26 results
High depression symptomatology and mental pain characterize suicidal psychiatric patients
- Maurizio Pompili, Marco Innamorati, Denise Erbuto, Mario Luciano, Gaia Sampogna, Giovanni Abbate-Daga, Stefano Barlati, Claudia Carmassi, Giovanni Castellini, Pasquale De Fazio, Giorgio Di Lorenzo, Marco Di Nicola, Silvia Ferrari, Arianna Goracci, Carla Gramaglia, Giovanni Martinotti, Maria Giulia Nanni, Massimo Pasquini, Federica Pinna, Nicola Poloni, Gianluca Serafini, Maria Signorelli, Alfonso Tortorella, Antonio Ventriglio, Umberto Volpe, Andrea Fiorillo
-
- Journal:
- European Psychiatry / Volume 65 / Issue 1 / 2022
- Published online by Cambridge University Press:
- 31 August 2022, e54
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Background
Symptoms of depression are transdiagnostic heterogenous features frequently assessed in psychiatric disorders, that impact the response to first-line treatment and are associated with higher suicide risk. This study assessed whether severe mental pain could characterize a specific phenotype of severely depressed high-risk psychiatric patients. We also aimed to analyze differences in treatments administered.
Methods2,297 adult patients (1,404 females and 893 males; mean age = 43.25 years, SD = 15.15) treated in several Italian psychiatric departments. Patients were assessed for psychiatric diagnoses, mental pain, symptoms of depression, hopelessness, and suicide risk.
ResultsMore than 23% of the patients reported high depression symptomatology and high mental pain (HI DEP/HI PAIN). Compared to patients with lower symptoms of depression, HI DEP/HI PAIN is more frequent among females admitted to an inpatient department and is associated with higher hopelessness and suicide risk. In addition, HI DEP/HI PAIN (compared to both patients with lower symptoms of depression and patients with higher symptoms of depression but lower mental pain) were more frequently diagnosed in patients with personality disorders and had different treatments.
ConclusionsPatients reporting severe symptoms of depression and high mental pain presented a mixture of particular dangerousness (high trait hopelessness and the presence of suicide ideation with more frequency and less controllability and previous suicide behaviors). The presence of severe mental pain may act synergically in expressing a clinical phenotype that is likewise treated with a more complex therapeutic regime than that administered to those experiencing symptoms of depression without mental pain.
19 - The EU, Competition Law and Workers Rights
- Edited by Sanjukta Paul, Wayne State University, Detroit, Shae McCrystal, University of Sydney, Ewan McGaughey, King's College London
-
- Book:
- The Cambridge Handbook of Labor in Competition Law
- Published online:
- 05 May 2022
- Print publication:
- 26 May 2022, pp 280-297
-
- Chapter
- Export citation
-
Summary
This paper delves into the ways in which EU competition law affects the right of workers to organize and combine with each other and act, collectively, in the furtherance of their rights and interests at work, in particular by means of collective agreements concluded with one or more employers. It begins by opposing the limited ‘labour exemption’ contained in the recent competition caselaw and contrasts that with a more traditional ‘labour law’ approach, that would typically see collective bargaining as a fundamental, and universal, labour rights to be enjoyed by all workers, or in the alternative will have to integrate the asymmetry of bargaining power between labour and digital monopsonies. We put forward a more nuanced and balanced approach, by reference to the concept of ‘predominantly personal work’, that could act as the new watershed concept around which labour rights and competition law could define their respective fields of operation and which may already inspire the recent Commission’s proposals enabling self-employed without employees (“solo self-employed”) to access the right to bargain collectively on a number of issues with digital platforms.
Prevalence and correlates of major depressive disorder, bipolar disorder and schizophrenia among nursing home residents without dementia: systematic review and meta-analysis
- Michele Fornaro, Marco Solmi, Brendon Stubbs, Nicola Veronese, Francesco Monaco, Stefano Novello, Andrea Fusco, Annalisa Anastasia, Domenico De Berardis, André F. Carvalho, Andrea de Bartolomeis, Eduard Vieta
-
- Journal:
- The British Journal of Psychiatry / Volume 216 / Issue 1 / January 2020
- Published online by Cambridge University Press:
- 13 March 2019, pp. 6-15
- Print publication:
- January 2020
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Background
The elderly population and numbers of nursing homes residents are growing at a rapid pace globally. Uncertainty exists regarding the actual rates of major depressive disorder (MDD), bipolar disorder and schizophrenia as previous evidence documenting high rates relies on suboptimal methodology.
