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Two types of mentalization-based treatment (MBT), day hospital MBT (MBT-DH) and intensive outpatient MBT (MBT-IOP), have been shown to be effective in treating patients with borderline personality disorder (BPD). This study evaluated trajectories of change in a multi-site trial of MBT-DH and MBT-IOP at 36 months after the start of treatment.
All 114 patients (MBT-DH n = 70, MBT-IOP n = 44) from the original multicentre trial were assessed at 24, 30 and 36 months after the start of treatment. The primary outcome was symptom severity measured with the Brief Symptom Inventory. Secondary outcome measures included borderline symptomatology, personality and interpersonal functioning, quality of life and self-harm. Data were analysed using multilevel modelling and the intention-to-treat principle.
Patients in both MBT-DH and MBT-IOP maintained the substantial improvements made during the intensive treatment phase and showed further gains during follow-up. Across both conditions, 83% of patients improved in terms of symptom severity, and 97% improved on borderline symptomatology. No significant differences were found between MBT-DH and MBT-IOP at 36 months after the start of treatment. However, trajectories of change were different. Whereas patients in MBT-DH showed greater improvement during the intensive treatment phase, patients in MBT-IOP showed greater continuing improvement during follow-up.
Patients in both conditions showed similar large improvements over the course of 36 months, despite large differences in treatment intensity. MBT-DH and MBT-IOP were associated with different trajectories of change. Cost-effectiveness considerations and predictors of differential treatment outcome may further inform optimal treatment selection.
Autism spectrum disorder (ASD) symptoms and attention deficit/ hyperactivity disorder (ADHD) symptoms are frequently comorbid with obsessive-compulsive disorder (OCD). However, limited research exists with respect to the relations between these symptoms, and their impact on OC symptom severity.
109 outpatients with primary OCD and 87 healthy controls were administered OCD, ADHD, and ASD questionnaires. Univariate analyses, correlations, and stepwise regression analyses were conducted.
OCD, ADHD, and autism symptoms were highly correlated, with OCD patients showing elevated ADHD as well as autism scores when compared with healthy controls. OCD patients with comorbid ADHD presented with higher autism symptoms and OCD symptoms, yet similar OCD severity scores as OCD without ADHD patients. the attention switching and lack of social skills subscales of the Autism Questionnaire (AQ) were particularly correlated with ADHD and OCD symptoms in the patient group. the AQ subscale attention switching proved to be the most significant predictor of OCD severity and symptoms (with the exception of hoarding). Contrary to expectations, the AQ subscale attention to detail did not predict OCD symptoms, nor did any of the AQ subscale scores predict hoarding symptoms.
OCD patients present with elevated scores of ADHD and ASD symptoms, and these symptoms (particularly attention switching) are important in predicting OC symptoms and severity. It is suggested that problems in attention may be related to the uncertainty about one's own memory as demonstrated by OCDs patients, as well as a common factor underlying comorbid ADHD and ASD symptoms.
The cause of depression is largely unknown, but several studies point to disturbances of biological rhythmicity. The functioning of the suprachiasmatic nucleus (SCN) is impaired, as evidenced by an increased prevalence of day-night rhythm perturbations, such as sleeping disorders. Moreover, the inhibitory SCN neurons on the hypothalamus-pituitary adrenocortical axis (HPA-axis) have decreased activity and HPA-activity is enhanced, when compared to non-depressed elderly. Using bright light therapy (BLT) the SCN can be stimulated. In addition, the beneficial effects of BLT on seasonal depression are well accepted. BLT is a potentially safe, nonexpensive and well accepted treatment option. But the current literature on BLT for depression is inconclusive.
RCT (ClinicalTrials.gov identifier: NCT00332670) in 89 subjects, of 60 years and older with a diagnosis of major depressive disorder. After inclusion subjects were randomly allocated to the active (BLT) vs. placebo (dim red light) condition. just before the start of light therapy, after completion of three weeks therapy period, and three weeks thereafter several endocrinological, psychophysiological, psychometrically, neuropsychological measures are performed:
Main effect analyses on HADRS-17 scores revealed significant antidepressant effects from BLT. Primary results will be presented.
