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6 results

  • Chapter 12 - Autism Spectrum Disorder: Assessment and Therapeutic Approaches within Forensic Settings

  • from Section 2 - Assessment and Therapeutic Approach
  • Edited by Jane M. McCarthy, Regi T. Alexander, Eddie Chaplin
  • Book:
    Forensic Aspects of Neurodevelopmental Disorders
    Published online:
    18 May 2023
    Print publication:
    01 June 2023, pp 137-147

  • Summary

    Whilst representing a relatively small proportion of the overall offender population, individuals with autism spectrum disorder (ASD) present with diverse needs and issues that can challenge mainstream forensic services. The specific topics discussed in this chapter focus on those related to the assessment of individuals withASD in forensic settings, notably obtaining a diagnosis of ASD, completing a forensic risk formulation and therapeutic needs profile, the assessment of psychopathy in ASD and presence of any co-occurring neurodevelopmental and/or psychiatric disorders. Therapeutic approaches within forensic settings in the form of psychological and pharmacological interventions are also reviewed, including the role of organisational and staff training in ASD. A case example is also provided. The potential additional needs that women with ASD who offend present with are discussed. A final summary is provided including potential research targets to inform the future direction of assessments and therapeutic approaches for people with ASD within forensic settings.

  • Decreased vitamin D levels in obsessive-compulsive disorder patients

  • Donatella Marazziti, Filippo M. Barberi, Leonardo Fontenelle, Beatrice Buccianelli, Manuel G. Carbone, Elisabetta Parra, Stefania Palermo, Lucia Massa, Claudia Tagliarini, Alessandra Della Vecchia, Federico Mucci, Alessandro Arone, Liliana Dell’Osso
  • Journal:
    CNS Spectrums / Volume 28 / Issue 5 / October 2023
    Published online by Cambridge University Press:
    23 September 2021, pp. 606-613
  • Objective

    The present paper compared vitamin D levels in adult patients with obsessive-compulsive disorder (OCD) and explored possible correlations with patients’ characteristics.

    Methods

    Fifty outpatients with OCD, according to DSM-5 criteria, were included and assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Hamilton Rating Scale for Depression (HRDS).

    Results

    All the patients except one showed lower vitamin D levels than normative values (>30 nm/L). Vitamin D values of the whole sample were negatively correlated with Y-BOCS total, compulsion subscale, and some items’ scores, specifically “interference from obsessions,” “distress associated with obsessions,” and “time spent on compulsions”. The same relationships were detected in men, while women showed negative correlations between vitamin D levels and Y-BOCS compulsion subscale and “resistance to compulsions,” “degree of control of compulsions,” “insight” item scores.

    Conclusions

    Our findings would indicate that vitamin D might be involved in the pathophysiology of OCD, and that it is possibly related to the severity of the disorder and to typical symptoms, with some sex-related peculiarities. Further studies are necessary to support or not our findings and to ascertain the effectiveness of vitamin D supplementation in patients with OCD.

  • Chapter 28 - Impact upon related conditions and quality of life

  • from Section 7 - The Prognosis of Neuropathic Pain
  • Edited by Cory Toth, Dwight E. Moulin
  • Book:
    Neuropathic Pain
    Published online:
    05 December 2013
    Print publication:
    07 November 2013, pp 334-340

  • Summary

    Fibromyalgia is an illness seen mostly in women and characterized by widespread body pain with abnormality located in the nervous system. A diagnosis of fibromyalgia should be considered when a patient presents with widespread body pain lasting for longer than 3 months, with associated tenderness to palpation of soft tissues, as well as the possible presence of symptoms of sleep disturbance, fatigue, cognitive symptoms, and mood changes. Nervous system, genetic, and psychological mechanisms likely all play a part in the final expression of fibromyalgia, with evidence showing abnormalities at multiple levels. Ideal management includes both non-pharmacological and pharmacological treatments in a multimodal approach incorporating a strong patient-centered internal locus of control. Non-pharmacological treatments with emphasis on a regular exercise program, stress management, and coping skills should be an integral part of any treatment strategy for fibromyalgia. The traditional pharmacological treatment paradigm begins with simple analgesics and tricyclic antidepressant medications (TCAs).

