The WPA-WHO Global Survey of Psychiatrists�� Attitudes Towards Mental Disorders Classification

This article describes the results of the WPA-WHO Global Survey of 4,887psychiatrists in 44 countries regarding their use of diagnostic classificationsystems in clinical practice, and the desirable characteristics of a classificationof mental disorders. The WHO will use these results to improve the clinicalutility of the ICD classification of mental disorders through the currentICD-10 revision process. Participants indicated that the most important purposesof a classification are to facilitate communication among clinicians and toinform treatment and management. They overwhelmingly preferred a simpler systemwith 100 or fewer categories, and over two-thirds preferred flexible guidanceto a strict criteria-based approach. Opinions were divided about how to incorporateseverity and functional status, while most respondents were receptive to asystem that incorporates a dimensional component. Significant minorities ofpsychiatrists in Latin America and Asia reported problems with the cross-culturalapplicability of existing classifications. Overall, ratings of ease of useand goodness of fit for specific ICD-10 categories were fairly high, but severalcategories were described as having poor utility in clinical practice. Thisrepresents an important focus for the ICD revision, as does ensuring thatthe ICD-11 classification of mental disorders is acceptable to psychiatriststhroughout the world.     

Survivre �� l��inceste : de l��adolescence �� l��age adulte. ��tude du cas d��un ��tudiant s��n��galais �� Dakar

The disclosure of incest is often difficult to accept. Denial or incredulity is common. Furthermore, attitudes to the consequences vary according to the period and the culture. The adverse effects of incest in children and young people could justify the prohibition of incest the world over. In this article, the authors report a case of a young student who consulted several health practitioners. Finally, he made a connection between his memories of incest with his grandmother and his failures in life. Recognition and long-term treatment of this sexual abuse within the family seem to be essential for the re-establishment of psychological development and social integration of this young man.     

Membrane Partitioning: ��Classical�� and ��Nonclassical�� Hydrophobic Effects

The free energy of transfer of nonpolar solutes from water to lipid bilayers is often dominated by a large negative enthalpy rather than the large positive entropy expected from the hydrophobic effect. This common observation has led to the idea that membrane partitioning is driven by the "nonclassical" hydrophobic effect. We examined this phenomenon by characterizing the partitioning of the well-studied peptide melittin using isothermal titration calorimetry (ITC) and circular dichroism (CD). We studied the temperature dependence of the entropic (-TΔS) and enthalpic (ΔH) components of free energy (ΔG) of partitioning of melittin into lipid membranes made of various mixtures of zwitterionic and anionic lipids. We found significant variations of the entropic and enthalpic components with temperature, lipid composition and vesicle size but only small changes in ΔG (entropy-enthalpy compensation). The heat capacity associated with partitioning had a large negative value of about -0.5 kcal mol(-1) K(-1). This hallmark of the hydrophobic effect was found to be independent of lipid composition. The measured heat capacity values were used to calculate the hydrophobic-effect free energy ΔG (hΦ), which we found to dominate melittin partitioning regardless of lipid composition. In the case of anionic membranes, additional free energy comes from coulombic attraction, which is characterized by a small effective peptide charge due to the lack of additivity of hydrophobic and electrostatic interactions in membrane interfaces [Ladokhin and White J Mol Biol 309:543-552, 2001]. Our results suggest that there is no need for a special effect-the nonclassical hydrophobic effect-to describe partitioning into lipid bilayers.     

Les ��tats anxieux dans l��histoire de la m��decine Deuxi��me partie: de la neurasth��nie au trouble anxi��t�� g��n��ralis��e

