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1.
BMJ Open ; 12(3): e052185, 2022 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-35301203

RESUMO

OBJECTIVES: Explore the views of two main stakeholders: mental health professionals and volunteers from three European countries, on the provision of volunteering in mental healthcare. DESIGN: A multicountry, multilingual and multicultural qualitative focus group study (n=24) with n=119 participants. PARTICIPANTS: Volunteers and mental health professionals in three European countries (Belgium, Portugal and the UK). RESULTS: Mental health professionals and volunteers consider it beneficial offering volunteering to their patients. In this study, six overarching themes arose: (1) there is a framework in which volunteering is organised, (2) the role of the volunteer is multifaceted, (3) every volunteering relationship has a different character, (4) to volunteer is to face challenges, (5) technology has potential in volunteering and (6) volunteering impacts us all. The variability of their views suggests a need for flexibility and innovation in the design and models of the programmes offered. CONCLUSIONS: Volunteering is not one single entity and is strongly connected to the cultural context and the mental healthcare services organisation. Despite the contextual differences between these three European countries, this study found extensive commonalities in attitudes towards volunteering in mental health.


Assuntos
Saúde Mental , Voluntários , Grupos Focais , Pessoal de Saúde , Humanos , Pesquisa Qualitativa
2.
JSES Int ; 6(1): 21-25, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35141671

RESUMO

BACKGROUND: A common complication of anatomic total shoulder arthroplasty (aTSA) is aseptic glenoid loosening. Monoblock polyethylene glenoid components with backside ingrowth or on-growth utilize hybrid fixation, with cementation of the peripheral pegs and central ingrowth or on-growth of bone have been designed to decrease glenoid loosening. However, there is a paucity of midterm data comparing cementation of the peripheral peg holes versus all press-fit implantation for hybrid glenoid constructs. The purpose of this study is to compare the minimum five-year clinical and radiographic outcomes of a press-fit hybrid glenoid component with a peripherally cemented hybrid glenoid component in aTSA. METHODS: Between years 2013-2015, we reviewed a total of 169 patients who underwent primary aTSA, with follow-up data spanning a minimum of five years, from an international multi-institutional database. There were 61 press-fit and 108 peripherally cemented glenoids. Shoulders were evaluated for outcome measures, which included clinical outcome scores, radiographic outcomes, and complication rates. RESULTS: Postoperatively, there were no statistically significant differences in patient satisfaction, shoulder function, pain scoring, the Simple Shoulder Test, the Constant score, the American Shoulder and Elbow Surgeons score, the University of California-Los Angeles score, nor the Shoulder Pain and Disability Index, between the two cohorts. There were no significant differences in adverse events (P = .791) or revision rates (P = .592). At the final radiographic follow-up, there were no significant differences between the two groups with regard to the incidence of radiolucent lines on the glenoid (P = .210) or humeral side (P = .282). CONCLUSION: At a minimum of 5-year follow-up, aTSA with a press-fit glenoid implant demonstrates no difference in clinical or radiographic outcomes when compared with a glenoid cohort where the peripheral pegs are cemented. In addition, there is no increased rate of aseptic glenoid loosening or need for revision surgery between the two groups with a lower rate of radiolucency detected than prior midterm data studies. Uncemented press-fit glenoid fixation with a cage component appears to be a safe and effective treatment option for patients undergoing primary aTSA at a minimum of 5-year follow-up.

