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Research on psychotic illness is loosening emphasis on diagnostic stringency in favour of including a more dimensionally based conceptualization of psychopathology and pathobiology. However, to clarify these notions requires investigation of the full scope of psychotic diagnoses.
The Cavan–Monaghan First Episode Psychosis Study ascertained cases of first episode psychosis across all 12 DSM-IV psychotic diagnoses via all routes to care: public, private or forensic; home-based, outpatient or inpatient. There was no arbitrary upper age cut-off and minimal impact of factors associated with variations in social milieu, ethnicity or urbanicity. Cases were evaluated epidemiologically and assessed for psychopathology, neuropsychology, neurology, antecedent factors, insight and quality of life.
Among 432 cases, the annual incidence of any DSM-IV psychotic diagnosis was 34.1/100 000 of population and encompassed functional psychotic diagnoses, substance-induced psychopathology and psychopathology due to general medical conditions, through to psychotic illness that defied contemporary diagnostic algorithms. These 12 DSM-IV diagnostic categories, including psychotic disorder not otherwise specified, showed clinical profiles that were consistently more similar than distinct.
There are considerable similarities and overlaps across a broad range of diagnostic categories in the absence of robust discontinuities between them. Thus, psychotic illness may be of such continuity that it cannot be fully captured by operational diagnostic algorithms that, at least in part, assume discontinuities. This may reflect the impact of diverse factors each of which acts on one or more overlapping components of a common, dysfunctional neuronal network implicated in the pathobiology of psychotic illness.
Cognitive tests of inhibitory control show variable results for the differential diagnosis between behavioural variant of Frontotemporal Dementia (bvFTD) and Alzheimer’s disease (AD). We compared the diagnostic accuracies of tests of inhibitory control and of a behavioural questionnaire, to distinguish bvFTD from AD.
Three groups of participants were enrolled: 27 bvFTD patients, 25 AD patients, and 24 healthy controls. Groups were matched for gender, education, and socio-economic level. Participants underwent a comprehensive neuropsychological assessment of inhibitory control, including Hayling Test, Stroop, the Five Digits Test (FDT) and the Delay Discounting Task (DDT). Caregivers completed the Barratt Impulsiveness Scale 11th version (BIS-11).
bvFTD and AD groups showed no difference in the tasks of inhibitory control, while the caregiver questionnaire revealed that bvFTD patients were significantly more impulsive (BIS-11: bvFTD 76.1+9.5, AD 62.9+13, p < .001).
Neuropsychological tests of inhibitory control failed to distinguish bvFTD from AD. On the contrary, impulsivity caregiver-completed questionnaire provided good distinction between bvFTD and AD. These results highlight the current limits of cognitive measures of inhibitory control for the differential diagnosis between bvFTD and AD, whereas questionnaire information appears more reliable and in line with clinical diagnostics.
To assess community mental health in suburban Dublin in 2018, 5 years after Ireland’s economic recession ended.
A cross-sectional, face-to-face, household survey was conducted in a random cluster sample of 351 households in Tallaght, a deprived suburb of Dublin.
A majority of respondents (61.3%) reported stress over the previous 12 months, with a higher rate in areas of high (66.9%) compared to lower deprivation (55.5%). Deprivation was not related to rates of loneliness (20.2%), feeling depressed (20.2%), loss of interest (19.7%) or anxiety (22.5%). Mean score for positive mental health (59.3/100, with a higher score indicating better mental health) was lower than that reported in a national sample in 2007 (68/100); positive mental health was associated with not living with a person with chronic illness, self-identifying as ‘non-Irish’ and greater age. Mean score for psychological distress (76.7/100, with a higher score indicating less distress) was also lower than that in 2007 (82/100); less psychological distress was associated with not living with a person with chronic illness or disability, greater age and identifying as non-Irish. The rate of ‘probable mental illness’ over the previous 4 weeks (13.1%) was higher than in 2007 (7%).
Our findings emphasise the high prevalence of stress, especially in deprived suburban areas; the centrality of carer burden in determining mental wellbeing; and associations between positive mental health on the one hand and greater age and identifying as non-Irish on the other.
Aberrations in reward and penalty processing are implicated in depression and putatively reflect altered dopamine signalling. This study exploits the advantages of a placebo-controlled design to examine how a novel D2 antagonist with adjunctive antidepressant properties modifies activity in the brain's reward network in depression.
We recruited 43 medication-naïve subjects across the range of depression severity (Beck's Depression Inventory-II score range: 0–43), including healthy volunteers, as well as people meeting full-criteria for major depressive disorder. In a double-blind placebo-controlled cross-over design, all subjects received either placebo or lurasidone (20 mg) across two visits separated by 1 week. Functional magnetic resonance imaging with the Monetary Incentive Delay (MID) task assessed reward functions via neural responses during anticipation and receipt of gains and losses. Arterial spin labelling measured cerebral blood flow (CBF) at rest.
