Empathy and the work of clinical psychiatrists: narrative review

Clinical research suggests that empathy is associated with better clinical outcomes in various areas of medical care, raising the question of whether a similar effect occurs in psychiatry. The aim of this review is to explore philosophical, neuroscientific and psychological perspectives on the concept of empathy in the context of the day-to-day work of clinical psychiatrists. The definition of empathy is outlined and sociodemographic factors, working conditions and psychiatrists’ beliefs that can potentially affect empathy in clinical encounters are explored; educational and training aspects are also reviewed. The review concludes suggesting that research on empathy is needed to understand contextual, training and relational factors that could benefit mental healthcare as well as the working conditions of clinical psychiatrists, both inextricably linked.

Psychotic disorders in young adults with perinatally acquired HIV: a UK case series

BACKGROUND

Increasing numbers of children with perinatally acquired HIV (PaHIV) are transitioning into adult care. People living with behaviourally acquired HIV are known to be at more risk of psychosis than uninfected peers. Young adults living with PaHIV face numerous risk factors; biological: lifelong exposure to a neurotrophic virus, antiretroviral medication and immune dysfunction during brain development, and environmental; social deprivation, ethnicity-related discrimination, and migration-related issues. To date, there is little published data on the prevalence of psychotic illness in young people growing up with PaHIV.

METHODS

We conducted a retrospective case note review of all individuals with PaHIV aged over 18 years registered for follow up at a dedicated clinic in the UK (n = 184).

RESULTS

In total, 12/184 (6.5%), median age 23 years (interquartile range 21-26), had experienced at least one psychotic episode. The presentation and course of the psychotic episodes experienced by our cohort varied from short-lived symptoms to long term illness and nine (75%) appear to have developed a severe and enduring mental illness requiring long term care.

CONCLUSION

The prevalence of psychosis in our cohort was clearly above the lifetime prevalence of psychosis in UK individuals aged 16-34 years, which has been reported to be 0.5-1.0%. This highlights the importance of clinical vigilance regarding the mental health of young people growing up with PaHIV and the need to integrate direct access to mental health services within the HIV centres providing medical care.

A narrative review of ablative neurosurgery in refractory mental disorders

Neurosurgery for mental disorder (NMD) is currently performed in the UK for cases of severe depressive disorder and obsessive–compulsive disorder refractory to treatment, under stringent regulations as set out under the Mental Health Act 1983. These surgical procedures appear to be effective for a proportion of individuals in this particularly treatment-resistant cohort. The two ablative procedures currently in use in the UK are anterior cingulotomy (ACING) and anterior capsulotomy (ACAPS). After briefly outlining these procedures, their evidence base and how they compare with other neurosurgical procedures, we suggest two ways in which they could be enhanced in terms of precision, namely the use of stereotactic (Gamma Knife®) radiosurgery guided by magnetic resonance imaging as well as a detailed and expanded standardised psychopathological and neuropsychological assessment both before and after surgery. The latter should involve extended long-term follow-up. We then reflect on how such psychopathological and neuropsychological assessments could help to understand why and how these procedures relieve patients’ suffering and distress.

Repeat cryoablation as a redo procedure for atrial fibrillation ablation: Is it a good choice?

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Medtronic Inc.

Introduction

Catheter ablation of atrial fibrillation, both cryoablation and radiofrequency pulmonary vein isolation, have demonstrated to be safe and effective techniques for treating symptomatic atrial fibrillation as a first procedure. However, about one in three patients may face a redo procedure due to AF recurrence. The most suitable technique for redo is unknown.

Purpose

The aim of this study is to assess the efficacy of cryoballoon AF ablation as a redo technique in patients with prior cryoballoon or radiofrequency AF ablation.

Methods

We analyzed a nation-wide real-world cryoablation registry (RECABA) and compared patients who were referred for a first cryoballoon AF ablation procedure with those who had previously undergone cryoballoon or radiofrequency pulmonary vein isolation. The primary endpoint was AF recurrence during the first year after a 3-month blanking period. We performed survival analysis and built univariate and multivariate cox regression models.

