An article published Online First and in a future edition of The Lancet describes the procedures involved in a near-total face transplant. The patient is US citizen Connie Culp. In 2004, she was shot in the face with a shotgun by her husband. The article details her ground-breaking surgery and recovery to date. It is the work of Professor Maria Siemionow, of the Cleveland Clinic, Cleveland, Ohio, USA, and collaborators.

Connie, 46 years old and mother of two, was left with most of the middle part of her face missing after the shooting. She lost her nose, mouth, nerve, skin and other structural damage. She was fortunate to survive the attack, but her face was completely disfigured. She could not drink from a cup and her speech was slurred. She lost her sense of smell as well. From 2004 to 2008, she underwent 23 major reconstructive operations. But unfortunately they failed to restore her disfigured structures and left her feeling humiliated in public. Doctors determined that the final option to allow her to recover facial function and a normal appearance was a full face transplant. Connie was informed of the risk of serious complications. These involved the need for lifelong immunosuppression. She signed the consent form.

A brain-dead woman matching ConnieВґs age, race, and skin complexion was the donor. In December 2008 the operation was carried-out by an eight-surgeon team, including Professor Siemionow. The surgery lasted twenty-two hours. The donor face covered 80 percent of the area of where Connie’s face had been, and contained various structures including the nose, upper lip, lower eyelids, and the upper jaw including incisor teeth, palate, and various glands. After the bone components of the graft were secure, connections of the arteries and veins were made. Around 2 hours and 40 minutes after the connections were completed, the donor tissue began to pink up. This confirmed the graft’s viability. The facial nerves were then connected.

Immediately following the operation, an assortment of immunosuppressant drugs was given to Connie. She remains on immunosuppressant medication to prevent rejection of her new face. Up to now, she remains negative for cytomegalovirus and other infections. She began physiotherapy and speech therapy 48 hours after the surgery and continued to do so once a day for the first six weeks, then three times per week during follow up. Connie was regularly evaluated on her ability to speak, smell, swallow, make facial expressions, and other muscle control functions in her new face. She also received psychological support once a day during the first six weeks, then three times per week.

There was one occurrence of rejection of the graft lining on day 47, but this was reversed with a 1g dose of methylprednisolone. Facial sensation returned, after 6 months. Motor muscle recovery is slow but progressing. It is assessed by repose (expressionless features), pucker, smile, and pronunciation of vowels. Connie’s upper lip and lower eyelid movements remain imperfect but it is too soon to expect complete recovery in this area. On the other hand, major functions which she had lacked for four years are now restored. Now, she can smell, eat solid foods, drink from a cup, and her speech is intelligible. Before the transplant she felt pain which she rated as 8 out of 10 in severity. It was due to scarring and contracted tissues in the affected area. She now rates the pain as 1 out of 10.The authors write: “Aesthetic outcome will be improved by excision of the redundant skin, which is planned about 1 year after transplantation…Psychologically, she is doing well. She has no symptoms of depression or post-traumatic stress disorder.”

She rated her own appearance as 5 out of 10 three weeks post-transplantation. Then 5 months after the procedure this had improved to 8 out of 10. The authors explain: “Since surgery, she has recovered self-confidence, and looks forward to rebuilding her social life and to helping others who have been similarly disabled by trauma.”

The authors point out that there are ethical challenges remaining for patient selection for future operations, as well as medical support, appreciation of the moral, professional, and financial responsibilities of the patient. All of these factors will be determined by the geographic, cultural, and economic conditions of each particular patient. The authors add: “Nevertheless, in complex physically and functionally disabling cases, the patient’s ethical right to make decisions should be respected, after being informed of the risks and benefits of the procedure and the need for life-long immunosuppression.”

They say in closing: “We show the feasibility of reconstruction of severely disfigured patients in a single surgical procedure using complete facial allotransplantation. Therefore, this should be taken in consideration as an early option for severely disfigured patients.”

Professor Siemionow explains: “The outcome of this particular case supports facial allotransplantation as a means of early intervention for patients with severe facial deformities. It is with great pride that we share the outcome of this surgery; our patient is doing remarkably well and is very pleased with the result.”

In an associated note, Dr Chenggang Yi and Dr Shuzhong Guo,from the Institute of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, China, comment: “In our view, all of the problems in human facial transplantation, immunological status, selection of the recipient and donor, surgical technique, and psychological considerations are all important…Technically, Siemionow and colleagues’ surgery was very complex, and the patient gained good functional recovery. So far, total facial transplantation has not been reported. We think the most difficult part of the face transplantation is the aesthetic and functional recovery of the upper eyelids.”