AimsTo carry out a systematic review and meta-analysis on the prevalence and correlates of MDD, bipolar disorder and schizophrenia spectrum disorder among nursing homes residents without dementia.
MethodMajor electronic databases were systematically searched from 1980 to July 2017 for original studies reporting on the prevalence and correlates of MDD among nursing homes residents without dementia. The prevalence of MDD in this population was meta-analysed through random-effects modelling and potential sources of heterogeneity were examined through subgroup/meta-regression analyses.
ResultsAcross 32 observational studies encompassing 13 394 nursing homes residents, 2110 people were diagnosed with MDD, resulting in a pooled prevalence rate of 18.9% (95% CI 14.8–23.8). Heterogeneity was high (I2 = 97%, P≤0.001); no evidence of publication bias was observed. Sensitivity analysis indicated the highest rates of MDD among North American residents (25.4%, 95% CI 18–34.5, P≤0.001). Prevalence of either bipolar disorder or schizophrenia spectrum disorder could not be reliably pooled because of the paucity of data.
ConclusionsMDD is highly prevalent among nursing homes residents without dementia. Efforts towards prevention, early recognition and management of MDD in this population are warranted.
Contributors
-
- By Jean-Michel Badier, Carmen Barba, Yerma Bartolini, Sebastian Bauer, Elinor Ben-Menachem, Arnaud Biraben, Paul Boon, Patrick Chauvel, Sophie Colnat-Coulbois, Alessio De Ciantis, Yves Denoyer, Nathalie Ehrle, Melania Falchi, Barbara Fiedler, Stefano Forlivesi, Elena Gardella, Martine Gavaret, Marco Giulioni, Wolfgang Graf, Renzo Guerrini, Thilo Hammen, Marcel Heers, Claire Haegelen, Audrey Henry, Björn Holnberg, Katrin Hüttemann, Burkhard Kasper, Frank Kerling, Tobias Knieß, Gerhard Kurlemann, Nicolas Lang, Louis Maillard, Francesco Mari, Anna Federica Marliani, Stefano Meletti, Roberto Michelucci, Anca Pasnicu, Elisabeth Pauli, Jean-Claude Peragut, Stefan Rampp, Christophe Rauch, Felix Rosenow, Guido Rubboli, Barbara Schmalbach, Friedhelm C. Schmitt, Mathieu Sprengers, Hermann Stefan, Adam Strzelczyk, Anne Thiriaux, Christian Tilz, Jean-Pierre Vignal, Kristl Vonck, Jörg Wellmer, Xintong Wu, Francesco Zellini
- Edited by Hermann Stefan, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany, Elinor Ben-Menachem, Göteborgs Universitet, Sweden, Patrick Chauvel, Université de la Méditerranée, Aix Marseille II, Renzo Guerrini
-
- Book:
- Case Studies in Epilepsy
- Published online:
- 05 December 2012
- Print publication:
- 22 November 2012, pp viii-x
-
- Chapter
- Export citation
Contributors
-
- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. Douglas Meeks, Monica Jyotsna Melanchthon, Ilie Melniciuc-Puica, Everett Mendoza, Raymond A. Mentzer, William W. Menzies, Ina Merdjanova, Franziska Metzger, Constant J. Mews, Marvin Meyer, Carol Meyers, Vasile Mihoc, Gunner Bjerg Mikkelsen, Maria Inêz de Castro Millen, Clyde Lee Miller, Bonnie J. Miller-McLemore, Alexander Mirkovic, Paul Misner, Nozomu Miyahira, R. W. L. Moberly, Gerald Moede, Aloo Osotsi Mojola, Sunanda Mongia, Rebeca Montemayor, James Moore, Roger E. Moore, Craig E. Morrison O.Carm, Jeffry H. Morrison, Keith Morrison, Wilson J. Moses, Tefetso Henry Mothibe, Mokgethi Motlhabi, Fulata Moyo, Henry Mugabe, Jesse Ndwiga Kanyua Mugambi, Peggy Mulambya-Kabonde, Robert Bruce Mullin, Pamela Mullins Reaves, Saskia Murk Jansen, Heleen L. Murre-Van den Berg, Augustine Musopole, Isaac M. T. Mwase, Philomena Mwaura, Cecilia Nahnfeldt, Anne Nasimiyu Wasike, Carmiña Navia Velasco, Thulani Ndlazi, Alexander Negrov, James B. Nelson, David G. Newcombe, Carol Newsom, Helen J. Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. Stewart, Cynthia Stokes Brown, Ken Stone, Anne Stott, Elizabeth Stuart, Monya Stubbs, Marjorie Hewitt Suchocki, David Kwang-sun Suh, Scott W. Sunquist, Keith Suter, Douglas Sweeney, Charles H. Talbert, Shawqi N. Talia, Elsa Tamez, Joseph B. Tamney, Jonathan Y. Tan, Yak-Hwee Tan, Kathryn Tanner, Feiya Tao, Elizabeth S. Tapia, Aquiline Tarimo, Claire Taylor, Mark Lewis Taylor, Bishop Abba Samuel Wolde Tekestebirhan, Eugene TeSelle, M. Thomas Thangaraj, David R. Thomas, Andrew Thornley, Scott Thumma, Marcelo Timotheo da Costa, George E. “Tink” Tinker, Ola Tjørhom, Karen Jo Torjesen, Iain R. Torrance, Fernando Torres-Londoño, Archbishop Demetrios [Trakatellis], Marit Trelstad, Christine Trevett, Phyllis Trible, Johannes Tromp, Paul Turner, Robert G. Tuttle, Archbishop Desmond Tutu, Peter Tyler, Anders Tyrberg, Justin Ukpong, Javier Ulloa, Camillus Umoh, Kristi Upson-Saia, Martina Urban, Monica Uribe, Elochukwu Eugene Uzukwu, Richard Vaggione, Gabriel Vahanian, Paul Valliere, T. J. Van Bavel, Steven Vanderputten, Peter Van der Veer, Huub Van de Sandt, Louis Van Tongeren, Luke A. Veronis, Noel Villalba, Ramón Vinke, Tim Vivian, David Voas, Elena Volkova, Katharina von Kellenbach, Elina Vuola, Timothy Wadkins, Elaine M. Wainwright, Randi Jones Walker, Dewey D. Wallace, Jerry Walls, Michael J. Walsh, Philip Walters, Janet Walton, Jonathan L. Walton, Wang Xiaochao, Patricia A. Ward, David Harrington Watt, Herold D. Weiss, Laurence L. Welborn, Sharon D. Welch, Timothy Wengert, Traci C. West, Merold Westphal, David Wetherell, Barbara Wheeler, Carolinne White, Jean-Paul Wiest, Frans Wijsen, Terry L. Wilder, Felix Wilfred, Rebecca Wilkin, Daniel H. Williams, D. Newell Williams, Michael A. Williams, Vincent L. Wimbush, Gabriele Winkler, Anders Winroth, Lauri Emílio Wirth, James A. Wiseman, Ebba Witt-Brattström, Teofil Wojciechowski, John Wolffe, Kenman L. Wong, Wong Wai Ching, Linda Woodhead, Wendy M. Wright, Rose Wu, Keith E. Yandell, Gale A. Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
-
- Book:
- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
- Print publication:
- 20 September 2010, pp xi-xliv
-
- Chapter
- Export citation
13 - MRS in breast cancer
- Peter B. Barker, The Johns Hopkins University School of Medicine, Alberto Bizzi, Nicola De Stefano, Università degli Studi, Siena, Rao Gullapalli, University of Maryland, Baltimore, Doris D. M. Lin, The Johns Hopkins University School of Medicine
-
- Book:
- Clinical MR Spectroscopy
- Published online:
- 04 August 2010
- Print publication:
- 12 November 2009, pp 229-242
-
- Chapter
- Export citation
-
Summary
Key points
MRS of the breast is more technically demanding than that in the brain.
