This study aimed to estimate the lifetime prevalence of Gilles de la Tourette's syndrome (GTS) in adolescents aged 16-17 in Israel. Over 28,000 adolescents were screened using a 4-item questionnaire followed by examination by a psychiatrist. 12 individuals met diagnostic criteria for GTS, yielding a point prevalence of 4.3 per 10,000. Rates of obsessive-compulsive disorder (OCD) were higher in those with GTS (41.7%) compared to the general population (3.4%), but rates of attention deficit hyperactivity disorder were similar. This study provides prevalence estimates for GTS in line with previous studies and highlights the high comorbidity between GTS and OCD.
DSM-5 Proposal for Sensory Processing Disorder. Submitted in 2008 for the American Psychiatric Association Manual. Includes second half of the proposal.
DSM-5 Proposal for Sensory Processing Disorder. Submitted in 2008 for the American Psychiatric Association Manual. Includes second half of the proposal.
Autism Spectrum Disorder and Particulate Matter Air Pollution before, during ...joaquin_project
Pregnant women may nearly double their risk of giving birth to a child with autism by inhaling smog spewed by vehicles or smoke stacks, according to a new Harvard study that could help unlock the deepest autism mysteries.
The research fortifies previous scientific findings that linked air pollution to autism. And it offers fresh insights by showing women in their third trimesters seem most vulnerable if they breathe in elevated levels of tiny airborne particles emitted by power plants, fires and automobiles.
The near death experience scale. Construction, reliability, and validityJosé Luis Moreno Garvayo
En este artículo se expone un criterio de demarcación para las experiencias cercanas a la muerte conocido como “escala de Greyson”: se trata de un cuestionario formado por 16 preguntas agrupadas en cuatro bloques (componentes cognitivo, afectivo, paranormal y trascendental) en las que el entrevistado debe marcar la respuesta que más se acerque a la experiencia vivida (con un 0 si no la ha experimentado, un 1 si lo ha hecho de forma poco intensa, o un 2 si ha sido muy intensa). El análisis de los resultados sirve para evaluar si el sujeto vivió una ECM (alcanzado una puntuación mínima de 7 según los postulados de Greyson), permitiendo descartar un síndrome orgánico del cerebro o una respuesta no específica al estrés sufrido por el “miedo a morir”. Para más detalles visitar: http://www.afanporsaber.es/2014/01/experiencias-cercanas-a-la-muerte-i/
International Journal of Humanities and Social Science Invention (IJHSSI)inventionjournals
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
Austin Journal of Genetics and Genomic Research is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of research in Genetics and Genomics.
The journal aims to promote research communications and provide a forum for researchers and physicians to find most recent advances in the areas of Genomic Research.
Austin Journal of Genetics and Genomic Research accepts original research articles, review articles, case reports and rapid communication on all the aspects of high-throughput Genomic Research.
https://userupload.net/06gt5zcwvh90
Genetic counseling is the process of advising individuals and families affected by or at risk of genetic disorders to help them understand and adapt to the medical, psychological and familial implications of genetic contributions to disease.[1] The process integrates:
Interpretation of family and medical histories to assess the chance of disease occurrence or recurrence
Education about inheritance, testing, management, prevention, resources
Counseling to promote informed choices and adaptation to the risk or condition.
General Psychology Interpret an instance of behavior (individual .docxlianaalbee2qly
General Psychology
: Interpret an instance of behavior (individual or collective) recently in the news from the point of view of any two of the three schools of thought that became popular when psychology emerged as a discipline. Your response should include specific details including the major theorists and goals of the two selected schools of psychological thought. Your response should be at least 200 words in length. You are required to use at least your textbook as source material for your response. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citations. Wade, C., Tavris, C., & Garry, M. (2014). Psychology (11th ed.). Upper Saddle River, NJ: Pearson Education. Must be done in APA format
ONE PAGE /275 WORDS ONE SOURCE BOOK REFERENCE
[1/29/16, 11:29 AM] josphat mungai (
[email protected]
):
Author: R.A. Noe
Employee training and development (6th ed.). New York, NY: McGraw-Hill
2:General Psychology
: A researcher hypothesizes that adults will respond differently to the same baby depending on how the child is dressed. Her colleague, on the other hand, hypothesizes that boys and girls are treated equally and that only temperamental differences lead to differences in their handling. Design a research study to test their hypotheses. Your response should be at least 200 words in length. You are required to use at least your textbook as source material for your response. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citations. Wade, C., Tavris, C., & Garry, M. (2014). Psychology (11th ed.). Upper Saddle River, NJ: Pearson Education. Must be done in APA format
ONE PAGE /275 WORDS ONE SOURCE BOOK REFERENCE
[1/29/16, 11:29 AM] josphat mungai (
[email protected]
):
Author: R.A. Noe
Employee training and development (6th ed.). New York, NY: McGraw-Hill
Put to the test: as genetic screening gets cheaper and easier, it's raising questions that health-care providers aren't prepared to answer
The American Prospect, November 2010
When my children were born in the mid-1990s, new parents could already see that prenatal genetic testing was altering the terrain of pregnancy and childbirth. Growing numbers of educated women were having children at older ages, with resulting difficulties and risks. More and more parents faced challenging, deeply personal decisions about whether to engage in genetic testing and what to do if they received unfavorable results.
I remember my own anxieties when my wife, Veronica, took a blood test that searched for elevated alpha-fetoproteins, which are associated with diverse ailments ranging from spina bifida to anencephaly. The mere prospect of these rare conditions--and even the choice to undergo the tests--was surprisingly painful. At least genetic counselors and other professionals were available to help guide us.
