Symptoms, functioning and quality of life after treatment in a residential sub-acute mental health service in Australia

Clinical Signs and Symptoms and Laboratory Findings of Methadone Poisoning in Children

Background: Poisoning accounts for about 7% of all accidents in children under 5 years and is implicated in over 5% of all childhood deaths in developing countries. Objectives: Due to the potential risks of methadone poisoning in children and increased cases of methadone poisoning among Iranian children, this study was conducted to investigate the clinical signs and symptoms and laboratory findings of methadone toxicity in children. Patients and Methods: The present retrospective, descriptive, cross-sectional study describes the clinical symptoms and signs and laboratory findings of methadone poisoning in children under 12 years old in Shahid Beheshti Hospital, Kashan, during the years 2009 to 2013. Results: Of 58 patients, 33 (56.9%) were male and 25 (43.1%) female (P = 0.294). The mean age of patients was 5.2 ± 1.0 years. All the cases of poisoning happened with methadone syrup, due to unsafe keeping of methadone in mineral water bottles and containers of other drugs. Signs and symptoms included drowsiness (91.4 %), miosis (75.9%), vomiting (69.0%), ineffective breathing (any kind of breathing problem except apnea) (62.1%), apnea (53.4%), cyanosis (43.1%), seizure (8.6%), ataxia (6.9%) and delirium (3.4%). Conclusions: Keeping methadone in appropriate containers and warning methadone consumers about the dangerous side effects of its consumption and the symptoms of methadone poisoning in children may minimize the occurrence of this form of poisoning and its complications in children.

Broad Concerns about Nanotechnology Patents: Symptoms and Diagnosis

We discuss the concerns that the patenting activity in the new nanotechnologies could blur the line between what is considered a discovery and what can be considered as an invention. We find that the nature of nanotechnology products, research, and the development agendas in science and engineering fields that include biomimetics pose a challenge to the present practice of including chemicals as eligible patent subject matter. After revisiting the historical development of patent law and noting its divergence from the developments in science and technology, we introduce the distinction between simple and complex machines as these relate to chemistry and nanotechnology. This distinction poses the question of what is the logical category of inventions that fall within patentable subject matter given that patent law was conceived to cover simple machines, not complex ones.

Menopause in Central America: attitudes, symptoms and treatment.

UCR::Investigación::Unidades de Investigación::Ciencias Básicas::Centro de Investigaciones en Productos Naturales (CIPRONA)

Efficacy of neurostimulation to treat symptoms of Mal de Debarquement Syndrome. A preliminary study using repetitive transcranial magnetic stimulation

Mal de debarquement syndrome (MdDS) is a rare and poorly understood condition of perceived continual motion. Using a multiple-case design (n = 13; 8 f; 63.5 ± 12.6 years), this study investigated the efficacy of eight 20-min sessions, over 4 weeks, of repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral pre-frontal cortex. Compared to sham, rTMS demonstrated improvement in balance and confidence in daily living activities. rTMS shows promise for the treatment of MdDS. However, larger trials with longer intervention periods are required.

Staff compliance with protocols to improve the management of behavioral and psychological symptoms of dementia

Using data from a larger study investigating the effectiveness of a structured clinical protocol to manage individuals in residential facilities who experience behavioral and psychological symptoms of dementia (BPSD), the current study investigated whether external clinical support in using the protocol with specific residents increased compliance in its use, over and above only providing a generic workshop about the protocol and management of BPSD. Results indicated that provision of the workshop, in addition to clinical support, was associated with significantly higher compliance. However, compliance was only found to be related to positive outcomes when staff received the generic workshop and not clinical support. When clinical support was provided, compliance was not related to outcomes or worse outcomes. These findings, when considered in the context of the results of the larger trial, suggest that the relationship among clinical support, compliance with BPSD protocols, and clinical outcomes for residents and staff is complex and needs further investigation.

The acute effects of exercise on cigarette cravings, withdrawal symptoms, affect, and smoking behaviour: systematic review update and meta-analysis

