IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\\n\\n
IntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
With the desire to make book publishing more relevant for the digital age and offer innovative Open Access publishing options, we are thrilled to announce the launch of our new publishing format: IntechOpen Book Series.
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Designed to cover fast-moving research fields in rapidly expanding areas, our Book Series feature a Topic structure allowing us to present the most relevant sub-disciplines. Book Series are headed by Series Editors, and a team of Topic Editors supported by international Editorial Board members. Topics are always open for submissions, with an Annual Volume published each calendar year.
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After a robust peer-review process, accepted works are published quickly, thanks to Online First, ensuring research is made available to the scientific community without delay.
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Our innovative Book Series format brings you:
\n\n
\n\t
Topic Focused Publications - Each topic showcases high impact subject areas
\n\t
Renowned Editorial Expertise - Series Editors, Topic Editors, and a team of international Board Members that permanently support each Book Series
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Fast Publishing - quick turnaround which is unique for book publishing
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The benefit of ISSN and ISBN for increased citation and indexing possibilities
\n
\n\n\n\n
IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\n\n
IntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
We invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\n\n
Note: Edited in October 2021
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\r\n\tAn RNA virus is a virus that contains ribonucleic acid called RNA, it plays a crucial role in carrying genetic information from one generation to the next. RNA viruses usually have a single-stranded RNA (ssRNA) but also pose a double-stranded RNA (dsRNA). Most the RNA viruses replicate and are assembled in the cytoplasm, but DNA viruses replicate and are assembled in the nucleus of the host cell.
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\r\n\tHuman infections caused by RNA virus include Hepatitis A, C and E, Nipah virus, Ebola, HIV, polio, measles, Rabies, SARS-CoV2, Dengue Fever, West Nile fever, Zika virus, Influenza, Hantavirus, etc. \r\n\tThis book chapter’s main theme will be focused on transmission dynamics, pathogenesis, mechanisms of host interaction and response, epigenetics and markers, molecular diagnosis, RNA interacting proteins, RNA binding proteins, advanced development of tools for diagnosis, possible development of concepts for vaccines and anti drugs for RNA viruses, immunological mechanisms, treatment, prevention and control. \r\n\t
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Diagnosis and Treatment Approach",doi:"10.5772/intechopen.91153",slug:"what-is-capgras-syndrome-diagnosis-and-treatment-approach",body:'\n
\n
1. Introduction
\n
In delusional misidentification syndromes (DMSs), the individual everlastingly misidentifies persons, places, objects, or events. Capgras syndrome (CS) is the most common in the umbrella term DMS [1, 2]. Perhaps the best known form of DMS is the Capgras syndrome, originally described by Dr. Joseph Capgras and his colleague, J. Reboul-Lachaux, in the early twentieth century [3]. They first encounter this impressive phenomenon when their patient Madame M. insisted that all her friends, family, relatives, and neighbors were being replaced or constantly misperceived as being an imposter [4]. The term l’illusion des sosies (the illusion of doubles) was used to describe the case of a woman who strongly believes that various “doubles” had taken the place of people she knew [3]. It is an essential feature of the Capgras syndrome, the denial of identity of known persons and the delusional belief that this person has been substituted by a double [5].
\n
CS is characterized by the delusional denial of identity of a significant other and the belief that they have been replaced by a double. Some patients with CS may deny the identity of the actual spouse and claim that there are two spouses, the actual and the imposter [6]. Therefore there are four conditions in patient with CS: the person is recognized, and the patient affirms the resemblance of the double to the misidentified significant other; no identity is attributed to the double, who has neither name nor existence; the double is an imposter, pretending to be the original they are replacing; the original has disappeared, his/her absence remaining unquestioned [7].
\n
\n
\n
2. Features of Capgras syndrome: phenomenology, diagnosis, and epidemiology
\n
The rareness of CS, as well as its impressive clinical manifestation as a colorful syndrome, has caused most publications to present case descriptions as scientific curiosities [8, 9]. CS has also attracted the attention of novelists in fictional literature. Dostoevsky provided a dramatic description of the phenomenon in his novel, The Possessed [6]. Sociocultural factors essentially shape the phenomena and thus mightily influence the establishment of definitions of this disorder [10]. Therefore, it may be necessary to mention. The meaning given to the terms ‘change’ and ‘transformation’ of physical identity has been called ‘incarnations’ or ‘possessions’ of other bodies in some cultures [10]. Possessions by an evil spirit have early origins within Paganism, Wicca, Haitian voodoo, Buddhism, Hinduism, Judaism, and Christianity [11]. There is a belief in some countries that people can be possessed by Satan and made to act in strange, immoral, and antisocial ways. In the United States, among European-American Catholics, there exists a belief that demons may possess a person. Possessing demons are presumed to cause experiences of proscribed feelings, thoughts, or behaviors in the person. Occasionally, solutions involve exorcism rituals [12].
\n
It is generally being reported as single case studies in the literature. Although an uncommon psychiatric disorder, Capgras delusion has been central to the development of theories of delusions [6]. It is not dealt with particularly in the DSM-5 and may be classified as delusional disorder, suiting either the persecutory or the unspecified type [13]. With no consensual clinical criteria for this syndrome, it is usual to refer to their original description [7]. The basic manifestation was a false belief that real and familiar persons or oneself is replaced by strange, malicious imposters [14]. In fact, CS is a ‘hypoidentification’ of a person closely related to the patient [6]. CS is more frequent in women than men, with a sex ratio of approximately 2:1, but this result was not found across all studies [7]. Only a few reports have described this syndrome in patients during childhood [15].
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The remarkable feature of Capgras delusion is that patients are able to recognize the close relation, the related person’s face, but deny his or her identity and often use subtle misperceived differences in behaviour, personality, or physical appearance to distinguish between him or her and the imagined impersonator [16, 17]. Patients with CS find ways to defend their irrational beliefs [4]. Generally, the patients support their conviction in revealing detail. This sign may be a habit or a personality trait; small misperceived differences, for instance, in physical appearance and behaviour, may vary over time [7]. And these are frequently used to distinguish the imposter from the loved one [18]. Surprisingly, patients may show implicit or explicit awareness of their true situation [6]. Some research suggests that a considerable number of patients with CS have some awareness of the bizarre nature of the misidentification delusions and therefore tend not to report them, especially during initial interviews when they are less likely to be confident with the clinician [19].
\n
Common to all DMS is the delusional denial of identity of objects having affective significance for the patient, and it is exceptional for there to be only one imposter, but these objects are limited in number. CS may be associated with other DMSs, and these frequently evolve from one another because of this relation and similarity [7, 20].
\n
It sometimes occurs isolated, hereby justifying its autonomy as a ‘delusion’ [7]. CS may be accompanied by other delusions and thus may rarely exemplify a ‘monothematic’ delusion [6]. Erotomanic delusions and delusional jealousy [i.e., Othello jealousy] were identified in 9.1% and 6.4% of patients with CS, respectively [21, 22]. However, delusional misidentification syndromes uncommonly appear independent of comorbid pathology [23].
\n
The absence of consensual clinical criteria makes the epidemiological data uncertain [7]. Thus, the prevalence of CS may be underrated. More than half of the patients of the registered cases suffered from mental disorders without any organic association, among which schizophrenia spectrum disorders were diagnosed in 6 of 10 patients with CS [21, 22]. The Capgras delusion has been reported in association with other psychiatric disorders in 60–75% of cases and in organic illnesses in 25–40% of cases [23]. The Capgras delusion has usually been recognized in the contextual relationship of psychiatric disorders and often occurs in conjunction with paranoia, derealization, and depersonalization [6]. The Capgras syndrome may represent a delusional evolution of the phenomena of depersonalization and derealization [24]. Nonspecific, derealization-depersonalization experiences are frequent, especially in psychotic disorders, and are considered a significant core symptom of CS [7]. Studies on the prevalence of this disease or comorbid disease show differences. A study has found that the prevalence of DMS in psychiatric populations was less than 1% [14]. Another study has found that its prevalence in all psychiatric inpatients is 1.3–4.1% [25]. It is around 3% for hospitalized psychotic patients [17]. In a recent prospective study of patients hospitalized for a first psychotic episode, it was found that CS was diagnosed approximately 1 in 10 of patients. The prevalence was maximal among patients presenting schizophreniform psychosis 50%, brief psychosis 34.8%, and unspecified psychosis 23.9%, and the prevalence was moderate for a major depressive episode 15%, schizophrenia 11%, or delusional disorders 11% [14]. The most common psychiatric diagnoses in CS have been paranoid schizophrenia, schizoaffective disorder, and bipolar affective disorder [23]. CS has been linked with multiple pathologies. It has been described in psychiatric as well as organic disorders. In the last few decades, reports have increasingly stressed the aetiologic importance of heterogeneity of conditions that have been found in the patients with misidentification syndromes like the Capgras delusion, including cerebrovascular disease, post-traumatic encephalopathy, temporal lobe epilepsy, postencephalitic Parkinsonism, viral encephalitis, migraine, vitamin B12 deficiency, hepatic encephalopathy, chronic alcoholism, hypothyroidism, pseudohypoparathyroidism, and dementia [23]. Schizophrenia remains the most common co-occurring mental disorder associated with case reports of Capgras delusion [25, 26]. Also, family history of psychosis is reportedly present in half of CS patients [20]. Medications and drug toxicity have also been reported to cause CS [27].
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3. Explanations for Capgras syndrome
\n
Since initial reports of CS involved patients with psychiatric illness, their close relations, and how they interacted with each other, early explanations of the delusion were predominately psychodynamic interpretations. There are several psychodynamic approaches. Consequently, these explanations included suggestions that CS might develop out of Oedipal issues in women as a defence against hostility or incestuous, guilty desires, or out of hidden homosexuality in men. Later attempts to account for CS resulted in hypotheses of anxiety-induced regression of cognitive and emotional functioning, pathological splitting of internalized object representations, insufficiently repressed conflicting or ambivalent feelings toward the implicated person, and the projection of negative emotions that come to light from these conflicting feelings [17]. In the psychodynamic theory, it is supposed that the delusion is a way in which the patient copes with the ambivalent emotions that he feels toward the close family member who is duplicated [15]. There are several explanations brought about by psychodynamic approaches of misidentification syndromes. Premorbid psychopathology, motivation, and loss of ego functions may be important in determining which vulnerable patients develop CS [6].
\n
Capgras delusion can occur due to ‘spatial disorientation, anatomic disconnection, memory and executive process impairment, and loss of ego’ [4]. While psychodynamic theories consist of ambivalence theory, depersonalization theory, and regression theory, neurocognitive hypotheses focus on right hemispheric dysfunction, face-recognition processing abnormalities, and focal structural cerebral abnormalities [28]. There are two components of the visual recognition of a familiar face, one of which is responsible for conscious recognition of the face and the remembrance of associated semantic information, while the other is responsible for the limbic-mediated emotional arousal including the feeling of familiarity that accompanies the conscious recognition of a known face [9].
