Disorder Clinic (disorder + clinic)

Distribution by Scientific Domains

Selected Abstracts

Intimate Partner and General Aggression Perpetration Among Combat Veterans Presenting to a Posttraumatic Stress Disorder Clinic

Casey T. Taft PhD
This study examined rates and correlates of intimate partner and general aggression perpetration among 236 male combat veterans seeking services in a Veteran's Affairs posttraumatic stress disorder (PTSD) clinic. Approximately 33% of those in an intimate relationship reported perpetrating partner physical aggression in the previous year, and 91% reported partner psychological aggression. Comparable rates were found for general aggression perpetration among partnered and nonpartnered veterans. PTSD symptoms as well as symptoms of depression were associated with aggression across subgroups and forms of aggression, and PTSD symptoms reflecting arousal and lack of control were generally the strongest predictor of aggression. Findings indicate a need for additional aggression screening and intervention development for this population, and highlight the targeting of heightened arousal and lack of behavioral control in aggression interventions. [source]

Hepatitis A and B immunization for individuals with inherited bleeding disorders

HAEMOPHILIA, Issue 2 2009
Summary., Hepatitis A and B vaccines are highly effective tools that can greatly reduce infection risk in the bleeding disorder population. Although hepatitis A and B immunization for individuals with bleeding disorders is universally recommended, various advisory bodies often differ with respect to many practical aspects of vaccination. To review the published literature and guidelines and form a practical, comprehensive and consistent approach to hepatitis A and B immunization for individuals with bleeding disorders. We reviewed published immunization guidelines from North American immunization advisory bodies and published statements from North American and international haemophilia advisory bodies. A search of the MEDLINE database was performed to find original published literature pertaining to hepatitis A or B immunization of patients with haemophilia or bleeding disorder patients that provided supporting or refuting evidence for advisory body guidelines. Various advisory bodies' immunization guidelines regarding individuals with bleeding disorders have contradictory statements and often did not clarify issues (e.g. post vaccination surveillance). Published literature addressing immunization in bleeding disorder patients is sparse and mostly examines route of vaccine administration, complications and corresponding antibody response. Although the risk of hepatitis A and B infection is low, the use of simple measures such as vaccination is reasonable and advocated by haemophilia advisory bodies. Following our review of the available literature and North American guidelines, we have developed comprehensive and practical recommendations addressing hepatitis A and B immunization for the bleeding disorder population that may be applicable in Bleeding Disorder clinics. [source]

Identifying functional impairment with scores from the repeatable battery for the assessment of neuropsychological status (RBANS)

Valerie L. Hobson
Abstract Objective To examine the link between RBANS scores and functional impairment. Functional status was evaluated through informant report using the clinical dementia rating (CDR) scale. Methods Archival data were reviewed from records of 99 patients in a memory disorder clinic (MDC) research database. Consensus-based diagnoses were Alzheimer's disease (AD; n,=,48), mild cognitive impairment (MCI; n,=,48), AD with vascular components; (n,=,2) and dementia due to psychiatric conditions (n,=,1). Results The RBANS language index score was significantly related to CDR domain scores of community affairs (p,<,.01), home and hobbies (p,<,.01), personal care (p,<,.05), memory (p,<,0.01), and judgment (p,<,0.01). RBANS immediate memory index scores were significantly related to (p,<,0.05) the CDR Memory and judgment and problem solving domains. Based on these findings, follow-up regressions were conducted. Semantic fluency was significantly related to CDR memory (p,<,0.01), judgment (p,<,0.05), community affairs (p,<,0.05), home/hobbies (p,<,0.05), and personal care (p,<,0.05) functional domains. Picture naming was significantly related to the CDR personal care domain (p,<,0.05). List learning was significantly related to CDR memory functional domain (p,<,0.01) and judgment (p,<,0.05). Lastly, story memory was significantly related to the CDR judgment domain (p,<,0.05). Conclusions The RBANS may be an indicator of functional impairment as well as a neuropsychological testing tool. The use of the RBANS could reduce the amount of testing that is administered to the patient, or can provide a way to compare other measurements of functional impairment to assess accuracy of findings. Copyright 2009 John Wiley & Sons, Ltd. [source]

Cognitive Screening Using a Tape Recorder: A Pilot Study

Peter W. Schofield MD
OBJECTIVES: To determine whether a tape recorder can be used to administer cognitive tests efficiently and yield valid results. DESIGN: Convenience sample. Administration of cognitive test materials by tape recorder and conventional technique. SETTING: Outpatient clinic. PARTICIPANTS: Subjects from memory disorder clinic, hostel accommodation, and community. MEASUREMENTS: Responses to Hopkins Verbal Learning Test,revised, verbal fluency items from the controlled oral word association test, 10-item naming task, a construction task, and speed writing task. RESULTS: Performances on the tape- and clinician-administered battery of tests were highly correlated. Memory impairment was accurately detected using the tape battery. Data from 30 minutes of testing via tape were obtained at the cost to the clinician of 2 to 3 minutes of scoring time. CONCLUSION: Tape-administration of cognitive test material warrants further study as an efficient means of cognitive screening. [source]

