To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The metabolic management of patients on cardiopulmonary bypass (CPB) is a complex process, involving several key biochemical and physiological parameters essential to maintaining homeostasis and reducing morbidity and mortality associated with CPB and cardiac surgery. There is movement toward goal directed perfusion (GDP), using indexed parameters such as carbon dioxide production, oxygen delivery and oxygen consumption to individualize perfusion strategies. This chapter provides an overview of the fundamental principles surrounding the metabolic management of the patient on CPB.
Voice hearing occurs across a number of psychiatric diagnoses and appears to be present on a continuum within the general population. Previous research has highlighted the potential role of past experiences of shame in proneness to voice hearing in the general population.
This study aimed to extend this past research and compare people with distressing voices, people with voices but no distress, and a non-voice hearing control group, on various dimensions of shame and shame memory characteristics.
In a cross-sectional, online study 39 distressed voice hearers, 31 non-distressed voice hearers and 50 non-voice hearers undertook a shame memory priming task in which they were prompted to recall a memory of a shaming experience from their past. They then completed questionnaires assessing the characteristics of the recalled shame event and the psychological sequalae of this event (i.e. intrusions, hyperarousal, avoidance, the centrality of shame memories, external shame, and self-criticism).
The majority of recalled shame memories involved experiences such as interpersonal criticism or experiences of being devalued. Univariate analyses found no significant differences between the three groups with regard to the shame events that were recalled, but the distressed voice hearer group reported significantly more hyperarousal, intrusions, self-criticism, and external shame in relation to their experience.
The findings suggest that voice hearers recall similar types of shame experiences to non-voice hearers, but that problematic psychological sequelae of these shame experiences (in the form of intrusive memories, hyperarousal, external shame, and self-criticism) may specifically contribute to distressing voice hearing.
Cognitive deficits may be characteristic for only a subgroup of first-episode psychosis (FEP) and the link with clinical and functional outcomes is less profound than previously thought. This study aimed to identify cognitive subgroups in a large sample of FEP using a clustering approach with healthy controls as a reference group, subsequently linking cognitive subgroups to clinical and functional outcomes.
204 FEP patients were included. Hierarchical cluster analysis was performed using baseline brief assessment of cognition in schizophrenia (BACS). Cognitive subgroups were compared to 40 controls and linked to longitudinal clinical and functional outcomes (PANSS, GAF, self-reported WHODAS 2.0) up to 12-month follow-up.
Three distinct cognitive clusters emerged: relative to controls, we found one cluster with preserved cognition (n = 76), one moderately impaired cluster (n = 74) and one severely impaired cluster (n = 54). Patients with severely impaired cognition had more severe clinical symptoms at baseline, 6- and 12-month follow-up as compared to patients with preserved cognition. General functioning (GAF) in the severely impaired cluster was significantly lower than in those with preserved cognition at baseline and showed trend-level effects at 6- and 12-month follow-up. No significant differences in self-reported functional outcome (WHODAS 2.0) were present.
Current results demonstrate the existence of three distinct cognitive subgroups, corresponding with clinical outcome at baseline, 6- and 12-month follow-up. Importantly, the cognitively preserved subgroup was larger than the severely impaired group. Early identification of discrete cognitive profiles can offer valuable information about the clinical outcome but may not be relevant in predicting self-reported functional outcomes.
Galeaclolusite, [Al6(AsO4)3(OH)9(H2O)4]⋅8H2O, is a new secondary hydrated aluminium arsenate mineral from Cap Garonne, Var, France. It forms crusts and spheroids of white fibres up to 50 μm long by 0.4 μm wide and only 0.1 μm thick. The fibres are elongated along  and flattened on (100). The calculated density is 2.27 g⋅cm–3. Optically, galeaclolusite is biaxial with α = 1.550(5), β not determined, γ = 1.570(5) (white light) and partial orientation: Z = c (fibre axis). Electron microprobe analyses coupled with crystal structure refinement results gives an empirical formula based on 33 O atoms of Al5.72Si0.08As2.88O33H34.12. Galeaclolusite is orthorhombic, Pnma, with a = 19.855(4), b = 17.6933(11), c = 7.7799(5) Å, V = 2733.0(7) Å3 and Z = 4. The crystal structure of galeaclolusite was established from its close relationship to bulachite and refined using synchrotron powder X-ray diffraction data. It is based on heteropolyhedral layers, parallel to (100), of composition Al6(AsO4)3(OH)9(H2O)4 and with H-bonded H2O between the layers. The layers contain  spiral chains of edge-shared octahedra, decorated with corner-connected AsO4 tetrahedra, that are the same as in the mineral liskeardite.