3.
J Pediatr Orthop ; 41(10): e865-e870, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34469396

RESUMO

BACKGROUND: Obesity rates continue to rise among children and adolescents across the globe. A multicenter research consortium composed of institutions in the Southern US, located in states endemic for childhood obesity, was formed to evaluate the effect of obesity on pediatric musculoskeletal disorders. This study evaluates the effect of body mass index (BMI) percentile and socioeconomic status (SES) on surgical site infections (SSIs) and perioperative complications in patients with adolescent idiopathic scoliosis (AIS) treated with posterior spinal fusion (PSF). METHODS: Eleven centers in the Southern US retrospectively reviewed postoperative AIS patients after PSF between 2011 and 2017. Each center contributed data to a centralized database from patients in the following BMI-for-age groups: normal weight (NW, 5th to <85th percentile), overweight (OW, 85th to <95th percentile), and obese (OB, ≥95th percentile). The primary outcome variable was the occurrence of an SSI. SES was measured by the Area Deprivation Index (ADI), with higher scores indicating a lower SES. RESULTS: Seven hundred fifty-one patients were included in this study (256 NW, 235 OW, and 260 OB). OB and OW patients presented with significantly higher ADIs indicating a lower SES (P<0.001). In addition, SSI rates were significantly different between BMI groups (0.8% NW, 4.3% OW, and 5.4% OB, P=0.012). Further analysis showed that superficial and not deep SSIs were significantly different between BMI groups. These differences in SSI rates persisted even while controlling for ADI. Wound dehiscence and readmission rates were significantly different between groups (P=0.004 and 0.03, respectively), with OB patients demonstrating the highest rates. EBL and cell saver return were significantly higher in overweight patients (P=0.007 and 0.002, respectively). CONCLUSION: OB and OW AIS patients have significantly greater superficial SSI rates than NW patients, even after controlling for SES. LEVEL OF EVIDENCE: Level III.


Assuntos
Cifose , Obesidade Infantil , Escoliose , Adolescente , Índice de Massa Corporal , Criança , Humanos , Obesidade Infantil/complicações , Obesidade Infantil/epidemiologia , Estudos Retrospectivos , Escoliose/epidemiologia , Escoliose/cirurgia , Resultado do Tratamento , Estados Unidos/epidemiologia
4.
JBJS Case Connect ; 10(3): e20.00182, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32960020

RESUMO

CASE: A 69-year-old woman with a history of breast cancer, on long-term antiresorptive medications, was treated with carbon fiber cephalomedullary nails for bilateral atypical femur fractures. Her thigh pain was presumed to be from metastatic lesions and was treated with radiation without standard imaging. The index procedure was complicated by a left nail fracture. The patient underwent exchange cephalomedullary nail fixation with plate augmentation. At 1 year, the patient was asymptomatic with radiographs demonstrating healing. CONCLUSION: This case highlights the importance of appropriate imaging in all patients with thigh pain on antiresorptive therapy and features an uncommon complication of carbon fiber cephalomedullary nail fixation.


Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Neoplasias Ósseas/complicações , Denosumab/efeitos adversos , Fraturas do Fêmur/etiologia , Complicações Pós-Operatórias/etiologia , Idoso , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Feminino , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Humanos , Complicações Pós-Operatórias/cirurgia , Reoperação
5.
PLoS One ; 14(9): e0222891, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31550279

RESUMO

INTRODUCTION: The NICE clinical guidelines on psychosocial interventions for the treatment of schizophrenia and psychosis in adults are based on the results of randomized controlled trials (RCTs), which may not be studies with a pragmatic design, leading to uncertainty on applicability or recommendations to everyday clinical practice. AIM: To assess the level of pragmatism of the evidence used to develop the NICE guideline for psychosocial interventions in psychoses. MATERIAL AND METHODS: We conducted a systematic and critical appraisal of RCTs used to develop the 'psychological therapy and psychosocial interventions' section of the NICE guideline on the treatment and management of psychosis and schizophrenia in adults, published in 2014. For each study we assessed pragmatism using the pragmatic-explanatory continuum indicator summary-2 (PRECIS-2) and the Cochrane risk of bias tool. The mean score of PRECIS-2, averaging across nine domains, was calculated to describe the level of pragmatism of each individual study. RESULTS: A total of 143 studies were included in the analysis. Based on the PRECIS-2 tool, 16.8% were explanatory, 33.6% pragmatic, and 49.7% were rated in an intermediate category. Compared to explanatory studies, pragmatic studies showed a lower risk of bias. Additionally, pragmatism did not significantly improve over time, and no associations were found between pragmatism and a number of trial characteristics. However, studies with a UK leading investigator had the highest mean score of pragmatism. Cognitive behavioural therapy (CBT), art therapy, family intervention, psychoeducation, and adherence therapy, showed the higher average pragmatism scores. CONCLUSIONS: Two third of studies used to produce NICE recommendations on psychosocial interventions for the treatment of schizophrenia and psychosis in adults are based on studies that did not employ a pragmatic design.


