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Psychoeducational interventions are promising long-term therapeutic options for bipolar disorder. We have developed a novel, web-based psychoeducational treatment for bipolar disorder, called “Beating Bipolar” www.BeatingBipolar.org. This was developed using an interative process involving several focus groups with patients, carers, families and professionals. The key areas covered in the package are: i) diagnosis; ii) causes; iii) medication; iv) lifestyle; v) relapse prevention and early intervention; vi) psychological approaches; vii) gender-specific considerations and viii) advice for family and carers. The 8 modules are delivered online on a fortnightly basis over a four-month period.
Objectives and aims
We aim to test the acceptability of the package to users and are currently conducting an exploratory randomised clinical trial (Trial registration: ISRCTN81375447).
The primary outcome measure will be quality of life, measured using the WHOQOL-Bref, and secondary outcome assessments will include scores on the Global Assessment of Functioning (GAF), the Functioning Assessment Short Test (FAST), the Schedule of Assessment of Insight (SAI), the Montgomery Asberg Depression Rating Scale (MADRS), the Young Mania Rating Scale (YMRS), and the number and severity of depressive and manic or hypomanic episodes experienced during the 10-month follow-up period. An assessment of costs and a detailed process evaluation involving qualitative interviews with participants will also be completed.
Initial findings will be presented during the symposium.
It is expected that findings from this exploratory trial will inform the design of a definitive randomised controlled trial of this intervention in the future.
Individuals with major mental illnesses (MMI) die significantly younger than the general population. Rates of Cardiovascular morbidity and mortality have fallen in the general population, due to effective primary prevention through the use of accurate cardiovascular risk assessment algorithms. This reduction has not occurred in individuals with MMI and there is evidence that the mortality gap is widening.
To determine the cardiometabolic risk profile and cardiovascular risk score in patients with schizophrenia compared to controls.
1,977 individuals with schizophrenia or related psychoses were compared to 215,165 controls. Cardiometabolic risk factors including cholesterol, BMI, systolic blood pressure, smoking status and diabetes were compared. Mean age and sex adjusted 10 year cardiovascular risk prediction scores were generated and compared using the Joint British Societies Score (JBS2).
Rates of diabetes, smoking and obesity were significantly higher in both men and women with schizophrenia compared to controls. In men with schizophrenia mean JBS2 score was lower than controls (10.2% vs. 10.9%). Rates of individuals at high risk of cardiovascular disease (JBS2 >20%) were lower in men with schizophrenia (28.4% vs. 39.3%). In women with schizophrenia mean JBS2 scores were higher (8.3% vs. 7.9%) and the rate of individuals at high risk of cardiovascular disease was higher than in controls (13.4% vs. 11.8%).
Despite high rates of cardiometabolic risk factors in men and women with schizophrenia across all age groups, cardiovascular risk algorithms may not adequately predict increased 10 year cardiovascular risk in men.
Individuals with serious mental illnesses experience poor physical health, particularly increased rates of cardiometabolic disorders. There are corresponding increases in premature mortality.
To assess the nature and extent of cardiometabolic risk factors and comorbidities in bipolar disorder and depression compared to controls.
Cross-sectional analysis of records for 502,602 participants within the UK Biobank database. Mood disorder was identified using an internally developed algorithm. Presence of cardiometabolic conditions and risk factors was examined. Multinomial logistic regression analyses were applied.
Compared to controls, individuals with bipolar and depression were significantly more likely to smoke. Rates of smoking were particularly elevated in the bipolar group, with a RRR of 3.18 (95% CI 2.790–3.632) compared to controls.
Individuals with bipolar disorder or severe recurrent depression were significantly more likely to be underweight, and have classes I, II and III obesity. All mood disorders were significantly associated with Class II and Class III obesity.
Bipolar disorder was significantly associated with increased rates of hypertension, diabetes, MI, angina and stroke. Severe depression was also associated with an increased risk of hypertension, diabetes, angina and stroke and individuals with moderate depressive disorder showed increased rates of MI, angina and stroke. Rates of ‘no cardiovascular illness’ were significantly reduced across the mood disorder spectrum.
Individuals with mood disorder have significantly increased rates of both cardiovascular risk factors and cardiometabolic illness. These findings using a large and extensive national dataset highlight a significant health inequality.
Using data from a prospective birth cohort, we aimed to test for an association between exposure to tobacco smoke in utero or during early development and the experience of hypomania assessed in young adulthood.
We used data on 2957 participants from a large birth cohort (Avon longitudinal study of parents and children [ALSPAC]). The primary outcome of interest was hypomania, and the secondary outcome was “hypomania plus previous psychotic experiences (PE)”. Maternally-reported smoking during pregnancy, paternal smoking and exposure to environmental tobacco smoke (ETS) in childhood were the exposures of interest. Multivariable logistic regression was used and estimates of association were adjusted for socio-economic, lifestyle and obstetric factors.