BLT reduces nonseasonal depression in elderly patients. Additional lightning may easily be implemented in the homes of patients to serve as add-on treatment to antidepressants or as a stand-alone treatment in elderly depressed patients. Our data support the role of a dysfunctional biological clock in depressed elderly subjects, such a finding may guide further development of novel chronobiological oriented treatment strategies.
The association between depression and metabolic syndrome is becoming more obvious.
We examined the relationship between the number and individual components of metabolic syndrome and late-life depressive symptom clusters.
In 1279 individuals aged 50 through 70 participating in the Nijmegen Biomedical Study (Cross-sectional populationbased survey), we measured all metabolic syndrome components and depressive symptoms using the Beck Depression Inventory (BDI). Principal components analysis of BDI-items yielded two factors, representing a cognitive-affective and a somatic-affective symptom-cluster. Multiple regression analyses adjusted for confounders were conducted with BDI sum score and both depression symptom-clusters as dependent variables, respectively. We explored the differences in this association between men and women.
In fully adjusted models, both presence of the metabolic syndrome as well as number of components was associated with the BDI sumscore(resp. β=0.063;p=0.022 vs. β=0.112;p< 0.001), the latter showing the strongest association. These associations were primarily driven by the somatic-affective symptom-cluster. Testing individual components of the metabolic syndrome, showed that in men waist circumference, triglycerides and HDL cholesterol were significantly associated with depression, whereas in women only the waist circumference.
The specific association somatic-affective symptoms suggest confounding by a (subclinical) somatic condition in stead of a real association with classical depression. The identified sex-differences suggest different pathways between depression and metabolic perturbations in men only. However, as vascular disease develops at higher ages in women and findings were in the same direction but non-significant in women, future research in older women sample should confirm our findings.
There is increasing interest in day-to-day affect fluctuations of patients with depressive and anxiety disorders. Few studies have compared repeated assessments of positive affect (PA) and negative affect (NA) across diagnostic groups, and fluctuation patterns were not uniformly defined. The aim of this study is to compare affect fluctuations in patients with a current episode of depressive or anxiety disorder, in remitted patients and in controls, using affect instability as a core concept but also describing other measures of variability and adjusting for possible confounders.
Ecological momentary assessment (EMA) data were obtained from 365 participants of the Netherlands Study of Depression and Anxiety with current (n = 95), remitted (n = 178) or no (n = 92) DSM-IV defined depression/anxiety disorder. For 2 weeks, five times per day, participants filled-out items on PA and NA. Affect instability was calculated as the root mean square of successive differences (RMSSD). Tests on group differences in RMSSD, within-person variance, and autocorrelation were performed, controlling for mean affect levels.
Current depression/anxiety patients had the highest affect instability in both PA and NA, followed by remitters and then controls. Instability differences between groups remained significant when controlling for mean affect levels, but differences between current and remitted were no longer significant.
Patients with a current disorder have higher instability of NA and PA than remitted patients and controls. Especially with regard to NA, this could be interpreted as patients with a current disorder being more sensitive to internal and external stressors and having suboptimal affect regulation.
Depression is a prevalent and impairing condition. Behavioral activation (BA) is a parsimonious, cost-effective, and easily disseminated psychological intervention for depression. The current meta-analysis expands on the existing literature supporting the efficacy of BA for depression by examining the effects of BA on additional relevant outcomes for patients with depression, namely the reduction in anxiety symptoms and increase in activation.
Randomized controlled trials of BA for depression compared to active and inactive control were identified via a systematic review. Effect sizes using Hedges's g were calculated for each outcome compared to both active and inactive control using random effects models. Subgroup analyses were used to examine the inclusion of a discussion of values as a moderator of depression symptom outcome in BA.