Cho levels have been reported to be higher in malignant breast cancer than in benign lesions and normal breast tissue.
Early decreases in Cho signal intensity may be seen in lesions that respond to treatment.
MRS is limited by sensitivity to lesions at least 1 cm3.
Inadequate sensitivity may lead to false negatives, and both false positives and negatives may arise due to insufficient water and lipid suppression, or other artifacts.
Introduction: MRS of breast tissues
Although the vast majority of magnetic resonance spectroscopy (MRS) studies in humans have been performed to date in the central nervous system, there is growing interest in the application of MRS to other organ systems in the body. This is particularly true for areas such as breast cancer, where conventional diagnostic techniques have relatively limited sensitivity and/or specificity. MRS of the breast presents a number of technical challenges (described in detail later in this chapter) which are gradually being overcome, allowing clinical research studies to be performed. Early MRS studies of human breast cancer focused on the phosphorus (31P) nucleus, since localized, water-suppressed proton spectroscopy was not available at that time. However, with the development of improved gradient hardware, spatial localization, and water suppression techniques, 31P spectroscopy has largely been replaced by proton (1H) MRS. The much higher sensitivity of the proton nucleus allows spectra with higher signal-to-noise ratios (SNR) to be recorded from smaller volumes of tissue compared to 31P.
10 - MRS in traumatic brain injury
- Peter B. Barker, The Johns Hopkins University School of Medicine, Alberto Bizzi, Nicola De Stefano, Università degli Studi, Siena, Rao Gullapalli, University of Maryland, Baltimore, Doris D. M. Lin, The Johns Hopkins University School of Medicine
-
- Book:
- Clinical MR Spectroscopy
- Published online:
- 04 August 2010
- Print publication:
- 12 November 2009, pp 161-179
-
- Chapter
- Export citation
-
Summary
Key points
TBI is a major cause of morbidity in young adults and children.
Low levels of NAA and, if seen, increased lactate, in the early stage of injury are prognostic of poor outcome.
Other common metabolic abnormalities in TBI (most of which also correlate with poor outcome) include increased levels of choline, myo-inositol, and glutamate plus glutamine.
Metabolic abnormalities are observed with MRS in regions of the brain with normal appearance in conventional MRI.
MRI and MRS are difficult to perform in acutely ill TBI patients: MRS may be more feasible in mild TBI patients for the purpose of predicting long-term cognitive deficits.
The role of MRS in guiding TBI therapy is unknown.
The comparative value of MRS compared to other advanced imaging modalities remains to be determined.
Introduction
Traumatic brain injury (TBI) is a leading cause of death and lifelong disability among children and young adults across the developed world. TBI is estimated to result in greater than $60 billion in direct and indirect annual costs due to health care and work loss disability. The Centers for Disease Control and Prevention (CDC) estimate that each year approximately 1.4 million Americans survive a TBI, among whom approximately 235,000 are hospitalized. Approximately 80,500 new TBI survivors are left each year with residual deficits consequent to their injury, which lead to long-term disabilities that may or may not be improved through rehabilitation. In 2001, 157,708 people died from acute traumatic injury, which accounted for about 6.5% of all deaths in the United States.
12 - MRS in prostate cancer
- Peter B. Barker, The Johns Hopkins University School of Medicine, Alberto Bizzi, Nicola De Stefano, Università degli Studi, Siena, Rao Gullapalli, University of Maryland, Baltimore, Doris D. M. Lin, The Johns Hopkins University School of Medicine
-
- Book:
- Clinical MR Spectroscopy
- Published online:
- 04 August 2010
- Print publication:
- 12 November 2009, pp 212-228
-
- Chapter
- Export citation
-
Summary
Key points
Prostate cancer has a high incidence, and is one of the leading causes of death in men.
The sensitivity and specificity of diagnosing prostate cancer with conventional imaging methods (ultra sound, MRI) is relatively low.
The normal prostate contains high levels of citrate (Cit) which can be detected in the proton spectrum at 2.6 ppm. Other compounds detectable in vivo include creatine, choline, spermine, and lipids.
