Emergency psychiatry and mental health policy: An International point of view

No Abstract

Malingering in clinical practice with specific reference to psychiatry and psychology

No Abstrac

Coping styles and depression in patients with systemic lupus erythematosus and rheumatoid arthritis

No Abstract

The Rotterdam Elderly Pain Observation Scale (REPOS):A new behavioral pain scale for non-communicative adults and cognitively impaired elderly persons

Several observation scales have been developed to measure pain in elderly persons with cognitive impairments. Most scales, however, do not provide cut-off scores for pain, and previous studies do not include data on non-verbal patients with diagnoses other than dementia. Objective: The development of an easy-to-use, reliable and valid pain observation scale, the Rotterdam Elderly Pain Observation Scale (REPOS), for use in nursing home residents incapable of reporting pain themselves. Methods: In this multicenter case-control study 174 residents of various cognitive levels were videotaped at rest and during a potentially painful activity. Prevalences and co- occurrences of behaviors were examined, and interrelationships were identified. To reduce number of items, multiple linear regression analysis was used. Interrater-, and intrarater agreements and internal consistency were investigated. To estimate validity, REPOS was related to Numeric Rating Scale (NRS) and Pain Assessment in Advanced Dementia-Scale (PAINAD), and activity and rest situations were compared. Results: A one-dimensional model with a good fit was found. After redundancy analysis, ten items remained. Interrater- and intrarater agreements of two observers were good. Internal consistency was moderate. Correlations between REPOS and NRS were small to medium, and between REPOS and PAINAD large. REPOS-scores for the two situations differed significantly. A total score of 3 and higher indicates pain. Conclusions: REPOS appears to be promising for identifying pain in residents of various cognitive levels. To improve pain management, a cut-off score for pain was determined, together with a treatment protocol. Its conciseness suggests good usefulness in daily practice.</p

Towards the Final Fate of an Unstable Black String

Black strings, one class of higher dimensional analogues of black holes, were shown to be unstable to long wavelength perturbations by Gregory and Laflamme in 1992, via a linear analysis. We revisit the problem through numerical solution of the full equations of motion, and focus on trying to determine the end-state of a perturbed, unstable black string. Our preliminary results show that such a spacetime tends towards a solution resembling a sequence of spherical black holes connected by thin black strings, at least at intermediate times. However, our code fails then, primarily due to large gradients that develop in metric functions, as the coordinate system we use is not well adapted to the nature of the unfolding solution. We are thus unable to determine how close the solution we see is to the final end-state, though we do observe rich dynamical behavior of the system in the intermediate stages.Comment: 17 pages, 7 figure

Virtual monochromatic dual-energy CT reconstructions improve detection of cerebral infarct in patients with suspicion of stroke

Purpose: Early infarcts are hard to diagnose on non-contrast head CT. Dual-energy CT (DECT) may potentially increase infarct differentiation. The optimal DECT settings for differentiation were identified and evaluated. Methods: One hundred and twenty-five consecutive patients who presented with suspected acute ischemic stroke (AIS) and underwent non-contrast DECT and subsequent DWI were retrospectively identified. The DWI was used as reference standard. First, virtual monochromatic images (VMI) of 25 patients were reconstructed from 40 to 140 keV and scored by two readers for acute infarct. Sensitivity, specificity, positive, and negative predictive values for infarct detection were compared and a subset of VMI energies were selected. Next, for a separate larger cohort of 100 suspected AIS patients, conventional non-contrast CT (NCT) and selected VMI were scored by two readers for the presence and location of infarct. The same statistics for infarct detection were calculated. Infarct location match was compared per vascular territory. Subgroup analyses were dichotomized by time from last-seen-well to CT imaging. Results: A total of 80–90 keV VMI were marginally more sensitive (36.3–37.3%) than NCT (32.4%; p > 0.680), with marginally higher specificity (92.2–94.4 vs 91.1%; p > 0.509) for infarct detection. Location match was superior for VMI compared with NCT (28.7–27.4 vs 19.5%; p < 0.010). Within 4.5 h from last-seen-well, 80 keV VMI more accurately detected infarct (58.0 vs 54.0%) and localized infarcts (27.1 vs 11.9%; p = 0.004) than NCT, whereas after 4.5 h, 90 keV VMI was more accurate (69.3 vs 66.3%). Conclusion: Non-contrast 80–90 keV VMI best differentiates normal from infarcted brain parenchyma

Non-contrast dual-energy CT virtual ischemia maps accurately estimate ischemic core size in large-vessel occlusive stroke

