Introduction During the last decade there has been a resurgence of interest on the use of psychedelics as novel treatments for mental disorders, including treatment-resistant depression (TRD). Psilocybin, the chemical component of “magic mushrooms”, has been administered with psychotherapy in randomized clinical trials (RCTs) showing large and sustained antidepressant effects. As the use of psilocybin expands, it is becoming more important to understand whether psilocybin’s psychedelic effects are required for psilocybin’s antidepressant effects. Psilocybin’s psychedelic effects are known to be dependent on serotonin 2A receptor (5-HT2AR) activation. Given the safety concerns associated with psilocybin’s psychedelic effects, all studies have used it in conjunction with at least 12 hours of intensive psychotherapy. This makes psilocybin-assisted psychotherapy (PAP) highly resource intensive and impedes scalability given limited resources and access to trained therapists in most jurisdictions. Studies in healthy volunteers have shown that psilocybin’s psychedelic effects are blocked by 5-HT2AR antagonists like risperidone and ketanserin. In a pre-clinical study using a mouse model of depression, administration of ketanserin followed by psilocybin had the same antidepressant effect as psilocybin alone. We propose to conduct the first study to test in humans whether the antidepressant effects of psilocybin are attenuated by 5-HT2AR blockade from risperidone. Objectives Aim 1: To evaluate the feasibility and tolerability of administering psilocybin with risperidone in adults with TRD by evaluating recruitment, retention, tolerability, and safety. Aim 2: To evaluate psychedelic effects (measured with the 5-Dimensional Altered States of Consciousness Rating Scale) in the three groups. Aim 3: To evaluate antidepressant effects (measured with the Montgomery Asberg Depression Rating Scale; MADRS) in the three groups. . Methods A three-arm, 4-week, double blind, proof-of-concept RCT for patients with a DSM-5 major depressive episode that has failed to respond to at least two adequate trials of antidepressants. Participants will be randomized to: 1) psilocybin 25 mg plus risperidone 1 mg; 2) psilocybin 25 mg plus placebo; 3) placebo plus risperidone 1 mg. All participants will receive 12 hours of manualized psychotherapy. Results Ethics approval for the proposed study has been obtained. We will present preliminary feasibility data at the meeting in March. Conclusions If the study demonstrates that psilocybin’s psychedelic effects are not necessary for psilocybin’s antidepressant effects, the combination of psilocybin and a 5-HT2AR antagonist, such as risperidone, could increase acceptability and access to the use of psilocybin to treat MDD and related conditions. Disclosure of Interest None Declared

Alopecia Areata (AA) is an autoimmune condition that is characterised by non-scarring hair loss. Its aesthetic repercussions can lead to profound changes in psychological well-being. Although physical activity (PA) has been associated with better mental health outcomes in diverse populations, the association in individuals with AA has not been established. The aim of this study was to examine the associations between PA and mental health outcomes in individuals with AA to inform intervention strategies for this specific population. A cross-sectional study was conducted among individuals who were diagnosed with AA. A total of 83 respondents aged (40.95 ± 13.24 years) completed a self-report questionnaire consisting of International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Depression and Anxiety Stress Scale (DASS-21). Three-way contingency Chi-square analyses were used to determine the associations between PA, mental health outcomes and participants with hair loss of more than 50% on the scalp. 81.9% of the participants did not meet PA guidelines. Participants with hair loss of more than 50% on the scalp, and who did not meet PA guidelines, were significantly more likely to experience symptoms of severe depression (p = .003), moderate anxiety (p = .04) and mild stress (p = .003) than those who met guidelines Findings suggest that increased PA participation in AA individuals with severe hair loss is associated with improved mental health status. Intervention efforts for this specific population should consider barriers and enablers to PA participation as they face challenges that differ from the general population.

The post-traumatic disorder syndrome cluster is defined in terms of a stressor being associated with subsequent psychological and behavioral consequences. This chapter traces the history of the post-traumatic syndromes; outlines the current nosology of this group of disorders; addresses some of the more contentious areas in the field, such as vicarious exposure to stressful events; and finally summarizes treatment approaches.

