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Subjective measures (SMs) of awareness assume (a) participants can accurately report the implicit/explicit status of their knowledge and (b) the act of reporting does not change that knowledge. However, SMs suffer from nonveridicality (e.g., overreporting of “guess” responses) and reactivity (e.g., prompting rule search). Attempting to improve the validity of “guess” responses, we conducted an exploratory mixed-methods replication of Rebuschat et al. (2013). Participants (N = 30) were randomly assigned to Traditional, True Guess, and NoSMs conditions. True Guess participants were led to believe the computer would replace “guess” responses with random answers. Confirming that SMs are reactive, Traditional and True Guess participants responded more slowly and accurately, with greater awareness of the linguistic target. Moreover, although True Guess participants responded “guess” less frequently, interviews revealed this was due not to greater veridicality, but rather to additional reactivity. We conclude with directions for further research to enhance the validity of SMs.
Reducing stigma is a perennial target of mental health advocates, but effectively addressing stigma relies on the ability to correctly understand and accurately measure culture-specific and location-specific components of stigma and discrimination.
We developed two culture-sensitive measures that assess the core components of stigma. The 40-item Interpersonal Distance Scale (IDS) asks respondents about their willingness to establish four different types of relationships with individuals with 10 target conditions, including five mental health-related conditions and five comparison conditions. The 40-item Occupational Restrictiveness Scale (ORS) asks respondents how suitable it is for individuals with the 10 conditions to assume four different types of occupations. The scales – which take 15 min to complete – were administered as part of a 2013 survey in Ningxia Province, China to a representative sample of 2425 adult community members.
IDS and ORS differentiated the level of stigma between the 10 conditions. Of the total, 81% of respondents were unwilling to have interpersonal relationships with individuals with mental health-related conditions and 91% considered them unsuitable for various occupations. Substantial differences in attitudes about the five mental health-related conditions suggest that there is no community consensus about what constitutes a ‘mental illness’.
Selection of comparison conditions, types of social relationships, and types of occupations considered by the IDS and ORS make it possible to develop culture-sensitive and cohort-specific measures of interpersonal distance and occupational restrictiveness that can be used to compare the level and type of stigma associated with different conditions and to monitor changes in stigma over time.
The majority of the world’s population is believed to speak more than one language. Moreover, given current demographic trends, older adults make up a significant portion of our population. In this chapter, we review what is known about the intersection between cognitive aging and language processing in one’s first and second language. We review current research findings concerning speech and language processing in older bilinguals at the level of words, sentences, and discourse. We review the implications of being bilingual for nonlinguistic cognitive functions and cognitive reserve. We close by highlighting the need for models of auditory and visual language processing to accommodate age-related changes in sensation, perception and cognition, and to account for important individual differences in language history and use.
Firefighting service is known to involve high rates of exposure to potentially traumatic situations, and research on mental health in firefighting populations is of critical importance in understanding the impact of occupational exposure. To date, the literature concerning prevalence of trauma-related mental disorders such as posttraumatic stress disorder (PTSD) has not distinguished between symptomology associated routine duty-related exposure and exposure to large-scale disaster. The present systematic review synthesizes a heterogeneous cross-national literature on large-scale disaster exposure in firefighters and provides support for the hypothesis that the prevalence of PTSD, major depressive disorder, and anxiety disorders are elevated in firefighters compared with rates observed in the general population. In addition, we conducted narrative synthesis concerning several commonly assessed predictive factors for disorder and found that sociodemographic factors appear to bear a weak relationship to mental disorder, while incident-related factors, such as severity and duration of disaster exposure, bear a stronger and more consistent relationship to the development of PTSD and depression in cross-national samples. Future work should expand on these preliminary findings to better understand the impact of disaster exposure in firefighting personnel.