Since the beginning of 2020, the coronavirus disease (COVID-19) pandemic has dramatically influenced almost every aspect of human life. Activities requiring human gatherings have either been postponed, canceled, or held completely virtually. To supplement lack of in-person contact, people have increasingly turned to virtual settings online, advantages of which include increased inclusivity and accessibility and a reduced carbon footprint. However, emerging online technologies cannot fully replace in-person scientific events. In-person meetings are not susceptible to poor Internet connectivity problems, and they provide novel opportunities for socialization, creating new collaborations and sharing ideas. To continue such activities, a hybrid model for scientific events could be a solution offering both in-person and virtual components. While participants can freely choose the mode of their participation, virtual meetings would most benefit those who cannot attend in-person due to the limitations. In-person portions of meetings should be organized with full consideration of prevention and safety strategies, including risk assessment and mitigation, venue and environmental sanitation, participant protection and disease prevention, and promoting the hybrid model. This new way of interaction between scholars can be considered as a part of a resilience system, which was neglected previously and should become a part of routine practice in the scientific community.
Northern Australia is a region where limited information exists on environments at the last glacial maximum (LGM). Girraween Lagoon is located on the central northern coast of Australia and is a site representative of regional tropical savanna woodlands. Girraween Lagoon remained a perennial waterbody throughout the LGM, and as a result retains a complete proxy record of last-glacial climate, vegetation and fire. This study combines independent palynological and geochemical analyses to demonstrate a dramatic reduction in both tree cover and woody richness, and an expansion of grassland, relative to current vegetation at the site. The process of tree decline was primarily controlled by the cool-dry glacial climate and CO2 effects, though more localised site characteristics restricted wetland-associated vegetation. Fire processes played less of a role in determining vegetation than during the Holocene and modern day, with reduced fire activity consistent with significantly lower biomass available to burn. Girraween Lagoon's unique and detailed palaeoecological record provides the opportunity to explore and assess modelling studies of vegetation distribution during the LGM, particularly where a number of different global vegetation and/or climate simulations are inconsistent for northern Australia, and at a range of resolutions.
Poor sleep is a common complaint in postpartum depression (PPD). Depression as well as sleep disturbances may affect parenting functions and mother-infant relationship. The purpose of this study was to examine the relationship between objective sleep data, parenting stress and bonding in PPD.
Forty-five mothers (age: 34.5 ± 5.4 years SD) suffering from PPD were examined 212 ± 156 days (SD) after parturition. Depression was measured by Hamilton Depression Rating Scale (HDRS-ADS) and Beck Depression Inventory (BDI). Parenting stress and bonding were assessed by self report scales, i.e. Parenting Stress Index (PSI) and Postpartum Bonding Questionnaire (PBQ). In a subsample of 10 participants sleep parameters were assessed by actigraphy and sleep logs during seven consecutive days. Actigraphic sleep parameters were put in relation to severity of depression, PSI and PBQ scores.
Poor sleep, i.e. low total sleep time (TST) was negatively correlated to depression (HRDS-ADS) (r = -.63; p < .05). Low TST was associated with poor bonding (r = -.82; p = .02), especially attitudes of “rejection and anger”. Severity of depression (BDI) was correlated with parenting stress (r =.50; p =.005). Mothers with high parenting stress tended to have more difficulties in bonding (r =.65; p =.016). Neither sleep parameters nor parenting stress and bonding were correlated with the infant's age.
In PPD poor sleep should be recognized and treated early, because it is associated to parenting stress and disturbed bonding, which might have a detrimental impact on mother-infant relationship.
The presentation aims at summarizing current knowledge about sleep in children and adolescents and at describing possible factors influencing their sleep.
