Psychosocial Outcomes of Canadian Clubhouse Members: A Multi-Site Longitudinal Evaluation

The Clubhouse model of psychosocial rehabilitation supports individuals with mental health challenges using a person centered and recovery-oriented approach. Clubhouses around the world have been found to be effective in supporting their member's recovery. However, there is a lack of multi-site and longitudinal studies on the Clubhouse model. Therefore, the purpose of the present study was to longitudinally assess the psychosocial outcomes of Clubhouse members across six accredited Clubhouses in Canada. Due to the COVID-19 pandemic occurring midway through the study, a secondary aim was to assess the impact of the pandemic on the psychosocial outcomes of Clubhouse members. A total of 462 Clubhouse members consented to participate in the study. Members completed a questionnaire battery every 6 months over a 2-year period (five data points total). The last three data points were collected during the COVID-19 pandemic. Psychosocial outcomes included mental health symptoms, substance use, community integration, and satisfaction with life, and were analyzed using multilevel growth models. The results indicated that satisfaction with life and psychological integration increased over the study period, while mental health symptoms, substance use, and physical integration decreased. Examining Clubhouse participation, length of Clubhouse membership and frequency of Clubhouse use predicted higher life satisfaction, lower substance use, and fewer mental health symptoms over the study period. The results of the present study provide invaluable insight into the psychosocial impact of Clubhouses on Canadian Clubhouse members, particularly during COVID-19.

Multilevel factors in providers' decisions to utilize CPT in military- and veteran-serving treatment settings

Numerous guidelines exist to inform decision-making regarding psychological treatment of patients with posttraumatic stress disorder (PTSD). While strides have been made in the implementation of evidence-based psychotherapies (EBPs) for PTSD in the United States. Department of Veterans Affairs (VA), a large population of veterans does not receive such services. Research has been conducted on veterans' decisions to enroll in EBPs; however, less is known about providers' perspectives related to offering trauma-focused therapies to the military and veteran population, particularly outside the United States. This study utilizes baseline data from a larger investigation aimed to support the sustained implementation of cognitive processing therapy (CPT) in U.S. VA and Canadian Operational Stress Injury (OSI) and Department of Defense settings. Providers who trained in CPT (N = 55) participated in interviews regarding their opinions of CPT, preferred treatments for PTSD, and their process in assessing appropriate PTSD treatments for each patient. A directed content analysis approach was used to identify themes for providers' decision-making to utilize CPT within the context of four Consolidated Framework for Implementation Research (CFIR) domains. In the outer setting domain, providers reported disconnect from policy and leadership as a barrier, and in the inner setting CFIR domain, providers reported multiple facilitators: available resources, leadership support, and compatibility with CPT. The CFIR domain for characteristics of the individuals aligned with a theme of theoretical orientation and training as a facilitator. The intervention characteristics domain aligned with facilitators and barriers; complexity of CPT was a barrier, but relative advantage and perceived strength of evidence were facilitators toward implementation. The systems surrounding and supporting EBP delivery within the U.S. VA, Canada OSI, and Canadian Forces clinics have more similarities than differences regarding barriers and facilitators to delivering CPT. Despite variability in funding and training, provider experiences across all three systems suggest similar themes. Further investigation is needed to determine whether these findings extend to community samples or sites not yet offering EBPs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A multisite longitudinal evaluation of Canadian clubhouse members: Impact on hospitalizations and community functioning

OBJECTIVE

The Clubhouse model of psychosocial rehabilitation supports the personal recovery of individuals with severe mental health challenges. To date, there has never been a multisite, longitudinal study examining the outcomes of Clubhouse members in Canada. Therefore, the purpose of the present study was to longitudinally assess the psychosocial outcomes and hospitalization rates of Clubhouse members from six Clubhouses across Canada. An exploratory aim of this study was to assess the psychosocial impact of the COVID-19 pandemic on Clubhouse members.

METHOD

The present study used a participatory approach with six accredited Clubhouses across Canada. A total of 462 Clubhouse members consented to participate in the study. Members completed a questionnaire battery every 6 months over a 2-year period (five data points total). The last three data points were collected during the COVID-19 pandemic. Primary outcomes included community functioning, measured by the Multnomah Community Ability Scale, and self-reported hospitalization rates. Data were analyzed using multilevel growth models.