By that point, amniocentesis had been in wide use for more than t.
Autism Spectrum Disorder and Particulate Matter Air Pollution before, during ...joaquin_project
Pregnant women may nearly double their risk of giving birth to a child with autism by inhaling smog spewed by vehicles or smoke stacks, according to a new Harvard study that could help unlock the deepest autism mysteries.
The research fortifies previous scientific findings that linked air pollution to autism. And it offers fresh insights by showing women in their third trimesters seem most vulnerable if they breathe in elevated levels of tiny airborne particles emitted by power plants, fires and automobiles.
The near death experience scale. Construction, reliability, and validityJosé Luis Moreno Garvayo
En este artículo se expone un criterio de demarcación para las experiencias cercanas a la muerte conocido como “escala de Greyson”: se trata de un cuestionario formado por 16 preguntas agrupadas en cuatro bloques (componentes cognitivo, afectivo, paranormal y trascendental) en las que el entrevistado debe marcar la respuesta que más se acerque a la experiencia vivida (con un 0 si no la ha experimentado, un 1 si lo ha hecho de forma poco intensa, o un 2 si ha sido muy intensa). El análisis de los resultados sirve para evaluar si el sujeto vivió una ECM (alcanzado una puntuación mínima de 7 según los postulados de Greyson), permitiendo descartar un síndrome orgánico del cerebro o una respuesta no específica al estrés sufrido por el “miedo a morir”. Para más detalles visitar: http://www.afanporsaber.es/2014/01/experiencias-cercanas-a-la-muerte-i/
International Journal of Humanities and Social Science Invention (IJHSSI)inventionjournals
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
Austin Journal of Genetics and Genomic Research is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of research in Genetics and Genomics.
The journal aims to promote research communications and provide a forum for researchers and physicians to find most recent advances in the areas of Genomic Research.
Austin Journal of Genetics and Genomic Research accepts original research articles, review articles, case reports and rapid communication on all the aspects of high-throughput Genomic Research.
https://userupload.net/06gt5zcwvh90
Genetic counseling is the process of advising individuals and families affected by or at risk of genetic disorders to help them understand and adapt to the medical, psychological and familial implications of genetic contributions to disease.[1] The process integrates:
Interpretation of family and medical histories to assess the chance of disease occurrence or recurrence
Education about inheritance, testing, management, prevention, resources
Counseling to promote informed choices and adaptation to the risk or condition.
General Psychology Interpret an instance of behavior (individual .docxlianaalbee2qly
General Psychology
: Interpret an instance of behavior (individual or collective) recently in the news from the point of view of any two of the three schools of thought that became popular when psychology emerged as a discipline. Your response should include specific details including the major theorists and goals of the two selected schools of psychological thought. Your response should be at least 200 words in length. You are required to use at least your textbook as source material for your response. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citations. Wade, C., Tavris, C., & Garry, M. (2014). Psychology (11th ed.). Upper Saddle River, NJ: Pearson Education. Must be done in APA format
ONE PAGE /275 WORDS ONE SOURCE BOOK REFERENCE
[1/29/16, 11:29 AM] josphat mungai (
[email protected]
):
Author: R.A. Noe
Employee training and development (6th ed.). New York, NY: McGraw-Hill
2:General Psychology
: A researcher hypothesizes that adults will respond differently to the same baby depending on how the child is dressed. Her colleague, on the other hand, hypothesizes that boys and girls are treated equally and that only temperamental differences lead to differences in their handling. Design a research study to test their hypotheses. Your response should be at least 200 words in length. You are required to use at least your textbook as source material for your response. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citations. Wade, C., Tavris, C., & Garry, M. (2014). Psychology (11th ed.). Upper Saddle River, NJ: Pearson Education. Must be done in APA format
ONE PAGE /275 WORDS ONE SOURCE BOOK REFERENCE
[1/29/16, 11:29 AM] josphat mungai (
[email protected]
):
Author: R.A. Noe
Employee training and development (6th ed.). New York, NY: McGraw-Hill
Put to the test: as genetic screening gets cheaper and easier, it's raising questions that health-care providers aren't prepared to answer
The American Prospect, November 2010
When my children were born in the mid-1990s, new parents could already see that prenatal genetic testing was altering the terrain of pregnancy and childbirth. Growing numbers of educated women were having children at older ages, with resulting difficulties and risks. More and more parents faced challenging, deeply personal decisions about whether to engage in genetic testing and what to do if they received unfavorable results.
I remember my own anxieties when my wife, Veronica, took a blood test that searched for elevated alpha-fetoproteins, which are associated with diverse ailments ranging from spina bifida to anencephaly. The mere prospect of these rare conditions--and even the choice to undergo the tests--was surprisingly painful. At least genetic counselors and other professionals were available to help guide us.
By that point, amniocentesis had been in wide use for more than t.
Screening Tool for Developmental Disorders in ChildrenApollo Hospitals
Developmental problems are a diverse group of conditions that affect and limit children and their life-chances. A ready reference for a Paediatrician would be the first six chapters of the latest edition (18th) of the Nelson Textbook of Pediatrics (The Field of Pediatrics, Growth & Development, Psychological Disorders, Social Issues, Children with Special Health Needs and Nutrition and Human Genetics and Metabolic Diseases).
