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Lesbian, bisexual, or gay individuals (LBGs) have an increased risk for mental health problems compared to heterosexuals, but this association has sparsely been investigated for psychotic disorders. The aim of this study was: (1) to examine whether LBG sexual orientation is more prevalent in individuals with a non-affective psychotic disorder (NAPD) than in people without a psychotic disorder; and if so, (2) to explore possible mediating pathways.
Methods
Sexual orientation was assessed in the 6-year follow-up assessment of the Dutch Genetic Risk and Outcome of Psychosis study (GROUP), a case–control study with 1547 participants (582 patients with psychotic disorder, 604 siblings, and 361 controls). Binary logistic regression analyses were used to calculate the risk of patients with a psychotic disorder being LBG, compared to siblings and controls. Perceived discrimination, history of bullying, childhood trauma (CT), and sexual identity disclosure were investigated as potential mediating variables.
Results
The proportion of individuals with LBG orientation was 6.8% in patients (n = 40), 4.3% in siblings (n = 26), and 2.5% in controls (n = 10). The age- and gender-adjusted odds ratio of LBG for patients was 1.57 (95% CI 1.08–2.27; p = 0.019), compared to siblings and controls. Discrimination, bullying, and CT all partially mediated this association.
Conclusions
Adverse social experiences related to sexual minority status may increase the risk for NAPD. Sexual identity, behavior, and difficulties need more attention in everyday clinical practice.
Patients with generalized social anxiety disorder (SAD) avoid various social situations and can be reluctant to engage in in vivo exposure therapy. Highly personalized practising can be required before patients are ready to perform in vivo exposure. Virtual reality-based therapy could be beneficial for this group.
Aims:
To assess the feasibility and potential effect of virtual reality-based cognitive behavioural therapy (VR-CBT) for patients with severe generalized SAD.
Methods:
Fifteen patients with generalized SAD attended up to 16 VR-CBT sessions. Questionnaires on clinical and functional outcomes, and diary assessments on social activity, social anxiety and paranoia were completed at baseline, post-treatment and at 6-months follow-up.
Results:
Two patients dropped out of treatment. Improvements in social anxiety and quality of life were found at post-treatment. At follow-up, depressive symptoms had decreased, and the effect on social anxiety was maintained. With respect to diary assessments, social anxiety in company and paranoia were significantly reduced by post-treatment. These improvements were maintained at follow-up. No increase was observed in social activity.
Conclusions:
This uncontrolled pilot study demonstrates the feasibility and treatment potential of VR-CBT in a difficult-to-treat group of patients with generalized SAD. Results suggest that VR-CBT may be effective in reducing anxiety as well as depression, and can increase quality of life.
Psychiatric rehabilitation (PR) can improve functioning in people with severe mental illness (SMI), but outcomes are still suboptimal. Cognitive impairments have severe implications for functioning and might reduce the effects of PR. It has been demonstrated that performance in cognitive tests can be improved by cognitive remediation (CR). However, there is no consistent evidence that CR as a stand-alone intervention leads to improvements in real-life functioning. The present study investigated whether a combination of PR and CR enhances the effect of a stand-alone PR or CR intervention on separate domains of functioning.
Method
A meta-analysis of randomized controlled trials of PR combined with CR in people with SMI was conducted, reporting on functioning outcomes. A multivariate meta-regression analysis was carried out to evaluate moderator effects.
Results
The meta-analysis included 23 studies with 1819 patients. Enhancing PR with CR had significant beneficial effects on vocational outcomes (e.g. employment rate: SMD = 0.41), and social skills (SMD = 0.24). No significant effects were found on relationships and outcomes of community functioning. Effects on vocational outcomes were moderated by years of education, intensity of the intervention, type of CR approach and integration of treatment goals for PR and CR. Type of PR was no significant moderator.
Conclusions
Augmenting PR by adding cognitive training can improve vocational and social functioning in patients with SMI more than a stand-alone PR intervention. First indications exist that a synergetic mechanism also works the other way around, with beneficial effects of the combined intervention compared with a stand-alone CR intervention.
