The psychosis risk timeline: can we improve our preventive strategies? Part 3: primary common pathways and preventive strategies

2019 ◽  
Vol 25 (05) ◽  
pp. 321-332
Author(s):  
Karen Romain ◽  
Alexandra Eriksson ◽  
Richard Onyon ◽  
Manoj Kumar
Keyword(s):  
Risk Factors ◽  
Psychiatric Disorders ◽  
Recent Literature ◽  
Learning Objectives ◽  
List Type ◽  
Preventive Strategies ◽  
Psychosis Risk ◽  
Preventive Work ◽  
Key Aspects ◽  
Inflammatory Changes

SUMMARYPsychosis is a recognised feature of several psychiatric disorders and it causes patients significant distress and morbidity. It is therefore important to keep knowledge of possible risk factors for psychosis up to date and to have an overview model on which further learning can be structured. This article concludes a three-part series. It gives a review of evidence regarding common pathways by which many risk factors come together to influence the development of psychosis and finalises our suggested overview model, a psychosis risk timeline. The three primary pathways considered are based on the major themes identified in this narrative review of recent literature and they focus on neurological, neurochemical and inflammatory changes. We link each back to the factors discussed in the first and second parts of this series that alter psychosis risk through different mechanisms and at different stages throughout life. We then consider and summarise key aspects of this complex topic with the aim of providing current and future clinicians with a model on which to build their knowledge and begin to access and understand current psychosis research and implications for future preventive work.LEARNING OBJECTIVESAfter reading this article you will be able to: •give an overview of common pathways thought to link identified risk factors with psychosis development•understand neurochemical, neurostructural and inflammatory changes associated with psychosis•demonstrate increased knowledge of possible preventive strategies.DECLARATION OF INTERESTNone.

The psychosis risk timeline: can we improve our preventive strategies? Part 1: early life

2019 ◽  
Vol 25 (05) ◽  
pp. 299-308
Author(s):  
Karen Romain ◽  
Alexandra Eriksson ◽  
Richard Onyon ◽  
Manoj Kumar
Keyword(s):  
Risk Factors ◽  
Early Life ◽  
Clinical Utility ◽  
Learning Objectives ◽  
List Type ◽  
Preventive Strategies ◽  
Wide Range ◽  
Psychosis Risk ◽  
Key Aspects

SUMMARYPsychosis is a complex presentation with a wide range of factors contributing to its development, biological and environmental. Psychosis is a feature present in a variety of psychiatric disorders. It is important for clinicians to keep up to date with evidence regarding current understanding of the reasons psychosis may occur. Furthermore, it is necessary to find clinical utility from this knowledge so that effective primary, secondary and tertiary preventative strategies can be considered. This article is the first of a three-part series that examines contemporary knowledge of risk factors for psychosis and presents an overview of current explanations. The articles focus on the psychosis risk timeline, which gives a structure within which to consider key aspects of risk likely to affect people at different stages of life. In this first article, early life is discussed. It covers elements that contribute in the prenatal and early childhood period and includes genetic, nutritional and infective risk factors.LEARNING OBJECTIVESAfter reading this article you will be able to: •give an up-to-date overview of psychosis risk factors that can affect early life•describe some important genetic risk factors•understand more about the role of environmental factors such as nutrition and infection.DECLARATION OF INTERESTNone.

The psychosis risk timeline: can we improve our preventive strategies? Part 2: adolescence and adulthood

2019 ◽  
Vol 25 (05) ◽  
pp. 309-320
Author(s):  
Karen Romain ◽  
Alexandra Eriksson ◽  
Richard Onyon ◽  
Manoj Kumar
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Young People ◽  
Substance Misuse ◽  
Learning Objectives ◽  
Current Evidence ◽  
Psychotic Symptoms ◽  
List Type ◽  
Preventive Strategies ◽  
Psychosis Risk

SUMMARYCurrent understanding of psychosis development is relevant to patients' clinical outcomes in mental health services as a whole, given that psychotic symptoms can be a feature of many different diagnoses at different stages of life. Understanding the risk factors helps clinicians to contemplate primary, secondary and tertiary preventive strategies that it may be possible to implement. In this second article of a three-part series, the psychosis risk timeline is again considered, here focusing on risk factors more likely to be encountered during later childhood, adolescence and adulthood. These include environmental factors, substance misuse, and social and psychopathological aspects.LEARNING OBJECTIVES:After reading this article you will be able to: •understanding the range of risk factors for development of psychotic symptoms in young people and adults•understand in particular the association between trauma/abuse and subsequent psychosis•appreciate current evidence for the nature and strength of the link between substance misuse and psychosis.DECLARATION OF INTEREST:None.

scholarly journals Metabolic syndrome in psychiatry: advances in understanding and management

2014 ◽  
Vol 20 (2) ◽  
pp. 101-112 ◽  
Author(s):  
Cyrus S. H. Ho ◽  
Melvyn W. B. Zhang ◽  
Anselm Mak ◽  
Roger C. M. Ho
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Psychiatric Disorders ◽  
Psychiatric Patients ◽  
Learning Objectives ◽  
List Type ◽  
Type Number ◽  
Unhealthy Lifestyle ◽  
Definition Of ◽  
The Relationship

