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BACKGROUND: Although it is generally agreed that personality disorders are an important topic in old-age psychiatry, DSM-5 has paid relatively little attention to older persons affected with this severe mental disorder. AIM: To look closely and carefully at several aspects of the way in which DSM-5 defines personality disorders relating to older persons. METHOD: We make a critical evaluation of the description of personality disorders given in DSM-5. RESULTS: First of all, we question whether the phrase 'personality change due to another medical condition' should really be included in the dsm-5 chapter of personality disorders because a personality change actually has the features of a persistent conduct disorder. Secondly, we argue that in a future revised version of dsm-5 personality disorders affecting older persons should be referred to specifically as 'late-onset' personality disorders. Thirdly, we stress that the research programme relating to the dimensional dsm-5 model of personality disorders should involve a larger number of older persons. In addition, more research is needed with regard to the use, wording and validity of the phrase 'personality change due to a medical condition'. Those responsible for the revision of the DSM-5 should ensure that the concept 'late-onset personality disorders' is incorporated in the text. CONCLUSION: The description of personality disorders in DSM-5 is confusing. This is probably due to the transitional period between the old categorical (dsm-iv) system and the newly proposed dimensional approach to personality disorders in DSM-5, an approach that needs further investigation. However, this intervening period could be a good opportunity for doing further research into personality disorders in older adults

Fitness correlates of male coloration in a Lake Victoria cichlid fish

Sexual selection by female choice has contributed to the rapid evolution of phenotypic diversity in the cichlid fish species flocks of East Africa. Yet, very little is known about the ecological mechanisms that drive the evolution of female mating preferences. We studied fitness correlates of male nuptial coloration in a member of a diverse Lake Victoria cichlid lineage, Pundamilia nyererei. In this species, male red coloration is subject to intraspecific sexual selection by female mate choice. Male nuptial coloration plays a critical role also in reproductive isolation between this species and the closely related sympatric species P. pundamilia. Here, we show that P. nyererei male coloration is carotenoid based, illustrating the potential for honest signaling of individual quality. In a wild population, we found that variation in male coloration was not associated with variation in a set of strongly intercorrelated indicators of male dominance: male size, territory size, and territory location. Instead, the 2 male characters that predominantly determine female choice, territory size and red coloration, may be independent predictors of male quality: males with bright red coloration and large territories had lower parasite infestation rates. As a result, female preferences tended to select against heavily parasitized males. Consistent with parasite-mediated sexual selection, males had higher and more variable parasite loads than female

The spliceosome as target for anticancer treatment

The spliceosome is a ribonucleoprotein complex involved in RNA splicing, that is, the removal of non-coding introns from precursor messenger RNA. (Alternative) Splicing events may play an essential role in tumourigenesis. The recent discovery that the spliceosome is a target for novel compounds with anticancer activity opens up new therapeutic avenues

Strengths and Weaknesses for Climate Change: Adaptation in Water Governance: A Comparison Across Six European Regions

This chapter comparatively analyses the policy and governance contexts of six European regions that are affected by different hydrological impacts of climate change. The results demonstrate that a major governance strength across regions lies in the organization of management capacities to deal with existing water-related risks. For example, the Dutch context focuses on water safety, Cyprus has a clear policy framework to deal with water scarcity and in the Norwegian city of Bergen, wastewater is well managed. As a consequence of this focus on present-day risks, climate adaptation governance also focuses on historical risks. New or exacerbated risks posed by climate change remain largely untreated, and responsibilities for dealing with climate-related risks remain unspecified, as also becomes clear in the German and Spanish cases. A high degree of governmental fragmentation is identified as another point of weakness. Identified most clearly in the Portuguese case but recognizable in all regional contexts, different subdomains of water management are dealt with under separate policies and are governed by different responsible agencies. Consequently, information about current performance of the water system is scattered and coordinative efforts, which are key to developing adaptation strategies, are hampered

Physical activity for people living with dementia: carer outcomes and side effects from the perspectives of professionals and family carers

Adherence to physical activity is challenging for people living with dementia, and largely dependent on carers' involvement. Carers are likely to support physical activity based on their perceived balance between benefits and potential side effects of such intervention for both patients and themselves. Professionals also have a role in terms of optimising such interventions not only for people with dementia but also their carers.publishe

The Risk of QTc-Interval Prolongation in Breast Cancer Patients Treated with Tamoxifen in Combination with Serotonin Reuptake Inhibitors

Purpose: Antidepressants like the serotonin reuptake inhibitors (SRIs) are often used concomitantly with tamoxifen (e.g. for treatment of depression). This may lead to an additional prolongation of the QTc-interval, with an increased risk of cardiac side effects. Therefore we investigated whether there is a drug-drug interaction between tamoxifen and SRIs resulting in a prolonged QTc-interval. Methods: Electrocardiograms (ECGs) of 100 patients were collected at steady state tamoxifen treatment, with or without concomitant SRI co-medication. QTc-interval was manually measured and calculated using the Fridericia formula. Primary outcome was difference in QTc-interval between tamoxifen monotherapy and tamoxifen concomitantly with an SRI. Results: The mean QTc-interval was 12.4 ms longer when tamoxifen was given concomitantly with an SRI (95% CI:1.8–23.1 ms; P = 0.023). Prolongation of the QTc-interval was particularly pronounced for paroxetine (17.2 ms; 95%CI:1.4–33.0 ms; P = 0.04), escitalopram (12.5 ms; 95%CI:4.4–20.6 ms; P 500 ms. Conclusions: Concomitant use of tamoxifen and SRIs resulted in a significantly higher mean QTc-interval, which was especially the case for paroxetine, escitalopram and citalopram. When concomitant administration with an SRI is warranted venlafaxine is preferred

Prognostic factors in men with metastatic castration-resistant prostate cancer treated with cabazitaxel

Background: Treatment selection for men with metastatic castration-resistant prostate cancer (mCRPC) has become increasingly challenging with the introduction of novel therapies at earlier disease stages. The purpose of this study was to identify prognostic factors for overall survival (OS) and PSA response in patients with mCRPC treated with cabazitaxel. Results: 224 mCRPC patients were included in the current analysis. In multivariable analysis, WHO performance status, baseline hemoglobin, alkaline phosphatase and albumin were all significantly associated with OS. Hemoglobin and alkaline phosphatase were significantly associated with PSA response. Conclusions: This study identified prognostic factors for OS and PSA response of men with mCRPC treated with cabazitaxel. In an increasingly complicated treatment landscape with several treatment options available our findings might serve to estimate the chance of survival of men qualifying for treatment with second-line chemotherapy in daily practice. Furthermore, these data can be used to risk-stratify patients in clinical trials. Methods: We performed a post-hoc analysis of a randomized phase II trial of mCRPC patients treated with cabazitaxel. Cox and logistic regression models were used to investigate the influence of clinical and biochemical variables on OS and PSA response. Nomograms were developed to estimate the chance of PSA response and OS