Branch vital, angela condom use among african-american women-nfmij-6-1-09William Kritsonis
Dr. William Allan Kritsonis, Editor-in-Chief, NATIONAL FORUM JOURNALS (Founded 1982). Dr. Kritsonis has served as an elementary school teacher, elementary and middle school principal, superintendent of schools, director of student teaching and field experiences, professor, author, consultant, and journal editor. Dr. Kritsonis has considerable experience in chairing PhD dissertations and master thesis and has supervised practicums for teacher candidates, curriculum supervisors, central office personnel, principals, and superintendents. He also has experience in teaching in doctoral and masters programs in elementary and secondary education as well as educational leadership and supervision. He has earned the rank as professor at three universities in two states, including successful post-tenure reviews.
1Running Head FINAL PROPOSAL CHILD ABUSE AND ADULT MENTAL HEAL.docxdrennanmicah
1
Running Head: FINAL PROPOSAL: CHILD ABUSE AND ADULT MENTAL HEALTH
2
FINAL PROPOSAL: CHILD ABUSE AND ADULT MENTAL HEALTH
Diamond Newton
Southern New Hampshire University
March 3, 2019
Problem Statement
Several adults struggle from a variety of mental health issues (suicidal thoughts and tendencies, alcoholism, depression, and drug abusers.) A lot of those issues may stem from what took place during an adult’s childhood that stem from a variety of reasons. Some adults seek help and some refuse to seek help. The adults who do seek help come to realize that their current issues stem from when they were a child and still developing as a human. Child abuse can come in many forms, physical, mental, and sexual. Adults who have been exposed or experienced this are likely to suffer from some form of mental health issue. It is important to figure out the root of mental health issues in adults so the root can be addressed. Children need to be in a healthy environment with nothing short of love and care. Exposing children to a harsh reality is only breeding them into an adult who suffers from mental health issues.
Literature Review
The study of psychology helps researchers to understand better what is going on with a person. Researchers studied what happened in a person's life that causes them to make the decisions they do and behave in a certain way. Adults have this stigmatism that they can do whatever they want because they are "grown." Many adults suffer from something that can cause to lead towards suicidal thoughts and tendencies, alcoholism, depression, and drug abusers. A lot of those issues may stem from what took place during an adult’s childhood. There could be some reasons adults tend to display certain mental health traits that have been studied in many different forms by researchers. What we will be reviewed is the abuse, physical or mental, that an adult endured as a child and how it affects them in their adulthood.
Blanco, C., Grant, B. F., Hasin, D. S., Lin, K. H., Olfson, M. Sugaya, L. (2012) recognized that child physical abuse had been associated with an increased risk of suicide attempts. The study conducted included Blacks, Hispanics and young adults between the ages of 18-24 in 2001-2002 and 2004-2005. In person, interviews were conducted in Wave 1. In Wave 2 used similar methods as Wave 1 but it excluded the individuals who were not eligible. Wave 2 also interviews went into depth about the questions asked for the participants first 17 years of life. There are many other variables that have been added to the data that relate to childhood physical abuse and mental health distress in adult years. Those other adversatives included the history of child sexual abuse and neglect, parental psychopathology, and perceived parental support, described as emotional neglect.
The advantages to this design would be the inclusion of other childhood adversities that could contribute to adult psychiatri.
Rates and Predictors of Suicidal Ideation During the FirstYe.docxaudeleypearl
Rates and Predictors of Suicidal Ideation During the First
Year After Traumatic Brain Injury
Jessica L. Mackelprang, PhD, Charles H. Bombardier, PhD, Jesse R. Fann, MD, MPH, Nancy R. Temkin, PhD,
Jason K. Barber, MS, and Sureyya S. Dikmen, PhD
Suicide is a major public health problem among
the 1.7 million people who sustain traumatic
brain injury (TBI) each year in the United
States.1 People with a history of TBI in both
civilian and military populations are 1.55 to
4.05 times more likely to die by suicide than
the general population.2---5 In a study of
Australian outpatients with a history of TBI,
the majority of whom had no preinjury history
of suicide attempts, suicide attempts were
reported by 17.4% (30 of 172) of the sample
over a 5-year period.6 Nearly half of the
individuals who attempted suicide had made
multiple attempts.6,7 The Centers for Disease
Control and Prevention recently called for
investigations of individual-level risk and
protective factors for self-directed violence
among people with TBI as an important com-
ponent of improving long-term outcomes.8
Rates of suicidal ideation (SI) after TBI
have been found to exceed 20% in some
studies6,9---14; however, in a recent systematic
review of SI and behavior after TBI, Bahraini
et al. highlighted the paucity of research in
this area.15 They concluded that additional
research is needed to determine the prevalence
of SI and behavior after brain injury, as well as
to ascertain patient-level factors that may be
associated with increased suicide risk. Studies
examining whether injury severity predicts
post-TBI suicidality have yielded inconclusive
findings.6,13,16,17 In perhaps the most thorough
study on this topic to date, Tsaousides et al.12
surveyed 356 community-dwelling adults with
a self-reported history of TBI and found that
preinjury substance abuse was the only corre-
late of current SI. Risk factors for SI after TBI
have been underinvestigated. Research in this
area has been limited by reliance on retro-
spective reporting and self-reported history of
TBI,12,18---20 with only a few studies including
objective indicators of TBI severity.6 Most
studies have involved cross-sectional designs
and have included participants whose time
since injury varied from several months to
many years.12,21 Finally, because most existing
studies have included relatively small, poten-
tially biased samples21 recruited from outpa-
tient clinics or TBI survivor programs,6,7,12 they
may not be representative of the population of
people who sustain TBI.
Given these gaps in the existing literature,
our objectives were (1) to investigate rates of SI
during the first year after complicated mild to
severe TBI in a representative sample of adults
who had been admitted to a level I trauma
center and (2) to investigate whether demo-
graphic characteristics, preinjury psychiatric
history, or injury-related factors predicted SI.
