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During psychotherapy some patients experience large symptom improvements between sessions, termed sudden gains. Most commonly, sudden gains are observed during treatment for depression (40–50% of participants), but these are occasionally also observed in treatment for anxiety (15–20%). This study investigated the impact of comorbid depression on sudden gains in a primary anxiety sample. It was hypothesised that sudden gains would occur more frequently in participants with anxiety and comorbid depression than anxiety-only participants. The sample consisted of 58 adults who participated in a 12-week transdiagnostic cognitive-behavioural therapy (tCBT) programme. Sudden gains were more frequent in the comorbid depression group than in the anxiety-only group. Sudden gains may be predominantly a function of depressive disorders, which supports the higher rates seen in depressive disorders compared with anxiety disorders. Future research should endeavour to replicate these findings, as this was the first study designed to specifically investigate comorbidity in sudden gains.
To evaluate the effect of a transdiagnostic cognitive behavioural therapy (tCBT) protocol in an individual delivery format, adapted from a protocol that has been extensively evaluated in a group delivery format.
tCBT was provided to a cohort (N = 18) of adults with a range of anxiety disorders (55.6% male; M age = 40.6, SD = 17.6), at a speciality anxiety disorder research clinic. A within-subjects repeated measures design was employed. Pre-to-post-treatment diagnostic assessments were analysed through repeated measures analysis of variance, and session-by-session self-reported measures of anxiety, depression, and quality of life were modelled through mixed-effect regression modelling (MRM) to maximise the sample of treatment initiators.
Significant and large reductions for clinician-rated primary diagnosis severity (Hedges g = 1.63), and overall clinical global impressions (g = 1.43) were observed, and self-reported anxiety and depression symptoms showed significant reductions over the course of treatment with medium-to-large effect sizes (g = 0.66 and 0.74, respectively). Significant improvement to quality of life was also observed with medium effect size (g = 0.53).
There is now preliminary support for the use of an adaptation of an established group-based tCBT protocol for use with individuals. Implications and recommendations for future investigations are provided.
Transdiagnostic group cognitive-behavioral therapy (tCBT) is a delivery model that could help overcome barriers to large-scale implementation of evidence-based psychotherapy for anxiety disorders. The aim of this study was to assess the effectiveness of combining group tCBT with treatment-as-usual (TAU), compared to TAU, for the treatment of anxiety disorders in community-based mental health care.
In a multicenter single-blind, two-arm pragmatic superiority randomized trial, we recruited participants aged 18–65 who met DSM-5 criteria for principal diagnoses of generalized anxiety disorder, social anxiety disorder, panic disorder, or agoraphobia. Group tCBT consisted of 12 weekly 2 h sessions. There were no restrictions for TAU. The primary outcome measures were the Beck Anxiety Inventory (BAI) and clinician severity rating from the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5) for the principal anxiety disorder at post-treatment, with intention-to-treat analysis.
A total of 231 participants were randomized to either tCBT + TAU (117) or TAU (114), with outcome data available for, respectively, 95 and 106. Results of the mixed-effects regression models showed superior improvement at post-treatment for participants in tCBT + TAU, compared to TAU, for BAI [p < 0.001; unadjusted post-treatment mean (s.d.): 13.20 (9.13) v. 20.85 (10.96), Cohen's d = 0.76] and ADIS-5 [p < 0.001; 3.27 (2.19) v. 4.93 (2.00), Cohen's d = 0.79].
Our findings suggest that the addition of group tCBT into usual care can reduce symptom severity in patients with anxiety disorders, and support tCBT dissemination in routine community-based care.
It is well established that late-type main-sequence (MS) stars display a relationship between X-ray activity and the Rossby number, Ro, the ratio of rotation period to the convective turnover time. This manifests itself as a saturated regime (where X-ray activity is constant) and an unsaturated regime (where X-ray activity anti-correlates with Rossby number). However, this relationship breaks down for the fastest rotators. We cross-correlated SuperWASP visually classified photometric light curves and All-Sky Automated Survey for Supernovae automatically classified photometric light curves with XMM-Newton X-ray observations to identify 3 178 stars displaying a photometrically defined rotational modulation in their light curve and corresponding X-ray observations. We fitted a power-law to characterise the rotation–activity relation of 900 MS stars. We identified that automatically classified rotationally modulated light curves are not as reliable as visually classified light curves for this work. We found a power-law index in the unsaturated regime of G- to M-type stars of
for the SuperWASP catalogue, in line with the canonical value of
. We find evidence of supersaturation in the fastest rotating K-type stars, with a power-law index of
While suppression is associated with detrimental post-traumatic psychological adjustment, research has not considered the effect of culture on this relationship.