Results

From 1742 patients, 1625 had a 12-month follow-up visit. 1551 (95.45%) underwent a first cryoballoon ablation, whereas 33 (2.03%) had a previous CB ablation performed and 41 (2.52%) a previous RF ablation.

Mean age was 58.6 ±10.4 years and 511 (31.5%) were women. 463 (28.5%) had persistent atrial fibrillation and there were no major clinical differences between groups.

Prior-CB group had a higher share of veins without electrogram visualization, with a median of 100% (IQR 75%-100%), compared to prior-RF group (median 67%, IQR 25%-75%) and first procedure group (median 25%, IQR 0%-50%). Kruskal-Wallis test Chi2=54.35, p<0.0001.

12-month Kaplan–Meier estimate of freedom from AF recurrence after the blanking period was 78.5% (95% CI 76.2% - 80.7%) in the first procedure group, 61.0% (95% CI 41.4% - 75.8%) in the prior-CB and 89.2% (95% CI 73.6% - 95.9%) in the prior-RF group. Log-rank test Chi2=17.49, p<0.0001.

Multivariate cox regression analysis pointed female sex, persistent AF, and prior-CB ablation as independent predictors of AF recurrence. The adjusted HR for AF recurrence of prior-CB ablation vs first-CB ablation was 3.13 (95% CI 1.82 -5.40) and for prior-RF vs first CB-ablation was 1.01 (95% CI 0.51 – 1.97).

Conclusion

Repeat cryoballoon AF ablation shows higher rates of AF recurrences compared to first CB procedures or after prior RF ablation. These data suggest that patients with AF recurrence after CB-ablation have worse arrhythmic outcomes and may benefit from other ablation techniques after a recurrence.

A retrospective examination of care pathways in individuals with treatment-resistant depression

BACKGROUND

Individuals with treatment-resistant depression (TRD) experience a high burden of illness. Current guidelines recommend a stepped care approach for treating depression, but the extent to which best-practice care pathways are adhered to is unclear.

AIMS

To explore the extent and nature of 'treatment gaps' (non-adherence to stepped care pathways) experienced by a sample of patients with established TRD (non-response to two or more adequate treatments in the current depressive episode) across three cities in the UK.

METHOD

Five treatment gaps were considered and compared with guidelines, in a cross-sectional retrospective analysis: delay to receiving treatment, lack of access to psychological therapies, delays to medication changes, delays to adjunctive (pharmacological augmentation) treatment and lack of access to secondary care. We additionally explored participant characteristics associated with the extent of treatment gaps experienced.

RESULTS

Of 178 patients with TRD, 47% had been in the current depressive episode for >1 year before initiating antidepressants; 53% had received adequate psychological therapy. A total of 47 and 51% had remained on an unsuccessful first and second antidepressant trial respectively for >16 weeks, and 24 and 27% for >1 year before medication switch, respectively. Further, 54% had tried three or more antidepressant medications within their episode, and only 11% had received adjunctive treatment.

CONCLUSIONS

There appears to be a considerable difference between treatment guidelines for depression and the reality of care received by people with TRD. Future research examining representative samples of patients could determine recommendations for optimising care pathways, and ultimately outcomes, for individuals with this illness.

Introducing artificial intelligence in acute psychiatric inpatient care: qualitative study of its use to conduct nursing observations

Background

All patients admitted to an acute inpatient mental health unit must have nursing observations carried out at night either hourly or every 15 minutes, to ascertain that they are safe and breathing. However, while this practice ensures patient safety, it can also disturb patients’ sleep, which in turn can impact negatively on their recovery.

Objective

This article describes the process of introducing artificial intelligence (‘digitally assisted nursing observations’) in an acute mental health inpatient ward, to enable staff to carry out the hourly and the 15 minutes observations, minimising disruption of patients’ sleep while maintaining their safety.

Findings

The preliminary data obtained indicate that the digitally assisted nursing observations agreed with the observations without sensors when both were carried out in parallel and that over an estimated 755 patient nights, the new system has not been associated with any untoward incidents. Preliminary qualitative data suggest that the new technology improves patients’ and staff’s experience at night.