Alcohol Use Disorders and Anxiety Disorders: Relation to the P300 Event-Related Potential

ALCOHOLISM, Issue 9 2001
Mary-Anne Enoch
Background: The robust association of alcoholism with reduced P300 event-related potential amplitude has been largely established in severely affected alcoholics and their offspring. Few studies have examined the relationship of increased arousal, anxiety, and P300. In this study, we sought to determine whether P300 group differences could be discerned in well functioning individuals with less severe forms of alcohol use disorders and anxiety disorders. We were particularly interested in looking at the subgroup of alcohol use disorders accompanied by anxiety disorders. This subgroup has previously been found to have diminished , amplitude in the resting EEG. Methods: Male and female community volunteers (99 unrelated index participants and 78 relatives) and 21 unrelated volunteers from an anxiety disorder clinic were interviewed by using the Schedule for Affective Disorders and Schizophrenia, Lifetime version. Blind-rated lifetime psychiatric diagnoses were assigned according to DSM-III-R criteria. Auditory and visual P300 event-related potentials were elicited with an oddball paradigm and were recorded at the midparietal (Pz) site. Results: As expected, auditory P300 amplitudes were significantly reduced in participants with alcohol use disorders and significantly increased in participants with lifetime anxiety disorders. However, more detailed analysis revealed that, in an apparent paradox, auditory P300 amplitudes were lowest in individuals with comorbid alcohol use and anxiety disorders and highest in individuals with anxiety disorders alone. Visual P300 amplitudes followed the same trends but were generally not significant. Conclusions: Even in a sample of largely community-ascertained individuals, auditory P300 amplitude is reduced in alcoholics, particularly those with anxiety disorders, and is highest in nonalcoholics with anxiety disorders. [source]

"Jerky" dystonia in children: Spectrum of phenotypes and genetic testing,

Friedrich Asmus MD
Abstract Hyperkinetic dystonia is characterized by phasic, tremulous, and "jerky" movements in addition to twisting postures. We studied longitudinally 23 index patients with hyperkinetic dystonia from a quaternary pediatric movement disorder clinic in Ireland. Four clinical categories emerged: (1) Eight patients were diagnosed with myoclonus-dystonia, of whom seven carried heterozygous epsilon sarcoglycan (SGCE) mutations, including a novel deletion of exon 10. Gait disorder, unsteadiness, or frequent falls before 18 months were detected in all SGCE mutation carriers, whereas the typical neck-predominant presentation developed only years later. (2) One patient classified as benign hereditary chorea, because jerks were choreiform and continuous rather than action-induced, carried a heterozygous stop mutation of the TITF -1 gene (Y114X, exon 2). (3) Three mutation-negative patients were grouped as "myoclonic dystonia" with jerks only in the body regions affected by dystonia. (4) Eleven patients presented with a novel combination of dystonia and low amplitude poly-mini myoclonus of the upper limbs and pectoral muscles (D-PMM). In early childhood up to 3 years of age, an initial presentation with predominant gait impairment with only subtle jerks should prompt consideration of SGCE mutation analysis in addition to testing for DYT1 mutations. A causative gene for D-PMM remains to be identified. 2008 Movement Disorder Society [source]

Translation and validation of the standard Chinese version of PDQ-39: A quality-of-life measure for patients with Parkinson's disease

Kin-Lun Tsang MBBS
Abstract PDQ-39 has been widely used in the research and clinical management of Parkinson's disease. It has been translated into and validated in various non-English languages. We report here on the validity and reliability results for the translated standard Chinese PDQ-39 questionnaire. Fifty-four patients were recruited from a movement disorder clinic and two regional patient groups, and data were collected by direct interview. Nineteen patients had the tests repeated 4 weeks later to assess the test,retest and interrater reliability. The standard Chinese version of PDQ-39 demonstrated acceptable internal consistency (Cronbach's , = 0.54,0.90) and was comparable to versions in other languages. Further analysis showed good construct validity and test,retest reliability. Implications and limitations of the study are discussed. 2002 Movement Disorder Society [source]

Factors associated with the temporomandibular disorder, pain dysfunction syndrome (PDS): Manchester case,control study