\n
\n
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4. Psychodynamic proposals in Capgras delusion
\n
Despite the sharp increase in the number of published cases accompanied by various suggestions regarding an organic etiology, to accurately explain the delusion, it is necessary to embrace the psychodynamic as well as the organic. Even if a specific neuropsychological lesion is found in the end, the psychodynamics of the individual will still be pertinent and remain substantial [29]. An association between CS and depersonalization has been thought to exist onward the time when the disorder was first described. Some authors put forward that depersonalization may be the basis of the disorder which may develop in some individuals. CS can be evaluated as a disorder of ego function which permeates the entire personality [29]. Some authors postulated that cerebral dysfunction leads to feelings of derealization and depersonalization which in turn may develop into Capgras’ syndrome in the presence of paranoid ideation [29].
\n
The psychodynamic conception of the Capgras phenomenon is basically a love-hate conflict that is resolved by reflecting ambivalent feelings onto a fictitious double [29]. On the one hand, there are a long-standing love and on the other hand a visible hatred. In those cases when it occurs, it is very substantial that before the onset of the delusion of doubles, the patient shows an increased love and sexual desire toward the object. This overreaction results from a desire for reassurance regarding the love of the object and fear of losing it simultaneously. Theories suggested that CS could arise out of an Electra complex and incest desires, Oedipal problems, and latent homosexuality. Personality disintegration coupled with an evolutionary regression to more primitive modes of cognitive and emotional functioning; division of internalized object representations; ambivalent feelings toward a familiar other that are not sufficiently suppressed; and the feelings of anxiety, guilt, and anger resulting from this struggle are reflected onto imagined imposter [20]. Instead of approving these demands, the object becomes even more repulsed and is unable to cover up these feelings that clearly aggravate the situation, and a vicious circle is established [29].
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5. Face-recognition system in Capgras delusion
\n
Usually, we do not strive for facial recognition. The ability to identify people who we met before is a headstone of our social interactions. Face recognition is a multistage process ending with the identification of a person. Prosopagnosia is defined as loss of familiarity to previously known faces and the inability to learn to recognize new faces. Although these patients fail to recognize faces, they are still able to show affective responses to these faces [30, 31]. Several studies have suggested that CS represents a ‘mirror image’ of prosopagnosia, thus suggesting different neural circuits for facial processing: a cognitive circuit (impaired in prosopagnosia) and an affective circuit (impaired in CS). In the affective circuit, the ventral route from the visual centers to the temporal lobes may be protected, also active in conscious face recognition; however, the dorsal visual track that gives the face its emotional significance is damaged. A brief disruption of the ventral visual pathway leads to prosopagnosia, whereas damage to the dorsal visual areas leads to an impaired sense of familiarity for known faces, as in CS [9, 17, 30, 32]. While the ability to identify that person is intact, patient with CS probably has a brain lesion that interferes with the patient’s ability to sense a familiarity toward the significant other [15]. It has been suggested that the impairment seen in the Capgras delusion was linked to a disruption of pathways connecting face-sensitive regions to limbic cortex, which is involved in the accompanying emotional response [30]. Perhaps arising from the conflicting experience of recognizing a known face without any accompanying affective reaction, the patient can understand that the absence of this emotional arousal is to establish the belief that the person he is looking at is an imposter [9, 33]. In another connectivity study, posterior coupled with anterior right hemisphere dysfunction may have involved in the emergence of Capgras delusion [34]. Also, it has been suggested that CS results from the disconnection of the face processing regions in the inferior temporal lobe from structures in the limbic system, especially the amygdala, which is very important in assigning emotional value to familiar faces [34]. Common to the CS is a fixed false belief but infrequently transient [35]. However, anatomical disconnection models fail to efficiently consider the transient nature of the misidentification episodes [34]. Therefore, it has been suggested that CS may be associated with the ‘kindling of subcortical structures’. Kindling refers to repeated subthreshold stimuli which may result in psychomotor outbursts or overt seizure activity [34]. Autonomic responses and eye movements are involved in face perception which may cause the patient believe that the person has been replaced by an imposter. Studies on patient with CS like other psychiatric disorders have shown abnormal scan paths to facial stimuli or abnormal skin conductance response (SCR) in face processing tasks [30, 33]. The absence of identity recognition, accompanied by a lack of SCR, stimulates the patient to explore unfamiliar faces, and identity recognition of familiar faces leads to a more detailed exploration in the eye region, and it results in gaze avoidance of the eye region [33]. Vision is important in accessing reserved knowledge in the etiology of CS. However, surprisingly CS has also been reported in a number of blind patients which suggests that it cannot have an exclusively visual basis [34]. Some theories assume that two deficits are necessary for delusions to occur in the case of Capgras delusion like other DMSs [32, 36]. This is also called ‘two-hit’ process [20]. The first one, the brain’s ability to attach emotional emphasis, may be the lack of autonomic arousal which leads to the abductive inference that the person is an imposter [30]. The other deficit is an impaired ability to reassess beliefs [the global consistency-checking mechanism] which prevents the rejection of the bizarre belief. The second deficit leads to the persistence of that abnormal perception as a delusion resistant to reasoning, also related to the right anterior cortex of the second deficit [9, 30, 32, 36].
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6. Cognitive domains in Capgras delusion: memory, executive impairment, and confabulation
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Neuropsychological deficits in patient with CS were reported across multiple cognitive domains, including memory, executive functioning, and visuospatial processing. These studies suggest that memory was statistically more likely to be impaired than other cognitive domains. Therefore, the memory may be playing an important role in the development of these delusions [32]. The existence of confabulations may have a role in prognosis and predicted significantly longer delusion duration, once more supporting the importance of memory impairment in patients with CS [32]. To mention a little more about the confabulation, some authors are focusing on confabulation in these patients because they are thought to be confabulation and delusion are closely related. When asked how they can explain their beliefs, Capgras patients will often confabulate. Confabulation is a kind of false memory that occurs when patients produce stories that fill in gaps in their memories, whereas a delusion is a mental state, typically thought of as a belief. Confabulation and delusion cannot be completely the same [37, 38]. Some researchers suggested that CS comes out when right hemisphere dysfunction causes a memory disconnection that leads to a failure to put new information together with representations about a significant individual and to keep in reserved over time [17]. Against all of these, although many patients have subtle deficits in face recognition and memory for faces, they do not have difficulty in recognizing faces in everyday life [1, 2]. CS is distinguished by its delusional mechanism: it is neither a hallucination nor an illusion—the object is correctly recognized in its appearance. CS is not a memory disorder. The person is correctly recognized; people are memorized [7]. Language deficits may not be absent, because of the right hemispherical dominance of the lesions [32].
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7. Neuroanatomical and neuropsychological impairments in Capgras syndrome
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In 1971 a case of Capgras was described in a young man following a head injury, with no previous history of psychiatric disorder. Since then, many patients with CS have undergone more thorough neurological investigations [29]. Identification disorders like CS are very frequent in neurodegenerative diseases [7]. Regarding the organic conditions that occur in Capgras delusion, this appears mainly in various types of dementia like Alzheimer, Lewy bodies, and Parkinson [39]. The prevalence of CS in Lewy body dementia may be as high as 25% and 10% in Alzheimer-type dementia. Identification disorders are much rarer in other types of dementia, especially those associated with Parkinson’s disease [7]. Nearly half of the cases in CS were associated with neurocognitive disorders, such as delirium, traumatic brain encephalopathy, cerebrovascular disease, dementia, meningioma, encephalitis, and multiple sclerosis [21, 22]. Although there is usually a delay in the presentation of Capgras delusion after cerebral events, there are also such cases of immediate presentation [31]. Psychotic disorders with CS tend to present in the late teens and early twenties. It reflects the long mean duration of the delusion in the functional group [26]. Those with neurological disorder associated with the onset of the delusion had a mean age of 60, in keeping with their presentation in middle to late adulthood, especially as Capgras delusion in dementia tends to occur in the later stages [26]. Therefore all individuals with Capgras should be examined for organic pathology [9]. In a literature review of patients with CS who had associated organic factors, there are several single case reports in patients with Capgras delusion which suggest structural and metabolic anomalies in mostly right-sided frontal, temporal, or parietal brain regions. But most of CS patients had bilateral lesions although, for those with unilateral lesions, right hemisphere lesions were much more likely [30]. Some studies give emphasis to the presence of two lesion sites, one in right frontal and the other in right temporal cortex [30]. The identity of the imposter is significantly associated with the reported underlying etiology. Capgras’ delusion is reportedly due to functional psychiatric disorder, which is more likely to view their parent as an imposter, whereas the spouse is involved in those with suspected neurological etiology. There may be mentioned two reasons. The first one is may be because of the different mean age for the groups. The age of onset of Capgras delusion is different between those with organic disorders and those with neurological disorders [26]. The other reason is about Capgras delusion’s feature. Capgras delusion is the phenomenon mostly specific to close relatives. This supports the role of intimacy [9, 26]. Selectivity for familiar persons is essential, though sometimes relative, and the syndrome can extend to persons who are simply known or famous [7]. Against this, the frequency with which strangers and multiple imposters are implicated in all cases of Capgras delusion can be up to 39% [26]. Multiple imposters are significantly more likely to occur in functional cases, while the involvement of inanimate objects would seem to suggest organic etiology [26]. The neuropsychological findings discussed may lead to some account of the possible mechanisms by which an abnormal experience may be generated in a subset of Capgras patients, but some researchers do not think in itself account for the formation of delusional belief [40]. Consequently, the explanation may offer a useful, helpful analysis of a certain step in the pathology of the CS in a subgroup of more neurological patients but could be unlikely to enlighten about delusions more generally or those with Capgras in the context of a functional psychosis such as schizophrenia or bipolar disorder [40].
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8. Neuropsychological assessment for Capgras syndrome
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The term CS does not demonstrate a well-defined mental disorder. Over the years various studies have suggested psychodynamic and neurophysiological interpretations for CS, and various aetiologies have been recommended for the condition’s development [15, 17, 28].
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Although frequently seen in psychotic cases, Capgras has also been associated with neurological disorders suggesting that the syndrome has an organic basis [14]. According to a study, CS patients were classified into groups according to whether or not they had evidence of neurological disorder. Some of the patients identified as having no neurological lesion might be found to have organic brain disease with more sophisticated imaging techniques or at post-mortem evaluation [41]. In another study, approximately one in five of patients with CS presented with organic mental disorders [1, 2]. Multiple hypotheses have been put forth regarding the underlying pathophysiology of CS. Some areas of the brain are responsible for the etiology of this disease. Results of structural and neuroimaging studies of CS provide support for an organic etiology [17]. Multiple studies and reports have remarked on CS in the setting of various neurological and neurodegenerative diseases [42]. There is a study that found more widespread bilateral frontal and temporal cortex atrophy in schizophrenia patients with CS than schizophrenia patients without the syndrome by using computerized tomography (CT) [17]. Likewise other studies using CT found global brain atrophy in combination with right hemisphere lesions in patients with dementia. There is also reported that positron emission tomography [PET] demonstrated abnormal brain glucose metabolism in paralimbic structures and temporal lobes of patients with Alzheimer’s dementia comorbid with CS and other subcategories of delusional misidentification syndromes [17]. Numerous neuropsychological researches support an association between CS and right frontal and temporal lobe abnormalities, and also many study reports indicate that patients with CS tend to have inferior scores on neuropsychological tests of frontal lobe function [17]. Even though less well documented, regions of the prefrontal cortex are also associated within facial processing: projections from the face processing areas in the right ventromedial occipitotemporal regions to the ventromedial prefrontal cortex via the uncinate fasciculus as well as limbic-thalamic pathways are well established [34].
