition and what appropriate services are available is important. The dental team should understand the possible modes of therapy that the child is receiving and work with these principles during dental appointments. Simple strategies such as asking the parent how best to communicate with the child, understanding what makes the child feel at ease and whether the child has any other phobias or anxieties can help.

Hip screening in newborns in the UK: what are the latest guidelines?

2021 ◽  
pp. 1-7
Author(s):  
Ayla C Newton ◽  
Marion Bohatschek ◽  
Andreas Rehm ◽  
Elizabeth Ashby
Keyword(s):  
Physical Examination ◽  
Congenital Abnormalities ◽  
Screening Programme ◽  
Developmental Dysplasia ◽  
Special Focus ◽  
Timely Manner ◽  
Appropriate Treatment ◽  
The Uk

The Newborn and Infant Physical Examination screening is a national screening programme which aims to identify infants with congenital abnormalities to minimise the risk of long-term complications. It involves a top to toe examination with special focus on the heart, eyes, testes and hips. The hip component of the Newborn and Infant Physical Examination screen aims to pick up infants with developmental dysplasia of the hips and refer them for appropriate treatment in a timely manner. Guidelines for the hip section of have recently changed. This article reviews these changes, the timings of the follow up and investigations, and the diagnosis and management of developmental dysplasia of the hips.

Obsessive–compulsive disorder and tics in children and adolescents

2012 ◽  
pp. 1680-1693
Author(s):  
Martine F. Flament ◽  
Philippe Robaey
Keyword(s):  
Children And Adolescents ◽  
Treatment Strategies ◽  
Tic Disorders ◽  
Older Individuals ◽  
Obsessive Compulsive ◽  
Pharmacological Agents ◽  
Assessment And Treatment ◽  
Ongoing Relationship

Paediatric OCD is the disorder, in child psychiatry, whose clinical picture most closely resembles its adult counterpart. Despite a relative diversity, the symptom pool is remarkably finite, and very similar to that seen in older individuals. Prevalence, comorbidity, and response to behavioural and drug treatment also appear similar across the lifespan. For tic disorders, there is continuity between child and adult presentations, but the disease is much more prone to resolve spontaneously, or to be less disruptive in adulthood. Both OCD and tics occur more often in males than in females, and are likely to be linked to an array of neurobiological abnormalities, many of which remain to be understood. Invaluable benefits can now be obtained from available behavioural and pharmacological treatments, but complete remission remains uncertain and long-term management may be required. Thus, the treatment of OCD and tics in children and adolescents remains a clinical challenge. It requires careful assessment of the targeted symptoms and, in many cases, comorbidity; attention to the quality of the child's functioning at home and with peers; use of specific CBT interventions, which are not readily available (or accessible) in all communities; patience and caution in the choice and adjustment of medication; and vigilance in watching potential side effects. Given the possible chronicity of OCD and/or tic disorders, and their changing patterns in severity and impact over the childhood and adolescent years, optimal treatment generally requires a long-term ongoing relationship with the child and family. Current conceptualizations of OCD and tic disorders have been shaped by advances in systems neuroscience and functional in vivo neuroimaging. Continued success in these areas should lead to the targetting of specific brain circuits for more intensive research. This should include testing novel pharmacological agents, tracking treatment response using neuroimaging techniques, and possibly investigating circuit-based therapies using deep-brain stimulation for refractory cases. The identification of the PANDAS subgroup of patients, with an abrupt onset and dramatic exacerbations, certainly brings new insights into the pathophysiology of OCD and tic disorders, and may lead to new assessment and treatment strategies. The increasing evidence for susceptibility genes in OCD and tic disorders will also doubtless point to new therapeutic directions. Furthermore, it is likely that many of the empirical findings used in research on paediatric OCD and tic disorders will be relevant to a better understanding of both normal development, and other disorders of childhood onset.

Accidental adrenaline auto-injector-induced digital ischaemia: a proposed treatment algorithm

2021 ◽  
Vol 14 (4) ◽  
pp. e237016
Author(s):  
Elizabeth Rajiah ◽  
Andrew R McKean ◽  
Charles Bain
Keyword(s):  
Treatment Algorithm ◽  
Treatment Strategies ◽  
Hand Surgery ◽  
Adverse Outcomes ◽  
Volar Aspect ◽  
Digital Necrosis ◽  
The Uk ◽  
Digital Ischaemia ◽  
Digital Block

Increased numbers of adrenaline auto-injectors (AAIs) are in circulation in the UK. The rate of accidental auto-injection injuries has increased during this time. Various treatment strategies are described in the literature. We present the case of a 32-year-old, right-hand-dominant man who sustained an unintentional AAI injury to the volar aspect of his right thumb. On presentation to the emergency department, the thumb was ischaemic. There was no improvement with simple conservative measures (warm soaks). The patient was referred to our tertiary hand surgery service and a digital block using 2% lidocaine promoted reversal of ischaemia within 2 hours with no long-term sequelae. Phentolamine rescue, on standby, was not necessary in this case. In this case report, we highlight the therapeutic challenges associated with managing AAI injury and propose an evidence-based treatment algorithm to prevent risk of severe adverse outcomes such as digital necrosis.