ORAL DISEASES, Issue 6 2001
TV Macfarlane
OBJECTIVES:,To determine the individual and combined effects of potential risk factors in relation to the temporomandibular disorder, Pain Dysfunction Syndrome (PDS). DESIGN:,Case,control study. MATERIAL AND METHODS:,Cases were new referrals to the temporomandibular disorder clinic of the University Dental Hospital of Manchester, diagnosed with PDS. Controls were randomly selected from 24 dental practices. Using a postal questionnaire information was collected on socio-demographic, local mechanical, psychological factors, co-morbidities and illness behaviour. The adjusted participation rate was similar in cases and controls (64%), and 131 cases and 196 controls finally participated in the study. RESULTS:,Compared with the controls, the cases were more likely to report that their teeth felt as though they did not fit together properly [odds ratio (OR) 8, 95% Confidence Interval (CI) 6,13] and report history of facial trauma (OR 3, 95% CI 2,6). Both diurnal and nocturnal grinding were significantly associated with PDS, and individuals who reported grinding their teeth both during the day and at night had a risk of 6; 95% CI 3,13 for PDS compared with those who did not. A history of orthodontic treatment, having any dentures, having missing teeth, use of chewing gum or biting the fingernails did not show any relationship with PDS. People who took medication for the bowels had a higher risk of PDS (OR 2, 95% CI 1,4). Participants with frequent headaches had a threefold increase in risk of having PDS (OR 3, 95% CI 2,5) while having pain in parts of the body other than the head was associated with an OR of 3 (95% CI 2,5). An increased propensity to have PDS was seen in those individuals with higher levels of psychological distress (OR 3; 95% CI 1,4 in the highest category, test for trend P < 0.001) and sleep disturbance (OR 5; 95% CI 2,94 in the highest category, test for trend P < 0.001). Aspects of illness behaviour, such as disease conviction (OR 4; 95% CI 2,9 in the highest category) and perception of illness (0.3; 95% CI 0.2,0.5) were associated with PDS. The result for the denial scale became statistically significant after adjustment for age and gender (2; 95% CI 1,3). CONCLUSIONS:,The current case,control study provides complementary epidemiological information on oro-facial pain (OFP) and supports a multifactorial aetiology of PDS, with factors from many domains, including local mechanical factors, psychological and co-morbidities. People with PDS were characterized by frequent headaches, history of facial trauma, teeth grinding, sleep problems, pain elsewhere in the body and high levels of psychological distress. From the results of current study and available evidence it seems inappropriate to consider PDS in isolation and future research should adopt a multidisciplinary approach to OFP. [source]

Developing a Chinese quality of life in dementia instrument for patients with early-to-moderate dementia: an exploratory test of validity

Yi-Chen Chiu
Aims., The purpose of this study was to examine the psychometric properties of the Chinese Dementia Quality of Life instrument, which included testing the different pathways through theoretical quality of life domains (self-esteem, feelings of belonging and sense of aesthetics) to reach outcomes of positive and negative affect. Background., Perceived quality of life in dementia has been conceptualised based on dementia stages. However, the relationships among quality of life domains are unclear in patients with dementia with a Mini-Mental State Examination >10. Design., Cross-sectional study. Methods., Older people (n = 110) were consecutively recruited from memory disorder clinics and community wellness centres (controls). Of these participants, 27 were controls, 39 were diagnosed with questionable dementia and 44 with mild-to-moderate Alzheimer's disease. The instrument was back translated and validated. Results., The instrument has good overall internal consistency (Cronbach's alpha = 084,094). Item-total correlation coefficients, indicating construct validity, were all significant, except for one item. anova showed that controls, patients with questionable dementia and those with mild-to-moderate Alzheimer's disease differed significantly in scores on Sense of Aesthetics subscale. Instrument total score and scores on three of five subscales (not Feelings of Belonging) differed significantly between control and dementia groups, but not between patients with questionable dementia and those with mild-to-moderate Alzheimer's disease. Factor analyses showed two inconsistencies with the instrument's prior conceptualisation, namely the Self-Esteem and Negative Affect subscales. The Positive Affect path model was supported but not the Negative Affect path model. Conclusions., This patient-reported Dementia Quality of Life instrument has acceptable psychometric properties in Taiwanese patients with dementia with a Mini-Mental State Examination score >10. Relevance to clinical practice., The Chinese Dementia Quality of Life instrument can be used to assess subjective quality of life in Taiwanese patients with dementia with a Mini-Mental State Examination score >10. [source]

An analysis of the evidence-practice continuum: is surgery for obstructive sleep apnoea contraindicated?

