Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level

Physical disorders are, compared to the general population, more prevalentin people with severe mental illness (SMI). Although this excess morbidityand mortality is largely due to modifiable lifestyle risk factors, the screeningand assessment of physical health aspects remains poor, even in developedcountries. Moreover, specific patient, provider, treatment and system factorsact as barriers to the recognition and to the management of physical diseasesin people with SMI. Psychiatrists can play a pivotal role in the improvementof the physical health of these patients by expanding their task from clinicalpsychiatric care to the monitoring and treatment of crucial physical parameters.At a system level, actions are not easy to realize, especially for developingcountries. However, at an individual level, even simple and very basic monitoringand treatment actions, undertaken by the treating clinician, can already improvethe problem of suboptimal medical care in this population. Adhering to monitoringand treatment guidelines will result in a substantial enhancement of physicalhealth outcomes. Furthermore, psychiatrists can help educate and motivatepeople with SMI to address their suboptimal lifestyle, including smoking,unhealthy diet and lack of exercise. The adoption of the recommendations presentedin this paper across health care systems throughout the world will contributeto a significant improvement in the medical and related psychiatric healthoutcomes of patients with SMI.     

The name Cryptolepis bifida L.Joubert & Venter,a later homonym of C. bifida (Blume) P.I.Forst., corrected

A new Cryptolepis species from Kenya and Tanzania was named Cryptolepis bifida L.Joubert & Venter. However, this name is a later homonym of Cryptolepis bifida (Blume) P.I.Forst. and is herewith corrected to Cryptolepis ibayana L.Joubert & Venter. © 2009 The Linnean Society of London, Botanical Journal of the Linnean Society, 2009, 160 , 355.     

Functional morphology and evolution of the cystoid Echinosphaerites

Echinosphaerites , known from the Lower and Middle Ordovician, has branched biserial brachioles. Such features are so far unknown in the Rhombifera. Echinosphaerites had a skeletal meshwork like that of other blastozoan echinoderms, with a fine outer mesh layer and an inner coarse mesh layer. During evolution the number and location of brachioles, including the pattern of brachiole branching, changed by increase in the number of brachioles and increased complexity of the branching pattern. The exothecal pore structures increased in the complexity of patterns of tangential canals. The pattern of skeletal growth in Echinosphaerites is discussed. The Echinosphaeritidae and Caryocystitidae families are closely related and show parallel development.     

MECHANISMS OF AVIAN IMPRINTING: A REVIEW

Filial imprinting is the process through which early social preferences become restricted to a particular object or class of objects. Evidence is presented showing that filial preferences are formed not only as a result of learning through exposure to an object, but also under the influence of visual and auditory predispositions. The development of these predispositions is dependent upon certain non-specific experience. There is little evidence for an endogenously affected sensitive period for imprinting. It is more likely that the end of sensitivity is a result of the imprinting process itself. Similarly, it is now firmly established that filial and sexual preferences are reversible. Evidence suggests, however, that the first stimulus to which the young animal is exposed may exert a greater influence on filial preferences than subsequent stimuli. The learning process of imprinting is often regarded as being different from conventional associative learning. However, the imprinting object itself can function as a reinforcer. Recent studies have attempted to test predictions from an interpretation of filial imprinting as a form of associative learning. The first results suggest that ‘blocking’ may occur in imprinting, whilst there is no evidence for ‘overshadowing’. Social interactions with siblings and parent(-surrogates) have been shown to affect the formation of filial and sexual preferences. The influence of these interactions is particularly prominent in sexual imprinting, making earlier claims about naive species-specific biases unlikely. Although auditory stimuli play an important role in the formation of social attachments, there is little evidence for auditory imprinting per se. Auditory preferences formed as a result of mere (pre- or postnatal) exposure are relatively weak and short-lasting. Exposure to visual stimuli during auditory training significantly improves auditory learning, possibly through a process of reinforcement. It is becoming increasingly clear that filial and sexual imprinting are two different (although perhaps analogous) processes. Different mechanisms are likely to underlie the two processes, although there is evidence to suggest that the same brain region is involved in recognition of familiar stimuli in both filial and sexual imprinting. There is little evidence for a direct role of hormones in the learning process of imprinting. Androgen metabolism may be a factor constraining the development of a predisposition in the chick. Research into the neural mechanism of filial imprinting in the chick has revealed that a restricted part of the forebrain (IMHV) is likely to be a site of memory storage. Changes in synapse morphology and in the number of NMDA receptors have been found, limited to this region, and correlated with the strength of preference.     

Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization's World Mental Health Survey Initiative

Data are presented on patterns of failure and delay in making initial treatmentcontact after first onset of a mental disorder in 15 countries in the WorldHealth Organization (WHO)''s World Mental Health (WMH) Surveys. Representativeface-to-face household surveys were conducted among 76,012 respondents aged18 and older in Belgium, Colombia, France, Germany, Israel, Italy, Japan,Lebanon, Mexico, the Netherlands, New Zealand, Nigeria, People''s Republicof China (Beijing and Shanghai), Spain, and the United States. The WHO CompositeInternational Diagnostic Interview (CIDI) was used to assess lifetime DSM-IVanxiety, mood, and substance use disorders. Ages of onset for individual disordersand ages of first treatment contact for each disorder were used to calculatethe extent of failure and delay in initial help seeking. The proportion oflifetime cases making treatment contact in the year of disorder onset rangedfrom 0.8 to 36.4% for anxiety disorders, from 6.0 to 52.1% for mood disorders,and from 0.9 to 18.6% for substance use disorders. By 50 years, the proportionof lifetime cases making treatment contact ranged from 15.2 to 95.0% for anxietydisorders, from 7.9 to 98.6% for mood disorders, and from 19.8 to 86.1% forsubstance use disorders. Median delays among cases eventually making contactranged from 3.0 to 30.0 years for anxiety disorders, from 1.0 to 14.0 yearsfor mood disorders, and from 6.0 to 18.0 years for substance use disorders.Failure and delays in treatment seeking were generally greater in developingcountries, older cohorts, men, and cases with earlier ages of onset. Theseresults show that failure and delays in initial help seeking are pervasiveproblems worldwide. Interventions to ensure prompt initial treatment contactsare needed to reduce the global burdens and hazards of untreated mental disorders.     

Compartmentation and Activities of Enzymes Involved in the Metabolism of Amino Acids Implicated in Osmoregulatory Mechanisms in Acanthamoeba castellanii1

Glutamate dehydrogenase in Acanthamoeba castellanii is an NAD-dependent cytosolic enzyme. This is similar to glutamate dehydrogenases in Phycomycetes, but very different from the dual coenzyme-specific enzymes located in mitochondria in animals and in mitochondria and chloroplasts in higher plants. Pyrroline-5-carboxylate (P-5-C) reductase occurs also in the cytoplasm in A. castellanii and has very high affinities for L-P-5-C (K_m= 12 μM) and NADH (K_m= 15 _μM). In contrast, ornithine aminotransferase and proline oxidase are mitochondrial enzymes. No proline-inhibited γ-glutamyl kinase was detected while an active glutamine synthetase was found in the cytosolic compartment. Evidence for a mitochondrial transport system for L-proline was obtained. Two possible pathways for proline biosynthesis in A. castellanii are discussed based on information obtained about activities and subcellular compartmentation of enzymes.