First 150 years of catatonia:Looking back at its complicated history and forward to the road ahead

Karl Ludwig Kahlbaum(1828-1899)was the first to conceptualize and describe the main clinical features of a novel psychiatric illness,which he termed catatonia in his groundbreaking monograph published 150 years ago.Although Kahlbaum postulated catatonia as a separate disease entity characterized by psychomotor symptoms and a cyclical course,a close examination of his 26 cases reveals that most of them presented with motor symptom complexes or syndromes associated with various psychiatric and medical conditions.In his classification system,Kraepelin categorized catatonic motor symptoms that occur in combination with psychotic symptoms and typically have a poor prognosis within his dementia praecox(schizophrenia)disease entity.Because of the substantial influence of Kraepelin’s classification,catatonia was predominantly perceived as a component of schizophrenia for most of the 20th century.However,with the advent of the psychopharmacotherapy era starting from the early 1950s,interest in catatonia in both clinical practice and research subsided until the early 2000s.The past two decades have witnessed a resurgence of interest in catatonia.The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition,marked a paradigmatic shift by acknowledging that catatonia can occur secondary to various psychiatric and medical conditions.The introduction of an independent diagnostic category termed“Catatonia Not Otherwise Specified”significantly stimulated research in this field.The authors briefly review the history and findings of recent catatonia research and highlight promising directions for future exploration.

Debt,sleep deprivation and psychological distress among online ride-hailing drivers:evidence from China

An online ride-hailing driver(ORHD)refers to a driver who takes orders and provides rental car services to passengers via an online service platform.1 ORHD plays a significant role in the urban transport system worldwide,operating through many platforms.According to official data from the Chinese Ministry of Transport,a total of 1.6 million vehicle transport permits were issued by the end of March 2022.

Functional brain imaging of gastrointestinal sensation in health and disease

It has since long been known, from everyday experience as well as from animal and human studies, that psychological processes-both affective and cognitive- exert an influence on gastrointestinal sensorimotor function. More specifically, a link between psychological factors and visceral hypersensitivity has been suggested, mainly based on research in functional gastrointestinal disorder patients. However, until recently, the exact nature of this putative relationship remained unclear, mainly due to a lack of non-invasive methods to study the （neurobiological） mechanisms underlying this relationship in non-sleeping humans. As functional brain imaging, introduced in visceral sensory neuroscience some 10 years ago, does provide a method for in vivo study of brain-gut interactions, insight into the neurobiological mechanisms underlying visceral sensation in general and the influence of psychological factors more particularly, has rapidly grown. In this article, an overview of brain imaging evidence on gastrointestinal sensation will be given, with special emphasis on the brain mechanisms underlying the interaction between affective ＆ cognitive processes and visceral sensation. First, the reciprocal neural pathways between the brain and the gut （brain- gut axis） will be briefly outlined, including brain imaging evidence in healthy volunteers. Second, functional brain imaging studies assessing the influence of psychological factors on brain processing of visceral sensation in healthy humans will be discussed in more detail. Finally, brain imaging work investigating differences in brain responses to visceral distension between healthy volunteers and functional gastrointestinal disorder patients will be highlighted.

Auditory hallucinations: A review of the ERC “VOICE” project

In this invited review I provide a selective overview of recent research on brain mechanisms and cognitive processes involved in auditory hallucinations. The review is focused on research carried out in the "VOICE" ERC Advanced Grant Project, funded by the European Research Council, but I also review and discuss the literature in general. Auditory hallucinations are suggested to be perceptual phenomena, with a neuronal origin in the speech perception areas in the temporal lobe. The phenomenology of auditory hallucinations is conceptualized along three domains, or dimensions; a perceptual dimension, experienced as someone speaking to the patient; a cognitive dimension, experienced as an inability to inhibit, or ignore the voices, and an emotional dimension, experienced as the "voices" having primarily a negative, or sinister, emotional tone. I will review cognitive, imaging, and neurochemistry data related to these dimensions, primarily the first two. The reviewed data are summarized in a model that sees auditory hallucinations as initiated from temporal lobe neuronal hyper-activation that draws attentional focus inward, and which is not inhibited due to frontal lobe hypo-activation. It is further suggested that this is maintained through abnormal glutamate and possibly gamma-amino-butyric-acid transmitter mediation, which could point towards new pathways for pharmacological treatment. A final section discusses new methods of acquiring quantitative data on the phenomenology and subjective experience of auditory hallucination that goes beyond standard interview questionnaires, by suggesting an iP hone/iP od app.