RESULTS

The results of the analysis indicated stability over the study period in community functioning and rates of hospitalization. Subscales of community functioning, including interference in functioning and behavioral problems improved over the course of the study, while adjustment to the community and social competence remained stable.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The consistency in outcomes across the study is notable, due to the worldwide impact of COVID-19 on mental health. Clubhouses may have had a buffering effect for members, in that membership diminished the impact of the pandemic on mental health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Managing high-risk behaviours and challenges to prevent housing loss in permanent supportive housing: a rapid review

Permanent supportive housing is an effective intervention for stably housing most people experiencing homelessness and mental illness who have complex support needs. However, high-risk behaviours and challenges are prevalent among this population and have the potential to seriously harm health and threaten housing tenures. Yet, the research on the relationship between high-risk issues and housing stability in permanent supportive housing has not been previously synthesized. This rapid review aimed to identify the housing-related outcomes of high-risk behaviours and challenges in permanent supportive housing settings, as well as the approaches used by agencies and residents to address them. A range of high-risk behaviours and challenges were examined, including risks to self (overdose, suicide/suicide attempts, non-suicidal self-injury, falls/fall-related injuries), and risks to multiple parties and/or building (fire-setting/arson, hoarding, apartment takeovers, physical/sexual violence, property damage, drug selling, sex trafficking). The search strategy included four components to identify relevant academic and grey literature: (1) searches of MEDLINE, APA PsycINFO, and CINAHL Plus; (2) hand searches of three journals with aims specific to housing and homelessness; (3) website browsing/searching of seven homelessness, supportive housing, and mental health agencies and networks; and (4) Advanced Google searches. A total of 32 articles were eligible and included in the review. Six studies examined the impacts of high-risk behaviours and challenges on housing tenancies, with overdose being identified as a notable cause of death. Twenty-six studies examined approaches and barriers to managing high-risk behaviours and challenges in PSH programs. These were categorized into eight types of approaches: (1) clinical, (2) relational/educational, (3) surveillant, (4) restrictive, (5) strategic, (6) design-based, (7) legal, and (8) self-defence. Consistent across all approaches was a lack of rigorous examination of their effectiveness. Further, some approaches that are legal, restrictive, surveillant, or strategic in nature may be used to promote safety, but may conflict with other program objectives, including housing stability, or resident empowerment and choice. Research priorities were identified to address the key evidence gaps and move toward best practices for preventing and managing high-risk behaviours and challenges in permanent supportive housing.

Making the case for citizenship-oriented mental healthcare for youth in Canada

Purpose

Varying stakeholders have highlighted how recovery-oriented mental health services such as youth mental health services have traditionally focused on supporting individual resources to promote recovery (e.g., agency) to the exclusion of addressing structural issues that influence recovery (e.g. poverty). One response to this criticism has been work helping people with mental health problems recover a sense of citizenship and sense of belonging in their communities. Work on citizenship has yet to influence youth mental healthcare in Canada’s provinces and territories. This paper aims to highlight ways that youth mental healthcare can better help youth recover a sense of citizenship.

Design/methodology/approach

The arguments described in this paper were established through discussion and consensus among authors based on clinical experience in youth mental health and an understanding of Canada’s healthcare policy landscape, including current best practices as well as guidelines for recovery-oriented care by the Mental Health Commission of Canada.

Findings

Here, this study proposes several recommendations that can help young with mental health problems recover their sense of citizenship at the social, systems and service levels. These include addressing the social determinants of health; developing a citizenship-based system of care; addressing identity-related disparities; employing youth community health workers within services; adapting and delivering citizenship-based interventions; and connecting youth in care to civic-oriented organizations.

Originality/value

This paper provides the first discussion of how the concept of citizenship can be applied to youth mental health in Canada in multiple ways. The authors hope that this work provides momentum for adopting policies and practices that can help youth in Canada recover a sense of citizenship following a mental health crisis.