Discussion

This project suggests that the digitally assisted nursing observations could maintain patients’ safety while potentially improving patients’ and staff’s experience in an acute psychiatric ward. The limitations of this study, namely, its narrative character and the fact that patients were not randomised to the new technology, suggest taking the reported findings as qualitative and preliminary.

Clinical implications

These results suggest that the care provided at night in acute inpatient psychiatric units could be substantially improved with this technology. This warrants a more thorough and stringent evaluation.

A Phenomenological Exploration of the Voices Reported by Borderline Personality and Schizophrenia Patients

INTRODUCTION

Over time, there have been different views regarding the verbal auditory hallucinations (VAHs) reported by borderline personality disorder (BPD) and schizophrenia patients. More recently, their similarity has been emphasized, a view that undoubtedly has significant implications in terms of differential diagnosis and management. To explore this important issue, we undertook a detailed phenomenological assessment of persistent VAH reported by BPD and schizophrenia DSM-IV participants.

METHODS

The Psychotic Symptoms Rating Scale (PSYRATS), the Revised Beliefs About Voices Questionnaire (BAVQ-R), the Multidimensional Scale for Hallucinations (MSH), and a detailed clinical interview were administered to 11 BPD and 10 schizophrenia DSM-IV participants.

RESULTS

The VAHs of both groups were similar regarding intensity, reported as located inside or outside the head, and frequency in which they were described as a third-person phenomenon. However, the patients' stance towards their VAH was clearly different. Whilst BPD patients identified them in a clear way in terms of gender and age and disliked them, schizophrenia patients identified them more vaguely, reported them both as more disruptive but at the same time engaged with them more positively; schizophrenia patients also integrated their VAH more into delusions.

DISCUSSION

Whilst reporting similar intensity of their VAH, the 2 groups' stance towards them were strikingly different in that BPD participants regarded them as identifiable and unequivocally unpleasant whilst schizophrenia participants regarded them in a rather vague and ambiguous manner. Methodologically, this preliminary study suggests that in-depth phenomenological assessment can help to elucidate the differential diagnosis of VAH in these, possibly other, clinical groups. Further research is warranted to establish whether these preliminary findings are replicated on a bigger clinical sample.

Threshold stability using active fixation LV lead

Introduction

The proper functioning of the CRT devices depends on the correct positioning of the electrodes, sometimes being compromised by the absence of suitable epicardial veins, leads instability or unacceptable high thresholds, among other. In 2017, a novel quadripolar active fixation LV lead was released with an innovative helical mechanism that expands to attach the lead within the vessel.

Objectives

Study the impact of the active fixation LV lead on threshold stability and dislocations.

Methods

We included 127 consecutive patients undergoing CRT between September 2017 to December 2019 in one hospital. They were randomly assigned: 62p active fixation VI leads vs 65p standard VI leads. LV thresholds, capture losses and dislocations were collected at standard pacing checks (1 week, 2 months, 6 months).

Results

The mean age of the sample was 73,9±8,4 years. 75% patients were male and 48,4% suffered ischemic cardiomyopathy. The two groups were similar according to this variables. 5 (7.7%) dislocations were reported in the control group against 2 (3.2%) in the active fixation group (n.s). The mean threshold (V) at the moment of the implant was 1,4 in the active fixation vs 1,41 in the standard LV leads; at the first visit 1,55 vs 1,99; at two months 1,59 vs 2,13 and at six months 1,74 vs 2,48.

The threshold stability is shown in Figure 1.

Conclusions

– The active fixation LV lead provides higher threshold stability than the conventional one.

– There is a non-significant tendency to reduce dislocations.

