Does Mental Illness Impact the Incidence of Crime and Victimisation among Young People?

While the high prevalence of offending and victimisation among young people is well established, no study to date has compared official crime records of young people with mental illness with those without mental illness. This case linkage study sought to determine whether young people with a formal history of mental illness were more likely to have official histories of offending and victimisation than young people who had no recorded histories of mental illness. Results suggested that young people with a history of mental illness are particularly vulnerable to violence. While a weak association was established between violent offending and mental illness, a stronger relationship was found between victimisation and mental illness, especially violent victimisation. Consistent with literature regarding the victim-offender overlap, a history of offending placed young people at a substantially higher risk of victimisation. Implications of these results are discussed in the context of how public mental health services could better protect these vulnerable young people.

Human papillomavirus-associated oral intraepithelial neoplasia.

This study evaluated an unusual subset of oral epithelial dysplasia for the presence of transcriptionally active high-risk HPV subtypes and to further characterize the histological criteria for this condition. There were 20 cases diagnosed as epithelial dysplasia with marked apoptosis of the anterior oral cavity. Clinical and follow-up data were collected and histopathological features were documented. Immunoperoxidase studies were performed for p16 and in situ hybridization studies were performed for low- and high-risk HPV sub-types. Gender- and site-matched controls of conventional moderate-to-severe oral epithelial dysplasia were similarly evaluated using immunoperoxidase studies for p16 and in situ hybridization; the number of apoptotic cells for study and control cases was counted at two different tissue sites. There were 17 men and 3 women with a median age of 56 years. Seventeen lesions were described as white and five were described as rough or papillary. Thirteen were located on the lateral or ventral tongue, some extending onto the floor of the mouth. Epithelial hyperplasia with marked karyorrhexis and apoptosis were present in all the cases, along with features of conventional oral epithelial dysplasia. A statistically significant number of apoptotic cells were identified in the study cases when compared with controls (P>0.0001). Twenty cases were positive for high-risk HPV by in situ hybridization and all 19 nineteen cases evaluated for p16 demonstrated overexpression. Two patients were diagnosed with squamous cell carcinomas and one patient developed recurrent disease. We report a subset of oral epithelial dysplasia that occurs mostly in adult men on the ventral or lateral tongue and is positive for high-risk HPV and for p16. We propose use of the term 'HPV-associated Oral Intraepithelial Neoplasia' to characterize these lesions of the oral cavity for consistency in nomenclature with HPV-associated lesions of the lower anogenital tract. One case recurred and one developed invasive cancer.

Enhancing parenting skills for parents with mental illness: the Mental Health Positive Parenting Program.

OBJECTIVE: To determine the effect of the Mental Health Positive Parenting Program (MHPPP) on parenting practices of parents reporting a mental health problem. DESIGN, SETTING AND PARTICIPANTS: A prospective before-and-after examination of positive parenting skills and parent-reported child outcomes among parents of children aged 2-10 years who had self-reported a mental health problem. One hundred and eleven (85.4%) of 130 parents who commenced the MHPPP completed the program. Of these, 77.5% (n = 86) completed both before- and after-intervention measures. The MHPPP was conducted across four community health centres. INTERVENTION: A 10-week intervention was tailored to parents with a mental health problem. The intervention was divided into a 6-week group parenting program based on the Positive Parenting Program and four weekly home visits. MAIN OUTCOME MEASURES: Parental discipline practices and children's behaviour were measured by the Parenting Scale (PS) and the Eyberg Child Behavior Inventory (ECBI), respectively. RESULTS: Following the MHPPP, parents scored significantly lower on each of the PS subscales: laxness (Z = - 6.23; P < 0.001), over-reactivity (Z = - 7.15; P < 0.001) and verbosity (Z = - 6.59; P < 0.001); and significantly lower on both ECBI subscales: intensity (Z = - 7.08, P < 0.001) and problem (Z = - 7.57; P < 0.001). CONCLUSIONS: Our findings suggest the MHPPP can reduce the number of dysfunctional parenting strategies and parent-reported child behavioural problems. The MHPPP is a promising avenue for early intervention in this population.