The last ??great neurosis,?? described by general practitioners before the Freudian classification, the neurasthenia (Beard, 1869, 1880; Charcot, 1887) originated between 1870 and 1900 in the USA and in Europe. It was then dismembered and annexed by the psychiatrists, through psychasthenia (Janet, 1903) and mild depressive states. It declined slowly at the beginning of the 20th century, but is still alive in the textbook of P. Guiraud (1956) and in the ICD-10 (1992). Helped by the works of E. Brissaud (1890) and E. Hecker (1892), Freud??s ??anxiety neurosis?? (1895) remains, however, the most famous clinical entity resulting from the dismemberment of neurasthenia. It includes anxious expectation, anxiety attacks, and somatic equivalents. Diffused in France by Hartenberg, Lalanne (1902), and then Heckel (1917), it was contested by G. Ballet, Pitres and Regis (1902) and F. Raymond (1911) ?? successor of Charcot at the Salpêtrière Hospital. After 1910, the hereditary ??emotive constitution?? of E. Dupré tended to gather the manifestations of anxiety neurosis, several hysterical symptoms, some depressive disorders, and post-traumatic disorders resulting from the lst World War (Devaux and Logre, 1917; De Fleury, 1924). But many French authors separated psychical anxiety and somatic anguish ?? later named panic disorder, (Brissaud, 1902; Claude and Lévy-Va1ensi, 1938; Ey, 1950). After 1945, the emergence of several somatic entities such as stress, vagotonia, and spasmophilia can be seen as new attempts by general practitioners for the annexation of anxiety disorders. After 1960, two opposite clinical orientations can be described: those inspired by psychoanalysis maintain the autonomy of anxiety neurosis; others separate, from psychopharmacological criteria, generalized anxiety and acute anguish. This last, named ??panic attack?? (D. Klein, 1962), gathers in fact the symptoms of paroxysmal anxiety (Brissaud), anxiety attack (Freud), emotive attack (Dupré), emotive or anxious crisis (Devaux and Logre), and the mental paroxysmal form of anxiety (Heckel). Though the clinical dichotomy between generalized anxiety and panic disorder has been emphasized by DSM-IV and ICD-10, a dimensiona1 approach of mental disorders would include most anxious and ??neurotic?? symptoms, beyond anxiety neurosis.     

Approche ph��nom��nologique du n��ant

In this article, we address the issue of nothingness on the basis of perceptive experience in its phenomenological dimension. Through an analysis of the visual perception and various types of memories related to it, we will try to answer three questions: what is phenomenological nothingness? What role does it play in the emergence of determinations within the consciousness? What are its relationships with disappearance and forgetting involved in all the stages of object donation in consciousness?     

��mergence du moi c��r��bral de Theodor Meynert �� Antonio Damasio

Antonio Damasio??s works have brought emotions into line with current trends in neuroscience. They are conceived as the addition, to a perception, of the somatic effects it has induced. Nevertheless, this continuous and relatively steady process of body perception has also led to the less-known hypothesis of the ??neural self.?? Behind the explicit and apparently contradictory reference to William James and Sigmund Freud, there lies a common source: Theodor Meynert??s conception of a ??cortical self.?? Our aim is to enlight a stream unified around what we call here ??cerebral self.?? The Self is thus considered as the cerebral projection or presentation of the body. The specificity of this notion is particularly highlighted by its confrontation to the closely, yet disembodied, notion of ??cerebral subject.??     

Smoking during Pregnancy: Findings from the 2009–2010 Canadian Community Health Survey

Objectives

Smoking during pregnancy may cause many health problems for pregnant women and their newborns. However, there is a paucity of research that has examined the predictors of smoking during pregnancy in Canada. This study used data from the 2009–2010 Canadian Community Health Survey (CCHS) to estimate the prevalence of smoking during pregnancy and examine the demographic, socioeconomic, health-related and behavioral determinants of this behavior.

Methods and Findings

The data were obtained from the 2009–2010 CCHS master data file. Weighted estimates of the prevalence were calculated. Multivariable logistic regression was used to determine demographic, socioeconomic, health related and behavioral characteristics associated with smoking behavior during pregnancy. Women living in the Northern Territories had a high rate of smoking during pregnancy (59.3%). The prevalence of smoking during pregnancy was also high among women under 25 years old, of low socioeconomic status, who reported not having a regular medical doctor, being fair to poor in self-perceived health, having at least one chronic disease, having at least one mental illness, being heavy smokers, and being regular alcohol drinkers. Results from multivariable logistic regression revealed that the odds of smoking during pregnancy were decreased with increasing age (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.91–0.99), having a regular family doctor [OR, 0.24; 95% CI, 0.11–0.52], having highest level of family income [OR, 0.09; 95% CI, 0.03–0.29]. Mothers who reported poor or fair self-perceived health [OR, 2.13; 95% CI, 0.96–4.71] and those who had at least one mental illness [OR, 1.81; 95% CI, 1.00–3.28] had greater odds of smoking during pregnancy.