“Some key points in facial transplantation remain intractable. Therefore the objective is to identify potential problems, and develop management strategies to resolve them. The day may not be far when facial transplantation becomes the standard of care for disfigured patients.”

“Near-total human face transplantation for a severely disfigured patient in the USA”
Maria Siemionow, Frank Papay, Daniel Alam, Steven Bernard, Risal Djohan, Chad Gordon, Mark Hendrickson, Robert Lohman, Bijan Eghtesad, Kathy Coffman, Eric Kodish, Carmen Paradis, Robin Avery, John Fung
DOI: 10.1016/S0140-6736(09)61155-7
thelancet

Stephanie Brunner (B.A.)

Summer, in all its blazing, sunny glory, is back! There’s plenty of time to get out on the fairway with your golf clubs or onto a court with your racquet. However, this also means there’s time for a sports injury to put an end to your summer fun. Golfer’s elbow, climber’s finger and runner’s knee are just a few of the problems that can plague the boys (and girls) of summer.

Dr. William Levine, chief of sports medicine at NewYork-Presbyterian Hospital/Columbia University Medical Center, recommends the following rules of the game to avoid athletic injuries:

- Your best bet is to prevent injuries before they happen. First of all, start slow. Don’t expect to be in the same playing condition that you ended up in last fall, even if you have been maintaining your fitness level. New activities require muscles and joints to respond in a different way. This may result in minor soreness while your body adjusts. If you push yourself too hard too soon, that minor soreness could turn into something more serious.

- Don’t forget to warm up. Although you may feel warm in good weather, you still have to give your muscles a chance to go through the motions and get blood pumping to all the necessary areas. Gentle stretching before finishing your activity will help those hard-working muscles retain and improve flexibility.

- For tennis elbow, runner’s knee, and similar injuries, try R.I.C.E. — Rest, Ice, Compression and Elevation. Rest means that the injured area is not put through any undue strain. When icing a body part, apply the ice in a covering so that it is not in direct contact with the skin. A cotton handkerchief covering the ice is helpful. Ice the affected area several times a day, for about 20 minutes at a time. Compression is applying pressure to the injured area to stop bleeding (if any is occurring) or to reduce swelling. Elevation helps in these respects as well. Compression and elevation are to be used in the case of acute injuries, such as a twisted ankle.

- Take frequent breaks. Even tennis pros rest between sets. Taking a rest doesn’t mean that you have to completely stop all activity, although it may be advisable sometimes. Just rest the body parts that are working hard and are susceptible to injury.

- The single most important thing you can do is pay attention to your body. Don’t ignore the little aches and pains in the joints and muscles. They are early signals that could help you prevent more serious injuries.

NewYork-Presbyterian Hospital/Weill Cornell Medical Center

Urinary tract infections are common in women, costing an estimated $2.5 billion per year to treat in 2000 in the United States alone. These infections frequently recur, affecting 2 to 3 percent of all women. A depletion of vaginal lactobacilli, a type of bacteria, is associated with urinary tract infection risk, which suggests that replenishing these bacteria may be beneficial. Researchers conducted a double-blind placebo-controlled trial to investigate this theory. Their results are published in Clinical Infectious Diseases and now available online.

In the study, young women with a history of recurrent urinary tract infections received antibiotics for acute urinary tract infections. They were then randomized to receive either a Lactobacillus crispatus intravaginal suppository probiotic, called LACTIN-V, or a placebo for five days, then once a week for 10 weeks.

The results suggest that the probiotic may reduce the rate of recurrent urinary tract infections in women prone to these infections. Of the 100 women who participated in the study, 50 received LACTIN-V, and 50 received the placebo. Seven of the women who received LACTIN-V had at least one urinary tract infection, compared to 13 in the placebo group.

According to study author Ann Stapleton, MD, of the University of Washington in Seattle, “Larger efficacy trials of this novel preventive method for recurrent urinary tract infections are warranted to determine if use of vaginal Lactobacillus could replace long-term antimicrobial preventive treatments.”

Source
Clinical Infectious Diseases

There’s been a lot of concern about the spread of swine flu, a new strain of flu virus which emerged in 2009. Swine flu is one of the major strains of flu around this winter. While for most people it is an unpleasant but mild illness, it can be serious. It has already caused a number of deaths this year.

However, there are treatments that can help with symptoms. And there are things you can do to help protect yourself from catching the virus.

Best Health, produced by the BMJ Group, has brought together the latest research about swine flu and weighed up the evidence about how to prevent and treat it. Here’s what it says:

— The seasonal flu vaccine for 2010/2011 protects against swine flu and other types of seasonal flu and is unlikely to cause any serious side effects.

— People with chronic diseases (like asthma or heart disease), people over 65, and pregnant women are all being encouraged to get vaccinated because they are more at risk of complications from flu.