Influence of different second generation antipsychotics on the QTc interval: A pragmatic study

AIM To investigate whether differential influence on the QTc interval exists among four second generation antipsychotics(SGAs) in psychosis.METHODS Data were drawn from a pragmatic, randomized headto-head trial of the SGAs risperidone, olanzapine, quetiapine, and ziprasidone in acute admissions patients with psychosis, and with follow-up visits at discharge or maximally 6-9 wk, 3, 6, 12 and 24 mo. Electrocardiograms were recorded on all visits. To mimic clinical shared decision-making, the patients were randomized not to a single drug, but to a sequenceof the SGAs under investigation. The first drug in the sequence defined the randomization group, but the patient and/or clinician could choose an SGA later in the sequence if prior negative experiences with the first one(s) in the sequence had occurred. The study focuses on the time of, and actual use of the SGAs under investigation, that is until treatment discontinuation or change, in order to capture the direct medication effects on the QTc interval. Secondary intention-to-treat(ITT) analyses were also performed. RESULTS A total of 173 patients, with even distribution among the treatment groups, underwent ECG assessments. About 70% were males and 43% had never used antipsychotic drugs before the study. The mean antipsychotic doses in milligrams per day with standard deviations(SD) were 3.4(1.2) for risperidone, 13.9(4.6) for olanzapine, 325.9(185.8) for quetiapine, and 97.2(42.8) for ziprasidone treated groups. The time until discontinuation of the antipsychotic drug used did not differ in a statistically significant way among the groups(Log-Rank test: P = 0.171). The maximum QTc interval recorded during follow-up was 462 ms. Based on linear mixed effects analyses, the QTc interval change per day with standard error was-0.0030(0.0280) for risperidone;-0.0099(0.0108) for olanzapine;-0.0027(0.0170) for quetiapine, and-0.0081(0.0229) for ziprasidone. There were no statistically significant differences among the groups in this regard. LME analyses based on ITT groups(the randomization groups), revealed almost identical slopes with-0.0063(0.0160) for risperidone,-0.0130(0.0126) for olanzapine,-0.0034(0.0168) for quetiapine, and-0.0045(0.0225) for ziprasidone. CONCLUSION None of the SGAs under investigation led to statistically significant QTc prolongation. No statistically significant differences among the SGAs were found.

Exercise interventions for older adults: A systematic review of meta-analyses

Background:The evidence concerning which physical exercise characteristics are most effective for older adults is fragmented.We aimed to characterize the extent of this diversity and inconsistency and identify future directions for research by undertaking a systematic review of metaanalyses of exercise interventions in older adults.Methods:We searched the Cochrane Database of Systematic Reviews,PsycInfo,MEDLINE,Embase,CINAHL,AMED,SPORTDiscus,and Web of Science for articles that met the following criteria:(1)meta-analyses that synthesized measures of improvement(e.g.,effect sizes)on any outcome identified in studies of exercise interventions;(2)participants in the studies meta-analyzed were adults aged 65+or had a mean age of 70+;(3)meta-analyses that included studies of any type of exercise,including its duration,frequency,intensity,and mode of delivery;(4)interventions that included multiple components(e.g.,exercise and cognitive stimulation),with effect sizes that were computed separately for the exercise component;and(5)meta-analyses that were published in any year or language.The characteristics of the reviews,of the interventions,and of the parameters improved through exercise were reported through narrative synthesis.Identification of the interventions linked to the largest improvements was carried out by identifying the highest values for improvement recorded across the reviews.The study included 56 meta-analyses that were heterogeneous in relation to population,sample size,settings,outcomes,and intervention characteristics.Results:The largest effect sizes for improvement were found for resistance training,meditative movement interventions,and exercise-based active videogames.Conclusion:The review identified important gaps in research,including a lack of studies investigating the benefits of group interventions,the characteristics of professionals delivering the interventions associated with better outcomes,and the impact of motivational strategies and of significant others(e.g.,carers)on intervention delivery and outcomes.

