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1
Kuna, Martin. Počátky raného středověku v Čechách: Archeologický výzkum sídelní aglomerace kultury pražského typu v Roztokách = The onset of the early middle ages in Bohemia : archaeological research at a large settlement site of the Prague-type culture at Roztoky. Praha: Archeologický ústav AV ČR, 2005.
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2
Kuna, Martin. Počátky raného středověku v Čechách: Archeologický výzkum sídelní aglomerace kultury pražského typu v Roztokách = The onset of the early middle ages in Bohemia : archaeological research at a large settlement site of the Prague-type culture at Roztoky. Praha: Archeologický ústav AV ČR, 2005.
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3
Bjornsson, Andri S. Age at Onset and Clinical Course of Body Dysmorphic Disorder. Edited by Katharine A. Phillips. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190254131.003.0010.
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This chapter reviews studies that have been conducted to determine the age at onset and course of illness of body dysmorphic disorder (BDD). Age at onset has been examined in two large samples, and the mean age at onset was the same in both studies (16.7 years). About two thirds of people had onset of BDD before age 18. There were more similarities than differences between the early-onset group (before age 18) and the later-onset group, although the early-onset group had a higher prevalence of attempted suicide than the late-onset group in both samples. The clinical course of BDD is often chronic unless appropriate treatment is received. These findings point to the need for early education on healthy body image and treatment interventions for BDD, especially among adolescents.
4
Vasudev, Akshya. Manic syndromes in old age. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199644957.003.0044.
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Manic syndromes in the elderly are different from those seen in the younger bipolar population. They are a heterogenous group but can probably be divided into two main groups based on age of onset of the illness: late onset bipolar disorder (LOB) and early onset bipolar disorder (EOB). This chapter elaborates on differences in these two groups based on epidemiological data findings, clinical presentation, aetiopathogenesis and management. Latest concepts with regards to the vascular mania hypothesis, neuroimaging findings, cognitive impairment in bipolar disorder are also dealt with. A critical review of pharmacological management options is also provided with reference to recently published data on mood stabilisers, antipsychotic and antidepressant usage for this age group.
5
Jones, Matthew, and Jennifer Thompson. Atypical presentations of Alzheimer’s disease. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198779803.003.0005.
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Alzheimer’s disease usually presents in older age with progressive episodic memory loss. Atypical presentations of Alzheimer’s disease occur and involve non-amnestic and early-onset forms of the disease. Posterior cortical atrophy (PCA) and logopenic progressive aphasia (lvPPA) are two well-described syndromes that are most commonly due to atypical presentations of Alzheimer’s disease. PCA is a higher-order disturbance of vision whilst lvPPA is characterized by hesitant speech with word-finding difficulties and problems with repetition of words and phrases. Early-onset Alzheimer’s disease presents before the age of 65 and typically consists of a constellation of progressive cortical deficits including language disturbance, apraxia, visuospatial deficits, and poor working memory. Alzheimer’s disease may rarely be inherited because of an autosomal dominant mutation in one of three genes (PSEN1, PSEN2, and APP). Recognition and accurate diagnosis of these atypical forms is vital to ensure patients receive the most appropriate care and treatment.
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Williams, J. Corey, and Hanna E. Stevens. Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) Study. Edited by Ish P. Bhalla, Rajesh R. Tampi, Vinod H. Srihari, and Michael E. Hochman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190625085.003.0009.
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This chapter provides a summary of a landmark study in child and adolescent psychiatry that addresses the treatment of youth with psychotic disorders. Are second generation antipsychotics superior to first generation antipsychotics in the treatment of early-onset schizophrenia spectrum disorders? Starting with that question, it describes the basics of the study, including funding, study locations, who was studied, how many patients, study design, study intervention, follow-up, endpoints including treatment response and adverse events, results, and criticism and limitations. No differences in symptom change were found between groups, but each group had a specific set of adverse events that distinguished it. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
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Lleo, Alberto, and Rafael Blesa. Clinical course of Alzheimer’s disease. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199569854.003.0002.
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• Alzheimer’s disease is an age-related neurodegenerative disorder, with onset usually in late life, characterized by cognitive impairment, a variety of behavioural symptoms, and restrictions in the activities of daily living• The initial symptom is episodic memory loss, in particular in delayed recall of visual and/or verbal material. Immediate and remote memory is usually preserved in early stages...
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Xu, Huji, Feng Huang, Chan-Bum Choi, and Tae-Hwan Kim. Axial spondyloarthritis in Asia. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198734444.003.0028.
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The prevalence of axial spondyloarthritis (axSpA) in Chinese and Korean populations is not dissimilar to that in Caucasians. However, the age of onset is younger and peripheral arthritis of the lower limb is relatively more common. Multicenter studies have revealed similarities and differences among different ethnic backgrounds. For example, the dominant HLA-B27 subtype in Chinese SpA is B2704, while it is B2705 in Koreans. Both Chinese and Korean rheumatologists have adopted ASAS/EULAR guidelines to manage axSpA. TNFi are covered by insurance in Korea but not in China. Owing to early onset and the high cost of TNFi therapy, axSpA has placed enormous burdens on both patients and society in Asia. To achieve a higher HRQoL, rheumatologists are bringing forward cost-effective and treat-to-target therapeutic strategies by integrating nonpharmacological treatment, traditional medications, and biologics in a multimodality setting. Further basic and clinical studies in Asian populations are needed to improve decision-making in clinical practice.
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Lynch, Bernadette, and Aine Burns. The patient with scleroderma. Edited by Giuseppe Remuzzi. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0165.