— Treatments that are likely to work if you have swine flu are the antiviral medicines oseltamivir (Tamiflu) and zanamivir (Relenza). These medicines are not a cure for flu, but they may cut the time you are ill by about one day and you may be less likely to get complications from flu, such as pneumonia, although the evidence about this is not clear.

— If you’re pregnant and you suspect you have flu, you should call your doctor immediately. It’s important for pregnant women with swine flu to start taking antiviral medicines as soon as possible.

— Breastfeeding will help protect your baby against the virus, so you should carry on breastfeeding if you can, even if you get sick. You can continue to breastfeed while taking antiviral medicines.

— For most children, symptoms of swine flu are similar to those in adults, and the disease is not likely to be severe. Children can also take antiviral medicines, on the advice of a doctor.

— The best way to avoid catching swine flu (or any other type of cold or flu) is to wash your hands regularly with soap and hot water. Other sensible hygiene measures to help prevent the spread of swine flu are:

– Cover your nose and mouth when you cough or sneeze, using a tissue where possible

– Dispose of used tissues quickly and sensibly

– Clean regularly-touched hard surfaces (e.g. door handles and kitchen surfaces) frequently, using normal cleaning products

– Make sure your children follow these hygiene rules

— There is no evidence that wearing masks on the street, or while going about your daily business, will protect you against swine flu. Most masks are designed to stop you from passing on the germs you breathe out, not to stop germs getting in. Masks might be helpful if you have swine flu, to avoid giving it to people who are caring for you, or if you are caring for someone at home with swine flu.

Source: British Medical Journal

View drug information on Relenza; Tamiflu capsule.

Researchers at University of the Pacific in Stockton, California, have developed a new method of fine-tuning a mass spectrometer to rapidly identify foreign substances in pet food. The breakthrough discovery enables scientists to determine whether pet food has been contaminated in a matter of minutes a process which currently takes several hours or longer.

Professor O. David Sparkman and graduate student Teresa Vail used a mass spectrometer machine and D.A.R.T. (Direct Analysis in Real Time) device to determine that a can of dog food that was recently recalled contained melamine, a chemical used in plastic furniture, cookware and fertilizers abroad. The chemical is at the heart of the nationwide recall of contaminated pet food.

Sparkman said by using mass spectrometry, which is used to weigh and identify molecules in substances, they were able to determine that a sample of dog food contained melamine “because it gave off a computer signal that is specific to the chemical.” The D.A.R.T. device, when connected to the spectrometer machine, allows the food’s components to be read as signals on a computer screen, he said. “It took less time [to obtain] the results than to open up the can,” according to Professor Sparkman, who says the new method could save federal regulators time and money when testing food imports.

The idea to use the method came after Vail learned that some of the cans of pet food she recently had purchased for her own dogs were recalled due to the possibility they contained melamine. Under Sparkman’s direction, she tested the dog food and found that only one of a dozen cans tested positive for the chemical.

Vail and Sparkman will present their breakthrough method in June at an American Society of Mass Spectrometry conference in Indianapolis. Sparkman says he hopes the method will be applied widely as a “standardized tool” to help keep pets safe.

Academy Communications
P.O. Box 231
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United States
academycom

There is no danger if your child received the H1N1 vaccine that was recalled by Sanofi Pasteur. That is the information being provided to anyone calling the NJ Poison Control Center’s hotline, according to Bruce Ruck, Pharm.D., Director of Drug Information and Professional Education. The public should be reassured that this recall took place because specific lots were found to be slightly weaker than they should have been. The vaccine involved was intended for use only in children 6 months to 35 months of age and was in prefilled syringes. If a child was outside of that age group or did not get the vaccine in a prefilled syringe, this recall does not apply at all. Further, according to the Centers for Disease Control and Prevention (CDC), the potency of the vaccine was still good enough to provide immunity for the children who received the vaccine, provided the second dose is received 28 days later.

According to Peter Wenger, MD, a Pediatric Infectious Disease Specialist at UMDNJ-New Jersey Medical School, there are no safety concerns related to this recall. Based upon the information received from the CDC, Dr. Wenger said he expects the vaccine to be effective. Revaccination is not being suggested at this time. All children under the age of 10 should always receive a second dose of vaccine, regardless of what vaccine they received. No one needs an extra dose because of the recall.

Specialists from the NJ Poison Information and Education System (NJPIES) are available to answer any further safety concerns you may have. NJPIES provides free consultation through telephone hotline services and the web. Medical professionals such as physicians, registered nurses, and pharmacists offer confidential advice regarding poison emergencies and provide information on poison prevention, drugs, food poisoning, animal bites and more. The specialists are available 24 hours a day, seven days a week.