Twenty-eight studies were included. Meta-analyses of symptom change between groups from baseline-to-post intervention indicated that BA outperformed inactive control conditions for improvements in depression (g = 0.83), anxiety (g = 0.37), and activation (g = 0.64). The difference between BA and active control conditions was not significant for improvements in depression (g = 0.15), anxiety (g = 0.03), and activation (g = 0.04). There was no evidence for a discussion of values augmenting BA efficacy. Study quality was generally low, and there was evidence of publication bias.
In addition to improving depression, BA shows efficacy for reducing symptoms of anxiety and increasing activation. BA may not offer better outcomes relative to other active interventions. There is room for improvement in the quality of research in this area.
Major depressive disorder (MDD) is a common mood disorder, with a heritability of around 34%. Molecular genetic studies made significant progress and identified genetic markers associated with the risk of MDD; however, progress is slowed down by substantial heterogeneity as MDD is assessed differently across international cohorts. Here, we used a standardized online approach to measure MDD in multiple cohorts in the Netherlands and evaluated whether this approach can be used in epidemiological and genetic association studies of depression.
Within the Biobank Netherlands Internet Collaboration (BIONIC) project, we collected MDD data in eight cohorts involving 31 936 participants, using the online Lifetime Depression Assessment Self-report (LIDAS), and estimated the prevalence of current and lifetime MDD in 22 623 unrelated individuals. In a large Netherlands Twin Register (NTR) twin-family dataset (n ≈ 18 000), we estimated the heritability of MDD, and the prediction of MDD in a subset (n = 4782) through Polygenic Risk Score (PRS).
Estimates of current and lifetime MDD prevalence were 6.7% and 18.1%, respectively, in line with population estimates based on validated psychiatric interviews. In the NTR heritability estimates were 0.34/0.30 (s.e. = 0.02/0.02) for current/lifetime MDD, respectively, showing that the LIDAS gives similar heritability rates for MDD as reported in the literature. The PRS predicted risk of MDD (OR 1.23, 95% CI 1.15–1.32, R2 = 1.47%).
By assessing MDD status in the Netherlands using the LIDAS instrument, we were able to confirm previously reported MDD prevalence and heritability estimates, which suggests that this instrument can be used in epidemiological and genetic association studies of depression.
Technological progress has enabled researchers to use new unobtrusive measures of relationships between actors in social network analysis. However, research on how these unobtrusive measures of peer connections relate to traditional sociometric nominations in adolescents is scarce. Therefore, the current study compared traditional peer nominated networks with more unobtrusive measures of peer connections: Communication networks that consist of instant messages in an online social platform and proximity networks based on smartphones’ Bluetooth signals that measure peer proximity. The three social network types were compared in their coverage, stability, overlap, and the extent to which the networks exhibit the often observed sex segregation in adolescent social networks.
Two samples were derived from the MyMovez project: a longitudinal sample of 444 adolescents who participated in the first three waves of the first year of the project (Y1; 51% male; Mage = 11.29, SDage = 1.26) and a cross-sectional sample of 774 adolescents that participated in fifth wave in the third year (Y3; 48% male; Mage = 10.76, SDage = 1.23). In the project, all participants received a research smartphone and a wrist-worn accelerometer. On the research smartphone, participants received daily questionnaires such as peer nomination questions (i.e., nominated network). In addition, the smartphone automatically scanned for other smartphones via Bluetooth signal every 15 minutes of the day (i.e., proximity network). In the Y3 sample, the research smartphone also had a social platform in which participants could send messages to each other (i.e., communication network).
The results show that nominated networks provided data for the most participants compared to the other two networks, but in these networks, participants had the lowest number of connections with peers. Nominated networks showed to be more stable over time compared to proximity or communication networks. That is, more connections remained the same in nominated networks than in proximity networks over the three waves of Y1. The overlap between the three networks was rather small, indicating that the networks measured different types of connections. Nominated and communication networks were segregated by sex, whereas this was less the case in proximity networks.
The communication and proximity networks seem to be promising unobtrusive measures of peer connections and are less of a burden to the participant compared to a nominated network. However, given the structural differences between the networks and the number of connections per wave, the communication and proximity networks should not be used as direct substitutes for sociometric nominations, and researchers should bear in mind what type of connections they wish to assess.
