To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Two types of mentalisation-based treatment (MBT) have been developed and empirically evaluated for borderline personality disorder (BPD): day hospital MBT (MBT-DH) and intensive out-patient MBT (MBT-IOP). No trial has yet compared their efficacy.
To compare the efficacy of MBT-DH and MBT-IOP 18 months after start of treatment. MBT-DH was hypothesised to be superior to MBT-IOP because of its higher treatment intensity.
In a multicentre randomised controlled trial (Nederlands Trial Register: NTR2292) conducted at three sites in the Netherlands, patients with BPD were randomly assigned to MBT-DH (n = 70) or MBT-IOP (n = 44). The primary outcome was symptom severity (Brief Symptom Inventory). Secondary outcome measures included borderline symptomatology, personality functioning, interpersonal functioning, quality of life and self-harm. Patients were assessed every 6 months from baseline to 18 months after start of treatment. Data were analysed using multilevel modelling based on intention-to-treat principles.
Significant improvements were found on all outcome measures, with moderate to very large effect sizes for both groups. MBT-DH was not superior to MBT-IOP on the primary outcome measure, but MBT-DH showed a clear tendency towards superiority on secondary outcomes.
Although MBT-DH was not superior to MBT-IOP on the primary outcome measure despite its greater treatment intensity, MBT-DH showed a tendency to be more effective on secondary outcomes, particularly in terms of relational functioning. Patients receiving MBT-DH and MBT-IOP, thus, seem to follow different trajectories of change, which may have important implications for clinical decision-making. Longer-term follow-up and cost-effectiveness considerations may ultimately determine the optimal intensity of specialised treatments such as MBT for patients with BPD.
Declaration of interest
P.L. and D.L.B. have been involved in the training and dissemination of MBT.
The aim of this study was to reanalyse the data from Cuijpers et al.'s (2018) meta-analysis, to examine Eysenck's claim that psychotherapy is not effective. Cuijpers et al., after correcting for bias, concluded that the effect of psychotherapy for depression was small (standardised mean difference, SMD, between 0.20 and 0.30), providing evidence that psychotherapy is not as effective as generally accepted.
The data for this study were the effect sizes included in Cuijpers et al. (2018). We removed outliers from the data set of effects, corrected for publication bias and segregated psychotherapy from other interventions. In our study, we considered wait-list (WL) controls as the most appropriate estimate of the natural history of depression without intervention.
The SMD for all interventions and for psychotherapy compared to WL controls was approximately 0.70, a value consistent with past estimates of the effectiveness of psychotherapy. Psychotherapy was also more effective than care-as-usual (SMD = 0.31) and other control groups (SMD = 0.43).
The re-analysis reveals that psychotherapy for adult patients diagnosed with depression is effective.
Day hospital mentalization-based treatment (MBT-DH) is a promising treatment for borderline personality disorder (BPD) but its evidence base is still limited. This multi-site randomized trial compared the efficacy of MBT-DH delivered by a newly set-up service v. specialist treatment as usual (S-TAU) tailored to the individual needs of patients, and offered by a well-established treatment service.
Two mental healthcare institutes in The Netherlands participated in the study. Patients who met DSM-IV criteria for BPD and had a score of ⩾20 on the borderline personality disorder severity index (BPDSI) were randomly allocated to MBT-DH (N = 54) or S-TAU (N = 41). The primary outcome variable was the total score on the BPDSI. Secondary outcome variables included symptom severity, quality of life, and interpersonal functioning. Data were collected at baseline and every 6 months until 18-month follow-up, and were analyzed using multilevel analyses based on intention-to-treat principles.
Both treatments were associated with significant improvements in all outcome variables. MBT-DH was not superior to S-TAU on any outcome variable. MBT-DH was associated with higher acceptability in BPD patients compared v. S-TAU, reflected in significantly higher early drop-out rates in S-TAU (34%) v. MBT-DH (9%).
MBT-DH delivered by a newly set-up service is as effective as specialist TAU in The Netherlands in the treatment of BPD at 18-month follow-up. Further research is needed to investigate treatment outcomes in the longer term and the cost-effectiveness of these treatments.
Replicability of findings is an essential prerequisite of research. For both basic and clinical research, however, low replicability of findings has recently been reported. Replicability may be affected by research biases not sufficiently controlled for by the existing research standards. Several biases such as researcher allegiance or selective reporting are well-known for affecting results. For psychotherapy and pharmacotherapy research, specific additional biases may affect outcome (e.g. therapist allegiance, therapist effects or impairments in treatment implementation). For meta-analyses further specific biases are relevant. In psychotherapy and pharmacotherapy research these biases have not yet been systematically discussed in the context of replicability. Using a list of 13 biases as a starting point, we discuss each bias's impact on replicability. We illustrate each bias by selective findings of recent research, showing that (1) several biases are not yet sufficiently controlled for by the presently applied research standards, (2) these biases have a pernicious effect on replicability of findings. For the sake of research credibility, it is critical to avoid these biases in future research. To control for biases and to improve replicability, we propose to systematically implement several measures in psychotherapy and pharmacotherapy research, such as adversarial collaboration (inviting academic rivals to collaborate), reviewing study design prior to knowing the results, triple-blind data analysis (including subjects, investigators and data managers/statisticians), data analysis by other research teams (crowdsourcing), and, last not least, updating reporting standards such as CONSORT or the Template for Intervention Description and Replication (TIDieR).
