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To determine the effect on decisional-related and clinical outcomes of decision aids for depression treatment in adults in randomised clinical trials. In January 2019, a systematic search was conducted in five databases. Study selection and data extraction were performed in duplicate. Meta-analyses were performed, and standardised and weighted mean differences were calculated, with corresponding 95% confidence intervals. The certainty of the evidence was evaluated with GRADE methodology.
Six randomised clinical trials were included. The pooled estimates showed that decision aids for depression treatment had a beneficial effect on patients’ decisional conflict, patient knowledge and information exchange between patient and health professional. However, no statistically significant effect was found for doctor facilitation, treatment adherence or depressive symptoms. The certainty of the evidence was very low for all outcomes.
Using decision aids to choose treatment in patients with depression may have a a beneficial effect on decisional-related outcomes, but it may not translate into an improvement in clinical outcomes.
We present the bat assemblage from the early Miocene (MN4, 16.9–15.95 MY) basin of Ribesalbes-Alcora, which has yielded the remains of ten chiropteran taxa. Bat assemblages are rarely recovered in the fluvio-lacustrine fossil record. A bat species described in this work, Cuvierimops penalveri sp. nov., is a new form of a typically Oligocene free-tailed bat. In addition, the other molossids Hydromops helveticus, Rhizomops cf. brasiliensis, Chaerephon sp., Tadarida sp., and the vespertilionids Myotis cf. intermedius and Miostrellus aff. petersbuchensis, as well as undetermined fossils ascribed to the genera Submyotodon, Plecotus, and Rhinolophus are described. This is the first record of the genus Rhizomops in the early Miocene; the genus Cuvierimops is the first recording from the Neogene, while the ‘Lazarus taxon’ Chaerephon is the first fossil record of this genus, registered previously only in Holocene deposits. This bat assemblage with a high abundance of molossids is typical from the early Oligocene of western Europe, while in the early Miocene from Europe the molossids are scarce. The abundance of these bats is consistent with the presence of a tropical forest surrounding a paleolake. The fossils from the Ribesalbes-Alcora Basin represent the most complete bat assemblage of the Iberian Peninsula during this age, and significantly increase our knowledge about the early Miocene bats of Europe.
Background: Hand hygiene (HH) is the most important measure for preventing healthcare-associated infections. The objective is to gain insight into the evolution of the degree of compliance with recommendations (DCR) on HH and its associated factors in the surgical areas of a tertiary-care hospital. Methods: This observational, cross-sectional study, was repeated over time, with direct observation of the DCR on HH during the daily activity of healthcare workers in surgical areas: general surgery, urology, vascular surgery, traumatology, neurosurgery, thoracic surgery, heart surgery, pediatric surgery, otorhinolaryngology, gynecology and obstetrics, ophthalmology. Over 14 years (from 2005 to 2018), 15,946 HH opportunities were registered, together with different additional variables (age, sex, professional position, surgical area ). The 2 test was used to study the association and the crude, and adjusted odds ratios were used to quantify its magnitude. Results: The DCR on HH in surgical areas was 49.7% (95% CI, 48.9%–50.5%), and in the group of nonsurgical areas it was 53.4% (95% CI, 53.1%–54.1%). The area with the highest degree of compliance was urology (56.7%; 95% CI, 53.9%–59.6%), and the area with the lowest degree of compliance was traumatology (43.3%; 95% CI, 40.4%–46.2%). Some associated factors were the indications after an activity has been performed (58.6%; aOR, 2.7; 95% CI, 2.5–2.9) and the availability of pocket-size alcohol-based disinfectant (63.8%; aOR, 2.4; 95% CI, 2.2–2.5). Conclusions: The DCR on HH in surgical areas is lower than in other hospital areas, and there is still some margin for improvement. We have identified some modifiable factors that have an independent association with HH compliance in surgical areas. Focusing on them will increase compliance with HH with the ultimate goal of reducing healthcare-associated infections.
Background:Pseudomonas aeruginosa, is the third etiologic agent of healthcare associated infections, and the most frequent pathogen in ventilator-associated pneumonia (VAP). In critical care units is associated with high mortality, long hospital stay, and high healthcare-associated costs. We evaluated the effectiveness of filter placement in the water taps in critical care units to prevent the occurrence of healthcare-associated infections (HAIa) by Pseudomonas aeruginosa. Methods: This experimental study was both cross-over and open-label in nature. We included patients admitted for >24 hours in critical care units over 24 months. The study was divided into 4 periods of 6 months each. We divided the study into 2 groups: patients in units with filters and patients in units without filters. We compared the incidence density of P. aeruginosa HAIs (number of cases divided by the number of person days) according the ECDC definition of case criteria between the groups. The 2 test was used, and the magnitude of the association was calculated as a rate ratio with a 95% confidence interval, adjusted using a Poisson regression model. Results: Overall, 1,132 patients were included in the study: 595 in units with water tap filters and 537 in units without water tap filters. HAI incidence among patients in units with water tap filters was 5.3 per 1,000 person days stay; without water tap filters, HAI incidence was 4.7 per 1,000 person days stay (HR, 0.94; 95% CI, 0.47–1.90). Conclusions: The preliminary results of this study indicate a a lower incidence of P. aeruginosa HAIs in units with filters placed in water taps than in units without filters.