Citrate is a strongly coupled mutiple at 1.5 and 3.0 T. For optimum detection, careful attention to pulse sequence parameters (TR, TE) is required. TE 120 ms is commonly used at 1.5 T, and TE 75–100 ms at 3 T.
Multiple studies have reported that prostate cancer is associated with decreased levels of citrate and increased levels of Cho, compared to both normal prostate and also benign prostatic hyperplasia (BPH).
MRS and MRSI of the prostate is technically challenging: water- and lipid-suppressed 3D-MRSI is the method of choice for most prostate spectroscopy studies.
Some studies report that adding MRSI to conventional MRI increases sensitivity and specificity of prostate cancer diagnosis.
MRSI is traditionally performed with an endorectal surface coil, but acceptable quality data may be obtained at 3 T with external phased-array coils which are more comfortable for patients.
2 - Pulse sequences and protocol design
- Peter B. Barker, The Johns Hopkins University School of Medicine, Alberto Bizzi, Nicola De Stefano, Università degli Studi, Siena, Rao Gullapalli, University of Maryland, Baltimore, Doris D. M. Lin, The Johns Hopkins University School of Medicine
-
- Book:
- Clinical MR Spectroscopy
- Published online:
- 04 August 2010
- Print publication:
- 12 November 2009, pp 19-33
-
- Chapter
- Export citation
1 - Introduction to MR spectroscopy in vivo
- Peter B. Barker, The Johns Hopkins University School of Medicine, Alberto Bizzi, Nicola De Stefano, Università degli Studi, Siena, Rao Gullapalli, University of Maryland, Baltimore, Doris D. M. Lin, The Johns Hopkins University School of Medicine
-
- Book:
- Clinical MR Spectroscopy
- Published online:
- 04 August 2010
- Print publication:
- 12 November 2009, pp 1-18
-
- Chapter
- Export citation
9 - MRS in neurodegenerative disease
- Peter B. Barker, The Johns Hopkins University School of Medicine, Alberto Bizzi, Nicola De Stefano, Università degli Studi, Siena, Rao Gullapalli, University of Maryland, Baltimore, Doris D. M. Lin, The Johns Hopkins University School of Medicine
-
- Book:
- Clinical MR Spectroscopy
- Published online:
- 04 August 2010
- Print publication:
- 12 November 2009, pp 144-160
-
- Chapter
- Export citation
-
Summary
Key points
Despite the relatively common occurrence of neurodegenerative diseases, MRS is lightly used in these conditions, most likely because of lack of sensitivity and overlap of spectral findings in different disorders.
MRS usually shows decreased levels of NAA in dementia.
Dementias associated with gliosis (e.g. Alzheimer's) also have increased myo-inositol (mI).
mI/NAA ratios correlate with clinical severity and histopathological involvement in Alzheimer's disease.
mI/NAA ratios, and regional variations in metabolite levels, may be helpful in the differential diagnosis of different dementias (Alzheimer, vascular, frontotemporal, Lewy body).
Parkinson's disease does not seem to be associated with any metabolic disorders, although other Parkinsonian disorders (e.g. multiple system atrophy) may show reduced NAA in the basal ganglia.
Metabolic changes in Huntington's disease are unclear; some studies have reported elevated lactate levels in the basal ganglia, but others have not.
Prion diseases are characterized by decreased NAA levels.
In amyotrophic lateral sclerosis (ALS), upper motor neuron NAA decreases may be helpful in establishing a diagnosis.
Introduction
Neurodegenerative diseases include a very wide group of disorders affecting the central nervous system (CNS). Many of these disorders arise from the combined effects of genetic predisposition and environmental factors. This results in reduced cognition (e.g. Alzheimer's disease, dementia with Lewy bodies, and vascular dementia), motor system performance (e.g. amyotrophic lateral sclerosis), or both (e.g. Parkinson's disease and prion diseases).