There was weak evidence of an association between exposure to maternal smoking in utero and lifetime hypomania. However, there was a strong association of maternal smoking during pregnancy within the sub-group of individuals with hypomania who had also experienced psychotic symptoms (OR = 3.45; 95% CI: 1.49–7.98; P = 0.004). There was no association between paternal smoking, or exposure to ETS during childhood, and hypomania outcomes.
Exposure to smoking in utero may be a risk factor for more severe forms of psychopathology on the mood-psychosis spectrum, rather than DSM-defined bipolar disorder.
This study investigated differences in cognitive performance between middle-aged adults with and without a lifetime history of mood disorder features, adjusting for a range of potential confounders.
Cross-sectional analysis of baseline data from the UK Biobank cohort. Adults aged 40–69 (n = 143,828) were assessed using measures of reasoning, reaction time and memory. Self-reported data on lifetime features of major depression and bipolar disorder were used to construct groups for comparison against controls. Regression models examined the association between mood disorder classification and cognitive performance, adjusting for sociodemographic, lifestyle and clinical confounders.
Inverse associations between lifetime history of bipolar or severe recurrent depression features and cognitive performance were attenuated or reversed after adjusting for confounders, including psychotropic medication use and current depressive symptoms. Participants with a lifetime history of single episode or moderate recurrent depression features outperformed controls to a small (but statistically significant) degree, independent of adjustment for confounders. There was a significant interaction between use of psychotropic medication and lifetime mood disorder features, with reduced cognitive performance observed in participants taking psychotropic medication.
In this general population sample of adults in middle age, lifetime features of recurrent depression or bipolar disorder were only associated with cognitive impairment within unadjusted analyses. These findings underscore the importance of adjusting for potential confounders when investigating mood disorder-related cognitive function.
Gaia will see little of the Galactic mid-plane and nuclear bulge due to high extinction at optical wavelengths. To study the structure and kinematics of the inner Galaxy we must look to longer wavelengths. The Vista Variables in the Via Lactea (VVV, Minniti et al. 2010) survey currently provides just over 4 years of observations covering approximately 560 square degrees of the Galactic bulge and plane. Typically each source is observed 50–150 times in the Ks band over this period. Using these data we provide relative proper motions for approximately 200 million unique sources down to Ks∼16 with uncertainties approaching 1 mas yr−1. In addition, we fit a solution of the parallactic motion of all sources with significant proper motion and discover a number of new nearby brown dwarfs. These results will allow us to identify faint common proper motion companions to stars with Gaia parallaxes, increasing the number of brown dwarf benchmark objects. Our absolute astrometric calibration precision is currently ∼ 2 mas yr−1, based on PPMXL. The Gaia absolute astrometric reference grid will allow us to precisely anchor our results and measure the streaming motions of stars in the bulge. Finally, we anticipate that the catalogue could provide kinematic distances to the numerous optically invisible high amplitude variable stars that VVV is discovering.
Inverse Compton scattering is a promising method to implement a high brightness, ultra-short, energy tunable X-ray source at accelerator facilities. We have developed an inverse Compton backscattering X-ray source driven by the multi-10 TW laser installed at Daresbury. Hard X-rays, with spectral peaks ranging from 15 to 30 keV, depending on the scattering geometry, will be generated through the interaction of laser pulses with electron bunches delivered by the energy recovery linac machine, initially known as energy recovery linac prototype and subsequently renamed accelerators and lasers in combined experiments. X-ray pulses containing 9 × 107 photons per pulse will be created from head-on collisions, with a pulse duration comparable to the incoming electron bunch length. For transverse collisions 8 × 106 photons per pulse will be generated, where the laser pulse transit time defines the X-ray pulse duration. The peak spectral brightness is predicted to be ~1021 photons/(s mm2 mrad2 0.1% Δλ/λ).
A project to develop an Accounting Standard for Insurance, with the aim of enhancing understandability, relevance, reliability and comparability of general purpose financial reporting for insurance worldwide, is being progressed by the International Accounting Standards Board. The basis of the proposals is that assets and liabilities be shown at fair values (market values for quoted instruments). This paper, prepared by a Working Party established by the Life Board of the United Kingdom actuarial profession, summarises and comments upon a number of the principal features of the proposals, as they have emerged up to September 2001. The paper goes on to consider how a system of reporting for prudential regulatory purposes might be built upon a fair value general reporting base, summarising the thinking of a number of other bodies, proposing certain principles and suggesting lines of development. The appendices to the paper discuss a number of issues in further depth and present some illustrative results of some investigations into applying fair value methods in practice. The emphasis of the paper is on reporting for life assurance business, although many of the principles apply equally to general insurance.