For preschoolers, there is evidence that objectively assessed (sleep-EEG, actigraphy) poor sleep is associated with increased endocrine activity; this is to say, with increased morning cortisol secretion, an associative pattern observed so far only in adults. Furthermore, poor sleep and increased cortisol secretion are associated with emotional and behavioral difficulties.
During life span, notable changes occur with respect to sleep quantity and quality. Compared to childhood, in adolescence, three prominent changes occur: First, sleep quantity declines from about 10 hours at 10 years of age to between 6.5 and 8.5 hours in older adolescents. Second, a marked shift towards a longer sleep duration and later bed time from school nights to weekend nights is observable. Third, daytime sleepiness (20%) and insomnia symptoms (25%) are common among adolescents.
Among a variety of factors affecting adolescents’ sleep, we could show that negative parenting styles unfavorably influenced adolescents’ sleep quality, suggesting that even 18 years old adolescents may be far away from been emotionally independent from their parents. Furthermore, the so-called weekend-shift was correlated with increased sleepiness during the week, suggesting that irregular sleep schedules may negatively influence sleep quality and daytime functioning.
Last, if compared to healthy controls, children and adolescents after cleft lip and palate (CLP) repair were not at risk reporting sleep difficulties; rather, irrespective of the presence of CLP, sleep was affected by psychological strain.
In depression, changes in EEG sleep measures are well documented findings. However, the predictive value of these alterations for treatment and long-term course of depression still warrants clarification. Therefore, we examined whether the previous course of depression, treatment response during antidepressant therapy, and the long-term outcome in follow-up are associated with sleep regulation. Since the hypothalamic-pituitary-adrenocortical (HPA) system may play a crucial role in depression's neurobiology, we evaluated HPA system function as well.
15 patients (4 men, 11 women; age 43–59) with depression were enrolled in the study. HPA system assessment using the combined DEX/CRH test and sleep EEG studies were conducted at baseline, after a 6 week antidepressant treatment period (trimipramine), and at follow-up, i.e., after 2-10 years.
The previous clinical course, i.e., the number of episodes until baseline, correlated significantly with EEG sleep measures i.e. sleep continuity values, slow wave sleep (SWS) and REM latency.
During treatment sleep continuity values improved and the correlation with the previous long-term course disappeared. The correlation with SWS persisted. The only sleep EEG marker at baseline predictive for treatment response was REM latency.
In the prospective long-term outcome SWS and REM density variables were related to the occurrence of recurrences. These sleep EEG markers correlated closely with HPA system regulation.
The long-term outcome of depression is related to the sleep EEG pattern: SWS and REM density measures may reflect predictive markers for the long-term course. These markers are associated with HPA system regulation.
Patients with obsessive-compulsive disorder (OCD) with the compulsion to wash have fear of contamination or feel contaminated. The compulsion to wash often lasts for hours, so that massive difficulties to cope with everyday life follow. There exist only few data on the aetiology of specific OCD-subgroups as the compulsive disorder to wash. Specific neural correlates of OCD with compulsion to wash have never been analyzed before. Existing neuroimaging data on OCD generally show changes of neural activity in the striatum, orbitofrontal cortex and anterior cingulated gyrus. A dysfunction of frontostriatal loops is supposed as one cause of OCD. From a psychoanalytic point of view OCD with the specific compulsion to wash is related to a suppression of autosexual and aggressive drives.
In our neuroimaging study (fMRI) we compared the neural networks of OCD-patients with the compulsion to wash and healthy controls. We used a picture-paradigm consisting of autosexual, aggressive, disgusting, neutral and water pictures. We were interested in the neural correlates of OCD-patients with compulsion to wash regarding the different affective pictures categories and expected neural differences between patients and controls. Stimuli were taken partly from the IAPS, partly also self- constructed and validated by a control group. First results point at significant differences in neural activity between patients and healthy controls, especially in diseases-related components as autosexual, aggressive and water pictures. OCD-patients used a more extended and more emotional related network of brain structures.
Our study provides new insights into neural correlates of OCD-patients with the compulsion to wash.