Adam G. Elshaug BA BSc(Hons) MPH
Abstract Rationale, aims and objectives, Currently there are multiple surgical interventions utilized in the treatment of adult obstructive sleep apnoea (OSA). The role of these operations remains controversial, with perspectives on treatment efficacy varying considerably. Despite this, their use is proliferating. Objectives, In this paper, we present the degree of variability that occurs in the application of these procedures, and examine the effectiveness of surgical intervention as a treatment for OSA. Method, A multi-centre retrospective clinical audit of consecutive, unselected surgical cases presenting at the sleep disorder clinics of two teaching hospitals in a major Australian city. Patients acted as their own historical controls, undergoing polysomnography pre and post surgery to gauge effectiveness. Results, On variability demonstrate 94 individuals in this cohort received 220 individual upper airway surgical procedures, 184 occurred in their first operation (mean 2.5 per person; range 1,7) and 36 occurred in a second operation (n = 18; cumulative mean of 4 per person; range 3,7). These 94 individuals received 41 varying combinations of surgery. Results on effectiveness demonstrate an overall physiological success rate of 13% (87% fail). One operation reduced OSA severity by 20% (patients still had severe OSA), and two operations by 35% (still moderate OSA). In contrast, conventional Continuous Positive Airway Pressure therapy controlled OSA (n = 64). Conclusions, This case study demonstrates substantial procedural variability and limited effectiveness. This raises questions as to the quality of care, the treatment-derived health outcomes of this population and of efficient resource allocation. This issue requires greater policy attention. [source]

Critical Therapeutics: Cultural Politics and Clinical Reality in Two Eating Disorder Treatment Centers

Rebecca J. Lester
Recent studies suggest that eating disorders are increasing in Mexico and that this seems to correspond with Mexico's push to modernization. In this respect, Mexico exemplifies the acculturation hypothesis of eating disorders, namely, that anorexia and bulimia are culture-bound syndromes tied to postindustrial capitalist development and neoliberalist values, and that their appearance elsewhere is indicative of acculturation to those values. Available evidence for this claim, however, is often problematic. On the basis of five years of comparative fieldwork in eating disorder clinics in Mexico City and a small Midwestern city in the United States, I reframe this as an ethnographic question by examining how specific clinical practices at each site entangle global diagnostic categories with local social realities in ways that problematize existing epistemologies about culture and illness. In this regard, debates about acculturation and the global rise of eating disorders foreground issues of central epistemological and practical importance to contemporary medical anthropology more generally. [source]

Haplotype analysis of the PARK 11 gene, GIGYF2, in sporadic Parkinson's disease,

Greg T. Sutherland PhD
Abstract Familial Parkinsonism (PARK) genes are strong candidates for conferring susceptibility to common forms of PD. However, most studies to date have provided little evidence that their common variants substantially influence disease risk. Recently, mutations were described in the gene, GIGYF2 (TNRC15), located at the PARK11 locus (2q37.1). Here, we use a haplotype tagging approach to examine common variation in the GIGYF2 gene and PD risk. PD cases (n = 568) and age and gender-matched control subjects (n = 568) were recruited from three specialist movement disorder clinics in Brisbane (Australia) and the Australian electoral roll. Twelve tagging SNPs were assessed in all subjects and haplotype and genotype associations were explored. Overall our findings suggest that common genetic variants of GIGYF2 do not significantly affect sporadic PD risk in Australian Caucasians. 2008 Movement Disorder Society [source]

Parkinson's disease and LRRK2: Frequency of a common mutation in U.S. movement disorder clinics

Denise M. Kay PhD
Abstract The G2019S mutation in the LRRK2 gene is reportedly a common cause of familial Parkinson's disease (PD) and may also have a significant role in nonfamilial PD. The objective of this study was to assess mutation carrier frequency in PD patients from movement disorder clinics in the United States, stratified by family history, age at onset, and geography; to determine carrier frequency in a large and well-characterized control population; to examine segregation of mutation in families of patients; and to correlate genotype with clinical phenotype. One thousand four hundred twenty-five unrelated PD patients from movement disorder clinics in Oregon, Washington, and New York and 1,647 unrelated controls were studied. The G2019S mutation was detected using a TaqMan assay and verified by sequencing. Eighteen of 1,425 patients and one of 1,647 controls had the mutation. Carrier frequency ( 2SE) in patients was 0.013 0.006 overall, 0.030 0.019 in familial PD, 0.007 0.005 in nonfamilial PD, 0.016 0.013 in early-onset PD, and 0.012 0.007 in late-onset PD. Geographic differences were insignificant. Age at onset of mutation carriers ranged from 28 to 71 years. Mutation carriers were clinically indistinguishable from idiopathic PD. LRRK2 G2019S is the single most common pathogenic mutation linked to neurodegenerative disease to date. 2005 Movement Disorder Society [source]