Figure 1

Funding Acknowledgement

Type of funding source: None

Hebephrenia is dead, long live hebephrenia, or why Hecker and Chaslin were on to something

Since its first description in 1863, ‘hebephrenia’ has highlighted a group of patients characterised by an early onset of illness, formal thought disorder, bizarre behaviour and incongruent emotional expression. A proportion of patients with the most severe form of mental illness have a clinical presentation that is best captured by this diagnosis. Here, we outline the construct of hebephrenia and two of its core overlapping constituent parts: bizarre behaviour and the disorganisation dimension. We argue that, despite the removal of hebephrenia (disorganised schizophrenia) from DSM-5, clinicians should consider it as a differential diagnosis, particularly in suspected personality disorder.

Consent to discuss participation in research: a pilot study

Background

Equitable access to research studies needs to be increased for all patients. There is debate about which is the best approach to use to discuss participation in research in real-world clinical settings.

Objective

We aimed to determine the feasibility of asking all clinical staff within one hospital Trust (an organisation that provides secondary health services within the English and Welsh National Health Service) to use a newly created form on the Trust’s electronic patient records system, as a means of asking patients to consent to discuss participation in research (the opt-in approach). We also aimed to collect feedback from patients and clinicians about their views of the opt-in approach.

Methods

Four pilot sites were selected in the Trust: two memory clinics, an adult mental health team and an acute adult ward. Data were collected in three phases: (1) for 6 months, pilot site staff were asked to complete a consent to discuss participation in research form with patients; (2) staff feedback on the form was collected through an online survey; and (3) patient feedback was collected through focus groups.

Findings

Of 1779 patients attending services during the pilot period, 197 (11%) had a form completed by staff and 143 (8%) opted-in to finding out about research. Staff cited limited time, low priority and poor user experience of the electronic patient records system as reasons for low uptake of the form. Patients generally approved of the approach but offered suggestions for improvement.

Conclusions

There were mixed results for adopting an opt-in approach; uptake was very low, limiting its value as an effective strategy for improving access to research.

Clinical implications

Alternative strategies to the opt-in approach, such as transparent opt out approaches, warrant consideration to maximise access to research within routine clinical care.

Clozapine-induced pericarditis: an ethical dilemma

Clozapine is an atypical antipsychotic used most frequently in the management of treatment-resistant schizophrenia, where severely unwell patients have failed to respond to standard antipsychotic therapy. Clozapine is associated with a number of risks, such as agranulocytosis and long-term cardiometabolic morbidity. Reported less frequently is the risk of severe cardiac complications. The case reported here provides an important example of chronic clozapine toxicity leading to pericarditis. This case also describes a difficult ethical dilemma, where the physical risk to a patient with a diagnosis of schizophrenia must be balanced with the potentially adverse psychiatric risk that would follow, if the patient were to be weaned off this effective antipsychotic therapy. It is frequently reported that clozapine is stopped due to its toxicity. In this case however, the mental health and functional benefit of continuing with clozapine was deemed to outweigh the physical risk of progression of the pericarditis.

A narrative review of the success of intramuscular gluteal injections and its impact in psychiatry

There are 12 billion injections given worldwide every year. For many injections, the intramuscular route is favoured over the subcutaneous route due to the increased vascularity of muscle tissue and the corresponding increase in the bioavailability of drugs when administered intramuscularly. This paper is a review of the variables that affect the success of intramuscular injections and the implications that these success rates have in psychiatry and general medicine. Studies have shown that the success rates of intended intramuscular injections vary between 32 and 52%, with the rest potentially resulting in inadvertent subcutaneous drug deposition. These rates are found to be even lower for certain at-risk populations, such as obese patients and those on antipsychotic medications. The variables associated with an increased risk of injection failure include female sex, obesity, site of injection, and subcutaneous fat depth. New guidelines and methods are needed in order to address this challenge and ensure that patients receive optimum care. Looking forward, the best way to improve the delivery of intramuscular injections worldwide is to develop uniform algorithms or innovative medical devices to confirm or guarantee successful delivery at the bedside.

Stabilising sleep for patients admitted at acute crisis to a psychiatric hospital (OWLS): an assessor-blind pilot randomised controlled trial

BACKGROUND

When patients are admitted onto psychiatric wards, sleep problems are highly prevalent. We carried out the first trial testing a psychological sleep treatment at acute admission (Oxford Ward sLeep Solution, OWLS).