Assuntos
Guias de Prática Clínica como Assunto , Ensaios Clínicos Pragmáticos como Assunto/normas , Reabilitação Psiquiátrica/métodos , Transtornos Psicóticos/terapia , Esquizofrenia/terapia , Órgãos Governamentais/normas , Humanos , Reabilitação Psiquiátrica/normas , Projetos de Pesquisa/normas , Reino Unido
6.
PLoS One ; 14(5): e0216929, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31095611

RESUMO

INTRODUCTION: Volunteer befriending can be used to address social isolation in patients with psychosis. Traditionally this involves face-to-face encounters between a volunteer and a patient, but modern digital technology also makes it possible to have these interactions remotely. This study aimed to explore the views and interests of patients with psychosis about different formats of volunteering, face-to-face or digitally. METHODS: A survey was conducted with patients with psychotic disorders in community mental health teams in London. Questions covered socio-demographic characteristics, quality of life, loneliness, views on the different formats of volunteering and types of volunteers, and their interest in getting volunteering support, face-to-face or digitally. Binary logistic regressions were used to investigate potential predictors of interest in getting volunteering support face-to-face or digitally. RESULTS: A total of 151 patients with psychotic disorders were included in this study. More than half of the patients (n = 87, 57.6%) had not heard about these volunteering programs. Many were interested in getting face-to-face (n = 87, 57.6%) and digital (n = 56, 37.1%) volunteering. For the face-to-face encounters, most preferred them to be weekly (n = 36, 41.4%), for one-hour (n = 32, 36.8%), and with an open-ended relationship (n = 45, 51.7%). For the digital contacts, most preferred them to be weekly (n = 17, 30.9%) and through text messages (n = 26, 46.4%). A minority of patients (n = 20, 13.2%) did not use digital technology. Patients with lower quality of life were significantly more likely to prefer face-to-face volunteering (p < .05). Younger patients and with fewer years of diagnosis were significantly more likely to prefer digital volunteering (p < .05). CONCLUSIONS: The variability in patients' interests suggests that different formats of volunteer support should be offered. Digital volunteering may become more important in the future, since many younger patients are interested in it.


Assuntos
Preferência do Paciente , Transtornos Psicóticos/reabilitação , Comportamento Social , Isolamento Social/psicologia , Envio de Mensagens de Texto , Voluntários , Adulto , Idoso , Feminino , Amigos , Humanos , Internet , Londres , Solidão , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Análise de Regressão , Classe Social , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
7.
Psychol Psychother ; 92(3): 299-341, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-29888437

RESUMO

PURPOSE: This review aims to identify how the term 'resilience' is conceptualized across adult mental health research due to ongoing criticism regarding the lack of consistency in its conceptualization. METHOD: A systematic search, including hand searches of book chapters, was conducted using search terms ('resilien*') AND ('mental illness' OR 'mental health problem'). Papers were excluded if they did not meet the following criteria: written in English, provide a clear conceptualization of resilience, include only adults (aged 18 + ) in the sample, solely focus on individuals with a primary diagnosis of mental illness, and peer-reviewed. Data were extracted on conceptualizations of resilience, demographic, and diagnostic variables of the study population, publication year, and the research design used. Conceptualizations were combined and collapsed into overarching themes and then refined through joint discussion, consultation with a third reviewer, and input from a larger multidisciplinary team. RESULTS: Thirty-one texts (6 book chapters, 4 reviews, 2 appraisals/critical evaluations, 1 editorial, and 18 research projects) were included. Two broad understandings of resilience were identified: resilience as a process and resilience as a characteristic of an individual. Processes comprise three themes: 'immunity', 'bouncing back', and 'growth', whilst characteristics are captured in two themes 'personal resources' and 'social resources'. CONCLUSIONS: These findings suggest that resilience can be conceptualized in a clear and meaningful manner in adult mental health research. The five themes reflect distinct ways of using the term resilience. Whilst each one of them may have merit in future research, it appears beneficial to make clear in research which exact conceptualization of resilience has been adopted. PRACTITIONER POINTS: When considering and reading about 'resilience', one should be aware that there are different concepts of it. The main difference is between resilience as a personal characteristic and resilience as a process. Therapy may address resilience as a personal characteristic by utilizing individual and social resources. The therapeutic process may be understood as resilience in form of bouncing back and personal growth.