Conclusions

There are a number of demographic, socio-economic, health-related and behavioral characteristics that should be considered in developing and implementing effective population health promotional strategies to prevent smoking during pregnancy, promoting health and well-being of pregnant women and their newborns.     

Where Do the Rural Poor Deliver When High Coverage of Health Facility Delivery Is Achieved? Findings from a Community and Hospital Survey in Tanzania

Introduction

As part of maternal mortality reducing strategies, coverage of delivery care among sub-Saharan African rural poor will improve, with a range of facilities providing services. Whether high coverage will benefit all socio-economic groups is unknown. Iringa rural District, Southern Tanzania, with high facility delivery coverage, offers a paradigm to address this question. Delivery services are available in first-line facilities (dispensaries, health centres) and one hospital. We assessed whether all socio-economic groups access the only comprehensive emergency obstetric care facility equally, and surveyed existing delivery services.

Methods

District population characteristics were obtained from a household community survey (n = 463). A Hospital survey collected data on women who delivered in this facility (n = 1072). Principal component analysis on household assets was used to assess socio-economic status. Hospital population socio-demographic characteristics were compared to District population using multivariable logistic regression. Deliveries'' distribution in District facilities and staffing were analysed using routine data.

Results

Women from the hospital compared to the District population were more likely to be wealthier. Adjusted odds ratio of hospital delivery increased progressively across socio-economic groups, from 1.73 for the poorer (p = 0.0031) to 4.53 (p<0.0001) for the richest. Remarkable dispersion of deliveries and poor staffing were found. In 2012, 5505/7645 (72%) institutional deliveries took place in 68 first-line facilities, the remaining in the hospital. 56/68 (67.6%) first-line facilities reported ≤100 deliveries/year, attending 33% of deliveries. Insufficient numbers of skilled birth attendants were found in 42.9% of facilities.

Discussion

Poorer women remain disadvantaged in high coverage, as they access lower level facilities and are under-represented where life-saving transfusions and caesarean sections are available. Tackling the challenges posed by low caseloads and staffing on first-line rural care requires confronting a dilemma between coverage and quality. Reducing number of delivery sites is recommended to improve quality and equity of care.     

Cell Adhesion, the Backbone of the Synapse: ��Vertebrate�� and ��Invertebrate�� Perspectives

