Background Christian clergy have often been identified as'frontline mental health workers'and gatekeepers to mental health services.However,despite this,collaboration between clergy and mental health services ...Background Christian clergy have often been identified as'frontline mental health workers'and gatekeepers to mental health services.However,despite this,collaboration between clergy and mental health services remains poor,with some US clergy referring on as little as 10%of cases.Aims In this study,we aimed to evaluate the collaborative relationship between UK clergy and medical practitioners,with the purpose of identifying key issues that should be addressed to improve such collaboration between the two services.Methods We surveyed 124 clergy,48 general practitioners and 13 psychiatrists in Wales.Part 1 of the survey covered four main themes:demographics;types of mental health cases seen by clergy and practitioners;referral rates between clergy and mental health services;attitude and relationship between clergy and mental health services.Part 2 was directed at clergy only and assessed how sensitive clergy were in identifying and referring on mental health disorders by using seven virtual case vignettes.Results Clergy frequently encountered mental health cases and around 60%-80%regularly referred on to a healthcare professional.Clergy appeared very effective at identifying and referring on high risk scenarios,such as psychosis,suicidal ideation and substance misuse,however were less effective at identifying and referring on clinical depression and anxiety.Clergy rarely received referrals from medical professionals.Both medical professionals and clergy felt they needed to engage in a more collaborative relationship,and around of onethird of practitioners were prepared to offer training to clergy.Conclusion Most clergy in Wales regularly encounter mental health cases and appear effective at recognising and referring on mental health disorders;however,a large minority do not(20%-40%).Clergy generally do not receive referrals from mental health professionals,despite the proven benefits.Therefore,improving collaboration,developing spiritual training for mental health professionals,and mental health training for clergy is likely useful,a notion that many clergy and medical professionals deem important and are prepared to support.展开更多
治疗药物监测(Therapeutic Drug Monitoring,TDM)通过定量测定和解释血药浓度以优化药物治疗。TDM着眼于药代动力学的个体差异,使个体化药物治疗成为可能。在精神病学和神经病学领域中,有可能明显获益于TDM的主要患者群体包括少年儿童...治疗药物监测(Therapeutic Drug Monitoring,TDM)通过定量测定和解释血药浓度以优化药物治疗。TDM着眼于药代动力学的个体差异,使个体化药物治疗成为可能。在精神病学和神经病学领域中,有可能明显获益于TDM的主要患者群体包括少年儿童、孕妇、老年患者、智障患者、药物滥用者、涉法精神病患者、已知或怀疑药代动力学异常的患者以及合并躯体疾病影响药代动力学的患者。常规剂量下治疗无效,用药依从性难以判断,药物耐受性不佳,以及可能存在药代动力学方面的药物-药物相互作用等情况都是治疗药物监测的典型指征。然而,只有将TDM充分整合到临床治疗过程中,才能发挥其优化药物治疗的潜在优势。为了向临床医生和实验室提供有效的TDM信息,神经精神药理学与药物精神病学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的TDM专家组在2004年发表了第一版《精神科治疗药物监测指南》。2011年进行了更新之后,现在再次更新。遵循新版指南,可能会改善神经精神药物治疗的效果,加快很多患者的康复,并降低医疗费用。展开更多
The enzyme steroid sulfatase(STS)desulfates a variety of steroid compounds thereby altering their activity.STS is expressed in the skin,and its deficiency in this tissue has been linked to the dermatological condition...The enzyme steroid sulfatase(STS)desulfates a variety of steroid compounds thereby altering their activity.STS is expressed in the skin,and its deficiency in this tissue has been linked to the dermatological condition X-linked ichthyosis.STS is also highly expressed in the developing and adult human brain,and in a variety of steroidogenic organs(including the placenta and gonads);therefore it has the potential to influence brain development and function directly and/or indirectly(through influencing the hormonal milieu).In this review,we first discuss evidence from human and animal model studies suggesting that STS deficiency might predispose to neurobehavioural abnormalities and certain psychiatric disorders.We subsequently discuss potential mechanisms that may underlie these vulnerabilities.The data described herein have potential implications for understanding the complete spectrum ofclinical phenotypes associated with X-linked ichthyosis,and may indicate novel pathogenic mechanisms underlying psychological dysfunction in developmental disorders such as attention deficit hyperactivity disorder and Turner syndrome.展开更多