Materials from the localities of Araia d'Alcora in the Ribesalbes-Alcora Basin (Spain, early Miocene, Biozone C, MN4) have yielded an assemblage of erinaceids and metatherians, relatively rich for an Iberian site. The most common erinaceid is the gymnure Galerix symeonidisi Doukas, 1986, present in almost all of the studied sites. Other erinaceids in the faunal list are possibly an indeterminate species of the genera Lantanotherium Filhol, 1888 and Atelerix Pomel, 1848, in what constitutes one of their oldest occurrences in Europe. Metatherians are represented by the herpetotheriid Amphiperatherium frequens erkertshofense (Koenigswald, 1970). The material described here was partially published by Furió and colleagues in 2012. We complete it with new material from the known localities and with material from new sites. We describe for the first time the lower dentition of this taxon in this basin, thus increasing knowledge of the high variability of its decidual molars. In addition, the climatic preferences of the species A. frequens (von Meyer, 1846), which was probably less strict in its humidity requirements than previously thought, are also discussed.
Growing evidence suggests that emotion socialization may be disrupted by maternal depression. However, little is known about emotion-related parenting by mothers with bipolar disorder or whether affective modeling in early childhood is linked to young adults’ recollections of emotion socialization practices. The current study investigates emotion socialization by mothers with histories of major depression, bipolar disorder, or no mood disorder. Affective modeling was coded from parent–child interactions in early childhood and maternal responses to negative emotions were recollected by young adult offspring (n = 131, 59.5% female, M age = 22.16, SD = 2.58). Multilevel models revealed that maternal bipolar disorder was associated with more neglecting, punishing, and magnifying responses to children's emotions, whereas maternal major depression was associated with more magnifying responses; links between maternal diagnosis and magnifying responses were robust to covariates. Young adult recollections of maternal responses to emotion were predicted by affective modeling in early childhood, providing preliminary validity evidence for the Emotions as a Child Scale. Findings provide novel evidence that major depression and bipolar disorder are associated with altered emotion socialization and that maternal affective modeling in early childhood prospectively predicts young adults’ recollections of emotion socialization in families with and without mood disorder.
The Paleolithic diet (PaleoDiet) is an allegedly healthy dietary pattern inspired by the consumption of wild foods and animals assumed to be consumed in the Paleolithic era. Despite gaining popularity in the media, different operational definitions of this Paleolithic nutritional intake have been used in research. Our hypothesis is that specific components used to define the PaleoDiet may modulate the association of this diet with several health outcomes. We comprehensively reviewed currently applied PaleoDiet scores and suggested a new score based on the food composition of current PaleoDiet definitions and the theoretical food content of a staple dietary pattern in the Paleolithic age. In a PubMed search up to December 2019, fourteen different PaleoDiet definitions were found. We observed some common components of the PaleoDiet among these definitions although we also found high heterogeneity in the list of specific foods that should be encouraged or banned within the PaleoDiet. Most studies suggest that the PaleoDiet may have beneficial effects in the prevention of cardiometabolic diseases (type 2 diabetes, overweight/obesity, CVD and hyperlipidaemias) but the level of evidence is still weak because of the limited number of studies with a large sample size, hard outcomes instead of surrogate outcomes and long-term follow-up. Finally, we propose a new PaleoDiet score composed of eleven food items, based on a high consumption of fruits, nuts, vegetables, fish, eggs and unprocessed meats (lean meats); and a minimum content of dairy products, grains and cereals, and legumes and practical absence of processed (or ultra-processed) foods or culinary ingredients.
Mixed Bipolar patients are those who have co-existing depressive symptoms during mania. These patients are supposed to have a worse evolution.
The objective of this study was to compare the long-term outcomes of patients who had at least one mixed episode with those who experienced only pure manic episodes.
169 outpatients diagnosed of Bipolar I disorder and treated at least during two years were included. 120 patients (71%) complited the follow-up over 10 years. Baseline demographic and clinical variables were included.
The patients with mixed episodes (37%) had a significantly younger mean age at onset comparing with those with manic episodes (25.3 years vs. 30.8 years; p=0.025) they also had more previous mood- incongruent psychotic symptoms χ2= 6.77, p=0.034), more number of hospitalizations (OR= 1.36, 95% CI = 1.14; -1.63; p< 0.001), and more number of episodes (OR= 1.21, 95% CI = 1.10-1.31; p< 0.001). There were no significant differences relating to depressive episodes, alcohol use, drug abuse, suicidal behaviour and suicide attempts.