Lurasidone altered fronto-striatal activity during anticipation and outcome phases of the MID task. A significant three-way Medication-by-Depression severity-by-Outcome interaction emerged in the anterior cingulate cortex (ACC) after correction for multiple comparisons. Follow-up analyses revealed significantly higher ACC activation to losses in high- v. low depression participants in the placebo condition, with a normalisation by lurasidone. This effect could not be accounted for by shifts in resting CBF.
Lurasidone acutely normalises reward processing signals in individuals with depressive symptoms. Lurasidone's antidepressant effects may arise from reducing responses to penalty outcomes in individuals with depressive symptoms.
To date, Ireland has been a leading light in the provision of youth mental health services. However, cognisant of the efforts of governmental and non-governmental agencies working in youth mental health, there is much to be done. Barriers into care as well as discontinuity of care across the spectrum of services remain key challenges. This editorial provides guidance for the next stage of development in youth mental care and support that will require significant national engagement and resource investment.
Discourse surrounding spectral music frequently makes reference to nature and related language. Practitioners, theorists, and musicologists have discussed different aspects and perspectives on the idea of nature in the relation to this music and it is not always clear that these terms are used in the same way. This article examines the different meanings of ‘nature’ applied to various concepts and techniques in spectral music, the extent to which these descriptors may be misleading, and the cultural context and possible motivations for the use of this kind of rhetoric. Through a discussion of the derivation structure in spectral music, a focus on human perception, metaphorical references to nature, the rhetoric surrounding the harmonic series and instrumental (re)synthesis, and finally mimetic references to nature in music using spectral techniques (including a discussion of the music of François-Bernard Mâche), the article endeavours to provide a thorough survey of the subject.
This review will outline the role of visiting cardiac surgical teams in low- and middle-income countries drawing on the collective experience of the authors in a wide range of locations. Requests for assistance can emerge from local programmes at a beginner or advanced stage. However, in all circumstances, careful pre-trip planning is necessary in conjunction with clinical and non-clinical local partners. The clinical evaluation, surgical procedures, and postoperative care all serve as a template for collaboration and education between the visiting and local teams in every aspect of care. Education focusses on both common and patient-specific issues. Case selection must appropriately balance the clinical priorities, safety, and educational objectives within the time constraints of trip duration. Considerable communication and practical challenges will present, and clinicians may need to make significant adjustments to their usual practice in order to function effectively in a resource-limited, unfamiliar, and multilingual environment. The effectiveness of visiting trips should be measured and constantly evaluated. Local and visiting teams should use data-driven evaluations of measurable outcomes and critical qualitative evaluation to repeatedly re-assess their interim goals. Progress invariably takes several years to achieve the final goal: an autonomous self-governing, self-financed, cardiac programme capable of providing care for children with complex CHD. This outcome is consistent with redundancy for the visiting trips model at the site, although fraternal, professional, and academic links will invariably remain for many years.
Despite the inverse association between skin colour and efficiency of cutaneous vitamin D synthesis, in addition to the widely accepted racial disparity in vitamin D status, populations of ethnic minority are understudied in terms of setting target serum 25-hydroxyvitamin D concentrations and corresponding dietary requirements for vitamin D. In minority groups, prevention of vitamin D deficiency on a population basis is challenging due to the lack of clarity surrounding the metabolism and transport of vitamin D. Authoritative agencies have been unable to define pregnancy-specific dietary recommendations for vitamin D, owing to an absence of sufficient evidence to confirm whether nutritional requirements for vitamin D are altered during pregnancy. While the question of setting race- and pregnancy-specific dietary reference values for vitamin D has not been addressed to date, endemic vitamin D deficiency has been reported among gravidae worldwide, specifically among ethnic minorities and white women resident at high latitude. In light of the increased risk of nutritional rickets among infants of ethnic minority, coupled with growing evidence for potential non-skeletal roles of vitamin D in perinatal health, determination of the dietary vitamin D requirement that will prevent deficiency during pregnancy is a research priority. However, systematic approaches to establishing dietary requirements are limited by the quality of the available evidence and the under-representation of minority groups in clinical research. This review considers the evidence for racial differences in vitamin D status and response to vitamin D supplementation, with particular application to pregnancy-specific requirements among ethnic minorities resident at high latitudes.
Physical inactivity in older adults presents a significant problem within modern societies globally. Using a mixed-method approach, this study explored strategies for the development and delivery of physical activity (PA) interventions by investigating what behaviour change techniques (BCTs) are useful, and how these techniques should be implemented to be feasible for older adults. Sixty-six older adults completed a survey indicating the most useful BCTs, mapping on to motivational, volitional and automatic factors. Of these, 48 older adults participated in an interview exploring strategies for a PA intervention targeted at older adults. The most useful BCT identified in the survey was autonomy support (61.3%), followed by instruction to perform the behaviour (43.5%) and having a credible source of information about PA (42.6%). The key themes discussed in the interviews included providing support in making an informed choice, instruction on how to perform PA, information about health consequences, social support, goal setting, action and coping plans, behavioural demonstration and practice, and monitoring PA. The interviews also revealed key aspects of programme implementation including face-to-face delivery, followed up with additional materials; low cost; age-appropriate PA level; and individualised approach. Interventions assisting older adults in increasing their PA participation across a range of settings should incorporate BCTs targeting multiple processes, while tailoring their delivery to older adults’ preferences to ensure their feasibility in supporting regular PA engagement.