Prevalence and correlates of aggressive behavior in psychiatric inpatient populations

Aggressive behavior in patients with psychiatric disorders is attracting increasing research interest.One reason for this is that psychiatric patients are generally considered more likely to be aggressive,which raises a related question of whether diagnoses of psychiatric disorders predict the prevalence of aggressive behavior.Predicting aggression in psychiatric wards is crucial,because aggressive behavior not only endangers the safety of both patients and staff,but it also extends the hospitalization times.Predictions of aggressive behavior also need careful attention to ensure effective treatment planning.This literature review explores the relationship between aggressive behavior and psychiatric disorders and syndromes(dementia,psychoactive substance use,acute psychotic disorder,schizophrenia,bipolar affective disorder,major depressive disorder,obsessivecompulsive disorder,personality disorders and intellectual disability).The prevalence of aggressive behavior and its underlying risk factors,such as sex,age,comorbid psychiatric disorders,socioeconomic status,and history of aggressive behavior are discussed as these are the components that mostly contribute to the increased risk of aggressive behavior.Measurement tools commonly used to predict and detect aggressive behavior and to differentiate between different forms of aggressive behavior in both research and clinical practice are also reviewed.Successful aggression prevention programs can be developed based on the current findings of the correlates of aggressive behavior in psychiatric patients.

Trajectories of response in schizophrenia-spectrum disorders: A one-year prospective cohort study of antipsychotic effectiveness

BACKGROUND Antipsychotic drugs remain the mainstay of schizophrenia treatment;however,their effectiveness has been questioned,and it is not possible to predict the response to a specific antipsychotic drug in an individual patient.Thus,it is important to compare the effectiveness of the various antipsychotics and search for possible response predictors.AIM To investigate the effectiveness of antipsychotic drugs,we examined response trajectories and predictors for belonging to different trajectory groups.METHODS The Bergen-Stavanger-Innsbruck-Trondheim(BeSt InTro)trial compared the effectiveness of three atypical antipsychotics-amisulpride,aripiprazole,and olanzapine-in a prospective,semirandomized,rater-blind,head-to-head design.Adult participants with a schizophrenia spectrum disorder diagnosis,according to international classification of diseases,Tenth Revision(ICD-10)F20–29,were included.Participants were followed for a period of 12 mo,with assessments at baseline;after one,three and six weeks;and after three,six,nine and 12 mo.A latent class mixed model was fitted to our data.The three-trajectory model based on the Positive and Negative Syndrome Scale(PANSS)total score reduction was found to have adequate fit,and the study drugs,as well as various demographic and clinical parameters,were tested as predictors for belonging to the different trajectory groups.RESULTS Overall,144 participants were included,and 41%completed the 12-mo study period.The largest trajectory group,consisting of 74%of participants,showed a PANSS total score reduction of 59%from baseline to 12 mo(Good response group).A trajectory group comprising 13%of participants had their PANSS total score reduced by 82.5%at 12 mo(Strong response group),while the last response trajectory group comprising 13%of the participants had a PANSS total score reduction of 13.6%(Slight response group).The largest part of the total reduction for the Good and Strong response groups occurred at six weeks of treatment,amounting to 45%and 48%reductions from baseline,respectively.The use of amisulpride predicted belonging to the Strong response group,while unemployment,depression,and negative psychotic symptoms at baseline increased the chance of belonging to the Slight response group,indicating a poor response to antipsychotic drug treatment.CONCLUSION Most of the participants(87%)had a good outcome after one year.Amisulpride users,more often than aripiprazole and olanzapine users,belonged to the response trajectory group with a strong response.