This study investigated cultural differences in the effects of expressive suppression, whilst watching a traumatic film, on subjective distress, psychophysiological responses and intrusive memory.
Australians of European heritage or East Asian Australian participants (n = 82) were randomly assigned to either a suppression group (instructed to suppress their emotions during the film) or a control group (no instructions regarding emotion management). Electrodermal activity, heart rate and heart rate variability (root mean square of the successive differences; RMSSD) were measured pre-, during and post-film. Participants reported the number of film-related intrusions in the 5 min and 7 days post-viewing.
While the European Australian group did not differ significantly on RMSSD, the East Asian suppression group scored significantly higher on RMSSD during the film than the East Asian control group. Second, those in the suppression groups, regardless of cultural background, reported significantly fewer intrusions immediately post-film than controls. Third, we found that for the European Australian group, change in heart rate interacted with group (control versus suppression) when predicting weekly intrusions. However, for the East Asian group change in heart rate did not interact with group when predicting weekly intrusions.
The findings are discussed in the context of current research on culture and emotion regulation and implications for post-traumatic stress disorder.
The development of user-friendly nutrition resources for pregnant women seldom involves end-users. This qualitative study used a citizens’ jury approach to determine if our modification of a longstanding, frequently used dietitian-informed diet and diabetes booklet was deemed to be a good healthy eating resource for pregnant women.
Midwives recruited thirteen first-time pregnant women not requiring specialist obstetric care or specialist dietetic advice for any reason. Participants were sent a copy of the modified healthy eating in pregnancy booklet prior to ‘jury day’. Five women were unable to attend the citizens’ jury citing reasons such as early labour. At the jury, five experts presented evidence. Participants adjourned, with an independent facilitator, to ‘deliberate’ as to whether the resource was suitable or not. The verdict was presented, and subsequent discussion was audio-recorded, transcribed and inductively content analysed.
Southland, New Zealand.
Pregnant women aged 19–35 years (n 8), of whom half had a household income <$NZ30 000.
The verdict was ‘Yes’; the resource was good. Three themes were derived: communication of health information, resource content and harm reduction in pregnancy. Based on these data, ways to enhance the quality and usability of the booklet were evident.
Citizens’ juries can be used to obtain an independent assessment by end-users of health resources. Our modified diet and diabetes booklet was considered suitable for providing healthy eating advice to pregnant women. Inclusion of end-users’ perspectives is critical for end-user relevant content, comprehension and resource credibility.
Now-a-days, obesity and other cardiovascular risk factors (CVRF) became a matter of concern in Schizophrenia, due to their potential relation with atipical antypsychotics. The high prevalence of CVRF in schizophrenic patients is a consensual issue, but there are only a few studies in Portugal.
This is an observational transversal study thats aims to evaluate the presence of CVRF, and to establish the relationship between these ones and anthropometric measurements evaluating global and regional adiposity, in a population of schizophrenic patients.
Material and Methods:
The authors studied a population of 25 schizophrenic patients followed at our Department of Psychiatry. These instruments were used: PANSS (Positive and Negative Symptoms Scale), and a semi-structured interview, with sociodemografic data, and information about life style, medication and schizophrenia. These informations were completed according to the clinical process. The following measurements were recorded: weight, height, abdominal circunference, lipidic and glicemic values, and blood pressure.
The high frequency of CVRF in the population of this study confirms the importance of regular medical evaluations, in every patients with Schizophrenia, to allow early diagnosis/monitorization of CVRF. However, our results dont confirm the benefit of anthropometric measurements as screening methods, possibly due to our small sample. Curiously, we found a week correlation bettween CVRF and environment factors (as medication or life style), what can reforce the hold ideia of Schizophrenic susceptibility to CVRF.
Epilepsy rarely presents as psychosis; this is reportedly more common in temporal lobe epilepsy, particularly mesial temporal lobe sclerosis (MTLS). in first psychotic episodes, epilepsy is often a neglected diagnosis. Also, distinguishing ictal behavioral manifestations from postictal psychosis may be troublesome, hindering adequate management.