Introduction: Intoxicated patients with decreased Glasgow Coma Scale (GCS) are common presentations to emergency departments. These patients are often intubated due to presumed full stomachs and perceived aspiration risk. Gastric ultrasound (GUS) -- a simple, non-invasive and objective option -- could be applied to this problem. This pilot study uses GUS alongside usual care at a music festival; a bounded, intoxication-dense environment where airways are often managed using non-invasive airway strategies. We aim to (1) clarify the gastric contents of any intubated patients, and (2) assess if patients managed without intubation go on to have a lack of aspiration sequelae because of empty stomachs or in spite of full stomachs. Methods: A prospective cohort study was conducted at a multi-day music festival. Patients presenting to on-site medical services with GCS ≤ 13 and known or suspected substance use were included. Patients with trauma, instability, metabolic derangements or additional aspiration risk factors (eg morbid obesity, pregnancy) were excluded. Standard GUS was performed by a trained provider and results were categorized according to convention as FS (full stomach, ie solids or liquids >1.5mL/kg) or ES (empty stomach, ie empty or liquids <1.5mL/kg). Additional patient data were extracted from linked medical records post event. Results: 33 patients met inclusion criteria and 27 remained after exclusions were applied and consent obtained. 25 patients reported substance use and 19 polysubstance use. The FS group had 15 patients (7 solid & 8 liquid > 1.5), and the ES group had 12 patients (5 empty & 12 liquid < 1.5). The median low GCS documented for FS and ES was 7 and 11 respectively, and 10 patients total had a GCS of 8 or less (6 FS & 4 ES). No patients were intubated and all were managed conservatively according to usual care. 3 patients (2 FS, 1 ES) were transferred to hospital. No patients re-registered at medical for clinically significant aspiration. Conclusion: This pilot study demonstrates the potential utility of GUS in stratifying aspiration risk in intoxicated patients with decreased GCS. “Empty” stomachs might avoid intubation, while the implications and true risks of “full” stomachs for aspiration sequelae in the absence of intubation remain unclear. Due to the small numbers in this pilot study and the quoted GUS sensitivity (only 95%), further research is needed to evaluate the safe application of this modality to clinical decision-making in intoxicated patients.
The effective management of chronic asthma requires long-term adherence to both pharmacotherapy and optimal self-management practices. The use of mobile applications (apps) offer a promising and cost-effective platform to support the self-management of asthma. However, students as consumers may not always be sufficiently knowledgeable to select the best app to link with the management of their condition. If school psychologists become familiar with apps, they may be better positioned to provide guidance to students about app selection and how to identify apps that include appropriate behaviour change techniques (BCT). Accordingly, the overall aim of this study was to present a method by which school psychologists could identify quality apps for the purpose of supporting students who need to self-manage chronic asthma. A directed content analysis was used to evaluate asthma apps, based on behaviour change content and app quality. A systematic selection process yielded a total of 36 apps (26 from iTunes, 12 from Google Play) that were evaluated using two published rating measures. Overall, apps contained limited BCTs and a low level of quality health information. Conversely, apps with higher quality health information utilised a larger range of BCTs than lower quality apps. It was concluded that while apps designed to support the management of asthma appear to be a potentially valuable addition to traditional interventions, the technology is still in its infancy, and school psychologists should be aware of the limited behaviour change content, age appropriateness of apps, and whether the health information provided is evidence-based.
This article captures the webinar narrative on March 31, 2020 of four expert panelists addressing three questions on the current coronavirus disease 2019 (COVID-19) pandemic. Each panelist was selected for their unique personal expertise, ranging from front-line emergency physicians from multiple countries, an international media personality, former director of the US Strategic National Stockpile, and one of the foremost international experts in disaster medicine and public policy. The forum was moderated by one of the most widely recognized disaster medical experts in the world. The four panelists were asked three questions regarding the current pandemic as follows:
1. What do you see as a particular issue of concern during the current pandemic?
2. What do you see as a particular strength during the current pandemic?
3. If you could change one thing about the way that the pandemic response is occurring, what would you change?
The combination of clozapine and other potentially leukopenic drugs may pose a greater risk for neutropenia. However, neutropenia may not always be due to clozapine. When adding potentially leukopenic drugs, clinicians should look for possible alternatives especially as clozapine is often a drug used as the last resort in treatment refractory schizophrenia.
To investigate trends in health-related quality of life and health service use associated with diabetes and/or major depression in South Australia from 1998 to 2008.
Data analyzed were from 9,059 persons aged ≥15 years who participated in representative surveys of the South Australian population in 1998, 2004 and 2008. Major depression was determined using the mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD). Diagnosed diabetes and health service use was determined by self-report. Health-related quality of life was assessed using the 36-item Short-Form Health Survey (SF-36) and the 15-item Assessment of Quality of Life (AQoL) instruments. Weighted age-standardized and multiple-adjusted means of dependent measures were computed.
The prevalence of diabetes only, major depression only, and comorbid diabetes and major depression increased by 74%, 36% and 53% from 1998 to 2008. Mean health-related quality of life scores were 9% to 41% lower (worse), and health service use was 49% higher for persons with comorbid diabetes and major depression than for those with diabetes only (all P-values < 0.05), consistently over the 10-year period.
If past trends continue, our results suggest that the population health and economic burden of comorbid diabetes and major depression will grow similarly over the next decade or so. These trends have important implications for making health policy and resource allocation decisions.