RATIONALE: Smoking cessation is associated with cigarette cravings and tobacco withdrawal symptoms (TWS), and exercise appears to ameliorate many of these negative effects. A number of studies have examined the relationships between exercise, cigarette cravings, and TWS. OBJECTIVES: The objectives of this study were (a) to review and update the literature examining the effects of short bouts of exercise on cigarette cravings, TWS, affect, and smoking behaviour and (b) to conduct meta-analyses of the effect of exercise on cigarette cravings. METHODS: A systematic review of all studies published between January 2006 and June 2011 was conducted. RESULTS: Fifteen new studies were identified, 12 of which found a positive effect of exercise on cigarette cravings. The magnitude of statistically significant effect sizes for 'desire to smoke' and 'strength of desire to smoke' ranged from 0.4 to 1.98 in favour of exercise compared to passive control conditions, and peaked either during or soon after treatment. Effects were found up to 30 min post-exercise. Cigarette cravings were reduced following exercise with a wide range of intensities from isometric exercise and yoga to activity as high as 80-85 % heart rate reserve. Meta-analyses revealed weighted mean differences of -1.90 and -2.41 in 'desire to smoke' and 'strength of desire to smoke' outcomes, respectively. Measures of TWS and negative affect were reduced following light-moderate intensity exercise, but increased during vigorous exercise. CONCLUSIONS: Exercise can have a positive effect on cigarette cravings and TWS. However, the most effective exercise intensity to reduce cravings and the underlying mechanisms associated with this effect remain unclear.

Specific mood symptoms confer risk for subsequent suicidal ideation in bipolar disorder with and without suicide attempt history: multi-wave data from STEP-BD

BACKGROUND: Little is known about specific mood symptoms that may confer risk for suicidal ideation (SI) among patients with bipolar disorder (BD). We evaluated prospectively whether particular symptoms of depression and mania precede the onset or worsening of SI, among adults with or without a history of a suicide attempt. METHODS: We examined prospective data from a large (N = 2,741) cohort of patients participating in the Systematic Treatment Enhancement Program for BD (STEP-BD). We evaluated history of suicide attempts at baseline, and symptoms of depression and mania at baseline and follow-up visits. Hierarchical linear modeling tested whether specific mood symptoms predicted subsequent levels of SI, and whether the strength of the associations differed based on suicide attempt history, after accounting for the influence of other mood symptoms and current SI. RESULTS: Beyond overall current depression and mania symptom severity, baseline SI, and illness characteristics, several mood symptoms, including guilt, reduced self-esteem, psychomotor retardation and agitation, increases in appetite, and distractibility predicted more severe levels of subsequent SI. Problems with concentration, distraction, sleep loss and decreased need for sleep predicted subsequent SI more strongly among individuals with a suicide attempt history. CONCLUSIONS: Several specific mood symptoms may confer risk for the onset or worsening of SI among treatment-seeking patients with BD. Individuals with a previous suicide attempt may be at greater risk in part due to greater reactivity to certain mood symptoms in the form of SI. However, overall, effect sizes were small, suggesting the need to identify additional proximal predictors of SI.

Association between autism symptoms and functioning in children with ADHD

OBJECTIVE: To examine the association between autism spectrum disorder (ASD) symptoms and (a) social functioning, (b) mental health, (c) quality of life and (d) sleep in children with and without attention-deficit hyperactivity disorder (ADHD).

METHODS: Participants were 6-10-year-old children with ADHD (N=164) and without ADHD (N=198). ADHD was assessed via community-based screening (wave 1) and case confirmation using the Diagnostic Interview Schedule for Children IV (DISC-IV) (wave 2). ASD symptoms were identified using the Social Communication Questionnaire (SCQ). Outcome measures were social functioning (Strengths and Difficulties Questionnaire (SDQ)), mental health (DISC-IV, SDQ), quality of life (QoL, Pediatric Quality of Life Inventory 4.0) and sleep problem severity.

RESULTS: Greater ASD symptoms were associated with more parent and teacher-reported peer problems and emotional and conduct problems. For every SD increase in SCQ scores, internalising (OR 1.8, 95% CI 1.3 to 2.6, p=0.001) and externalising disorders (OR 1.5, 95% CI 1.1 to 2.1, p=0.02) increased, QoL decreased by 6.7 units (p<0.001), and moderate/severe sleep problems increased (OR 1.5, 95% CI 1.0 to 2.2, p=0.04). Most findings held in analyses adjusting for socio-demographic factors, ADHD symptom severity and comorbidities (when not the outcome), with the exception of externalising disorders and sleep problems.

CONCLUSIONS: ASD symptoms are associated with poorer functioning in children with ADHD. It is important to identify and potentially manage ASD symptoms in children with ADHD given that they exacerbate functional impairments in this already vulnerable group.

Epigenetic predictors of psychotic symptoms in adolescence

 This thesis focused on the role of epigenetic processes in the development of psychotic symptoms during adolescence. The findings suggest that exposure to influenza and/or diabetes/glycosuria during gestation may predispose an individual to the later development of psychotic symptoms via altered expression of specific genes involved in early brain development.

