Psychosocial and Biological Factors Contributing to Body Weight Gain in Schizophrenia

Overweight and obesity are frequently reported to be a significant issue in schizophrenia resulting in the inherent complications of these disorders. Body weight gain also commonly results from treatment with the most tolerable and efficacious pharmacological treatments, second-generation antipsychotics. However there are numerous other factors that contribute to increased body mass in individuals with schizophrenia prior to the initiation of treatment. With prior research indicating that individuals with schizophrenia have higher rates of overweight and obesity before treatment. Therefore this article provides a review of pertinent issues associated with body weight gain in schizophrenia in an attempt to delineate the impact of both the disease and treatment upon body weight gain. The results of the review indicate that body weight gain in schizophrenia occurs from both psychosocial and biological factors that are further compounded by antipsychotic treatment. The article concludes with recommendations for future research

Prevalence & Prescription: Prescribing Practices of Clozapine in Australia between 2005 & 2010

Clozapine is an anti-psychotic used to treat refractory schizophrenia. This study reviews the rates of clozapine prescription for refractory schizophrenia in a region of Australia and compares the prescribing patterns to the estimated prevalence rates of refractory schizophrenia in the region. Utilising a pharmacoepidemiological approach; the results indicated that only 8.4% of the individuals estimated to be suffering from refractory schizophrenia in the region were prescribed clozapine between 2005 and 2010, with only 4.1% continuing clozapine to the conclusion of the study. In conclusion it is evident that clozapine is widely under-prescribed in this area of Australia

A Qualitative Analysis of Medical Students' Views of Their First Psychiatry Rotation

Objective: The importance of student’s perspectives in informing curricula and pedagogy has long been recognised. However, student’s perspectives are rarely reported in the academic literature. Therefore this study explores and reports on medical student’s perspectives of their first psychiatry clinical rotation in a ‘new’ era medical school in Australia. Method: Seventy-three graduate entry medical students completed a semi-structured questionnaire about their experiences during a mental health rotation. The responses were analysed and coded into thematic categories. Results: The following thematic categories were evident; staff, breadth of experience, attitudes towards mental health, course materials and structure, and professional development. Conclusion: The results are discussed in the context of the current academic recommendations for the teaching of psychiatry and behavioural science to medical students. Although the use of student feedback is recommended by the literature, pragmatically it is rarely utilised and if it is utilised it is not reported in the academic literature. It is recommended that educators embrace the use of student’s perspectives to evaluate and inform their teaching

Biology of Sexual Dysfunction

Sexual activity is a multifaceted activity, involving complex interactions between the nervous system, the endocrine system, the vascular system and a variety of structures that are instrumental in sexual excitement, intercourse and satisfaction. Sexual function has three components i.e., desire, arousal and orgasm. Many sexual dysfunctions can be categorized according to the phase of sexual response that is affected. In actual clinical practice however, sexual desire, arousal and orgasmic difficulties more often than not coexist, suggesting an integration of phases. Sexual dysfunction can result from a wide variety of psychological and physiological causes including derangements in the levels of sex hormones and neurotrensmitters. This review deals with the biology of different phases of sexual function as well as implications of hormones and neurotransmitters in sexual dysfunctio

The Association between Household Socioeconomic Position and Prevalent Tuberculosis in Zambia: A Case-Control Study