Source: UMDNJ

Childhood schizophrenia, also known as childhood-onset schizophrenia or early-onset schizophrenia is basically the same as schizophrenia in adults, but its onset occurs earlier in life. In some cases the patient may be ten years old, or even younger. Childhood schizophrenia can have a serious impact on the child’s ability to function properly.

Schizophrenia is a serious psychiatric illness. The patient experiences strange thoughts, strange feelings, and abnormal behavior. Schizophrenia is rare in children and difficult to recognize during its early phases.

Experts are not sure what the causes of schizophrenia are. Recent studies suggest a combination of factors, including brain changes, as well as biochemical, environmental and genetic factors may play a part.

Schizophrenia cannot be cured with modern medicine and therapies. However, it can be controlled.

Other interesting related articles:

What is Schizophrenia?

What is Schizoaffective Disorder?

What is Catatonic Schizophrenia?

What is Disorganized Schizophrenia (Hebephrenia)?

What is Paranoid Schizophrenia?

What are the Different Types of Schizophrenia?

A child with schizophrenia may have gradual changes in behavior – a child who was once clearly enjoying relationships with others may begin to become withdrawn and shy, and appear to be in a world of their own. They child may start talking about unusual ideas and fears. They may become clingy (with their parents) and say things that do not make any sense. Sometimes the schoolteacher may be the first person to notice the signs symptoms.

A child with schizophrenia may have hallucinations, delusions, irrational thinking, bizarre behavior, difficulties performing everyday tasks, such as washing.

Early age onset of schizophrenia poses special challenges for diagnosis, treatment and personal development.

Childhood schizophrenia is sometimes grouped together with similar conditions, known collectively as schizophrenia spectrum disorders.

Early-onset schizophrenia starts when the child is aged between 13 and 18 years.
Very early-onset schizophrenia starts when the child is aged 12 years or less.

What are the Signs and Symptoms of Childhood Schizophrenia?
A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

The child may:
See things that are not there – visual hallucinations (much less common than hearing things)
Hear things that do not exist – auditory hallucinations
Appear to lack emotion
Have emotions which do not go with the situation
Be socially withdrawn
Not do well at school
Care for himself/herself poorly
Have bizarre eating rituals
Speak in an incoherent way
Have illogical thoughts
Be agitated
When symptoms start very early they tend to grow very gradually. Parents and family members may initially aware of something that is wrong, but cannot define it clearly and usually put them down to a developmental phase the child is going through. However, the signs do not go away, they gradually become more noticeable. The child may eventually develop symptoms of psychosis, which may include delusions, hallucinations and disordered thoughts. Eventually the disordered thoughts may lead to a break from reality, causing distress to the child and his/her family.

When to seek medical help – parents, guardians and family member may not be keen to seek medical help and stigmatize the child with a label. However, early treatment will help a patient with childhood schizophrenia.

If the child is not longer washing properly, socializing, and has become violent and aggressive, or has other signs that may indicate a mental disorder, it is important to seek medical help. The child may not have childhood schizophrenia – he/she may have depression, an anxiety disorder, some kind of developmental disorder, or a simple medical illness.

If your child has hallucinations, delusions or disorganized thinking, seek medical help immediately.

What are the Risk Factors for Childhood Schizophrenia?
A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.
Genetics – children with a family history of schizophrenia have a higher risk of developing it themselves. If there is no history of schizophrenia in your family your chances of developing it (any type, child-onset or adult-onset schizophrenia) are less than 1%. However, that risk rises to 10% if one of your parents was/is a sufferer.

A gene that is probably the most studied “schizophrenia gene” plays a surprising role in the brain: It controls the birth of new neurons in addition to their integration into existing brain circuitry, according to an article published by Cell.

A Swedish study found that schizophrenia and bipolar disorder have the same genetic causes.
Viral infection – if the fetus (unborn baby in the womb) is exposed to a viral infection, there is a bigger risk of developing childhood schizophrenia.
Fetal malnutrition – if the fetus suffers from malnutrition during the mother’s pregnancy there is a higher risk of developing childhood schizophrenia.
Stress during early life – experts say that severe stress early on in life may be a contributory factory towards the development of childhood schizophrenia. Stressful experiences often precede the emergence of schizophrenia. Before any acute symptoms are apparent, people with schizophrenia habitually become bad-tempered, anxious, and unfocussed. This can trigger relationship problems. These factors are often blamed for the onset of the disease, when really it was the other way round – the disease caused the crisis. Therefore, it is extremely difficult to know whether schizophrenia caused certain stresses or occurred as a result of them.
Childhood abuse or trauma
Age of parents when baby is born – older parents have a higher risk of having children with childhood schizophrenia, compared to younger parents.

