Patient Information about Gout: An International Review of Existing Educational Resources.

OBJECTIVE: Inadequate patient information about gout may contribute to poor disease outcomes. We reviewed existing educational resources for gout to identify strengths and weaknesses and compare resources cross-nationally. METHODS: Content, readability, and dietary recommendations were reviewed using a sample of 30 resources (print and Web-based) from 6 countries. RESULTS: More than half of the resources were written at a highly complex level. Some content areas were lacking coverage, including comorbidity risks, uric acid target levels, and continuing allopurinol during acute attacks. CONCLUSION: Our findings suggest significant room for improvement in gout patient educational resources, particularly regarding self-management.

Multi-TI Arterial Spin Labeling MRI with Variable TR and Bolus Duration for Cerebral Blood Flow and Arterial Transit Time Mapping.

Arterial spin labeling (ASL) is an MRI perfusion imaging method from which quantitative cerebral blood flow (CBF) can be calculated. We present a multi-TI ASL method (multi-TI integrated ASL) in which variable post-labeling delays and variable TRs are used to improve the estimation of arterial transit time (ATT) and CBF while shortening the scan time by 41% compared to the conventional methods. Variable bolus widths allow for T1 and M0 estimation from raw ASL data. Multi-TI integrated pseudo-continuous ASL images were collected at 7 TI times ranging 100-4300 ms. Voxel-wise T1 and M0 maps were estimated, then CBF and ATT maps were created using the estimated T1 tissue map. All maps were consistent with physiological values reported in the literature. Based on simulations and in vivo comparisons, this method demonstrates higher CBF and ATT estimation efficiency than other ATT acquisition methods and better fit to the perfusion model. It produces CBF maps with reduced sensitivity to errors from ATT and tissue T1 variations. The estimated M0, T1, and ATT maps also have potential clinical utility. The method requires a single scan acquired within a clinically acceptable scan time (under 6 minutes) and with low sensitivity to motion.

Cerebral blood flow quantification in swine using pseudo-continuous arterial spin labeling.

PURPOSE: To develop quantitative cerebral blood flow (CBF) imaging using pseudo-continuous arterial spin labeling (PCASL) in swine, accounting for their cerebrovascular anatomy and physiology. MATERIALS AND METHODS: Five domestic pigs (2.5-3 months, 25 kg) were used in these studies. The orientation of the labeled arteries, T1bl , M0bl , and T1gm were measured in swine. Labeling parameters were tuned with respect to blood velocity to optimize labeling efficiency based on the data collected from three subjects. Finally, CBF and arterial transit time (ATT) maps for two subjects were created from PCASL data to determine global averages. RESULTS: The average labeling efficiency over measured velocities of 5-18 cm/s was 0.930. The average T1bl was 1546 ms, the average T1gm was 1224 ms, and the average blood-to-white matter ratio of M0 was 1.25, which was used to find M0bl . The global averages over the subjects were 54.05 mL/100 g tissue/min CBF and 1261 ms ATT. CONCLUSION: This study demonstrates the feasibility of PCASL for CBF quantification in swine. Quantification of CBF using PCASL in swine can be further developed as an accessible and cost-effective model of human cerebral perfusion for investigating injuries that affect blood flow.

Dimensions of suicidality: analyzing the domains of the SIS-MAP Suicide Risk Assessment Instrument and the development of a brief screener.

This study aimed at validating the domains of suicidality assessed by the Scale for Impact of Suicidality-Management, Assessment and Planning of Care (SIS-MAP) and creating a brief screener based on the full scale. A total of 50 individuals with suicidal ideation were given the SIS-MAP interview. Support was found for these domains of suicide risk; in particular, the subscales of ideation and protective factors for suicide risk were highly reliable. For each domain of suicidality, items most predictive of total risk index scores were selected to create a brief screener aimed at expediting the assessment process. The screener was reliable, predicted overall suicide risk index scores, and approached significance in predicting subsequent suicide attempts.

Reducing treatment delay for early intervention: evaluation of a community based crisis helpline.

BACKGROUND: A limited number of studies have assessed the pathways to care of patients experiencing psychosis for the first time. Helpline/clinic programs may offer patients who are still functional but have potential for crisis an alternative that is free from judgment. METHODS: In this study we report on patient calling a round-the-clock crisis helpline for suicide prevention supported by psychiatric facilities in Mumbai, India. Chi-square and test of mean differences were used to compare outcomes between first-episode patients and those with a previous history. RESULTS: Within five years, the helpline received 15,169 calls. Of those callers, 2341 (15.4%) experienced suicidal ideation. Two hundred and thirty four patients opting for counseling lasting 12 months agreed to a psychiatric assessment. Of those, 32 were fist time psychosis sufferers, whereas, 54 had previously been psychotic. Of all psychiatric assessments, the clinic received 94 patients with 'first-episode psychosis'. We found that the duration of illness was significantly shorter (17 vs. 28 months) and suicide attempts were fewer (16 vs. 21) in first-time psychosis sufferers compared to those with a treatment history. CONCLUSIONS: We conclude that some first-episode patients of schizophrenia and other disorders do access services by using helplines. We also argue that helplines may be somewhat immune to stigma, allowing patients a safe alternative when finding help.

Persistent suicide risk in clinically improved schizophrenia patients: challenge of the suicidal dimension.

BACKGROUND: Suicide is a major problem in schizophrenia, estimated to affect 9%-13% of patients. About 25% of schizophrenic patients make at least one suicide attempt in their lifetime. Current outcome measures do not address this problem, even though it affects quality of life and patient safety. The aim of this study was to assess suicidality in long-term clinically improved schizophrenia patients who were treated in a nongovernmental psychiatric treatment centre in Mumbai, India. METHOD: Participants were 61 patients out of 200 consecutive hospitalized first-episode patients with schizophrenia diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders who were much improved on the Clinical Global Impression Scale-Improvement (CGI-I) scale at the endpoint of a 10-year follow-up. Clinical assessment tools included the Positive and Negative Syndrome Scale for Schizophrenia, CGI-I, Global Assessment of Functioning, and suicidality. RESULTS: Many of the patients, although clinically improved, experienced emerging suicidality during the 10-year follow-up period. All of the patients reported significant suicidality (ie, suicide attempts, suicidal crises, or suicidal ideation) at the end of the study, whereas only 83% had reported previous significant suicidality at baseline. No sociodemographic and clinical variables at baseline were predictive of suicidal status at the end of the 10-year follow-up. CONCLUSION: Schizophrenia is a complex neurobehavioral disorder that appears to be closely associated with suicidal behavior. Adequate assessment and management of suicidality needs to be a continual process, even in patients who respond well to treatment.

Weight-gain in psychiatric treatment: risks, implications, and strategies for prevention and management.

Weight-gain in psychiatric populations is a common clinical challenge. Many patients suffering from mental disorders, when exposed to psychotropic medications, gain significant weight with or without other side-effects. In addition to reducing the patients' willingness to comply with treatment, this weight-gain may create added psychological or physiological problems that need to be addressed. Thus, it is critical that clinicians take precautions to monitor and control weight-gain and take into account and treat all problems facing an individual. In this review, we examine some of the key issues surrounding weight-gain in individuals suffering from mental disorders for contemporary practitioners in community clinics. We describe some factors known to make certain patients more susceptible to treatment-induced weight-gain and mechanisms implicated in this process. We also highlight a few psychological and pharmacological interventions that have proven effective in weight management. Importantly, we provide critical steps for management and prevention of weight-gain and related issues in the clinical practice of psychopharmacology.