Over the past years, studies of unaffected first-degree relatives of schizophrenic patients have reported cognitive deficits in the domains of executive functions, memory, and attention. However, these deficits may rely on lower level information processing deficits. Here, we investigated visual information processing with a visual backward masking task. A vernier target was followed by a grating mask. Observers had to indicate the offset direction of the vernier. We determined the SOA between the vernier and the grating onset for schizophrenic patients, their healthy first order relatives, and a healthy control group. Schizophrenic patients needed SOAs about three times longer than healthy controls to reach a predefined criterion level. Backward masking performance of unaffected relatives was significantly better than the one of patients but significantly worse than performance of controls. This result adds further evidence that low level deficits as determined by visual backward masking are endophenotypes of schizophrenia.
Due to the complexity of psychiatric diseases, endophenotypes are of primary interest in psychiatric research. They are stable markers which are assumed to be related to a small number of genes involved in the pathophysiology of the disease. Visual backward masking (BM), like other parameters measuring early information processing, was proposed to be a reliable marker for schizophrenia. Performance deficits in BM are considerably more pronounced in schizophrenic patients and their unaffected relatives compared to controls. As shown before, in the present study BM performance was significantly worse in schizophrenic patients compared to controls; healthy relatives of schizophrenic patients performed intermediately.
Several candidate genes for schizophrenia including nicotinic receptor α7 subunit (CHRNA7), catechol-O-methyltransferase (COMT), dystrobrevin-binding protein 1 (dysbindin, DTNBP1) and metabotropic glutamate receptor 3 gene (GRM3) were investigated for their association with schizophrenia and BM in two independent samples. A strong and reproducible association was observed for CHRNA7 with both diagnosis of schizophrenia and BM performance. In conclusion, BM is an excellent endophenotype which will likely support the search for further candidate genes and related pathophysiological pathways in schizophrenia. Moreover, CHRNA7 has further supported its important role as one of the main candidate genes for schizophrenia.
Sleep regulation is closely associated to HPA activity. Alterations in both systems may be precursors of psychiatric disorders like depression even at an early stage of development. So far the impact of microstructure in sleep regulation like sleep spindles is unknown. In recent studies, sleep spindles have been linked to efficient cortical-subcortical connectivity and cognitive abilities especially during neurodevelopment.
Sleep spindles in kindergarten children were analyzed and related to sleep regulation and HPA axis functioning.
Patients and Methods: Nine five-year old kindergarten children were enrolled in a cross-sectional examination of HPA system activity assessed by saliva cortisol measurements (morning cortisol after awakening) and sleep regulation investigated by sleep EEG-monitoring. Sleep EEG spindles were visually scored and were put into relation to macrostructural sleep and HPA activity parameters.
Sleep spindles were correlated to basal morning cortisol secretion (AUC basal) (curvilinear r = .83, p = .01), though were negatively correlated to cortisol increase (AUC netto) after awakening (r = -.77, p < .05). Though not statistically significant but by trend, spindle density (i.e. number of spindles per hour of stage 2 -sleep) is negatively correlated to REM density (r = - .57, p = .11), as increase of awakening cortisol was associated to REM density by trend (r = .63, p = .07).
Not only sleep continuation parameters as reported before but also sleep microstructure reflected by sleep spindles may be associated to sleep regulation and HPA system functioning.
Frowning expresses negative emotions like anger, fear, and sadness. According to the facial feedback hypothesis, suppression of frowning will also diminish the corresponding negative emotions. Hence, mood improvement has been observed in patients who underwent treatment of glabellar frown lines with botulinum neurotoxin. This observation suggests the possibility that the intervention may be employed for the management of psychiatric disorders associated with negative emotions. Preliminary data from an open case series indicate that the intervention might improve the symptoms of depression.
Aims & objectives
To test whether an onabotulinumtoxinA injection into the glabellar region is benefical as an adjunctive treatment of major depression within a clinical trial.
We used a randomized, double-blinded, placebo-controlled study design (n = 30; ClinicalTrials.gov, number, NCT00934687).