Personal recovery in the postdischarge period for individuals with schizophrenia spectrum diagnoses: The role of community integration and social support

OBJECTIVE

The experience of personal recovery from mental health has been theorized to occur through several pathways. CHIME is a seminal theoretical framework of personal recovery that is widely endorsed by the existing literature. Few studies have examined the utility of the CHIME framework with those experiencing acute challenges in their engagement in the recovery process. The purpose of the present study was to examine part of the CHIME framework for individuals with schizophrenia spectrum diagnoses in the period immediately following hospitalization. Specifically, the impact of social support and community integration on personal recovery was examined.

METHODS

The present study involved a secondary analysis of a Phase 2 clinical trial. Assessment measures were administered to participants 1-month (n = 82) and 6-months (n = 72) postdischarge from a psychiatric hospital. Hierarchical regression and mediation analyses were conducted to assess the relationship between social support, community integration, and 1-month and 6-month personal recovery.

RESULTS

Hierarchical regression analysis indicated that community integration and social support significantly predicted personal recovery. Mediation analyses indicated social support partially accounts for the relationship between community integration and personal recovery at 1- and 6-months postdischarge, providing evidence for social support as a mechanism of personal recovery during this time.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

This quantitative investigation of CHIME highlights the mechanism of social support for individuals who are experiencing acute challenges in their recovery. These findings point to the need for interventions that enhance community integration and social support postdischarge. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Trauma-focused cognitive behavioral therapy for children and youth in low and middle-income countries: A systematic review

BACKGROUND

Trauma-focused cognitive behavioral therapy (TF-CBT) has been identified as a gold standard treatment for childhood posttraumatic stress disorder (PTSD) in Western countries. More recently, TF-CBT has emerged in the literature as an area of interest for children and youth affected by conflict and war in low- and middle-income countries (LMIC).

METHODS

The present systematic review assesses the current evidence base of TF-CBT for children and youth in LMIC, with a focus on conflict-affected countries. A total of 143 articles were identified, of which 11 articles, representing 1,354 participants, met the proposed inclusion criteria.

RESULTS

Results showed that the majority of the studies identified were conducted in low-resource community settings in East or Central Africa (n = 8). It was also found that cultural considerations were taken into account in TF-CBT delivery to meet the needs of local populations. Additionally, measures were translated and validated for local use.

CONCLUSIONS

Findings of outcome data indicated that TF-CBT was effective in treating trauma-related symptoms and improving psychosocial functioning in children and adolescents in LMICs. Given the limited number of published literature available in this area, further studies are needed to conclude when and for whom trauma-focused interventions are most relevant.

Mechanisms and moderators of behavioural couples therapy for alcohol and substance use disorders: an updated review of the literature

INTRODUCTION

Behavioural couples therapy (BCT) and alcohol behavioural couples therapy (ABCT) are couples-based interventions for substance use disorders (SUDs) that have been deemed a 'gold standard' treatment. Despite the substantial amount of promising research, there is a lack of research on the active components of treatment and treatment mechanisms and moderators. Since the most recent meta-analysis, a number of studies have been conducted that advance our understanding of the efficacy of BCT and ABCT.

AIMS

The purpose of the present review was to provide an update on the current knowledge of these treatments and to investigate mediators and moderators of treatment.

METHOD

A systematic search strategy of relevant databases from 2008 to 2021 identified 20 relevant articles that were coded for relevant information including study design, treatment, outcomes, as well as mechanisms and moderators.

RESULTS

The results indicated that BCT and ABCT are successful in reducing alcohol and substance use for both male and female clients, dual problem couples, and for reducing post-traumatic stress symptoms and intimate partner violence. The reviewed studies discussed a number of treatment mechanisms, with the most studied mechanism being relationship functioning. Moderators included relationship functioning and patient gender.

CONCLUSIONS

The results point to the need for additional research on active treatment components, mechanisms and moderators, in order to provide a more efficient and cost-effective treatment.