Drugs – the use of drugs that affect the mind or mental processes during adolescence may sometimes raise the risk of developing schizophrenia.

What are the Causes of Childhood Schizophrenia?

Experts are not sure, but they believe childhood schizophrenia arises and develops in the same way as the adult type of schizophrenia. We really don’t know why schizophrenia onset (start) occurs during childhood for some people, and later on for other individuals.

Research indicates that most forms of schizophrenia are caused by brain dysfunction; we just don’t know why that brain dysfunction occurs. Most likely, it is caused by a combination of genetics and environmental triggers.

What are environmental triggers? Imagine your body is full of buttons, and some of those buttons result in schizophrenia if somebody comes and presses them enough times and in the right sequences. The buttons would be your genetic susceptibility, while the person pressing them would be the environmental factors.

Experts believe that an imbalance of dopamine, a neurotransmitter, is involved in the onset of schizophrenia. They also believe that this imbalance is most likely caused by your genes making you susceptible to the illness. Some researchers say other the levels of other neurotransmitters, such as serotonin, may also be involved.

Changes in key brain functions, such as perception, emotion and behavior lead experts to conclude that the brain is the biological site of schizophrenia.

Schizophrenia could be caused by faulty signaling in the brain, according to research published in the journal Molecular Psychiatry.

Diagnosing Childhood Schizophrenia
The American Academy of Child Adolescent Psychiatry writes on its web site:

Children with schizophrenia must have a complete evaluation. Parents should ask their family physician or pediatrician to refer them to a psychiatrist, preferably a child and adolescent psychiatrist, who is specifically trained and skilled at evaluating, diagnosing, and treating children with schizophrenia. Children with schizophrenia need a comprehensive treatment plan. A combination of medication, individual therapy, family therapy, and specialized programs (school, activities, etc.) is often necessary. Psychiatric medication can be helpful for many of the symptoms and problems identified. These medications require careful monitoring by a psychiatrist (preferably a child and adolescent psychiatrist.)

To help with diagnosis, the following tests may be done:

Physical exam – the child’s height, weight, heart rate, blood pressure, temperature are checked. The doctor will listen to the patient’s heart and lungs, and check the abdomen.

CBC (complete blood count) – to check for alcohol and drugs, as well as thyroid function.

MRI (magnetic resonance imaging) or CT (computed tomography) scan – the aim here is to look for brain lesions or any abnormalities in the brain structure.

EEG (electroencephalogram) – to check for brain function.

Psychological evaluation – the psychiatrist, preferably a child and adolescent psychiatrist, who is specifically trained and skilled at evaluating, diagnosing, and treating children with schizophrenia will ask the patient about their thoughts, feelings and behavior patterns. They will discuss symptoms, when they started, how severe they are, and how they affect the patient’s life. The doctor will also try to find out how often and when episodes had occurred.

The doctor will most probably try to find out whether the child had any thoughts about self-harm or harming other people.

The patient’s ability to think and function in a way appropriate for his/her age will be evaluated. Among other things, this may involve looking through the child’s school reports, and completing some psychological questionnaires to evaluate their moods, anxieties and possible psychosis.

A proper diagnosis may take time

Sometimes a long time may pass before a diagnosis of schizophrenia is confirmed. Other conditions/illnesses, such as bipolar disorder (manic depression), depression or substance abuse have to be considered – these conditions have many overlapping signs and symptoms. Most doctors will chose to monitor the child for a few months before confirming a diagnosis. During this time the doctor will try to determine whether symptoms occur at home, school or everywhere. Sometimes medications may be prescribed before an official diagnosis is reached, as may be the cases with aggression or self-harm.

Diagnostic criteria for Childhood Schizophrenia

For diagnosis of childhood schizophrenia to be officially confirmed, the patient must meet specific DSM symptom criteria. DSM stands for the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. This manual is used by health care professionals to diagnose mental conditions – insurance companies also use this manual when deciding on reimbursing the patient’s medical expenses.

Initially, the child may be diagnosed with a non-specific psychotic disorder, instead of schizophrenia. As the patient’s behavior and thinking patterns and signs and symptoms become more evident and easier to define and describe over time, a diagnosis of schizophrenia may be reached – as long as the criteria are met.