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Scleroderma is tightness, thickening, and non-pitting induration of skin. Two forms of the skin disease are described. Limited cutaneous systemic sclerosis (lcSSc) which occurs distal to the wrists (or ankles) and/or over the face and neck, often associated with longstanding Raynaud’s phenomenon, and diffuse cutaneous systemic sclerosis (dcSSc) where truncal as well as acral skin involvement occurs as well as tendon friction rubs. In this latter condition the onset of the skin changes occurs within 1 year of onset of Raynaud’s phenomenon; however, the skin involvement may precede onset of vascular symptoms.The skin manifestations are the outward manifestation of a systemic disease, systemic sclerosis. Lung, heart, and gut involvement are frequent. Scleroderma renal crisis, usually presenting as accelerated hypertension and acute kidney injury, is one of the most severe complications of this disease. Autoantibodies against RNA polymerase are associated with scleroderma renal crisis. It occurs in 12% of dcSSc and 2% of lcSSc patients (men and women) and carries a high morbidity and mortality although careful supportive care and blood pressure management using angiotensin converting enzyme inhibitors (ACEI) or angiotensin-II receptor blockers have improved short-term outcomes. In general, beta blockers should be avoided in the early management.Approximately two-thirds of patients require dialysis, of these many recover enough function to come off dialysis. Higher blood pressure and younger age at presentation have a better prognosis. ACEIs should be continued even after dialysis is established as the latter increases the chance of late recovery. Average time to coming off dialysis is 11 months but recovery is uncommon after 24 months. After a crisis renal function continues to improve for several years.
10
Staedtke, Verena, and Eric H. Kossoff. Epilepsy Syndromes in Childhood. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0074.
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Epilepsy syndromes of childhood are a heterogeneous group of disorders that occur at specific neurodevelopmental stages, with a variable prognosis ranging from benign to catastrophic. In clinical practice they are categorized based on seizure type, age of onset, clinical presentation, electroencephalographic (EEG) findings, as well as response to treatment. In addition, recent advancements in neuroimaging and genetic testing have become important diagnostic tools revealing underlying defects for some of these syndromes. This knowledge has consequences for clinical practice, as it opens new perspectives for early diagnosis, prognosis and treatment. Here, we provide an up-to-date overview of the most common pediatric epilepsy syndromes, their clinical findings, associated EEG findings, and clinical management.
11
Lleó, Alberto, and Rafael Blesa. Clinical course of Alzheimer’s disease. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198779803.003.0004.
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Alzheimer’s disease (AD) is an age-related neurodegenerative disorder, with onset usually in late life, characterized by progressive cognitive impairment, a variety of behavioural symptoms, and impairment in the activities of daily living. The initial symptom in typical AD is episodic memory loss, which reflects hippocampal dysfunction. The memory deficits are very characteristic with low recall performance despite retrieval facilitations with cueing. These initial deficits can be identified by appropriate cognitive tests. Behavioural symptoms can be present at early stages of the disease (even in pre-clinical states), although the frequency increases as the disease progresses. In the past decade there has been a growing interest in characterizing these pre-clinical and prodromal stages as treatments are expected to be more effective in these phases.
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Kainth, Daraspreet Singh, Karanpal Singh Dhaliwal, and David W. Polly. Spinal Deformity and Scoliosis. Edited by Mehul J. Desai. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199350940.003.0021.
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Spinal deformity can be present in children, adolescents, and adults. Early-onset scoliosis, which affects children less than 10 years of age, can be the result of congenital abnormalities or neuromuscular disease or can be idiopathic. Adolescents most commonly develop scoliosis as the result of adolescent idiopathic scoliosis. Adult deformity can be the result of progression of conditions present in childhood or adolescence, or from degenerative changes. Many conditions can lead to spine deformity, including congenital causes, trauma, cancer, osteoporosis, postsurgical, and idiopathic causes. Though deformity treatment needs to be tailored to the individual, there are many guiding principles and concepts that apply when treating patients with scoliosis and spinal deformity. This chapter reviews important concepts such the deformity classification systems, deformity parameters, treatment options, and associated risks and benefits.
13
Kessler, Ronald C., Emil F. Coccaro, Maurizio Fava, and Katie A. McLaughlin. The Phenomenology and Epidemiology of Intermittent Explosive Disorder. Edited by Jon E. Grant and Marc N. Potenza. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780195389715.013.0053.
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Intermittent explosive disorder (IED) is characterized by recurrent episodes of impulsive, uncontrollable aggression out of proportion to the severity of provoking agents. Few epidemiological studies have been carried out on the prevalence and correlates of IED. Data are reported here from the most recent and largest of these studies: the U.S. National Comorbidity Survey Replication (NCS-R) and the World Health Organization World Mental Health (WMH) surveys. These studies show that IED is a commonly occurring disorder that typically has an early age of onset, a persistent course, and strong comorbidity with a number of other usually secondary mental disorders. This disorder is almost twice as common among men as women. It is often associated with substantial distress and impairment. However, only a minority of people with IED obtain treatment for their uncontrollable anger. This combination of features makes IED an ideal target for early detection and intervention aimed at secondary prevention of anger attacks as well as primary prevention of secondary disorders.
14
Ferreira, Isabel, and Jos WR Twisk. Physical activity, cardiorespiratory fitness, and cardiovascular health. Edited by Neil Armstrong and Willem van Mechelen. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198757672.003.0017.
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It is now recognized that cardiovascular disease (CVD) is partly a paediatric problem, i.e. the onset begins in childhood, although clinical symptoms may not become apparent until later in life. Therefore, from a primary prevention point of view, the extent to which physical activity or physical fitness in childhood may deter this process is of utmost importance. Although physical activity and CRF at a young age have not been directly linked to the incidence of CVD, evidence thus far supports cardiovascular health benefits of early higher physical activity and CRF levels on cardiometabolic risk factors like obesity, blood pressure, insulin resistance, and their maintenance throughout the course of life. By affecting these intermediary pathways, lifelong (high-intensity) physical activity may also deter the age-related decreases in CRF and related signs of premature arterial ageing.
15
Logsdon, M. Cynthia, Catherine Monk, and Alison E. Hipwell. Perinatal Experiences of Adolescent Mothers. Edited by Amy Wenzel. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780199778072.013.008.