Adjunctive Peony-Glycyrrhiza decoction for antipsychotic-induced hyperprolactinaemia:a meta-analysis of randomised controlled trials

Background Hyperprolactinaemia is a common adverse effect of antipsychotics （APs）. The results of Peony-Glycyrrhiza decoction （PGD） as a potentially useful adjunctivetreatment for hyperprolactinaemia are inconsistent.Aim This meta-analysis of randomised controlled trials （RCTs） examined the effcacy and safety of adjunctive PGDtherapy for AP-induced hyperprolactinaemia.Methods English （PubMed, Embase, Cochrane Library, PsycINFO） and Chinese （Chinese National Knowledge Infrastructure, Wanfang Data） databases were systematicallysearched up to 10 June 2018. The inclusion criteria were based on PICOS-Participants： adult patients with schizophrenia; Intervention： PGD plus APs; Comparison： APs plus placebo or AP monotherapy; Outcomes： effcacy and safety; Study design： RCTs. The weighted mean difference （WMD） and risk ratio （RR） along with their 95% CIs were calculated using Review Manager （RevMan） V.5.3 software.Results Five RCTs （n=450） were included and analysed. Two RCTs （n=140） were double-blind and four RCTs （n=409） reported ‘random’ assignment with specifc description. The PGD group showed a signifcantly lower serum prolactin level at endpoint than the control group （n=380, WMD： ？32.69 ng/mL （95% CI -41.66 to 23.72）, p〈0.00001, I2=97%）. Similarly, the superiority of PGD over the control groups was also found in the improvement of hyperprolactinaemia-related symptoms. No difference was found in the improvement of psychiatric symptoms assessed by the Positive and Negative Syndrome Scale （n=403, WMD： -0.62 （95% CI -2.38 to 1.15）, p=0.49, I^2=0%）. There were similar rates of all-cause discontinuation （n=330, RR 0.93 （95% CI 0.63 to 1.37）, p=0.71, I^2=0%） and adverse drug reactions between the two groups. According to the Grading of Recommendations Assessment, Development and Evaluation approach, the level of evidence of primary and secondary outcomes ranged from ‘very low’ （14.3%）, ‘low’ （42.8%）, ‘moderate’ （14.3%）, to ‘high’ （28.6%）.Conclusions Current evidence supports the adjunctive use of PGD to suppress elevated prolactin and improve prolactin-induced symptoms without signifcant adverse events in adult patients with AP-induced hyperprolactinaemia. High-quality RCTs with longer duration are needed to confrm these fndings.

Psychosocial aspects of hematopoietic stem cell transplantation

Hematopoietic stem cell transplantation(HSCT)has become a conventional and potentially curative treatment for various hematological diseases.As more sophisticated procedures have been developed and mortality rates have decreased,attention has shifted to the psychosocial challenges associated with transplantation.The psychosocial difficulties accompanying transplantation are addressed in the context of both quality of life(QOL)and psychopathological research.Among the psychiatric comorbidities of HSCT,anxiety,depression,sleep and sexual disorders,delirium and post-traumatic stress disorder are the most studied conditions.Recently,more attention has been focused on the psychosocial burden of caregivers.Devising recommendations for the management of psychiatric symptoms and psychosocial interventions in HSCT sufferers and close relatives is a major concern to consultation–liaison psychiatrists and transplant teams.This review synthesizes and critically evaluates the current literature on the psychosocial aspects of HSCT and appraises the clinical significance of these outcomes.Issues of QOL assessment;psychosocial functioning and QOL in the course of HSCT;impact of graft-versus-host disease and other predictors of QOL and psychosocial functioning;comorbid psychiatric disorders;and interventions to maintain or improve QOL and reduce psychopathology and psychosocial burden on family members are presented.

Effects of Religious vs. Conventional Cognitive-Behavioral Therapy on Inflammatory Markers and Stress Hormones in Major Depression and Chronic Medical Illness: A Randomized Clinical Trial

