Are current labeling terms suitable for people who are at risk of psychosis?

Inclusion of 'attenuated psychosis syndrome (APS)' in the DSM-5 has been hotly debated because of the concern about stigmatising young patients with a 'psychosis risk' label. This study aimed to investigate whether current labeling terms such as 'at risk mental state', 'ultra-high risk' (UHR) and 'APS' are suitable for people who are at risk of psychosis. This study included 105 subjects (55 patients aged 15-25years who used an early interventional service to prevent psychosis and 50 professionals who worked with them). A questionnaire regarding their opinions about the stigma associated with the above labels and the Mental Health Consumers' Experience of Stigma scale were administered. The patients were less likely than the professionals to agree that there was stigma associated with the terms 'UHR' and 'APS'. Significantly more patients with a family history of psychosis and those who had transitioned to psychosis agreed that there was stigma associated with the term 'UHR' and/or that this term should be changed. Patients who agreed with the negative attitude items for the three labeling terms and the need to change the terms 'UHR' and 'schizophrenia' showed significantly higher scores on the Stigma scale. In conclusion, patients at risk of psychosis may experience less stigma related to labels than expected by professionals, suggesting that mental health professionals may not be able to help patients unless they listen to their views on nosological and treatment issues rather than make assumptions. Previous stigmatising experiences may have strengthened the stigma attached to this label.

The effectiveness of simple psychological and physical activity interventions for high prevalence mental health problems in young people: A factorial randomised controlled trial

BACKGROUND

The prevalence and burden of disease of depression and anxiety disorders in young people necessitates effective early intervention strategies. The aim of this study was to evaluate the effectiveness of low-intensity interventions (problem solving therapy (PST) and physical activity promotion) in young people (15-25 years) with mild-moderate depression and/or anxiety.

METHOD

A 2×2 factorial randomised controlled trial (RCT) with factors of PST versus supportive counselling (control) and behavioural activation physical activity versus lifestyle psychoeducation (control). Help-seeking participants (n=176) were randomised to receive up to 6 manualised intervention sessions. Primary outcomes were post-intervention depressive symptoms (Beck Depression Inventory-II (BDI-II), anxiety symptoms (Beck Anxiety Inventory), and Montgomery-Åsberg Depression Rating Scale (MADRS)). Trial registration ACTRN12608000550303.

RESULTS

Depression symptoms were significantly reduced in the physical activity group compared to psychoeducation (BDI-II: d=0.41 (95% CI: 0.07-0.76); MADRS: d=0.48 (95% CI: 0.13-0.82), but not post-intervention anxiety symptoms. PST was not superior to supportive counselling, nor were any interactions between interventions significant.

LIMITATIONS

As self reported levels of physical activity did not significantly differ between baseline and end-point in those randomised to the physical activity intervention, it is unclear as to whether some form of physical activity not measured in the trial may have led to the difference in depression symptoms.

CONCLUSIONS

PST was not superior to supportive counselling in reducing depression and anxiety symptoms in young people. Participants who received the physical activity intervention reported the greatest reduction in depression symptoms, however further research is required to establish the mechanism of action and to determine its effectiveness as an adjunct intervention in routine clinical practice.

The effectiveness of simple psychological and exercise interventions for high prevalence mental health problems in young people: a factorial randomised controlled trial

Background

The prevalence of mental illness in young people is the highest of any age group, with the onset of depression, anxiety and substance use peaking between 18 and 24 years. Effective treatments that target sub-threshold or mild to moderate levels of disorder in young people are required to reduce the risk of persistence and recurrence. The aims of this study are to evaluate whether treatments that are less intensive than cognitive-behaviour therapy, such as problem solving therapy and exercise treatments, are acceptable and effective in managing depression and anxiety symptoms in young people and to identify possible attributes in those who are likely to respond to these treatments.