The clinical management of bipolar disorder complexity using a stratified model.

OBJECTIVE: To provide practical and clinically meaningful treatment recommendations that amalgamate clinical and research considerations for several common, and as yet understudied, bipolar disorder complex presentations, within the framework of a proposed stratified model. METHODS: A comprehensive search of the literature was undertaken using electronic database search engines (Medline, PubMed, Web of Science) using key words (e.g., bipolar disorder, anxiety, rapid cycling, and subsyndromal). All relevant randomised controlled trials were examined, in addition to review papers, meta-analyses, and book chapters known to the authors. The findings formed the basis of the treatment recommendations within this paper. RESULTS: In light of the many broad presentations of bipolar disorder, a stratified model of bipolar disorder complexity was developed to facilitate consideration of the myriad of complexities that can occur during the longitudinal course of illness and the appropriate selection of treatment. Evidence-based treatment recommendations are provided for the following bipolar disorder presentations: bipolar II disorder, subsyndromal symptoms, mixed states, rapid cycling, comorbid anxiety, comorbid substance abuse, and for the following special populations: young, elderly, and bipolar disorder around the time of pregnancy and birth. In addition, some key strategies for countering treatment non-response and alternative medication recommendations are provided. CONCLUSIONS: Treatment recommendations for the more challenging presentations of bipolar disorder have historically received less attention, despite their prevalence. This review acknowledges the weaknesses in the current evidence base on which treatment recommendations are generally formulated, and additionally emphasises the need for high-quality research in this area. The stratified model provides a means for conceptualizing the complexity of many bipolar disorder presentations and considering their management.

Who picks psychiatry? Perceptions, preferences and personality of medical students.

OBJECTIVES: This study aimed to characterise the personality profiles of junior medical students most likely to choose psychiatry as a career, determine aspects of psychiatry that most attract potential recruits, and identify misperceptions about psychiatry that may dissuade students from pursuing this specialism. METHOD: A total of 580 second-year medical students from the University of New South Wales, Australia completed a set of questionnaires that measured the likelihood with which various medical specialties were being considered as careers, personality traits using the NEO Five-Factor Inventory (NEO-FFI), and the degree to which students perceived each specialty as attractive across a number of parameters. RESULTS: Only 86 students (15%) indicated a strong likelihood of choosing psychiatry, compared to other specialties which attracted higher proportions of students (range 19-49%). These 86 students had significantly higher openness scores than those who indicated a lesser likelihood of pursuing psychiatry. Students who were highly interested in psychiatry ranked it as very attractive in respect to providing interesting and challenging subject matter, and relatively attractive in respect to financial reward, work enjoyment, good lifestyle, having a bright and interesting future, and association with colleagues. However, psychiatry remained less attractive with respect to prestige, perceived low effectiveness of treatments, degree to which it draws upon aspects of medical training, and lack of reliable scientific foundation. Within the entire sample, psychiatry was ranked most unattractive compared to the other specialties across eight of the 13 parameters assessed. CONCLUSIONS: Students interested in psychiatry are more likely to be 'open' and view the specialty as interesting and challenging. Such characteristics should be promoted more widely along with countering myths that as a specialty, psychiatry lacks a scientific foundation or is somehow different from mainstream medicine in terms of training and outcomes. Championing psychiatry in this manner may attract more recruits and enhance its prestige.

Role of positron emission tomography--computed tomography in head and neck cancer.