Acknowledgments
- Peter B. Barker, The Johns Hopkins University School of Medicine, Alberto Bizzi, Nicola De Stefano, Università degli Studi, Siena, Rao Gullapalli, University of Maryland, Baltimore, Doris D. M. Lin, The Johns Hopkins University School of Medicine
-
- Book:
- Clinical MR Spectroscopy
- Published online:
- 04 August 2010
- Print publication:
- 12 November 2009, pp viii-viii
-
- Chapter
- Export citation
Clinical MR Spectroscopy
- Techniques and Applications
- Peter B. Barker, Alberto Bizzi, Nicola De Stefano, Rao Gullapalli, Doris D. M. Lin
-
- Published online:
- 04 August 2010
- Print publication:
- 12 November 2009
-
In vivo magnetic resonance spectrosopy (MRS) is increasingly being used in the clinical setting, particularly for neurological disorders. Clinical MR Spectroscopy – Techniques and Applications explains both the underlying physical principles of MRS and provides a perceptive review of clinical MRS applications. Topics covered include an introduction to MRS physics, information content of spectra from different organ systems, spectral analysis methods, recommended protocols and localization techniques, and normal age- and region-related spectral variations in the brain. Clinical applications in the brain are discussed for brain tumors, hypoxic and ischemic injury, infectious, inflammatory and demyelinating diseases, epilepsy, neurodegenerative disorders, trauma and metabolic diseases. Outside of the brain, techniques and applications are discussed for MRS in the musculosketal system, breast and prostate. Written by leading MRS experts, this is an invaluable guide for anyone interested in in vivo MRS, including radiologists, neurologists, neurosurgeons, oncologists and medical researchers.
Frontmatter
- Peter B. Barker, The Johns Hopkins University School of Medicine, Alberto Bizzi, Nicola De Stefano, Università degli Studi, Siena, Rao Gullapalli, University of Maryland, Baltimore, Doris D. M. Lin, The Johns Hopkins University School of Medicine
-
- Book:
- Clinical MR Spectroscopy
- Published online:
- 04 August 2010
- Print publication:
- 12 November 2009, pp i-iv
-
- Chapter
- Export citation
8 - MRS in epilepsy
- Peter B. Barker, The Johns Hopkins University School of Medicine, Alberto Bizzi, Nicola De Stefano, Università degli Studi, Siena, Rao Gullapalli, University of Maryland, Baltimore, Doris D. M. Lin, The Johns Hopkins University School of Medicine
-
- Book:
- Clinical MR Spectroscopy
- Published online:
- 04 August 2010
- Print publication:
- 12 November 2009, pp 131-143
-
- Chapter
- Export citation
-
Summary
Key points
MRS is principally used as an adjunct diagnostic technique for evaluating patients with medically intractable epilepsy (in order to identify the seizure focus).
Most commonly, NAA is reduced in epileptogenic tissue; metabolic abnormalities are often subtle.
Metabolic abnormalities may be more widespread than seen on MRI, and present in the contralateral hemisphere.
MRS may occasionally be helpful when other techniques (e.g. MRI) are either normal or non-specific.
MRS measures of the inhibitory neurotransmitter GABA using spectral editing may help determine optimal drug regimen.
MRS may also be a useful research tool for determining epileptogenic networks in the brain.
Introduction
Epilepsy, the condition of recurrent seizures, is a relatively common neurological disorder, estimated to affect between 1 and 2 million people in the US alone. A multitude of etiologies cause epilepsy, including tumors, developmental abnormalities, febrile illness, trauma, or infection. However, not infrequently, the cause is unknown. Many patients with epilepsy can be successfully treated pharmacologically, but when medical management fails to adequately control seizure activity, surgical resection of the epileptogenic tissue may be considered. For surgery to be successful, seizures must be of focal onset from a well-defined location. It has been estimated that up to 10% of patients with epilepsy are medically intractable, of whom approximately 20% may be candidates for surgical treatment. Traditionally, scalp electroencephalography (EEG) and often invasive (subdural grid or depth electrode) EEG are used to identify the epileptogenic regions of the brain, but increasingly magnetic resonance imaging (MRI), positron emission tomography (PET), ictal single photon emission computed tomography (SPECT), and, more recently, magnetoencephalography (MEG) are also used.