Community-based residential treatment for alcohol and substance use problems: A realist review

Research and reviews to date suggest that community-based residential treatments for substance use disorders (SUDs) have mixed effectiveness, with some studies finding positive outcomes while others finding no differences between intervention arms, including inpatient, outpatient, and control groups. In order to understand these mixed findings, reviews have underscored the importance of outlining the active treatment components of residential treatment, as well as treatment mechanisms and outcomes. Further, there is very little research on the underlying theories explaining how and for whom residential treatments are effective. The purpose of the present realist synthesis was to address this gap in the literature by exploring how, why, for whom, and in what circumstances, community-based residential treatments are effective. Following the RAMESES Publication Standards, a search was undertaken for articles examining community-based residential treatments in PsycINFO and PubMed from anytime to January 2020. The search generated 28 articles that met inclusion criteria and were extracted for relevant information. Results of the realist synthesis identified six Context-Mechanism-Outcome (CMO) configurations. Contextual factors that generated subsequent mechanisms and outcomes included substance-related problem severity, psychiatric comorbidities, diverse populations, pre-treatment relationships, lack of structure and lack of coping strategies. These CMO configurations provide important information for clinicians, treatment centres and policy makers, including the specific programme components that need to be offered in treatment to facilitate positive treatment outcomes.

Integration of Twelve Step with Evidence-Based Practices in a Residential Treatment Center

Background: Residential treatment for substance use disorders (SUDs) typically involves both medical and psychological treatments to best meet the needs of service users. Common treatments include Twelve Step Facilitation (TSF) as well as evidence-based practices (EBPs) such as cognitive behavioral therapies and medications. Researchers have discussed the difficulties with implementation and sustainability of EBPs within treatment centers that predominantly use TSF. Objectives: Understanding the process of implementation is an important area of study to inform future implementation efforts. The present study involved a qualitative investigation of a residential treatment center that integrated EBPs alongside TSF. Treatment stakeholders (N=22) were interviewed about their experience with integration. Results: The results indicated that the organization's evolution to integrate evidence-based practices (e.g., medication, evidenced-based psychotherapy) occurred through a process of themes including staff members' personal allegiance to Twelve Step; tension among staff members; staff collaboration; and integration of theoretical orientations. The results parallel those found in the Normalization Process Theory of implementation. Conclusions: The present study provides an understanding as to how Twelve Step and EBPs can be integrated into a residential treatment center, allowing for service users to have choice in their care. The program's ability to navigate the treatment evolution can be used as an example for integrating evidence-based practice with Twelve Step to meet the many needs of individuals seeking substance use treatment.

Randomized trial of a brief peer support intervention for individuals with schizophrenia transitioning from hospital to community

This phase 2 randomized trial examined the outcomes of a brief, transitional, peer support intervention designed to address the poor outcomes that are common for individuals with schizophrenia spectrum illnesses in the period immediately following hospitalization. In the context of treatment-as-usual, participants were provided with a peer support intervention, 'the Welcome Basket,' in which participants received 1-2 sessions of peer support in the two weeks before discharge and met weekly for a month post-discharge. The study also piloted a brief version of this intervention with only one community session post-discharge with the same pre-discharge process. It was hypothesized that the full intervention would improve community transition outcomes, with community functioning (Multnomah Community Ability Scale) being the primary measure and secondary measures including symptomatology, community integration, personal recovery, quality of life, and social support. The examination of the brief intervention was exploratory. Measures were completed at baseline, 1-month post-discharge, and follow-up at 6 months. A total of 110 participants were randomized to one of three interventions, with outcome data obtained from 82 and follow-up from 74. While feasible, we did not find that the Welcome Basket intervention was superior to treatment as usual for any of our primary or secondary outcome measures. Future work is needed to determine whether a more extended intervention is required and whether specific subgroups of patients may benefit (e.g. those without access to immediate psychiatric care or those better able to engage with a peer).

Implementation of peer support in mental health services: A systematic review of the literature

Peer support within mental health services has a growing evidence base and aligns with current policies of recovery-oriented care. Despite these advantages, widespread implementation of peer support remains limited, likely due to various methodological and implementation issues. Researchers have noted the importance of utilizing an implementation framework to understand best practices for implementation. Therefore, the purpose of the current study was to synthesize the existing literature on the implementation of peer support interventions and identify barriers and facilitators using an implementation framework. The Consolidated Framework for Implementation Research (CFIR) was used to organize the literature obtained in the systematic search and synthesize best practices for implementation. The systematic search identified 19 published articles that were coded for relevant information including implementation barriers and facilitators. The review highlighted a number of important elements for implementation within the CFIR domains, including clear role definition, a flexible organizational culture, and education for peer and nonpeer staff. Implementation barriers included an organizational culture without a recovery focus, allied practitioners' beliefs about peer support, and an unclear peer role. The results of this review provide a summary of best practices for the implementation of peer support in mental health services that can be used by researchers and service providers in future implementation. These practices should continue to be tested and reworked as the climate of recovery-oriented services within mental health organizations evolves. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Interpersonal dysfunction and treatment outcome in GAD: A systematic review