Presentation to the emergency department (ED) due to hypoglycemia among diabetics is not an uncommon event. Traditional teaching has been for hospital admission and extended observation for recurrence of hypoglycemia among individuals on long-acting insulin and oral diabetic medications. Home observation has been considered by some to be a reasonable alternative if the risk of recurrent hypoglycemia is felt to be low. The following study was performed to evaluate the likelihood and patterns of recurrent hypoglycemia in individuals discharged from the ED following a hypoglycemic event. A retrospective chart review of electronic medical records was performed over 2 calendar years using the Ninth Revision of the International Classification of Diseases (ICD-9) diagnosis for hypoglycemia for patients evaluated in a single ED with an annual volume of 100,000 patients. Chart reviews were performed to identify unique patient encounters with symptomatic blood sugar readings less than 55 mg/dL who were taking oral or injectable diabetic medications. Specific medications taken, blood sugar readings obtained, and general demographic information was ascertained. For those discharged, hospital records from all nearby health systems as well as all area county Emergency Medical Service (EMS) encounters and county death records were reviewed for any further patient contact that took place within 7 days of discharge. Return hospital visits or EMS encounters within 48 hours were arbitrarily defined as recurrent hypoglycemic events. Data is reported as frequency of occurrence with 95% confidence interval (CI) and with significance determined using Chi Square analysis. There were 272 hypoglycemic patients identified meeting inclusion criteria with 76 patients admitted and 196 patients discharged (144 insulin only, 33 insulin and oral agents, 19 oral agents alone) over the study period. Of those discharged, 3 patients on oral agents alone, 15.8% (CI 0-32.2%), 3 patients on insulin and oral agents, 9.1% (CI 0-18.9%), and 4 of 144 patient on insulin alone, 2.7% (CI 0.1-5.4%) had return visits to the ED within 48 hours. Patients taking oral agents alone had a significantly greater likelihood of return ED visits compared to those taking insulin without any oral agents (P=.01). Patients taking an oral agent with or without insulin additionally had a significant risk of return ED visits compared to insulin only patients (P=.01). All 4 patients who returned after being discharged who were taking injectable insulin alone (5.9% [CI 0.3-11.5%]) were noted to be on long-acting once-daily dosed insulin glargine (Lantus). No patients were identified by county death records or EMS records over the 7 days following discharge. Individuals taking blood sugar lowering agents discharged from the ED following a hypoglycemic event may be at risk of recurrent visits related to further hypoglycemic episodes. This risk is considerably greater in those taking oral agents and those on long-acting insulin. Hospital observation in this high-risk population should be considered.

B. G. Buchanan, S. L. Rossell, J. J. Maller, W. L. Toh, S. Brennan and D. J. Castle Psychological Medicine / FirstView Article / March 2013, pp 1 ­ 9 DOI: 10.1017/S0033291713000421, Published online: 11 March 2013 Link to this article: http://journals.cambridge.org/abstract_S0033291713000421 How to cite this article: B. G. Buchanan, S. L. Rossell, J. J. Maller, W. L. Toh, S. Brennan and D. J. Castle Brain connectivity in body dysmorphic disorder compared with controls: a diffusion tensor imaging study. Psychological Medicine, Available on CJO 2013 doi:10.1017/S0033291713000421 Request Permissions : Click here

Background Several neuroimaging studies have investigated brain grey matter in people with body dysmorphic disorder (BDD), showing possible abnormalities in the limbic system, orbitofrontal cortex, caudate nuclei and temporal lobes. This study takes these findings forward by investigating white matter properties in BDD compared with controls using diffusion tensor imaging. It was hypothesized that the BDD sample would have widespread significantly reduced white matter connectivity as characterized by fractional anisotropy (FA). Method A total of 20 participants with BDD and 20 healthy controls matched on age, gender and handedness underwent diffusion tensor imaging. FA, a measure of water diffusion within a voxel, was compared between groups on a voxel-by-voxel basis across the brain using tract-based spatial statistics within the FSL package. Results Results showed that, compared with healthy controls, BDD patients demonstrated significantly lower FA ( p < 0.05) in most major white matter tracts throughout the brain, including in the superior longitudinal fasciculus, inferior fronto-occipital fasciculus and corpus callosum. Lower FA levels could be accounted for by increased radial diffusivity as characterized by eigenvalues 2 and 3. No area of higher FA was found in BDD. Conclusions This study provided the first evidence of compromised white matter integrity within BDD patients. This suggests that there are inefficient connections between different brain areas, which may explain the cognitive and emotion regulation deficits within BDD patients.