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The United States has one of the highest rates of teen pregnancy in the developed world. Pregnancy and parenting prior to age 20 are associated with compromised biopsychosocial outcomes for the mother, the fetus, and the future child—though the strong coupling of poverty and early pregnancy indicate that these outcomes may not be uniquely attributable to maternal age. This chapter reviews psychological as well as biological factors associated with risk for adolescent pregnancy, such as the potential correlation between conduct disorder and pregnancy, as well as data suggesting that environmental factors as varied as exposure to endocrine disrupters and psychosocial stress may contribute to the earlier onset of puberty, sexual activity, and, ultimately, conception. Pregnancy outcomes for both the mother and the child are reviewed, as well as what is known about mental health status in pregnant and parenting teenagers. This chapter covers the importance of social support for this population and the treatment of perinatal psychopathology in childbearing adolescents.
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Hanney, Maria Luisa. Older people with learning disabilities. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199644957.003.0050.
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Elderly people with Learning Disabilities are a heterogeneous clinically complex population with unique medical and social challenges. Little is known of the epidemiology of mental ill health in this group. Emerging evidence indicates that they suffer higher rates of mental illness than the general population and than their younger peer group. Point prevalence of mental ill health in elderly people with Learning Disabilities has been reported about 69% compared with 48% in the younger peer group. This higher rate of psychiatric diagnosis in the older group is mainly due to a higher rate of dementia of about 21 %. People with Down syndrome appear to have lower rates of mental ill health apart from depression and early onset dementia of Alzheimer’s type. People with Learning Disability due to other causes are also at higher risk of developing dementia at an earlier age than the general population
17
Dodds, Chris, Chandra M. Kumar, and Frédérique Servin. Cognitive dysfunction and sleep disorders. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198735571.003.0014.
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Cognitive dysfunction is largely a problem in the elderly, but it can occur at any age. The two major presentations, delirium and postoperative cognitive dysfunction (POCD), are compared. Risks for delirium are explored; key points from the patient’s history and possible ways to ameliorate the onset are then reviewed. The presentation of POCD is described, and the lack of our understanding of its causes is highlighted. Known triggers such as centrally active anticholinergic drugs or pain are identified. Current thinking in the inflammatory responses within microglia and astrocytes is summarized. Sleep in the elderly is contrasted with that in younger persons, and the main stages of sleep, SWS and REM, described. The impact and importance of the effects that surgery/anaesthesia has on sleep stages is reviewed. Obstructive sleep apnoea is described, including its effect on the safety of anaesthesia and recovery. Periodic limb movement disorders and early Parkinson disease are described.
18
James, Anthony. Depressive Disorders in Childhood and Adolescence. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780198801900.003.0008.
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This chapter focuses on depressive disorders in childhood and adolescence. Depression in children and adolescents is a complex and debilitating disease, and typically has a lifelong, chronic, and recurrent course. The peak age of onset of depression is between 13 and 15 years. After providing a clinical picture of depression, this chapter discusses early childhood depression and differential diagnosis, including paediatric bipolar disorder, psychotic depression and seasonal affective disorder, oppositional and conduct disorder, and substance misuse and medical conditions. It then examines comorbidity, paying attention to bipolar disorder and suicidal behaviour, along with the assessment and prevention of depression. It also considers some of the determinants of depression, such as stress, trauma, life events, and biological factors such as genetics, brain mechanisms, hormones, and resilience. Finally, it describes treatment options for childhood and adolescent depression.
19
Bloch, Michael H. Natural History and Long-Term Outcome of OCD. Edited by Christopher Pittenger. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228163.003.0005.
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Obsessive-compulsive disorder (OCD) is often a chronic condition. Convergent evidence suggests that early-onset and adult-onset disease are importantly distinct: early-onset OCD is more highly genetic, has a male bias, and is more often associated with tic disorders and attention deficit disorder. Adult-onset OCD has an equal male–female ratio and is more often associated with anxiety and depression. Long-term follow-up studies from before institution of effective treatments suggest that a minority of individuals with adult-onset OCD remit, and many have persistent severe symptoms. There are few analogous studies of patients with childhood-onset OCD. Prognosis has improved over the past 30 years with the development of effective, evidence-based pharmacotherapy and psychotherapies. More recent long-term follow-up studies of both adult-onset and pediatric-onset OCD suggest remission rates of up to 50%. Refractory illness nevertheless remains an important clinical problem.
20
Pipitone, Nicolò, Annibale Versari, and Carlo Salvarani. Large-vessel vasculitis. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0133.
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Large-vessel vasculitis includes giant cell arteritis (GCA) and Takayasu's arteritis (TAK). GCA affects patients aged over 50, mainly of white European ethnicity. GCA occurs together with polymyalgia rheumatica (PMR) more frequently than expected by chance. In both conditions, females are affected two to three times more often than males. GCA mainly involves large- and medium-sized arteries, particularly the branches of the proximal aorta including the temporal arteries. Vasculitic involvement results in the typical manifestations of GCA including temporal headache, jaw claudication, and visual loss. A systemic inflammatory response and a marked response to glucocorticoids is characteristic of GCA. GCA usually remits within 6 months to 2 years from disease onset. However, some patients have a chronic-relapsing course and may require long-standing treatment. Mortality is not increased, but there is significant morbidity mainly related to chronic glucocorticoid use and cranial ischaemic events, especially visual loss. The diagnosis of GCA rests on the characteristic clinical features and raised inflammatory markers, but temporal artery biopsy remains the gold standard to support the clinical suspicion. Imaging techniques are also used to demonstrate large-vessel involvement in GCA. Glucocorticoids are the mainstay of treatment for GCA, but other therapeutic approaches have been proposed and novel ones are being developed. TAK mainly involves the aorta and its main branches. Women are particularly affected with a female:male ratio of 9:1. In most patients, age of onset is between 20 and 30 years. Early manifestations of TAK are non-specific and include constitutional and musculoskeletal symptoms. Later on, vascular complications become manifest. Most patients develop vessel stenoses, particularly in the branches of the aortic artery, leading to manifestations of vascular hypoperfusion. Aneurysms occur in a minority of cases. There are no specific laboratory tests to diagnose TAK, although most patients have raised inflammatory markers, therefore, imaging techniques are required to secure the diagnosis. Glucocorticoids are the mainstay of treatment of TAK. However, many patients have an insufficient response to glucocorticoids alone, or relapse when they are tapered or discontinued. Immunosuppressive agents and, in refractory cases, biological drugs can often attain disease control and prevent vascular complications. Revascularization procedures are required in patients with severe established stenoses or occlusions.