Background: Depressive disorder is often accompanied by physiological changes that may adversely affect the course of medical illness, including an increase in pro-inflammatory cytokines. Methods: We examine the effects of religious cognitive behavioral therapy (RCBT) vs. conventional CBT (CCBT) on pro-/anti-inflammatory indicators and stress hormones in 132 individuals with major depressive disorder (MDD) and chronic medical illness who were recruited into a multi-site randomized clinical trial. Biomarkers (C-reactive protein and pro-inflammatory cytokines TNF-α, IL-1β, IFN-γ, IL-6, IL-12-p70), anti-inflammatory cytokines (IL1ra, IL-4, IL-10), and stress hormones (urinary cortisol, epinephrine, norepinephrine) were assessed at baseline, 12 weeks, and 24 weeks. Differential effects of baseline religiosity on treatment response were also examined, along with effects of religiosity on changes in biomarkers over time independent of treatment group. Biomarker levels were log transformed where possible to normalize distributions. Mixed models were used to examine trajectories of change. Results: CRP increased and IL-4, IL-10, and epinephrine decreased over time, mostly in the opposite direction expected (except epinephrine). No significant difference between RCBT and CCBT was found on average trajectory of change in any biomarkers. Religiosity interacted with treatment group in effects on IL-6, such that CCBT was more effective than RCBT in lowering lL-6 in those with low religiosity whereas RCBT appeared to be more effective than CCBT in those with high religiosity. Higher baseline religiosity also tended to predict an increase in pro-inflammatory cytokines INF-γ and IL-12 (p70) and urinary cortisol over time. Conclusions: RCBT and CCBT had similar effects on stress biomarkers. CCBT was more effective in reducing IL-6 levels in those with low religiosity, whereas RCBT tended to be more effective in those with high religiosity. Unexpectedly, higher baseline religiosity was associated with an increase in several stress biomarkers.

Patients’ Experiences of Trust in the Patient-Nurse Relationship——A Systematic Review of Qualitative Studies

Aims and Objectives: To report a synthesis of the literature on the meaning of trust in the context of patients’ experiences of nursing. The review question was “How do patients describe the meaning of trust in the nursing relationship?” Background: Trust is essential in nursing as it has the potential to create opportunities for the human being to gain faith, hope and meaning in life as well as open up for new experiences. Trust is an interpersonal and essential element of all patient-nurse relationships and requires nurses to create a trusting relationship with the patients. Design: Systematic qualitative literature review. Methods: Systematic searches were conducted for the period January 2002 to December 2012, updated in January 2014. 20 papers were included. Results: Four categories emerged: Attitudes related to trust, indicating that trust is fundamental and existential;Experiences of trust, concerning how trust can be sensed;The patient-nurse relationship, revealing the qualities of the person who creates trust;and Where trust occurs, illuminating the contextual relevancies of trust. Conclusions: Patients’ experiences of trust in nursing are dependent on the nurses’ knowledge, level of commitment in the dialogue to creating and developing the relationship and contextual issues. Implications for nursing practice: Reflection on a trusting relationship with the patient is necessary for a deeper conceptual understanding of trust in nursing. Clinical nurse researchers nurse supervisors, managers and nurse educatorsshould discuss different areas of trust during nursing supervision and focus-group meetings as well as with nursing graduates to ensure that nurses develop knowledge of how to create a trusting patient-nurse relationship.

Reproducibility and replicability of systematic reviews

Irreproducibility of research causes a major concern in academia.This concern affects all study designs regardless of scientific fields.Without testing the reproducibility and replicability it is almost impossible to repeat the research and to gain the same or similar results.In addition,irreproducibility limits the translation of research findings into practice where the same results are expected.To find the solutions,the Interacademy Partnership for Health gathered academics from established networks of science,medicine and engineering around a table to introduce seven strategies that can enhance the reproducibility:pre-registration,open methods,open data,collaboration,automation,reporting guidelines,and post-publication reviews.The current editorial discusses the generalisability and practicality of these strategies to systematic reviews and claims that systematic reviews have even a greater potential than other research designs to lead the movement toward the reproducibility of research.Moreover,I discuss the potential of reproducibility,on the other hand,to upgrade the systematic review from review to research.Furthermore,there are references to the successful and ongoing practices from collaborative efforts around the world to encourage the systematic reviewers,the journal editors and publishers,the organizations linked to evidence synthesis,and the funders and policy makers to facilitate this movement and to gain the public trust in research.