Assuntos
Pesquisa Biomédica , Transtornos Mentais/psicologia , Resiliência Psicológica , Terminologia como Assunto , Humanos
8.
BMC Psychiatry ; 18(1): 378, 2018 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-30514260

RESUMO

BACKGROUND: The literature suggests that many people in the general population tend to distance themselves from those with mental illness. However, there are volunteers that behave differently, spending their free time with people with mental illness and providing direct input in the form of befriending. Whilst there are a range of befriending programmes, little is known about who these volunteer befrienders are, and a previous review of different forms of volunteering in mental health care found data on only 63 befrienders. METHODS: We conducted a systematic electronic search of databases (BNI, CNIL, EMBASE, MEDLINE, PsycINFO, Cochrane Registers, Web of Science) to detect all papers reporting characteristics of befriending volunteers in mental health care published between 2011 and April 2018. The articles retrieved were combined with previous papers identified in an earlier review and with relevant papers identified by experts in the field. The articles that met the inclusion criteria were extracted and narratively synthesised. RESULTS: Nine studies met the inclusion criteria for this review, reporting characteristics of a total of 577 volunteer befrienders. The most often reported characteristics were age and gender, motivations to volunteer and experience of the role. Whilst characteristics vary greatly, most volunteers are female, and the average age is 50 years. Motivations generally fit into the categories of "giving" and "getting" and experiences are mixed. CONCLUSION: Published research on volunteer befrienders has increased in the last eight years, but is still limited. The range of characteristics suggests that there is a potential for encouraging a variety of people to volunteer as befrienders for people with mental illness. Understanding the characteristics and motivations of volunteers may help refine programmes and improve the experience of the volunteer befrienders.


Assuntos
Amigos/psicologia , Relações Interpessoais , Transtornos Mentais/terapia , Motivação , Voluntários/psicologia , Humanos , Narração
9.
Int J Soc Psychiatry ; 64(5): 470-475, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29775112

RESUMO

BACKGROUND: Research suggests there is a propensity for people in the general population to distance themselves from people with severe mental illness (SMI), which reportedly decreases with increased contact with individuals with SMI. Volunteer befrienders in the mental health sector have ongoing contact with this population, yet little data exist to reflect their attitudes towards people with SMI. METHOD: A questionnaire was distributed to all volunteer befrienders for people with SMI within volunteering programmes organised in five Austrian regions. A vignette described an individual with SMI and was followed by questions assessing willingness to interact with this person in personal or professional contexts. Social distance scores, calculated based on responses to attitude items, were used as the dependent variable in regression analyses. Independent variables included participant characteristics, experience of family/friends with mental illness, time spent befriending and satisfaction with the relationship. RESULTS: Questionnaires were completed and returned by 360 volunteers (54.0%). A minority would allow someone with SMI to look after their children (6.2%), while most volunteers positively endorsed other personal interactions such as having the individual marry into their family (67.8%) or become a neighbour (99.7%). Social distance ( M = 2.5, standard deviation [ SD] = 1.16) was not associated with any independent variables. CONCLUSIONS: Volunteers had a lower desire for social distance from individuals with SMI as compared to findings from the general population. Future research may establish whether lower social distance is part of the motivation to volunteer as a befriender to people with severe mental illness or develops over time in that role or both.


Assuntos
Amigos/psicologia , Transtornos Mentais , Distância Psicológica , Estereotipagem , Voluntários/psicologia , Adulto , Idoso , Áustria , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Autorrelato
10.
Soc Psychiatry Psychiatr Epidemiol ; 53(8): 841-847, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29651621

RESUMO

PURPOSE: Large numbers of volunteers provide one-to-one support for people with mental illness, sometimes referred to as befriending. However, there has been very little research on their characteristics and motivations. This study aimed to assess the personal characteristics and motivations of such volunteers across different regions in Austria. METHODS: Questionnaires assessing characteristics and motivations were distributed to 663 volunteers providing befriending for people with mental illness within volunteering programmes organised in four Austrian regions. RESULTS: Questionnaires were completed and returned by 360 out of 663 approached volunteers (response rate 54%). Whilst most socio-demographic characteristics were widely distributed, 78% were female; 42% reported to have a family member and 56% a friend with a mental illness. Most volunteers cited motivations to do something both for others (e.g. "feel a responsibility to help others") and for themselves (e.g. "enhance my awareness of mental health issues"). When the total group was divided into four subgroups in a cluster analysis based on their socio-demographic characteristics, a subgroup of female, single and younger volunteers in full-time employment expressed motivations to achieve something for themselves significantly more often than other subgroups. CONCLUSIONS: The study provides the largest sample of volunteers in befriending programmes for people with mental illness in the research literature to date. The findings suggest that people with different characteristics can be recruited to volunteer for befriending programmes. Recruitment strategies and supervision arrangements should consider motivations both to help others and to achieve something for themselves, and may be varied for specific volunteer subgroups.