4 - Normal regional variations: brain development and aging
- Peter B. Barker, The Johns Hopkins University School of Medicine, Alberto Bizzi, Nicola De Stefano, Università degli Studi, Siena, Rao Gullapalli, University of Maryland, Baltimore, Doris D. M. Lin, The Johns Hopkins University School of Medicine
-
- Book:
- Clinical MR Spectroscopy
- Published online:
- 04 August 2010
- Print publication:
- 12 November 2009, pp 51-60
-
- Chapter
- Export citation
-
Summary
Key points
Substantial regional variations in proton brain spectra exist; differences between gray and white matter, anterior–posterior gradients, and differences between the supra- and infra-tentorial brain are common.
Spectra change rapidly over the first few years of life; at birth, NAA is low, and choline and myo-inositol are high. By about 4 years of age, spectra from most regions have a more “adult-like” appearance.
In normal development, only subtle age-related changes are found between the ages of 4 and 20 years.
In normal aging, only subtle age-related changes are found. A recent meta-analysis indicated the most common findings are mildly increased choline and creatine in frontal brain regions of elderly subjects (> 68 years), and stable or slightly decreasing (parietal regions only) NAA.
Introduction
Interpretation of spectra from patients with neuropathology requires a knowledge of the normal regional and age-related spectral variations seen in the healthy brain. This is a difficult issue, since spectra are quite dependent on the technique used to record them (particularly choice of echo time, and field strength), and also show quite large regional and age-related (at least in young children) dependencies. However, while there still remain some gaps in the literature (e.g. detailed, regional studies in very young children), for the most part regional and age-related changes in brain spectra are now well-characterized. This chapter reviews what is known about regional metabolite variations, as well as metabolic changes associated with brain development, and aging.
7 - MRS in infectious, inflammatory, and demyelinating lesions
- Peter B. Barker, The Johns Hopkins University School of Medicine, Alberto Bizzi, Nicola De Stefano, Università degli Studi, Siena, Rao Gullapalli, University of Maryland, Baltimore, Doris D. M. Lin, The Johns Hopkins University School of Medicine
-
- Book:
- Clinical MR Spectroscopy
- Published online:
- 04 August 2010
- Print publication:
- 12 November 2009, pp 110-130
-
- Chapter
- Export citation
-
Summary
Key points
MRS can provide useful clinical, metabolic information in infection, inflammation, and demyelination.
Pyogenic abscess have a unique metabolic pattern with decreased levels of all normally observed brain metabolites, and elevation of succinate, alanine, acetate, and amino acids, as well as lipids and lactate. This pattern is quite distinct from that seen in brain tumors.
Tuberculomas are characterized by elevated lipid and an absence of all other resonances.
MRS is extensively used in research studies of HIV infection; early changes include elevated choline and myo-inositol perhaps associated with microglial proliferation, while later changes (associated with cognitive impairment, and dementia) include reduced NAA (neuronal loss).
MRS may also be useful in assisting differential diagnosis in HIV-associated lesions.
MRS shows decreased NAA (suggesting axonal dysfunction and loss) in early multiple sclerosis, as well as increased Cho and myo-inositol and lipids (suggesting demyelination). NAA correlates with clinical disability. White matter that appears normal on T2 MRI may be abnormal metabolically in MS. Lactate may be elevated in acute, inflammatory demyelination.
Acute disseminated encephalomyelitis (ADEM) may show similar spectral patterns to MS; however, ADEM with good clinical outcome usually only shows mild NAA losses in lesions.
Introduction
Intracranial infection, inflammation, and demyelination include a wide range of disorders of the central nervous system (CNS). Magnetic resonance imaging (MRI) plays a crucial role in the diagnosis and therapeutic decision making in these diseases.
3 - Spectral analysis methods, quantitation, and common artifacts
- Peter B. Barker, The Johns Hopkins University School of Medicine, Alberto Bizzi, Nicola De Stefano, Università degli Studi, Siena, Rao Gullapalli, University of Maryland, Baltimore, Doris D. M. Lin, The Johns Hopkins University School of Medicine
-
- Book:
- Clinical MR Spectroscopy
- Published online:
- 04 August 2010
- Print publication:
- 12 November 2009, pp 34-50
-
- Chapter
- Export citation
-
Summary
Key points
Correct post-processing and quantitation are key aspects of in vivo MRS.