26-year-old female without known psychiatric or neurological disorder, brought to the emergency department due to rapidly progressive behavioral disturbance, with Capgras and persecutory delusions, marked aggressiveness and disorientation. Hallucinations were absent. According to her mother, she experienced several “fits” during the previous 2 days, and she also invariably sustains these every month, around “the full moon days”. Blood and urine tests and a brain CT scan were normal. She was treated with risperidone and lorazepam, with symptom remission in two days. Further exploration revealed a two year history of undiagnosed partial complex and generalized seizures; MRI disclosed right MTLS. Interictal EEG and video-EEG were normal (with a negative psychogenic induction trial). the symptoms are successfully controlled with oxcarbazepine.
Although the EEG was not carried out acutely, this seems to be a case of postictal psychosis; this diagnosis is also supported by the clinical progression. the differential diagnoses include toxic psychosis and non-convulsive status epilepticus; a brief review of epilepsy-related psychosis will be conducted. A low suspicion threshold must be kept in these situations, and a meticulous multidisciplinary approach seems advisable.
Attenders (n = 124, response rate 84%) of five GPs in Montpellier completed questionnaires on health (reason for visit, cause of problem, GHQ-12), disability (WHODAS II) and service use (CSRI). For each patient, the GP filled in a brief form including a rating of severity of physical and psychological illness. Overall 30.6% of patients were classified as GHQ cases indicating probable non-psychotic psychiatric morbidity and 58.9% were rated as having a physical illness by the GP. Patients with psychiatric morbidity showed as high levels of disability as those with a physical illness, with however a greater number of domains of life affected. They also had a greatly increased number of disability days and used services to a greater extent than those without psychiatric morbidity, these links being stronger than with physical illness. Use of the WHODAS II and the CSRI has not been previously reported in France. This study shows that they could be useful instruments for depicting disability and service use in general practice. The findings from this initial study indicate the need for greater research in primary care focusing on accurate detection and treatment of patients so that disability and excess service use associated with psychiatric morbidity might be reduced.
Les symptômes négatifs dans la schizophrénie, le plus souvent chroniques et prédictifs du fonctionnement actuel et futur des patients, restent actuellement difficiles à traiter tant sur le plan médicamenteux que psychothérapique. Or, il s’agit d’un groupe de symptômes vaste et hétérogène qu’il est difficile d’étudier dans son ensemble. C’est pourquoi, nous avons choisi de nous intéresser à l’un d’entre eux : l’apathie à la fois symptôme cardinal dans les descriptions précoces de la schizophrénie et symptôme transnosographique. Dans la schizophrénie, il est également admis qu’il existe des troubles de la motivation qui entrent dans la description des symptômes négatifs. Les données de la littérature suggèrent qu’il existerait uniquement sur un plan conceptuel un lien entre motivation et apathie. L’objectif principal de cette étude transversale est de rechercher s’il existe une association entre motivation et apathie chez des patients souffrant de schizophrénie. Soixante-quinze patients hospitalisés ayant un diagnostic de schizophrénie selon les critères du DSM IV, âgés de 18 à 60 ans ont été inclus. Les critères de jugement principaux sont :
– l’Apathie évaluée par deux échelles dont la « Lille Apathy Rating Scale » (LARS) ;
– la Motivation explorée par la BIRT Motivation Questionnaire (BMQ), par une échelle de sensibilité à la punition et à la récompense et par une tâche d’apprentissage par renforcement.
Les résultats montrent que les patients apathiques sont significativement moins motivés et plus sensibles à la punition que les patients non apathiques, et présentent une corrélation positive significative entre les scores obtenus à la LARS et à la BIRT (p < 0,001). Il existe donc une association entre motivation et apathie chez des patients souffrant de schizophrénie montrant que plus les patients sont apathiques, moins ils sont motivés. Une meilleure compréhension de cette symptomatologie négative doit permettre le développement de stratégies thérapeutiques spécifiques.
Both psychotherapy and pharmacotherapy approaches are needed to a successful treatment of tobacco addiction. Until now, bupropion and nicotine substitutes where the more important pharmacological agents, but things are becoming to change.
The authors make a review about the new drugs available.
Varenicline tartrate has been approved by FDA in May of 2006, and preliminary studies of efficacy reveal percentages of tobacco cessation even higher than bupropion. Rimonabant is another new drug with potential utility in tobacco addiction. It is the first selective blocker of canabinoid receptors CB1. Selegiline and Topiramate can be useful in cases of comorbidity or resistance to other drugs, but they need more studies to establish their utility in treatment of tobacco addiction. Antinicotine vaccines are also been discussed, because they could reduce the cerebral distribution of nicotine, and then act in the positive reinforcement of tobacco addiction.