Mather and colleagues postulate that norepinephrine promotes selective processing of emotionally salient information through local “hotspots” where norepinephrine release interacts with glutamatergic activity. However, findings in rodents and humans indicate that norepinephrine is ineffective in modulating mnemonic processes in the absence of a functional amygdala. We therefore argue that emphasis should shift toward modulatory effects of amygdala-driven changes at the network level.
Consistent with principles of developmental psychopathology, this paper presents a broad psychodynamic structural developmental perspective that establishes conceptual continuities between processes of normal personality development, personality organization, concepts of psychopathology, and processes of therapeutic change. The major assumption of this approach is that personality development proceeds in a dialectic synergistic interaction between the development of capacities for interpersonal relatedness and the development of self-definition or identity. Extensive research demonstrates that these two dimensions define two broad types of personality organization, each with a particular experiential mode; preferred forms of cognition, defense, and adaptation; unique qualities of interpersonal relatedness and specific types of object and self-representation. Severe disruptions of this normal dialectic developmental process result in various forms of psychopathology organized in two basic configurations in which there is distorted defensive preoccupation, at different developmental levels, with one of these polarities (relatedness or self-definition) at the expense of the development of the other dimension. This paper reviews empirical findings supporting this approach to normal and disrupted personality development throughout the life cycle and considers its relationship to the internalizing–externalizing distinction in childhood and adolescence, attachment theory, and research on the interaction between biological and psychosocial factors in development across the life span. Finally, we discuss the implications of this approach for intervention and prevention.
We report a branch site mutation in the gene of the enzyme tyrosine hydroxylase (TH): a −24t
> a substitution two bases upstream of the adenosine in the branchpoint sequence (BPS) of intron
11. As normal lariat formation is therefore prevented, alternative splicing takes place: use of the BPS
of intron 12 results in skipping of exon 12, whereas the use of a cryptic branch site in intron 11 leads
to partial retention of this intron in the mRNA. This leads in both cases to an aberrant protein
product. In the one case, skipping of exon 12 results in the absence of 32 amino acids. In the other,
retention of 36 nucleotides of intron 11 in the mRNA results in the incorporation of twelve additional
amino acids. The functional consequences of this mutation for the patient, who is also heterozygous
for another previously identified mutation, become apparent in a severe clinical phenotype.
Stable Si3N4/SiCw co-dispersions containing up to 20 wt.% of whiskers have been prepared. Homogeneous green bodies with relative green density above 55% and pore size in the range 40-50 nm have been obtained by pressure assisted colloidal filtration. By optimizing the temperature and/or the amount of sintering additives, densities above 90-95 % have been achieved by pressureless sintering of these consolidated compacts.
The existing data on proper motions from meridian catalogues and proper motion surveys appear to be reasonably complete for motions larger than 0.24 arc seconds per year and down to the 19th magnitude visual but for motions between 0.24 and 0.18 there exists a lacuna for stars between 8.5 and 11.5 visual which could easily be observed by repeating Carte du Ciel plates.
Recent velocity profile data for the western equatorial Indian Ocean are presented and discussed. These display a very low frequency variability of small vertical scales. Wunsch's (1977) theoretical model of a forced equatorial response at the annual period is shown to provide a rational explanation of the phenomenon.
Introduction and historical background
The oceanographic response of the western Indian Ocean to the atmospheric monsoon regime is a complicated one, both from the observational and theoretical points of view. Several phenomena have a clearly documented relationship to the monsoon forcing although many of the details are not clearly understood. The most dramatic of these monsoon phenomena, the Somali Current, has been discussed by Swallow in Chapter 29 of this book.
In the open, equatorial Indian Ocean two phenomena exist whose seasonal variability is clearly associated with the monsoon–the equatorial undercurrent and the equatorial surface jet. Recent observations suggest there may be other monsoon-related currents at greater depths.The equatorial undercurrent is a permanent feature of both the Atlantic and Pacific Oceans (Philander, 1973) and is generally believed to be associated with the persistent trade winds from the east. This westward stress at the surface, and corresponding difference in elevation of the sea surface, is balanced by a zonal pressure gradient between the boundaries. Indian Ocean such a zonal pressure gradient can only be established by the northeast monsoon. The observations (Taft and Knauss, 1967; Swallow, 1967; Knox, 1976; Kort et al., 1975) have shown an undercurrent only during the latter part of the northeast monsoon, with large variations in strength from year to year.