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9. The association between Capgras delusion and schizophrenia
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Some people with schizophrenia exhibit this syndrome, but it is not related directly to schizophrenia itself; there are people with schizophrenia who do not exhibit CS, as well as people with CS who do not exhibit schizophrenia. The mean age of schizophrenic patients with Capgras syndrome is older than the age at which schizophrenia alone is usually expected to occur. When brain abnormalities of people with schizophrenia affect certain areas, CS and schizophrenia will occur concurrently. Capgras delusion and schizophrenia seem to be statistically related, at least in the case of the paranoid subtype of schizophrenia. It has been claimed that right hemisphere damage is a characteristic of schizophrenia; perhaps the imperfect evaluation of beliefs, which we have suggested, occurs as an outcome of damage to a particular area of the right frontal lobe, which is necessary for the occurrence even of the persecutory and grandiose delusions that are common in paranoid schizophrenia. Accounting the association of Capgras delusion with paranoid schizophrenia, the same neuropsychological deterioration of belief assessment is required for both, and in cases of patients with persecutory or grandiose delusions where the neuropathology also has affected the track from face recognition to the autonomic nervous system, Capgras delusion will also be existing [43, 44]. CS in paranoid schizophrenia may improve with successful treatment. But recurrence of illness may be accompanied by a return of delusional material [44].
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10. Differential diagnosis of primary and secondary Capgras delusions
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It is important to note that the Capgras delusion can be either a primary condition that is part of a ‘mental illness’ or a secondary condition that is the direct result of an organic disease of the brain. Also, the primary and secondary versions differ significantly in their presentation. In primary Capgras syndrome, the patient is more likely to be furious or violent toward the imposter. In secondary CS, the imposters do not change over time. This is different from the situation in schizophrenia where the delusions can vary [45]. The mean age of onset of the delusion was earlier in primary Capgras (mean age 32 years) than in secondary Capgras (mean age 48.5 years). Primary cases are more likely to have a subtle onset which evolved gradually, whereas secondary cases are more likely to have sudden-onset delusions. Primary cases show associated psychotic symptoms, particularly paranoid thought, whereas psychotic symptoms are not very often of the secondary cases. The patients with CS without apparent organic cerebral dysfunction were more likely to have experienced other psychiatric symptoms prior to the onset of the Capgras delusion than those with organic cerebral dysfunction [41]. Patients with neurological impairments were more likely to regard the misidentification as benign or as due to illusory, whereas patients without evidence of neurological basis were more likely to appraise the delusions as being threatening [41]. Thus, hostility and violence are seen much more frequently in those patients diagnosed as schizophrenic than in other patients [46].
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11. The role of Capgras syndrome in violence
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Acting on delusions is a crucial clinical issue. There is a positive relationship between delusions and serious violent acts. Although the pathway from delusions to violent outcomes is not direct, the risk is greatly increased when symptoms are acute, especially at the time of initial presentation and if not treated [19]. And the risk also can be changed according to the etiology of delusions. There is a requirement to be concerned about the patient’s tendency for violence and to evaluate for it thoroughly in Capgras delusion [45]. In patients with CS of an organic nature, violence may be associated with few or no affective manifestations (e.g., hostility, aggression, and auditory hallucinations), and may not be associated with paranoid elements [7]. Delusional symptoms in CS such as persecutory thoughts, threat-control symptoms, command auditory and/or visual hallucinations, and hallucinations of threatening content have all demonstrated to be significant predictors of violence act and aggressive behaviour [28]. If the patients are married, divorced, or separated, the most frequent doubles are the spouse. If the patients are single, the most frequent doubles are the siblings [19]. It should be noted that healthcare professionals may become the objects of delusional misidentification [42]. Because the double is usually assumed to have malicious, the CS could be characterized by hostility toward misidentified objects, and, later, it can lead to physical harm to others [19]. The assault associated with CS, the tendency to violence, cannot be attributed purely to the delusion’s existence. Other factors are presumably to affect the possibility of violent act. A significantly higher tendency for interpersonal violence are men disclosed among male subjects, average age at 40 years old, with a history of aggressive behaviour and substance abuse; social withdrawal prior to the violent act is common, and the violence is usually well planned [19, 21, 22]. Persecutory paranoid motivations have been implicated as a key factor in acts of violence toward family members who constitute the majority of victims in CS [28]. Physical violence was expressed by 58.2% of patients with CS and 62.5% of patients with CS engaged in acts of interpersonal violence toward their close family members and caregivers [21, 22]. Mothers and spouses were the most frequently attacked group of relatives, respectively. Also, it was found that 1 of 10 Capgras patients attempted homicide [21, 22]. Most of the perpetrators were males suffering from mental disorders without organic association. A higher incidence of self-harm and suicide attempts, which is about 1 in 10 of patients with CS, was detected among females even in patients with psychiatric disorders and in patients with neurodegenerative disorders [21, 22]. Although in the usual cases, the misidentified object is a person, hence justifying the title of delusional identification of people, the CS is not restricted to person misidentification but can also involve other living or lifeless objects [7, 19]. Physical violence against objects was also common, such as setting fire to one else’s estate [21, 22].
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12. Differential diagnosis of Capgras syndrome
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The differential diagnosis of patients who suffered CS is crucial. It is substantial to rule out the presence of brain disease in every patient with Capgras delusion [45]. Many patients with CS also present with medical illnesses of organic etiologies, associated with delusional misidentification; these patients may respond well to treatment of the medical condition underlying the onset of CS [47]. The syndrome should be differentiated from the quite common false recognitions which occur in confusional states and the transient misidentifications encountered in mania [8]. For this purpose, ending with a complete mental status examination, as well as thorough testing of cognition, is important. Neuropsychological testing and neuroimaging are often indicated. Clinicians should clarify the nature of the underlying psychiatric illness [45].
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13. Key features and biomarker of Capgras syndrome
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Low platelet monoamine oxidase (MAO) activity is a biochemical abnormality which is present in some psychiatric disease. Some authors suggested that the low platelet MAO activity might be proposed as a potential biochemical marker of CS. It is also thought that reduced monoamine oxidase activity in primary psychiatric patients with CS may give a piece of information to the pathogenetic mechanism underlying the reported cases of CS in organic patients without a primary behavioral disorder. However, study results show that platelet monoamine oxidase activity in patients with delusional misidentifications did not differ notably from that of schizophrenia and nonpsychiatric controls [41, 48].
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The key features currently considered to be critical to the development of the Capgras delusion are as follows:
There is an abnormal perceptual experience that is a prerequisite for the delusion.
This perceptual experience is accompanied by a paranoid which leads to misattribution of the abnormal perceptual experience.
The loss of normal response to known faces occurs in the context of more generalized derealization-depersonalization [41].
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14. Treatment considerations
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Delusion in CS should be treated timely because it can cause a dangerous condition [42]. However, there are no guidelines to assist clinicians to care for patients presenting with CS in selecting complementary examinations to be performed or in selecting treatment [7]. Likewise, the symptoms of DMS are very refractory to treatment despite various interventions including psychotherapy and pharmacotherapy approaches [19]. The CS like other DMSs is known to develop similar to the comorbid disorder that they accompany, disappearing after remission even though it is not unusual for them to continue after the disappearance of the comorbid disorder [7]. Thus, treatment of the underlying neurological or psychiatric conditions may not lead to remission of CS [27]. The presence of depersonalization, derealization or visual-perceptual disturbances, and other comorbidities may influence the treatment of CS [47]. The syndrome has been linked to dopaminergic overactivity, and serotonin abnormality has been implicated in some but not all studies. Similarly, reduced platelet monoamine oxidase activity has been noted by some but not by others [17]. According to the results of the case studies in the literature, CS patients are sometimes responsive to typical and atypical antipsychotics such as olanzapine, risperidone, quetiapine, sulpiride, trifluoperazine, and pimozide [19]. Pharmacological treatment of CS is based on antipsychotics, antidepressants, anticonvulsant, and benzodiazepines considering patient needs and characteristics, but no control trials are available [49]. In the literature, there have been reported cases with a diagnosis of organic or functional delusional disorder associated with CS whose DMS responded well to pimozide that is well known for the treatment of monosymptomatic delusional disorders [49]. Experience with the new generation of atypical antipsychotics for the treatment of CS is quite limited. Although for patients manifesting any psychotic disorder, atypical antipsychotics are usually recommended because of the reduced risk of adverse effects [6, 47]. A crucial point of a case report is the positive outcome in response to antipsychotic medication [olanzapine] [49]. The combination of antipsychotic drug therapy and selective serotonin reuptake inhibitor (SSRI) may produce a positive outcome in patients with CS [15].
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A case report also suggested the use of clorazepate which is benzodiazepine. In this case report, in addition to the antipsychotic properties of clorazepate, its anticonvulsant properties were also utilized in CS patient with the suggestion of some researches that found an over 90% incidence of electroencephalographic abnormalities in CS patients [26]. According to the results of the case studies, it showed a positive outcome in a patient with CS after treatment with mirtazapine that is also a serotonin 2A receptor antagonist, which could potentially afford its antipsychotic effects resulting in significantly decreasing the symptoms of CS [19, 27].
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With patients who have progressive dementia, such as dementia with Lewy bodies, in which misidentification syndromes are common occurred, cholinesterase inhibitors have demonstrated benefit to reduce psychiatric symptoms [6].
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Electroconvulsive therapy (ECT) has been reported to benefit either alone or in conjunction with antipsychotics, mood stabilizer, or antidepressant medication in patients with CS. It has been suggested that ECT provides permanent effective control of CS [42, 47, 49].
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Psychotherapy may be beneficial in the treatment of selected patients with CS in order to reform the patient’s relationship with his family. The psychoanalytic theories show that the emotions which the patient experiences in regard to the people with whom he is confronted are transferred to the imposters, and therefore, in this way from a safe delusional distance, the patient gives himself to refuse them without guilt, sometimes manifesting an aggressive behaviour toward them [21, 22]. It has been shown that group psychotherapy may also be beneficial by becoming less prone to feel hostile toward others, thereby weakening the delusional misidentification process for psychotic patients with DMS [40]. Cognitive behavioural therapy (CBT) may be a utilized form of psychotherapy intervention in some cases by assisting the patient to overcome the delusional beliefs [21, 22].
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It is quite common in cases of delusion for his/her family members of the deluded person to be concerned about the delusion and to try to get rid of it by constantly challenging it [43]. It may be beneficial to know that just as an impairment in the interpersonal relationship between the patient and the object may occur before the onset of the delusion, an amelioration in this relationship is an essential factor in the amelioration of symptoms. Therefore treatment must include helping the partner or person implicated to gain insight and perhaps change their attitude toward the patient [29].
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15. Conclusion
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CS is a different neuropsychiatric symptom of interest to researchers over the past century. No approved questionnaires focus on CS. While noting that the Capgras syndrome has no formal place in recognized diagnostic systems, it should be emphasized that this is of significance. It is crucial to keep them in mind as a possibility and to pursue any possible clues. Capgras delusion is a complex psychopathological phenomenon that presents in a wide range of psychiatric and neurological disorders with differing patterns dependent on the main etiology. Misidentifications in CS are fixed false beliefs and, therefore, represent true delusions. Even if when patients are confronted over and over with the illogical nature of the delusion, they keep their beliefs. Specific questions and interventions may assist to clinicians in successfully identifying patients with CS. In a series of interviews with these patients, some focus on identifying CS, rather than a single interview which is likely to increase the detection of the delusional misidentification. The clinician should always be mindful of the risk of aggression and homicide in CS.