AbstractOne thing that is certain about the aetiology of schizophrenia is that there is no single cause. This might reflect the fact that the schizophrenia construct itself is heterogeneous, such that specific subtypes might in the future be found to have specific causes. But it is more useful at this stage of our knowledge to conclude that, like other disorders such as ischaemic heart disease and diabetes mellitus, schizophrenia results from the cumulative effects of a number of risk factors. These may be crudely divided into the familial-genetic and the environmental, though there are clearly interactions between the two.

Study ObjectivesComputed tomography (CT) is a vital adjunct in the evaluation and care of trauma patients. While its usefulness is undisputable, this benefit comes with radiation-related risk given the relatively high doses of ionizing radiation that are used. This concern has generated a debate over the proper role of CT in stable trauma patients. In particular, patients who are awake and alert and have minimal physical complaints after a high energy accident (falling from height or high speed motor vehicle accident) often undergo multiple CT scans “just to make sure” that they don't have significant injury. While several studies have promoted this approach, to date there has been no well-designed study to exam this practice in this patient population. We addressed the following questions: How closely do physician assessment and CT scan results agree in the alert stable patient who has experienced high energy trauma but has no complaints or physical findings to suggest injury? Can physicians reliably detect severe injuries in this select patient population?MethodsDesign/Setting: This is a prospective cohort study conducted at 3 Level I trauma centers. A convenience sample was enrolled when study personnel were available.ParticipantsPatients were included if they met the inclusion criteria: blunt trauma, trauma team activation, Glasgow Coma Score 15, systolic blood pressure on arrival > 100, age between 18 and 65. Patients were excluded if they were transferred from another hospital, if they were pregnant or if no CT scan was obtained. Trauma team leaders completed a survey regarding the reliability of the patient and suspicion of any injury and severe injury in various body regions (head, neck, chest, abdomen, pelvis and extremities). The patient's chart was later abstracted for outcome and injuries detected on x-ray or CT. Major injuries were defined a priori.Results150 patients were enrolled. Mean age was 43 (SD=17.6). Mechanisms of injury were: MVA 55%, fall 20%, motorcycle accident 10%, bicycle accident 9%, other 6%. 46% of patients were deemed unreliable mostly because of intoxication or distracting injury. 43% of patients were admitted to the floor and 35% were admitted to the ICU. 18% of patients were discharged home and 2 patients died in the hospital. Among all patients included in the study, there were 89 major injuries, 43 of which were not suspected by the physician. Among the patients that were deemed reliable (n=81), there were 11 major injuries that were not detected. These injuries occurred in 5 patients and included sacral fracture, acetabular fracture, C7 facet fracture, T9 fracture and small intraparenchymal contusions in 2 patients. The calculated negative predictive value of physician assessment ranged from 0.89 to 0.99 (95% CI 0.80 to 0.99). Sensitivity of physician assessment to the presence of any major injury was 0.68 (0.46-0.84). 47 patients were assessed by more than 1 provider. Using the AC1 statistic, there was good inter-observer agreement of patient reliability (0.948 +/− 0.74) and of major injury assessment (ranging from 0.81 to 1.0 +/− 0.03 to 0.10).ConclusionEven among patients deemed reliable, there were a number of missed major injuries. Physicians should not rely strictly on their assessment to detect major injuries in patients who have experienced high energy trauma. Particular care should be taken among patients who are felt to be unreliable. Study ObjectivesComputed tomography (CT) is a vital adjunct in the evaluation and care of trauma patients. While its usefulness is undisputable, this benefit comes with radiation-related risk given the relatively high doses of ionizing radiation that are used. This concern has generated a debate over the proper role of CT in stable trauma patients. In particular, patients who are awake and alert and have minimal physical complaints after a high energy accident (falling from height or high speed motor vehicle accident) often undergo multiple CT scans “just to make sure” that they don't have significant injury. While several studies have promoted this approach, to date there has been no well-designed study to exam this practice in this patient population. We addressed the following questions: How closely do physician assessment and CT scan results agree in the alert stable patient who has experienced high energy trauma but has no complaints or physical findings to suggest injury? Can physicians reliably detect severe injuries in this select patient population? Computed tomography (CT) is a vital adjunct in the evaluation and care of trauma patients. While its usefulness is undisputable, this benefit comes with radiation-related risk given the relatively high doses of ionizing radiation that are used. This concern has generated a debate over the proper role of CT