文摘Background Christian clergy have often been identified as'frontline mental health workers'and gatekeepers to mental health services.However,despite this,collaboration between clergy and mental health services remains poor,with some US clergy referring on as little as 10%of cases.Aims In this study,we aimed to evaluate the collaborative relationship between UK clergy and medical practitioners,with the purpose of identifying key issues that should be addressed to improve such collaboration between the two services.Methods We surveyed 124 clergy,48 general practitioners and 13 psychiatrists in Wales.Part 1 of the survey covered four main themes:demographics;types of mental health cases seen by clergy and practitioners;referral rates between clergy and mental health services;attitude and relationship between clergy and mental health services.Part 2 was directed at clergy only and assessed how sensitive clergy were in identifying and referring on mental health disorders by using seven virtual case vignettes.Results Clergy frequently encountered mental health cases and around 60%-80%regularly referred on to a healthcare professional.Clergy appeared very effective at identifying and referring on high risk scenarios,such as psychosis,suicidal ideation and substance misuse,however were less effective at identifying and referring on clinical depression and anxiety.Clergy rarely received referrals from medical professionals.Both medical professionals and clergy felt they needed to engage in a more collaborative relationship,and around of onethird of practitioners were prepared to offer training to clergy.Conclusion Most clergy in Wales regularly encounter mental health cases and appear effective at recognising and referring on mental health disorders;however,a large minority do not(20%-40%).Clergy generally do not receive referrals from mental health professionals,despite the proven benefits.Therefore,improving collaboration,developing spiritual training for mental health professionals,and mental health training for clergy is likely useful,a notion that many clergy and medical professionals deem important and are prepared to support.
文摘治疗药物监测(Therapeutic Drug Monitoring,TDM)通过定量测定和解释血药浓度以优化药物治疗。TDM着眼于药代动力学的个体差异,使个体化药物治疗成为可能。在精神病学和神经病学领域中,有可能明显获益于TDM的主要患者群体包括少年儿童、孕妇、老年患者、智障患者、药物滥用者、涉法精神病患者、已知或怀疑药代动力学异常的患者以及合并躯体疾病影响药代动力学的患者。常规剂量下治疗无效,用药依从性难以判断,药物耐受性不佳,以及可能存在药代动力学方面的药物-药物相互作用等情况都是治疗药物监测的典型指征。然而,只有将TDM充分整合到临床治疗过程中,才能发挥其优化药物治疗的潜在优势。为了向临床医生和实验室提供有效的TDM信息,神经精神药理学与药物精神病学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的TDM专家组在2004年发表了第一版《精神科治疗药物监测指南》。2011年进行了更新之后,现在再次更新。遵循新版指南,可能会改善神经精神药物治疗的效果,加快很多患者的康复,并降低医疗费用。
基金Supported by Medical Research Council United Kingdom New Investigator Research Grant(G0900636)to Davies W
文摘The enzyme steroid sulfatase(STS)desulfates a variety of steroid compounds thereby altering their activity.STS is expressed in the skin,and its deficiency in this tissue has been linked to the dermatological condition X-linked ichthyosis.STS is also highly expressed in the developing and adult human brain,and in a variety of steroidogenic organs(including the placenta and gonads);therefore it has the potential to influence brain development and function directly and/or indirectly(through influencing the hormonal milieu).In this review,we first discuss evidence from human and animal model studies suggesting that STS deficiency might predispose to neurobehavioural abnormalities and certain psychiatric disorders.We subsequently discuss potential mechanisms that may underlie these vulnerabilities.The data described herein have potential implications for understanding the complete spectrum ofclinical phenotypes associated with X-linked ichthyosis,and may indicate novel pathogenic mechanisms underlying psychological dysfunction in developmental disorders such as attention deficit hyperactivity disorder and Turner syndrome.