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\n\n',keywords:"Capgras syndrome, misidentification syndromes, psychotic disorder",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/71110.pdf",chapterXML:"https://mts.intechopen.com/source/xml/71110.xml",downloadPdfUrl:"/chapter/pdf-download/71110",previewPdfUrl:"/chapter/pdf-preview/71110",totalDownloads:928,totalViews:0,totalCrossrefCites:0,totalDimensionsCites:0,totalAltmetricsMentions:1,introChapter:null,impactScore:0,impactScorePercentile:30,impactScoreQuartile:2,hasAltmetrics:1,dateSubmitted:"November 14th 2019",dateReviewed:"January 12th 2020",datePrePublished:"February 14th 2020",datePublished:"May 12th 2021",dateFinished:"February 14th 2020",readingETA:"0",abstract:"Capgras delusion is a complex psychopathological phenomenon that presents in a wide range of psychiatric and neurological disorders with differing patterns dependent on the main etiology. An underlying neurological disease should be suspected where the delusion concerns a spouse or inanimate objects and is associated with visual hallucinations, while a functional disorder is suggested by multiple imposters, strangers, additional delusions, and auditory hallucinations. Misidentifications in Capgras syndrome (CS) are fixed false beliefs and, therefore, represent true delusions. Even if when patients are confronted over and over with the illogical nature of the delusion, they keep their beliefs. Surprisingly, patients may show implicit or explicit awareness of their true situation. Some research suggests that a considerable number of patients with CS have some awareness of the bizarre nature of the misidentification delusions and therefore tend not to report them, especially during initial interviews when they are less likely to be confident with the clinician. Specific questions and interventions may assist clinicians in successfully identifying patients with CS. In a series of interviews with these patients, some focus on identifying CS, rather than a single interview which is likely to increase the detection of the delusional misidentification. The clinician should always be mindful of the risk of aggression and homicide in CS.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/71110",risUrl:"/chapter/ris/71110",book:{id:"9530",slug:"anxiety-disorders-the-new-achievements"},signatures:"Aslı Enzel Koc and Cicek Hocaoglu",authors:[{id:"28322",title:"Prof.",name:"Cicek",middleName:null,surname:"Hocaoglu",fullName:"Cicek Hocaoglu",slug:"cicek-hocaoglu",email:"cicekh@gmail.com",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/28322/images/system/28322.jpg",institution:{name:"Recep Tayyip Erdoğan University",institutionURL:null,country:{name:"Turkey"}}},{id:"315460",title:"Dr.",name:"Aslı",middleName:"Enzel",surname:"Koc",fullName:"Aslı Koc",slug:"asli-koc",email:"sovera972@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Recep Tayyip Erdoğan University",institutionURL:null,country:{name:"Turkey"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Features of Capgras syndrome: phenomenology, diagnosis, and epidemiology",level:"1"},{id:"sec_3",title:"3. Explanations for Capgras syndrome",level:"1"},{id:"sec_4",title:"4. Psychodynamic proposals in Capgras delusion",level:"1"},{id:"sec_5",title:"5. Face-recognition system in Capgras delusion",level:"1"},{id:"sec_6",title:"6. Cognitive domains in Capgras delusion: memory, executive impairment, and confabulation",level:"1"},{id:"sec_7",title:"7. Neuroanatomical and neuropsychological impairments in Capgras syndrome",level:"1"},{id:"sec_8",title:"8. Neuropsychological assessment for Capgras syndrome",level:"1"},{id:"sec_9",title:"9. The association between Capgras delusion and schizophrenia",level:"1"},{id:"sec_10",title:"10. Differential diagnosis of primary and secondary Capgras delusions",level:"1"},{id:"sec_11",title:"11. The role of Capgras syndrome in violence",level:"1"},{id:"sec_12",title:"12. Differential diagnosis of Capgras syndrome",level:"1"},{id:"sec_13",title:"13. Key features and biomarker of Capgras syndrome",level:"1"},{id:"sec_14",title:"14. Treatment considerations",level:"1"},{id:"sec_15",title:"15. Conclusion",level:"1"}],chapterReferences:[{id:"B1",body:'\nBreen N, Caine D, Coltheart M. Mirrored-self misidentification: Two cases of focal onset dementia. Neurocase. 2001;7(3):239-254. DOI: 10.1093/neucas/7.3.239\n'},{id:"B2",body:'\nFeinberg TE, Roane D. Self-representation in delusional misidentification and confabulated “others”. Cortex. 2017;87:118-128. DOI: 10.1016/j.cortex.2016.07.014\n'},{id:"B3",body:'\nAlam A. A Brief Overview of the Capgras Delusion Brooklyn College. Available from: https://www.academia.edu/33990249/Brief_Overview_of_Capgras_Delusion\n\n'},{id:"B4",body:'\nLykouras L, Typaldou M, Mourtzouchou P. Neuropsychological relationships in paranoid schizophrenia with and without delusional misidentification syndromes: A comparative study. Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2008;32:1445-1448\n'},{id:"B5",body:'\nFeinberg TE, Roane DM. Delusional misidentification. Psychiatric Clinics of North America. 2005;28(3):665-683. DOI: 10.1016/j.psc.2005.05.002\n'},{id:"B6",body:'\nBarrelle A, Luauté JP. Capgras syndrome and other delusional misidentification syndromes. Frontiers of Neurology and Neuroscience. 2018;42:35-43. DOI: 10.1159/000475680\n'},{id:"B7",body:'\nChristodoulou GN. The syndrome of Capgras. The British Journal of Psychiatry. 1977;130(6):556-564. DOI: 10.1192/bjp.130.6.556\n'},{id:"B8",body:'\nHirstein W, Ramachandran VS. Capgras syndrome: A novel probe for understanding the neural representation of the identity and familiarity of persons. Proceedings. Biological Sciences. 1997;264(1380):437-444. DOI: 10.1098/rspb.1997.0062\n'},{id:"B9",body:'\nCurrell EA, Werbeloff N, Hayes JF, Bell V. Cognitive neuropsychiatric analysis of an additional large Capgras delusion case series. Cognitive Neuropsychiatry. 2019;24(2):123-134. DOI: 10.1080/13546805.2019.1584098\n'},{id:"B10",body:'\nRodrigues ACT, Banzato CEM. Delusional misidentification syndrome: Why such nosologic challenge remains intractable. Psychopathology. 2006;39(6):296-302. DOI: 10.1159/000095777\n'},{id:"B11",body:'\nAntonio V, Iris B, Fabiana R, Federica C, Vishal B. Delusion, possession and religion. Nordic Journal of Psychiatry. 2018 Sep;72(Suppl 1):S13-S15. DOI: 10.1080/08039488.2018.1525639\n'},{id:"B12",body:'\nGaines AD. Culture-specific delusions. Psychiatric Clinics of North America. 1995;18(2):281-301. DOI: 10.1016/s0193-953x(18)30055-8\n'},{id:"B13",body:'\nSalvatore P, Bhuvaneswar C, Tohen M, Khalsa HM, Maggini C, Baldessarini RJ. Capgras\' syndrome in first-episode psychotic disorders. Psychopathology. 2014;47(4):261-269. DOI: 10.1159/000357813\n'},{id:"B14",body:'\nMazzone L, Armando M, De Crescenzo F, Demaria F, Valeri G, Vicari S. Clinical picture and treatment implication in a child with Capgras syndrome: A case report. Journal of Medical Case Reports. 2012;6:406. DOI: 10.1186/1752-1947-6-406\n'},{id:"B15",body:'\nThiel CM, Studte S, Hildebrandt H, Huster R, Weerda R. When a loved one feels unfamiliar: A case study on the neural basis of Capgras delusion. Cortex. 2014;52:75-85. DOI: 10.1016/j.cortex.2013.11.011\n'},{id:"B16",body:'\nBourget D, Whitehurst L. Capgras syndrome: A review of the neurophysiological correlates and presenting clinical features in cases involving physical violence. The Canadian Journal of Psychiatry. 2004;49(11):719-725. DOI: 10.1177/070674370404901102\n'},{id:"B17",body:'\nEdelstyn NMJ, Oyebode F, Barrett K. The delusions of Capgras and intermetamorphosis in a patient with right-hemisphere white-matter pathology. Psychopathology. 2001;34(6):299-304. DOI: 10.1159/000049328\n'},{id:"B18",body:'\nKarakasi MV, Markopoulou M, Alexandri M, Douzenis A, Pavlidis P. In fear of the most loved ones. A comprehensive review on Capgras misidentification phenomenon and case report involving attempted murder under Capgras syndrome in a relapse of a schizophrenia spectrum disorder. Journal of Forensic and Legal Medicine. 2019;66:8-24. DOI: 10.1016/j.jflm.2019.05.019\n'},{id:"B19",body:'\nDe Pauw KW, Szulecka TK. Dangerous delusions, violence and the misidentification syndromes. The British Journal of Psychiatry. 1988;152:91-96\n'},{id:"B20",body:'\nEdelstyn NMJ, Oyebode F. A review of the phenomenology and cognitive neuropsychological origins of the Capgras syndrome. International Journal of Geriatric Psychiatry. 1999;14(1):48-59. DOI: 10.1002/(sici)1099-1166(199901)14:1<48::aid-gps891>3.0.co;2-0\n'},{id:"B21",body:'\nJariwala PC, Shah ND, Dave KR, Mehta RY. Delusional misidentification syndromes in patients of paranoid schizophrenia: Case series and review. Telangana Journal of Psychiatry. 2018;3(2):125-129\n'},{id:"B22",body:'\nDe Pauw KW. Psychodynamic approaches to the capgras delusion: A critical historical review. Psycho-pathology. 1994;27(3-5):154-160. DOI: 10.1159/000284864\n'},{id:"B23",body:'\nSilva A, Leong GB, Weinstock R, Sharma KK, Klein RL. Delusional misidentification syndromes and dangerousness. Psychopathology. 1994;27(3-5):215-219. DOI: 10.1159/000284872\n'},{id:"B24",body:'\nPandis C, Agrawal N, Poole N. Capgras’ delusion - A systematic review of 255 published cases. Psycho-pathology. 2019;52:161-173. DOI: 10.1159/000500474\n'},{id:"B25",body:'\nKhouzam HR. Capgras syndrome responding to the antidepressant mirtazapine. Comprehensive Therapy. 2002;28(3):238-240. DOI: 10.1007/s12019-002-0033-9\n'},{id:"B26",body:'\nSinkman A. The syndrome of Capgras. Psychiatry: Interpersonal and Biological Processes. 2008;71(4):371-378. DOI: 10.1521/psyc.2008.71.4.371\n'},{id:"B27",body:'\nCarabellese F, Rocca G, Candelli C, Catanesi R. Mental illness, violence and delusional misidentifications: The role of Capgras’ syndrome in matricide. Journal of Forensic and Legal Medicine. 2014;21:9-13. DOI: 10.1016/j.jflm.2013.10.012\n'},{id:"B28",body:'\nAlbonico A, Barton J. Progress in perceptual research: The case of prosopagnosia. F1000Research. 2019;8:765. DOI: 10.12688/f1000research.18492.1\n'},{id:"B29",body:'\nEnoch MD, Ball HN. Uncommon Psychiatric Syndromes. 4th ed. Arnold; Hodder Arnold Publication, CRC Press; 2001\n'},{id:"B30",body:'\nDarby R, Prasad S. Lesion-related delusional misidentification syndromes: A comprehensive review of reported cases. The Journal of Neuropsychiatry and Clinical Neurosciences. 2016;28(3):217-222. DOI: 10.1176/appi.neuropsych.15100376\n'},{id:"B31",body:'\nEllis HD, Young AW. Accounting for delusional misidentifications. The British Journal of Psychiatry. 1990;157:239-248\n'},{id:"B32",body:'\nBrighetti G, Bonifacci P, Borlimi R, Ottaviani C. “Far from the heart far from the eye”: Evidence from the Capgras delusion. Cognitive Neuropsychiatry. 2007;12(3):189-197. DOI: 10.1080/13546800600892183\n'},{id:"B33",body:'\nGarcha M, Sivakumar K, Leary M, Yacoub HA. Transient Capgras syndrome secondary to bilateral ischemic stroke. Cognitive and Behavioral Neurology. 2018;31(2):96-98. DOI: 10.1097/wnn.0000000000000152\n'},{id:"B34",body:'\nColtheart M, Langdon R, McKay R. Delusional belief. Annual Revues of Psychology. 2011;62:271-298\n'},{id:"B35",body:'\nHirstein W. The misidentification syndromes as mindreading disorders. Cognitive Neuropsychiatry. 