Evidence-based pharmacotherapy of panic disorder

This paper reviews the literature on the pharmacotherapy of panic disorder, in order to address the questions (1) what is the first-line pharmacotherapy of choice for panic disorder?, (2) for how long should maintenance pharmacotherapy be continued, and (3) what is the optimal approach to the treatment-refractory patient with panic disorder. A MEDLINE search (1966-2003) was undertaken to collate randomized controlled trials of pharmacotherapy in panic disorder. A review of the evidence indicates that SSRIs are currently the first line agent of choice in panic disorder, and that pharmacotherapy should be continued for at least 1 year. There has been relatively little research on the pharmacotherapy of treatment-refractory panic disorder, and this area requires future attentio

Experiences of psychosocial and programme-related barriers to recovery in lifestyle interventions for noncommunicable diseases

Background: The majority of global deaths are due to noncommunicable diseases, largely preventable and treatable utilising behavioural interventions.Objectives: The study investigated patients’ experiences of a lifestyle intervention programme for noncommunicable diseases (NCDs), and the influence that psychosocial and programme-related barriers had on patients’ ability to improve their well-being.Methods: Fourteen patients with NCDs were interviewed before and on completion of a 12-week lifestyle intervention programme at a sports and exercise medicine clinic. Thematic analysis techniques were used to analyse interview data.Results: Patients described their experiences of NCDs diagnosis as traumatic, and their own relationship with their bodies and with the disorder(s) to be vulnerable and significantly challenging. Professional incompetence and unethical treatment were included as barriers to recovery. Barriers specifically relating to the programme included scheduling, as well as the online assessment component. Those reporting more premorbid psychosocial barriers were more likely to experience current complications, whether disease- or treatment-related, often emphasising the negative influence of programme and professional-related problems.Conclusion: Qualitative methodologies enabled the study to yield clinically relevant insights with respect to patients with NCDs. Accounting for the trauma and vulnerability experienced by this cohort may assist in the development of more patient-centred interventions and sustainable secondary prevention of NCDs.Keywords: chronic diseases of lifestyle; intervention evaluation; psychological risk factors; social support; professional conduc

Heroin detoxification during pregnancy: A systematic review and retrospective study of the management of heroin addiction in pregnancy

Background. There is general consensus that methadone maintenance is the gold standard in the management of pregnant heroin users. However, in South African state hospitals, methadone withdrawal is the routine procedure offered to these patients, as methadone maintenance programmes are unavailable in the public sector.Objectives. To conduct a systematic review of the literature on heroin detoxification in pregnancy, and to document pregnancy outcomes in heroin users detoxified with methadone at Groote Schuur Hospital (GSH), Cape Town, from 2006 to 2010.Methods. A literature search was undertaken to identify key publications on the management of heroin addiction in pregnancy. Patients for the study were identified from the GSH methadone registry, and data were collected from the clinical files.Results. A total of 20 relevant publications were identified and reviewed. Early case reports described an increased risk of stillbirths and fetal distress after methadone detoxification, but more recent case series involving larger numbers of patients showed positive outcomes. In our study, six pregnant patients received methadone withdrawal over a 5-year period at GSH, and all the neonates had good Apgar scores and were discharged home within 3 days of delivery.Conclusions. There is limited evidence on the management of heroin addiction during pregnancy, and the only two guidelines identified suggest that methadone maintenance is preferable to methadone withdrawal. The favourable pregnancy outcomes in this small sample of patients managed with methadone withdrawal suggest that it may be safe and deserves further study

Transitions between lifetime alcohol use, regular use and remission: Results from the 2004 South African Stress and Health Survey

Background. Hazardous alcohol consumption presents a serious threat to the health and wellbeing of all people and is linked to chronic and acute health problems.Objectives. To: (i) estimate the prevalence of alcohol use disorders and remission from alcohol abuse and dependence in the South African (SA) population; and (ii) determine whether age of onset, education, sex and level of cohort alcohol use are associated with commencement of use, regularity of use, and transitions to and remission from more harmful levels of use.Methods. The study was a nationally representative sample of 4 315  individuals aged ≥18 years. In a multistage, area probability sample of adults, data were collected from 4 311 alcohol users using the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview version 3.0. All analyses were carried out using SAS version 9.4.Results. Of the respondents, 40.6% indicated lifetime use of alcohol,  35.3% reported regular use, and 8.8% met diagnostic criteria for alcohol abuse and 2.7% for alcohol dependence. The prevalence of remission from lifetime abuse without dependence was 55.9%. The median age of onset of alcohol use was 20 years, with transition from use to regular use occurring within ~1 - 3 years. The results suggest that males, students (compared with those who had completed a high level of education) and greater  alcohol use in the respondent’s birth cohort were all associated with increased odds of commencing alcohol use. For transitions from use to regular use, increased odds were associated with males, greater birth cohort alcohol use, low education and later (>21 years) onset of first alcohol use.Conclusions. Our findings suggest that cohort alcohol use is associated with transition to commencement of use and from use to regular use in the general SA population. The study further highlighted the need for  interventions among males and university students, given that hazardous alcohol consumption seems to be the most prevalent public health issue encountered by university students and males

Is induction of very rapid sustained VT significant in patients with syncope?