Age at onset differed significantly between the mixed episode and pure mania groups, with mixed episode patients having a younger age of onset. This is interesting as one of the major results of the study we have found that age at onset mediates some of the factors classically related to outcome in mixed episodes like alcohol abuse and suicide attempts. However, independently of age at onset, these patients represent a especially severe type of bipolar disorder.
In Spain, consumption of psychotropic drugs is high and benzodiazepines represent 74% of the total. His prescription in primary care is very common and their use continues to grow. They are safe and effective drugs, but patients with prolonged use are elaborating the most adverse effects, particularly the dependency.
Descriptive ans cross-sectional.
Primary Health Care.
We seleted 202 patients treated with benzodiazepines, consecutive sample, belonging to the health center Los Barrio who were seen in consultation during 2009.
We conducted through a questionnaire that cointained the treatment and demographic characteristics.
We detect a frequency of use of benzodiazepines 9% (95% CI 4,7-12,1%). The profile of the consumer responds to middle-aged woman, with primary and housewives. Somatic diseases were associated in 72.6% (CI 67,2-77,5%) and had mental pathology at 59.7% (CI 53,9-65,3%). 35% (95% 29,6-40,6%) of prescribed benzodiazepines were clorazape dipotassium. Consumption was constant for over a year. The prescription from primary care represents 81% (95% 76,3-85,4%) and in 65% (CI 59,3-70,3%) is associated with other psychoactive drug.
In our area, highlights the prescription of benzodiazepines from primary care on demand and consumption during prolonged time. Interventions should be conducted on the prescription of benzodiazepines in medical and other interventions for patient support.
We analyzed the association of age at onset of psychosis(AOP) with having a history of cannabis use in patients with a first episode of non-affective psychosis(FENAP) and investigated the impact on the AOP of exposure to cannabis in adolescence, compared with young adulthood, and of the additional exposure to cocaine.
We recruited 112 consecutive patients with a FENAP. CIDI was used to assess drug use and to define the age at onset of heaviest use(AOHU) of a drug, as the age when drug was used the most for each patient. The effect of cannabis and cocaine AOHU on AOP was explored through Kruskal-Wallis and Mann-Whitney tests, and logistic regression. Sex-adjusted cumulative hazard curves and Cox regression models were used to compare the AOP of patients with and without a history of cannabis use, or associated cocaine use.
AOP was significantly associated with the use of cannabis, independently of sex, use of cocaine, tobacco smoking or excessive alcohol consumption. There was a dose-response relationship between cannabis AOHU and AOP: the earlier the AOHU the earlier the AOP. Hazard curves showed that patients with a history of cannabis use had a higher hazard of having a first episode psychosis than the rest of the patients (sex-adjusted log rank χ2=23.43,df=1, p< 0.001). Their respective median AOP (25th, 75th percentiles) were 23.5 (21,28) and 33.5 years (27,45) (for log-transformed AOP, t=5.6, df=110, p< 0.001).
Our results are in favor of a catalytic role for cannabis use in onset of psychosis.
A randomized, controlled study showed that a telephone-based nursing strategy was effective to improve adherence to antipsychotic treatment in clinically stable outpatients with schizophrenia. Post hoc analysis was carried out to identify factors associated with intervention success.
Patients (n= 865) were randomized to receive monthly telephone calls from a nurse or standard clinical follow-up. Calls were performed at weeks 4, 8, and 12, consisting of a brief semistructured interview to assess adherence and attitudes toward medication (DAI-10). Primary endpoint: difference in the percentage of adherent patients after phone follow-up versus control group at week 16. Non conditional logistic regression with backward stepwise procedure was used to identify variables involved with adherence improvement.
410 (96.7%) patients fulfilled adherence criteria in the intervention group vs 402 (91.1%) in the control group. A difference of 5.5% was found between groups (95% CI 2.3, 8.6%; p= 0.0007).
The telephone intervention was significantly associated with an improvement in adherence in those patients with a prior negative attitude toward treatment (OR 4.7, 95% CI 2.4, 9.0; p< 0.0001), but there was not a significant association in patients with a previous positive perception (OR 1.2, 95% CI 0.8, 1.9; p= 0.36). A slight concordance was obtained between adherence improvement after the intervention and the improvement in attitude toward treatment (kappa 0.21, 95% CI 0.15, 0.27).
A nurse telephone follow-up could be a complementary and easy to implement strategy to improve therapeutic adherence, particularly in those patients with negative attitudes toward antipsychotic treatment.
