Forensic child and adolescent psychiatry: a review of the past 10 years

BACKGROUND AND METHODS: Risk factors for recurrence of Crohn's disease and the evidence for progress in reducing recurrence following resection were reviewed. A Medline based literature review was carried out. RESULTS AND CONCLUSION: Only smoking has been confirmed as a significant adverse risk factor for recurrence. Evidence for differing recurrence rates in fibrostenosing disease and perforating disease is inconclusive, but such a classification along with the endoscopic findings of recurrence may have a place in the analysis of therapeutic trials. Minimal resectional surgery with clearing of only macroscopic disease seems to be justified, with no clear benefits from different anastomotic techniques. Recent trials offer encouraging evidence of the usefulness of 5-aminosalicylic acid, particularly higher-dose regimens started early after resection, although the long-term benefits are uncertain. The oral steroid, budesonide, offers a potent treatment with minimal side-effects, but evidence of its prevention of recurrence is presently weak.     

Ethics in psychiatry

Psychiatric ethics are a part of general medical ethics. But there are some special ethic problems in psychiatry: The often especially intensive emotional relationship between patient and doctor, the need to make decisions for patients who have lost decisional capabilities, the question of involuntary treatment for patients who are dangerous to themselves or others and further some diagnostic and therapeutic difficulties.     

Prolactin in psychiatry

Prolactin is a protein hormone synthesized and secreted by the anterior pituitary gland. Because the monoamines dopamine and serotonin are important in the control of its secretion, prolactin has been the subject of much psychoendocrine research in recent years. The authors review some of the implications of the main findings of such research as they relate to schizophrenia, affective disorders, premenstrual syndrome, and alcoholism and discuss its possible usefulness to clinicians. As a research strategy, prolactin studies have a good potential for identifying specific neurotransmitters involved in discrete psychopathologic entities.     

Tests in psychiatry

High-grade prostatic intra-epithelial neoplasia (HGPIN) is the most likely precancerous lesion for prostatic carcinoma. A high incidence of its association with cancer has been reported in Western countries. On the other hand, information regarding its incidence is limited in Japan, where the mortality due to prostate cancer is much lower. We reviewed 53 clinical stage T2 or T3 prostatic cancers of Japanese patients living in Osaka, Japan (mean age, 67.2 years). These cases were subdivided into a pre-operatively non-castrated group (34 cases) and a medically or surgically castrated group (19 cases). HGPIN was found in 27 cases. The incidence of HGPIN was significantly lower in the castrated group (21.0%) compared with the non-castrated group (67.6%). In the non-castrated group, patient age, pathological stage, Gleason score, tumor size and serum prostate-specific antigen showed no significant correlation with HGPIN. Advanced pathological stage and tumor size tended to decrease the incidence of HGPIN, although this was not statistically significant. When the study group was limited to stage T2 tumors of the non-castrated group, the incidence of HGPIN was 81.0%. HGPIN in Japan may also be clinically and etiologically significant as a precursor of clinical cancer.     

Neuroimaging in psychiatry

The promise of neuroimaging as an aid to diagnosis is discussed, and findings from the most accessible imaging techniques are reviewed. In addition, some of the earliest findings from functional MR imaging and other technologies are presented with several illustrations. Strategies for interpretation, critique of imaging techniques, and review of major findings for brain injury, mood, anxiety, schizophrenia, and attention deficit disorders are offered. Examples of normal and pathologic images illustrate actual cases and examples of the newer imaging technologies.     

Forensic medicine in China

PURPOSE: A variant form of anterior hypospadias, called a megameatus and intact prepuce (MIP), is thought to be less amenable to conventional distal hypospadias repair. The feasibility of using the standard technique with a parameatal-based foreskin flap is described herein. MATERIALS AND METHODS: Nine children with the MIP variant underwent repair. A foreskin flap for urethroplasty was harvested from either the ventral (Mathiew) or unilateral site. The glans was split along with the cleft glanular groove to create the glans wings. The flap was laid on the urethral plate to form a neourethra, and glanulomeatoplasty was completed by approximation of the glans wings. Sleeve reapproximation of the penile foreskin was performed for uncircumcised skin closure. RESULTS: The functional and cosmetic results of the procedure were excellent in 8 cases including 1 with temporary postoperative edema of redundant foreskin. The last case underwent excision of the ventral excess foreskin for cosmetic reasons. CONCLUSIONS: Although the etiology of the MIP variant remains obscure, the urethral plate distal to the meatus is uniformly pliable and healthy in this variant. Furthermore, the ventral portion just proximal to the meatus is well developed and not atretic so that the parameatal ventral foreskin is safely harvested for onlay urethroplasty.     