The diagnostic criteria for childhood and adult schizophrenia are fundamentally the same, and include:

Two of the following are present:
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized or catatonic behavior
- Lack of emotion
- Social withdrawal
- Inability to carry out routine daily tasks, such as bathing or dressing
Failure to achieve the expected level of academic, social or work performance
Signs persevere for six months or more
Other mental health disorders have been excluded

What are the Treatment Options for Childhood Schizophrenia?
Childhood schizophrenia is a condition that lasts throughout life – it is a chronic condition. Children with schizophrenia require treatment on a permanent basis; even when symptoms seem to have disappeared. Treatment is basically the same for all forms of schizophrenia. However, because childhood is such a strategic period in the formation of the person, treatment can be a challenge.

A whole team of health care professionals will be involved in treating a child with schizophrenia; usually led by a psychiatrist specialized in childhood schizophrenia. Schizophrenia can affect many areas of the patient’s life – therefore the team will have a wide range of experts, including:
A case worker
A GP (general practitioner, primary care physician, family doctor)
A pediatrician
A pharmacist
A psychiatric nurse
A psychiatrist
A psychotherapist
A social worker
Members of the child’s family
Medications – most medications used for childhood schizophrenia are the same as the ones used for adult schizophrenia, with antipsychotics being at the heart of treatment. The medications are mostly used off-label in children – this means they have not been specifically approved for pediatric use, but can be legally if the doctor believes it will help the child.

Antipsychotic medication may have serious side effects. It is important for parents and guardians, and also the patient to be aware of them, and to be able to weigh them up against the benefits they offer.

Atypical antipsychotics (2nd generation antipsychotics) – are a group of antipsychotic drugs used to treat psychiatric conditions. Atypicals differ from typical antipsychotics in that they are less likely to cause extrapyramidal symptoms (EPS). EPS include parkinsonian-type movements, rigidity and tremor. The Food and Drug Administration (FDA) in the USA has approved two atypical antipsychotics for children aged between 13 and 17 years:
Risperidone (Risperdal)
Aripiprazole (Abilify)
They are effective in treating hallucinations, lack of emotion, motivation problems and delusions.

Side effects may include:

Weight gain
Diabetes
High cholesterol
Typical antipsychotics (1st generation antipsychotics) – although they are as effective in treating the same symptoms atypical antipsychotics are, patients are more likely to have extrapyramidal symptoms (EPS), including involuntary movements of the face, tremor and parkinsonian-type movements. The generic versions of these drugs are much cheaper than atypical antipsychotics. Because of the risk of serious side effects, they are not usually recommended for pediatric use, unless other treatments have not worked.

Side effects in children – children may have different, and sometimes worse side effects than adults. Sometimes the side effects may even be life-threatening. When the child is very young, he/she may not be able to talk about medical problems clearly, and might not really know what is going on. Parents/guardians need to make sure they have discussed all aspects of the child’s medication with the doctor – any health problems experienced during treatment need to be reported immediately.

If any problems with medications are identified early, the doctor can then adjust the dosage, or change the treatment (use another drug). A parent/guardian can also be taught to manage side effects.

Drug interactions (drug clashes with other substances) – it is important that the parents/guardians, and eventually the patient know what other medications, vitamins, minerals and herbal supplements may clash with their medications.

Psychotherapy – psychotherapy consists of a series of techniques for treating mental health, emotional and some psychiatric disorders. Psychotherapy helps the patient understand what helps them feel positive or anxious, as well as accepting their strong and weak points. If people can identify their feelings and ways of thinking they become better at coping with difficult situations. It only works if a trusting relationship can be built up between the client and the psychotherapist (in psychology “client” can mean “patient”). Treatment can continue for several months, and even years. Psychotherapy may be practiced on a one-to-one basis, or in pairs, and even in groups.

With individual therapy the child has the opportunity to learn about childhood schizophrenia; understand it better and cope with persistent symptoms. The importance of complying to a treatment plan becomes more compelling and relevant. Psychotherapy may also help the child overcome the stigma associated with schizophrenia.

The child’s family may also benefit from family psychotherapy, which may become a vital source of support and education.

Social and academic skills training – this is a vital part of childhood schizophrenia treatment. The child will benefit from help in overcoming problem relationships and difficulties at school. Treatment plans can be set in place to deal with problems with washing and dressing, and functioning in an “appropriate” way for his/her age.

Hospitalization – this may be necessary when symptoms are severe, both for the child’s personal safety, the safety of others, and to make sure he/she gets enough sleep, proper nutrition, and hygiene. It is vital that symptoms are brought under control rapidly – which a hospital setting is often better equipped to do.