Head and neck squamous cell carcinoma (HNC) is the sixth most common cancer worldwide. In the United States, it accounts for approximately 2% of all cancers and 2% of cancer deaths. The introduction of integrated positron emission tomography and computed tomography (PET/CT) has revolutionized imaging by permitting improved and more accurate anatomic localization of functional abnormalities in the complex territory of the head and neck region, and PET/CT has become a standard clinical imaging modality in patients with HNC. The main indications for PET/CT in HNC are in pretherapy staging, detection of unknown primaries, and monitoring of therapy response or disease surveillance. Although PET/CT is a promising tool in diagnosis and surveillance of HNC, there is lack of consensus as to its use, accuracy, and implications for patient management. The existing literature on the role of PET/CT in the management of HNC is reviewed, and a summary of the current debate is provided. Second primary cancers are the main cause of death among HNC patients with early disease, and the presence of distant metastases greatly impairs the survival of patients with advanced HNC. Therefore, early detection of second primary and metastatic tumors is imperative for optimizing survival outcome. However, given the lack of randomized, prospective trials addressing the role of PET/CT after chemoradiotherapy, the ideal function of PET/CT in disease surveillance has yet to be defined.

Otolaryngology and the American presidency: a medical legacy.

The various medical histories of eminent members of state have been well documented and explored. Such accounts provide interesting insights into advances in treatment and management of disease. Moreover, historical cases serve as a timely reminder of how the central tenets of good medical practice do not change with time. Two American presidents, Ulysses S. Grant and Grover Cleveland, were afflicted with diseases of the head and neck, and one would subsequently die from his illness. Here we examine their diagnosis, treatment and their disease in the context of modern management.

Nine key principles to guide youth mental health: development of service models in New South Wales.

AIMS: Historically, the Australian health system has failed to meet the needs of young people with mental health problems and mental illness. In 2006, New South Wales (NSW) Health allocated considerable funds to the reform agenda of mental health services in NSW to address this inadequacy. Children and Young People's Mental Health (CYPMH), a service that provides mental health care for young people aged 12-24 years, with moderate to severe mental health problems, was chosen to establish a prototype Youth Mental Health (YMH) Service Model for NSW. This paper describes nine key principles developed by CYPMH to guide the development of YMH Service Models in NSW. METHODS: A literature review, numerous stakeholder consultations and consideration of clinical best practice were utilized to inform the development of the key principles. RESULTS: Subsequent to their development, the nine key principles were formally endorsed by the Mental Health Program Council to ensure consistency and monitor the progress of YMH services across NSW. As a result, between 2008 and 2012 YMH Services across NSW regularly reported on their activities against each of the nine key principles demonstrating how each principle was addressed within their service. CONCLUSIONS: The nine key principles provide mental health services a framework for how to reorient services to accommodate YMH and provide a high-quality model of care. [Corrections added on 29 November 2013, after first online publication: The last two sentences of the Results section have been replaced with "As a result, between 2008 and 2012 YMH Services across NSW regularly reported on their activities against each of the nine key principles demonstrating how each principle was addressed within their service."].

Prophylactic total thyroidectomy using the minimally invasive video-assisted approach in children with multiple endocrine neoplasia type 2.

BACKGROUND: There have been few reports of prophylactic thyroidectomy using the minimally invasive video-assisted thyroidectomy (MIVAT) approach in children with multiple endocrine neoplasia 2 (MEN2). METHODS: We conducted a retrospective review of a prospectively maintained database of patients who underwent MIVAT for total thyroidectomy. RESULTS: Six children underwent MIVAT; RET codon mutations identified were 634, 620, 611, and 918. Mean operative time was 93 minutes (range, 68-105 minutes). Five patients were discharged on the first postoperative day; however, 1 patient had a postoperative hematoma and was discharged 2 days postoperatively. There were no cases of laryngeal nerve palsy or postoperative hypoparathyroidism. High levels of satisfaction with postoperative cosmesis were reported. Calcitonin levels have been undetectable at follow-up thus far (mean follow-up, 42.8 months). CONCLUSION: Although our outcomes are similar to those reported using the traditional approach, it is important to note that MIVAT is essentially the same operation, just performed through a smaller incision, with resulting benefits in terms of pain, cosmesis and, perhaps, morbidity.

Is coping well a matter of personality? A study of euthymic unipolar and bipolar patients.

