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Currently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly extrapolate recommendations for BD-II from available evidence for bipolar disorder type I (BD-I). Comparing the impact of lithium discontinuation is one way of assessing effectiveness in both groups.
To compare the impact of lithium discontinuation on hospital admissions and self-harm in patients with BD-I or schizoaffective disorder (SZD) and patients with BD-II or other bipolar disorder.
Mirror-image study, examining hospital admissions within 2 years before and after lithium discontinuation in both patient groups. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of bipolar disorder as compared with other mood stabilisers.
For the whole sample, the mean number of admissions/patient/review period doubled from 0.44 to 0.95 (P<0.001) after lithium discontinuation. The mean number of bed days/patient/review period doubled from 11 to 22 (P = 0.025). This increase in admissions and bed days was exclusively attributable to patients with BD-I/SZD. Not having consulted with a doctor prior to lithium discontinuation or no treatment with an alternative mood stabiliser at the time of lithium discontinuation led to more admissions.
The higher relapse risk in patients with BD-I/SZD suggests a higher threshold for discontinuing lithium than for patients with BD-II/other bipolar disorder. In patients with BD-II/other bipolar disorder, however, judged on the impact of discontinuation alone, lithium did not appear to prevent more severe depressive episodes requiring hospital admission.
This paper documents the existence of swiping – that is, inversion of a wh-phrase and its associated preposition under sluicing – in a non-Germanic language. We discuss swiping in a variety of Ontario French (Lafontaine French, LFF), which shares some of the characteristics of its extensively-studied English counterpart (Ross 1969, Merchant 2002, among others). We offer a preliminary description of swiping in LFF and consider some implications of these novel facts for the theory of swiping and sluicing. We suggest that LFF swiping supports an analysis in terms of non-constituent deletion, as originally suggested by Ross (1969) in his seminal work on sluicing.
Scholars of Britain’s external relations in the nineteenth and twentieth centuries readily acknowledge the global nature of their subject. Yet in practice, they tend to dissect it along bilateral lines or with an exclusive focus on the imperial periphery. The tension between Britain’s global strategic interests and its ability to safeguard them has likewise long been the subject of scholarly debates, invariably accompanied by more or less explicit assumptions about the nation’s decline in the twentieth century. Already Arnold J. Toynbee, in reflecting on the origins of the Second World War, contrasted Britain’s assumed position as ‘the arbiter of Europe’ from around the time of the War of the Spanish Succession at the beginning of the eighteenth century until the final years of peace before 1914 with the country’s reduced circumstances in the interwar period.
Foreign ministries form a central part of modern diplomatic practice. They emerged slowly and haphazardly from the late fifteenth century onwards. With the growth in scope – both geographical and temporal – and intensity of diplomacy came the need for a central organization that could control and coordinate policy at the seat of government.
In Tudor and Elizabethan England, too, the steady growth of diplomatic activity spurred on institutional change in the shape of the Principal Secretary of State. Initially, an officer of the royal household, executing the decisions of the monarch and the Privy Council, over time much of his business came to be focused on foreign affairs.
A fundamental truth about British power in the nineteenth century and beyond was that Britain was a global power. Her international position rested on her global economic, naval and political presence, and her foreign policy operated on a global scale. This volume throws into sharp relief the material elements of British power, but also its less tangible components, from Britain's global network of naval bases to the vast range of intersecting commercial, financial and intelligence relationships, which reinforced the country's political power. Leading historians reshape the scholarly debate surrounding the nature of British global power at a crucial period of transformation in international politics, and in so doing they deepen our understanding of the global nature of British power, the shifts in the international landscape from the high Victorian period to the 1960s, and the changing nature of the British state in this period.
Across psychopathologies, trauma-exposed individuals suffer from difficulties in inhibiting emotions and regulating attention. In trauma-exposed individuals without psychopathology, only subtle alterations of neural activity involved in regulating emotions have been reported. It remains unclear how these neural systems react to demanding environments, when acute (non-traumatic but ordinary) stress serves to perturbate the system. Moreover, associations with subthreshold clinical symptoms are poorly understood.