METHODS
This study was part of the recruitment phase
of a clinical trial ...
Contents lists available at ScienceDirectNeuroscience and AlleneMcclendon878
Contents lists available at ScienceDirect
Neuroscience and Biobehavioral Reviews
journal homepage: www.elsevier.com/locate/neubiorev
Changing conceptualizations of regression: What prospective studies reveal
about the onset of autism spectrum disorder
Sally Ozonoffa,⁎, Ana-Maria Iosifb
a Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California – Davis, 2825 50th Street, Sacramento CA, 95817, USA
b Department of Public Health Sciences, University of California – Davis, Medical Sciences 1C, Davis CA, 95616, USA
A R T I C L E I N F O
Keywords:
Autism spectrum disorder
Onset patterns
Regression
Prospective studies
A B S T R A C T
Until the last decade, studies of the timing of early symptom emergence in autism spectrum disorder (ASD) relied
upon retrospective methods. Recent investigations, however, are raising significant questions about the accuracy
and validity of such data. Questions about when and how behavioral signs of autism emerge may be better
answered through prospective studies, in which infants are enrolled near birth and followed longitudinally until
the age at which ASD can be confidently diagnosed or ruled out. This review summarizes the results of recent
studies that utilized prospective methods to study infants at high risk of developing ASD due to family history.
Collectively, prospective studies demonstrate that the onset of ASD involves declines in the rates of key social
and communication behaviors during the first years of life for most children. This corpus of literature suggests
that regressive onset patterns occur much more frequently than previously recognized and may be the rule rather
than the exception.
1. Introduction
The onset of behavioral signs of autism spectrum disorder (ASD) is
usually conceptualized as occurring in one of two ways: an early onset
pattern, in which children demonstrate delays and deviances in social
and communication development early in life, and a regressive pattern,
in which children develop largely as expected for some period and then
experience a substantial decline in or loss of previously developed
skills. While it was long believed that the majority of children with ASD
demonstrated an early onset pattern, more recent studies suggest that
regressive onset occurs more frequently than previously recognized
(Brignell et al., 2017; Hansen et al., 2008; Kern et al., 2015; Pickles
et al., 2009; Shumway et al., 2011; Thurm et al., 2014; for a review, see
meta-analysis by Barger et al., 2013). Studies occasionally also identify
a third onset pattern, that of developmental stagnation or plateau
(Shumway et al., 2011), that is characterized by intact early skills that
fail to progress or transform into more advanced developmental
achievements. This onset pattern is distinct from regression, in that the
child does not lose acquired skills, but instead fails to make expected
gains.
1.1. Methods for measuring onset patterns
The most common procedure fo ...
11. Identifying the Elements of the Limitations & ImplicationsGo tBenitoSumpter862
11. Identifying the Elements of the Limitations & Implications
Go to the Limitations/Implications section(s) and identify the limitations of the study and how those limitations impacted the whole study.
12. Identifying the Elements of the Conclusion Section
Go to the Conclusion section and identify the conclusive statements of the study and the recommendations made for future research.
POST # 1 EDITHA
When assessing an adolescent with bipolar disorder, what are some of the diagnostic and treatment challenges the clinician might face?
Bipolar disorder is a serious mental health disorder that is often first diagnosed during young adulthood or adolescence. Symptoms of the illness, however, also can appear in early childhood. Although once thought rare in children, diagnosis of bipolar disorder in children has significantly increased over the last decade (Papolos & Bronsteen, 2018). Despite the increased diagnosis of bipolar disorder in children, assessment and diagnosis remain challenging and controversial. This is, in part, because of the lack of research on this disorder in children and adolescents and the growing recognition that the disease can present differently in children from how it presents in adults (AACAP, 2019). Over the years, more attention has focused on the unique presentation of bipolar disorder in the young that has introduced new ways of looking at this disease and assessing it in children.
The importance of identifying the presence of bipolar disease at an early age is highlighted by data showing that adults in whom bipolar disease started at an early age have a more severe course of the illness compared with adult-onset disease. Early-onset disease is associated with a higher risk of suicide; severe mood lability and polarity; lower quality of life and greater functional impairment; higher rates of comorbidity; and a higher risk of substance use disorders compared with adult-onset disease (Papolos & Bronsteen, 2018). Although some children meet the criteria established for adults categorized in the DSM-5, many children fall outside these classical categories, and diagnosis in these children is particularly challenging and difficult (APA, 2013). For these children, additional information beyond what is provided in the DSM may help make an accurate diagnosis which causes increased challenges in assessment and diagnosis.
References
Papolos, D, & Bronsteen A. (2018) bipolar disorder in children: assessment in general pediatric practice. Curr Opin Pediatr, 25(3):419-426.
American Academy of Child and Adolescent Psychiatry (AACAP). (2019) bipolar disorder: Parents’ Medication Guide for Bipolar Disorder in Children & Adolescents.
American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Association.
RESEARCH ARTICLE
Association of suicidal behavior with exposure
to suicide and suicide attempt: A systematic
...
11. Identifying the Elements of the Limitations & ImplicationsGo tSantosConleyha
11. Identifying the Elements of the Limitations & Implications
Go to the Limitations/Implications section(s) and identify the limitations of the study and how those limitations impacted the whole study.
12. Identifying the Elements of the Conclusion Section
Go to the Conclusion section and identify the conclusive statements of the study and the recommendations made for future research.
POST # 1 EDITHA
When assessing an adolescent with bipolar disorder, what are some of the diagnostic and treatment challenges the clinician might face?