Bithynids snails are a widespread group of molluscs in European freshwater systems. However, not much information is available on trematode communities from molluscs of this family. Here, we investigate the trematode diversity of Bithynia tentaculata, based on molecular and morphological data. A total of 682 snails from the rivers Lippe and Rhine in North Rhine-Westphalia, Germany, and 121 B. tentaculata from Curonian Lagoon, Lithuania were screened for infections with digeneans. In total, B. tentaculata showed a trematode prevalence of 12.9% and 14%, respectively. The phylogenetic analyses based on 55 novel sequences for 36 isolates demonstrated a high diversity of digeneans. Analyses of the molecular and morphological data revealed a species-rich trematode fauna, comprising 20 species, belonging to ten families. Interestingly, the larval trematode community of B. tentaculata shows little overlap with the well-studied trematode fauna of lymnaeids and planorbids, and some of the detected species (Echinochasmus beleocephalus and E. coaxatus) constitute first records for B. tentaculata in Central Europe. Our study revealed an abundant, diverse and distinct trematode fauna in B. tentaculata, which highlights the need for further research on this so far understudied host–parasite system. Therefore, we might currently be underestimating the ecological roles of several parasite communities of non-pulmonate snail host families in European fresh waters.
Despite their claimed advantages, toehold strategies have rarely been adopted in recent corporate takeovers and do not seem to increase acquirer returns. Are toeholds ineffective and becoming obsolete? We show that this is not the case. We find that toeholds are preferred for executing difficult takeovers. After controlling for such endogeneity in toehold-based acquisitions, toeholds do increase returns to acquirers. Moreover, the performance of toehold strategies improves over time due to more selective and more effective acquisition of toeholds. We find that this time trend is in part explained by learning from past toehold acquisitions.
The science of studying diamond inclusions for understanding Earth history has developed significantly over the past decades, with new instrumentation and techniques applied to diamond sample archives revealing the stories contained within diamond inclusions. This chapter reviews what diamonds can tell us about the deep carbon cycle over the course of Earth’s history. It reviews how the geochemistry of diamonds and their inclusions inform us about the deep carbon cycle, the origin of the diamonds in Earth’s mantle, and the evolution of diamonds through time.
The effects of roughness on the frictional drag and pressure drop in laminar channel flow are investigated numerically. The inflow is fully developed smooth wall flow, and square rib roughness, aligned normal to the bulk flow direction, is introduced as a step change. The roughness height and spacing are systematically varied, and the flow is examined as it develops over the rough wall and becomes fully developed. The length of the development region depends primarily on the roughness height, although the effects of spacing become more important as the height decreases. In the fully developed rough wall regime, the friction coefficients always increase with roughness when compared to the smooth wall case, but the increase depends crucially on the roughness height and to a lesser extent on the spacing. Using the constricted diameter in the definition of the friction factor collapses the data on the smooth wall value to within 10 % for all roughnesses studied here, with the remaining deviation increasing linearly with roughness spacing. The friction factors scale with the inverse of the Reynolds number, as seen elsewhere. The scaling of the development length and the friction coefficient can be explained by the relative contributions made by the pressure drop on each element and the skin friction acting over the surface area. These observations are examined in terms of the flow patterns in the vicinity of the roughness elements, which leads us to propose a definition for fully rough laminar flow.
Theory and modelling remain central to improving our understanding of undulatory and oscillatory swimming. Simple models based on added mass can help to give great insight into the mechanics of undulatory swimming, as demonstrated by animals such as eels, stingrays and knifefish. To understand the swimming of oscillatory swimmers such as tuna and dolphins, models need to consider both added mass forces and circulatory forces. For all types of swimming, experiments and theory agree that the most important velocity scale is the characteristic lateral velocity of the tail motion rather than the swimming speed, which erases to a large extent the difference between results obtained in a tethered mode, compared to those obtained using a free swimming condition. There is no one-to-one connection between the integrated swimming performance and the details of the wake structure, in that similar levels of efficiency can occur with very different wake structures. Flexibility and viscous effects play crucial roles in determining the efficiency, and for isolated propulsors changing the profile shape can significantly improve both thrust and efficiency. Also, combined heave and pitch motions with an appropriate phase difference are essential to achieve high performance. Reducing the aspect ratio will always reduce thrust and efficiency, but its effects are now reasonably well understood. Planform shape can have an important mitigating influence, as do non-sinusoidal gaits and intermittent actuation.