The present fMRI study investigated response inhibition of emotional faces before and after psychosocial stress situations. Specifically, it compared 25 women (mean age 31.5 ± 9.7 years) who had suffered severe early life trauma but who did not have a history of or current psychiatric disorder, with 25 age- and education-matched trauma-naïve women.
Under stress, response inhibition related to fearful faces was reduced in both groups. Compared to controls, trauma-exposed women showed decreased left inferior frontal gyrus (IFG) activation under stress when inhibiting responses to fearful faces, while activation of the right anterior insula was slightly increased. Also, groups differed in brain–behaviour correlations. Whereas stress-induced false alarm rates on fearful stimuli negatively correlated with stress-induced IFG signal in controls, in trauma-exposed participants, they positively correlated with stress-induced insula activation.
Neural facilitation of emotion inhibition during stress appears to be altered in trauma-exposed women, even without a history of or current psychopathology. Decreased activation of the IFG in concert with heightened bottom-up salience of fear related cues may increase vulnerability to stress-related diseases.
Impaired cognitive functioning constitutes an important symptom of major depressive disorder (MDD), potentially associated with elevated cortisol levels. Adverse childhood experiences (ACE) enhance the risk for MDD and can contribute to disturbances in the stress systems, including cortisol and cognitive functions. In healthy participants, cortisol administration as well as acute stress can affect cognitive performance. In the current study, we tested cognitive performance in MDD patients with (N = 32) and without (N = 52) ACE and healthy participants with (N = 22) and without (N = 37) ACE after psychosocial stress induction (Trier Social Stress Test, TSST) and a control condition (Placebo-TSST). MDD predicted lower performance in verbal learning and both selective and sustained attention, while ACE predicted lower performance in psychomotoric speed and working memory. There were no interaction effects of MDD and ACE. After stress, MDD patients were more likely to show lower performance in working memory as well as in selective and sustained attention compared with participants without MDD. Individuals with ACE were more likely to show lower performance in verbal memory after stress compared with individuals without ACE. Our results indicate negative effects of MDD and ACE on distinct cognitive domains. Furthermore, MDD and/or ACE seem to enhance susceptibility for stress-related cognitive impairments.
With the emergence of modern techniques of environmental analysis and widespread availability of accessible tools and quantitative data, the question of environmental determinism is once again on the agenda. This paper is theoretical in character, attempting, for the benefit of drawing up research designs, to understand and evaluate the character of environmental determinism. We reach three main conclusions: (1) in a typical pattern of research design, studies seek to detect simultaneous shifts in the environmental and archaeological records, variously positing the former to have influenced, triggered or caused the latter; (2) the question of determinism involves uncertainty about the justification for the above research design in particular in what comes to biologism and the concept of environmental thresholds on the one hand and the externality of the drivers of transformation in human groups and societies on the other; (3) adapting the concepts of the social production of vulnerability and the social basis of hazards from anthropology may help to clarify the available research design choices at hand.
This article discusses the role of archives of transitional justice and “dealing with the past” (DWP) mechanisms when determining the fate of missing persons. The concept of dealing with the past, the terms “enforced disappearance” and “missing person”, and the specific role of archives in periods of transition are examined. Subsequently, specific questions and challenges related to access and use of archives by DWP mechanisms, including those mechanisms with a mandate to determine the fate of missing persons, are described. Many questions related to access to archives, information management and preservation of records are similarly applicable to DWP mechanisms in general and to specific mechanisms mandated to search for missing persons. The article provides some examples of States’ obligations related to maintaining and providing access to archives that could assist in the search for missing persons under international law and policy. The article concludes by emphasizing the importance of the preservation and protection of archives relevant for dealing with the past. It further highlights the need to grant DWP mechanisms, especially those aimed at determining the fate of missing persons, access to those archives.
Usnea viktoriana P. Clerc & Otte is described as new. It is characterized by the presence of alectorialic acid as major secondary compound mainly present in the aggregated efflorescent soralia with long isidiofibrils. Usnea parafloridana K. Mark, Will-Wolf & Randlane is synonymized with U. praetervisa (Asahina) P. Clerc. Both U. viktoriana and U. praetervisa are supported by molecular analysis. A key to the shrubby-subpendulous sorediate Usnea species in Europe is provided.