Ventricular enlargement is one of the most consistent brain changes associated with schizophrenia. However, there are only few cross-sectional studies in genetic at risk individuals, and no studies in individuals meeting ultra high risk (UHR) criteria of developing frank psychosis. This study investigates the timing of ventricular volume changes across the different stages of emerging psychotic disorders.
We measured ventricular volumes in 473 subjects comparing 135 UHR subjects (of whom 39 subsequently developed a psychotic illness), 162 first-episode psychosis (FEP) subjects, 89 chronic schizophrenia (CS) subjects with 87 normal controls (NC). 29 UHR, 25 FEP, 13 CS, and 24 HV had longitudinal follow up scans.
We found significant ventricular enlargement in FEP and CS, but not in UHR and NC. Longitudinal analysis confirmed ventricular enlargement in non-affective psychosis only. UHR patients had normal ventricular volumes regardless of whether they made transition to frank psychosis or not.
Our results are suggestive that ventricular enlargement is a consequence of transition and/or progression of illness rather than a risk marker in that it is apparent only after the onset of frank psychosis, with prominence in patients with schizophrenia-like psychoses. The results parallel our previous study in that hippocampal volumes were reduced in CS and normal in patients having non-schizophrenic psychoses as well in UHR individuals.
During the past few decades, the schizophrenia cognitive literature has focused mainly on executive functions, a cluster of cognitive brain functions involved in attention, planning, sequencing, decision making, initiating and inhibiting behaviors which are associated with the prefrontal cortex. Emerging evidence, however, indicates that long-term memory, associated with the temporal lobes, is an equally, if not more salient feature of the impaired cognitive profile of schizophrenia. Evidence of impaired encoding relative to spared post-encoding, and an apparent dissociation between the levels of impairment of explicit and implicit memory processes, provides further indication that the long-term memory deficits of schizophrenia are mediated primarily by the medial-temporal lobes rather than other cortical structures. Functional magnetic resonance imaging (fMRI) has been used to investigate the neurobiological basis of long-term memory deficits. Data from these studies have confirmed the role of the frontal, medial and inferior temporal regions in the memory dysfunctions observed in patients. Further, research suggests that memory strategies used by individuals with schizophrenia might be impaired as a result of the disturbance of the functional connectivity of prefrontal and temporal-limbic structures. In order to identify the unique contribution of the temporal lobes to the long-term memory deficit of schizophrenia, fMRI studies must focus on memory tasks which specifically elicit activation in this brain region.
Efficacy of conventional repetitive transcranial magnetic stimulation (rTMS) in major depressive disorder (MDD) is limited. The authors report here on an alternative treatment using low energy synchronized TMS (sTMS) at the intrinsic frequency of subjects’ alpha electroencephalogram (EEG).
Establish efficacy and safety profile of sTMS in MDD.
(1) Examine the clinical effectiveness of sTMS.
(2) Identify adverse effects associated with sTMS.
Fifty-two MDD subjects with 17-item Hamilton Depression Rating Scale (HAMD17) scores >17 were enrolled into a randomized, sham controlled, double-blind trial. Current medication remained unchanged during the trial. Depressive symptoms were evaluated by HAMD17 administered weekly.
EEGs were recorded at baseline to determine the stimulus frequency and at week 4 to evaluate the physiological effect. sTMS was delivered through three 6000-G cylindrical neodymium magnets synchronously rotating at a rate equal to the subject's intrinsic alpha frequency.
Forty-five subjects completed at least 1 week of treatment and were evaluable. Those who received active treatment had superior clinical response to sham (t = 2.54, P = 0.01), where 55.2% in the active treatment group were clinical responders versus 12.5% in sham (X2 = 7.82, P = 0.005). No significant side effects were reported. The clinical improvement was correlated with the degree of EEG improvement (r = .46, P = 0.009).
A therapeutic effect in MDD subjects can be achieved through administration of sTMS at the subject's alpha EEG frequency. Because of minimal side effects, this appears to be a safe and effective treatment option.
The widespread evolution of herbicide resistance in weed populations has become an increasing concern for no-tillage (NT) growers in semiarid regions of the U.S. Great Plains. Lack of cost-effective and alternative new herbicide sites of action further exacerbates the problem of herbicide-resistant (HR) weeds and threatens the long-term sustainability of prevailing cropping systems in the region. A recent decline in commodity prices and increasing herbicide costs to manage HR weeds has spurred research efforts to build a strong rationale for developing ecologically based integrated weed management (IWM) strategies in the U.S. Great Plains. Integration of cover crops (CCs) in NT dryland production systems potentially offers several ecosystem services, including weed control, soil health improvement, decline in selective pest pressure, and overall reduction in pest management inputs. This review article aims to document the role of CCs for IWM, with emphasis on exploring emerging weed issues; ecological, economic, and agronomic benefits of growing CCs; and constraints preventing adoption of CCs in NT cropping systems in the semiarid Great Plains. We attempt to focus on changes in weed management practices, their long-term impacts on weed seedbanks, weed shifts, and herbicide-resistance evolution in the most common weed species in the region. We also highlight current knowledge gaps and propose new research priorities based on an improved understanding of CC management strategies that will ultimately aid in achieving sustainable weed management goals and preserving natural resources in water-limited environments.