METHODS

This assessor-blind parallel-group pilot trial randomised patients to receive sleep treatment at acute crisis [STAC, plus standard care (SC)], or SC alone (1 : 1). STAC included cognitive-behavioural therapy (CBT) for insomnia, sleep monitoring and light/dark exposure for circadian entrainment, delivered over 2 weeks. Assessments took place at 0, 2, 4 and 12 weeks. Feasibility outcomes assessed recruitment, retention of participants and uptake of the therapy. Primary efficacy outcomes were the Insomnia Severity Index and Warwick-Edinburgh Mental Wellbeing Scale at week 2. Analyses were intention-to-treat, estimating treatment effect with 95% confidence intervals.

RESULTS

Between October 2015 and July 2016, 40 participants were recruited (from 43 assessed eligible). All participants offered STAC completed treatment (mean sessions received = 8.6, s.d. = 1.5). All participants completed the primary end point. Compared with SC, STAC led to large effect size (ES) reductions in insomnia at week 2 (adjusted mean difference -4.6, 95% CI -7.7 to -1.4, ES -0.9), a small improvement in psychological wellbeing (adjusted mean difference 3.7, 95% CI -2.8 to 10.1, ES 0.3) and patients were discharged 8.5 days earlier. One patient in the STAC group had an adverse event, unrelated to participation.

CONCLUSIONS

In this challenging environment for research, the trial was feasible. Therapy uptake was high. STAC may be a highly effective treatment for sleep disturbance on wards with potential wider benefits on wellbeing and admission length.

A pilot study evaluating the effectiveness of a medicines education group in a mental health inpatient setting: A UK perspective

Introduction:

It is estimated that up to 50% of medications for long-term conditions are not taken as prescribed. In mental health conditions, poor adherence leads to increased relapse, suicide rates, and hospitalizations. It is recommended that health care professionals aim to elicit and address beliefs and attitudes about medication, and to understand the patient's experience of taking them, as these, among other factors, affect adherence rates. This study evaluated a pilot trial of a medicines group for adult inpatients on an acute mental health ward.

Methods:

This study comprises a pilot service evaluation of a medicines education group through the descriptive analysis of data obtained using a tailored outcome measure using validated experience and attitude measures. The medicines education group was designed by a multidisciplinary team and focused on eliciting perceptual and practical barriers to adherence, lived experience, psychoeducation, and shared problem solving. The group was run during a period of 3 months and was compared to a baseline data set.

Results:

In total there were 35 medicine group attendees, there were 3 dropouts, and the outcome measure was fully completed in 68% of cases, with only 4 refusing, indicating this pilot evaluation was feasible and acceptable. Descriptive analysis found that on average, group attendees reported a better understanding of the purpose and side effects of their medication, and felt more involved in decisions about their medicines compared with the baseline data set.

Discussion:

This pilot evaluation found that running a novel medicines education group, targeting perceptual and practical barriers to adherence, was acceptable to attendees and feasible to deliver on an adult psychiatric inpatient unit.

Photocatalytic activity of Ag/Al2O3-Gd2O3 photocatalysts prepared by the sol-gel method in the degradation of 4-chlorophenol