Childhood trauma is associated with higher risk for mental disorders, including psychosis. Heightened sensitivity to social stress may be a mechanism. This virtual reality study tested the effect of childhood trauma on level of paranoid ideations and distress in response to social stress, in interaction with psychosis liability and level of social stress exposure.
Method
Seventy-five individuals with higher psychosis liability (55 with recent onset psychotic disorder and 20 at ultra-high risk for psychosis) and 95 individuals with lower psychosis liability (42 siblings and 53 controls) were exposed to a virtual café in five experiments with 0–3 social stressors (crowded, other ethnicity and hostility). Paranoid ideation was measured after each experiment. Subjective distress was self-rated before and after experiments. Multilevel random regression analyses were used to test main effects of childhood trauma and interaction effects.
Results
Childhood trauma was more prevalent in individuals with higher psychosis liability, and was associated with higher level of (subclinical) psychotic and affective symptoms. Individuals with a history of childhood trauma responded with more subjective distress to virtual social stress exposures. The effects of childhood trauma on paranoia and subjective distress were significantly stronger when the number of virtual environmental stressors increased. Higher psychosis liability increased the effect of childhood trauma on peak subjective distress and stress reactivity during experiments.
Conclusions
Childhood trauma is associated with heightened social stress sensitivity and may contribute to psychotic and affective dysregulation later in life, through a sensitized paranoid and stress response to social stressors.
The Dutch national research programme into the feasibility of retrievable storage of radioactive waste (CORA Programme Phase I; CORA: Comité Opslag Radioactief Afval = Committee on Radioactive Waste Disposal) examined the suitability of Tertiary clay deposits for such storage. Long-term isolation – up to 1 million years – of high-level radioactive waste under varying conditions is essential. A key concern is the hydro-mechanical response of the clay deposits in which radioactive waste might possibly be stored, in particular during glacial climate conditions as has happened repeatedly in the Netherlands during the Pleistocene. To evaluate this possibility hydro-mechanical computer simulations and mechanical laboratory experiments have been performed to analyse the effects of glacial loading by a thousand-metre-thick ice sheet on the permeability characteristics, fluid flow rates and the associated migration of radio-nuclides both within and out of Tertiary clays.
Glacial loading causes the expulsion of pore water from deeply buried clay deposits into adjoining aquifers. The rates and duration of the consolidation-driven outflow of water from the clay deposit, are very sensitive to the permeability of the clay and the dynamics of the advancing ice sheet. The maximum outflow rate of pore water is 1 mm per year. This rate is approximately three times faster than the flow rate of water in clay prior to ice loading. These preliminary simulation studies also indicate that cyclic loading can result in more rapid migration of radio-nuclides in clays. In clay deposits that are covered by a thick ice sheet, the contribution of dispersed transport relative to the total transport by diffusion amounts to 14%, assuming that there is no absorption of radio-nuclides by the clays and a longitudinal dispersivity of 50 m.
Current ultra-high-risk (UHR) criteria appear insufficient to predict imminent onset of first-episode psychosis, as a meta-analysis showed that about 20% of patients have a psychotic outcome after 2 years. Therefore, we aimed to develop a stage-dependent predictive model in UHR individuals who were seeking help for co-morbid disorders.
Method
Baseline data on symptomatology, and environmental and psychological factors of 185 UHR patients (aged 14–35 years) participating in the Dutch Early Detection and Intervention Evaluation study were analysed with Cox proportional hazard analyses.
Results
At 18 months, the overall transition rate was 17.3%. The final predictor model included five variables: observed blunted affect [hazard ratio (HR) 3.39, 95% confidence interval (CI) 1.56–7.35, p < 0.001], subjective complaints of impaired motor function (HR 5.88, 95% CI 1.21–6.10, p = 0.02), beliefs about social marginalization (HR 2.76, 95% CI 1.14–6.72, p = 0.03), decline in social functioning (HR 1.10, 95% CI 1.01–1.17, p = 0.03), and distress associated with suspiciousness (HR 1.02, 95% CI 1.00–1.03, p = 0.01). The positive predictive value of the model was 80.0%. The resulting prognostic index stratified the general risk into three risk classes with significantly different survival curves. In the highest risk class, transition to psychosis emerged on average ⩾8 months earlier than in the lowest risk class.