BACKGROUND: Although historically tuberculosis (TB) has been associated with poverty, few analytical studies from developing countries have tried to: 1. assess the relative impact of poverty on TB after the emergence of HIV; 2. explore the causal mechanism underlying this association; and 3. estimate how many cases of TB could be prevented by improving household socioeconomic position (SEP). METHODS AND FINDINGS: We undertook a case-control study nested within a population-based TB and HIV prevalence survey conducted in 2005-2006 in two Zambian communities. Cases were defined as persons (15+ years of age) culture positive for M. tuberculosis. Controls were randomly drawn from the TB-free participants enrolled in the prevalence survey. We developed a composite index of household SEP combining variables accounting for four different domains of household SEP. The analysis of the mediation pathway between household SEP and TB was driven by a pre-defined conceptual framework. Adjusted Population Attributable Fractions (aPAF) were estimated. Prevalent TB was significantly associated with lower household SEP [aOR = 6.2, 95%CI: 2.0-19.2 and aOR = 3.4, 95%CI: 1.8-7.6 respectively for low and medium household SEP compared to high]. Other risk factors for prevalent TB included having a diet poor in proteins [aOR = 3.1, 95%CI: 1.1-8.7], being HIV positive [aOR = 3.1, 95%CI: 1.7-5.8], not BCG vaccinated [aOR = 7.7, 95%CI: 2.8-20.8], and having a history of migration [aOR = 5.2, 95%CI: 2.7-10.2]. These associations were not confounded by household SEP. The association between household SEP and TB appeared to be mediated by inadequate consumption of protein food. Approximately the same proportion of cases could be attributed to this variable and HIV infection (aPAF = 42% and 36%, respectively). CONCLUSIONS: While the fight against HIV remains central for TB control, interventions addressing low household SEP and, especially food availability, may contribute to strengthen our control efforts

Natural History of Tuberculosis: Duration and Fatality of Untreated Pulmonary Tuberculosis in HIV Negative Patients: A Systematic Review

Background The prognosis, specifically the case fatality and duration, of untreated tuberculosis is important as many patients are not correctly diagnosed and therefore receive inadequate or no treatment. Furthermore, duration and case fatality of tuberculosis are key parameters in interpreting epidemiological data. Methodology and Principal Findings To estimate the duration and case fatality of untreated pulmonary tuberculosis in HIV negative patients we reviewed studies from the pre-chemotherapy era. Untreated smear-positive tuberculosis among HIV negative individuals has a 10-year case fatality variously reported between 53% and 86%, with a weighted mean of 70%. Ten-year case fatality of culture-positive smear-negative tuberculosis was nowhere reported directly but can be indirectly estimated to be approximately 20%. The duration of tuberculosis from onset to cure or death is approximately 3 years and appears to be similar for smear-positive and smear-negative tuberculosis. Conclusions Current models of untreated tuberculosis that assume a total duration of 2 years until self-cure or death underestimate the duration of disease by about one year, but their case fatality estimates of 70% for smear-positive and 20% for culture-positive smear-negative tuberculosis appear to be satisfactory

Myocardial tagging by Cardiovascular Magnetic Resonance: evolution of techniques--pulse sequences, analysis algorithms, and applications

Cardiovascular magnetic resonance (CMR) tagging has been established as an essential technique for measuring regional myocardial function. It allows quantification of local intramyocardial motion measures, e.g. strain and strain rate. The invention of CMR tagging came in the late eighties, where the technique allowed for the first time for visualizing transmural myocardial movement without having to implant physical markers. This new idea opened the door for a series of developments and improvements that continue up to the present time. Different tagging techniques are currently available that are more extensive, improved, and sophisticated than they were twenty years ago. Each of these techniques has different versions for improved resolution, signal-to-noise ratio (SNR), scan time, anatomical coverage, three-dimensional capability, and image quality. The tagging techniques covered in this article can be broadly divided into two main categories: 1) Basic techniques, which include magnetization saturation, spatial modulation of magnetization (SPAMM), delay alternating with nutations for tailored excitation (DANTE), and complementary SPAMM (CSPAMM); and 2) Advanced techniques, which include harmonic phase (HARP), displacement encoding with stimulated echoes (DENSE), and strain encoding (SENC). Although most of these techniques were developed by separate groups and evolved from different backgrounds, they are in fact closely related to each other, and they can be interpreted from more than one perspective. Some of these techniques even followed parallel paths of developments, as illustrated in the article. As each technique has its own advantages, some efforts have been made to combine different techniques together for improved image quality or composite information acquisition. In this review, different developments in pulse sequences and related image processing techniques are described along with the necessities that led to their invention, which makes this article easy to read and the covered techniques easy to follow. Major studies that applied CMR tagging for studying myocardial mechanics are also summarized. Finally, the current article includes a plethora of ideas and techniques with over 300 references that motivate the reader to think about the future of CMR tagging