Interpersonal dysfunction is posited to maintain worry and generalized anxiety disorder (GAD). It has been suggested that the low remission rates in psychotherapy for GAD may be attributable, in part, to inadequately addressing interpersonal dysfunction. This paper systematically reviewed the literature examining the moderating role of interpersonal dysfunction on GAD psychotherapy outcomes and change in interpersonal dysfunction over the course of GAD treatment. Thirteen studies were identified, seven of which examined the relationship between interpersonal dysfunction or distress and treatment outcome and nine investigated change in interpersonal dysfunction over the course of psychotherapy. The majority of studies indicated that interpersonal dysfunction improves following psychotherapy. However, there is preliminary evidence that not all subscales of interpersonal dysfunction improve, including subscales relevant to GAD pathology such as overly-nurturant dysfunction. Further, greater interpersonal dysfunction predicted worse treatment outcomes. As such, interpersonal dysfunction may hinder treatment success and further research is needed to delineate for whom additional or integrated interpersonal interventions may be needed. Approaches to target interpersonal dysfunction in GAD are discussed.

Transition Experiences Following Psychiatric Hospitalization: A systematic Review of the Literature

The period immediately following discharge after inpatient stay for mental illness has been found to be the time of greatest risk for adverse outcomes (e.g., rehospitalization, relapse, suicide). However, the experiences of patients as they transition from the hospital to the community are not well understood. The purpose of the present review was to systematically search and synthesize the literature examining the transition experiences of individuals following inpatient psychiatric stay. A systematic search was conducted for studies examining the experiences of patients as they transition back into their communities, using qualitative or quantitative methods. Qualitative articles were analyzed using thematic content analysis. Quantitative articles were extracted and summarized. The search identified 1614 abstracts, of which 27 (18 qualitative; 9 quantitative) were included in the review. The results of the analysis identified themes necessary for transition including safety, supported autonomy, and the opportunity to engage in a number of reintegration activities. A number of barriers were found that prevent integration, such as poverty, interpersonal difficulties, and stigma. The results highlight the disconnect that occurs for patients as they transition from hospital, pointing to the need for effective transitional interventions that target these challenges.

Realist-informed review of motivational interviewing for adolescent health behaviors

BACKGROUND

Clinical research investigating effective intervention strategies for adolescents to improve health behaviors has shifted to the application of motivational interviewing (MI). Evidence indicates that MI is an effective intervention for improving health behaviors as related to diet, exercise, and diabetes among adolescents. However, there is a lack of understanding about the mechanisms through which MI works and the contextual factors impacting MI effectiveness. The purpose of this review was to understand how, for whom, and under what circumstances MI works for adolescent health behavior change, which will inform future implementation of this intervention. To provide this in-depth understanding, a realist-informed systematic review was conducted in order to synthesize the evidence on the use of MI for health behaviors. Self-determination theory (SDT) was chosen as the candidate theory for testing in the present review.

METHODS

Databases including PsycINFO, Healthstar, Cochrane, and PubMed were searched for articles published until March 2017. The search strategy included studies that examined or reviewed the effectiveness or efficacy of MI to change health behaviors among adolescent populations. The search identified 185 abstracts, of which 28 were included in the review. The literature was synthesized qualitatively (immersion/crystallization) and tested SDT as the candidate theory.

RESULTS

Based on SDT, three mechanisms were found within reviewed studies, including competence, relatedness, and autonomy. The following contexts were found to impact mechanisms: school setting, clinician MI proficiency, parental involvement, and peer involvement.

CONCLUSIONS

This realist-informed systematic review provides advances in understanding the mechanisms involved in MI for adolescent health behavior change. Additionally, it provides important practical information as to which contexts create the conditions for these mechanisms to occur, leading to health behavior change. The results can inform future MI interventions for adolescent health behavior change. Future research should continue to test this realist theory and also examine mechanism variables not extensively documented in order to improve our understanding of MI in this population.