Methods/design

This is a factorial randomised controlled trial conducted at a large, metropolitan youth mental health service. Participants are young help-seekers aged 15-25 years with sub-threshold or mild to moderate levels of depression and anxiety (with or without comorbid substance use). The interventions comprise 4 treatment combinations delivered by psychologists over 6 sessions on a weekly basis: a psychological intervention (problem solving therapy versus supportive counselling) and an exercise intervention (behavioural exercise versus psychoeducation). Structured assessments occur at baseline, mid-point, end-point (6 weeks) and at a 6- and 12-month follow-up. The primary outcomes are depression and anxiety symptoms as measured by the Beck Depression and Anxiety Inventories. Secondary outcomes include remission (defined as no longer meeting the diagnostic criteria for a disorder if threshold level was reached at baseline, or no longer scoring in the clinical range on scale scores if sub-threshold at baseline), substance use, and functioning.

Discussion

The effectiveness of less complex psychological and exercise interventions in young help-seekers with sub-threshold or mild to moderate presentations of high prevalence disorders is yet to be explored. This study has been designed to examine the effectiveness of these interventions delivered alone, or in combination, in a youth-specific service. If effective, the interventions have the potential to prevent the progression of early symptoms and distress to later and potentially more serious stages of mental disorder and reduce the likelihood of ongoing problems associated with the risk of persistence and recurrence.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12608000550303

Projection of future cancer incidence and new cancer cases in Manitoba, 2006-2025

INTRODUCTION

Projecting the burden of cancer is important for evaluating prevention strategies and for administrative planning at cancer facilities.

METHODS

We projected cancer incidence and counts for the population of Manitoba using population projections from the Manitoba Bureau of Statistics for the years 2006 to 2025 and cancer incidence data from the Manitoba Cancer Registry for the years 1976 to 2005. Data were analyzed using a version of the age-period-cohort model with recommended modifications that was developed and tested in the Nordic countries.

RESULTS

The overall incidence of cancer in Manitoba is not projected to change substantially from 2006 to 2025. However, the age-standardized incidence for lung cancer is expected to decrease, particularly for males, highlighting the importance of tobacco prevention. The total number of new cancer cases per year is expected to increase 36% over the projection period, attributable primarily to demographic changes.

CONCLUSION

As the population of Manitoba increases, resource and infrastructure planning will need to account for the expected increase in cancer cases.

Stalking among juveniles

BACKGROUND

There is an almost total lack of empirical research on stalking among juveniles.

AIMS

To examine the characteristics, nature and impacts of stalking by juveniles.

METHOD

Analysis of consecutive court applications for a restraining order against a juvenile because of stalking behaviours.

RESULTS

A total of 299 juvenile stalkers were identified. The majority were male (64%) and their victims predominantly female (69%). Most pursued a previously known victim (98%), favouring direct means of contact via unwanted approaches (76%) and telephone calls or text messaging (67%). Threats (75%) and physical and sexual assaults (54%) were common. The contexts for juvenile stalking involved an extension of bullying (28%), retaliation for a perceived harm (22%), a reaction to rejection (22%), sexual predation (5%) and infatuation (2%).

CONCLUSIONS

Juvenile stalking is characterised by direct, intense, overtly threatening and all too often violent forms of pursuit. The seriousness that is afforded to adult forms of stalking should similarly apply to this behaviour among juveniles given the even greater rates of disruption to the victim's life and risks of being attacked.

Organ failure, infection, and the systemic inflammatory response syndrome are associated with elevated levels of urinary intestinal fatty acid binding protein: study of 100 consecutive patients in a surgical intensive care unit

BACKGROUND

Intestinal mucosal ischemia and subsequent barrier dysfunction have been related to the development of organ dysfunction and death in the critically ill. We hypothesized that urine concentrations of intestinal fatty acid binding protein (IFABP), a sensitive marker of intestinal ischemia, might predict the development of the systemic inflammatory response syndrome (SIRS) and organ dysfunction.

METHODS

One hundred consecutive critically ill patients were prospectively studied for the development of infectious complications, organ dysfunction, and SIRS. Urine was collected daily for measurement of IFABP.

RESULTS

A total of 58 males and 42 females (mean age, 56 years; range,16-85 years) were studied. Of these 100 patients, 40 patients developed complications and 5 patients developed SIRS. IFABP was significantly elevated in all patients with SIRS, and IFABP levels peaked an average of 1.4 days (range, 0-7 days) before the diagnosis of SIRS.