Brucellosis is usually acquired by humans through contact with infected animals or the consumption of raw milk from infected ruminants. Brucella suis biovar 2 (BSB2) is mainly encountered in hares and wild boars (Sus scrofa), and is known to have very low pathogenicity to humans with only two case reports published in the literature. Human cases of brucellosis caused by BSB2 were identified through the national mandatory notification of brucellosis. The identification of the bacterium species and biovar were confirmed by the national reference laboratory. Epidemiological data were obtained during medical follow-up visits. Seven human cases were identified between 2004 and 2016, all confirmed by the isolation of BSB2 in clinical specimens. All patients had direct contact with wild boars while hunting or preparing wild boar meat for consumption. Five patients had chronic medical conditions possibly responsible for an increased risk of infection. Our findings suggest that BSB2 might be an emerging pathogen in hunters with massive exposure through the dressing of wild boar carcasses. Hunters, especially those with chronic medical conditions, should be informed about the risk of BSB2 infection and should receive information on protective measures.
The Gaudeamus Muziekweek is now in its sixty-ninth year and, as ever, it focuses on young music pioneers, in hopes of presenting a snapshot of the newest ideas in contemporary music being developed across the world. The festival's dense and diverse programming is compressed into five full days, in 2016 from 7 to 11 September, squeezed principally within one labyrinthian building, the TivoliVredenburg, whose impressive monolithic glass exterior imposes itself as a pillar of cultural life in central Utrecht. Amid this density, it is impossible to provide anything but a partial account of the festival, and my presentation is far from impartial, as I was one of the five nominated composers for this year's Gaudeamus Award. If only from these fragments and particular foci, then, I will present my own reactions and estimations of how the festival has highlighted some of the innovations and interests of a few of the newest practitioners of new new music.
The Betting Act 1926 legalised cash betting in Ireland and led to the appearance, for the first time, of the legally regulated and licensed betting office. The introduction of this legislation was a pragmatic step, designed to eradicate the undesirable practice of street bookmaking. This article seeks to examine the operation of the legislation over the entire period of its enactment before it was superseded by the Betting Act 1931. What follows focuses on the bookmaker, their social background, geographical distribution, clientele and business practices. The industry, as it made its transition from its illegal to regulated forms, was characterised by both continuity and change. How bookmakers were perceived in the context of the puritanical atmosphere of the Free State is also considered. Attitudes to bookmakers depended on the scale of their involvement in the business, where they conducted their business, and who they conducted it with. Debates featuring these issues were spliced with contemporary concerns about class, gender and youth.
This chapter looks at Irish government efforts to control the politics of commemorating the 1916 Easter Rising after 1969. It begins by looking at how the Irish government dealt with the attempt by militant republicans to claim ownership through commemoration not merely of Irish republicanism and the memory of the Rising, but the Irish Republic as it existed in state form. The dramatic particularities of the Provisional Sinn Féin Commemorations of 1976 in Dublin and Belfast have been looked at elsewhere. Here, the focus is on commemoration as a component of the northern policy of the 1973–1977 Fine Gael–Labour coalition government and, secondly, on Fianna Fáil's analysis of this policy in 1978 and its decision effectively to retain it. Material hitherto not in the public sphere illuminates the northern policy of the coalition government, and the important, if not pivotal, role of Conor Cruise O'Brien in formulating commemorative policy, particularly through the new National Day of Reconciliation, later designated a National Day of Commemoration, which was designed to replace all other government commemorative events. The chapter concludes that, although reframing 1916 within St Patrick's Day in this manner was never a popular success, it nonetheless acted as a bridge into a very low-key commemorative acknowledgement of 1916, a policy that endured arguably until 2006. Though it is acknowledged that the commemorative policy of the Irish government was ideologically linked to wider security policies, they are not explored here. New British counter-insurgency policies in Ulster after 1975 facilitated new popular mobilisation and new commemorative practices in ‘the North’, as republicans insisted on utilising the pantheon of Irish commemorative dates. Though commemoration is always protean, fugitive and resistant to state control, the lesson of the mid-1970s is that Irish governments could, through the state apparatus, partially refashion public norms in relation to commemoration. This was not possible in ‘the North’. In this sense, northern nationalist commemorations of 1916 had their own, often factional, dynamics; they drew on shared ‘Irish republican’ cultural capital in radically different ways. Northern nationalist commemoration, whether in 1966 or 1976 or now, is not an offshoot of southern actions or conceptualisations. So, although the commemoration policies of the Irish government were partly articulated in the language of not encouraging northern violence, their real success was in reshaping the public culture of the ‘little platoon’ of the Irish state.