Varenicline and rimonabant are two promising drugs in farmacological treatment of tobacco addiction
The general population prevalence and incidence of late-life agoraphobia was estimated and its clinical characteristics and risk factors described using data from the French ESPRIT study. One thousand nine hundred and sixty-eight persons aged 65 and above were randomly recruited from the electoral rolls of the district of Montpellier. Prevalent and incident agoraphobia diagnosed by a standardized psychiatric examination and validated by a clinical panel was assessed at base-line and over 4-year follow-up. The one-month prevalence of agoraphobia was estimated at 10.4% of whom 10.9% reported having the first-episode at age 65 or over. During the 4-year follow-up 11.2% of participants without agoraphobia at base line were classified as cases giving an incident rate of 32 per 1000 person-years. These 132 incident late-onset cases were associated with higher incident rates of anxiety disorders and suicidal ideation. Only two incident cases had past or concurrent panic attacks, which was not significantly different from non-cases. The principal base-line risk factors for incident cases derived from a multivariate model incorporating all significant risk factors were younger age of onset (OR = 0.94; 95% CI 0.90–0.99, P = 0.02), poorer visuospatial memory performance (OR = 1.60; 95% CI 1.02–2.49, P = 0.04), severe depression (OR = 2.62; 95% CI 1.34–5.10, P = 0.005) and trait anxiety (OR = 1.73; 95% CI 1.03–2.90, P = 0.04). No significant association was found with cardiac pathologies. We conclude that agoraphobia has high prevalence in the elderly and unlike younger cases, late-onset cases are not more common in women, and are not associated with panic attacks, suggesting a late-life subtype. Severe depression, trait anxiety and poor visuospatial memory are the principal risk factors for late-onset agoraphobia.
Nowadays, the lesbian, gay and bisexual (LGB) community still suffers from prejudice and social stigma, including from medical professionals.
Thus, it is urgent to draw attention to this population since these individuals have an increased risk of mental disorders, substance abuse and dependence, suicidal ideation and suicide attempt or complete suicide.
To underline the prevalence of mental disorders and increased suicide risk in the LGB population.
To summarize the latest literature about this field.
A brief review of the latest literature was performed on PubMed using the keywords “mental health”, “suicidal risk”, “LGB population”.
LGB individuals appear to be at increased risk of mental disorders and suicidal behavior than heterosexuals. According to Meyer, they are exposed to what is called the minority stress: proximal, depending on the subject and related to fear of rejection and internalized homophobia and distal, regardless of the individual including prejudice, social stress, social exclusion (including their own families) and violence.
The odds of attempting suicide are approximately 2 to 7 times higher for lesbians, gay men and bisexuals (LGBs) than for heterosexuals.
Minority stress related to prejudice and stigma against LGB people has a significant risk that can be related to suicide ideation and attempt.
The higher rate of many psychiatric conditions noted in this community underscores the need for clinicians to provide nonjudgmental care and approachable environment.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Evidence suggests that somatic rather than cognitive depressive symptoms are risk factors for recurrent cardiac events in at-risk patients. However, this has never been explored using a time-dependent approach in a narrow time-frame, allowing a cardiac event-free time-window.
The analysis was performed on 595 participants [70.6% male, median age 72 (27–98)] drawn from the UPBEAT-UK heart disease patient cohort with 6-monthly follow-ups over 3 years. Depressive symptomatology was measured using the Patient Health Questionnaire-9 (PHQ-9) (four somatic, five cognitive items). New cardiac events (NCEs) including cardiac-related mortality were identified by expert examination of patient records. Analyses were performed using Cox proportional hazard models with delayed entry, with time-dependent depressive dimensions and covariates measured 12–18 months (median: 14.1, IQR: 3.5) prior to the event, with a 12-month cardiac event-free gap.
There were 95 NCEs during the follow-up [median time-to-event from baseline: 22.3 months (IQR: 13.4)]. Both the somatic (HR 1.12, 95% CI 1.05–1.20, p = 0.001) and cognitive dimensions (HR 1.11, 95% CI 1.03–1.18, p = 0.004) were time-dependent risk factors for an NCE in the multi-adjusted models. Specific symptoms (poor appetite/overeating for the somatic dimension, hopelessness and feeling like a failure for the cognitive dimension) were also significantly associated.
This is the first study of the association between depressive symptom dimensions and NCEs in at-risk patients using a time-to-event standardised approach. Both dimensions considered apart were independent predictors of an NCE, along with specific items, suggesting regular assessments and tailored interventions targeting specific depressive symptoms may help to prevent NCEs in at-risk populations.
