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From Brain To Behaviour – What will we know in 10 years’ time?

Matt Butler
University of Manchester

The winning essay from the 3rd Edinburgh University Neurological Society (EUNS) National Conference 2015.

Introduction

The arbitrary distinction between the disciplines of psychiatry and neurology has become increasingly unhelpful in the successful treatment of patients with nervous system disorders. Since the divergence of the disciplines in the 19th and 20th centuries, neurology has been concerned with conditions arising from discreet lesions in the nervous system; conversely psychiatry with conditions involving higher cortical dysfunction. With the development of awareness of the psychopathological underpinnings of nervous system diseases, propelled by advances in neuroscientific understanding, the disparity between fields is more slender than ever. In a decade’s time, with increasing insight provided by neuroimaging, neurogenetics and neuropathophysiology, we will be closer to a singular unified discipline encompassing the study and treatment of both neurological and psychiatric disorders.

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Review: Should we screen for asymptomatic coronary artery disease in the community?

Introduction: Coronary artery disease (CAD) is the accumulation of atherosclerotic plaque in the coronary arteries; resulting in limited myocardial perfusion. CAD has high levels of global morbidity and mortality and is well researched. Asymptomatic coronary artery disease (ACAD) is the precursor subclinical state and is inadequately detected and researched. The aim of this article was to cross-examine the current research on ACAD. Emphasis was placed on methods of assessment and screening of ACAD.

Materials and Methods: A review of the literature was completed following a structured protocol; search engines, inclusion and exclusion criteria were defined a priori.

Results: Forty-eight articles met all inclusion criteria and were retrieved for detailed analysis. Outcome-based evidence suggested that cardiovascular disease risk stratification followed by imaging based assessments in low-to-moderate risk candidates were shown to be of clinical value in ACAD. A ‘treat all’ primary preventative approach was shown to be of most benefit; however the social and financial implications of this remain unclear.

Conclusions: Effective management of ACAD is essential to lower the worldwide incidence, morbidity and mortality of CAD. Further outcome-based evidence highlighting the benefits of identification, screening and early primary prevention of ACAD is urgently needed.

Keywords: Asymptomatic coronary artery disease, asymptomatic coronary atherosclerosis, subclinical coronary artery disease, subclinical coronary atherosclerosis, asymptomatic coronary artery disease screening, asymptomatic coronary artery disease investigations, asymptomatic coronary artery disease management

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