Synapses are asymmetric intercellular junctions that mediate neuronal communication. The number, type, and connectivity patterns of synapses determine the formation, maintenance, and function of neural circuitries. The complexity and specificity of synaptogenesis relies upon modulation of adhesive properties, which regulate contact initiation, synapse formation, maturation, and functional plasticity. Disruption of adhesion may result in structural and functional imbalance that may lead to neurodevelopmental diseases, such as autism, or neurodegeneration, such as Alzheimer''s disease. Therefore, understanding the roles of different adhesion protein families in synapse formation is crucial for unraveling the biology of neuronal circuit formation, as well as the pathogenesis of some brain disorders. The present review summarizes some of the knowledge that has been acquired in vertebrate and invertebrate genetic model organisms.Synapses are asymmetric, intercellular junctions that are the basic structural units of neuronal transmission. The correct development of synaptic specializations and the establishment of appropriate connectivity patterns are crucial for the assembly of functional neuronal circuits. Improper synapse formation and function may cause neurodevelopmental disorders, such as mental retardation (MsR) and autism spectrum disorders (ASD) (McAllister 2007; Sudhof 2008), and likely play a role in neurodegenerative disorders, such as Alzheimer''s disease (AD) (Haass and Selkoe 2007).At chemical synapses (reviewed in Sudhof 2004; Zhai and Bellen 2004; Waites et al. 2005; McAllister 2007; Jin and Garner 2008), the presynaptic compartment contains synaptic vesicles (SV), organized in functionally distinct subcellular pools. A subset of SVs docks to the presynaptic membrane around protein-dense release sites, named active zones (AZ). Upon the arrival of an action potential at the terminal, the docked and “primed” SVs fuse with the plasma membrane and release neurotransmitter molecules into the synaptic cleft. Depending on the type of synapse (i.e., excitatory vs. inhibitory synapses), neurotransmitters ultimately activate an appropriate set of postsynaptic receptors that are accurately apposed to the AZ.Synapse formation occurs in several steps (Fig. 1) (reviewed in Eaton and Davis 2003; Goda and Davis 2003; Waites et al. 2005; Garner et al. 2006; Gerrow and El-Husseini 2006; McAllister 2007). Spatiotemporal signals guide axons through heterogeneous cellular environments to contact appropriate postsynaptic targets. At their destination, axonal growth cones initiate synaptogenesis through adhesive interactions with target cells. In the mammalian central nervous system (CNS), immature postsynaptic dendritic spines initially protrude as thin, actin-rich filopodia on the surface of dendrites. Similarly, at the Drosophila neuromuscular junction (NMJ), myopodia develop from the muscles (Ritzenthaler et al. 2000). The stabilization of intercellular contacts and their elaboration into mature, functional synapses involves cytoskeletal arrangements and recruitment of pre- and postsynaptic components to contact sites in spines and boutons. Conversely, retraction of contacts results in synaptic elimination. Both stabilization and retraction sculpt a functional neuronal circuitry.Open in a separate windowFigure 1.(A–C) Different stages of synapse formation. (A) Target selection, (B) Synapse assembly, (C) Synapse maturation and stabilization. (D–F) The role of cell adhesion molecules in synapse formation is exemplified by the paradigm of N-cadherin and catenins in regulation of the morphology and strength of dendritic spine heads. (D) At an early stage the dendritic spines are elongated from motile structures “seeking” their synaptic partners. (E) The contacts between the presynaptic and postsynaptic compartments are stabilized by recruitment of additional cell adhesion molecules. Adhesional interactions activate downstream pathways that remodel the cytoskeleton and organize pre- and postsynaptic apparatuses. (F) Cell adhesion complexes, stabilized by increased synaptic activity, promote the expansion of the dendritic spine head and the maturation/ stabilization of the synapse. Retraction and expansion is dependent on synaptic plasticity.In addition to the plastic nature of synapse formation, the vast heterogeneity of synapses (in terms of target selection, morphology, and type of neurotransmitter released) greatly enhances the complexity of synaptogenesis (reviewed in Craig and Boudin 2001; Craig et al. 2006; Gerrow and El-Husseini 2006). The complexity and specificity of synaptogenesis relies upon the modulation of adhesion between the pre- and postsynaptic components (reviewed in Craig et al. 2006; Gerrow and El-Husseini 2006; Piechotta et al. 2006; Dalva et al. 2007; Shapiro et al. 2007; Yamada and Nelson 2007; Gottmann 2008). Cell adhesive interactions enable cell–cell recognition via extracellular domains and also mediate intracellular signaling cascades that affect synapse morphology and organize scaffolding complexes. Thus, cell adhesion molecules (CAMs) coordinate multiple synaptogenic steps.However, in vitro and in vivo studies of vertebrate CAMs are often at odds with each other. Indeed, there are no examples of mutants for synaptic CAMs that exhibit prominent defects in synapse formation. This apparent “resilience” of synapses is probably caused by functional redundancy or compensatory effects among different CAMs (Piechotta et al. 2006). Hence, studies using simpler organisms less riddled by redundancy, such as Caenorhabditis elegans and Drosophila, have aided in our understanding of the role that these molecules play in organizing synapses.In this survey, we discuss the roles of the best characterized CAM families of proteins involved in synaptogenesis. Our focus is to highlight the complex principles that govern the molecular basis of synapse formation and function from a comparative perspective. We will present results from cell culture studies as well as in vivo analyses in vertebrate systems and refer to invertebrate studies, mainly performed in Drosophila and C. elegans, when they have provided important insights into the role of particular CAM protein families. However, we do not discuss secreted factors, for which we refer the reader to numerous excellent reviews (as for example Washbourne et al. 2004; Salinas 2005; Piechotta et al. 2006; Shapiro et al. 2006; Dalva 2007; Yamada and Nelson 2007; Biederer and Stagi 2008; Salinas and Zou 2008).     

Geniom® Technology—The Benchtop Array Facility

Abstract

Febit AG develops an integrated benchtop instrument for in situ microarrays preparation, hybridization, readout and data analysis.