N-Acetylcysteine in depressive symptoms and functionality: a systematic review and meta-analysis

OBJECTIVE: To assess the utility of N-acetylcysteine administration for depressive symptoms in subjects with psychiatric conditions using a systematic review and meta-analysis. DATA SOURCES: A computerized literature search was conducted in MEDLINE, Embase, the Cochrane Library, SciELO, PsycINFO, Scopus, and Web of Knowledge. No year or country restrictions were used. The Boolean terms used for the electronic database search were (NAC OR N-acetylcysteine OR acetylcysteine) AND (depression OR depressive OR depressed) AND (trial). The last search was performed in November 2014. STUDY SELECTION: The literature was searched for double-blind, randomized, placebo-controlled trials using N-acetylcysteine for depressive symptoms regardless of the main psychiatric condition. Using keywords and cross-referenced bibliographies, 38 studies were identified and examined in depth. Of those, 33 articles were rejected because inclusion criteria were not met. Finally, 5 studies were included. DATA EXTRACTION: Data were extracted independently by 2 investigators. The primary outcome measure was change in depressive symptoms. Functionality, quality of life, and manic and anxiety symptoms were also examined. A full review and meta-analysis were performed. Standardized mean differences (SMDs) and odds ratios (ORs) with 95% CIs were calculated. RESULTS: Five studies fulfilled our inclusion criteria for the meta-analysis, providing data on 574 participants, of whom 291 were randomized to receive N-acetylcysteine and 283 to placebo. The follow-up varied from 12 to 24 weeks. Two studies included subjects with bipolar disorder and current depressive symptoms, 1 included subjects with MDD in a current depressive episode, and 2 included subjects with depressive symptoms in the context of other psychiatric conditions (1 trichotillomania and 1 heavy smoking). Treatment with N-acetylcysteine improved depressive symptoms as assessed by Montgomery-Asberg Depression Rating Scale and Hamilton Depression Rating Scale when compared to placebo (SMD = 0.37; 95% CI = 0.19 to 0.55; P < .001). Subjects receiving N-acetylcysteine had better depressive symptoms scores on the Clinical Global Impressions-Severity of Illness scale at follow-up than subjects on placebo (SMD = 0.22; 95% CI = 0.03 to 0.41; P < .001). In addition, global functionality was better in N-acetylcysteine than in placebo conditions. There were no changes in quality of life. With regard to adverse events, only minor adverse events were associated with N-acetylcysteine (OR = 1.61; 95% CI = 1.01 to 2.59; P = .049). CONCLUSIONS: Administration of N-acetylcysteine ameliorates depressive symptoms, improves functionality, and shows good tolerability.

The association between anxiety symptoms and sleep in school-aged children: a combined insight from the Children's Sleep Habits Questionnaire and actigraphy

The current study assessed the association between anxiety symptoms and sleep in 90 school-aged children, aged 6-12 years (Mage = 108 months, 52.2% male). The Children's Sleep Habits Questionnaire (CSHQ) and 14 nights of actigraphy were used to assess sleep. Anxiety was assessed using the Spence Children's Anxiety Scale (SCAS). A significant association was found between parent-reported anxiety symptoms and current sleep problems (i.e., CSHQ total scores ≥ 41). An examination of SCAS subscales identified a specific association between generalized anxiety disorder (GAD) symptoms and increased parental sleep concerns, including sleep onset delay, sleep duration, and daytime sleepiness. Regarding actigraphy, whilst anxiety was not associated with average sleep variables, a relationship was identified between anxiety and the night-to-night variability of actigraphy-derived sleep schedules.

Association between autism symptoms and family functioning in children with attention-deficit/hyperactivity disorder: a community-based study

Autism spectrum disorder (ASD) symptoms are elevated in populations of children with attention-deficit/hyperactivity disorder (ADHD). This study examined cross-sectional associations between ASD symptoms and family functioning in children with and without ADHD. Participants were recruited to a longitudinal cohort study, aged 6-10 years (164 ADHD; 198 controls). ADHD cases were ascertained using community-based screening and diagnostic confirmation from a diagnostic interview. ASD symptoms were measured using the Social Communication Questionnaire. Outcome variables were parent mental health, family quality of life (FQoL), couple conflict and support, and parenting behaviours. After adjustment for a range of child and family factors (including other mental health comorbidities), higher ASD symptoms were associated with poorer FQoL across all three domains; emotional impact (p = 0.008), family impact (p = 0.001) and time impact (p = 0.003). In adjusted analyses by subgroup, parents of children with ADHD+ASD had poorer parent self-efficacy (p = 0.01), poorer FQoL (p ≤ 0.05), with weak evidence of an association for less couple support (p = 0.06), compared to parents of children with ADHD only. Inspection of covariates in the adjusted analyses indicated that the association between ASD symptoms and most family functioning measures was accounted forby child internalising and externalising disorders, ADHD severity, and socioeconomic status; however, ASD symptoms appear to be independently associated with poorer FQoL in children with ADHD. The presence of ASD symptoms in children with ADHD may signal the need for enhanced family support.