Bipolar disorder is a serious mental health disorder that is often first diagnosed during young adulthood or adolescence. Symptoms of the illness, however, also can appear in early childhood. Although once thought rare in children, diagnosis of bipolar disorder in children has significantly increased over the last decade (Papolos & Bronsteen, 2018). Despite the increased diagnosis of bipolar disorder in children, assessment and diagnosis remain challenging and controversial. This is, in part, because of the lack of research on this disorder in children and adolescents and the growing recognition that the disease can present differently in children from how it presents in adults (AACAP, 2019). Over the years, more attention has focused on the unique presentation of bipolar disorder in the young that has introduced new ways of looking at this disease and assessing it in children.
The importance of identifying the presence of bipolar disease at an early age is highlighted by data showing that adults in whom bipolar disease started at an early age have a more severe course of the illness compared with adult-onset disease. Early-onset disease is associated with a higher risk of suicide; severe mood lability and polarity; lower quality of life and greater functional impairment; higher rates of comorbidity; and a higher risk of substance use disorders compared with adult-onset disease (Papolos & Bronsteen, 2018). Although some children meet the criteria established for adults categorized in the DSM-5, many children fall outside these classical categories, and diagnosis in these children is particularly challenging and difficult (APA, 2013). For these children, additional information beyond what is provided in the DSM may help make an accurate diagnosis which causes increased challenges in assessment and diagnosis.
References
Papolos, D, & Bronsteen A. (2018) bipolar disorder in children: assessment in general pediatric practice. Curr Opin Pediatr, 25(3):419-426.
American Academy of Child and Adolescent Psychiatry (AACAP). (2019) bipolar disorder: Parents’ Medication Guide for Bipolar Disorder in Children & Adolescents.
American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Association.
RESEARCH ARTICLE
Association of suicidal behavior with exposure
to suicide and suicide attempt: A systematic
...
Dr. William Allan Kritsonis, Editor-in-Chief, NATIONAL FORUM JOURNALS (Founded 1982). Dr. Kritsonis has served as an elementary school teacher, elementary and middle school principal, superintendent of schools, director of student teaching and field experiences, professor, author, consultant, and journal editor. Dr. Kritsonis has considerable experience in chairing PhD dissertations and master thesis and has supervised practicums for teacher candidates, curriculum supervisors, central office personnel, principals, and superintendents. He also has experience in teaching in doctoral and masters programs in elementary and secondary education as well as educational leadership and supervision. He has earned the rank as professor at three universities in two states, including successful post-tenure reviews.
The spectrum of childhood neoplasms – Evaluation of 161 cases in surgical pat...Apollo Hospitals
Although major cause of childhood morbidity and mortality in the developing world is still malnutrition and infections, pediatric neoplasms are also rising in number. Although pediatric neoplasms occur infrequently, they present a challenging diagnostic and therapeutic problem. Unfamiliarity with these conditions may lead to the erroneous diagnosis and unnecessary aggressive therapy. This was a retrospective analysis of 161 cases of pediatric tumors, both benign and malignant, in surgical pathology department excluding neurosurgery, cardiothoracic, and hemato-lymphoid malignancies (age group 0–12 years) encountered over a period of 5 years: January 2004–December 2008. The clinical, radiological, and therapeutic data were obtained from patients’ case paper records. Pattern of childhood tumors was studied with a focus on tumor incidence, age and sex distribution, demographic pattern, and histological type.
Similar to An Epidemiologic Study of Gilles de la Tourette's Syndrome in Israel (20)
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
An Epidemiologic Study of Gilles de la Tourette's Syndrome in Israel
1. An Epidemiologic Study of Gilles de la Tourette's
Syndrome in Israel
Alan Apter, MD; David L. Pauls, PhD; Avi Bleich, MD; Ada H. Zohar, PhD; Shmuel Kron, MD; Gidi Ratzoni, MD;
Anat Dycian, MA; Moshe Kotler, MD; Avi Weizman, MD; Natan Gadot, MD; Donald J. Cohen, MD
Objectives: The goal of this study was to estimate the
lifetime prevalence of Gilles de la Tourette's syndrome
(GTS) in adolescents aged 16 to 17 years.
Design: Population-based epidemiologic study.
Subjects: Eighteen thousand three hundred sixty-four
males and 9673 females aged 16 to 17 years screened for
induction into the Israel Defense Force.
Results: Of the 28 037 individuals screened, 12 met diag-
nostic criteria for GTS. The point prevalence in this popu-
lation was 4.3m=+-1.2(meanm=+-SE)per 10 000. The 95% con-
fidence interval for this estimate is 1.9 to 6.7 per 10 000. The
point prevalencewas 4.9m=+-1.6 per 10 000 for males (95% con-
fidence interval, 1.8 per 10 000) and 3.1 m=+-1.8per 10 000 for
females (95% confidence interval, 0 to 6.6 per 10 000). The
rate ofobsessive-compulsivedisorder (OCD) was significantly
elevated amongthe subjects with GTS (41.7%) comparedwith
the population point prevalence of OCD (3.4) in those with-
out GTS. In contrast, the rate ofattention deficit hyperactivity
disorder was only 8.3% comparedwith the populationpoint
prevalence of 3.9% in those individuals without GTS.
Conclusions: The prevalence estimates from this pop-
ulation-based study are in agreement with previous re-
sults based on surveys of younger children. The sex ratio
observed in this study is not as large as reported in Pre-
vious studies and remains to be explored in other studies
of adolescents and adults.