Filtering, phase-correction and baseline correction improve MRS data.
Peak area estimation can be done using parametric or non-parametric routines in either the time domain or frequency domains.
“LCModel” software is becoming widely used and accepted, particularly for single-voxel MRS data.
MRSI processing requires additional steps; k-space filtering and other manipulations can improve MRSI data quality.
A variety of strategies are available for quantitation, based on either internal or external reference standards, or phantom replacement methodology.
Quantitation routines should take into account voxel composition, particularly the amount of CSF partial volume present.
MRS is sensitive to field inhomogeneity and other artifacts.
Introduction
Methods for spectral analysis and the quantitative analysis of spectral data are arguably as important as the techniques used to collect the data; the use of incorrect analysis methods can lead to systematic errors or misinterpretation of spectra. In general, the ultimate goal of spectral analysis is to determine the concentrations of the compounds present in the spectra. In MRS, the area under the spectral peak is proportional to the metabolite concentration; however, determining the proportionality constant can be challenging. In addition, peak area measurements in in-vivo spectroscopy are complicated by resonance overlap, baseline distortions, and lineshapes that often only poorly approximate conventional models such as Gaussian or Lorentzian functions. Therefore, quantitative analysis of in vivo MRS data is challenging. This chapter reviews basic spectral processing techniques, methods for determining peak areas, and strategies for calculating metabolite concentrations.
14 - MRS in musculoskeletal disease
- Peter B. Barker, The Johns Hopkins University School of Medicine, Alberto Bizzi, Nicola De Stefano, Università degli Studi, Siena, Rao Gullapalli, University of Maryland, Baltimore, Doris D. M. Lin, The Johns Hopkins University School of Medicine
-
- Book:
- Clinical MR Spectroscopy
- Published online:
- 04 August 2010
- Print publication:
- 12 November 2009, pp 243-255
-
- Chapter
- Export citation
-
Summary
Key points
31P-MRS allows the detection of phosphate-containing metabolites that are central to energy metabolism, and therefore is particularly suitable for studying muscle physiology and its disorders in vivo.
Time-resolved signals from inorganic phosphates, phosphocreatine, phosphodiesters/monoesters, and intermediates of ATP reflect physiologic changes in muscles during rest, exercise, and recovery.
Quantitative analysis of metabolites allows estimates of cytosolic ADP based on a number of assumptions, and the recovery of ADP has been used as a measure of in vivo mitochondrial function.
In pathologic states including metabolic (mitochondrial or glycolytic pathway) dysfunction, hereditary and acquired myopathies, 31P-MRS shows biochemical alterations (reduced PCr, increased Pi, slow ADP recovery) that tend to overlap between pathologies.
Glycogenolytic disorders (such as McArdle's disease) may show paradoxical alkalosis during exercise.
Muscle 31P-MRS is valuable in monitoring therapeutic response in a number of neuromuscular disorders.
1H-MRS currently has a limited role in the clinical evaluation of musculoskeletal disease, but has been used as a research tool to assess intramyocellular lipid, which has been implicated in skeletal muscle insulin resistance and type 2 diabetes mellitus.
Introduction
Magnetic resonance spectroscopy (MRS) of skeletal muscle has been studied over several decades. In particular, muscle MRS has been utilized to study carbohydrate metabolism (by 13-carbon (13C) MRS), lipid metabolism (by proton (1H) MRS) and, more widely, energy metabolism (by 31-phosphorus (31P) MRS).
Index
- Peter B. Barker, The Johns Hopkins University School of Medicine, Alberto Bizzi, Nicola De Stefano, Università degli Studi, Siena, Rao Gullapalli, University of Maryland, Baltimore, Doris D. M. Lin, The Johns Hopkins University School of Medicine
-
- Book:
- Clinical MR Spectroscopy
- Published online:
- 04 August 2010
- Print publication:
- 12 November 2009, pp 256-264
-
- Chapter
- Export citation