To explore food perceptions among grandparents and understand the influence of these perceptions on food choice for the younger generations in their family.
Qualitative methodology, thematic analysis of the transcripts from fourteen focus groups.
Grandparents in the southern region of the United States.
Participants were fifty-eight Black, Hispanic, and White grandparents, predominantly women (72%), ranging in age from 44–86 years (mean age = 65·4 (sd 9·97) years).
Grandparents’ perceptions related to personal food choice were related to health issues and the media. Grandparents’ perceived influence on their children’s and grandchildren’s food choices was described through the themes of proximity and power (level of influence based on an interaction of geographic proximity to grandchildren and the power given to them by their children and grandchildren to make food decisions), healthy v. unhealthy spoiling, cultural food tradition, and reciprocal exchange of knowledge.
Our results highlight areas for future research including nutrition interventions for older adults as well as factors that may be helpful to consider when engaging grandparents concerning food decisions for younger generations to promote health. Specifically, power should be assessed as part of a holistic approach to addressing dietary influence, the term ‘healthy spoiling’ can be used to reframe notions of traditional spoiling, and the role of cultural food tradition should be adapted differently by race.
The article systematically assesses U.S.-Native relations today and their historical foundations in light of a narrow, empirical definition of colonial empire. Examining three core elements of colonial empire—the formal impairment of sovereignty, the intensive practical impairment of sovereignty through practices of governance and administration, and the continuing otherness of the dominated and dominant groups—we compare contemporary U.S.-Native political relations to canonical instances of formal colonial indirect rule empires. Based on this analysis, we argue that the United States today is a paradigmatic case of formal colonial empire in the narrow, traditional sense, one that should be better integrated into the comparative, historical, and sociological study of such formal empires. Furthermore, this prominent contemporary case stands against the idea that the era of formal colonial empire is over.
Objectives: Prior research has identified numerous genetic (including sex), education, health, and lifestyle factors that predict cognitive decline. Traditional model selection approaches (e.g., backward or stepwise selection) attempt to find one model that best fits the observed data, risking interpretations that only the selected predictors are important. In reality, several predictor combinations may fit similarly well but result in different conclusions (e.g., about size and significance of parameter estimates). In this study, we describe an alternative method, Information-Theoretic (IT) model averaging, and apply it to characterize a set of complex interactions in a longitudinal study on cognitive decline. Methods: Here, we used longitudinal cognitive data from 1256 late–middle aged adults from the Wisconsin Registry for Alzheimer’s Prevention study to examine the effects of sex, apolipoprotein E (APOE) ɛ4 allele (non-modifiable factors), and literacy achievement (modifiable) on cognitive decline. For each outcome, we applied IT model averaging to a set of models with different combinations of interactions among sex, APOE, literacy, and age. Results: For a list-learning test, model-averaged results showed better performance for women versus men, with faster decline among men; increased literacy was associated with better performance, particularly among men. APOE had less of an association with cognitive performance in this age range (∼40–70 years). Conclusions: These results illustrate the utility of the IT approach and point to literacy as a potential modifier of cognitive decline. Whether the protective effect of literacy is due to educational attainment or intrinsic verbal intellectual ability is the topic of ongoing work. (JINS, 2019, 25, 119–133)
Background: Down Syndrome (DS) has a mosaicism of presentations, but a number of common features. Cerebral evoked potentials (somatosensory, visual and auditory) can be higher in amplitude in DS. The aim of this study is to explore the value of the neurophysiological amplitude of three different modalities in DS individuals undergoing spinal surgery, or epilepsy evaluation. Methods: Standard procedure of EEG evaluation was conducted. We routinely monitor somatosensory (SSEP) and motor evoked potentials (MEP), using peripheral nerves stimulation and transcranial electrical stimulation during surgery. We report findings from 14 DS individuals age-matched to 14 individuals with idiopathic scoliosis Results: The amplitude of the SSEP is significantly higher in DS individuals than in age-matched controls using the same parameters. SSEP;10.2±2.5µV vs 2.4±2.3µV (p<0.05, paired t-test). The threshold for eliciting MEPs was also significantly lower in DS in comparison to controls, 175±20V vs 629±100V, (p<0.05, paired t-test). Interictal EEG showed high amplitude spike and waves, and greater intracortical coherence in DS with epilepsy than non-DS patients Conclusions: Robust neurophysiological findings showed high amplitude sensory evoked potentials, low threshold motor evoked potentials, and high amplitude spikes and wave, all reflect a common process of increased neuronal synchronicity and oscillatory behaviour in Down Syndrome.