(Arch Gen Psychiatry. 1993;50:734-738)
Gilles
DE LA Tourette's syn¬
drome (GTS) is a neu¬
ropsychiatrie disorder
with onset in childhood,
characterized by motor
and phonic tics that wax and wane over
the course of the illness. During the past
decade, GTS has been the focus of con¬
siderable research1·2; however, few epide¬
miologie studies have been conducted to
establish the prevalence of GTS in the gen¬
eral population. In an early study, Lucas
and colleagues3 searched for all cases of GTS
in a computerized diagnostic index main¬
tained at the Mayo Clinic, Rochester, Minn.
Twenty-seven patients were identified from
this registry; however, not all came from
the immediate Rochester area. To obtain a
better prevalence estimate, Lucas and col¬
leagues attempted to ascertain all cases iden¬
tified between 1968 and 1979 in Roches¬
ter. Three individuals were located, yielding
a rate for this community of 0.046 per
10 000.
A more recent study surveyed all phy¬
sicians in the state of North Dakota in an
attempt to identify all patients with GTS
in their care.4 The prevalence estimate for
this study was considerably higher than that
reported by Lucas and coworkers.3 For
adults, the total overall rate was 0.50 per
10 000. The prevalence was estimated to
be 0.77 per 10 000 for males and 0.22 per
10 000 for females. Among school-age chil¬
dren, the total rate was estimated to be 5.2
per 10 000, with a prevalence of 9.3 per
10 000 for males and a prevalence of 1.0
per 10 000 for females.
A shortcoming of both of these stud¬
ies was the reliance on identified treated
cases. To address this problem, a study of
From the Geha Psychiatric
Hospital, Department of Child
and Adolescent Psychiatry,
Sackler School of Medicine, Tel
Aviv University, Petah Tikva,
Israel (Drs Apter, Ratzoni,
Weizman, and Gadot); the
Department of Psychiatry,
Sakler School of Medicine, Tel
Aviv University, Ramat Aviv,
Israel (Drs Apter, Bleich, and
Ratzoni); Israel Defense Force
(Drs Apter, Bleich, Kron, and
Ratzoni and Ms Dycian); the
Child Study Center (Drs Pauls,
Zohar, and Cohen) and the
Department of Genetics
(Dr Pauls), Yale University
School of Medicine, New Haven,
Conn; the Department of
Psychology, Hebrew University,
Jerusalem, Israel (Dr Zohar);
and the Department of
Psychiatry, Albert Einstein
College of Medicine, New York,
NY (Dr Kotler).
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2. SUBJECTS AND METHODS
SAMPLE
The sample consisted of a cohort of 16- to 17-year-old Is¬
raelis screened at an Israel Defense Force induction center
in Israel. Some institutionalized individuals (0.02%) were
not personally evaluated, but extensive information about
them was available from medical records. All medical records
from institutionalized adolescents were evaluated by three
board-certified child psychiatrists (A.A., G.R., and A.W.) to
determine whether any of them met criteria for GTS; no
individuals with GTS were identified. Females who claimed
exemption from the military on religious grounds (on av¬
erage, 5% of the general Israeli population) were not in¬
cluded in the study.
All subjects were screened for lifetime occurrence of
motor and/or phonic tics at the time of preliminary induc¬
tion evaluations. Altogether, more than 28 000 individuals
were assessed during a 1-year period.
ASSESSMENT PROCEDURE
A three-stage ascertainment procedure was used to identify
affected individuals. The initial screeningstage utilized a four-
item self-report questionnaire (Table I ) that elicited infor¬
mation about the lifetime occurrence of tics. After comple¬
tion of the questionnaire, each subject was examined by an
induction center physician who was trained to recognize tics
and GTS. Altogether, 12 psychiatrists participated in the first-
stage screening. All of them were trained by a board-certified
child psychiatrist experienced with GTS (A.W.). The train¬
ingincluded lectures and audio-visual materials obtained from
the GTS clinic at the Yale University Child Study Center, New
Haven, Conn. All 12 Israel Defense Force clinicians specif¬
ically asked the same four questions, reviewed the written
responses, and observed the young people to assess the pres¬
ence of tics. For quality assurance, each physician signed the
questionnaire after the physical examination. All individuals
who responded positively to at least one screening question
were included in the second stage of the evaluation.
In the second stage of ascertainment, all individuals
were examined clinicallyby one of three board-certified child
psychiatrists (A.A., G.R., and A.W.) with special research
interest and training for the diagnosis of tic disorders. The
second stage of the assessment consisted of a nonstructured
clinical interview that assessed general psychopathology and
determined the nature of tics, if present, and the course of
the tic disorder. If, after this interview, the clinician be¬
lieved that the individual possibly met DSM-III-R criteria
for GTS, the adolescent was included in the third stage of
the ascertainment process.
In the third stage, individuals were formally adminis¬
tered the Yale Schedule for Tourette's Syndrome and Other
Behavioral Syndromes (YSTSOBS)7 by a member of the same
team of child psychiatrists that conducted the second-stage
interviews. The YSTSOBS is a precoded structured inter¬
view developed specifically for a family study of GTS.8 The
tic section of this interview grew out of a questionnaire first
developed for a survey designed to collect information about
the presence and severity of tic symptoms from the mem¬
bership of the Tourette Syndrome Association.9 The most
informative and reliable items from that questionnaire
were combined with items from rating scales developed
for clinical assessment of GTS and related disorders.10
The OCD section of the interview was developed from
items included in the Yale-Brown Obsessive Compulsive
Scale.11 Specifically, items that elicit information regard¬
ing the presence of obsessions and compulsions, the
senselessness or repugnance of those symptoms, and
resistance to the thoughts and behaviors are included.