Dual-energy CT (DECT) material decomposition techniques may better detect edema within cerebral infarcts than conventional non-contrast CT (NCCT). This study compared if Virtual Ischemia Maps (VIM) derived from non-contrast DECT of patients with acute ischemic stroke due to large-vessel occlusion (AIS-LVO) are superior to NCCT for ischemic core estimation, compared against reference-standard DWI-MRI. Only patients whose baseline ischemic core was most likely to remain stable on follow-up MRI were included, defined as those with excellent post-thrombectomy revascularization or no perfusion mismatch. Twenty-four consecutive AIS-LVO patients with baseline non-contrast DECT, CT perfusion (CTP), and DWI-MRI were analyzed. The primary outcome measure was agreement between volumetric manually segmented VIM, NCCT, and automatically segmented CTP estimates of the ischemic core relative to manually segmented DWI volumes. Volume agreement was assessed using Bland–Altman plots and comparison of CT to DWI volume ratios. DWI volumes were better approximated by VIM than NCCT (VIM/DWI ratio 0.68 ± 0.35 vs. NCCT/DWI ratio 0.34 ± 0.35; P < 0.001) or CTP (CTP/DWI ratio 0.45 ± 0.67; P < 0.001), and VIM best correlated with DWI (r VIM = 0.90; r NCCT = 0.75; r CTP = 0.77; P < 0.001). Bland–Altman analyses indicated significantly greater agreement between DWI and VIM than NCCT core volumes (mean bias 0.60 [95%AI 0.39–0.82] vs. 0.20 [95%AI 0.11–0.30]). We conclude that DECT VIM estimates the ischemic core in AIS-LVO patients more accurately than NCCT

Sex Differences in Poststroke Cognitive Impairment: A Multicenter Study in 2343 Patients With Acute Ischemic Stroke

BACKGROUND: Poststroke cognitive impairment (PSCI) occurs in about half of stroke survivors. Cumulative evidence indicates that functional outcomes of stroke are worse in women than men. Yet it is unknown whether the occurrence and characteristics of PSCI differ between men and women. METHODS: Individual patient data from 9 cohorts of patients with ischemic stroke were harmonized and pooled through the Meta-VCI-Map consortium (n=2343, 38% women). We included patients with visible symptomatic infarcts on computed tomography/magnetic resonance imaging and cognitive assessment within 15 months after stroke. PSCI was defined as impairment in ≥1 cognitive domains on neuropsychological assessment. Logistic regression analyses were performed to compare men to women, adjusted for study cohort, to obtain odds ratios for PSCI and individual cognitive domains. We also explored sensitivity and specificity of cognitive screening tools for detecting PSCI, according to sex (Mini-Mental State Examination, 4 cohorts, n=1814; Montreal Cognitive Assessment, 3 cohorts, n=278). RESULTS: PSCI was found in 51% of both women and men. Men had a lower risk of impairment of attention and executive functioning (men: odds ratio, 0.76 [95% CI, 0.61-0.96]), and language (men: odds ratio, 0.67 [95% CI, 0.45-0.85]), but a higher risk of verbal memory impairment (men: odds ratio, 1.43 [95% CI, 1.17-1.75]). The sensitivity of Mini-Mental State Examination (<25) for PSCI was higher for women (0.53) than for men (0.27; P=0.02), with a lower specificity for women (0.80) than men (0.96; P=0.01). Sensitivity and specificity of Montreal Cognitive Assessment (<26.) for PSCI was comparable between women and men (0.91 versus 0.86; P=0.62 and 0.29 versus 0.28; P=0.86, respectively). CONCLUSIONS: Sex was not associated with PSCI occurrence but affected domains differed between men and women. The latter may explain why sensitivity of the Mini-Mental State Examination for detecting PSCI was higher in women with a lower specificity compared with men. These sex differences need to be considered when screening for and diagnosing PSCI in clinical practice

Sex Differences in Poststroke Cognitive Impairment : A Multicenter Study in 2343 Patients With Acute Ischemic Stroke

Funding Information: Dr Exalto is supported by Alzheimer Nederland WE.03-2019-15 and Netherlands CardioVascular Research Initiative: the Dutch Heart Foundation (CVON 2018-28 & 2012-06). The Meta-VCI Map consortium is supported by Vici Grant 918.16.616 from The Netherlands Organisation for Health Research and Development (ZonMw) to Dr Biessels. Harmonization analyses were supported by a Rudolf Magnus Young Talent Fellowship from the University Medical Center Utrecht Brain Center to Dr Biesbroek. The CASPER cohort was supported by Maastricht University, Health Foundation Limburg, and Stichting Adriana van Rinsum-Ponsen. The CROMIS-2 cohort was funded by the UK Stroke Association and the British Heart Foundation (grant number TSA BHF 2009/01). The CU-STRIDE cohort was supported by the Health and Health Services Research Fund of the Food and Health Bureau of the Government of Hong Kong (grant number 0708041), the Lui Che Woo Institute of Innovative Medicine, and Therese Pei Fong Chow Research Center for Prevention of Dementia. The GRECogVASC cohort was funded by Amiens University Hospital and by a grant from the French Ministry of Health (grant number DGOS R1/2013/144). The MSS-2 cohort is funded by the Wellcome Trust (grant number WT088134/Z/09/A to Dr Wardlaw) and the Row Fogo Charitable Trust. The PROCRAS cohort was funded via ZonMW as part of the TopZorg project in 2015 (grant number 842003011). The CODECS cohort (ongoing) is supported by a grant from Stichting Coolsingel (grant number 514). The Bundang VCI and Hallym VCI cohort groups do not wish to report any relevant funding sources. At the time of contribution, Dr Hamilton was funded by the College of Medicine and Veterinary Medicine at the University of Edinburgh and was supported by the Wellcome Trust through the Translational Neuroscience PhD program at the University of Edinburgh. Publisher Copyright: © 2023 Lippincott Williams and Wilkins. All rights reserved.Peer reviewedPublisher PD