CONCLUSION

Elevated concentrations of urine IFABP correlated with the clinical development of SIRS. Studies to assess the utility of IFABP as a predictor of organ dysfunction and SIRS in the critically ill are warranted.

Anaemia in pregnancy: a major health problem with implications for maternal health care

Women (n=2235) registering for antenatal care in two maternal and child health clinics in the Dar es Salaam area between June, 1991 and June 1992 had their haemoglobin (Hb) measured by use of a HaemoCuer haemoglobinometer. The prevalence of anaemia Hb<10.5 g/dl) was 60% while severe anaemia (Hb<7.0 //dl) was present in 4%. Young nullparous women, those who register for antenatal care late in the third trimester, and undernourished women constitute high risk groups also for severe anemia and require special attention. No single maternal characteristics or combination thereof was useful to identify a group of screening. The current national Hb level for referral to hospital (8.5 g/dl) identified 20% of the pregnant population. Most of these can successfully be treated and followed at the primary care level. To comply with the available means for care in the Dar es Salaam area, it is proposed that the cutoff level for referral be changed to <7g/dl. Appropriate methods to screen for anemia at primary health care (PHC) level must be explored and instituted. Training of antenatal care (ANC) providers in clinical identification of anemia and supply of haematinics must be improved and early booking for ANC promoted. Public health measures to improve the general nutrition and iron intake of all women are necessary to reduce this serious health problem in pregnancy.

A study of antenatal care at village level in rural Tanzania

Antenatal care is an acknowledged measure for the reduction of maternal and perinatal mortality. In the rural village of Ilula, Tanzania, the possible impact of antenatal care on mortality was studied longitudinally on the basis of the 707 women delivered in the study period. Ninety-five percent of the antenatal records were available. Anemia, malaria and anticipated obstetric problems were the most frequent reasons for interventions. Among the women from the area who were delivered in hospital, 90% had been referred there. No relationship was found between the number of antenatal visits and the pregnancy outcome, but perinatal mortality was correlated to a low birth weight. Even with a mean attendance rate of six visits and full coverage by antenatal care maternal and perinatal mortality remains high.

Influence of parietal cell vagotomy and selective gastric vagotomy on gastric emptying rate and serum gastrin concentration

Gastric emptying of a solid meal and serum gastrin concentration were studied in 26 patients with duodenal ulcer disease before and after parietal cell vagotomy (PCV), selective gastric vagotomy with drainage (SGV + D), or parietal cell vagotomy with drainage. PCV had no significant effect on gastric emptying rate, whereas emptying was significantly delayed after SGV + D. The integrated gastrin output 60 to 300 min after the test meal was insignificantly altered after PCV, but significantly increased after SGV + D. It is concluded that the drainage procedure did not normalize the disturbed gastric emptying after SGV. The prolonged hypergastrinemia period after food stimulation may reflect stasis.

Reaction of the human dental pulp to silver amalgam restorations. The modifying effect of treatment with calcium hydroxide

Cavities were prepared in 43 bicuspid teeth using two general categories of cavity depth. In the "deep" cavities the bottom was placed in the inner third of the dentin. In the "intermediate depth" cavities the bottom was positioned in the middle third of the dentin. The bottom of the cavities was either rubbed with calcium hydroxide, covered with calcium hydroxide, or left unlined before filling according to the wet amalgam technique. The teeth were extracted after 1 week and examined histologically. All cases, except 2 with deep and 1 with intermediate depth rubbed cavities, showed local vascular dilatation in the pulp underneath the cavity. In addition, all teeth with deep unlined cavities showed inflammatory cells as did 1 with an intermediate depth unlined cavity. There were fewer displaced odontoblast nuclei in the dentin in the calcium hydroxide-treated groups. The milder reactions in the rubbed or covered groups are probably due to the restrictive effect by calcium hydroxide on penetration of amalgam components. In the teeth with deep cavities there were only minor differences between the ones which had been rubbed and those which had been covered with calcium hydroxide.

A group-C ring chromosome in a mentally deficient male

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