Developing a realist theory of psychosocial rehabilitation: the Clubhouse model

BACKGROUND

Psychosocial rehabilitation is a service that supports recovery from mental illness by providing opportunities for skill development, self-determination, and social interaction. One type of psychosocial rehabilitation is the Clubhouse model. The purpose of the current project was to create, test, and refine a realist theory of psychosocial rehabilitation at Progress Place, an accredited Clubhouse.

METHOD

Realist evaluation is a theory driven evaluation that uncovers contexts, mechanisms, and outcomes, in order to develop a theory as to how a program works. The current study involved two phases, encompassing four steps: Phase 1 included (1) initial theory development and (2) initial theory refinement; and Phase 2 included (3) theory testing and (4) refinement.

RESULTS

The data from this two-phase approach identified three demi-regularities of recovery comprised of specific mechanisms and outcomes: the Restorative demi-regularity, the Reaffirming demi-regularity, and the Re-engaging demi-regularity. The theory derived from these demi-regularities suggests that there are various mechanisms that produce outcomes of recovery from the psychosocial rehabilitation perspective, and as such, it is necessary that programs promote a multifaceted, holistic perspective on recovery.

CONCLUSIONS

The realist evaluation identified that Progress Place promotes recovery for members. Additional research on the Clubhouse model should be conducted to further validate that the model initiates change and promotes recovery outcomes.

Patient dissatisfaction and institutional betrayal in the Canadian medical system: A qualitative study

Individuals who struggle with chronic medical conditions frequently use medical services and may depend on the medical system to ensure their overall well-being. As a result, they may be at a greater risk of feeling betrayed by the medical system when their needs are not being met. The current study aimed to qualitatively assess patients' negative experiences with the medical system that may lead to feelings of institutional betrayal. A total of 14 Canadian adults struggling with various chronic conditions completed an online open-ended questionnaire. Results indicated that institutional betrayal is composed of doctor-level betrayal (inadequate medical care and lack of psychological support) as well as system-level betrayal. The findings are discussed in the context of betrayal trauma theory; specifically, patients' appraisals of their negative health care experiences may play a vital role when one is considering the impact of institutional betrayal on an individual's overall well-being.

Children's Representation and Imitation of Events: How Goal Organization Influences 3-Year-Old Children's Memory for Action Sequences

Children's imitation of adults plays a prominent role in human cognitive development. However, few studies have investigated how children represent the complex structure of observed actions which underlies their imitation. We integrate theories of action segmentation, memory, and imitation to investigate whether children's event representation is organized according to veridical serial order or a higher level goal structure. Children were randomly assigned to learn novel event sequences either through interactive hands-on experience (Study 1) or via storybook (Study 2). Results demonstrate that children's representation of observed actions is organized according to higher level goals, even at the cost of representing the veridical temporal ordering of the sequence. We argue that prioritizing goal structure enhances event memory, and that this mental organization is a key mechanism of social-cognitive development in real-world, dynamic environments. It supports cultural learning and imitation in ecologically valid settings when social agents are multitasking and not demonstrating one isolated goal at a time.

Crowned dens syndrome misdiagnosed as polymyalgia rheumatica, giant cell arteritis, meningitis or spondylitis: an analysis of eight cases

BACKGROUND

The crowned dens syndrome, related to microcrystalline deposition in the peri-odontoid articular and abarticular structures, is mainly responsible for acute or chronic cervical pain.

PATIENTS

We report eight cases of crowned dens syndrome with atypical presentations mimicking giant cell arteritis, polymyalgia rheumatica, meningitis or discitis. The clinical and radiological aspects of these cases are presented and discussed.

RESULTS

For all patients, fever, cervical stiffness, headaches and biological inflammatory syndrome were reported. For three patients, impairment of general condition, occipito-temporal or mandible pain and weakness with inflammatory pain of the shoulder girdle was suggestive of giant cell arteritis and/or polymyalgia rheumatica, leading to temporal artery biopsy and/or long-term steroid treatment. Recurrence of clinical symptoms when tapering steroids was noted. In two cases, previous breast carcinoma led to the initial diagnosis of metastatic spondylitis. For three patients with vomiting, nausea and Kernig's and/or Brudzinski's sign, the first diagnosis was meningitis, leading to unhelpful lumbar puncture. In all cases, diagnosis of crowned dens syndrome once evoked, was confirmed by cervical CT scanning and dramatic improvement with non-steroidal anti-inflammatory drugs or colchicine.

