In their day-to-day work, clinicians will continue to use the fuzzy constructs operationally defined and narratively depicted in DSM-5 and ICD-11. Advances in our understanding of the individual-level and society-level causal mechanisms that contribute to vulnerability to mental disorder may ultimately lead to improved classification systems, and in turn to better individualized care as well as improved global mental health.
Panksepp’s separation-distress model of depression posits that endogenous opioid systems become dysregulated subsequent to early social trauma and that this dysregulation constitutes a risk factor for depression. We tested an aspect of this model by recruiting medically and psychiatrically healthy young adults (N = 32) who differed on one key criterion—exposure to early social trauma. In terms of core affective personality traits as measured by the Affective Neuroscience Personality Scales (ANPS), those not exposed to early social trauma scored significantly higher on SEEKING; the groups did not differ on SADNESS. Importantly, the groups also responded differently to a low-dose opioid challenge (0.2 mg sublingual buprenorphine vs. placebo). Buprenorphine administration had little effect on emotion in controls, but it reduced experience of both positive and negative emotion in trauma-exposed participants. The latter also showed a significant negative bias in social cognition that was not attenuated by buprenorphine, whereas controls were more likely to show a positive bias on buprenorphine (relative to trauma-exposed participants). The groups’ differing responses to buprenorphine suggest that their opioid systems are functioning differently. These data constitute preliminary proof of concept for a key aspect of the model. Further investigation of the role of endogenous opioids in depression subsequent to early social trauma is warranted.
Traumatic experiences are prevalent in South Africa and may result in psychiatric disorders such as post-traumatic stress disorder (PTSD). PTSD is accompanied by a range of psychobiological alterations, including changes in brain structure and functioning. General practitioners have an important role to play in identifying and assisting those in need of help. Efficacious psychotherapies and pharmacotherapies are available for PTSD, i.e. cognitive behavioural therapy and selective serotonin reuptake inhibitors.
Many states along the U.S. East Coast are engaged in offshore wind energy planning through the Renewable Energy Task Force process led by the Bureau of Ocean Energy Management (BOEM). Participants from federal, state, and local government use the task forces as a venue to share information and minimize potential conflicts between existing ocean uses and offshore wind farm construction and operations. Task force participants often only make information available in static map form, making comparisons between data sets challenging. To address this, the North and South Carolina Renewable Energy Task Forces are collaborating with the MarineCadastre.gov team to facilitate data sharing. The National Oceanic and Atmospheric Administration (NOAA) and BOEM have been collaborating since 2007 on MarineCadastre.gov, an integrated marine information system that provides jurisdictional, legal, physical, ecological, and ocean use data in a common geographic information system (GIS) framework. The MarineCadastre.gov website was developed in response to a call for a marine information system to support alternative energy development on the outer continental shelf in section 388 of the Energy Policy Act of 2005. Although the website has been designed specifically to support renewable energy siting within the U.S. outer continental shelf, it is also being used for various other ocean-related efforts. The MarineCadastre.gov website has three primary focus areas: Web map viewers and decision-support tools, a spatial data registry, and technical support and regional capacity building. The North and South Carolina Wind Energy Task Forces are combining national-scale data from the website with information specific to their planning areas into simple viewers available in the Map Gallery section of the website. This approach allows users to assess and minimize potential conflicts of offshore wind energy development and operation with existing ocean uses. Multiple issues, such as fishing, shipping, and defense, are viewed and considered simultaneously, in one location, allowing members of the task force to see their own data in a wider context. This enhances the utility of the information that was previously compared using static maps. Users can turn data layers on and off and pan and zoom to specific locations in the planning area as questions arise. The North and South Carolina Wind Energy Task Force data viewers are a simple but powerful mechanism for identifying areas of potential incompatibility, enhancing communication between task force members, and increasing the overall effectiveness of the task force process. The overarching goal of this work is to support the BOEM task forces in making sound decisions with the best available spatial information to facilitate responsible siting of offshore renewable energy infrastructure. This presentation will provide an overview of the primary focus areas of the MarineCadastre.gov project and its underlying technology, with particular attention given to the collaborations with the BOEM-led renewable energy task forces in North and South Carolina. Details on how these two BOEM task forces are incorporating use of the data viewers into their decision-making processes, the types of data being considered, and potential next steps for analyzing the spatial information in a group setting will be discussed.
Read moreThe present study provides evidence that childhood trauma is associated with altered cortical arousal and that the pattern of this association is dependent on the form of childhood trauma experienced.
Read moreWe found high rates of both alcohol abuse and antenatal depression, and a significant association between depression, substance use and alcohol abuse; EDS scores greater than 12 could be used to identify women at risk of alcohol dependence and/or substance abuse.
