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Psychopathy and violent recidivism among young criminal offenders.

OBJECTIVE: To investigate the predictive validity of psychopathic personality traits (assessed with the revised psychopathy checklist, PCL-R; Hare, 1991) for violent criminal recidivism among young offenders. METHOD: The relationship between PCL-R psychopathy and violent re-offending was studied in 98 young (M=18.40, range 15-20 years) violent and sex offenders subjected to forensic psychiatric evaluation in Sweden during 1988-95. Subjects were followed during detainment and for 24 months in the community to first reconviction for a violent offence. RESULTS: We found a modest but significant association between PCL-R scores and violent recidivism, almost exclusively accounted for by behavioural criteria. Among 13 possible confounders tested, conduct disorder before age 15 and a young age at first conviction eliminated the relationship between psychopathy and violent recidivism in pair-wise logistic regression models. CONCLUSION: PCL-R psychopathy may be a less valid predictor for violent criminal recidivism among severe youthful offenders than among adult offenders.

Adolescent↗

Cardiac arrhythmias in space. Role of vagotonia.

Rhythm disorders observed in space have always been minor but they are not unfrequent. They include: ventricular or supra-ventricular extrasystoles, nodal arrhythmias, auriculo-ventricular conduction disorders. There are several etiopathogenetic hypotheses: a strict selection must permit its elimination of an underlying heart disease; the potassium deficiency is often advanced but its role is not certain; the role of catecholamines is also discussed; the role of hypervagotony is extensively analysed as great clinical and electro-cardiographic evidence speaks for it. It can induce disorders which are more serious than those observed so far, particularly fibrillation or intermittent atrial flutter; weightlessness itself could partly condition the vagotonic state; and the effects of fluid shifts are also discussed from this point of view. The possible therapies for various atrial, nodal, ventricular disorders are reviewed, with greater detail for vagal atrial arrhythmias.

Adaptation, Physiological↗

The prevention of psychopathology in African Americans: an epidemiologic perspective.

Although improving the mental health status of African Americans is an important goal, it is not clear that this can be accomplished by increasing access to professional services. Many have argued that stressful social conditions are the major cause of mental disorder in blacks and thus, psychopathology can be prevented by eliminating racism, oppression and poor economic conditions. This review argues that while the notion of primary prevention with African Americans should be taken seriously, there is still a need for more and better epidemiologic research. Three bodies of knowledge relevant to black mental health are addressed: 1) the need for an epidemiologic knowledge base for prevention; 2) coping capacity and vulnerability to stress; 3) risk factor identification. Findings from a national survey of adult African Americans are presented as an example of risk factor identification for the purpose of specifying targets for preventive interventions. The paper concludes that before the prevention of psychopathology in black populations can be achieved, a number of measurement, theoretical and policy issues must be addressed. Specific directions for future research are outlined.

Black or African American↗

Personality disorders: new data versus old concepts.

PURPOSE OF REVIEW: The purpose of this paper is to review the most recent literature on personality disorders. RECENT FINDINGS: Recent data suggest that individual personality disorder criteria and full diagnosis may remit within 1-2 years. The same line of evidence disputes the separation of axis I and axis II disorders and suggests the presence of a continuum. Neuropsychological, neurobiological and genetic studies favor the presence of cognitive disorders and a non-specific mode of hereditability concerning all externalizing disorders. How to best treat personality disorders remains elusive. The most impressive news in the forensic field concerns the introduction of a new concept, dangerous and severe personality disorder by the UK government, for prevention and treatment purposes. SUMMARY: The most recent data do not adequately support a separate axis II. Future classification may need to move personality disorders to axis I, each under a suitable group of diseases and eliminate the very term 'personality' from the nomenclature, since it constitutes an empirically unsupported theoretical invasion in a system supposed to be 'atheoretical'.

Humans↗

Skin discoloration in chronic idiopathic thrombocytopenic purpura: detection of local iron deposition by X-ray spectrometry.