2010;15(1-3):233-260. DOI: 10.1080/13546800903414891\n'},{id:"B36",body:'\nEstrada-Bellmann I, Ulloa-Escobar Y, Barbosa-Flores SL, Pech-George RE, González-Treviño R, Conde-Gómez L, et al. Capgras syndrome as a psychiatric manifestation in Parkinson’s disease: A case report and literature review. Medicina Universitaria. 2015;17(66):49-52. DOI: 10.1016/j.rmu.2014.07.002\n'},{id:"B37",body:'\nBortolotti L, Broome MR. If you didn’t care, you wouldn’t notice: recognition and estrangement in psychopathology, Philosophy, Psychiatry, & Psychology. 2007;14(1):39-42\n'},{id:"B38",body:'\nUllrich S, Keers R, Shaw J, Doyle M, Coid JW. Acting on delusions: The role of negative affect in the pathway towards serious violence. The Journal of Forensic Psychiatry & Psychology. 2018;29(5):691-704. DOI: 10.1080/14789949.2018.1434227\n'},{id:"B39",body:'\nCipriani G, Vedovello M, Ulivi M, Lucetti C, Di Fiorino A, Nuti A. Delusional misidentification syndromes and dementia. American Journal of Alzheimer’s Disease & Other Dementiasr. 2013;28(7):671-678. DOI: 10.1177/1533317513506103\n'},{id:"B40",body:'\nSpiegel DR, Laroia R, Samuels D. A possible case of Capgras syndrome after a right anterior cerebral artery cerebrovascular accident treated successfully with mirtazapine. The Journal of Neuropsychiatry and Clinical Neurosciences. 2008;20(4):494\n'},{id:"B41",body:'\nBreen N, Caine D, Coltheart M, Hendy J, Roberts C. Towards an understanding of delusions of misidentification: Four case studies. Mind and Language. 2000;15(1):74-110. DOI: 10.1111/1468-0017.00124\n'},{id:"B42",body:'\nSilva JA, Leong GB, Miller AL. Delusional misidentification syndromes. CNS Drugs. 1996;5(2):89-102. DOI: 10.2165/00023210-199605020-00002\n'},{id:"B43",body:'\nColtheart M, Langdon R, McKay R. Schizophrenia and monothematic delusions. Schizophrenia Bulletin. 2007;33(3):642-647. DOI: 10.1093/schbul/sbm017\n'},{id:"B44",body:'\nMerrin EL. The Capgras phenomenon. Archives of General Psychiatry. 1976;33(8):965. DOI: 10.1001/archpsyc.1976.01770080083008\n'},{id:"B45",body:'\nSharpless B. Unusual and Rare Psychological Disorders: A Handbook for Clinical Practice and Research. New York: Oxford University Press; 2017\n'},{id:"B46",body:'\nJocic Z. Delusional misidentification syndromes. Jefferson Journal of Psychiatry. 1992;10:4\n'},{id:"B47",body:'\nJoseph AB. Delusional misidentification of the Capgras and intermetamorphosis types responding to clorazepate. Acta Psychiatrica Scandinavica. 1987;75(3):330-332. DOI: 10.1111/j.1600-0447.1987.tb02797.x\n'},{id:"B48",body:'\n Barton JL, Chaparala S, Barton ES, Jackson IV, Davis LG. Delusional misidentification and platelet monoamine oxidase. Biological Psychiatry. 1980;15(/2):275\n'},{id:"B49",body:'\nTorales J, Rodríguez H, Arce A, Moreno M, Riego V, Chávez E, et al. Olanzapine in the treatment of Capgras syndrome: A case report. International Journal of Culture and Mental Health. 2013;7(2):224-228. DOI: 10.1080/17542863.2013.775782\n'}],footnotes:[],contributors:[{corresp:null,contributorFullName:"Aslı Enzel Koc",address:null,affiliation:'
Medical School, Recep Tayyip Erdogan University, Rize, Turkey
Medical School, Recep Tayyip Erdogan University, Rize, Turkey
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1. Introduction
For improved academic achievement and acceptable reading proficiency levels, learners need to vigorously engage on varying reading activities. When they work as groups, they tend to learn from one another through collaboration, information sharing, and mentoring each other. There have been identified benefits of working as groups when primary school learners learn an unfamiliar language in the schools studied, this being referred to English language learning [1]. Research reveals that for primary school learners to engage in the form of groups during the processes of language learning and teaching, there are enriched social skills that are acquired, including cooperation and accountability, as such it becomes easy for learners to break down compound tasks into minor and convenient packages [2]. The main benefits of group work when developing language proficiency among learners include cultivated discussions and justifications, let alone contesting learner assumptions, yet the ultimate goal being emerging robust communication skills. This strategy has been observed to curb problems of shyness, lowered self-esteem coupled with self-motivation [3]. As emergent readers, learners in the primary school need daily continued engagement with reading exercises as learning to read has been recently regarded as one of the core educational objectives not for English language learning only, but across all the subjects underpinning the curriculum as there are also texts to be comprehended.
However, in the previously known South African schools’ classroom environment prior COVID-19 pandemic era, policy advocated for formation of learner groupings as learning and teaching has to be learner-centered and learner-paced, this being prescribed by the Curriculum and Assessment Policy Statements (CAPS) [4]. English language teachers, through this arrangement, would proudly report on escalating learner achievements that used to be paired up with improved reading proficiency levels. This makes us as authors of this manuscript to acknowledge the importance of group work. To our perception, working as groups when learning a language leads to a more effective and fun collaboration as learners with diverse learning styles and learning abilities are granted an opportunity to engage with others, thereby anticipating the comprehended text from diverse perspectives, yet promoting confidence levels and expanded listening, thinking, speaking, and writing skills. All these are regarded as the core language skills for language learning [5]. For learners to be successful, efficient, and effective scholars, these skills need to be mastered.
2. Literature review
Grouping of learners when studying a language has been proved to lead to progress and success in academic achievement [6]. Teamwork is of real importance as learners engaging in this manner were identified to have exhibited better achievement levels when compared with those who preferred to study or learn in a single-handed mode. Henceforth, there is a vital need for English language teachers to be quite conversant that indeed group work has some profits and therefore are expected to apply such strategy during the processes of teaching and learning.
On the other side, social distancing protocols emanating from COVID-19 regulations have resulted in schools being left with no other option than to disband the previously formulated classroom learner groupings [7]. One may ask himself, what then has the current state of the existing new normal put primary school language teachers together with the learners as recipients in the teaching-learning process, as previously been observed by the authors that this cohort of teachers has full confidence for language development when comprehending texts is handled not in an individual perspective, but by learners specifically arranged as groups to interact, engage, thereby learning as peers. Furthermore, learners in the studied schools got intimidated by the abrupt changes in the schooling situation more so that learning English language, being unfamiliar hence not their home language, needs to be nurtured. By so doing, learners would then value own cultural heritages attached to obtaining valued experience in English language [8].
As an operational method to inspire active learning, for communication skills joined mutually with critical thinking, there is a need to encourage group work among learners [9]. On the other side, literature reveals that the current situation across all environments due to the COVID-19 regulations has brought about some negative effects resulting in stress from loss of peer interaction with regard to academic content as learners are no longer denied access to practice the so-called previously known normality of either sitting as groups or as pairs in a classroom setting, as a way of responding to the constraints of social distancing observance [7, 10]. This current state of affairs is declared similar to the period when there was once some disturbance in the schooling mode of behavior. There emerged an influenza first perceived in the United States, then later swiftly blew out across the entire countries of the world. As reported by the public health schools in such communities had to be closed down due to the influenza pandemic [11]. The schooling situation or practices by then were declared to have slightly changed as all inhabitants were expected to give full observance of the prescribed instructions by the then governmental officials.
Furthermore, as learners actively engage in group work, they obtain chances to express own opinions and ideas. As deliberations reach climax within a specific group of learners, critical thinking and robust discussion are also improved [12]. When learners’ critical thinking and engagement skills are improved, problem-solving is then enhanced, together with improved communication skills, consequently leading to an enriched cultural awareness [13]. Such improved skills would be eminent as learners would have learnt to listen at others’ opinions, then providing feedback. As this entire exercise is carried out, one would notice that learners forming a single group originate from dissimilar linguistic constituencies, different backgrounds, diverse cultures yet with varying learning styles, as such, at their early ages, learners then learn to have respect for each unique individual.
This manuscript is strengthened by Guskey’s model of teacher change [14]. A model of teacher change has been used for this investigation pertaining to changes currently championing the education system, as brought about by the COVID-19 etiquettes that need to be observed by all individuals around the country [15]. The framework further portrays ecological changes in consideration of the attitudes and beliefs toward teaching and learning, as is the case in the current schooling situation. Previously, teachers strongly believed that for an operational and functional language development in learners, better results used to be eminent when learners were grouped, yet the current situation has resulted on learner groupings being disbanded.
With respect to the main objective of this chapter, authors opine that for learners to comprehend any text with understanding, there is a dire requirement for a combined practice between the text itself and learners brainstorming as a group. To uplift and motivate this notion, language teachers are therefore anticipated as the ones to constantly allocate reading tasks to learners in the form of groups, irrespective of whether during the normal classroom environment, or for tasks assigned as take-home activities. If English language teachers would embark in this practice, language proficiency among learners would surely be enhanced as perceived by the authors [16]. Teachers therefore are regarded as the core recipients to ensure language enhancement in learners, as suggested by the theory underpinning this manuscript [14]. Innovative reading skills, ease at comprehending with text, and upgraded language skills would then emerge, therefore leading to academic excellence as the greatest percentage of the subjects buttressing the curriculum in the schools investigated are offered in the English medium.