in stable trauma patients. In particular, patients who are awake and alert and have minimal physical complaints after a high energy accident (falling from height or high speed motor vehicle accident) often undergo multiple CT scans “just to make sure” that they don't have significant injury. While several studies have promoted this approach, to date there has been no well-designed study to exam this practice in this patient population. We addressed the following questions: How closely do physician assessment and CT scan results agree in the alert stable patient who has experienced high energy trauma but has no complaints or physical findings to suggest injury? Can physicians reliably detect severe injuries in this select patient population? MethodsDesign/Setting: This is a prospective cohort study conducted at 3 Level I trauma centers. A convenience sample was enrolled when study personnel were available. Design/Setting: This is a prospective cohort study conducted at 3 Level I trauma centers. A convenience sample was enrolled when study personnel were available. ParticipantsPatients were included if they met the inclusion criteria: blunt trauma, trauma team activation, Glasgow Coma Score 15, systolic blood pressure on arrival > 100, age between 18 and 65. Patients were excluded if they were transferred from another hospital, if they were pregnant or if no CT scan was obtained. Trauma team leaders completed a survey regarding the reliability of the patient and suspicion of any injury and severe injury in various body regions (head, neck, chest, abdomen, pelvis and extremities). The patient's chart was later abstracted for outcome and injuries detected on x-ray or CT. Major injuries were defined a priori. Patients were included if they met the inclusion criteria: blunt trauma, trauma team activation, Glasgow Coma Score 15, systolic blood pressure on arrival > 100, age between 18 and 65. Patients were excluded if they were transferred from another hospital, if they were pregnant or if no CT scan was obtained. Trauma team leaders completed a survey regarding the reliability of the patient and suspicion of any injury and severe injury in various body regions (head, neck, chest, abdomen, pelvis and extremities). The patient's chart was later abstracted for outcome and injuries detected on x-ray or CT. Major injuries were defined a priori. Results150 patients were enrolled. Mean age was 43 (SD=17.6). Mechanisms of injury were: MVA 55%, fall 20%, motorcycle accident 10%, bicycle accident 9%, other 6%. 46% of patients were deemed unreliable mostly because of intoxication or distracting injury. 43% of patients were admitted to the floor and 35% were admitted to the ICU. 18% of patients were discharged home and 2 patients died in the hospital. Among all patients included in the study, there were 89 major injuries, 43 of which were not suspected by the physician. Among the patients that were deemed reliable (n=81), there were 11 major injuries that were not detected. These injuries occurred in 5 patients and included sacral fracture, acetabular fracture, C7 facet fracture, T9 fracture and small intraparenchymal contusions in 2 patients. The calculated negative predictive value of physician assessment ranged from 0.89 to 0.99 (95% CI 0.80 to 0.99). Sensitivity of physician assessment to the presence of any major injury was 0.68 (0.46-0.84). 47 patients were assessed by more than 1 provider. Using the AC1 statistic, there was good inter-observer agreement of patient reliability (0.948 +/− 0.74) and of major injury assessment (ranging from 0.81 to 1.0 +/− 0.03 to 0.10). 150 patients were enrolled. Mean age was 43 (SD=17.6). Mechanisms of injury were: MVA 55%, fall 20%, motorcycle accident 10%, bicycle accident 9%, other 6%. 46% of patients were deemed unreliable mostly because of intoxication or distracting injury. 43% of patients were admitted to the floor and 35% were admitted to the ICU. 18% of patients were discharged home and 2 patients died in the hospital. Among all patients included in the study, there were 89 major injuries, 43 of which were not suspected by the physician. Among the patients that were deemed reliable (n=81), there were 11 major injuries that were not detected. These injuries occurred in 5 patients and included sacral fracture, acetabular fracture, C7 facet fracture, T9 fracture and small intraparenchymal contusions in 2 patients. The calculated negative predictive value of physician assessment ranged from 0.89 to 0.99 (95% CI 0.80 to 0.99). Sensitivity of physician assessment to the presence of any major injury was 0.68 (0.46-0.84). 47 patients were assessed by more than 1 provider. Using the AC1 statistic, there was good inter-observer agreement of patient reliability (0.948 +/− 0.74) and of major injury assessment (ranging from 0.81 to 1.0 +/− 0.03 to 0.10). ConclusionEven among patients deemed reliable, there were a number of missed major injuries. Physicians should not rely strictly on their assessment to detect major injuries in patients who have experienced high energy trauma. Particular care should be taken among patients who are felt to be unreliable. Even among patients deemed reliable, there were a number of missed major injuries. Physicians should not rely strictly on their assessment to detect major injuries in patients who have experienced high energy trauma. Particular care should be taken among patients who are felt to be unreliable.