Assuntos
Amigos/psicologia , Comportamento de Ajuda , Transtornos Mentais/psicologia , Motivação , Voluntários/psicologia , Adulto , Áustria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
11.
BMC Psychiatry ; 18(1): 64, 2018 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-29523114

RESUMO

BACKGROUND: Befriending has become a widely used method for tackling social isolation in individuals with severe mental illness (SMI), and evidence exists to support its effectiveness. However, patient preferences for befriending remain unclear. We aimed to determine whether patients with SMI want a volunteer befriender and, if so, the volunteer characteristics and character of the relationship they would prefer. METHODS: A survey of outpatients was conducted across London-based community mental health teams, for individuals diagnosed with affective or psychotic disorders. Questions consisted of measures of demographic characteristics, befriending preferences and social context, including measures of time spent in activities, number of social contacts, loneliness and subjective quality of life (SQOL). Binary logistic regressions were used to investigate potential predictors of willingness to participate in befriending. RESULTS: The sample comprised of 201 participants with a mean age of 43 years. The majority (58%) of the sample indicated willingness to participate in befriending. In univariable analyses this was associated with less time spent in activities in the previous week, higher level of loneliness and lower SQOL. When all three variables were tested as predictors in a multivariable analysis, only lower SQOL remained significantly associated with willingness to take part in befriending. Relative to other options presented, large proportions of participants indicated preference for weekly (44%), 1-hour (39%) meetings with a befriender, with no limits on the relationship duration (53%). Otherwise, patient preferences exhibited great variability in relation to other characteristics of befriending schemes. CONCLUSIONS: A substantial number of patients with SMI appear willing to take part in a befriending scheme. Patients with lower SQOL are more likely to accept befriending, so that befriending schemes may be a realistic option to help patients with particularly low SQOL. The large variability in preferences for different types of befriending suggests that there is no one-size-fits-all formula and that schemes may have to be flexible and accommodate different individual preferences.


Assuntos
Solidão/psicologia , Transtornos Mentais/psicologia , Índice de Gravidade de Doença , Isolamento Social/psicologia , Apoio Social , Inquéritos e Questionários , Adulto , Estudos Transversais , Feminino , Humanos , Londres/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/terapia , Qualidade de Vida/psicologia , Voluntários/psicologia
12.
Schizophr Res ; 103(1-3): 26-39, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18555666

RESUMO

BACKGROUND: One of the cardinal features of schizotypal personality disorder (SPD) is language abnormalities. The focus of this study was to determine whether or not there are also processing abnormalities of pure tones differing in pitch and duration in SPD. METHODS: Thirteen neuroleptic-naïve male subjects met full criteria for SPD and were group-matched on age and parental socio-economic status to 13 comparison subjects. Verbal learning was measured with the California Verbal Learning Test. Heschl's gyrus volumes were measured using structural MRI. Whole-brain fMRI activation patterns in an auditory task of listening to tones including pitch and duration deviants were compared between SPD and control subjects. In a second and separate ROI analysis we found that peak activation in superior temporal gyrus (STG), Brodmann Areas 41 and 42, was correlated with verbal learning and clinical measures derived from the SCID-II interview. RESULTS: In the region of the STG, SPD subjects demonstrated more activation to pitch deviants bilaterally (p<0.001); and to duration deviants in the left hemisphere (p=0.005) (two-sample t). SPD subjects also showed more bilateral parietal cortex activation to duration deviants. In no region did comparison subjects activate more than SPD subjects in either experiment. Exploratory correlations for SPD subjects suggest a relationship between peak activation on the right for deviant tones in the pitch experiment with odd speech and impaired verbal learning. There was no difference between groups on Heschl's gyrus volume. CONCLUSIONS: These data suggest that SPD subjects have inefficient or hyper-responsive processing of pure tones both in terms of pitch and duration deviance that is not attributable to smaller Heschl's gyrus volumes. Finally, these auditory processing abnormalities may have significance for the odd speech heard in some SPD subjects and downstream language and verbal learning deficits.