3. Methods and materials
For the purposes of this investigation, the authors followed a qualitative approach entrenched by a case study design. This is a research approach applied for generating an in-depth understanding for some compound issues affecting real-life situations. Authors used this type of design in order to have an understanding of recent social distancing trajectories affecting the previous normal running of schools [17]. Truths pertaining human behavior as authors studied the real-world circumstances that unfolded were put together [18]. An inclusive understanding pertaining to teacher perspectives on language development on the view that grouping of learners was no longer a practice, henceforth social distancing code of practice, was followed. For the context of this study, investigation was based on administering semistructured interviews to 10 purposefully selected teachers from three different primary schools in one district of the Eastern Cape Province in South Africa [19, 20]. Authors decided to embark on selecting participants in a purposive manner as this sampling technique allows researchers to rely on own judgment when nominating population members to participate. Henceforth, we decided to identify teachers from the surrounding locations where high COVID-19 death tolls had been reported by statistics [11]. Further than that, purposive sampling was a method that suited us well, hence the limited number of our participants who served as primary data sources by virtue of the case study designed ingraining this investigation. Participants nominated were teachers who offered English language as a medium reinforcing the utmost percentage of subjects enrolled in these particular schools.
As perceived by research, semistructured interviews as a data-collection instrument permitted the authors full engagement with all participants, more so that chances to explore more on crucial emerging themes seemed eminent [21]. Open-ended interview questions revolved around viewpoints of teachers on the subject of learner proficiency reading levels as directed by the abolishing of engaging on reading as groups, despite the previously reported improved readership in learners when such reading exercises used to be tackled in daily learner groupings. Despite the interview schedule containing open-ended questions, authors were at liberty to throw follow-up questions in instances where further clarities were deemed necessary. As a way of observing the current social distancing procedures, as well as avoiding grouping all participants in one common venue, interviews were conducted in a one-on-one fashion. Authors arranged meetings for each single participant at a single time. The interaction or engagements between the authors and participants started in September 2021 and at a later stage got terminated beginning December 2021 as both the interviewers and the interviewees became entangled in the processes of administering examinations in their varying work stations. As the interview schedule was administered, authors took some recordings, which were later replayed again and again. These recordings were taken in a different number of visits and days, for an interval ranging between 15 and 20 minutes for each individual participant. This method helped authors to be able to transcribe all responses from all participants, avoiding not to disregard any single response. Similar or relevant responses were grouped together and thereby coded by the authors as a way of formulating themes [17, 18, 19, 20, 21, 22].
4. Research results
There are two themes that emerged during data analysis from an argument of findings for this investigation [22]. In consideration of reading proficiency levels, it emerged that reading is affected by disbanded learner groupings due to the COVID-19 pandemic era code of practice. The second finding outlined relates to learner attitudes resulting in feeling isolated from their peers, and yet this is proving to somehow influence language development intertwined with learner achievement.
4.1 Proficiency levels in reading
Among the group of participants, one teacher reported own observance on proficiency levels in reading among learners since in the classroom setting, learner groupings had no longer become the talk of the schooling environment: My greatest worry is that learners in my class previously performed maximally well during the times when I used to group them as per their reading abilities. On the same view, another participant concurred: With time, all those who still displayed some difficulties in reading texts would improve through interactions and support made by members in a single group. Learners would later require me as their teacher to allow time to engage in competing as groups as a way to encourage learners to be all in an accepted level with regards to their proficiencies in comprehending with texts.
4.2 Learner attitudes versus isolation
It was divulged that the majority of learners felt isolated from their peers. Henceforth, the current COVID-19 social distancing restrictions pertaining to the seating logic of one learner seated in a stipulated distance away from the other, they no longer had opportunities to either exchange ideas or share information as they used to when seated as groups.
In relation to this encounter, one participant argued that: Even if those learners who are super gifted than the rest have successfully comprehended with the text within a short space of time, as their teacher I have recently developed reluctance to either pair or group learners according to their reading abilities, with fear of clomping learners together, in case one contaminates the deadly disease from the other. On that note one participant reported a story that left us so sad, but without any remedy to suggest: As I came a little bit closer, one by one, to those learners with difficulties to comprehend with the assigned texts, they almost gave me a similar response that they felt so isolated and deserted as groupmates who used to assist them were now seated afar, making it difficult to easily exchange ideas and ask for assistance and mentorship when they came across new, unfamiliar and difficult words.
5. Discussion
Pertaining to reading proficiency levels, a key finding was a noted deterioration in reading progress among learners. Teachers offering English language as a subject debated that motivation within learners as groups no longer exists, actually, it has then been compromised as each learner had to battle or struggle on comprehending the text all alone, this somehow displaying a sudden lack of collegiality among learners registered for the same subject. This situation was even made worse by the current situation that existed when learners were at their cultural or rather home backgrounds. Learners had reported to respective teachers that isolation also roams in their living environments to such an extent that even if one had a neighbor with whom they are enrolled for the same grade, phase, or subject, parents denied their children access to visit others for purposes of information sharing sessions [23]. As authors of this manuscript, we really feel pity for the cohort of learners experiencing difficulties in comprehending with texts. Actually, this then becomes a call for language teachers to identify alternative strategies that would curb the situation of learners who feel isolated and left alone, as this might lead to implications of increased learner-dropout rate as well as lowered progression levels. On the other side, a reading nation is a wealthy nation, we all need to engage with written texts in order to be an economically balanced country.
To curb the situation, learners need to be motivated so as to be able to adapt in the unfamiliar systems of self-independency. Motivation is known for its importance especially in learning an unfamiliar language, in this instance this being an English language. Motivated learners have since been noted of achieving their goals, while on the other hand those with lack of motivation become victims of not obtaining the intended academic achievement. Nurtured motivation has been identified to lead higher levels of language competence. It therefore lies with English language teachers that as learners are held in situations of no longer vibrantly engaging with group members in the classroom environment, learners be encouraged and driven toward attaining short-term goals such as reading and writing, by so doing, they would improve in language proficiencies. Dissolution of learner groupings is perceived by learners as not supportive toward language learning. With limited collaboration, some learners could undergo stress disorders or related sicknesses [6, 7, 8, 9, 10].
Furthermore, as collaborative learning has proved to yield good results, teachers are then advised to let learners learn as either pairs or groups, even if the seating plan makes learners to be scattered from each other [24]. This method of learning collaboratively has been proved by other writers to have some advantages as research argues that in group work learners have an opportunity to learn from each other as they can better unpack some ideas clearer to respective classmates, as compared with how a teacher would have tackled it, this at times resulting from that some learners have an introvert attitude, as such become reluctant to seek assistance from their teachers [25].
From the collected data, it also emerged that the newly designed seating plan for learners to be positioned apart from their peers seemed to have some adverse impacts on learning, and specifically for the purposes of this investigation, isolation led to attitudes of neglect, this having an influence on language development [26]. The current seating plan in the schooling environment is attached with compliance of COVID-19 regulations on social distancing as prescribed by the South African government. Elements of anxiety in learners revolve around logistics encounters with regard to loneliness, discomposure, and loss of peer interaction [27]. To the authors’ perspective, these critical aspects are likely to have an influence on academic content and uncertainty in learner progression. Teachers also reported that learners whose comprehension levels were not of the expected average normally raised concerns that the current seating plan causes lots of stress, likely to impact on their development in learning.
On the other side, teachers also reported their concern regarding learner isolation as this might impact on emotional and social learning [28]. Proficiency gaps in reading abilities were noted by language teachers to have erupted ever since the innovations on the classroom seating plans, in so much that isolation even from friends and family in general, have normally resulted into an unhealthy social learning environment. This finding is in line with the views that for a task to be considered as outcomes-based, learners are expected to cultivate some links in between the content learnt and the encompassing learning styles thereof. Moreover, as learners comprehend and intermingle in the target language that is being learnt, there seems to be a crucial need for them to interact and communicate among themselves for easy access to acquire the logistics of the new and the unacquainted language. Engaging in such a strategy is likely to rebuild self-confidence, this leading to improved language proficiency levels [29]. For satisfactory progress, learning in schools needs to be a process administered through social relationships, including oneself, life, as well as collaborating with others through unanimous decision-making [30, 31]. By so doing, the school then becomes a family because of the supportive networking by both teachers and groups of learners. For such networking to be lost, it then really becomes a greatest concern ever. As the authors of this manuscript, we therefore opine for paramount importance that language teachers devise the necessary strategies aimed toward improved language proficiency with revised approaches to help rebuild the lost self-intrinsic inspiration within learners as swept away by isolation logistics.
6. Conclusion
The fundamental aim of this chapter was to measure the extent to which terminated learner groupings as a way of responding to the COVID-19 social distancing logistics had any influence on language enhancement. Importance of this investigation is reaffirmed as all the underlying discussions for this article have been proven to be aligned with the model of teacher change [14]. An examination of disbanded learner groupings led to the key finding outlining that indeed group work yields best results in relation to reading proficiency in leaners. From the data analyzed, it has become eminent to note that restricted groupings of learners in the current schooling situation seem to have an effect of redundancy toward a healthy reading culture. As perceived by the authors of this chapter, a nation with restricted or deprived culture of reading is tantamount to a vehicle expected to be in motion, yet fully loaded with a dead engine. Findings of this investigation therefore imply that despite the restrictions to group learners in classroom settings, language teachers are faced with a huge task to motivate the young, yet highlighting to them that with time they need to develop responsive attitudes with that sense of individual drive toward their learning, as the current state of affairs has led to all scholars being held up in the predicament of self-studies, of which no one had ever anticipated. Henceforth, authors recommend that managerial implications of this investigation be vested on the policymakers to redesign functional policies that would act as alternatives into restoring worthwhile sitting plans, yet, rebuilding that sense of inner ambiguity among learners no longer able to collaborate with peers as was in the previously disbanded learner groupings.
Acknowledgments
First and foremost, let me appreciate and thank the Almighty God for the strength and wisdom. Without His blessings, I doubt if we would have courage to successfully write this manuscript.
To write a book chapter is really hard work than I ever imagined, yet rewarding because as I continue embarking on the process of writing, my research skills coupled with academic writing logistics are sharpened day by day. This chapter encompasses to measure whether disbanding learner groupings as per the social distancing protocols brought about by COVID-19 restrictions has any significant impact on language enhancement.
I would be making a mistake not to acknowledge the amazing obligation that I owe toward researchers who encouraged me on manuscript writing. For this manuscript to be written in completion, an immense amount of work was done and would not have happened without an inspiration by a number of compassionate researchers whom I collaborated with, inclusive of:
Dr. Nomxolisi Mtsi, who was the first person to inspire me on research writing. As I narrated to her that my life situation had its ups and downs, she just told me that there was always a way out for whatever situation experienced. This academic was the one who whispered out loud in my ears that I need to start focusing on research writing. I can assume in me she sensed a hungry academic that needed some inspiration to grow. She went an extra mile to introduce me to Dr. Thandiswa Mpiti, with whom we are in the same field of research: languages. I am so grateful to have networked with such an academic, engaging on research writing, sharing experiences, and stimulating one another.