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Pipitone, Nicolò, Annibale Versari, and Carlo Salvarani. Large-vessel vasculitis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642489.003.0133_update_003.
Full textAbstract:
Large-vessel vasculitis includes giant cell arteritis (GCA) and Takayasu’s arteritis (TAK). GCA affects patients aged over 50, mainly of white European ethnicity. GCA occurs together with polymyalgia rheumatica (PMR) more frequently than expected by chance. In both conditions, females are affected two to three times more often than males. GCA mainly involves large- and medium-sized arteries, particularly the branches of the proximal aorta including the temporal arteries. Vasculitic involvement results in the typical manifestations of GCA including temporal headache, jaw claudication, and visual loss. A systemic inflammatory response and a marked response to glucocorticoids is characteristic of GCA. GCA usually remits within 6 months to 2 years from disease onset. However, some patients have a chronic-relapsing course and may require longstanding treatment. Mortality is not increased, but there is significant morbidity mainly related to chronic glucocorticoid use and cranial ischaemic events, especially visual loss. The diagnosis of GCA rests on the characteristic clinical features and raised inflammatory markers, but temporal artery biopsy remains the gold standard to support the clinical suspicion. Imaging techniques are also used to demonstrate large-vessel involvement in GCA. Glucocorticoids are the mainstay of treatment for GCA, but other therapeutic approaches have been proposed and novel ones are being developed. TAK mainly involves the aorta and its main branches. Women are particularly affected with a female:male ratio of 9:1. In most patients, age of onset is between 20 and 30 years. Early manifestations of TAK are non-specific and include constitutional and musculoskeletal symptoms. Later on, vascular complications become manifest. Most patients develop vessel stenoses, particularly in the branches of the aortic artery, leading to manifestations of vascular hypoperfusion. Aneurysms occur in a minority of cases. There are no specific laboratory tests to diagnose TAK, although most patients have raised inflammatory markers, therefore, imaging techniques are required to secure the diagnosis. Glucocorticoids are the mainstay of treatment of TAK. However, many patients have an insufficient response to glucocorticoids alone, or relapse when they are tapered or discontinued. Immunosuppressive agents and, in refractory cases, biological drugs can often attain disease control and prevent vascular complications. Revascularization procedures are required in patients with severe established stenoses or occlusions.
22
Wild, Edward J., and Sarah J. Tabrizi. Premanifest and Early Huntington’s Disease. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199929146.003.0005.
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The traditional view that individuals carrying an expanded Huntington’s disease (HD) gene undergo phenoconversion, a stochastic event that takes them from symptom-free to symptomatic, is now disputed among clinicians, HD researchers, and patient and family advocates. Disease onset is officially declared when neurologic abnormalities that are unequivocally due to HD are diagnosed, but subjective symptoms and objective signs emerge gradually, and it is more helpful to consider and openly discuss a prodromal period, often as long as 10 years, which can provide a helpful framework for discussion and management. Considerable progress has been made in defining the neurobiologic processes that underlie the development of HD in humans and measures that can predict this for the purpose of conducting clinical trials, but these measures have not yet been validated sufficiently to make them useful in the clinical setting. This chapter discusses the multidisciplinary care of patients with premanifest, prodromal, and early manifest HD.
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Ahmed, Ahmed I., Sarah Aldhaheri, and Allison Bannick. Inherited Metabolic Diseases (IMDs) and Pregnancy. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190667351.003.0030.
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Inherited metabolic diseases (IMDs) are rare genetic disorders: clinically heterogeneous, and they can present at any age. With the expanded newborn screening panels, many of the IMDs have been successfully screened. Early diagnosis and treatment of these conditions have led to improved neurological outcomes and overall survival of these individuals, and now many of them are reaching childbearing age. Despite treatment, the potential presence of preexisting organ involvement may not only impact their fertility potentials but also may impose a higher risk of adverse maternal and fetal outcomes. Pregnancy leads to an extra strain on maternal metabolism; this may result in the manifestation of symptoms of a previously unknown disease or a progression of a known disease. This chapter will address the possible complications of some inherited disorders of metabolism that are associated with maternal or fetal neurological manifestations such as disorders of energy metabolism (eg, mitochondrial disorders, adult onset urea cycle disorders, ornithine transcarbamylase (OTC) deficiency, amino acidopathies, phenylketonuria (PKU), and impaired fatty acid oxidation disorders). We will provide special emphasis on the available potential treatments and plan of care during pregnancy and postpartum periods.
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Pezzini, Alessandro. Genetics. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198722366.003.0011.
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Ischaemic stroke is a heterogeneous multifactorial disorder. Although epidemiological data from twin and family studies provide substantial evidence for a genetic basis for stroke, the contribution of genetic factors identified so far is small. Large progress has been made in single-gene disorders associated with ischaemic stroke, particularly at young age. By contrast, little is known about the genes associated with multifactorial stroke. The reported genome-wide association studies of ischaemic stroke have shown that no single common genetic variant imparts major risk, but data on early-onset disease are scarce in this regard. Larger studies with samples numbering in the thousands are ongoing to identify common variants with smaller effects on risk. This approach, in addition with new analytic techniques, will likely contribute to the identification of additional genes, novel pathways, and eventually novel therapeutic approaches to cerebrovascular disorders in the near future. The aims of this review are to summarize data on clinical, genetic, and epidemiologic aspects of monogenic conditions associated with juvenile ischaemic stroke, to discuss recent findings and methodological limitations regarding the genetics of sporadic ischaemic stroke in this age category, and to provide a brief overview of the potential future approaches to stroke genetics.
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Rahman, Shamima, and Mirian C. H. Janssen. Coenzyme Q10 Deficiency. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199972135.003.0011.