A forty-six-year-old woman with a 32 years' history of idiopathic thrombocytopenic purpura presented with black-brown discoloration of her lower limbs. Noninvasive diagnostic X-ray spectrometry (DXS) for determination of trace elements in external tissues revealed striking local iron deposition confined to the skin area with the pigmentary changes. Iron deposition in the skin was probably due to recurrent local purpura caused by longstanding bleeding disorder. Hence DXS proved useful in the detection of local iron load and eliminated the need for skin biopsy in this patient with bleeding tendency.

Female↗

Clinical and metabolic effects of Gynodian-depot in vegetoneurotic disorders following removal of uterine myoma in menopausal patients.

Clinical and metabolic effects of depot-injections of estradiol valerianate-dehydroepiandrosterone enanthate at a 1:50 ratio (Gynodian-depot) in the treatment of severe clinical manifestations of the vegetoneurotic syndrome were evaluated in menopuasal patients after hysterectomy for uterine myoma. Favourable comprehensive effects of the drug were noted, which in most patients contributed to the elimination or significant alleviation of major vegetoneurotic, psychoemotional and metabolic-endocrine disorders. An effective combination of the estrogenic and androgenic hormonal components and their ratios, coupled with very insignificant side-effects, is an important advantage of the drug, permitting its large-scale use for the control of menopausal complications, particularly after surgery for a uterine tumour.

Climacteric↗

Cognitive-behavioral therapy and treatment for late-life depression.

Cognitive-behavioral therapy is a brief psychotherapy stemming from a model that emphasizes the importance of distorted thoughts and the lack of pleasurable activities in the development of affective disorders. The focus of the therapy can be on either eliminating distorted thought systems or increasing the number of pleasant events that occur on a daily basis, or both. The highly structured therapy presents various skills for patients to learn through class exercises and homework assignments. Older adults respond well to cognitive-behavioral therapy, reporting that they appreciate the structure and the opportunity to learn skills that can help when they are confronted with new stresses. Many also like the focus on here-and-now problems rather than the past. A few treatment modifications are necessary to accommodate community elders complaining of depression. Generally, information must be presented more slowly, taking advantage of multiple modes of presentation. To maintain an active learning process, elder patients should be asked frequently to summarize the material being presented. They should also be given handouts of complex materials and encouraged to maintain notebooks. Other modifications may be required for special populations of older patients.

Age Factors↗

[Functional craniomandibular disorders and ENT-symptoms].

Complaints in the otolaryngologic region, that cannot be referred to an otolaryngological pathologic process, are often caused by or combined with craniomandibular dysfunctions. As a rule these complaints are not the result of direct mechanical irritation of the articular tissues, but the effect of neuromuscular incoordination and spasms. Consequently the term "Costen's syndrome" is obsolete and should be used no more. In many cases the interaction of otolaryngological symptoms and craniomandibular disorders can only be proved ex iuvantibus. Occlusal equilibration combined with physical and physiotherapeutic treatment are approved methods to normalize neuromuscular function and eliminate muscle tension and pain.

Deglutition Disorders↗

New trends in specific immunoadsorption.

Plasma exchange is widely accepted to remove pathogenic substances from patients' blood that cannot be eliminated otherwise like cholesterol in severe forms of familial hypercholesterolaemia or immunoglobulins and circulating immune complexes (CIC) in many autoimmune disorders. But dilution of other plasma proteins, as well as side effects and costs of substitution fluids, limit its efficiency. In immunoadsorption, the pathogen is bound specifically, generally no substitution fluids are needed and plasma can be conducted over the immunoadsorption columns as often as needed to achieve any reduction that one aims at, in some instances below the detection limit (e.g. HLA-antibodies in transplantations). The frequency of aphaereses is determined by the speed of the patients' improvement and the rebound of the eliminated substance, which can in some disorders be slowed down or stopped by concomitant immunosuppression. Generally, immunoadsorption is used in patients, where less expensive and demanding treatment options have failed, like severe hypercholesterolaemia, autoimmune disorders or hyperviscosity syndromes.

Autoantibodies↗

Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V.