I cannot turn a blind eye on this one. To Dr. Shakespeare Chiphambo, no matter how the awkward timing would be, he is always eager to read through my drafts and offer whatever form of assistance I require from him in relation to manuscript writing.
I am ceaselessly appreciative to my mentor: Professor Bongani Bantwini, my managers at work: Professor Nolutho Diko and Mrs. Nondwe Mtshatsha. These seasoned academics would always and forever encourage me to make it a priority that I prioritize on manuscript writing to be considered as fully blown in academia. My mentor would always go an extra mile to read through my drafts.
Without proficiencies, collaboration, and support from my colleague at work, Dr. Ntando Elliot Mpahla, the research expertise on manuscript writing, would not have been to this level.
To all the researchers who would preach into my ears that to be regarded as a real academic one has to embark on publishing, thank you so much for inspiring more authors to have courage to convert their ideas to becoming stories. It is because of such inspiring comments that I have obtained some growth opportunities.
For the publication of this manuscript, I wish to extend my sincere gratitude to the Walter Sisulu Research Directorate for offering funding toward our publications. This stimulates and encourages us as researchers to have a maintained zeal toward the project as academic writers.
Writing a chapter about real-life experiences encountered in the workplace during the processes of teaching and learning is indeed a bizarre process, but through the ongoing support of the colleagues in the same field of work, there was continued motivation and inspiration to maintain the passion of bringing all our stories to life.
A very special word of thanks goes to my family. My kids, Yonela, Tina, and Zenazi, for supporting me without complaining even at times when I gave them less attention than they expected. My nephews and nieces, Odwa, Ongeziwe, Lisolethu, Kungawo, Amyoli, and Minathi, for exercising patience when I took longer to assist them with their studies while I was still hooked up in this little piece of writing. Their level of understanding is well applauded. My brother, Campbell, and sisters, Xoliswa and Hombakazi, for always encouraging me in whatever endeavor intending to make my life a better one. My mom, Vuyiswa, who would always and forever urge all her kids to prioritize with engaging in furthering their studies for being successful and prominent citizens. Lastly, my debt goes to my late dad, Erick Vuyisilet, who always dreamt big about the level of education for his children.
Conclusions to this study have been sharpened by contributions of our participants. For the time they excellently dedicated in engaging in this investigation, they are highly acknowledged.
Interview Schedule for English First Additional Language Primary School teachers
To what extent is social distancing in relation to learner attitudes versus isolation affecting language development?
What role does social distancing play with respect to learner groupings on reading proficiency levels?
Your participation in this regard is of the highest value in this enquiry. Thank You.
\n',keywords:"learner groupings, language, social distancing, learner achievement, reading proficiency",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/81785.pdf",chapterXML:"https://mts.intechopen.com/source/xml/81785.xml",downloadPdfUrl:"/chapter/pdf-download/81785",previewPdfUrl:"/chapter/pdf-preview/81785",totalDownloads:14,totalViews:0,totalCrossrefCites:0,dateSubmitted:"February 18th 2022",dateReviewed:"April 12th 2022",datePrePublished:"June 24th 2022",datePublished:null,dateFinished:"May 14th 2022",readingETA:"0",abstract:"Information sharing is a fundamental aspect in learning an unfamiliar, yet, an additional language, with specific regards to reading comprehension. Language teachers are faced with a task to monitor development, performance, and effectiveness in learner reading proficiencies. This chapter aims to measure if disbanding learner groupings as per the social distancing protocols brought about by COVID-19 restrictions has any impact on language enhancement. Henceforth, there are limited suggestions by literature in relation to disbanding learner groupings, yet improved reading proficiency is one of the crucial language aspects to be mastered for one to be a successful scholar. Nonetheless, this chapter aims to provide teaching strategies applied by English language teachers to necessitate transmitted learning in accordance with information sharing as learners are dependent on one another for language enhancement, thus leading to academic achievement.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/81785",risUrl:"/chapter/ris/81785",signatures:"Bulelwa Makena and Thandiswa Mpiti",book:{id:"10912",type:"book",title:"Psychosocial, Educational, and Economic Impacts of COVID-19",subtitle:null,fullTitle:"Psychosocial, Educational, and Economic Impacts of COVID-19",slug:null,publishedDate:null,bookSignature:"Dr. Jose C. 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Research results",level:"1"},{id:"sec_4_2",title:"4.1 Proficiency levels in reading",level:"2"},{id:"sec_5_2",title:"4.2 Learner attitudes versus isolation",level:"2"},{id:"sec_7",title:"5. Discussion",level:"1"},{id:"sec_8",title:"6. Conclusion",level:"1"},{id:"sec_9",title:"Acknowledgments",level:"1"},{id:"sec_10",title:"",level:"1"}],chapterReferences:[{id:"B1",body:'Barkley EF, Cross KP, Major CH. Collaborative Learning Techniques: A Handbook for College Faculty. San Francisco: Jossey-Bass Publishers; 2005. p. 90'},{id:"B2",body:'Beebe SA, Masterson JT. Communicating in Small Groups. Boston, Massachusetts: Pearson Education Inc; 2020. p. 12'},{id:"B3",body:'Cooper J. Cooperative learning and college teaching: Tips from the trenches. Teaching Professor. 1990;4:1-2. DOI: 10.1177/136548020100400206'},{id:"B4",body:'DBE Curriculum and Assessment Policy Statements. South African Government; 2011. 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COVID-19: A Global Transplant Perspective on Successfully Navigating a Pandemic. 2020. Available from: https://timesofindia.indiatimes.com/blogs/indic-positive/social-distancing-and-its-impact-on-kids/. [Accessed: September 06, 2021]'},{id:"B29",body:'Mpiti T, Makena B, Mpahla NE. Task-based approach in improving the communicative skill of English First Additional Language first-year student teachers. In: Proceedings of 15th International Technology, Education and Development Conference (INTED 21); 08-09 March 2021; Valentia, Spain. pp. 10732-10738'},{id:"B30",body:'Bates K. How Social Distancing Affects Social Development. 2021. Available from: https://bold.expert/how-social-distancing-affects-social-development/. [Accessed: September 6, 2021]'},{id:"B31",body:'Burden K, Aubusson P, Brindley S, Schuck S. Changing knowledge, changing technology: Implications for teacher education futures. Journal of Education for Teaching. 2016;42:4-16. DOI: 10.1080/02607476.2015.1125432'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Bulelwa Makena",address:"bmakena@wsu.ac.za",affiliation:'
Walter Sisiulu University, Komani Campus, South Africa
Walter Sisiulu University, Komani Campus, South Africa
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Our books are available hardcover, printed in full colour and produced to the highest standards on PEFC™ and FSC certified paper, complying with principles of responsible forestry worldwide. The paper size is 180 x 260 mm (7 x 10.2 inches).
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IntechOpen Books are printed specifically for your order
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Ordered, printed, and delivered in 7-15 business days
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Available for purchase at any time no minimum or maximum threshold on book order quantity
\n
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IntechOpen works with award winning print-houses and we hold to the fact that all of our printed products are of the highest quality.
\n\n
Prices and Discounts
\n\n
IntechOpen books retail price range is:
\n\n
100 - 159 GBP ex. VAT (available in USD and EUR)
\n\n
Discounts available:
\n\n
\n\t
All IntechOpen contributors can buy the print copies of books for an Author Exclusive price with discounts from 30% to 50% on retail price. Log in to your Author Panel to purchase a book at the discounted price.
\n\t
Libraries are offered a 20% discount.
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Book resellers receive a 20% standard trade discount.
\n
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Bulk discounts are granted for orders of 10 copies and more.
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There is no minimum or maximum threshold on the quantity of book orders.
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Terms and Conditions
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Payment Terms
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Orders have to be paid in advance and before printing. We accept payment in GBP, EUR and USD.
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We currently accept the following payment options:
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Credit Card
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PayPal
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Bank Transfer
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When paying with a credit card, you will be redirected to the PayPal.com online payment portal.
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IntechOpen will help you complete your payment safely and securely, keeping your personal, professional and financial information safe.
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In accordance with the best security practice, we do not accept card orders via email.
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General Handling and Delivery Info
\n\n
The combined printing and delivery time for orders vary from 7-15 business days, depending on the printed quantity and destination. This period does not include any customs clearance difficulties that may arise and that are beyond our control. Once your order has been printed and shipped, you will receive a confirmation email that includes your DHL tracking number. You can then track your order at www.dhl.com.
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If you do not receive your order within 30 days from the date your order is shipped, please contact us to inquire about the shipping status at orders@intechopen.com.
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Tax and Customs
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Tax: Residents of European Union countries need to add a Book Value-Added Tax Rate based on their country of residence. Institutions and companies, registered as VAT taxable entities in their own EU member state, will not pay VAT by providing IntechOpen with their VAT registration number. This is made possible by the EU reverse charge method.
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Customs: free shipping does not include any duties, taxes or clearing charges levied by the destination country. These charges are the responsibility of the customer and will vary from country to country.
\n\n
P.O. Boxes
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P.O. Boxes cannot be used as a Ship-To Address.
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Restricted Countries
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IntechOpen partners do not provide shipping service from Europe to the countries listed below. Please refrain from mailing items addressed to the countries listed below, until further notice.
\n\n
When ordering our books from the countries listed below, please provide an alternative mailing address. For any further assistance, please contact us at orders@intechopen.com.
\n\n
Restricted Ship-to Countries:
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\n\t
Afghanistan
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Belarus
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Central African Republic
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Cote d'Ivoire
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Congo
\n\t
Cuba (US only)
\n\t
Eritrea
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Iran, Islamic Republic of
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Iraq
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Korea, DPR
\n\t
Lebanon
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Libya
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Mali
\n\t
Myanmar
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Niger
\n\t
Somalia
\n\t
South Sudan
\n\t
Sudan
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Syria
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Yemen
\n\t
Zimbabwe
\n
\n\n
Return Policy
\n\n
POD products are non-returnable and non-refundable, except in the event of poor print quality or an error in quantity. If we delivered the item to you in error or the item is faulty, please contact us.
\n\n
Inspect your order carefully when it arrives. Any problems should be immediately reported to orders@intechopen.com.
\n\n
Representatives
\n\n
Print copies of our publications are most often purchased by universities, libraries, institutions and academia personnel, hence increasing the visibility and outreach of our authors' published work among science communities and institutions.
\n\n
Our books are available at our direct Print Sales Department and through selected representatives throughout the world.
\n\n
Books International
\n\n
Representative for: Brunei, Cambodia, Indonesia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, Vietnam (ASEAN)
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China Publishers Services Ltd - CPS
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Representative for: China, Taiwan, Hong Kong
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India - CBS Publishers & Distributors Pvt. Ltd.