Level-of-care determinations in psychiatry

Systematic education in professional nursing was established during 1782 in Germany by the general practitioner and midwife lecturer Franz Anton Mai. The second institution of this kind was opened in Karlsruhe during 1784 by the general practitioner Christian Ludwig Schweickhard. The archives in Karlsruhe showed that Mai also founded this second institution and gave the first lectures, while Schweickhard continued the lectures until 1811. On the one hand this shows the importance of the foundation of the nursing schools by Franz Anton Mai and on the other hand points out that the first nursing schools in Germany were strongly influenced by already existing schools for midwives.     

Practice-based research in psychiatry

OBJECTIVE: The authors describe the APA Practice Research Network (PRN), a national research initiative that ultimately will engage 1,000 practicing psychiatrists in collaborative clinical and services research. The PRN is designed to generate practice-relevant information and to inform future service delivery, policy, and financing decisions pertinent to psychiatry. METHOD: The authors review the relative strengths and limitations of practice-based research compared with other widely used research methods. They also describe the structure of the PRN and its procedures for recruiting network members and for identifying and developing specific network studies. The three primary sources of data for the PRN are 1) the biannual National Survey of Psychiatric Practice, which provides not only a mechanism for randomly recruiting the two-thirds of network participants who are not volunteers but also a baseline for assessing the generalizability of PRN findings; 2) separate biannual studies of psychiatric patients and treatments to characterize the network patient/treatment denominator, which is used to monitor trends in psychiatric practice and plan network studies; and 3) specific studies. RESULTS: Pilot data from the PRN have yielded detailed information on the diagnostic and clinical characteristics of 725 patients and on the treatments provided by network psychiatrists. CONCLUSIONS: The APA PRN offers a powerful complement to traditional clinical and health services research approaches. The PRN will help psychiatry improve its ability to meet patients needs in a context of rapidly evolving scientific and clinical progress and legislative and economic forces affecting health care delivery.     

Geriatric psychiatry in Taiwan

PURPOSE: To determine whether substance P is present in human tears. METHODS: Tear samples (1-2 microliters) were collected from one eye of each of 12 subjects. Two of the eyes had dry eye syndrome, two wore contact lenses and had dry eye syndrome, and eight were normal. Five of the eight normal eyes were scheduled to undergo excimer laser refractive surgery, and tears were collected from these eyes before and after surgery. Tear samples were analyzed by laser desorption mass spectrometry. Pooled samples from one individual were subjected to enzyme-linked immunoabsorbent assay. RESULTS: Laser desorption mass spectra of the 18 tear samples displayed well defined peaks with mass to charge (m/z) ratios ranging from 1343.7 to 1355.9 and/or 1356.9 to 1364.7, corresponding to an average m/z of 1349.8 +/- 1.13 for protonated substance P and 1361.2 +/- 0.54 for oxidized substance P obtained from 14 mass spectra of standards formulated with substance P concentrations ranging from 10(-4) M to 10(-12) M. As confirmation, an enzyme-linked immunoabsorbent assay performed twice on pooled tears from one eye detected substance P in both replicates at a concentration of 125 pg/ml (9.26 x 10(-11) M). CONCLUSIONS: These findings demonstrate that substance P is a component of tears obtained from normal eyes of men and women ranging in age from 26 to 60 years, from eyes fitted with contact lenses, from eyes with dry eye syndrome, and from eyes 1 and 2 days after excimer laser refractive surgery. Whether the concentration of substance P in tears varies with sex, age, or eye condition, the source of substance P in tears, and its role in tears remains to be discovered.     

行走不列颠

离开英伦已近半年。本以为不列颠的记忆会被天那边的海水稀释变淡,可它却一次次萦绕在我的梦里。印象深刻的是去年十二月去苏格兰。下火车时,天刚刚亮。刚下过雪,站台上依然能感受到凛冽的风,湿漉漉的城市笼罩在乌云底下。虽说是苏格兰首府,爱丁堡并不算大。城堡修筑在火山岩之上,逼仄嶙岣。远处大海,雾气缭绕看不真切。行人匆忙,也有旅人从容不迫,端着相机轮流拍照留影。