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Primary CoQ10 deficiencies are usually diagnosed in childhood, but late-onset forms are recognized. The expression of all clinical symptoms is extremely variable, but six major phenotypes are recognized: (1) encephalomyopathy, seizures, and ataxia; (2) infantile-onset multisystem disease; (3) cerebellar ataxia; (4) isolated myopathy; (5) Leigh syndrome; and (6) isolated nephrotic syndrome. Early treatment with exogenous CoQ10 supplementation may result in a good outcome.
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Lee, Christoph I. Early Imaging for Back Pain in Older Adults. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190223700.003.0015.
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This chapter, found in the back pain section of the book, provides a succinct synopsis of a key study examining the use of early imaging for back pain in older adults. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. The study showed that early imaging for new onset back pain among older adults presenting to primary care was not associated with improved patient-reported outcomes at 1-year follow-up. However, patients undergoing such early imaging had substantially higher resource use and reimbursement expenditures than those not undergoing early imaging. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.
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Chen, Eric Y. H., Antonio Ventriglio, and Dinesh Bhugra, eds. Early Intervention in Psychiatric Disorders Across Cultures. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198820833.001.0001.
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This volume emerges as a result of a dialogue that involves leading proponents of early intervention and global mental health in a variety of contexts. Since the revival of early intervention for psychotic disorders two decades ago, the early intervention paradigm has been elaborated and consolidated in a number of different cultural and clinical settings, and has also been developed to address other mental health conditions. The paradigm for early intervention involves addressing barriers to early detection of illness, the identification of early risk states, as well as the provision of specialized intervention to steer the psychopathology trajectory away from an adverse outcome in a timely fashion. This volume starts with a discussion of relevant cultural factors involved in these endeavours. Current ideas about brain changes in the different stages of the illness trajectory are then reviewed. This is followed by a discussion of real-life implementations of early intervention for psychosis in a number of different cultural settings, highlighting how the basic paradigm for early intervention has been adapted to different populations in diverse service settings to improve outcome. The second major theme of this book is about the application of this paradigm to other mental health conditions that share an onset around the youth developmental period. These disorders include personality disorders, substance use disorders, and bipolar disorder. Each of these disorders has a different early presentation trajectory, which brings specific challenges. Current approaches and future prospects in addressing these challenges are discussed.
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Reuben, Julia, and Daniel S. Shaw. Parental Depression and the Development of Coercion in Early Childhood. Edited by Thomas J. Dishion and James Snyder. Oxford University Press, 2015. http://dx.doi.org/10.1093/oxfordhb/9780199324552.013.7.
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One of the driving theories of the development of child antisocial behavior is Patterson’s model of parent-child coercion. Although Patterson hypothesized that coercive processes are established beginning in early childhood, few studies have sought to understand its developmental precursors in early childhood. Even fewer studies have attempted to examine factors that might compromise parenting quality and lead to coercive parent-child interactions during early childhood. One factor repeatedly shown to compromise parenting quality is parental depression. As such, this chapter focuses on how depression among mothers and alternative caregivers, including fathers, is associated with the early onset of coercive family dynamics. The results of the current study have implications for understanding the genesis of coercive processes and for the design of early prevention programs, affirming the importance of including maternal depression in our prevention models.
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Levy, David. History, epidemiology, and aetiology. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198766452.003.0001.
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Outline of the key landmarks in the history of Type 1 diabetes. Epidemiology, focusing on its rising incidence and the increasing prevalence of later-onset autoimmune diabetes. Genetics are briefly covered; the evidence for and against the impact of a variety of environmental factors thought to be important in aetiology are emphasized, especially in relation to prospective randomized clinical trials (RCT) in early Type 1 diabetes, aiming to delay the onset of autoimmunity in high-risk individuals or slow the decline in C-peptide levels shortly after clinical diagnosis. The balance-risk hypothesis, which allows for inclusion of protective and promoting factors, is introduced.
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Hosu, Liana G., and Lori A. Aronson. Anaphylaxis. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0009.
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Anaphylaxis has been defined as a “severe, life-threatening generalized or systemic hypersensitivity reaction” (Johansson et al., 2004). It is rapid in onset and may cause death or permanent disability. Early recognition and optimal management are critical. During anesthesia, recognition of anaphylaxis is often delayed because the clinical presentation can mimic other conditions. Epinephrine is the drug of choice in the treatment of anaphylaxis and should be given as early as possible.
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Abhishek, Abhishek, and Michael Doherty. Investigations of calcium pyrophosphate deposition. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0051.
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Joint aspiration and microscopic examination of the aspirated synovial fluid remains the gold standard for the diagnosis of calcium pyrophosphate crystal deposition (CPPD). If synovial fluid aspiration is not feasible, plain radiography and/or ultrasound scanning may be used to detect chondrocalcinosis (CC) which predominantly occurs due to calcium pyrophosphate (CPP) crystals, and this can be used as a diagnostic surrogate for CPPD as suggested by the EULAR Task Force. Acute CPP crystal arthritis often associates with a brisk acute phase response (elevated C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR), plasma viscosity) and neutrophilia. A mildly raised CRP and/or ESR may be present in chronic CPP crystal inflammatory arthritis. On the contrary, asymptomatic CC, or CPPD with osteoarthritis does not cause raised acute phase reactants. As CPPD most commonly occurs due to increasing age and osteoarthritis, investigations to screen for underlying metabolic abnormalities should be carried out in those with early-onset CPPD (under 55 years), or in those with florid polyarticular CC. As hyperparathyroidism gets more common with ageing its presence should be specifically sought in all age groups. Tests for other predisposing metabolic conditions should only be carried out in the presence of specific clinical features. Genotyping for mutations, especially in the ANKH gene, may be warranted in those with a family history of premature CPPD and no evidence of inherited metabolic predisposition, but such testing is unavailable to most clinicians.
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Shalev, Arieh Y., Anna C. Barbano, Wei Qi, and Charles R. Marmar. Prevention of Post-Traumatic Stress Disorder. Edited by Charles B. Nemeroff and Charles R. Marmar. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190259440.003.0037.