Read morePurpose: Social media (SM) use is increasingly becoming a source of information for IBD patients. Prior studies have shown internet recruited IBD patients have a decreased quality of life compared to clinic recruited patients. However, SM provides a unique mechanism of communication, and currently, there is limited data assessing its impact on IBD patients. We hypothesize that usage of social media improves quality of life (QOL) in IBD. Methods: A prospective, survey-based study was provided to IBD patients 18 years and older, seen in our IBD clinic. Age, gender, SM use, and education level were self-reported. SIBDQ, HBI, and disease type/duration/extent were obtained by chart review. For those affirming SM use, data was collected on mode of access, use of IBD specific groups, access frequency, posting frequency, effect on QOL, doctor awareness, use of SM information, and perceived reliability of this information. Results: Eighty-six patients (64% female) participated in the survey, with a mean age of 34 years. Disease distribution was: 76% CD, 22% UC, and 2% indeterminate. Most patients had college experience (74%), with 44% of those completing college. Most patients reported using SM sites (76%). Of the SM patients, 97% used Facebook, 25% used Twitter, and 25% used Linked-In. Twenty-three percent of patients used IBD-specific groups. The majority of all SM users reported using their mobile phone as their primary means of access. Compared to non-SM users, SM users were younger (p=0.000), diagnosed at a younger age (p=0.007), and had shorter disease duration (p=0.03). There was no difference in SIBDQ/HBI, gender, education level, or disease type. Of patients who used IBD-SM groups, 73% reported they had used advice, and 80% felt the information was reliable. Only 13% had made their doctor aware of their IBD group use. Forty-six percent of users accessed these groups once a week, and 54% posted once a month. A greater proportion of women reported using IBD-SM groups (p=0.05). There were no differences in age, disease duration/distribution, HBI scores, or education level. Fifty-three percent of IBD-SM users reported a subjective QOL improvement, but IBD-SM users had lower SIBDQ scores than non-IBD group SM users (p=0.017). Conclusion: IBD patients are routinely seeking out and using disease advice on social media that they view as reliable, often without input from their physician. Overall, patients using and not using IBD-specifi c social media have similar disease activity scores; however, patients using IBD-specific social media sites tend to have lower quality of life scores. Despite these lower scores, these patients feel social media use has a positive impact on their quality of life, suggesting their quality of life would be even worse without social media.
Read moreThis volume presents up-to-date, comprehensive and high quality reviews of the psychopharmacological evidence-base for each of the major psychiatric disorders, written by expert psychopharmacologists from around the world. Building on the success of the first edition, the volume summarizes the wealth of new developments in the field and sets them within the context of day-to-day clinical practice. All chapters have been fully updated and new contributions on personality disorders and substance dependence added. Each chapter provides information about optimal first line pharmacological interventions, maintenance pharmacotherapy and the management of treatment-refractory patients. The content is organized according to the DSM-V listing of psychiatric disorders, and covers all major conditions including schizophrenia, mood disorders, anxiety disorders, eating disorders and Alzheimer's disorder. These issues lie at the heart of clinical psychopharmacology, making this book invaluable to all practising and trainee clinicians, in a mental health setting or a less specialised environment.
Read moreIntroduction Hypocalcemia after thyroidectomy results in prolongation of hospitalization and patient discomfort but can be predicted by PTH assays. However, there is considerable variation in their use. Methods This study was undertaken to document current US and European practice patterns regarding the use of this assay. Anonymous surveys were collected in 2009–2011 from members of the American Academies of Otolaryngology-Head and Neck Surgery and Endocrine Surgery and the European, Italian, French, Spanish and British Societies of Endocrine Surgery. Results There were 356 American (3% response) and 61 European (10% response) respondents. 105 (29.8%) American and 25 (41%) European respondents reported routine PTH assay use. Fellowship trained surgeons reported increased use of the PTH assay (P = 0.004). Shorter reported average post-operative hospital stay was associated with American physicians (P = 0.0001), community practice location (P = 0.0002) and routine calcium supplementation ( P = 0.0015). Conclusions Surgical training was associated with routine use of the PTH assay. Average reported hospital stay was lower for American and community practice physicians and correlated with post-operative oral calcium use.
Read moreGiven that humans originated in Africa, it is likely that many seminal psychological observations and interventions originate in the continent. Relatively little attention has been paid, however, to more recent African contributions to the scientific fields of psychiatry and clinical psychology. This article notes that a number of major contributions to the understanding of brain-mind disorders have emerged from South Africa in particular. It briefly covers seminal contributions in evolutionary theory, psychotherapy, and neuroscience, as well as conceptual and practical contributions to reconciliation.
Read moreDue to the high burden of major depressive disorder, and its association with AIDS related stigma, routine screening of PLWHA for both conditions is recommended. However, more research is required to understand this association.
Read moreSouth Africa’s high levels of substance abuse represent one of the most pressing health problems afflicting the country. In particular, alcohol, stimulants such as tik (methamphetamine) and opiates such as heroin are devastating communities, aggravating poverty and crime, and contributing to child abuse and gender violence. Substance Use and Abuse in South Africa emerges from research being conducted by members of the Brain-Behaviour Initiative (BBI) at the University of Cape Town. This innovative set of research projects links neuroscience and behavioural science to social issues, providing fresh perspectives on the health problems afflicting South Africa. This ground-breaking book examines the problem of substance abuse from multiple perspectives, including recent discoveries in brain and behavioural science, and also takes a public health view. Its focus ranges from brain imaging, which shows the effects of drug abuse on the brain, to the psychology of addiction, and on to policy and prevention. This is the first book to address the nature of this problem in an integrated way, written by local researchers at the cutting edge.
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