It has been previously shown that genes implicated in psychiatric disorders modulated Blood oxygenation level dependent (BOLD) effect in brain regions. These studies add to the knowledge of vulnerability to disorders.
This study has investigated genetic modulation of brain networks associated with emotion processing.
Aim of this study was to examine the effect of two genetic markers (5HTTLPR and COMT) on BOLD effect connectivity in healthy individuals.
Ninety-one participants participated in four fMRI experiments (at 3T), with dynamic facial expressions of fear, anger, sadness or happiness. We explored the effect of genetic polymorphisms on empirically defined brain network commonly associated with the responses to any emotional expressions. Connectivity was examined by means of Granger analysis allowing to estimate the directionality of information flow between the defined brain regions.
Perception of dynamic emotional facial expressions was commonly associated with activation of the bilateral fusiform gyrus, right superior temporal sulcus, bilateral dorso-lateral prefrontal cortex and right amygdala. The genetic modulation of this network was observed only in experiments with fearful facial expressions. There was an interaction between the effects of genetic polymorphisms and the measures of connectivity: (p = 0.0002, adjusted R2 = 18%). This was accounted for by lower connectivity in individuals lacking both copies of COMT Val polymorphism who at the same time lacked both copies of L polymorphism of 5HTTLPR gene.
Our results clarify the mechanism of brain network reactivity to emotional signals that is associated with genetic polymorphisms.
Impaired episodic memory (EM) has been reported in schizophrenia. Intact EM requires that contextual features be bound to the content of the event, a mechanism called contextual binding (CB). It is proposed that binding errors during the encoding process are responsible for EM impairments in schizophrenia. The hippocampal formation is considered the central element for CB, it is hypothesized that the synaptic disorganization described in this condition results in such a deficit. The main goals of these studies were to investigate the neurofunctioning, neuroanatomy and neurofunctional connectivity of the hippocampus while performing a task that used CB mechanisms. Spatial relational processing is part of CB and is rooted in the hippocampal region. Visuospatial navigation (wayfinding task), was used as a probe to activate the hippocampus and its associated regions in a group of patients with schizophrenia (n=21) and matched healthy controls (n=23). During the wayfinding task individuals with schizophrenia found landmarks less frequently, made more errors and took more time to complete the task. fMRI result indicated that the patient group had a hypofunctioning of the posterior part of the hippocampus while performing the wayfinding task. VBM results indicated that controls had significantly more hippocampal GM than patients and poor performances at the wayfinding task was associated with decreased right hippocampal GM for the overall group. Connectivity results indicated that patient's hippocampus recruited alternate pathways and regions to guide and help them complete the wayfinding task. Structural and functional differences in the hippocampus might explain the connectivity differences and CB deficit in schizophrenia.
Cognitive Behaviour Therapy (CBT) is an effective psychological intervention for children and young people with anxiety disorders (James et al, 2013). This has led to interest in whether CBT programmes can be widely provided in schools to prevent or ameliorate anxiety symptoms in children.
Results from school based anxiety prevention trials are encouraging (Neil & Christensen 2009; Fisak, Richard, Mann 2011). Before the widespread use of school based preventive programmes can be advocated methodologically robust evaluations are required to demonstrate that they are effective when transported to everyday settings.
To undertake a pragmatic randomised controlled trial (RCT) of a universal school based CBT programme (Friends for Life) for children aged 9-10 years of age .
Three arm RCT comparing Friends for Life delivered by trained health or school leaders with usual school provision (Stallard et al,2012). Primary outcome the Revised Child Anxiety and Depression Scale (RCADS) at 12 month follow-up.
A total of 1362 children from 40 schools participated with 1257 (92%) being re-assessed at follow-up. There was a difference in adjusted mean child report RCADS scores for health-led versus school-led FRIENDS (−3.94, 95%CI −6.41 to −1.47) and health-led FRIENDS versus usual school provision (2.66, 95%CI −5.22 to −0.09). Health-led CBT resulted in greater reductions in symptoms of anxiety than the other two arms (Stallard et al 2014),
Our pragmatic trial demonstrates that universally delivered anxiety prevention programmes can be effective when transported into schools. However, effectiveness varies depending upon who delivers them.