Full textAbstract:
Post-traumatic stress disorder (PTSD) follows an exposure to traumatic events and as such its onset and early development are better charted then those of most other mental disorders. It is not surprising, therefore, that major efforts have been dedicated to preventing its occurrence before, during and after trauma exposure. This chapter discusses the rationale, desirability, feasibility and outcome of interventions designed to prevent PTSD. Several efficient interventions have been documented. Barriers to their early implementations, however, greatly reduce their effectiveness and require urgent attention.
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Greenberg, Jennifer L., Alexandra Sullivan, and Sabine Wilhelm. Treating Children and Adolescents with Body Dysmorphic Disorder. Edited by Katharine A. Phillips. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190254131.003.0028.
Full textAbstract:
Body dysmorphic disorder (BDD) is a common and severe disorder that typically has its onset during adolescence. Youth with BDD appear more severely ill than adults in terms of having poorer insight and a higher likelihood of having attempted suicide. Despite BDD’s severity and early onset, there is only limited research on its treatment in youth. Cognitive-behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) are the first-line treatments for BDD in adults and appear to be effective for adolescents with BDD. This chapter provides an overview of the treatment of BDD in youth, including cognitive-behavioral and pharmacologic approaches, and an illustrative case example. The chapter also addresses cosmetic treatment for BDD in children and adolescents, which appear to be ineffective.
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Pittenger, Christopher. The Neurobiology of Tic Disorders and Obsessive-Compulsive Disorder. Edited by Dennis S. Charney, Eric J. Nestler, Pamela Sklar, and Joseph D. Buxbaum. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190681425.003.0065.
Full textAbstract:
Obsessive-compulsive disorder (OCD) and Tourette syndrome (TS), along with other tic disorders, involve pathophysiological alterations in the cortico-striatal circuitry. Both are neurodevelopmental conditions, although OCD can also have adult onset. They are frequently comorbid and often run together in families. Recent genetic studies suggest shared risk factors, especially in the case of early-onset OCD. Because of these shared characteristics, they are treated together here. Structural and functional neuroimaging studies are refining our understanding of the abnormalities in corticostriatal connectivity that accompany symptomatology; in the case of TS, these have been accompanied by exciting observations in postmortem tissue that are beginning to connect observed anatomical and network abnormalities to underlying cellular substrates. Finally, recent advances in animal modeling of pathophysiology have allowed testing of specific etiological hypotheses and have established several systems in which more precise mechanistic studies of pathophysiology are now proceeding.
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Siebert, Stefan, Sengupta Raj, and Alexander Tsoukas. Inflammatory back pain. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198755296.003.0006.
Full textAbstract:
Inflammatory back pain (IBP) refers to a collection of symptoms that may help identify patients with possible inflammatory spinal disease. A number of criteria sets have been proposed for IBP, which share common features such as: onset of symptoms aged <40 years, alternating buttock pain, improvement with exercise, worsening with rest, gradual onset, early morning stiffness, and improvement with NSAIDs. The IBP criteria were initially developed and validated in patients with ankylosing spondylitis, but have subsequently been shown to perform similarly in patients with axial spondyloarthritis (axSpA). The Berlin criteria demonstrated the highest specificity (84%) and the Calin criteria the highest sensitivity (92%). IBP criteria have been used in primary and secondary care referral strategies to facilitate the identification of patients with potential axSpA. It is important to note that IBP does not equate to a diagnosis of axSpA and many patients with IBP will not have axSpA.
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Verrips, Aad. Cerebrotendinous Xanthomatosis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199972135.003.0040.
Full textAbstract:
Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive disease due to a defect in bile acid metabolism. Worldwide, more than 300 patients have been described. Mutations in the CYP27A1 gene result in sterol 27-hydroxylase deficiency leading to the accumulation of cholestanol in multiple body tissues. Premature cataracts, chronic diarrhea, tendon xanthomas, and neurological deterioration are the predominant clinical features. There are several disease stages, from being nearly asymptomatic in the early childhood years to severe disability in later stages of life. Adult CTX patients are often misdiagnosed initially, especially when tendon xanthomasa are absent. CTX should be considered in all patients with premature cataracts and in patients with neurological features such as spasticity, early-onset dementia, ataxia, or Parkinsonism.
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Fox, Grenville, Nicholas Hoque, and Timothy Watts. Infection. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198703952.003.0012.
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This chapter provides a problem-oriented approach to investigation and treatment of early and late onset neonatal bacterial infection, including group B streptococcus, meningitis, urine infection, conjunctivitis, umbilical sepsis, osteomyelitis, and septic arthritis. In addition, the prevention and management of congenital infection is covered, including hepatitis B and C, HIV, syphilis, CMV, toxoplasma, rubella, herpes simplex, and chickenpox. Other topics covered are infection control (including MRSA), fungal sepsis, TB, and an overview of immunizations in the first year of life.
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Brusse, Esther, Pascal Laforêt, and Ans T. van der Ploeg. Danon Disease. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199972135.003.0056.
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Danon disease, like Pompe disease, is a muscle disorder caused by a primary defect in lysosomal proteins. Danon disease (OMIM #300257) is an X-linked dominant disorder, with males being more severely affected than female carriers. In males, mean disease onset is in their early teens and in females in their late twenties. Clinical hallmarks are a severe cardiomyopathy, muscle weakness, and mild mental retardation. Retinal, liver, and pulmonary disease may also occur. Milder, sometimes isolated cardiac phenotypes without mental retardation are also described. Regular cardiac evaluation, even in asymptomatic patients, is obligatory.
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Dietz, Laura J., Jennifer Silk, and Marlissa Amole. Depressive Disorders. Edited by Thomas H. Ollendick, Susan W. White, and Bradley A. White. Oxford University Press, 2018. http://dx.doi.org/10.1093/oxfordhb/9780190634841.013.19.