Assuntos
Transtornos da Percepção Auditiva/diagnóstico , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Discriminação da Altura Tonal/fisiologia , Transtorno da Personalidade Esquizotípica/diagnóstico , Lobo Temporal/fisiopatologia , Percepção do Tempo/fisiologia , Adulto , Atenção/fisiologia , Transtornos da Percepção Auditiva/fisiopatologia , Mapeamento Encefálico , Dominância Cerebral/fisiologia , Potenciais Evocados Auditivos/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lobo Parietal/fisiopatologia , Valores de Referência , Linguagem do Esquizofrênico , Transtorno da Personalidade Esquizotípica/fisiopatologia , Aprendizagem Verbal/fisiologia
13.
Am J Psychiatry ; 161(9): 1603-11, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15337650

RESUMO

OBJECTIVE: The middle temporal gyrus and inferior temporal gyrus subserve language and semantic memory processing, visual perception, and multimodal sensory integration. Functional deficits in these cognitive processes have been well documented in patients with schizophrenia. However, there have been few in vivo structural magnetic resonance imaging (MRI) studies of the middle temporal gyrus and inferior temporal gyrus in schizophrenia. METHOD: Middle temporal gyrus and inferior temporal gyrus gray matter volumes were measured in 23 male patients diagnosed with chronic schizophrenia and 28 healthy male subjects by using high-spatial-resolution MRI. For comparison, superior temporal gyrus and fusiform gyrus gray matter volumes were also measured. Correlations between these four regions and clinical symptoms were also investigated. RESULTS: Relative to healthy subjects, the patients with chronic schizophrenia showed gray matter volume reductions in the left middle temporal gyrus (13% difference) and bilateral inferior temporal gyrus (10% difference in both hemispheres). In addition, the patients showed gray matter volume reductions in the left superior temporal gyrus (13% difference) and bilateral fusiform gyrus (10% difference in both hemispheres). More severe hallucinations were significantly correlated with smaller left hemisphere volumes in the superior temporal gyrus and middle temporal gyrus. CONCLUSIONS: These results suggest that patients with schizophrenia evince reduced gray matter volume in the left middle temporal gyrus and bilateral reductions in the inferior temporal gyrus. In conjunction with findings of left superior temporal gyrus reduction and bilateral fusiform gyrus reductions, these data suggest that schizophrenia may be characterized by left hemisphere-selective dorsal pathophysiology and bilateral ventral pathophysiology in temporal lobe gray matter.


Assuntos
Imageamento por Ressonância Magnética/estatística & dados numéricos , Esquizofrenia/diagnóstico , Lobo Temporal/anatomia & histologia , Adulto , Doença Crônica , Lateralidade Funcional/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Giro Para-Hipocampal/anatomia & histologia , Giro Para-Hipocampal/fisiopatologia , Esquizofrenia/fisiopatologia , Lobo Temporal/fisiopatologia
15.
Arch Gen Psychiatry ; 60(11): 1069-77, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14609882

RESUMO

CONTEXT: Whether psychoses associated with schizophrenia and affective disorder represent manifestations of different disorders or the same disorder is an important but unresolved question in psychiatry. Results of previous volumetric magnetic resonance imaging investigations indicate that gray matter volume reductions in neocortical regions may be specific to schizophrenia. OBJECTIVE: To simultaneously evaluate multiple olfactocentric paralimbic regions, which play crucial roles in human emotion and motivation, in first-episode patients with schizophrenia and affective psychosis. DESIGN: A cross-sectional study using high-spatial resolution magnetic resonance imaging in patients with schizophrenia and affective psychosis at their first hospitalization. SETTING: Inpatient units at a private psychiatric hospital. PARTICIPANTS: Fifty-three first-episode patients, 27 with schizophrenia and 26 with affective (mainly manic) psychosis, and 29 control subjects. MAIN OUTCOME MEASURES: Using high-spatial resolution magnetic resonance imaging, the gray matter volumes of 2 olfactocentric paralimbic regions of interest, the insular cortex and the temporal pole, were evaluated. RESULTS: A bilateral volume reduction in insular cortex gray matter was specific to first-episode patients with schizophrenia. In contrast, both first-episode psychosis groups showed a volume reduction in left temporal pole gray matter and an absence of normal left-greater-than-right asymmetry. Region of interest correlations showed that only patients with schizophrenia lacked a positive correlation between left temporal pole and left anterior amygdala-hippocampal complex gray matter volumes, whereas both psychosis groups were similar in lacking normal positive correlations between left temporal pole and left anterior superior temporal gyrus gray matter volumes. CONCLUSIONS: These partially different and partially similar patterns of structural abnormalities in olfactocentric paralimbic regions and their associated abnormalities in other temporolimbic regions may be important factors in the differential and common manifestations of the 2 psychoses.


