Dr Scott's response to our position statement enables us to clarify our views to health professionals and the public. We agree with Dr Scott on several points. There is an increasing evidence-based consensus that policy on alcohol, tobacco, cannabis and other substances should move from the 'war on drugs' towards a science-based public health approach (as was successful locally in addressing tobacco use). We agree that various substances differ in their associated costs and harms and that globally alcohol is a far more harmful substance than cannabis. We also agree that an approach to substances that emphasises harm reduction and human rights is also key, and that new local policies and programmes are urgently needed, given the enormous burden of disease caused by alcohol, tobacco, cannabis and other substance use. Our position statement was developed with these in mind! We have also submitted to this journal a position statement on harm reduction to emphasise the importance of this approach to alcohol, tobacco, cannabis and other substance use from a public health perspective.

Key nosological questions facing the DSM-5 and ICD-11 work groups on obsessive-compulsive and related disorders (OCRDs) included whether putative OCRDs should be classified together, and whether obsessive-compulsive disorder (OCD) should retain its classification as an anxiety disorder. Given that some of the putative OCRDs were new to the official nosologies, the work groups also had to grapple with the perennial questions of how to decide whether any condition is a mental disorder, and how to draw boundaries between disorder and normality. This chapter reviews some of the conceptual questions that emerged and some of the practical solutions that were suggested. The emphasis on both diagnostic validity and clinical utility is consistent with an integrative approach which holds that nosology should be both evidence-based and values-based.

Folic acid supplementation was not associated with risk of major childhood cancers.

Anxiety disorders are highly prevalent worldwide and engender substantial economic costs and disability. The World Health Organization is currently developing the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11), which represents the first opportunity to improve the validity, clinical utility, and global applicability of the classification in more than 25 years. This article describes changes in the organization and diagnostic guidelines for anxiety and fear-related disorders proposed by the ICD-11 Working Group on the Classification of Mood and Anxiety Disorders and the rationale and evidence base for the proposals. In ICD-11, anxiety and fear-related disorders that manifest across the lifespan are brought together under a new grouping, and are partly distinguished by their focus of apprehension. The focus of apprehension is the stimulus or situation that triggers the fear or anxiety and may be highly specific as in specific phobia or relate to a broader class of situations as in social anxiety disorder. The guidelines also clarify the relationship between panic disorder and agoraphobia and a qualifier is provided for panic attacks in the context of other disorders. A standardized format emphasizing essential features of anxiety disorders is intended to improve clinical utility. Guidelines will be further refined based on findings from two types of field studies: those using a case-controlled vignette methodology disseminated via the Internet to practitioners worldwide (http://gcp.network) and clinic-based field trials implemented globally at participating field study centers.

Finland and Denmark has a higher alcohol-attributed disease burden than Sweden and Norway in the period 1990-2013. Changes in consumption levels in general corresponded to changes in harm in Finland and Denmark, but not in Sweden and Norway for some years. All countries followed a similar pattern. The majority of disability-adjusted life years were due to premature mortality. Alcohol use disorder by non-fatal conditions accounted for a higher proportion of disability-adjusted life years in Norway and Sweden, compared with Finland and Denmark.

Nature Communications 6: Article number: 10106 (2015); Published: 3 December 2015; Updated: 3 March 2016 The original version of this Article contained an error in the spelling of the author Jennifer S. Stevens, which was incorrectly given as Jennifer J. Stevens. Furthermore, in Fig. 5, the titles for panels a and b were inadvertently switched.