The photocatalytic activity in the degradation of 4-chlorophenol (4-ClPh) in aqueous medium (80 ppm) using 2.0 wt% Ag/Al2O3-Gd2O3 (Ag/Al-Gd-x; where x = 2.0, 5.0, 15.0, 25.0 and 50.0 wt% of Gd2O3) photocatalysts prepared by the sol-gel method was studied under UV light irradiation. The photocatalysts were characterized by N2 physisorption, X-ray diffraction, SEM, HRTEM, UV-Vis, XPS, FTIR and fluorescence spectroscopy. About 67.0% of 4-ClPh was photoconverted after 4 h of UV light irradiation using Ag/γ--Al2O3. When Ag/Al-Gd-x photocatalysts were tested, the 4-ClPh photoconversion was improved and more than 90.0% of 4-ClPh was photoconverted after 3 h of UV light irradiation in the materials containing 15.0 and 25.0 wt% of Gd2O3. Ag/Al-Gd-25 was the material with the highest efficacy to mineralize dissolved organic carbon, mineralizing more than 85.0% after 4 h of UV light irradiation. Silver nanoparticles and micro-particles of irregular pentagonal shape intersected by plane nanobelts of Al2O3-Gd2O3 composite oxide were detected in the Ag/Al-Gd-25 photocatalyst. This material is characterized by a lowest recombination rate of electron-hole pairs. The low recombination rate of photo-induced electron-hole pairs in the Ag/Al-Gd-x photocatalysts with high Gd2O3 contents (≥15.0 wt%) confirmes that the presence of silver nanoparticles and microparticles interacting with Al2O3-Gd2O3 composite oxide entities favors the separation of photo-induced charges (e- and h+). These materials could be appropriate to be used as highly efficient photocatalysts to eliminate high concentrations of 4-ClPh in aqueous medium.

Mental health legislation in Chile

Chile does not have a mental health law or act, and no single legal body protecting those deemed to be afflicted by a mental disorder, setting standards of care and protecting and promoting their rights. Instead, pieces of mental health legislation are scattered about in different legal and administrative documents, including the country's Constitution, Health Code, Criminal Code and Civil Code. Remarkably, mental health legislation was the object of virtually no change or amendment from the middle of the 19th century until the year 2001. New pieces of legislation have been issued since but, despite improvements in the protection of people suffering from a mental illness, a mental health law in Chile is still needed.

A high-resolution frequency variable experimental setup for studying ferrofluids used in magnetic hyperthermia

A scanning system for specific absorption rate of ferrofluids with superparamagnetic nanoparticles is presented in this study. The system contains an induction heating device designed and built with a resonant inverter in order to generate magnetic field amplitudes up to 38 mT, over the frequency band 180-525 kHz. Its resonant circuit involves a variable capacitor with 1 nF of capacitance steps to easily select the desired frequency, reaching from 0.3 kHz/nF up to 5 kHz/nF of resolution. The device performance is characterized in order to compare with the theoretical predictions of frequency and amplitude, showing a good agreement with the resonant inverters theory. Additionally, the setup is tested using a synthetic iron oxide with 10 ± 1 nm diameter suspended in liquid glycerol, with concentrations at 1%. Meanwhile, the temperature rise is measured to determine the specific absorption rate and calculate the dissipated power density for each f. This device is a suitable alternative to studying ferrofluids and analyzes the dependence of the power absorption density with the magnetic field intensity and frequency.

A web-based clinical decision tool to support treatment decision-making in psychiatry: a pilot focus group study with clinicians, patients and carers

BACKGROUND

Treatment decision tools have been developed in many fields of medicine, including psychiatry, however benefits for patients have not been sustained once the support is withdrawn. We have developed a web-based computerised clinical decision support tool (CDST), which can provide patients and clinicians with continuous, up-to-date, personalised information about the efficacy and tolerability of competing interventions. To test the feasibility and acceptability of the CDST we conducted a focus group study, aimed to explore the views of clinicians, patients and carers.

METHODS

The CDST was developed in Oxford. To tailor treatments at an individual level, the CDST combines the best available evidence from the scientific literature with patient preferences and values, and with patient medical profile to generate personalised clinical recommendations. We conducted three focus groups comprising of three different participant types: consultant psychiatrists, participants with a mental health diagnosis and/or experience of caring for someone with a mental health diagnosis, and primary care practitioners and nurses. Each 1-h focus group started with a short visual demonstration of the CDST. To standardise the discussion during the focus groups, we used the same topic guide that covered themes relating to the acceptability and usability of the CDST. Focus groups were recorded and any identifying participant details were anonymised. Data were analysed thematically and managed using the Framework method and the constant comparative method.