Conclusions
Predicting a first-episode psychosis in help-seeking UHR patients was improved using a stage-dependent prognostic model including negative psychotic symptoms (observed flattened affect, subjective impaired motor functioning), impaired social functioning and distress associated with suspiciousness. Treatment intensity may be stratified and personalized using the risk stratification.
Environmental factors such as urban birth and ethnic minority position have been related to risk for psychotic disorders. There is some evidence that not only individual, but also neighborhood characteristics influence this risk. The aim of this study was to investigate social disorganization of neighborhoods and incidence of psychotic disorders.
Method
The research was a 7-year first-contact incidence study of psychotic disorders in The Hague. Neighborhood characteristics included continuous, dichotomous and cumulative measures of socio-economic level, residential mobility, ethnic diversity, proportion of single person households, voter turnout, population density and crime level. Using multilevel Poisson regression analysis, incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of psychotic disorders were calculated for the indicators of neighborhood social disorganization.
Results
A total of 618 incident cases were identified. Neighborhood socio-economic level and residential mobility had the strongest association with incidence of psychotic disorders [individual-level adjusted Wald χ21 = 13.03 (p = 0.0003) and 5.51 (p = 0.02), respectively]. All but one (proportion of single person households) of the dichotomous neighborhood indicators were significantly associated with a higher IRR. The cumulative degree of neighborhood social disorganization was strongly and linearly associated with the incidence of psychotic disorders (trend test, Wald χ25 = 25.76, p = 0.0001). The IRR in neighborhoods with the highest degree of social disorganization was 1.95 (95% CI 1.38–2.75) compared with the lowest disorganization category.
Conclusions
The findings suggest that the risk for developing a psychotic disorder is higher for people living in socially disorganized environments. Longitudinal studies are needed to investigate causality.
Although there is evidence for the effectiveness of interventions for psychosis among ultra-high-risk (UHR) groups, health economic evaluations are lacking. This study aimed to determine the cost effectiveness and cost–utility of cognitive–behavioural therapy (CBT) to prevent first-episode psychosis.
Method
The Dutch Early Detection and Intervention Evaluation study was a randomized controlled trial of 196 UHR patients with an 18-month follow-up. All participants were treated with routine care (RC) for non-psychotic disorders. The experimental group (n = 95) received add-on CBT to prevent first-episode psychosis. We report the intervention, medical and travel costs, as well as costs arising from loss of productivity. Treatment response was defined as psychosis-free survival and quality-adjusted life years (QALYs) gained.
Results
In the cost-effectiveness analysis, the proportion of averted psychoses was significantly higher in the CBT condition (89.5% v. 76.2%). CBT showed a 63.7% probability of being more cost effective, because it was less costly than RC by US$844 (£551) per prevented psychosis. In the cost–utility analysis, QALY health gains were slightly higher for CBT than for RC (0.60 v. 0.57) and the CBT intervention had a 52.3% probability of being the superior treatment because, for equal or better QALY gains, the costs of CBT were lower than those of RC.
Conclusions
Add-on preventive CBT for UHR resulted in a significant reduction in the incidence of first psychosis. QALY gains show little difference between the two conditions. The CBT intervention proved to be cost saving.
The risk for psychotic disorders is increased for many ethnic minority groups and may develop in early childhood. This study investigated whether the prevalence of psychotic experiences (PE) with high impact is higher among ethnic minority youth compared to majority youth and examined the significance of these PE.
Method
A school-based study assessed a large community sample of 1545 ethnic minority and majority children in The Netherlands (mean age 12.98 ± 1.81 years). The Dutch (n = 702, 45.4%), Moroccan-Dutch (n = 400, 25.9%) and Turkish-Dutch (n = 170, 11.0%) ethnic groups could be studied separately. Self-report questionnaires on PE, impact and cultural context were administered.
Results
Prevalence of PE with high impact was 3.1% in Dutch, 9.5% in Moroccan-Dutch and 7.1% in Turkish-Dutch youth. Compared to Dutch youth, odds ratios were 3.0 [95% confidence interval (CI) 1.7–5.1] for Moroccan-Dutch youth and 2.2 (95% CI 1.1–4.6) for Turkish-Dutch youth. Differences were not explained by cultural or religious differences.