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Depressive disorders onset early in development. Depression during childhood and adolescence is associated with serious disruptions in emotional, social, and occupational functioning into adulthood and a high likelihood of recurrence. This chapter discusses clinical manifestations, prevalence, and course of depression presenting in early childhood (ages 3–6), middle childhood/preadolescence (ages 7–12), and adolescence (13–18). An overview is presented of standardized interviews and questionnaires for clinical assessment of depression in children and adolescents; the chapter summarizes research on empirically supported treatments for youth depression. Also included is a case study of a depressed adolescent with treatment plans formulated from both cognitive behavior therapy and interpersonal psychotherapy perspectives. Future directions for research on depressive disorders in youths are discussed, including neuroimaging research using ecologically valid stimuli, empirically supported interventions for younger children and preadolescents, and personalization of psychosocial treatment to youth’s profiles of risk and protective factors to increase effectiveness.
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Adams, Harold P. Acute Ischemic Stroke. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0101.
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Ischemic stroke is a leading public health problem and the most common acute neurological disease. Advances in the understanding of the pathophysiology of stroke, in particular the importance of early restoration of adequate perfusion, have resulted in improvements in the management of patients with acute ischemic stroke. The interval from onset of stroke until the administration of interventions to restore blood flow is a crucial factor in success of treatment. Still, patients with stroke now are being treated successfully with neurological outcomes improving. These advances are reducing the likelihood of death or disability from this potentially devastating neurological disease.
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Smith, Zach. Lyme Disease. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0050.
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Lyme disease (LD) is a tick-borne illness caused by Borrelia burgdorferi that causes a range of symptoms, including rash, constitutional symptoms, arthritis, and neurologic or cardiac abnormalities. LD presents in three stages: primary, early disseminated, and tertiary disseminated. Each stage is highly variable in onset and presentation, and symptoms may manifest across multiple stages. Patients with early stages of LD are often seronegative, so the decision to treat is clinical. A history of a tick bite plus EM is a clear indication for antibiotics; early antibiotics may reduce the severity and duration of symptoms. A vaccine is not available at this time, and LD is not transmitted through people, food, water, or blood; however, B. Burgdorferi has been identified living in stored donated blood. If acquired during pregnancy, LD can be transmitted through the placenta to the fetus; after treatment, no known harm to the fetus has been identified.
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Allen, Shelley J. Pathophysiology of Alzheimer’s disease. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198779803.003.0002.
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We now know that the onset of the pathological processes leading to Alzheimer’s disease (AD) may be 15–20 years before symptoms appear. This focuses attention on synaptic changes and the early role of tau, and less on the hallmark amyloid plaques (Aβ) and neurofibrillary tau tangles. Sensitive biomarkers to allow early screening will be essential. Familial autosomal AD is the result of mutations in one of three genes (APP, PSEN1, or PSEN2), each directly related to increased Aβ, and informs pathological mechanisms in common sporadic cases, but are also subject to influence by many risk genes and environmental factors. The essential role of apolipoprotein E in neuronal repair and Aβ clearance provides a therapeutic target but also a challenge in carriers of the risk gene APOE4. Current treatments are symptomatic, derived from neurotransmitter deficits seen; particularly cholinergic, but emerging data suggest alternative targets which may prove more productive.
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Candido, Kenneth D., Teresa M. Kusper, and Nebojsa Nick Knezevic. Chronic Chest Wall Pain in Postherpetic Neuralgia. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0014.
Full textAbstract:
Postherpetic neuralgia (PHN) is a debilitating condition that frequently arises after herpes zoster (HZ) caused by the varicella-zoster virus. It is characterized by severe neuropathic pain and sensory disturbances persisting after the resolution of characteristic vesicular skin lesions. Most commonly affected are the thoracic dermatomes. Trigeminal (V1), cervical, and lumbar nerves are other frequently affected sites. Early treatment shortens the duration of acute HZ and may prevent the onset of PHN. A variety of modalities are utilized to treat PHN, including chemical compounds, interventional pain techniques, and neuromodulation. HZ vaccine is recommended for individuals more than 60 years old, and it is currently the best method of averting HZ and consequent progression to PHN.
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Faraone, Stephen V., Pradeep G. Bhide, and Joseph Biederman. Neurobiology of Attention Deficit Hyperactivity Disorder. Edited by Dennis S. Charney, Eric J. Nestler, Pamela Sklar, and Joseph D. Buxbaum. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190681425.003.0064.
Full textAbstract:
Attention deficit hyperactivity disorder (ADHD) is a prevalent, early-onset and persistent disorder of inattention, hyperactivity, and impulsivity. The mechanisms of action of ADHD medications, neuroimaging studies, and studies of monoamine systems and animal models suggest that dysregulation of catecholaminergic neurotransmission in cerebellar-corticostriatal circuits plays a key role in the pathophysiology of ADHD. The efficacy of ADHD medications likely arises from their differing profile of effects on (a) dopaminergic and noradrenergic systems and (b) the localization of these effects in prefrontal cortex and striatum. ADHD has a very high heritability, and although molecular genetic studies have found no causal common DNA variants yet, they have found strong evidence that rare duplications and deletions are risk factors for ADHD. Environmental risk factors, especially those that impact early neurodevelopment (i.e., exposure to cigarette smoking and alcohol during pregnancy), also influence susceptibility to ADHD.
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Struys, Eduard A., Marjo S. van der Knaap, and Gajja S. Salomons. 2-Hydroxyglutaric Acidurias. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199972135.003.0022.
Full textAbstract:
The group of congenital diseases related to 2-hydroxyglutaric acid metabolism consists of five disease entities: D-2-hydroxyglutaric aciduria Type I (D2HGA-I), D-2-hydroxyglutaric aciduria Type II (D2HGA-II), metaphyseal chondromatosis with D-2-hydroxyglutaric aciduria (MC-HGA), L-2-hydroxyglutaric aciduria (L2HGA), and combined D,L-2-hydroxyglutaric aciduria (DL2HGA). Overall, the clinical presentation varies from early onset with mostly lethal neonatal encephalopathy in DL2HGA to slowly progressive mental and motor delay with white matter abnormalities, with an insidious and sometimes adult clinical presentation in L2HGA. Currently no proven treatment options are available for these diseases, although recently gained novel biochemical and genetic insights open treatment perspectives.
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Wolfson, Amy R., and Terra Ziporyn. Adolescent sleep and later school start times. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198778240.003.0024.