Psychiatric Complications of Obesity and Its Treatment: A Brief Review

Obesity—defined as a body mass index (BMI) of 30 kg/m2 or more—is associated with a wide range of medical and psychiatric complications. Physical co-morbidities include: insulin resistance, type 2 diabetes mellitus, dyslipidemia, asthma, hypertension, coronary heart disease, osteoarthritis of the knee and polycystic ovary syndrome. Mental health problems are particularly more common among individuals presenting for treatment of obesity than those in the community. They have higher rates of depression, anxiety, increased substance abuse and an increased prevalence in eating disorders. It has been estimated that up to 60% of extremely obese individuals have been suffering from an Axis I psychiatric disorder;most commonly mood and anxiety disorders. Obstructive sleep apnea (OSA) can occur with obesity and can also lead to sleep disorders and psychiatric complications. Up to 40% of patients with sleep apnea were found to have affective disorder or alcohol abuse. Weight loss medications and surgery may add to the problem of psychological complications of obesity. For example, in 2008, rimonabant development was discontinued by manufacturer as it has been associated with an increased risk of adverse psychiatric events including suicidal ideation and suicidal behavior. On the other hand, the prevalence of obesity is also high among patents with psychiatric illness, which can be caused by the effects of psychotropic medications which can lead to increased appetite, weight gain, sedation and psychomotor retardation. Obesity is reported in more than 60% of patients with schizophrenia and bipolar disorder. Food intake is regulated by several neurotransmitters, peptides and amino acids. Antipsychotics which block dopamine D2 receptors increase appetite and result in significant weight gain, while drugs that increase brain dopamine concentration are anorexigenic.

Association of Genetic Variation in the Promoter Region of OXTR with Differences in Social Affective Neural Processing

Evidence supports the involvement of oxytocin in social behavior. The oxytocin receptor gene (OXTR) has been associated with differences in social brain function and risk for autism. Motivated by recent work, we investigated the effect of variation in the common functional rs2268498 T/C polymorphism in the promoter region of OXTR on neural responses to fear expressions. 46 healthy subjects were divided into genotype groups of C carriers (n = 32) and TT ho-mozygous (n = 14) and neural activity was measured during the recognition of fear and neutral expressions. Results showed that during the recognition of fear expressions, the TT genotype group exhibited increased responding in the inferior occipital gyrus, considered important for face processing, compared to carriers of the C allele (P < 0.005;cluster corrected for whole brain), an effect not found for neutral faces. These results indicate the impact of this OXTR genetic variant on individual differences in social affective neural processing.

A Health Impairment Process of Sickness Presenteeism in Norwegian Physicians: The Mediating Role of Exhaustion

Although work factors have been associated with both presenteeism and exhaustion among hospital physicians, we lack knowledge on the dynamic relationship between demands in the work context and presenteeism and how this can be mediated by symptoms of exhaustion when controlling for job resources. The objective of this study is to examine a health impairment process of presenteeism among university hospital physicians. A cross-sectional survey of 545 university hospital physicians in Norway was conducted. Variables included in the model were presenteeism, exhaustion, work-family conflict, role conflict, social support and control over work pace. Findings from structural equation modeling indicated that exhaustion mediates the relationship between job demands and presenteeism. Job resources had no direct effect on presenteeism in the hypothesized model. The variables in the study explained 17% of the variance in presenteeism. The study is one of the first to demonstrate that the relationship between job demands and presenteeism is mediated by exhaustion when controlling for job resources. The results highlight the importance of considering the link between health symptoms and job demands to reduce the negative effects of presenteeism.

Biomarkers of Mental Illness—What Can We Learn from Circadian Heart Rate?

Background: Much research in psychiatry has been a search for diagnostic biomarkers of mental illness but practically useful markers have remained elusive. The problem may be unrealistic expectations and the aim in this paper is to show that the relationship between circadian heart rate and psychiatric status can contribute to useful understanding in this regard. Aim: To discuss the biomarker implications of changes in circadian heart rate (CHR) in psychiatric disorders. Methods: Comparisons of CHR were made between and within individuals receiving treatment for different psychiatric disorders diagnosed according to criteria defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Results: Broadly different DSM-5 disorders are associated with distinctly different changes in CHR. Some disorders are more consistently associated with distinctive changes but CHR does not predict symptoms or specific clinical diagnoses reliably. Changes in CHR, particularly during sleep, are state-dependent. Clinical improvement is associated with normalisation of CHR. Conclusion: Changes in CHR are a part of the physiological changes in mental illness. Distinctly different changes in CHR suggest distinctly different physiological changes that may constitute diagnostic discrimination at a physiological level. An analysis of CHR can add objective adjunct information to clinical assessment and the evaluation of treatment but does not predict symptoms or clinical diagnoses reliably. Much the same is likely to apply to all candidate biomarkers of mental illness.