Conclusions
The increased risk for psychotic disorders in ethnic minorities may already be detectable in childhood, since PE with high impact were more common among ethnic minority youth compared to majority youth. The additional measurement of impact of PE appears to be a valid approach to identify those children at risk to develop psychotic or other more common psychiatric disorders.
We compare the performance of the very popular Tree-GPU code BONSAI with the older Particle-(Multi)Mesh code SUPERBOX. Both code we run on a same hardware using the GPU acceleration for the force calculation. SUPERBOX is a particle-mesh code with high resolution sub-grid and a higher order NGP (nearest grid point) force-calculation scheme. In our research, we are aiming to demonstrate that the new parallel version of SUPERBOX is capable to do the high resolution simulations of the interaction of the system of disc-bulge-halo composed galaxy. We describe the improvement of performance and scalability of SUPERBOX particularly for the Kepler cluster (NVIDIA K20 GPU). A comparison was made with the very popular and publicly available Tree-GPU code BONSAI†.
Newell & Shanks (N&S) criticize theories on decision making that include unconscious processes. To the extent that their own perspective becomes apparent, however, it is dated, implausible, and at odds with the major developments of the past decades. Their conclusions are, at least for research areas we feel entitled to evaluate, based on a biased sampling of the literature.
Ethnic minority position is associated with increased risk for psychotic outcomes, which may be mediated by experiences of social exclusion, defeat and discrimination. Sexual minorities are subject to similar stressors. The aim of this study is to examine whether sexual minorities are at increased risk for psychotic symptoms and to explore mediating pathways.
Method
A cross-sectional survey was performed assessing cumulative incidence of psychotic symptoms with the Composite International Diagnostic Interview in two separate random general population samples (NEMESIS-1 and NEMESIS-2). Participants were sexually active and aged 18–64 years (n = 5927, n = 5308). Being lesbian, gay or bisexual (LGB) was defined as having sexual relations with at least one same-sex partner during the past year. Lifetime experience of any psychotic symptom was analysed using logistic regression, adjusted for gender, educational level, urbanicity, foreign-born parents, living without a partner, cannabis use and other drug use.
Results
The rate of any psychotic symptom was elevated in the LGB population as compared with the heterosexual population both in NEMESIS-1 [odds ratio (OR) 2.56, 95% confidence interval (CI) 1.71–3.84] and NEMESIS-2 (OR 2.30, 95% CI 1.42–3.71). Childhood trauma, bullying and experience of discrimination partly mediated the association.
Conclusions
The finding that LGB orientation is associated with psychotic symptoms adds to the growing body of literature linking minority status with psychosis and other mental health problems, and suggests that exposure to minority stress represents an important mechanism.
Ethnicity has been associated with different incidence rates and different symptom profiles in young patients with psychotic-like disorders. No studies so far have examined the effect of ethnicity on symptoms in people with an At Risk Mental State (ARMS).
Method
In this cross-sectional study, we analysed the relationship between ethnicity and baseline data on the severity of psychopathology scores in 201 help-seeking patients who met the ARMS criteria and agreed to participate in the Dutch Early Detection and Intervention (EDIE-NL) trial. Eighty-seven of these patients had a non-Dutch ethnicity. We explored the possible mediating role of ethnic identity.
Results
Higher rates of negative symptoms, and of anhedonia in particular, were found in the ethnic minority group. This result could be attributed mainly to the Moroccan-Dutch and Turkish-Dutch subgroups, who also presented with more depression symptoms when the groups were examined separately. The ethnic minority group displayed a lower level of ethnic group identity compared to the immigrants of the International Comparative Study of Ethnocultural Youth (ICSEY). Ethnic identity was inversely related to symptoms in the Moroccan-Dutch patient group.
Conclusions
The prevalence of more severe negative symptoms and depression symptoms in ethnic minority groups deserves more attention, as the experience of attenuated positive symptoms when accompanied by negative symptoms or distress has proven to be predictive for transition to a first psychotic episode.