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) groups disorders into diagnostic classes on the basis of the subjective criterion of "shared phenomenological features." There are now sufficient data to eliminate this rational system and replace it with an empirically based structure that reflects the actual similarities among disorders. The existing structural evidence establishes that the mood and anxiety disorders should be collapsed together into an overarching class of emotional disorders, which can be decomposed into 3 subclasses: the bipolar disorders (bipolar I, bipolar II, cyclothymia), the distress disorders (major depression, dysthymic disorder, generalized anxiety disorder, posttraumatic stress disorder), and the fear disorders (panic disorder, agoraphobia, social phobia, specific phobia). The optimal placement of other syndromes (e.g., obsessive-compulsive disorder) needs to be clarified in future research.

Anxiety Disorders↗

Female physicians and substance abuse. Comparisons with male physicians presenting for assessment.

As with women in general, the vicissitudes of the female physician who suffers from a substance use disorder have been understudied, and such persons remain underrepresented in treatment. The purpose of the present study is to describe the similarities and differences between female and male physicians presenting for assessment; 108 physicians in total were included in the study, 10 of whom were female. Demographically, we found that the female physicians were more likely to be single and younger than their male counterparts. On clinical indices, females showed less impairment on legal and medical functioning, and better capability in sustaining abstinence and eliminating environmental cues to relapse. Of the women with substance use disorders, higher rates of comorbidity were found than with males. Although there were no significant differences in overall severity, males were more likely to be recommended to more intensive levels of care for either substance use or psychiatric disorders. The female physicians were recommended to a level of care of a lower intensity, but more often to a treatment with a dual-diagnosis focus. These findings are discussed in terms of the vulnerabilities of the female physician, barriers to treatment, tailoring treatment to female needs, and opportunities for prevention and further research.

Adult↗

The contribution of six chronic conditions to the total burden of mobility disability in the Dutch population.

OBJECTIVES: This study assessed the proportions of the burden of mobility disability in the Dutch population that are attributable to musculoskeletal diseases, lung diseases, neurological disorders, heart diseases, diabetes, and cancer. METHODS: National survey data were analyzed with an elimination technique that combines the results of logistic regression analysis and the disease prevalence. RESULTS: Of the total prevalence of disability (20.5%), 33.7% can be attributed to these six chronic conditions. Musculoskeletal disorders account for the major part, whereas the contribution of cancer is very small. CONCLUSIONS: The potential benefits of effective curative or preventive treatments for chronic conditions, in terms of reduction of the disability burden in the population, are limited.

Adolescent↗

[Effect of a blockade of the upper complex of the cervical neural structures on kidney function in patients after operations on the abdominal cavity organs].

The authors have included blockade of the upper complex of nervous structures of the neck in the program of treatment of patients after operations on the organs of the abdominal cavity. Studies on the urine-eliminating function of the kidneys and radioisotopic rhenography were performed in 105 patients before and after operation. The results show that the blockade contributes to prevention of functional disorders in the cells of renal tubules and to the improvement of the urine-eliminating and general hemocatharsic function of the kidneys.

Abdomen↗

[Hemomicrocirculatory disorders in pathogenesis of entero-enteroanastomosis insufficiency].

Morphofunctional changes of hemomicrocirculation in the walls of the small intestine in acute strangulation intestinal obstruction and after its surgical elimination were studied experimentally on 60 mongrel dogs (weight 7-20 kg). It is demonstrated that main causes of complications in postoperative period were disorders of microcirculation in the walls of the small intestine and inflammation in the bringing part of the small intestine. On day 3 to 7 after elimination of strangulation intestinal obstruction hemomicrocirculation in tissues of bringing loop of small intestine did not meet the requirements for reparation after resection of necrotic part and creation of entero-enteroanastomosis. This is the cause of insufficiency of entero-enteroanastomosis in this time interval.

Anastomosis, Surgical↗

Custom-fabricated masks for aeromechanical measures.

A technique is described for the construction of custom fabricated face masks designed for use in aeromechanical studies of individuals with speech disorders, such as those associated with craniofacial defects. The wax-elimination method of mask fabrication described herein is similar to routine dental laboratory procedures. Materials employed are heat-cured acrylic resin for the body of the mask and heat-cured resilient liner for the tissue contacting surface of the mask.

Acrylic Resins↗