BACKGROUND: Euthymic bipolar disorder (BD) patients often demonstrate better clinical outcomes than remitted patients with unipolar illness (UP). Reasons for this are uncertain, however, personality and coping styles are each likely to play a key role. This study examined differences between euthymic BD and UP patients with respect to the inter-relationship between personality, coping style, and clinical outcomes. METHODS: A total of 96 UP and 77 BD euthymic patients were recruited through the CADE Clinic, Royal North Shore Hospital in Sydney, and assessed by a team comprising Psychiatrists and Psychologists. They underwent a structured clinical diagnostic interview, and completed self-report measures of depression, anxiety, stress, personality, coping, social adjustment, self-esteem, dysfunctional attitudes, and fear of negative evaluation. RESULTS: Compared to UP, BD patients reported significantly higher scores on levels of extraversion, adaptive coping, self-esteem, and lower scores on trait anxiety and fear of negative evaluation. Extraversion correlated positively with self-esteem, adaptive coping styles, and negatively with trait anxiety and fear of negative evaluation. Trait anxiety and fear of negative evaluation correlated positively with eachother, and both correlated negatively with self-esteem and adaptive coping styles. Finally, self-esteem correlated positively with adaptive coping styles. LIMITATIONS: The results cannot be generalised to depressive states of BD and UP, as differences in the course of illness and types of depression are likely to impact on coping and clinical outcomes, particularly for BD. CONCLUSIONS: During remission, functioning is perhaps better 'preserved' in BD than in UP, possibly because of the protective role of extraversion which drives healthier coping styles.

Primary headache syndromes and sinus headache: An approach to diagnosis and management.

Chronic rhinosinusitis (CRS) and primary headache syndromes are common disease entities and headache and facial pain are common reasons for referral to otolaryngology units. Because of an association of nasal symptoms with primary headache syndromes and considerable similarities in their clinical presentations, primary headache syndromes may be misdiagnosed as sinus disease and vice versa. In this review we examine the evidence on which otolaryngologists can base clinical diagnosis and management and offer an approach to distinguishing these common clinical entities.

Computed tomography scans of paranasal sinuses before functional endoscopic sinus surgery.

This review aims to familiarize the radiologist with the common types of sinus surgery including their indications and techniques. We also illustrate how surgeons interpret 3D sinus anatomy when evaluating computed tomography (CT) studies. Preoperative evaluation by CT is mandatory for all patients undergoing functional endoscopic sinus surgery (FESS). In the past decade in particular, CT of the paranasal sinuses has become a roadmap for FESS. The radiologist's goal is to report on five key points: the extent of sinus opacification, opacification of sinus drainage pathways, anatomical variants, critical variants, and condition of surrounding soft tissues of the neck, brain and orbits. We present a systematic approach to the use of coronal, axial, and sagittal images in CT evaluation before FESS.

Warfarin-induced sublingual hematoma mimicking Ludwig angina: Conservative management of a potentially life-threatening condition.

Sublingual hematoma secondary to excessive anticoagulation is a rare, life-threatening condition. Reports in the literature have emphasized the importance of a prompt reversal of the causative coagulopathy by intravenous administration of vitamin K and fresh frozen plasma. In the event of an unstable airway, surgical intervention via tracheostomy or cricothyroidectomy is advocated. We report a case of sublingual hematoma that was treated conservatively, and we discuss the presentation and management of this entity.

Otolaryngology and Irish literature: an important medico-literary alliance.

For a comparatively small island, Ireland has made a disproportionately large contribution to world literature in all its aspects. The literary lineage of those who pursue medicine and also write is long and well established. The Irish contribution to world literature in all its aspects is well documented. Less explored, however, is the prominent influence of Dublin-based otolaryngologists in the Irish literary movement at the turn of the last century. Here, we examine two such figures, Sir William Wilde and Oliver St. John Gogarty, and their pivotal roles both professionally and in establishing Ireland on the world's literary stage. During the early part of the 1800s, otology was perceived as a defunct subspecialty that could be adequately managed, without much expertise, in the primary care setting. It was through the efforts of William Wilde and others that otology gained clinical and scientific credence during the latter half of the 19th century.