Furthermore, the YSTSOBS includes the Schedule for Af¬
fective Disorders and Schizophrenia for School-age Chil¬
dren,12 which enabled assessment of any psychiatric dis¬
order during the adolescent's lifetime.
To determine the sensitivity and specificity of the four-
item screening instrument, 562 consecutive individuals who
completed the four-item screening instrument were inter¬
viewed by trained child psychiatrists (G.R. and A.A.) who
were "blind" to the responses on the screening question¬
naire. The interviewers completed the sections of the
YSTSOBS that elicited information necessary for diagnoses
of GTS and tics, OCD, and ADHD.
school-age children was conducted in Monroe County,
New York.3 In this study, individuals were identified through
referrals resulting from public announcements, contact with
the public and private schools, and mailings to physi¬
cians and other treating health care professionals. Chil¬
dren who were identified through this screening were thor¬
oughly evaluated by the team of researchers using a battery
of standard instruments. With use of this two-stage as¬
certainment scheme, the population prevalence was es¬
timated to be 2.9 per 10 000.
In the most recent study,6 selected classrooms in a
southern California school district were surveyed. A
child study team that consisted of a psychologist, a
nurse, a speech and language specialist, a principal,
and teachers received student referrals from teachers
and parents for psychoeducational assessments. During
these interactions with the children, the school psy¬
chologist observed children for motor and vocal tics.
Children were referred from among more than 3000
students in three schools during a period of 2 years.
The sample included an overrepresentation of full-day
special education classes. Prevalence rates were esti¬
mated correcting for the number of special classes and
including individuals who met criteria for GTS, except
that the symptoms had not been present for 1 year.
The frequency of GTS was reported to be 105.3 per
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3. 10 000 for males and 13.2 per 10 000 for females.
While the Monroe County5 and southern California6
studies obtained cases from sources other than physi¬
cians, neither conducted a general population screen¬
ing for tics. Thus, to our knowledge, no study has sys¬
tematically screened all individuals in a population for
tics who were then followed up with a systematic clin¬
ical evaluation for the presence of GTS.
Israel provides a unique opportunity for population-
based studies of developmental psychopathology in ad¬
olescence. Between the ages of 16 and 17 years, all
Jewish and Druze adolescents are evaluated for physi¬
cal, psychological, and cognitive fitness in preparation
for army service. The only exceptions are some reli¬
gious girls. Furthermore, because individuals can be
observed closely throughout their military service and
because males who serve in the reserves can be fol¬
lowed up for many years, there is an opportunity to
learn more about the course of the disorder identified
in a population survey.
We took advantage of this complete population screen¬
ing in Israel. Approximately 28 000 adolescents between
the ages of 16 and 17 years who were being screened for
military induction were also screened for the presence of
tics. Our goals were to estimate (1) the point prevalence
of GTS, (2) the role ofobsessive-compulsive disorder (OCD),
and (3) attention-deficit hyperactivity disorder (ADHD)
among the individuals with GTS identified from a large
unselected population-based sample.
The cohort of individuals with GTS identified in this
initial screening are being followed through the course of
their military experience to determine the effect of stress
on the manifestation of the disorder. Gilles de la Tourette's
syndrome is a well-defined neuropsychiatrie entity with
important implications for the study of child and ado¬
lescent development and lends itself to a developmental
epidemiologie approach. Such a study of GTS could pro¬
vide a model for the study of similar psychopathologic
conditions as they develop through adolescence into
adulthood.
RESULTS
A total of 18 364 males and 9673 females between the
ages of 16 and 17 years were screened. The disparity in
the number of males and females reflects the fact that this
induction center specializes in the induction of males. Thus,
there are normally more males than females seen for screen¬
ing at this location. The only selection criterion is gender;
thus, the prevalence estimates should not be affected ex¬
cept that the estimate for females will have a larger SE.
Nine males and three females were diagnosed as hav¬
ing GTS. The point prevalence was 4.9±1.6 (mean±SE)
per 10000 for males and 3.1±1.8 per 10000 for fe¬
males. The 95% confidence intervals were 1.8 to 8.0 and
0 to 6.6 per 10 000 for males and females, respectively.
The overall point prevalence in this sample was 4.3 ± 1.2
per 10 000 (95% confidence interval, 1.9 to 6.7 per 10 000).
The male-to-female ratio was approximately 1.6:1.
The disorders associated with GTS are shown in
Table 2. Five (41.7%) of the 12 individuals had OCD;
only one (8.3%) had ADHD. The individual with ADHD
also had OCD and a wide range of other behavioral
problems.
Ofthe 562 individuals included in the sensitivity study,
11 were diagnosed as having a tic disorder. Of these 11
individuals, one met criteria for GTS and 10 had chronic
tics. Only one of these 11 denied having tics during the
initial screening. Thus, the sensitivity of the initial screen¬
ing instrument to identify tics was excellent (0.91); how¬
ever, the specificity was quite low. Of the 562 individuals
in this substudy, 62 answered positively to one of the
items on the screening instrument. As indicated above,
only 10 of those 62 actually met criteria for either chronic
tics or GTS. An additional four individuals met criteria
for transient tic disorder. While the specificity of this screen¬
ing method is low, for the purposes of our study, it was
critical to have the sensitivity of the screening instrument
as high as possible so as not to miss any affected indi¬
viduals. No individual who denied having tics on the screen¬
ing questionnaire was determined to have GTS.
As indicated above, all 562 individuals were inter¬
viewed to assess the lifetime occurrence of OCD and ADHD.