Review of: Santos Rego, M. A. (Ed.) (2016). A investigación educativa en Galicia 2002-2014. Vigo: Galaxia. 518 pp. ISBN: 978-84-9865-697-8. Depósito legal: VG 253-2016.This is a work that gathers the main contributions to educational research in Galicia between 2002 and 2014. They listed the main point made research, doctoral theses, books, chapters of books/monographs, articles published in relation to the main areas and core themes related to education as psychology and education, learning disabilities, developmental disorders, educational technology, teacher training, theoretical, philosophical and sociological foundations of education; teaching, school organization and educational innovation... This is a work/book aimed at anyone interested in educational issues in different areas and with the aim of adapting education to social needs Galicia today. Reseña de: Santos Rego, M. A. (Ed.) (2016). A investigación educativa en Galicia 2002-2014. Vigo: Galaxia. 518 pp. ISBN: 978-84-9865-697-8. Depósito legal: VG 253-2016.Se trata de la obra que recoge las principales aportaciones a la investigación educativa en Galicia entre los años 2002 y 2014. Se relacionan las principales investigaciones realizadas, las tesis doctorales leídas,  los libros, capítulos de libros/monografías, artículos publicados en relación con las principales áreas y núcleos temáticos relacionados con la educación como, entre otras, la psicología y la educación, las dificultades de aprendizaje, trastornos del desarrollo, tecnología educativa, formación de profesores, fundamentos teóricos, filosóficos y sociológicos de la educación; didáctica,  organización escolar e innovación educativa… Es una obra dirigida a toda persona interesada por los temas educativos en sus diferentes ámbitos y con el objetivo de adecuar la educación en Galicia  a las necesidades sociales en la actualidad

Визначення правового статусу садівницьких, городницьких та дачних товариств

Розкриваються особливості правового статусу садівницьких, городницьких та дач­них товариств, досліджується їх організаційно-правова форма та ті специфічні пра­вові ознаки, що знаходяться в її основі. У зв’язку з відсутністю правової бази діяль­ності цих товариств, робиться спроба сформувати основні теоретико-правові кон­цептуальні підходи до розуміння їх природи та змоделювати законодавчу схему регулювання їх діяльності.Раскрываются особенности правового статуса садоводческих, огороднических и дачных товариществ, исследуются их организационно-правовая форма и правовые особенности, составляющие ее основание. В связи с отсутствием правовых обоснований деятельности этих товариществ автор стремится сформировать основные теоре­тико-правовые концептуальные подходы к раскрытию их сущности и смоделировать законодательную схему регулирования деятельности рассматриваемых товариществ.In article features of legal status of garden, vegetable-garden and country companies reveal, their organizational legal form and those specific features that are in its basis are investigated. In connection with absence of legal base of activity of these communities is attempted to generate the basic theoretical-legal conceptual approaches to understanding of their nature and model legislative sphere of regulation of their activity becomes

The intrinsic charm contribution to the proton spin

The charm quark contribution to the first moment of $g_1(x,Q^2)$ is calculated using a heavy mass expansion of the divergence of the singlet axial current. It is shown to be small.Comment: LATEX, 6 page

Psychopathology and coping in recently diagnosed HIV/AIDS patients- the role of gender

Background. Although there is growing literature on the psychological responses to and the psychopathology associated with HIV/AIDS, few investigations have focused on the role of gender. This study compared psychiatric morbidity, coping responses, and disability in male and female outpatients recently diagnosed with HIV/AIDS.Method. One hundred and forty-nine patients (44 male, 105 female) with HIV/AIDS (mean ± standard deviation (SD) months since diagnosis 5.8 ± 4.1) attending an infectious diseases clinic at Tygerberg Hospital, Cape Town, were evaluated. Subjects were assessed using the MINI International Neuropsychiatric Interview (MINI), the Carver Brief COPE, and the Sheehan Disability Scale. In addition, negative life events and risk behaviours were evaluated.Results. Fifty-six per cent of patients were diagnosed with a psychiatric disorder, most commonly major depression (34.9%), dysthymic disorder (21.5%), post-traumatic stress disorder (14.8%), and alcohol dependence (10.1 %). There were no significant gender differences in the prevalence of mood disorders in the sample. Men, however, were more likely than women to meet diagnostic criteria for alcohol abuse or dependence, and to engage in certain risky sexual behaviours. Women were more likely to suffer from post-traumatic stress disorder, and to use coping strategies of planning and religion to deal with the illness. There were no significant gender differences in disability.Conclusion. Psychiatric disorders are common in recently diagnosed HIV/AIDS patients in South Africa. Clinicians should be aware of the high prevalence of mood disorders in both men and women, and of gender-different responses such as increased alcohol and substance use and more risky sexual behaviour in men