Equine obesity and the role of the veterinary nurse

UK-Vet Equine ◽  
2021 ◽  
Vol 5 (6) ◽  
pp. 265-268
Author(s):  
Clarissa Seeley ◽  
Stella Chapman
Keyword(s):  
Body Condition ◽  
The Body ◽  
Body Condition Scoring ◽  
Client Education ◽  
Inherent Problem ◽  
Equine Obesity ◽  
The Individual ◽  
The Uk

Equine obesity is defined as a medical disease in which excess body fat has accumulated to such an extent that it has an adverse effect on the general health of the horse. Obesity is a cause for concern, with one-third of the equine population in the UK being regarded as obese, although owner recognition of obesity in horses is an inherent problem, with many underestimating the body condition or weight of their horse. This is further complicated by the fact that with larger framed horses, or horses that are already overweight, assessing body condition is more difficult. There are a number of ways to assess body condition and the most practical means of regular assessment is body condition scoring, although this is regarded as subjective. As with many diseases and disorders, the cause of obesity is multifactorial. However, the most common reason for a horse to become obese is overfeeding, coupled with a lack of exercise. Obesity can be addressed with client education and veterinary nurses can provide advice on weight management programmes. However, these need to be tailored to the individual horse and owners need to recognise that they are entering into a long-term commitment.

scholarly journals Clinician-Patient Dialogue About Preventive Chronic Migraine Treatment

2020 ◽  
Vol 11 ◽  
pp. 215013272095993
Author(s):  
Andrew M. Blumenfeld
Keyword(s):  
Chronic Migraine ◽  
Treatment Approach ◽  
Treatment Options ◽  
Correct Diagnosis ◽  
Severe Form ◽  
Migraine Treatment ◽  
Appropriate Treatment ◽  
The Individual ◽  
Practical Recommendations

Many new medications for the treatment of migraine are now available on the market. In the current evolving migraine treatment landscape, an individualized treatment approach is needed. This review provides practical recommendations on how to obtain a correct diagnosis and then engage in a long-term partnership with patients with the most severe form of migraine: chronic migraine (CM). Given the need to effectively treat this complex neurological disease, clinicians in primary care, general neurologists, and headache specialists are at the forefront to ease the burden of this disease for their patients. This manuscript will review how to discuss the currently available treatment options to help control migraine attacks, manage expectations, and, together with the patient, determine the most effective and appropriate treatment. The goal is to create an environment where the clinician partners with the patient in shared decision-making to choose the most effective appropriate treatment for the individual patient.

Long-Term Treatment of Patients with Recurrent Unipolar Major Depression: Evidence to Clinical Practice

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S15) ◽  
pp. 4-5 ◽  
Author(s):  
Martin B. Keller
Keyword(s):  
Treatment Strategies ◽  
Patient Characteristics ◽  
Evidence Base ◽  
Term Treatment ◽  
Recurrent Depression ◽  
Long Term Treatment ◽  
Risk Factors For Recurrence ◽  
The Individual ◽  
Term Management

Major depressive disorder (MDD) is almost exclusively recurrent. The vast majority of patients who experience one episode of MDD will eventually experience at least one more episode during their lifetime. The recurrent nature of MDD increases the burden to both the individual and society. Hence, it is imperative that treatment strategies focus on achieving remission acutely, as well as maintaining of remission and preventing recurrence. The articles in this supplement are based on presentations and a dialogue among a group of experts who convened for a roundtable discussion on improving long-term outcomes with antidepressant therapy.Improving long-term treatment of MDD begins with understanding the clinical course of recurrent depression and the ability to recognize those patients who are at greatest risk for recurrence. James H. Kocsis, MD, reviews the course of recurrent depression, emphasizing the tendency for it to progressively worsen. He also discusses patient characteristics and other risk factors for recurrence as well as current recommendations for long-term management of recurrent depression.Although long-term antidepressant maintenance treatment studies are somewhat limited in number, they provide the evidence base that shapes existing guidelines for long-term management of recurrent depression. Michael E. Thase, MD, examines this evidence for the different classes of antidepressants. In addition, Thase reviews evidence for the efficacy of psychotherapy and discusses its potentially important role in long-term depression management.