As seen in Table 1, the initial screening questionnaire did
not include any questions regarding obsessions and com¬
pulsions or symptoms of inattention, impulsivity, or hy¬
peractivity. It was important to obtain an estimate of the
prevalence of OCD and ADHD in this sample to better
evaluate the rates of these two conditions among the in¬
dividuals with GTS. While our sample is quite small, it
can be used to determine the point prevalence of OCD
and ADHD in a random sample of 16- to 17-year-old in¬
dividuals in which all individuals were personally inter¬
viewed. Of the 562 inductees interviewed, 19 were di¬
agnosed as having OCD (3.4%), four (21.0%) of whom
had had tics at some point in their lives. A total of 22
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4. *OCD indicates obsessive-compulsive disorder; ADD, attention-deficit disorder; ADHD, attention-deficit hyperactivity disorder; minus sign, not present; and
plus sign, present.
individuals were determined to have a lifetime diagnosis
of ADHD (3.9%). Only one (4.5%) of these 22 had had
chronic tics.
COMMENT
To our knowledge, ours is the first population-based study
that has systematically screened a large unselected sam¬
ple for the presence of GTS. The overall prevalence esti¬
mate (4.2 per 10 000) we obtained is consistent with prior
estimates.4·5 This is somewhat surprising, because all pre¬
vious studies relied in some part on cases seen by a phy¬
sician or some other health care professional. In addition,
the sex ratio obtained was somewhat lower than that re¬
ported in previous studies. As noted, the prevalence was
estimated at 4.9 per 10 000 for males and 3.1 per 10 000
for females, resulting in a male-to-female ratio of 1.6:1.
This is different from the previous findings in which males
were at least three to four times more likely than females
to have GTS.
It is not immediately clear why the prevalence and
the sex ratio are so low. In all previous studies, individ¬
uals with GTS were identified through either health care
professionals or referral from special agencies. If there is
some referral bias, such that males are more likely than
females to be taken for help or put into special education
classes, then the ratio observed in these earlier studies
would be too large.
On the other hand, it is possible that the prevalence
estimates in our study are too low. Given the desirability
of being in the army in Israel, it is possible that these
individuals denied the existence of tics. However, the na-
ture of the induction process and the scrutiny of the eval¬
uation make it unlikely that an individual would be able
to suppress tics for the entire time of the assessment. Thus,
it is doubtful that denial is an important factor. Further¬
more, the results of the sensitivity study suggest that our
screening process was excellent for identification of sub¬
jects with GTS. However, it is still possible that a sub¬
stantial number of subjects denied ever having tics when
in fact that was not true. Because it was not possible to
obtain information from other sources (ie, family mem¬
bers, teachers, or peers), it was impossible to determine
with independent data whether tics did occur at some
earlier time.
Our findings are consistent with the hypothesis that
OCD is part of the clinical presentation of GTS in that
approximately 40% of all individuals with GTS were also
diagnosed as having OCD. Given that this is a sample of
16- to 17-year-old adolescents, this is probably an un¬
derestimate of the true frequency of OCD among patients
with GTS. It would be expected that some of these indi¬
viduals will eventually develop OCD.
In contrast, our findings do not support the hy¬
pothesis that ADHD is part of the clinical presentation
of GTS.13 Only one (8.3%) of the 12 subjects with GTS
was also diagnosed as having ADHD. This rate is not
significantly different from the rate obtained in this
population (3.9%). However, while these findings sup¬
port the hypothesis that the high rate of ADHD seen in
clinical samples of patients with GTS may result from
ascertainment bias similar to that described by Berk-
son14 and Pauls et al,15 a caveat must be noted. It is
very difficult to assess ADHD reliably. This is particu-
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5. larly true if the assessment is done in a retrospective
fashion, as was the case in our study. Furthermore, ad¬
olescents are not likely to be highly reliable reporters
of symptoms associated with ADHD. Unfortunately, no
other data were available regarding ADHD symptoms.
As discussed above, it was not possible to interview
parents, nor was it possible to obtain school or medical
records regarding childhood behavioral difficulties.
Thus, these findings must be interpreted with caution.
A much better research design to determine the rela¬
tionship between GTS and ADHD would include a
prospective longitudinal study of children at risk for
both disorders. It will only be possible to fully under¬
stand the relationship between the two conditions with
careful direct evaluation of children at risk with the
use of a variety of strategies designed to fully assess the
complete symptom profile of both disorders.
Although we screened a large sample of individu¬
als, the identified cohort of subjects with GTS is still
too small. Larger samples are needed so that analyses
that examine onset, severity, and course of illness can
be conducted for a non-clinic-based sample. Previous
work has suggested that only a minority of individuals
with GTS actually seek help for their disorder.5 Thus,
it is important to identify cases from additional epide¬
miologie studies so that it will be possible to under¬
stand more completely the full range of expression and
natural course of GTS.
Accepted for publication June 26, 1992.
This work was supportedin part bygrantsfrom the Tourette
Syndrome Association (Dr Apter, principal investigator), the
National Institutes of Health, Bethesda, Md (grant NS-
16648, Dr Pauls, principal investigator), and the National
Institute of Mental Health, Rockville, Md (grant MH-00508,
a Research Scientist Development Award to Dr Pauls).
The authors express appreciation to ProfY. Danon,former
chief of the Israel Defense Force Medical Corps, the physi¬
cians at the induction center where the sample was collected,
and Anat Hoffmanfor her contribution to the success of this
work. Finally, the authors express appreciation to two anon-
ymous reviewers for comments that substantially improved
the manuscript.
Reprint requests to the Child Study Center, Yale Uni¬
versity School of Medicine, 230 S Frontage Rd, New Haven,
CT 05610 (Dr Pauls).
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