The ventral pallidum (VP) is innervated by the mesolimbic dopaminergic system and it has a key role in motivation, reward, and memory processes. Neurotensin (NT) is an important neuromodulator which has been shown to modulate reinforcement in the ventral tegmental area, in the ventral mesencephalic region and in the central nucleus of amygdala. Neurotensin receptor 1 (NTR1) has already been detected in the VP in abundance, but its role in rewarding and reinforcing processes is not fully understood yet.In our present experiments, the effects of NT on positive reinforcement were investigated in the VP. In conditioned place preference (CPP) test, male Wistar rats were microinjected bilaterally with 100 ng or 250 ng NT in the volume of 0.4 μl. In other groups of animals, 35 ng NTR1 antagonist SR 48692 was applied by itself, or microinjected 15 min before 100 ng NT treatment.One hundred ng dose of NT induced CPP, whereas animals injected with 250 ng NT did not exhibit significant differences from the vehicle group.Antagonist pretreatment inhibited the effect of NT, while the antagonist applied by itself had no effect. Our results show that NT injected into the VP is involved in positive reinforcement. This effect is specific to NTR1 receptors because the development of CPP can be prevented by specific antagonist.

Heavy alcohol consumption is a well-known phenomenon on college campuses; however, the impact of alcohol-related emergency department visits among this sub-population is not well studied. In a large emergency department located in close proximity to a university campus, the following study was performed to evaluate characteristics of college-aged individuals presenting with alcohol intoxication and their impact on emergency department resources. A retrospective chart review of emergency department medical records over an 8-week time period was conducted to characterize alcohol-related visits among individuals 18-23 years of age. Visits in which recent alcohol consumption was noted were classified as: 1) primary alcohol-related effects (sedation/vomiting), 2) traumatic injuries 3) psychiatric-related complaints with coinciding alcohol consumption or 4) other ED presentations with alcohol ingestion noted. Impact on total nursing staff resources was calculated assuming a nursing:patient ratio of 1:3. Alcohol-related visits made up 8.5% (140/1657) of total visits in the 18-23-year-old population with 55.7% (78/140) due to primary alcohol effects, 39.2% (55/140) involving traumatic injuries, and 3.5% (4/140) with varying non-substance abuse related psychiatric complaints. Emergency department visits in females were more likely to be related to primary alcohol effects compared to males (73% versus 45% respectively)(p<0.01). Males were more likely to have visits related to traumatic injuries with concomitant alcohol consumption compared to females (50% versus 22% respectively)(p<0.01). During the hours of 11 PM-7 AM, 20% of all visits (110/550) in the 18-23 year age range were related to alcohol usage. During the 11 PM to 7 AM time period, 34% of visits were alcohol related on "traditional" drinking days (Thursday thru Saturday) compared to just 6% of visits on other days (Sunday-Thursday) (p<0.01). During night shift hours (11 PM - 7 AM) on 4 different days over the 5 weeks in which students occupied campus, at least 1 nurse, or ≥10% (≥24 hours cumulative patient care hours) of total nursing staff time, was dedicated to caring for intoxicated 18-23 year olds. Alcohol consumption amongst college-aged individuals near a university campus appears responsible for a sizeable number of emergency department visits. Recognition of these patterns of alcohol consumption can be used to better educate students on the risk of heavy alcohol consumption as well as influencing emergency department staffing patterns during times of peak alcohol consumption.