The Use of Antiepileptic Drugs in Acute Neuropsychiatric Conditions: Focus on Traumatic Brain Injury, Pain, and Alcohol Withdrawal

Antiepileptic drugs (AEDs), have demonstrated efficacy treating a number of acute conditions, encompassing a broad range of symptoms and syndromes, in addition to being first-line treatment for epilepsy. Clinically, since their inception, AEDs have been used off-label for acute and chronic medical conditions, both as primary and as adjuvant therapies. In this review, we describe the observed clinical effectiveness of AEDs across a set of commonly encountered acute conditions in the general hospital: traumatic brain injury, pain, alcohol withdrawal. In describing the individual benefits and usages of specific agents, the applicability of these agents to other common neuropsychiatric conditions may be further explored.

Current status of disparity in liver disease

Disparities have emerged as an important issue in many aspects of healthcare in developed countries and may be based on race,ethnicity,sex,geographical location,and socioeconomic status.For liver disease specifically,these potential disparities can affect access to care and outcome in viral hepatitis,chronic liver disease,and hepatocellular carcinoma.Shortages in hepatologists and medical providers versed in liver disease may amplify these disparities by compromising early detection of liver disease,surveillance for hepatocellular carcinoma,and prompt referral to subspecialists and transplant centers.In the United States,continued efforts have been made to address some of these disparities with better education of healthcare providers,use of telehealth to enhance access to specialists,reminders in electronic medical records,and modifying organ allocation systems for liver transplantation.This review will detail the current status of disparities in liver disease and describe current efforts to minimize these disparities.

Effect of Behavioural Therapy on Depression in Adolescents with Sickle Cell Disease

Background: Depression, one of the commonest mental health problems in SCD, has high prevalence rates. While psychological therapies have been found to be beneficial in mild to moderate depression, their use as non-pharmacological methods amongst adolescents in sub-Saharan Africa, particularly Nigeria, is still at its infancy. Objective: To determine the effect of behavioural activation therapy on depression in adolescents living with Sickle Cell Disease attending out-patient clinic at the Lagos State University Teaching Hospital, Lagos, Nigeria. Method: The study was conducted in Lagos State University Teaching Hospital, Lagos, Nigeria, between November 2017 to February 2018 (4 months) among adolescents living with SCD and depression attending out-patient clinic. A randomized control trial (RCT) was conducted among participants assigned to treatment (30) versus control (30) group. A manualized behavioral therapy programme developed was delivered to the treatment group. The data was analysed using the Statistical Package for Social Sciences (SPSS) version 23. Pair T-test was used to compare the two groups across continuous variables, pre- and post intervention. Analysis of Covariance (ANCOVA) was used to determine treatment effects controlling for baseline scores. Result: After the intervention, the mean depression score reduced from 22.13 ± 3.08 to 13.02 ± 4.56 while Paediatric quality of life score increase from 62.57 ± 17.85 to 67.90 ± 7.99 in the treatment group (BDI, p < 0.001;PedsQL, p = 0.045). However, the pre- and post-intervention mean depression scores in the control group showed insignificant reduction from 22.23 ± 3.24 to 21.60 ± 2.75 and mean PedsQL from pre-intervention scores of 59.67 ± 12.60 to 56.73 ± 8.94 post intervention (BDI, p = 0.388;PedsQL, p = 0.242). From multivariate analysis (ANCOVA), only the Quality of Life scores ceased to show any significant effect of the intervention. Conclusion: This study further strengthens and supports the extant literature that behavioral therapy alone is efficacious for depressive.