Cannabis use may be a risk factor for schizophrenia. Part of this association may be explained by genotype–environment interaction, and part of it by genotype–environment correlation. The latter issue has not been explored. We investigated whether cannabis use is associated with schizophrenia, and whether gene–environment correlation contributes to this association, by examining the prevalence of cannabis use in groups with different levels of genetic predisposition for schizophrenia.
Method
Case-control study of first-episode schizophrenia. Cases included all non-Western immigrants who made first contact with a physician for schizophrenia in The Hague, The Netherlands, between October 2000 and July 2005 (n=100; highest genetic predisposition). Two matched control groups were recruited, one among siblings of the cases (n=63; intermediate genetic predisposition) and one among immigrants who made contact with non-psychiatric secondary health-care services (n=100; lowest genetic predisposition). Conditional logistic regression analyses were used to predict schizophrenia as a function of cannabis use, and cannabis use as a function of genetic predisposition for schizophrenia.
Results
Cases had used cannabis significantly more often than their siblings and general hospital controls (59, 21 and 21% respectively). Cannabis use predicted schizophrenia [adjusted odds ratio (OR) cases compared to general hospital controls 7.8, 95% confidence interval (CI) 2.7–22.6; adjusted OR cases compared to siblings 15.9 (95% CI 1.5–167.1)], but genetic predisposition for schizophrenia did not predict cannabis use [adjusted OR intermediate predisposition compared to lowest predisposition 1.2 (95% CI 0.4–3.8)].
Conclusions
Cannabis use was associated with schizophrenia but there was no evidence for genotype–environment correlation.
The international Project “Lithium in magnetic CP stars” has been put into operation using telescopes of the Crimean Astrophysical Observatory (2.6-m reflector ZTSH), European Southern Observatory (1.4-m CAT, 1.52-m with FEROS), Mount Stromlo Observatory (74-inch), Nordic Optical Telescope Scientific Association (2.4-m with SOFIN), Special Astrophysical Observatory of the Russian Academy of Sciences (6-m BTA). Here we present an historical report of the different scientific results of this project since its beginning in 1996.
The lines of lithium at $\lambda 6708$ and $\lambda 6103$ are analyzed in high resolution spectra of some sharp-lined and slowly rotating roAp stars. Three spectral synthesis codes, STARSP, ZEEMAN2 and SYNTHM were used. New lines of the Rare Earth Elements from the DREAM database, and lines calculated on the basis of the NIST energy levels were included. Magnetic splitting and other line broadening processes were taken into account. Enhanced abundances of lithium in the atmospheres of the stars studied are obtained for both lithium lines. High estimates of $^6{\rm Li}/^7{\rm Li}$ ratio ($0.2\div0.5$) for the studied stars can be explained by Galactic Cosmic Ray (GCR) production by spallation reactions and the preservation of the original $^6{\rm Li}$ and $^7{\rm Li}$ by the strong magnetic fields.To search for other articles by the author(s) go to: http://adsabs.harvard.edu/abstract_service.html
The clinicopathological features of two unusual cystic lesions, one arising in the nose, a calcified mucocoele or a calcified retention cyst and the other in the maxillary sinus a dentigerous cyst originating in a supernumerary tooth, are described. The literature on these two rare lesions is briefly reviewed.
In this note the differential expression M[y] ≡ − y” + qy, q∈Lp(ℝ+) for some p ≧ l, is considered on [0,∞) together with the boundary condition either y(0) = 0 or y'(0) = 0. Lower bounds are given for the spectrum of the self-adjoint operators T generated by M[·] and these boundary conditions. The bounds depend on the Lp-norm of the coefficient q and they improve results of Everitt and Eastham. The bounds are optimal.
In this paper we consider the initial-boundary value problem for the semihnear diffusion equation ul=uxx+f(u) on the half-line x>0, when for 0<a<1 f(0)=f(a)=f(1)=0 and f(u)<0 on (0, a), f(u)>0 on (a, 1). For a wide class of initial and boundary values a uniformly valid asymptotic expression is given to which the solution converges exponentially. This expression is composed of a travelling wave and a solution of the stationary problem.
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