Background. Body dysmorphic disorder (BDD) is a poorly understood disorder that involves a preoccupation with imagined or minor bodily defects. Only a few studies of neuropsychological function have been conducted. Two previous studies have indicated executive dysfunction in BDD. The current study sought to further define these executive deficits.Method. Fourteen DSM-IV BDD patients and 14 age-and sex-matched control participants took part. Because of the high incidence of co-morbidity in BDD, patients with co-morbid Axis I disorders were not excluded. Control participants had no history of psychiatric illness. All participants completed the following executive function (EF) tests : Spatial Span (SS), Spatial Working Memory (SWM) and the Stockings of Cambridge (SOC) task. They also completed the Pattern Recognition (PR) test, a test of visual memory (VM).Results. BDD participants made significantly more between-search errors on the SWM task, an effect that increased with task difficulty. Between-search errors are an example of poor maintenance and manipulation of information. SOC results indicated slower subsequent thinking times (i.e. the time taken to plan) in BDD participants. There were no group differences in SS or PR scores. The severity of BDD, depressive or anxiety symptoms was not correlated with performance on any of the cognitive tasks.Conclusions. The results of this study indicate that BDD patients have EF deficits in on-line manipulation, planning and organization of information. By contrast, spatial memory capacity, motor speed and visual memory were intact. Considered with evidence from lesion and neuroimaging studies, these results suggest frontal lobe dysfunction in BDD.