Studies on neighbourhood characteristics and depression show equivocal results.
This large-scale pooled analysis examines whether urbanisation, socioeconomic, physical and social neighbourhood characteristics are associated with the prevalence and severity of depression.
Cross-sectional design including data are from eight Dutch cohort studies (n= 32 487). Prevalence of depression, either DSM-IV diagnosis of depressive disorder or scoring for moderately severe depression on symptom scales, and continuous depression severity scores were analysed. Neighbourhood characteristics were linked using postal codes and included (a) urbanisation grade, (b) socioeconomic characteristics: socioeconomic status, home value, social security beneficiaries and non-Dutch ancestry, (c) physical characteristics: air pollution, traffic noise and availability of green space and water, and (d) social characteristics: social cohesion and safety. Multilevel regression analyses were adjusted for the individual's age, gender, educational level and income. Cohort-specific estimates were pooled using random-effects analysis.
The pooled analysis showed that higher urbanisation grade (odds ratio (OR) = 1.05, 95% CI 1.01–1.10), lower socioeconomic status (OR = 0.90, 95% CI 0.87–0.95), higher number of social security beneficiaries (OR = 1.12, 95% CI 1.06–1.19), higher percentage of non-Dutch residents (OR = 1.08, 95% CI 1.02–1.14), higher levels of air pollution (OR = 1.07, 95% CI 1.01–1.12), less green space (OR = 0.94, 95% CI 0.88–0.99) and less social safety (OR = 0.92, 95% CI 0.88–0.97) were associated with higher prevalence of depression. All four socioeconomic neighbourhood characteristics and social safety were also consistently associated with continuous depression severity scores.
This large-scale pooled analysis across eight Dutch cohort studies shows that urbanisation and various socioeconomic, physical and social neighbourhood characteristics are associated with depression, indicating that a wide range of environmental aspects may relate to poor mental health.
Background. Frequency and quantity of alcohol consumption are metrics commonly used to measure alcohol consumption behaviors. Epidemiological studies indicate that these alcohol consumption measures are differentially associated with (mental) health outcomes and socioeconomic status (SES). The current study aims to elucidate to what extent genetic risk factors are shared between frequency and quantity of alcohol consumption, and how these alcohol consumption measures are genetically associated with four broad phenotypic categories: (i) SES; (ii) substance use disorders; (iii) other psychiatric disorders; and (iv) psychological/personality traits.
Methods. Genome-Wide Association analyses were conducted to test genetic associations with alcohol consumption frequency (N = 438 308) and alcohol consumption quantity (N = 307 098 regular alcohol drinkers) within UK Biobank. For the other phenotypes, we used genome-wide association studies summary statistics. Genetic correlations (rg) between the alcohol measures and other phenotypes were estimated using LD score regression.
Results. We found a substantial genetic correlation between the frequency and quantity of alcohol consumption (rg = 0.52). Nevertheless, both measures consistently showed opposite genetic correlations with SES traits, and many substance use, psychiatric, and psychological/personality traits. High alcohol consumption frequency was genetically associated with high SES and low risk of substance use disorders and other psychiatric disorders, whereas the opposite applies for high alcohol consumption quantity.
Conclusions. Although the frequency and quantity of alcohol consumption show substantial genetic overlap, they consistently show opposite patterns of genetic associations with SES-related phenotypes. Future studies should carefully consider the potential influence of SES on the shared genetic etiology between alcohol and adverse (mental) health outcomes.
Two types of mentalisation-based treatment (MBT) have been developed and empirically evaluated for borderline personality disorder (BPD): day hospital MBT (MBT-DH) and intensive out-patient MBT (MBT-IOP). No trial has yet compared their efficacy.