RESULTS

The focus groups took place in Oxford between October 2016 and January 2017. Overall 31 participants attended (12 consultants, 11 primary care practitioners and 8 patients or carers). The main themes that emerged related to CDST applications in clinical practice, communication, conflicting priorities, record keeping and data management. CDST was considered a useful clinical decision support, with recognised value in promoting clinician-patient collaboration and contributing to the development of personalised medicine. One major benefit of the CDST was perceived to be the open discussion about the possible side-effects of medications. Participants from all the three groups, however, universally commented that the terminology and language presented on the CDST were too medicalised, potentially leading to ethical issues around consent to treatment.

CONCLUSIONS

The CDST can improve communication pathways between patients, carers and clinicians, identifying care priorities and providing an up-to-date platform for implementing evidence-based practice, with regard to prescribing practices.

Schizophrenia on YouTube

OBJECTIVE

YouTube ( www.youtube.com ) is the most popular video-sharing Web site on the Internet and is used by medical students as a source of information regarding mental health conditions, including schizophrenia. The accuracy and educational utility of schizophrenia presentations on YouTube are unknown. The purpose of this study was to analyze the accuracy of depictions of psychosis in the context of a diagnosis of schizophrenia (referred to in this article as "acute schizophrenia") on YouTube and to assess the utility of these videos as educational tools for teaching medical students to recognize the clinical features of acute schizophrenia.

METHODS

YouTube was searched for videos purporting to show acute schizophrenia. Eligible videos were independently rated by two consultant psychiatrists on two separate occasions 22 days apart for diagnostic accuracy, psychopathology, and educational utility.

RESULTS

Videos (N=4,200) were assessed against predefined inclusion and exclusion criteria. The majority were not eligible for further analysis, mostly because they did not claim to show a patient with schizophrenia (74%) or contained duplicated content (11%). Of 35 videos that met the eligibility and adequacy criteria, only 12 accurately depicted acute schizophrenia. Accurate videos were characterized by persecutory delusions (83%), inappropriate affect (75%), and negative symptoms (83%). Despite the fact that 83% of accurate videos were deemed to have good educational utility compared with 15% of inaccurate videos, accurate and inaccurate videos had similar view counts (290,048 versus 186,124).

CONCLUSIONS

Schizophrenia presentations on YouTube offer a distorted picture of the condition.

Schizophrenia, Subjectivity, and Mindreading

A number of recent articles, many appearing in Schizophrenia Bulletin, signal a renewed interest in phenomenological approaches to our understanding of schizophrenia. These approaches conceptualize schizophrenia as a disorder of altered self-awareness and decreased prereflective social attunement, which may manifest as an impaired understanding of self, others, and the physical world. Phenomenological approaches to psychopathology are sometimes construed as being incompatible with the reductionistic methodology of contemporary neuroscience. In this article, we re-examine findings from the phenomenological investigation of schizophrenia in light of an influential neurocomputational account of mindreading, which postulates that understanding of others is subserved by coherent internal self-models. We argue that the phenomenological approach to schizophrenia is not incompatible with a neurocomputational account of mindreading, and that the 2 approaches should instead be viewed as existing in a relationship of mutual constraint and enlightenment. Our hypothesis, while speculative, is an attempt to marry the phenomenological and neuronal realities of schizophrenia. Furthermore, it has implications for psychotherapeutic interventions and future research.

Photocatalytic degradation of 2,4-dichlorophenol with MgAlTi mixed oxides catalysts obtained from layered double hydroxides

MgAl and MgAlTi mixed oxides were obtained from the thermal treatment of LDH materials synthesized by the sol-gel method; these materials were characterized by N2 physisorption, XRD, UV-vis, XPS, EDS-SEM and TEM techniques. According to the results, Ti was incorporated in the LDH layer when content in the material was low. The MgAl and MgAlTi mixed oxides were evaluated in the photo-degradation of 2,4-dichlorophenol (2,4-DCP) in the presence of UV light. A superior efficiency in the photo-degradation of 2,4-DCP, in comparison with the Degussa P-25 TiO2 reference catalyst was observed, reaching a total decomposition of the 2,4-DCP molecule in less than 60 min. According to the results, Ti was incorporated in the LDH layer when the content in the material was low. The MgAl and MgAlTi mixed oxides were evaluated in the photo-degradation of 2,4-dichlorophenol (2,4-DCP) in the presence of UV light. A superior efficiency in the photo-degradation of 2,4-DCP with the MgAl and MgAlTi mixed oxides, in comparison with the Degussa P-25 TiO2 reference catalyst was observed, reaching a total decomposition of the 2,4-DCP molecule in less than 60 min.