We show that a single onabotulinumtoxinA treatment shortly leads to a strong and sustained improvement in partly chronic major depression that did not respond sufficiently to previous treatment. As for the primary end-point, Hamilton Depression Rating Scale (HAM-D17) six weeks after treatment compared to baseline, scores of onabotulinumtoxinA recipients showed 37.9% (8.34 points) more improvement than those of placebo-treated participants (F = 12.30, p = 0.002, η2 = 0.31, d = 1.28).
Our findings support the concept that the facial musculature not only expresses, but also regulates, mood states. As it stands, treatment of glabellar frown lines with botulinum neurotoxin can be considered for depressed patients with the objective of inducing mood-lifting effects.
The aim of our study was to investigate social functioning of patients with first psychotic episode and to determine, how cognitive impairment and psychopathological symptoms could influence these functions over the illness duration.
32 patients with first psychotic episode and 32 healthy controls participated in the study. The diagnoses have been made according the DSM IV-criteria. Psychopathological symptoms were assessed by positive (SAPS) and negative (SANS) symptoms assessment scales and brief psychitric rating scale (BPRS). Cognitive functions such as executive functions, sustained attention, visual perseption have been studied by computerised version of the visual backward masking test, the Wisconsin Card Sorting Test (WCST) and the Continuous Performance Task.
The schizoid personality features of the healthy controls have been investigated by the Schizoid Personality Questionnaire – brief version (SPQ-B brief version). The follow up observation have been provided after 6 and 12 months for both groups. The patients' outcome have been measured by Health and Outcome Scale (HoNOS).
At the baseline the cognitive functions of the patients with first episode psychosis were considerably impaired compared to the healthy controls. Although, have not changed significantly over the two years. Moreover the patients, who have adhered to the treatment regime (treatment as usual) showed prominent improvement at social and symptomatic scales of HoNOS.
The first psychotic episode is an important period for prevention of social deterioration and the treatment adherence is a strong predictors of better social outcome.
Les conduites suicidaires (CS) constituent un problème de santé publique majeur à travers le monde. Elles présentent une vulnérabilité propre, et sont maintenant considérées comme une entité diagnostique indépendante dans le DSM5. La thérapie d’acceptation et d’engagement (ACT) est une thérapie intégrative ayant démontré son utilité dans une grande variété de troubles psychiatriques, à travers une diminution de l’évitement expérientiel et une amélioration de la flexibilité psychologique (socles communs à l’ensemble des troubles psychiatriques) .
Nous avons conduit une étude pilote suggérant la faisabilité de la thérapie ACT, sous forme de groupes, chez les patients suicidants (CHRU de Montpellier, Pr Courtet) . À travers la présentation des processus thérapeutiques utilisés dans la thérapie ACT, nous aborderons les hypothèses d’action de la thérapie ACT dans les conduites suicidaires. Puis nous présenterons l’étude IMPACT, en cours de réalisation dans le service urgences et post-urgences psychiatriques (CHRU de Montpellier, Pr Courtet). Il s’agit de la première étude contrôlée randomisée recherchant des biomarqueurs neuroanatomiques et fonctionnels de réponse à la thérapie ACT chez des patients ayant un trouble des conduites suicidaires. Nous aborderons enfin, de façon pratique, comment présenter la thérapie ACT à un patient, à travers une matrice . Il s’agit d’une analyse fonctionnelle permettant de faire percevoir au patient le fonctionnement actuel dans lequel il se sent enlisé, de mettre en lumière ce qui est important dans sa vie, et donc d’avoir un outil motivationnel simple et efficace pour l’accompagner vers le changement.
La thérapie ACT semble être une thérapie prometteuse dans la prise en charge des conduites suicidaires. L’étude IMPACT servira à accroître les connaissances sur les conduites suicidaires par l’identification de biomarqueurs de réponse thérapeutique et la mise en évidence des régions cérébrales associées aux processus thérapeutiques.
Amphetamine abuse has become a serious health concern worldwide, and this holds also true for Iran.
Investigating psychological and socio-demographic dimensions to predict amphetamine-abuse.
Hundred amphetamine abusers and 100 healthy controls took part in this cross-sectional study. Participants completed questionnaires covering socio-demographic and psychological dimensions.