What are the Possible Complications of Childhood Schizophrenia?
If the child with schizophrenia is not treated, there is a risk of serious complications, which may be behavioral, emotional, and cognitive. There is also a risk of eventual problems with the law. The following complications are possible:
Depression – more common later in life, but may also emerge beforehand. Although depression may be the result of the negative social impact caused by schizophrenia, some experts believe that depression may be a part of the disease itself.
Suicidal thoughts
Suicidal behavior
Inability to dress properly
Lack of personal hygiene
Decline in school performance
The child becomes unable to attend school
The child becomes an adult who cannot live independently
Social withdrawal
Withdrawal from family
Confrontations – arguments or physical confrontations
Substance abuse

Physical health – studies have shown that people with serious mental problems have a higher risk of developing (physical) health problems; not only because of side effects caused by medications.

The effect on loved ones – family members may suffer from grief, guilt, and several other emotional issues when faced with a loved one with childhood schizophrenia. The family members themselves are also at risk of depression, exhaustion, and other physical and mental problems.

With proper treatment, adherence to treatment (compliance, following the treatment plan), and support the child has a significantly better chance of eventually becoming a productive, independent and creative adult.

View drug information on Abilify; Risperdal Oral Formulation.

Good sleep in later life reduces the risk of falls and depression, is essential for maintaining activity and performance levels, and reduces challenging behaviour encountered in dementia sufferers. A multi-disciplinary research project headed by the University of Surrey in collaboration with the Universities of Loughborough and Bath and King’s College London will address practice and policy relevant issues arising from the nature, impact and management of the sleep-wake balance in later life. It will extend and ‘join up’ strategically targeted areas of sleep research relevant to understanding and improving autonomy, active ageing, and quality of later life.

Professor Sara Arber of the University of Surrey Department of Sociology who will lead the research commented, “Sleep problems in later life are widespread and adversely affect quality of life, but remain under acknowledged and little researched. Our research will find out the ‘real life’ experiences of poor sleep among older people, and identify strategies for improving sleep and reducing reliance on sleeping pills.”

This 4 year research project is funded by a ВЈ2.3 million grant from the Economic and Social Research Council (ESRC)1 as part of the New Dynamics of Ageing Research Programme. Academic partners from six disciplines and four institutions, together with five non-academic partners, will achieve these objectives through research within eight inter-linked work packages (see somnia.surrey.ac).

A range of methods will be used to improve understanding of disrupted sleep and use of sleep medication in later life, including secondary analysis of existing large databases, and in-depth research with older people in the community and care homes. Interventions will be conducted to evaluate the effects of ‘blue-enriched’ light on quality of sleep in the community and care homes, evaluate a supported self-management programme for insomnia among chronically ill patients in general practice, and evaluate newly-developed sensor-devices to improve sleep. A user-friendly information and advice website on sleep will be developed, and a sleep education module will be prepared for the DIPEx website (dipex).

About SURREY UNIVERSITY

Surrey is a truly international university, drawing its students and staff from 140 countries around the globe, focusing its research and teaching on the real word, whilst fully recognising its responsibilities to the region it serves. We offer high-calibre teaching, a world-class research base, a thriving postgraduate community and a high quality of life in a beautiful campus setting. At the same time we have a strong eye for innovation and enterprise and are at the forefront of developments in teaching and research.

SURREY UNIVERSITY
Guildford
Surrey
GU2 7XH
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A life-saving mail drop in the Midlands aims to tackle the fact that the area has the lowest proportion of people on the NHS Organ Donor Register (ODR) in the country.

From February more than 2.9 million homes in the region will receive the special leaflet inviting people to join the ODR as part of UK Transplant’s My life, My gift campaign. It contains basic facts about organ donation as well as a simple Freepost form for those wanting to join the register.

Just 19% of those living in the East Midlands and 22% in the West Midlands have joined the register, which helps save and transforms thousands of lives every year. This compares to a national figure of 24% and regional highs of 29% in Scotland and the West of England.

The maildrop is targeting areas of the country with the lowest proportion of sign-ups and has already been delivered to homes in London, Northern Ireland and the North of England. This will be its final leg.

To date, more than 14.9 million people have joined the register, while last year more than 3,000 lives were saved or transformed by the gift of an organ donor including 905 people from the Midlands.

Sadly though there is a desperate shortage of donors and in the Midlands alone 1,677 people are currently registered for an organ transplant. Many are from black and Asian communities where there is an even bigger shortage of donors.

Last year 63 people in the region died before getting that second chance a transplant could have given them, while many more face an agonising wait before an organ will be found.

Fiona Wellington, UK Transplant regional manager for the Midlands, said: “There are hundreds of people in the Midlands waiting for a transplant who, like the thousands of others across the UK, are affected by the chronic shortage of organs for donation. The biggest obstacle is that four out of ten families of potential donors refuse permission for their loved ones’ organs to be donated, often because they did not know what their wishes were.

“This mail drop gives people in the Midlands a real chance to make a difference. We know from research that 90% of people in the UK support organ donation, we just need more of these people to act on their good intentions, talk about their wishes with their families, and join the register. If more people did then more lives could be saved.”