Since regular HR diagrams require apparent magnitudes, colors or spectra, and parallaxes, and such complete data are available for relatively few stars, there may be some advantage in making up diagrams which utilize proper motions instead of parallaxes, and are thus statistically similar to an HR diagram. The reduced proper motion, first used by Hertzsprung, is defined as H = m + 5 + 5log μ, but may also be written as H = M + 5log T, where T is the tangential velocity, and is expressed in astronomical units per year. A diagram plotting H against color will thus contain the considerable dispersion in tangential velocity which is a serious disadvantage. However, this is outweighed by two practical advantages. First the one and the same person who does the proper motion survey can, and does also determine the other two quantities needed. Second, when using data obtained from such a proper motion survey one deals, statistically, with all the stars within a given distance and the results, therefore, are much more representative of the real situation in space than many HR diagrams which often contain an unrealistic preponderance of giants.
The papers presented this morning form a good illustration of the old adage that you should never publish a paper that is completely correct, for then you can write only one paper. But if you publish a paper with a lot of errors, you are sure to be criticized, and you can write a second paper to answer your critics, and if the heat proves to be too much you can write a third paper withdrawing everything.
First a bit of history. It is difficult to pin-point when exactly this question of the star density in high latitudes first came up, but I feel sure that it is Implied, to say the least, in the early work on faint blue stars by Malmquist (1927, 1938) and by Humason and Zwicky (1947). This morning Ivan King showed us a table of the changes in the frequency of occurrence among the stars in high galactic latitude as one goes to fainter and fainter magnitudes. This is exactly what I did in 1960 when I published a color-magnitude diagram for 4000 stars down to 19th photographic magnitude near the South Galactic Pole (Luyten 1960). These data had been obtained with the Palomar 48-inch telescope using Haro’s three-image method. I also made up a similar diagram calculated from what I thought were then the best available data on the luminosity and density functions. The conclusion of my analysis was that there seemed to be rather fewer M stars than had been expected, and a great many more stars with the color of F and G stars than expected. This idea was not popular at the time; hence this paper has been carefully ignored until these ideas were used by others twelve years later without reference to the 1960 paper.
The present state of the Palomar Proper Motion Survey is described. Before the CDC automated-computerized plate scanner became operational in 1972, 153 plate pairs had been blinked, whereas since then 443 pairs have been machine processed. Of the remaining 350 fields, some 40 are probably beyond the capability of the present system due to excessive star density.
Some 21000 new motions larger than 0″.18 annually have been published. The accuracy of an individual motion is about ± 0″.016 from a single machine-processed plate pair, as compared with ± 0″.025 from hand measured plates.
There is an indication that the number of large motions per unit area increases with galactic latitude.
A brief review is given of the several ways in which stellar motions may be used statistically. In the case where the motions of all stars shown on plates of certain regions are measured these are generally used to determine kinematical relations in the Galaxy and only secondarily for the estimation of luminosities; when motions are measured for special groups of stars the solar motion is first determined and then used for the calculation of distances and luminosities.
The proper Motion Survey with the 48-in Schmidt telescope has now progressed far enough such that we may begin to make some meaningful statistical discussions of the results obtained. Altogether 135 regions have been blinked - one seventh of the total - and in particular all fifty plates covering the area of the North Polar Cap, north of declination +69 (1855) have been blinked and completely measured.
White dwarfs have been known for slightly more than fifty years; with their planetlike diameters, and stellar-like masses their densities are enormously much higher than those of ‘normal’ stars. They thus appear to represent a state of matter totally unknown and possibly unattainable on earth.
The Proper Motion Survey on plates taken with the Bruce telescope of the Harvard Observatory was begun in 1928 with a fellowship from the Guggenheim Foundation. The plates used have a scale of 1 mm = 59”, generally go down to 16mpg though a few long exposure plates almost reach 18mpg and the survey is considered reasonably complete for the larger motions down to 14.5mpg.
There seems to be a consensus of opinion that the useful life of the commission has come to an end with the achievement of the principal aim of the historical task of the Carte du Ciel, presenting an overall picture of the Heavens as to positions of the fixed stars up to a definite limiting magnitude. The French presidents in succession with great energy, supported by the IAU, succeeded in overcoming all obstacles and in finishing the printed Astrographic Catalogue. Remaining tasks of deriving definitive plate constants, eventually deriving reliable proper motions of all stars in the programme evidently rests with individual observatories or at other commissions of the Union within their proper frame of activities.
Following a suggestion presented at the meeting of the Executive Committee in September 1969 a decision was reached to abolish the Commission 23 proper by merging it with Commission 24 (Stellar parallax and proper motion), and a working group in the latter commission would become a suitable means to continue work on data furnished by the Astrographic Catalogue.
Several of those observatories still in possession of Carte du Ciel-astrographs are going on with proper motion (p.m.) work in their zones or are preparing to do so. The application of the astrographs to the programme of attachment of stars to galaxies according to A. N. Dejč’s method is in progress.