Compared to healthy controls, amphetamine abusers reported more insecure and ambivalent attachment styles, higher novelty-seeking and risky behaviour, less current social support and stable relationships, and lower emotional competencies. No differences were found for socio-demographic dimensions.
Results from this cross-sectional study underscore that amphetamine abuse was related to poor social relationships, poor emotional competencies and higher risky behaviour. The cross-sectional nature of the study, however, does preclude any conclusions about the causal direction of amphetamine abuse and poor interactional behavior.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The concept of mental toughness has gained increasing importance among non-elite athletes for its psychological importance and explanatory power for a broad range of health-related behaviors. On the flip side, no study has focused so far on the psychological origins of mental toughness. Therefore, the aims of the present study were three-fold: to explore, to what extent psychological profiles of preschoolers at the age of five years predicted mental toughness scores and sleep disturbances at the age of 14 years, and to explore possible gender differences.
Nine years after their first assessment at the age of five years (preschoolers), a total of 77 adolescents (mean age: 14.35 years; SD = 1.22; 42% females) took part in the present follow-up study. At baseline, both parents and teachers completed the Strengths and Difficulties Questionnaire (SDQ), covering internalizing and externalizing problems, hyperactivity, negative peer relationships, and prosocial behavior. At follow-up, participants completed a booklet of questionnaires covering socio-demographic data, mental toughness, and sleep disturbances.
Preschoolers with high prosocial behavior and low internalizing and externalizing problems, as rated by parents and teachers, at the age of 14 years self-reported higher mental toughness and lower sleep disturbances. At the age of 14 years, and relative to their male counterparts, female participants reported lower MT scores and higher sleep disturbances.
The pattern of results suggests that mental toughness traits during adolescence have their origins during pre-school years.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Multiple sclerosis (MS) is a chronic progressive autoimmune disease. Fatigue, depression and cognitive impairments are the most common symptoms of patients with MS. Whereas there is extant research on fatigue, depression, and cognitive impairment of patients with MS during the clinical course, no research focused on the long term changes of psychological functioning, sleep problems, and physical activity on these patients. The aims of the present study were therefore to examine changes in physical activity, sleep disturbances, and mental toughness over a 1.5-year period of time in people with multiple sclerosis after the onset their MS.
A total of 18 patients with diagnosed MS (mean age: M = 33.61 years) took part in this study. They completed a booklet of questionnaires covering socio-demographic data, mental toughness, sleep disturbances, and physical activity, at the onset of disease and 1.5 years later.
In total, 1.5 years after the onset of MS, patients had lower levels of vigorous physical activity, but not statistically significant change in moderate physical activity. Patients with sleep disturbances at the onset of disease had statistically significant sleep disturbances also 1.5 years later.
Compared to the onset of disease, 1.5 years later, patients with MS reported similar mental toughness traits, sleep disturbances and levels of moderate physical activity. The pattern of results of the present pilot study suggests that the onset of MS is not an obstacle for doing moderate physical activity. Based on the result of this study, sleep disturbances remains stable by time.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The concept of the Dark Triad (DT) consists of the dimensions of Machiavellianism, narcissism, and psychopathy, and has gained increased interest within the last 15 years for its predictive power to explain success in the fields of economy, politics, and professional sport. However, recent research suggests that the associations between DT and behavior are not as uniform as expected.
Investigating the associations between DT traits and vulnerable narcissism, mental toughness, sleep quality, and stress perception.
A total of 720 participants between 18 and 28 years took part in the study. The sample consisted of military cadres in the US (n = 238), Switzerland (n = 220), and of students from the university of Basel (n = 262). Participants completed self-rating questionnaires covering DT traits, mental toughness, vulnerable narcissism, sleep quality, and perceived stress.
Irrespective of the sample, participants scoring high on vulnerable narcissism also reported higher DT traits, lower mental toughness, poor sleep quality, and higher scores on perceived stress.
The present pattern of results suggests a more fine-grained association between DT traits and further behavior, calling into question to what extent DT traits might be a predictor for greater success in the fields of economy, politics or elite sports. Specifically, vulnerable narcissism seems to be key for more unfavourable behavior.
Disclosure of interest
The authors have not supplied their declaration of competing interest.