SummaryMetabolic syndrome comprises a number of cardiovascular risk factors that increase morbidity and mortality. The increase in incidence of the syndrome among psychiatric patients has been unanimously demonstrated in recent studies and it has become one of the greatest challenges in psychiatric practice. Besides the use of psychotropic drugs, factors such as genetic polymorphisms, inflammation, endocrinopathies and unhealthy lifestyle contribute to the association between metabolic syndrome and a number of psychiatric disorders. In this article, we review the current diagnostic criteria for metabolic syndrome and propose clinically useful guidelines for psychiatrists to identify and monitor patients who may have the syndrome. We also outline the relationship between metabolic syndrome and individual psychiatric disorders, and discuss advances in pharmacological treatment for the syndrome, such as metformin.LEARNING OBJECTIVES•Be familiar with the definition of metabolic syndrome and its parameters of measurement.•Appreciate how individual psychiatric disorders contribute to metabolic syndrome and vice versa.•Develop a framework for the prevention, screening and management of metabolic syndrome in psychiatric patients.

scholarly journals Psychiatric assessment of adults in care proceedings

2019 ◽  
Vol 26 (1) ◽  
pp. 16-25
Author(s):  
Rajan Nathan ◽  
Ruth Scarisbrick ◽  
Gaynor Brown
Keyword(s):  
Critical Role ◽  
Legal Framework ◽  
Learning Objectives ◽  
Family Court ◽  
List Type ◽  
Assessment Framework ◽  
England And Wales ◽  
The Family ◽  
The Common ◽  
Key Aspects

SUMMARYPsychiatric assessments of adults involved in care proceedings can play a critical role in assisting the family court to resolve proceedings justly. To properly carry out this role, the psychiatric expert should have an up-to-date understanding of the wider context within which they are working. This article outlines the legal framework of care proceedings in England and Wales and summarises the key aspects of the process. The duties of the expert and how the expert is engaged are explained. Finally, guidance is presented on how the expert should approach questions that are commonly raised in these proceedings.LEARNING OBJECTIVESAfter reading this article you will be able to: •appreciate the legal framework relevant to care proceedings in England and Wales•recognise the circumstances in which expert psychiatric evidence relating to adults in care proceedings is commissioned•understand the common questions posed to expert psychiatrists undertaking assessments of adults in care proceedings and develop an assessment framework.

scholarly journals Meaningful patient engagement

2018 ◽  
Vol 24 (4) ◽  
pp. 245-251
Author(s):  
Clare Gerada
Keyword(s):  
Risk Factors ◽  
Mental Illness ◽  
Patient Engagement ◽  
Mentally Ill ◽  
Patient Perspective ◽  
Learning Objectives ◽  
List Type ◽  
Access To Services ◽  
The Individual ◽  
Health Programme

SUMMARYHolding a medical degree does not magically protect the individual from ever becoming unwell or needing medical help. However, for various reasons, most of which relate to personal, professional and institutional stigma, doctors are often denied the care they so readily provide to their own patients. The author has been running a ‘sick doctor’ service for 10 years and this article describes, from the practitioner-patient perspective, the barriers to care and what can be done to improve doctors' access to services.LEARNING OBJECTIVES•Appreciate the external and internal risk factors for mental illness in doctors•Understand why doctors do not attend for care when mentally unwell•Acknowledge how mentally ill doctors are exposed to stigma and how this can be overcomeDECLARATION OF INTERESTC.G. is a partner of the Hurley Group who won the contract for PHP in 2008 and is employed by and leads the NHS Practitioner Health Programme.

Cognitive impairment—risk factors and prevention

2017 ◽  
pp. 955-962
Author(s):  
Francesca Mangialasche ◽  
Tiia Ngandu ◽  
Miia Kivipelto
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Evidence Based ◽  
Preventive Strategies ◽  
Related Factors ◽  
Life Course Approach ◽  
Age Related ◽  
Key Aspects ◽  
Multicomponent Interventions ◽  
Preventive Effects

Cognitive impairment is common in advanced age, with dementia representing the main cause of disability in older adults. Prevention is crucial to halt the pandemic increase of this disorder, and can be achieved by managing several risk factors, including vascular and metabolic disorders, and psychosocial and lifestyle-related factors. While evidence-based approaches still need to be defined, the multifactorial and heterogeneous nature of late-life cognitive impairment suggests that multicomponent interventions targeting several risk factors simultaneously are needed for optimal preventive effects. A life course approach should also be considered to identify strategies that can be efficacious for subjects of different ages and with different risk profiles. This chapter summarizes major findings on risk and protective factors for age-related cognitive impairment, dementia, and Alzheimer’s disease, and reviews key aspects of preventive strategies, focusing on primary and secondary prevention.

scholarly journals Preventive strategies in depression: gathering evidence for risk factors and potential interventions