  • 10 - Achieving optimal treatment organisation in different countries

  • Edited by Francis Creed, University of Manchester, Peter Henningsen, Technische Universität München, Per Fink, Aarhus Universitet, Denmark
  • Book:
    Medically Unexplained Symptoms, Somatisation and Bodily Distress
    Published online:
    05 August 2011
    Print publication:
    14 July 2011, pp 236-252

  • Summary

    This chapter provides an overview of the current state of evidence regarding treatment of medically unexplained symptoms, somatisation and the functional somatic syndromes. Both primary and secondary care studies have been performed to assess the efficacy of psychological interventions, most commonly cognitive behaviour therapy administered by a mental health professional, or antidepressants, prescribed by the patient's usual doctor. Thirteen trials evaluated cognitive behaviour therapy, five evaluated antidepressants, four the effect of a consultation letter to the general practitioner (GP) and three the training of GPs. The chapter reviews psychological treatments and the use of antidepressants. It uses three systematic reviews to provide an overview of the evidence of efficacy of interventions for functional somatic symptoms. The evidence is stronger for some pharmacological treatments than for psychological treatments partly because of the universal use of placebo tablets and the lack of an attention-placebo in psychological treatment trials.

  • 25 - Opioid therapy in addicted patients: background and perspective from the UK

  • from 3 - Pain management
  • Edited by Gail A. Van Norman, University of Washington, Stephen Jackson, Stanley H. Rosenbaum, Susan K. Palmer
  • Book:
    Clinical Ethics in Anesthesiology
    Published online:
    05 March 2012
    Print publication:
    28 October 2010, pp 148-153

  • Summary

    The expert management of pharmacological and non-pharmacological treatments is essential to the concept of proportionality. When physicians use appropriate analgesics and write orders to titrate medication based on evidence of pain and suffering, such as groaning, agitation, verbal complaints, diaphoresis, hypertension, or unexplained tachycardia, they demonstrate that the intention of the act is geared toward alleviating pain. Until relatively recently, dying patients were routinely under-treated for pain because physicians feared that the treatment would hasten death. This chapter explains the case study of a 58-year-old woman with widely metastatic breast cancer. In the context of caring for a terminally ill patient, the double effect (DE) allows for good pain management. DE asks physicians to carefully examine their motives and assumes that one's private moral intentions are morally relevant. The principle of double effect permits aggressive treatment of pain when death may be an unintended effect of that treatment.

  • 21 - Psychiatry in primary care

  • from Section 4 - Psychiatry in Specific Settings
  • Edited by Robin M. Murray, King's College London, Kenneth S. Kendler, Virginia Commonwealth University, Peter McGuffin, University of Wales College of Medicine, Simon Wessely, Institute of Psychiatry, London, David J. Castle, University of Melbourne
  • Book:
    Essential Psychiatry
    Published online:
    22 August 2009
    Print publication:
    18 September 2008, pp 479-497

  • Summary

    This chapter outlines the historical background of alcohol problems, current classificatory systems for diagnosis, psychological and physical related disorders, and the epidemiology of alcohol disorders. A variety of research methodologies have been adopted to examine the relative contribution of genetic and environmental factors to alcohol dependence. Explanatory models for age and sex differences in adolescent drug use can be derived from a variety of theories, including social learning theory and social control theory. The general protocol is adapted from that developed for nicotine dependence and is a useful way to formulate the assessment process, because it translates into specific management plans. Psychological treatments are pivotal to treatment effectiveness, even when pharmacological treatments are administered. The relationships between alcoholism and other psychiatric disorders are some times complex, and it is not always easy to achieve abstinence from alcohol to make an adequate assessment of the nature of the relationship.