Cutaneous mucormycosis infection by Absidia in two consecutive liver transplant patients

Mucormycosis, although an infrequent fungal infection, has a high mortality in patients undergoing orthotopic liver transplantation. We present two cases of cutaneous Absidia mucormycosis in two successive patients undergoing liver transplantation in our hospital. In our literature search, we encountered only one published case of Absidia infection in liver transplantation.

Superficial magnetic imaging by an xy-scanner of three magnetoresistive channels

A scanning system developed for planar magnetic surfaces composed of a moving line of three magnetoresistive ultrasensitive transducers, complemented by a signal conditioning circuit is presented. After the calibration of the sensors, it was used to determine magnetized surface images with different shapes to evaluate the sensitivity of the device, and the images are represented in gray levels on a scale from 0 to 255 intensities, to get a visual representation of the magnetic field strength. The device is shown to be sensitive enough to detect gradients homogeneities and discontinuities in the magnetic field maps and images of magnetic susceptibility.

An induction heater device for studies of magnetic hyperthermia and specific absorption ratio measurements

The development of a device for generating ac magnetic fields based on a resonant inverter is presented, which has been specially designed to carry out experiments of magnetic hyperthermia. By determining the electric current in the LC resonant circuit, a maximum intensity of magnetic field around of 15 mT is calculated, with a frequency around of 206 kHz. This ac magnetic field is able to heat powdered magnetic materials embedded in biological systems to be used in biomedical applications. Indeed, in order to evaluate the sensitivity of the device we also present the measurements of the specific absorption rate in phantoms performed with commercially prepared Fe(3)O(4) and distilled water at different concentrations.

Nano and micro reoriented domains and their relation with the crystal structure in the New Fe1.5Zn1.5B7O13Cl boracite

New iron-zinc chlorine single crystals of Fe1.5Zn1.5B7O13Cl boracite were grown by chemical transport reactions in closed quartz ampoules, at a temperature of 1173 K. The crystal structure was characterized by X-ray powder diffraction (XRD) using the Rietveld refinement method and belongs to the trigonal/rombohedral system with space group R3c (No. 161). The cell parameters were a = 8.5726(1) angstroms, c = 21.0116(4) angstroms, V = 1337.26(3) angstroms3 and Z = 6. The refinement successfully proceeded and ended with sound merit figure values chi2 = 2.25, R(B) = 6.12%. Chemical analysis was performed with X-ray energy dispersive spectroscopy (EDS) and X-ray fluorescence (XRF). Ferroelectric nano and micro reoriented domains were found in this material using polarizing optical microscopy (PLM), scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The examination by TEM showed that in the trigonal/rombohedral system of Fe1.5Zn1.5B7O13Cl nanodomain structures exist. Thin (50-100 nm) mostly planar domains parallel to (100) were frequently observed in Fe1.5Zn1.5B7O13Cl boracite.

[Bipolar depression and unipolar depression: differential diagnosis in clinical practice]

When assessing a patient with depression it is crucial not to miss a diagnosis of bipolar depression. In this review we suggest that it can be achieved, first, by consistently usingstandardised diagnostic criteria (e.g., DSM-IV-TR or ICD 10) and, second, by ascertaining the presence of some clinical features. The latter include previous episodes of mood elevation, current or past episodes of psychotic depression, onset of recurrent depressive disorder before the age of 25, a strong family history of mood disorder and suicide, lack of response or "wearing off" of response to well conducted antidepressant treatment, and an unusually fast response to antidepressants with features of elation. Although more and better research is required to establish the validity, sensitivity, specificity, and predictive value of each one of these features we suggest that from a practical point of view they would increase clinicians' awareness of bipolar depression.