Study ObjectiveThe use of remote teleradiology provides emergency physicians with preliminary interpretation of radiographic studies in hospitals unable to provide 24-hour on-site board-certified radiologist coverage. Over 82% of community-based emergency departments are reported to use such resources to obtain timely radiologic interpretations. The following study was performed to assess the effectiveness of teleradiology by evaluating the incidence of major discrepancies between preliminary teleradiology reports and next day on-site radiology interpretations among varying study modalities.MethodsA retrospective review of all CT and ultrasonography studies performed at a large community-based emergency department (105,000 annual visits) over a 12-month time period (October 1, 2008-September 30, 2009) that were preliminarily interpreted by a remote teleradiologist was performed. Studies that were determined to have discrepancies between the preliminary teleradiology report and the "in-house" radiology interpretation were indentified. Discrepancies were categorized as "minor" if no immediate intervention were needed, or "major" if immediate return to the emergency department or alteration in patient care was felt to be necessary by the emergency physician receiving the report at the time the difference in the in-house radiologist's read was identified.ResultsA total of 10,749 CT and ultrasonography studies were preliminarily interpreted by teleradiology services over the study period with major discrepancies found in 0.47% (50/10,749)(95% CI= 0.36-0.62%) of total cases. Rates of major discrepancies were noted on 0.26% (5/1,957)(95% CI= 0.11 to 0.60%) of ultrasonographys and 0.50% of all CT studies (44/8,792)(95% CI= 0.37 to 0.67%) performed (p=0.15). Major discrepancy rates were identified on 0.65% (19/2193)(95% CI= 0.42 to 1.0%) of CT abdomen/pelvis studies when compared to 0.43% (25/5879)(95% CI= 0.29-0.63%) of CT studies of all other body parts (p=0.15).ConclusionThe overall rate of major discrepancies between preliminary teleradiology reports and on-site radiology interpretations is very low and provides an adequate means of providing accurate radiographic interpretation during time periods when no on-site radiology may be available. When comparing ultrasonography and CT scans of varying body parts there is no significant difference in likelihood of having major discrepancies noted. Study ObjectiveThe use of remote teleradiology provides emergency physicians with preliminary interpretation of radiographic studies in hospitals unable to provide 24-hour on-site board-certified radiologist coverage. Over 82% of community-based emergency departments are reported to use such resources to obtain timely radiologic interpretations. The following study was performed to assess the effectiveness of teleradiology by evaluating the incidence of major discrepancies between preliminary teleradiology reports and next day on-site radiology interpretations among varying study modalities. The use of remote teleradiology provides emergency physicians with preliminary interpretation of radiographic studies in hospitals unable to provide 24-hour on-site board-certified radiologist coverage. Over 82% of community-based emergency departments are reported to use such resources to obtain timely radiologic interpretations. The following study was performed to assess the effectiveness of teleradiology by evaluating the incidence of major discrepancies between preliminary teleradiology reports and next day on-site radiology interpretations among varying study modalities. MethodsA retrospective review of all CT and ultrasonography studies performed at a large community-based emergency department (105,000 annual visits) over a 12-month time period (October 1, 2008-September 30, 2009) that were preliminarily interpreted by a remote teleradiologist was performed. Studies that were determined to have discrepancies between the preliminary teleradiology report and the "in-house" radiology interpretation were indentified. Discrepancies were categorized as "minor" if no immediate intervention were needed, or "major" if immediate return to the emergency department or alteration in patient care was felt to be necessary by the emergency physician receiving the report at the time the difference in the in-house radiologist's read was identified. A retrospective review of all CT and ultrasonography studies performed at a large community-based emergency department (105,000 annual visits) over a 12-month time period (October 1, 2008-September 30, 2009) that were preliminarily interpreted by a remote teleradiologist was performed. Studies that were determined to have discrepancies between the preliminary teleradiology report and the "in-house" radiology interpretation were indentified. Discrepancies were categorized as "minor" if no immediate intervention were needed, or "major" if immediate return to the emergency department or alteration in patient care was felt to be necessary by the emergency physician receiving the report at the time the difference in the in-house radiologist's read was identified. ResultsA total of 10,749 CT and ultrasonography studies were preliminarily interpreted by teleradiology services over the study period with major discrepancies found in 0.47% (50/10,749)(95% CI= 0.36-0.62%) of total cases. Rates of major discrepancies were noted on 0.26% (5/1,957)(95% CI= 0.11 to 0.60%) of ultrasonographys and 0.50% of all CT studies (44/8,792)(95% CI= 0.37 to 0.67%) performed (p=0.15). Major discrepancy rates were identified on 0.65% (19/2193)(95% CI= 0.42 to 1.0%) of CT abdomen/pelvis studies when compared to 0.43% (25/5879)(95% CI= 0.29-0.63%) of CT studies of all other body parts (p=0.15). A total of 10,749 CT and ultrasonography studies were preliminarily interpreted by teleradiology services over the study period with major discrepancies found in 0.47% (50/10,749)(95% CI= 0.36-0.62%) of total cases. Rates of major discrepancies were noted on 0.26% (5/1,957)(95% CI= 0.11 to 0.60%) of ultrasonographys and 0.50% of all CT studies (44/8,792)(95% CI= 0.37 to 0.67%) performed (p=0.15). Major discrepancy rates were identified on 0.65% (19/2193)(95% CI= 0.42 to 1.0%) of CT abdomen/pelvis studies when compared to 0.43% (25/5879)(95% CI= 0.29-0.63%) of CT studies of all other body parts (p=0.15). ConclusionThe overall rate of major discrepancies between preliminary teleradiology reports and on-site radiology interpretations is very low and provides an adequate means of providing accurate radiographic interpretation during time periods when no on-site radiology may be available. When comparing ultrasonography and CT scans of varying body parts there is no significant difference in likelihood of having major discrepancies noted. The overall rate of major discrepancies between preliminary teleradiology reports and on-site radiology interpretations is very low and provides an adequate means of providing accurate radiographic interpretation during time periods when no on-site radiology may be available. When comparing ultrasonography and CT scans of varying body parts there is no significant difference in likelihood of having major discrepancies noted.