Tamsin May, UK Transplant Marketing and Campaigns Manager, said: “The mail drop is one of the ways in which we are trying to make the register even more accessible to those who want to pledge the gift of life.

“Our research shows that many people in the Midlands, as in the rest of the UK, support organ donation, but often expect to be asked to join the register, while others simply haven’t got round to signing up yet.

“With a convenient way of registering being delivered through their letterbox, we hope that people will act on their good intentions, talk to their family about their wishes, and invite others in their household to do the same.”

For people wanting to find out more about organ donation and transplantation before making their decision, the leaflet contains details of a dedicated website (mylifemygift) and the Organ Donor Line (0845 60 60 400) – which can also be used to join the ODR.

A photograph of the West Midlands donor co-ordinator team with local transplant recipients and a donor family, as well as other fully-captioned photos linked to the campaign including the My life, My gift logo, can be easily downloaded by visiting uktransplant.thirdlight.

Did you know?

1. The mylifemygift weblink contains regional information – including localised statistics and case studies relating to the Midlands – for journalists. Further case studies from the region are available for interview by contacting the UK Transplant press office.

2. 1,677 people in the Midlands currently need an organ transplant – 1,546 need a kidney transplant, 33 a liver, 33 a lung, 14 a heart and 4 a combined heart/lung.

3. The year April 06-March 07 saw 433 Midlands residents receive an organ transplant – 139 received a kidney from a deceased donor, 136 received a kidney from a living donor, 90 a liver, 20 a combined kidney/pancreas, 22 a heart and 18 a lung. A further 364 people had their sight restored by a cornea transplant.

4. Unfortunately, over the same period, 63 people died while waiting for a transplant.

5. You are more likely to need a transplant than become a donor.

6. All the major religions support organ donation and many actively promote it.

7. Repeated surveys show that the majority of the public support organ donation.

8. A deceased donor can donate a heart, lungs, two kidneys, pancreas, liver and can restore the sight of two people by donating their corneas. Donors can also give bone and tissue such as skin, heart valves and tendons. Skin grafts have helped people with severe burns and bone is used in orthopaedic surgery.

9. Black people are three times as likely as the general population to develop kidney failure, which can lead to the need for a transplant.

10. The need for organs in the Asian community is three to four times higher than that of the white community because conditions such as diabetes and heart disease, that can result in organ failure, occur more often in the Asian population.

11. The NHS Organ Donor Register is a confidential database operated by UK Transplant that contains the names of more than 14.9million individuals who wish to pass on the gift of life through organ donation after their death. This figure represents approximately 24% of the total UK population. The register can be accessed by authorised medical staff 24 hours a day, seven days a week, to establish an individual’s wishes for donation.

12. More than 9,000 people in the UK need an organ transplant to save or dramatically improve their lives but the shortage of donors means that just 3,000 transplants can be performed each year. More than 400 patients die each year while waiting. (Although 7,583 people are currently actively registered for a transplant, up to 2,000 others are also on the waiting list but are temporarily suspended for a variety of reasons.)

13. UK Transplant is the NHS organisation responsible for matching and allocating donated organs. It is part of NHS Blood and Transplant (NHSBT), a Special Health Authority within the NHS that manages the National Blood Service, Bio Products Laboratory, and UK Transplant.

UK Transplant

The NFU has today called for the Government and the cattle and sheep industry in Great Britain to stand together and suspend imports of cattle and sheep from areas where Bluetongue is known to be circulating in light of news that BTv1 has been detected in a batch of cattle imported from France.

NFU President Peter Kendall said: “The health and welfare of our cattle and sheep sectors must be our paramount concern and this recent incident of a batch of imported cattle testing positive for BTv1 is a major concern for all livestock keepers.

“There is currently no evidence that the BTv1 virus is circulating in the UK so our main priority must be to keep this BTv serotype out of the country.

“No vaccine manufacture has currently licensed a BTv1 vaccine in the UK so we do not have vaccine to allow farmers to protect their own stock at the moment.

“As an industry we need to know more about how these animals, which we understand had been vaccinated for BTv1 in France, tested positive for the virus when they arrived in England.

“In light of the uncertainty and the enormous risk to our industry it is only right that we do all that we can to protect our livestock sector and at the moment I believe that this means that we should suspend imports from BTv areas.

“I am sure that no farmer wants to import BTv1 into the country and therefore until we are confident that the controls on moving animals from BTv areas, as set out in the EU regulations, are working effectively to protect our livestock then we should suspend imports from these areas.”

The NFU will be talking to Defra and other industry organisations about this very important issue in the coming days.

NFU