2012 ◽  
Vol 201 (5) ◽  
pp. 339-341 ◽  
Author(s):  
Michael Berk ◽  
Felice Jacka
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Risk Factor ◽  
Major Depression ◽  
Vitamin D Deficiency ◽  
Treatment Strategy ◽  
Recent Literature ◽  
Preventive Strategies ◽  
Depression And Anxiety

SummaryThis editorial critiques the recent literature concerning both vitamin D deficiency in major depression and supplementation as a treatment strategy, and contextualises it within a broader approach to the prevention of depression, based on the recent evidence for lifestyle as a risk factor for depression and anxiety.

scholarly journals Assessing autolyzed foetal brains

2019 ◽  
Vol 46 (s2) ◽  
pp. S67
Author(s):  
JT Joseph
Keyword(s):  
Learning Objectives ◽  
List Type ◽  
Type Number ◽  
Delivery Time ◽  
External Examination ◽  
Posterior Extension ◽  
Technical Details ◽  
Key Aspects ◽  
The Brain ◽  
Anatomic Information

Problem:Evaluating very soft foetal brains is problematic, since anatomic information is often lost when these collapse on a dissection board.Methods:Present cases of very soft foetal brains photographed under water, discuss technical details on this technique, and indicate how these data can be used to evaluate the brains.Results:Foetal brains from intrauterine foetal deaths and from foetal terminations that have a long death-to-delivery time are often very soft, even after fixation, and collapse under their own weight on a dissection board. To better evaluate these brains, they have been floated and photographed in water. When possible, the brain is photographed intact in ventral and dorsal views. After the brainstem with cerebellum is removed and hemispheres are separated, these are all photographed; hemispheres are imaged in both lateral and medial views. This technique records developmental data about cortical gyration, the presence of olfactory tracts/bulbs, corpus callosum posterior extension, cerebellum foliation, and brainstem, which can be compared to standard brain development references. Problems with this technique include fragmentation of autolyzed brain into water.Discussions:Photography of very soft foetal brains under water allows evaluation of brains that normally collapse under their own weight. In cases too soft for meaningful dissection, these data often provide the only available brain developmental information.LEARNING OBJECTIVESThis presentation will enable the learner to:1.Photograph foetal brain under water2.Evaluate key aspects of external examination using standard developmental literature

Shared genetic architecture across psychiatric disorders

2021 ◽  
pp. 1-7
Author(s):  
Andrew D. Grotzinger
Keyword(s):  
Risk Factors ◽  
Psychiatric Disorders ◽  
Genetic Correlations ◽  
Fine Grained ◽  
Level Data ◽  
Symptom Level ◽  
Genetic Level ◽  
Genetic Signal ◽  
Family Based ◽  
Shared Genetic

Abstract Psychiatric disorders overlap substantially at the genetic level, with family-based methods long pointing toward transdiagnostic risk pathways. Psychiatric genomics has progressed rapidly in the last decade, shedding light on the biological makeup of cross-disorder risk at multiple levels of analysis. Over a hundred genetic variants have been identified that affect multiple disorders, with many more to be uncovered as sample sizes continue to grow. Cross-disorder mechanistic studies build on these findings to cluster transdiagnostic variants into meaningful categories, including in what tissues or when in development these variants are expressed. At the upper-most level, methods have been developed to estimate the overall shared genetic signal across pairs of traits (i.e. single-nucleotide polymorphism-based genetic correlations) and subsequently model these relationships to identify overarching, genomic risk factors. These factors can subsequently be associated with external traits (e.g. functional imaging phenotypes) to begin to understand the makeup of these transdiagnostic risk factors. As psychiatric genomic efforts continue to expand, we can begin to gain even greater insight by including more fine-grained phenotypes (i.e. symptom-level data) and explicitly considering the environment. The culmination of these efforts will help to inform bottom-up revisions of our current nosology.

The physiopathology of spontaneous hemorrhagic stroke: a systematic review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Alcivan Batista de Morais Filho ◽  
Thiago Luis de Holanda Rego ◽  
Letícia de Lima Mendonça ◽  
Sulyanne Saraiva de Almeida ◽  
Mariana Lima da Nóbrega ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Natural History ◽  
Hemorrhagic Stroke ◽  
Recent Literature ◽  
Clinical Manifestations ◽  
The Road ◽  
History Of

Abstract Hemorrhagic stroke (HS) is a major cause of death and disability worldwide, despite being less common, it presents more aggressively and leads to more severe sequelae than ischemic stroke. There are two types of HS: Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH), differing not only in the site of bleeding, but also in the mechanisms responsible for acute and subacute symptoms. This is a systematic review of databases in search of works of the last five years relating to the comprehension of both kinds of HS. Sixty two articles composed the direct findings of the recent literature and were further characterized to construct the pathophysiology in the order of events. The road to the understanding of the spontaneous HS pathophysiology is far from complete. Our findings show specific and individual results relating to the natural history of the disease of ICH and SAH, presenting common and different risk factors, distinct and similar clinical manifestations at onset or later days to weeks, and possible complications for both.

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