A risk of carbon monoxide (CO) poisoning occurs whenever fossil fuel combustion takes place in an enclosed setting. The use of backpacking stoves in tents has been recognized as the cause of a number of reported deaths and elevated carboxyhemoglobin levels in tent inhabitants. A study was performed to evaluate the amount of CO production occurring in varying tents with variable fuel types.

Whilst gains have been made in recent years in the pharmacological treatment of schizophrenia, a number of patients still have residual symptoms and disabilities, or simply do not show response to antipsychotic medications. For such 'treatment resistant' patients, there is little by way of randomised controlled data to support any particular type of further intervention, but combinations of agents (combined antipsychotics, augmentation with mood stabilisers, antidepressants, and other agents)can show benefit in certain patients in certain domains of symptomatology and psychosocial functioning. Certain psychological and psychosocial treatment strategies can also be of benefit in this regard. This article selectively reviews the literature treatment resistance in schizophrenia, and emphasises the importance of an holistic approach to individual patients. Keywords : schizophrenia, treatment resistance, antipsychotics, augmentation, psychosocial treatments South African Psychiatry Review Vol. 9(1) 2006: 17-23

Background. We describe the development, reliability and applications of the Diagnostic Interview for Psychoses (DIP), a comprehensive interview schedule for psychotic disorders.Method. The DIP is intended for use by interviewers with a clinical background and was designed to occupy the middle ground between fully structured, lay-administered schedules, and semi-structured, psychiatrist-administered interviews. It encompasses four main domains: (a) demographic data; (b) social functioning and disability; (c) a diagnostic module comprising symptoms, signs and past history ratings; and (d) patterns of service utilization and patient-perceived need for services. It generates diagnoses according to several sets of criteria using the OPCRIT computerized diagnostic algorithm and can be administered either on-screen or in a hard-copy format.Results. The DIP proved easy to use and was well accepted in the field. For the diagnostic module, inter-rater reliability was assessed on 20 cases rated by 24 clinicians: good reliability was demonstrated for both ICD-10 and DSM-III-R diagnoses. Seven cases were interviewed 2–11 weeks apart to determine test–retest reliability, with pairwise agreement of 0·8–1·0 for most items. Diagnostic validity was assessed in 10 cases, interviewed with the DIP and using the SCAN as ‘gold standard’: in nine cases clinical diagnoses were in agreement.Conclusions. The DIP is suitable for use in large-scale epidemiological studies of psychotic disorders, as well as in smaller studies where time is at a premium. While the diagnostic module stands on its own, the full DIP schedule, covering demography, social functioning and service utilization makes it a versatile multi-purpose tool.

OBJECTIVE:To determine the clinical correlates of dysmorphic concern in persons seeking cosmetic enhancement from cosmetic physicians.METHOD:A questionnaire survey of 137 patients attending the practices of two cosmetic physicians.RESULTS:Four subjects (2.9%; 95% CI = 0.8%-7.3%) had a diagnosis of body dysmorphic disorder (BDD), but many more expressed overconcern with physical appearance ('dysmorphic concern'). Dysmorphic concern accounted for a substantial amount of the variance for mood, social anxiety, and impairment in work and social functioning, while concerns related to how self or others perceive the putative flaw in appearance, impacted significantly on work and leisure activities, but did not apparently influence mood and social anxiety to any significant degree.CONCLUSIONS:Dysmorphic concern is a broad dimensional construct that is related to both inter- and intrapsychic distress and disablement associated with people seeking cosmetic enhancement