The role of medication in the treatment of pathological gambling: Bridging the gap between research and practice

2004 ◽  
Author(s):  
Richard J. Rosenthal
Keyword(s):  
Pathological Gambling ◽  
Treatment Strategies ◽  
Pathological Gambler ◽  
Future Research ◽  
Genetic Profiling ◽  
Hyperactivity Disorder ◽  
Clinical Syndromes ◽  
Negative Affects ◽  
Specific Symptoms

After reviewing the literature on the pharmacotherapy of pathological gambling, the author discusses treatment strategies and areas for future research. The clearest indication for medicating the pathological gambler is for the treatment of comorbid disorders, primarily depression, bipolar disorder, and attention deficit hyperactivity disorder. However, there are difficulties in diagnosing the dually disordered gambler. Other current pharmacological approaches involve the use of medication to treat specific symptoms, traits, or symptom clusters; to make negative affects more tolerable; and to reduce cravings. Future approaches will be directed at subgroups of gamblers. This may include genetic profiling, paired with recognition of neurotransmitter deficits, and the identification of clinical syndromes and subtypes. The author also discusses the kindling hypothesis as it may pertain to pathological gambling. The presence of kindling would make a strong case for earlier and more aggressive use of medication and for long-term maintenance to prevent relapse.

scholarly journals Osteoarthritis: etiology, epidemiology, impact on the individual and society and the main principles of management

Medicina ◽  
2010 ◽  
Vol 46 (11) ◽  
pp. 790 ◽  
Author(s):  
Giedrė Sakalauskienė ◽  
Dovilė Jauniškienė
Keyword(s):  
Treatment Modalities ◽  
Treatment Programs ◽  
Health Providers ◽  
Effective Interventions ◽  
Lack Of Information ◽  
Appropriate Treatment ◽  
Short And Long Term ◽  
The Individual

Etiology, epidemiology, and impact of osteoarthritis on an individual, society, and nation and the main principles of management of this disease are reviewed in the article. Treatment should be tailored to the needs of an individual patient. Physicians should be familiar with pharmacologic and nonpharmacologic treatment modalities to maximize effective utilization and a thorough understanding of short- and long-term complications and costs. Severity of osteoarthritis should be taken into physician’s and patient’s consideration while applying an appropriate treatment. A stepwise management of osteoarthritis has to be taken into account. As effective interventions remain underused, state arthritis programs, including osteoarthritis programs, have to be developed to build an appropriate scientific base in public health, observe burden and impact, assess and disseminate evidence-based interventions, and work to reduce and delay disability, and improve quality of life among people with arthritis. Adequate studies on the costs of osteoarthritis are urgently required so that cogent arguments can be made to governments to appropriately fund prevention and treatment programs for this condition. Its recognition as a major cause of disability, particularly in the aging population, should increase community focus on this important condition. Osteoarthritis as a pathogenic process and its impact on an individual and society should be taken into special consideration by health providers and officers developing the national health policy in Lithuania, because there is a lack of information related to the prevalence of osteoarthritis, risk factors, also osteoarthritisassociated disability, and costs of the management of this disease among Lithuanian inhabitants.

scholarly journals Exploration of attitudes regarding uptake of COVID-19 vaccines among vaccine hesitant adults in the UK: A qualitative analysis.

2021 ◽  
Author(s):  
Sarah Denford ◽  
Fiona Mowbray ◽  
Lauren Towler ◽  
Helena Wehling ◽  
Gemma Lasseter ◽  
...  
Keyword(s):  
Vaccine Uptake ◽  
Health Campaigns ◽  
Structured Interviews ◽  
First Results ◽  
Understanding Of Science ◽  
The Government ◽  
Public Health Campaigns ◽  
The Individual ◽  
The Uk

Abstract Background The aim of this work was to explore barriers and facilitators to uptake of COVID-19 vaccines and to explore views and reactions to efforts to improve vaccine uptake among those who were vaccine hesitant. Methods Semi-structured interviews were conducted with people between the age of 18-29 years who had not had a COVID-19 vaccine, and those between 30-49 years who have not received a second dose of a COVID-19 vaccine (more than 12 weeks after receiving a first). Results A total of 70 participants took part in the study, 35 participants had received one dose of the vaccine, and 35 had not received any vaccine. Participants described a possible willingness to be vaccinated to keep themselves and those around them safe, and to avoid restrictions and return to normal. Barriers to uptake included: 1) perceived lack of need for COVID-19 vaccinations, 2) concerns about the efficacy of vaccinations, 3) concerns about safety 4) access. Uptake appeared to be influenced by the age and health status of the individual, trust in government and knowledge and understanding of science. Introduction of vaccine passes may provide a motive for having a vaccine but may also be viewed as coercive. Conclusion Participants were hesitant, rather than opposed, and had questions about their need for, and the safety and efficacy of the vaccine. Young people did not consider themselves to be at risk of becoming ill from COVID-19, did not think the vaccination was effective in preventing infection and transmission, and did not think sufficient research had been conducted with regard to the possible long-term side-effects. These concerns were exacerbated by a lack of trust in the government and misunderstanding of science. In order to promote uptake, public health campaigns should focus on the provision of information from trusted sources that carefully explains the benefits of vaccination and addresses safety concerns more effectively. To overcome inertia in people with low levels of motivation to be vaccinated, appointments must be easily accessible.

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