To compare the efficacy of MBT-DH and MBT-IOP 18 months after start of treatment. MBT-DH was hypothesised to be superior to MBT-IOP because of its higher treatment intensity.
In a multicentre randomised controlled trial (Nederlands Trial Register: NTR2292) conducted at three sites in the Netherlands, patients with BPD were randomly assigned to MBT-DH (n = 70) or MBT-IOP (n = 44). The primary outcome was symptom severity (Brief Symptom Inventory). Secondary outcome measures included borderline symptomatology, personality functioning, interpersonal functioning, quality of life and self-harm. Patients were assessed every 6 months from baseline to 18 months after start of treatment. Data were analysed using multilevel modelling based on intention-to-treat principles.
Significant improvements were found on all outcome measures, with moderate to very large effect sizes for both groups. MBT-DH was not superior to MBT-IOP on the primary outcome measure, but MBT-DH showed a clear tendency towards superiority on secondary outcomes.
Although MBT-DH was not superior to MBT-IOP on the primary outcome measure despite its greater treatment intensity, MBT-DH showed a tendency to be more effective on secondary outcomes, particularly in terms of relational functioning. Patients receiving MBT-DH and MBT-IOP, thus, seem to follow different trajectories of change, which may have important implications for clinical decision-making. Longer-term follow-up and cost-effectiveness considerations may ultimately determine the optimal intensity of specialised treatments such as MBT for patients with BPD.
Atherosclerotic changes can be measured as changes in common carotid intima media thickness (CIMT). It is hypothesised that repeated infection-associated inflammatory responses in childhood contribute to the atherosclerotic process. We set out to determine whether the frequency of infectious diseases in childhood is associated with CIMT in adolescence. The study is part of the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) population-based birth cohort. At age 16 years, common CIMT was measured. We collected general practitioner (GP) diagnosed infections and prescribed antibiotics. Parent-reported infections were retrieved from annual questionnaires. Linear regression analysis assessed the association between number of infections during the first 4 years of life and common CIMT. Common CIMT measurement, GP and questionnaire data were available for 221 participants. No association was observed between the infection measures and CIMT. In a subgroup analysis, significant positive associations with CIMT were observed in participants with low parental education for 2–3 or ⩾7 GP diagnosed infections (+26.4 µm, 95% CI 0.4–52.4 and +26.8 µm, 95% CI 3.6–49.9, respectively) and ⩾3 antibiotic prescriptions (+35.5 µm, 95%CI 15.8–55.3). Overall, early childhood infections were not associated with common CIMT in adolescence. However, a higher number of childhood infections might contribute to the inflammatory process of atherosclerosis in subgroups with low education, this needs to be confirmed in future studies.
Fully resolved measurements of turbulent boundary layers are reported for the Reynolds number range
. Despite several decades of research in wall-bounded turbulence there is still controversy over the behaviour of streamwise turbulence intensities near the wall, especially at high Reynolds numbers. Much of it stems from the uncertainty in measurement due to finite spatial resolution. Conventional hot-wire anemometry is limited for high Reynolds number measurements due to limited spatial resolution issues that cause attenuation in the streamwise turbulence intensity profile near the wall. To address this issue we use the nano-scale thermal anemometry probe (NSTAP), developed at Princeton University to conduct velocity measurements in the high Reynolds number boundary layer facility at the University of Melbourne. The NSTAP has a sensing length almost one order of magnitude smaller than conventional hot-wires. This enables us to acquire fully resolved velocity measurements of turbulent boundary layers up to
. Results show that in the near-wall region, the viscous-scaled streamwise turbulence intensity grows with
in the Reynolds number range of the experiments. A second outer peak in the streamwise turbulence intensity is also shown to emerge at the highest Reynolds numbers. Moreover, the energy spectra in the near-wall region show excellent inner scaling over the small to moderate wavelength range, followed by a large-scale influence that increases with Reynolds number. Outer scaling in the outer region is found to collapse the energy spectra over high wavelengths across various Reynolds numbers.