CONCLUSION

This under-recognized entity must be considered as a differential diagnosis of meningitis and discitis, but also of giant cell arteritis and polymyalgia rheumatica, as well as a possible aetiology for fevers of unknown origin. CT scanning is necessary for diagnosis. Clinicians should be aware of such misleading clinical presentations.

Brown tumor of the spine and progressive paraplegia in a hemodialysis patient

STUDY DESIGN

Case report.

OBJECTIVE

To describe the radiographic features and management of spinal brown tumor and to document tumor mineralization after parathyroidectomy.

SUMMARY OF BACKGROUND DATA

Brown tumors are classic skeletal manifestations of hyperparathyroidism usually seen in severe forms. They are increasingly rare because hyperparathyroidism is now diagnosed and treated at an early stage.

METHODS

A case of brown tumor of the spine in a 37-year-old woman on chronic hemodialysis is described. The imaging findings before and after parathyroidectomy are discussed.

RESULTS

In a woman on chronic hemodialysis, a brown tumor of T8 caused acute spinal cord compression with paraplegia. Magnetic resonance imaging provided an accurate evaluation of the lesion, and needle biopsy confirmed the diagnosis. Emergent surgery was needed to relieve the spinal compression and stabilize the spine. The vertebral lesion underwent remineralization after parathyroidectomy.

CONCLUSION

Brown tumor is a benign tumor that resolves after parathyroidectomy. When brown tumor arises in the spine, surgery may be needed to preserve neurologic function.

[Pourfour du Petit syndrome: a rare aetiology of unilateral exophtalmos with mydriasis and lid retraction]

INTRODUCTION

Pourfour du Petit syndrome, rarely reported, is the opposite of Claude Bernard-Horner syndrome.

EXEGESES

A 67 years old female is hospitalised for dysphagia, allowing the discovery of oesophagus carcinoma with mediastinal, pleural and costal extension. The discovery of left unilateral mydriasis associated with exophthalmos and eyelid retraction suggest Pourfour du Petit syndrome; this diagnosis is confirmed by CT-scan, finding pedicular lysis of high dorsal vertebras and intra-canalar tumoral extension.

CONCLUSION

Pourfour du Petit syndrome has the same localisation value and the same aetiologies as Claude Bernard-Horner syndrome, but its mechanism proceeds byan exciting lesion of cervical sympathetic nervous system. The recognition of this entity can allow the diagnosis of pathologies that need emergency treatment.

A longitudinal insufficiency fracture of the tibia in association with a healed chronic osteomyelitis

Longitudinal stress fracture of the tibia often present with an atypical clinical presentation which can be mistaken for osseous tumor or osteomyelitis. We present a case of longitudinal stress fracture of the tibia which occurred in a patient with healed chronic osteomyelitis of the tibia. Magnetic resonance imaging failed to make the correct diagnosis. Accurate diagnosis was only obtained by helical CT which showed the longitudinal fracture line. Magnetic resonance imaging showed only non-specific signs of bone marrow edema, suggesting recurrence of osteomyelitis. Magnetic resonance imaging can be misleading in the absence of direct visualization of the fracture line.

Chronic cervical radiculopathy: lateral-approach periradicular corticosteroid injection

Thirty-two patients underwent periradicular corticosteroid injections with a lateral percutaneous approach under fluoroscopic guidance, to treat 34 foci of chronic cervical radiculopathy unresponsive to medical treatment alone. The mean evolutionary trends for radicular and neck pain relief were significant at 14 days (P <.001) and at 6 months (P <.001). The procedure did not produce any complications.

[A case of progressive multifocal leukoencephalopathy in AIDS: neuroimaging with clinical and pathologic correlation]

We present the neuroimaging features with clinical and pathologic correlation in a case of Progressive Multifocal Leukoencephalopathy (PML) in AIDS. CT and MRI showed typical lesions of PML. At pathology examination, characteristic lesions of PML were found in association with HIV encephalitis due to CNS infection by the virus.