Assuntos
Transtorno Bipolar/diagnóstico , Córtex Cerebral/anormalidades , Aumento da Imagem , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Transtornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Lobo Temporal/anormalidades , Doença Aguda , Adolescente , Adulto , Atrofia , Transtorno Bipolar/psicologia , Escalas de Graduação Psiquiátrica Breve , Córtex Cerebral/patologia , Diagnóstico Diferencial , Dominância Cerebral/fisiologia , Feminino , Humanos , Sistema Límbico/anormalidades , Sistema Límbico/patologia , Masculino , Computação Matemática , Entrevista Psiquiátrica Padronizada , Rede Nervosa/anormalidades , Rede Nervosa/patologia , Condutos Olfatórios/anormalidades , Condutos Olfatórios/patologia , Transtornos Psicóticos/psicologia , Lobo Temporal/patologia , Escalas de Wechsler
16.
Schizophr Res ; 64(1): 35-9, 2003 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-14511799

RESUMO

The fusiform gyrus is important for face and object recognition, is abnormal in schizophrenia, but has not been studied in schizotypal personality disorder (SPD). Thin-slice MR images showed no differences, either in right, left or total fusiform gyri volumes, between subjects with SPD (N=21) and normal controls (N=19). However, there was a correlation between severity of illusions and magical thinking suffered by the SPD subjects and smaller right fusiform gyrus volumes. This suggests that future studies may be useful in determining the functional competence of this gyrus in SPD.


Assuntos
Encéfalo/patologia , Ilusões/fisiologia , Magia/psicologia , Imageamento por Ressonância Magnética , Transtorno da Personalidade Esquizotípica/diagnóstico , Adolescente , Adulto , Análise de Variância , Mapeamento Encefálico , Humanos , Masculino , Corpos Mamilares/patologia , Pessoa de Meia-Idade , Lobo Occipital/patologia , Giro Para-Hipocampal/patologia , Lobo Parietal/patologia , Teste de Realidade , Transtorno da Personalidade Esquizotípica/genética , Lobo Temporal/patologia
17.
Clin Infect Dis ; 36(12): 1602-5, 2003 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-12802762

RESUMO

We screened 651 human immunodeficiency virus (HIV)-1-infected subjects for hepatitis B surface antigen (HBsAg) and antibody to hepatitis B surface antigen (anti-HBs). Of a total of 387 subjects who tested negative for both HBsAg and anti-HBs, 142 underwent further testing for isolated presence of antibody to hepatitis B core antigen (anti-HBc). Of these 142 subjects, 60 (42%) tested positive for anti-HBc (isolated anti-HBc). Individuals coinfected with HIV-1 and hepatitis C virus (HCV) were more likely to have isolated anti-HBc than were subjects with HIV-1 alone (80% vs. 16%, respectively). Our findings suggest that individuals with HIV-1/HCV coinfection for whom there is no serological evidence for hepatitis B virus when screened with HBsAg and anti-HBs will be positive for anti-HBc in >75% of cases. A screening strategy that tests only for HBsAg and anti-HBs in HIV-1-infected patients will miss a large number of individuals with isolated anti-HBc.