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Representative for: India, Bangladesh, Pakistan, Sri Lanka, Bhutan, Nepal, Maldives, Iran, Algeria, Bahrain, Egypt, Iraq, Israel, Jordan, Kuwait, Lebanon, Libya, Malta, Morocco, Oman, Qatar, Saudi Arabia, Syria, Tunis, United Arab Emirates and Yemen
\n\n
LSR Libros Servicios y Representaciones S.A. de C.V
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr.",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Rheinmetall (Germany)",country:{name:"Germany"}}},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. 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Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. 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After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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He previously worked as a post-doctoral fellow at the Ben-Gurion University of Negev, Israel; University of the Free State, South Africa; and Central University of Technology Bloemfontein, South Africa. He obtained his Ph.D. in Organic Chemistry from Nagaoka University of Technology, Japan. He has published more than seventy-four journal articles and attended several national and international conferences as speaker and chair. Dr. Kendrekar has received many international awards. He has several funded projects, namely, anti-malaria drug development, MRSA, and SARS-CoV-2 activity of curcumin and its formulations. He has filed four patents in collaboration with the University of Central Lancashire and Mayo Clinic Infectious Diseases. His present research includes organic synthesis, drug discovery and development, biochemistry, nanoscience, and nanotechnology.",institutionString:"Visiting Scientist at Lipid Nanostructures Laboratory, Centre for Smart Materials, School of Natural Sciences, University of Central Lancashire",institution:null},{id:"428125",title:"Dr.",name:"Vinayak",middleName:null,surname:"Adimule",slug:"vinayak-adimule",fullName:"Vinayak Adimule",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/428125/images/system/428125.jpg",biography:"Dr. Vinayak Adimule, MSc, Ph.D., is a professor and dean of R&D, Angadi Institute of Technology and Management, India. He has 15 years of research experience as a senior research scientist and associate research scientist in R&D organizations. He has published more than fifty research articles as well as several book chapters. He has two Indian patents and two international patents to his credit. Dr. Adimule has attended, chaired, and presented papers at national and international conferences. He is a guest editor for Topics in Catalysis and other journals. He is also an editorial board member, life member, and associate member for many international societies and research institutions. His research interests include nanoelectronics, material chemistry, artificial intelligence, sensors and actuators, bio-nanomaterials, and medicinal chemistry.",institutionString:"Angadi Institute of Technology and Management",institution:null},{id:"284317",title:"Prof.",name:"Kantharaju",middleName:null,surname:"Kamanna",slug:"kantharaju-kamanna",fullName:"Kantharaju Kamanna",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284317/images/21050_n.jpg",biography:"Prof. K. Kantharaju has received Bachelor of science (PCM), master of science (Organic Chemistry) and Doctor of Philosophy in Chemistry from Bangalore University. He worked as a Executive Research & Development @ Cadila Pharmaceuticals Ltd, Ahmedabad. He received DBT-postdoc fellow @ Molecular Biophysics Unit, Indian Institute of Science, Bangalore under the supervision of Prof. P. Balaram, later he moved to NIH-postdoc researcher at Drexel University College of Medicine, Philadelphia, USA, after his return from postdoc joined NITK-Surthakal as a Adhoc faculty at department of chemistry. Since from August 2013 working as a Associate Professor, and in 2016 promoted to Profeesor in the School of Basic Sciences: Department of Chemistry and having 20 years of teaching and research experiences.",institutionString:null,institution:{name:"Rani Channamma University, Belagavi",country:{name:"India"}}},{id:"158492",title:"Prof.",name:"Yusuf",middleName:null,surname:"Tutar",slug:"yusuf-tutar",fullName:"Yusuf Tutar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/158492/images/system/158492.jpeg",biography:"Prof. Dr. Yusuf Tutar conducts his research at the Hamidiye Faculty of Pharmacy, Department of Basic Pharmaceutical Sciences, Division of Biochemistry, University of Health Sciences, Turkey. He is also a faculty member in the Molecular Oncology Program. He obtained his MSc and Ph.D. at Oregon State University and Texas Tech University, respectively. He pursued his postdoctoral studies at Rutgers University Medical School and the National Institutes of Health (NIH/NIDDK), USA. His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. He is currently a professor at the Institute of Biomaterials and Bioengineering (IBB), Tokyo Medical and Dental University (TMDU). From 2010 to 2012, he was the dean of the Graduate School of Biomedical Science. Since 2012, he has served as the vice dean of the Graduate School of Medical and Dental Sciences. He has been the director of the IBB since 2020. Dr. Kagechika’s major research interests are the medicinal chemistry of retinoids, vitamins D/K, and nuclear receptors. He has developed various compounds including a drug for acute promyelocytic leukemia.",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",country:{name:"Japan"}}},{id:"94311",title:"Prof.",name:"Martins",middleName:"Ochubiojo",surname:"Ochubiojo Emeje",slug:"martins-ochubiojo-emeje",fullName:"Martins Ochubiojo Emeje",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94311/images/system/94311.jpeg",biography:"Martins Emeje obtained a BPharm with distinction from Ahmadu Bello University, Nigeria, and an MPharm and Ph.D. from the University of Nigeria (UNN), where he received the best Ph.D. award and was enlisted as UNN’s “Face of Research.” He established the first nanomedicine center in Nigeria and was the pioneer head of the intellectual property and technology transfer as well as the technology innovation and support center. Prof. Emeje’s several international fellowships include the prestigious Raman fellowship. He has published more than 150 articles and patents. He is also the head of R&D at NIPRD and holds a visiting professor position at Nnamdi Azikiwe University, Nigeria. He has a postgraduate certificate in Project Management from Walden University, Minnesota, as well as a professional teaching certificate and a World Bank certification in Public Procurement. Prof. Emeje was a national chairman of academic pharmacists in Nigeria and the 2021 winner of the May & Baker Nigeria Plc–sponsored prize for professional service in research and innovation.",institutionString:"National Institute for Pharmaceutical Research and Development",institution:{name:"National Institute for Pharmaceutical Research and Development",country:{name:"Nigeria"}}},{id:"436430",title:"Associate Prof.",name:"Mesut",middleName:null,surname:"Işık",slug:"mesut-isik",fullName:"Mesut Işık",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/436430/images/19686_n.jpg",biography:null,institutionString:null,institution:{name:"Bilecik University",country:{name:"Turkey"}}},{id:"268659",title:"Ms.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/268659/images/8143_n.jpg",biography:"Dr. Zhan received his undergraduate and graduate training in the fields of preventive medicine and epidemiology and statistics at the West China University of Medical Sciences in China during 1989 to 1999. He received his post-doctoral training in oncology and cancer proteomics for two years at the Cancer Research Institute of Human Medical University in China. In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a Principal Investigator and Scientist at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via machine-learning-based analyses of exosomal signatures. Dr. Paul has published in more than fifty peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award, a senior member of the Institute of Electrical and Electronics Engineers (IEEE), and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals. He is currently working on the protective activity of phenolic compounds in disorders associated with oxidative stress and inflammation.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329248",title:"Dr.",name:"Md. Faheem",middleName:null,surname:"Haider",slug:"md.-faheem-haider",fullName:"Md. Faheem Haider",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329248/images/system/329248.jpg",biography:"Dr. Md. Faheem Haider completed his BPharm in 2012 at Integral University, Lucknow, India. In 2014, he completed his MPharm with specialization in Pharmaceutics at Babasaheb Bhimrao Ambedkar University, Lucknow, India. He received his Ph.D. degree from Jamia Hamdard University, New Delhi, India, in 2018. He was selected for the GPAT six times and his best All India Rank was 34. Currently, he is an assistant professor at Integral University. Previously he was an assistant professor at IIMT University, Meerut, India. He has experience teaching DPharm, Pharm.D, BPharm, and MPharm students. He has more than five publications in reputed journals to his credit. Dr. Faheem’s research area is the development and characterization of nanoformulation for the delivery of drugs to various organs.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/system/329795.png",biography:"Dr. Mohd Aftab Siddiqui is an assistant professor in the Faculty of Pharmacy, Integral University, Lucknow, India, where he obtained a Ph.D. in Pharmacology in 2020. He also obtained a BPharm and MPharm from the same university in 2013 and 2015, respectively. His area of research is the pharmacological screening of herbal drugs/natural products in liver cancer and cardiac diseases. He is a member of many professional bodies and has guided many MPharm and PharmD research projects. Dr. Siddiqui has many national and international publications and one German patent to his credit.",institutionString:"Integral University",institution:null}]}},subseries:{item:{id:"2",type:"subseries",title:"Prosthodontics and Implant Dentistry",keywords:"Osseointegration, Hard Tissue, Peri-implant Soft Tissue, Restorative Materials, Prosthesis Design, Prosthesis, Patient Satisfaction, Rehabilitation",scope:"
\r\n\tThe success of dental implant treatment is not solely dependent on the osseointegration around the implant. Aside from the criteria used to describe the hard tissue response at the implant level, the success criteria in implant dentistry include three additional aspects: peri-implant soft tissue, prosthesis, and patient’s satisfaction.
\r\n
\r\n\tThe Prosthodontics and Implant Dentistry topic will provide readers with up-to-date resources on the prosthodontics factors such as aesthetics, restorative materials, the design of prosthesis, case selection, occlusion, oral rehabilitation, among others, all of which play an important role in determining the success of a well osseointegrated implant. With the help of digital dental technology, these can now be accomplished more predictably.
\r\n
\r\n\tThe end goal of prosthesis is always considered when planning successful implant placement. The readers in this field will be able to learn more about taking a holistic approach when treating their dental implant cases.
",coverUrl:"https://cdn.intechopen.com/series_topics/covers/2.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11398,editor:{id:"179568",title:"Associate Prof.",name:"Wen Lin",middleName:null,surname:"Chai",slug:"wen-lin-chai",fullName:"Wen Lin Chai",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRHGAQA4/Profile_Picture_2022-05-23T14:31:12.png",biography:"Professor Dr. Chai Wen Lin is currently a lecturer at the Department of Restorative Dentistry, Faculty of Dentistry of the University of Malaya. She obtained a Master of Dental Science in 2006 and a Ph.D. in 2011. Her Ph.D. research work on the soft tissue-implant interface at the University of Sheffield has yielded several important publications in the key implant journals. She was awarded an Excellent Exchange Award by the University of Sheffield which gave her the opportunity to work at the famous Faculty of Dentistry of the University of Gothenburg, Sweden, under the tutelage of Prof. Peter Thomsen. In 2016, she was appointed as a visiting scholar at UCLA, USA, with attachment in Hospital Dentistry, and involvement in research work related to zirconia implant. In 2016, her contribution to dentistry was recognized by the Royal College of Surgeon of Edinburgh with her being awarded a Fellowship in Dental Surgery. She has authored numerous papers published both in local and international journals. She was the Editor of the Malaysian Dental Journal for several years. Her main research interests are implant-soft tissue interface, zirconia implant, photofunctionalization, 3D-oral mucosal model and pulpal regeneration.",institutionString:null,institution:{name:"University of Malaya",institutionURL:null,country:{name:"Malaysia"}}},editorTwo:{id:"479686",title:"Dr.",name:"Ghee Seong",middleName:null,surname:"Lim",slug:"ghee-seong-lim",fullName:"Ghee Seong Lim",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003ScjLZQAZ/Profile_Picture_2022-06-08T14:17:06.png",biography:"Assoc. Prof Dr. Lim Ghee Seong graduated with a Bachelor of Dental Surgery from University of Malaya, Kuala Lumpur in 2008. He then pursued his Master in Clinical Dentistry, specializing in Restorative Dentistry at Newcastle University, Newcastle, UK, where he graduated with distinction. He has also been awarded the International Training Fellowship (Restorative Dentistry) from the Royal College of Surgeons. 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