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Early school bell times incompatible with adolescent sleep needs and patterns are a major contributor to widespread adolescent sleep insufficiency. Biological delay in sleep onset and social pressures during puberty, combined with the need to arise early on weekdays, make obtaining adequate and optimally timed sleep difficult for most adolescents, potentially impacting physical and emotional wellbeing, safety, and academic performance. Accumulating studies demonstrate that delaying school start times can effectively counter chronic insufficient sleep in adolescents, as well as enhance health, safety, and school success. That many secondary schools continue requiring attendance at times incompatible with healthy sleep suggests that empirical data have played a smaller role in influencing school hours than social and political factors. Overcoming the fear of change, failure of imagination, and ignorance about sleep currently blocking policy changes will require reframing school start times as a public health issue by shifting social norms about sleep.
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Ghavami, Golnaz Modarresi. Phonetics. Edited by Anousha Sedighi and Pouneh Shabani-Jadidi. Oxford University Press, 2018. http://dx.doi.org/10.1093/oxfordhb/9780198736745.013.4.
Full textAbstract:
This chapter discusses the articulatory and acoustic properties of the sound system of Standard Modern Persian. It starts with a brief review of early work on the sound system of New Persian and its development into Modern Persian. The second section examines consonants and vowels in Standard Modern Persian. In this section, issues such as place and manner of articulation of consonants, Voice Onset Time and its importance in distinguishing voiced and voiceless obstruents, the acoustics of glottal consonants, sibilant and non-sibilant fricatives, and rhotics are discussed. The section on vowels addresses vowel space, vowel length, and the acoustics of diphthongs in Standard Modern Persian. The phonetics of the suprasegmental features of stress and intonation are the topic a final section in this chapter.
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Whitworth, Caroline, and Stewart Fleming. Malignant hypertension. Edited by Neil Turner. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0216.
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Malignant hypertension (MH) is recognized clinically by elevated blood pressure together with retinal haemorrhages or exudates with or without papilloedema (grades III or IV hypertensive retinopathy); and may constitute a hypertensive emergency or crisis when complicated by evidence of end-organ damage including microangiopathic haemolysis, encephalopathy, left ventricular failure, and renal failure. Though reversible, it remains a significant cause of end-stage renal failure, and of cardiovascular and cerebrovascular morbidity and mortality in developing countries.MH can complicate pre-existing hypertension arising from diverse aetiologies, but most commonly develops from essential hypertension. The absolute level of blood pressure appears not to be critical to the development of MH, but the rate of rise of blood pressure may well be relevant in the pathogenesis. The pathogenesis of this transformation remains unclear.The pathological hallmark of MH is the presence of fibrinoid necrosis (medial vascular smooth muscle cell necrosis and fibrin deposition within the intima) involving the resistance arterioles in many organs. Fibrinoid necrosis is not specific to MH and this appearance is seen in other conditions causing a thrombotic microangiopathy such as haemolytic uraemic syndrome, scleroderma renal crisis, antiphospholipid syndrome, and acute vascular rejection post transplant. MH can both cause a thrombotic microangiopathy (TMA) but can also complicate underlying conditions associated with TMA.The pathophysiological factors that interact to generate and sustain this condition remain poorly understood. Risk factors include Afro-Caribbean race, smoking history, younger age of onset of hypertension, previous pregnancy, and untreated hypertension associated with non-compliance or cessation of antihypertensive therapy.Evidence from clinical studies and animal models point to a central role for the intrarenal renin–angiotensin system (RAS) in MH; there is good evidence for renal vasoconstriction and activation of the renal paracrine RAS potentiating MH once established; however, there may also be a role in the predisposition of MH suggested by presence of increased risk conferred by an ACE gene polymorphism in humans and polymorphisms for both ACE and AT1 receptor in an animal model of spontaneous MH. Other vasoactive mediators such as the endothelin and the inflammatory response may be important contributing to and increasing endothelial damage. There have been no randomized controlled trials to define the best treatment approach, but progressive lowering of pressures over days is considered safest unless made more urgent by critical clinical state. It seems logical to introduce ACE inhibition cautiously and early, but in view of the risk of rapid pressure lowering some recommend delay.
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Puttler, Leon I., Robert A. Zucker, and Hiram E. Fitzgerald. Developmental Science, Alcohol Use Disorders, and the Risk–Resilience Continuum. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190676001.003.0001.
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The origins and expression of addiction are best understood within the context of developmental processes and dynamic systems organization and change. For some individuals, these dynamic processes lead to risk cumulative or cascade effects that embody adverse childhood experiences that exacerbate risk; predict early onset of drinking, smoking, or other substance use; and often lead to a substance use disorder (SUD) during the transitions to adolescence and emergent adulthood. In other cases, protective factors within or outside of the individual’s immediate family enable embodiment of normative stress regulatory systems and neural networks that support resilience and prevention of SUDs. A case study is provided to illustrate these processes and principles of the organization of addictive behavior. Finally, a model of risk to resilience captures the flow of development and the extent to which individual-experience relationships contribute to risk and resilience.
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Ritchie, James, Darren Green, Constantina Chrysochou, and Philip A. Kalra. Renal artery stenosis. Edited by Neil Turner. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0213.
Full textAbstract:
Renovascular disease refers to a narrowing of a main or branch renal artery. Consequences include loss of functional renal tissue and renovascular hypertension, with other manifestations depending on the underlying cause. Worldwide the most common cause is atherosclerotic narrowing, with other causal pathologies including fibromuscular disease (FMD) and inflammatory conditions. FMD occurs much more frequently in women than in men, and is associated with smoking but genetic predisposing factors are also suspected. In South East Asia, Takayasu arteritis is an important cause.Takayasu disease often presents in a non-specific syndromic manner with fatigue and malaise. FMD often presents with early-onset hypertension. Atherosclerotic renal artery stenosis is often clinically silent with suspicion raised due to the existence of other cardiovascular pathology with the more dramatic presentations of acute decompensated heart failure or acute kidney injury less common. Clinical criteria can identify patients at risk.