Assuntos
Infecções por HIV/complicações , Anticorpos Anti-Hepatite B/isolamento & purificação , Antígenos do Núcleo do Vírus da Hepatite B/isolamento & purificação , Vírus da Hepatite B/isolamento & purificação , Hepatite B/complicações , Adulto , Infecções por HIV/imunologia , HIV-1 , Hepatite B/virologia , Humanos
18.
Arch Gen Psychiatry ; 60(4): 349-55, 2003 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12695311

RESUMO

BACKGROUND: The fusiform gyrus (FG), or occipitotemporal gyrus, is thought to subserve the processing and encoding of faces. Of note, several studies have reported that patients with schizophrenia show deficits in facial processing. It is thus hypothesized that the FG might be one brain region underlying abnormal facial recognition in schizophrenia. The objectives of this study were to determine whether there are abnormalities in gray matter volumes for the anterior and the posterior FG in patients with chronic schizophrenia and to investigate relationships between FG subregions and immediate and delayed memory for faces. METHODS: Patients were recruited from the Boston VA Healthcare System, Brockton Division, and control subjects were recruited through newspaper advertisement. Study participants included 21 male patients diagnosed as having chronic schizophrenia and 28 male controls. Participants underwent high-spatial-resolution magnetic resonance imaging, and facial recognition memory was evaluated. Main outcome measures included anterior and posterior FG gray matter volumes based on high-spatial-resolution magnetic resonance imaging, a detailed and reliable manual delineation using 3-dimensional information, and correlation coefficients between FG subregions and raw scores on immediate and delayed facial memory derived from the Wechsler Memory Scale III. RESULTS: Patients with chronic schizophrenia had overall smaller FG gray matter volumes (10%) than normal controls. Additionally, patients with schizophrenia performed more poorly than normal controls in both immediate and delayed facial memory tests. Moreover, the degree of poor performance on delayed memory for faces was significantly correlated with the degree of bilateral anterior FG reduction in patients with schizophrenia. CONCLUSION: These results suggest that neuroanatomic FG abnormalities underlie at least some of the deficits associated with facial recognition in schizophrenia.


Assuntos
Prosopagnosia/diagnóstico , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Lobo Temporal/anatomia & histologia , Adulto , Encéfalo/anatomia & histologia , Doença Crônica , Face , Lateralidade Funcional , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Reconhecimento Psicológico
19.
Psychol Sci ; 13(6): 526-31, 2002 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-12430836

RESUMO

Do participants in the Deese, Roediger, and McDermott (DRM) procedure demonstrate false memory because they think of nonpresented critical words during study and confuse them with words that were actually presented? In two experiments, 160 participants studied eight visually presented DRM lists at a rate of 2 s or 5 s per word. Half of the participants rehearsed silently: the other half rehearsed overtly. Following study, the participants' memory for the lists was tested by recall or recognition. Typical false memory results were obtained for both memory measures. More important, two new results were observed. First, a large majority of the overt-rehearsal participants spontaneously rehearsed approximately half of the critical words during study. Second, critical-word rehearsal at study enhanced subsequent false recall, but it had no effect on false recognition or remember judgments for falsely recognized critical words. Thinking of critical words during study was unnecessary for producing false memory.


Assuntos
Idioma , Aprendizagem/fisiologia , Memória/fisiologia , Reconhecimento Visual de Modelos/fisiologia , Reconhecimento Psicológico/fisiologia , Retenção Psicológica/fisiologia , Pensamento/fisiologia , Adulto , Humanos , Estudantes/psicologia
20.
Memory ; 10(4): 225-37, 2002 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12097208

RESUMO

Directed forgetting research shows that people can inhibit the retrieval of words that they were previously instructed to forget. The present research applied the directed forgetting procedure to the Deese/Roediger and McDermott (DRM) recall task to determine if directed forgetting instructions have similar or different effects on accurate and false memory. After studying lists of semantically related words, some participants were told to forget those lists, whereas other participants were not. All participants were then shown additional lists to remember. Following study, all participants were asked to free recall as many of the studied words as possible, including those they were previously instructed to forget. Directed forgetting instructions inhibited the accurate recall of studied words, but not the false recall of nonstudied critical words, whether measured by a within-participant or between-participants design. Contrary to an implicit activation hypothesis, false memories survived instructions to forget. These findings were reviewed in terms of fuzzy trace theory and the activation/monitoring approach to false memory.


Assuntos
Inibição Psicológica , Rememoração Mental , Repressão Psicológica , Adolescente , Adulto , Humanos , Modelos Psicológicos , Retenção Psicológica , Semântica
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