Childhood maltreatment, including abuse and neglect, may have sustained effects on the integrity and functioning of the brain, alter neurophysiological responsivity later in life, and predispose individuals toward psychiatric conditions involving socioaffective disturbances. This meta-analysis aims to quantify associations between self-reported childhood maltreatment and brain function in response to socioaffective cues in adults. Seventeen functional magnetic resonance imaging studies reporting on data from 848 individuals examined with the Childhood Trauma Questionnaire were included in a meta-analysis of whole-brain findings, or a review of region of interest findings. The spatial consistency of peak activations associated with maltreatment exposure was tested using activation likelihood estimation, using a threshold of p < .05 corrected for multiple comparisons. Adults exposed to childhood maltreatment showed significantly increased activation in the left superior frontal gyrus and left middle temporal gyrus, and decreased activation in the left superior parietal lobule and the left hippocampus. Although hyperresponsivity to socioaffective cues in the amygdala and ventral anterior cingulate cortex in correlation with maltreatment severity is a replicated finding in region of interest studies, null results are reported as well. The findings suggest that childhood maltreatment has sustained effects on brain function into adulthood, and highlight potential mechanisms for conveying vulnerability to development of psychopathology.

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Olfactory reference syndrome is characterised by the erroneous belief that one emits an unpleasant body odour. This results in significant distress and is often accompanied by repetitive behaviour such as frequent showering in an attempt to camouflage the perceived odour. The body odour concerns may have a delusional quality and do not respond to simple reassurance or counterexample. Herein, we report the case of an olfactory reference disorder (ORD) patient who had received multiple medical interventions and undergone polysurgery prior to an accurate diagnosis being established. ORD may lead to significant disability, yet often goes unrecognised for many years. For many patients, poor insight will contribute to their reluctance to consider psychiatric treatment. This case demonstrated that a multimodal treatment approach comprising judicious medication use, combined with cognitive behavioural therapy, in the context of a therapeutic alliance yielded therapeutic success.

This chapter explores the crumpled piece of fabric and focuses on threads that go into its construction and see how and when shame enters into its weave and how the problem of shame may be integrated into conscious life through an experience of the self. Temporality as chronicity is the conscious state of awareness of the regular movement of objects like the sun and the hands of a clock in the world around us. Achronicity and chronicity lie on a spectrum with many gradations between the extremes, and they may flow smoothly or roughly into and out of one another. Synchronicity in itself is shame-free, but if it is taken up into the chronicity of the ego's normal experience of life and considered in a different light, perhaps ethical, it may take on an aspect of shame. An important side-effect of the gradual integration was that a sense of shame actually developed and grew stronger as present temporality replaced dyschronicity.

<p class="p1">Genomics is the study of the genetic material that constitutes the genomes of organisms. This genetic material can be sequenced and it provides a powerful tool for the study of human, plant and animal evolutionary history and diseases. Genomics research is becoming increasingly commonplace due to significant advances in and reducing costs of technologies such as sequencing. This has led to new challenges including increasing cost and complexity of data. There is, therefore, an increasing need for computing infrastructure and skills to manage, store, analyze and interpret the data. In addition, there is a significant cost associated with recruitment of participants and collection and processing of biological samples, particularly for large human genetics studies on specific diseases. As a result, researchers are often reluctant to share the data due to the effort and associated cost. In Africa, where researchers are most commonly at the study recruitment, determination of phenotypes and collection of biological samples end of the genomic research spectrum, rather than the generation of genomic data, data sharing without adequate safeguards for the interests of the primary data generators is a concern. There are substantial ethical considerations in the sharing of human genomics data. The broad consent for data sharing preferred by genomics researchers and funders does not necessarily align with the expectations of researchers, research participants, legal authorities and bioethicists. In Africa, this is complicated by concerns about comprehension of genomics research studies, quality of research ethics reviews and understanding of the implications of broad consent, secondary analyses of shared data, return of results and incidental findings. Additional challenges with genomics research in Africa include the inability to transfer, store,<span class="Apple-converted-space"> </span>process and analyze large-scale genomics data on the continent, because this requires highly specialized skills and expensive computing infrastructure which are often unavailable. Recently initiatives such as H3Africa and H3ABioNet which aim to build capacity for large-scale genomics projects in Africa have emerged. Here we describe such initiatives, including the challenges faced in the generation, analysis and sharing of genomic data and how these challenges are being overcome.