Diffusion tensor imaging (DTI) is a relatively new imaging technique that is being increasingly used in different types of psychiatric patologies to characterize white matter microstructural organization in this kind of disorders. In the present study we use DTI to explore the structure of the white matter of borderline personality disorder (BPD) patients, using a novel voxel-based approach, tract-based spatial statistics (TBSS), to analyze the data.
Methods and materials
DTI was performed in a 1.5T MRI unit in 9 young male patients with a DSM-IV defined BPD and 14 healthy male control subjects (no significant age difference between groups).Voxel wise analysis was performed using TBSS (diffusion toolbox of FSL- functional MRI Software Library) to localize regions of white matter showing significant changes of fractional anisotropy (FA). Additional high resolution three dimensional datasets were also acquired and normalised white matter volume was estimated with SIENAX (part of FSL).
The TBSS analysis revealed a statistically significant decrease in FA at the anterior part of the body and the genu of the corpus callosum and frontal white matter. This finding is consistent with previously reported findings of subtle prefrontal white matter abnormalities in BPD.
Significant white matter tract alterations in patients with BPD where observed in frontal regions involved in emotional, behavioural and cognitive regulation, and these abnormalities may be linked to key aspects of psychopatology in these patients.
To evaluate the impact of the “Spanish Consensus on Physical Health in Patients with Schizophrenia” on psychiatrists’ evaluations of the physical health of patients with schizophrenia.
Epidemiological, non-interventional, national, multicentre study, with two retrospective, cross-sectional data collection stages in which 229 psychiatrists evaluated 1193 clinical records of patients with schizophrenia (ICD-10) seen in January and September of 2007.
Mean age of the patients was 39.7 ± 11.6 years, 65.5% were men, diagnosed for schizophrenia 14.0 ± 10.3 years ago. Forty percent of the patients suffer from a concomitant disease, the most prevalent being hypercholesterolemia (46.3%), hypertriglyceridaemia (33.5%) and arterial hypertension (26.0%). The difference in the number of patients who had all the physical measurements taken between the two cross-sectional evaluations was 13.8% (CI: 11.8%, 15.7%). The differences for each parameter were: weight 13.7% (CI: 11.7%, 15.6%), BMI 13.58% (CI: 11.6%, 15.5%), waist circumference 14.0% (CI: 12.0%, 15.39%), lipid profile 2.9% (CI: 1.9%, 3.9%) and glycaemia 2.6% (CI: 1.7%, 3.5%).
These results imply that the dissemination of the “Consensus on Physical Health in Schizophrenia Patients”, and possibly other actions, has made psychiatrists more aware of an integral approach to patients with schizophrenia, promoting increased monitoring of the physical health of these patients.
To study the changes in plasma concentration of homovanillic acid (pHVA) and its relation with clinical outcome during treatment of Bipolar I patients with olanzapine plus lithium.
Patients and Methods:
Fifty six (33 women and 23 men) Bipoar I patients, age 35.1±9.4 (SD) years, diagnosed according to DSM-IV, were treated initially with 10mg/day of olanzapine for 4 days and subsequently with 20 mg/day. On the 8th day lithium was added until a concentration of 0.6 to 1.2 mEq/L was reached in plasma. Patients were, at least, a week without neuroleptic or mood stabilizer medication.
Their clinical state was evaluated before and during 28 days of treatment with the Young scale and with the Clinical Global Impression.
Morning fasting levels of pHVA were analyzed the same days that scales were passed.
Plasma HVA after 28 days of treatment does not decline as habitually happens with neuroleptic treatment alone. Moreover, there was a trend toward significance of a Positive Correlation between pHVA and clinical improvement.
The addition of Lithium to Olanzapine altered the pattern of pHVA response from the first days of treatment up to day 28, suppressing the habitual decline in pHVA concentration. These results are similar to those observed by Bowers et al. (1992) when lithium was combined with perphenazine. The correlation between changes in pHVA concentration during 28 days of treatment and clinical outcome was the opposite to that found in schizophrenic patients treated with neuroleptics alone.
Looking for a substantial increase in the reliability and validity of voice analysis measurements in depression, we have developed a new experimental paradigm. The paradigm is based on two vocal tasks with different levels of cognitive processing and a baseline verbal task. It has been applied to 40 subjects, 20 patients with affective disorders and 20 normal individuals. We have found that an important set of vocal parameters, at different intervals, discriminates patients from normal subjects. Here, we discuss four of them – those that have been especially consistent; the patients had longer reaction times, a higher proportion of relative spectral energy (at a very low frequency band), narrower fundamental frequency range and higher proportion of omissions. Under the proposed paradigm, the acoustic analysis could be a promising instrument for the development of quantitative indicators of depression.
Bipolar disorder is a serious mental illness which may affect between 2% and 5% of the population. These patients present much higher morbidity and mortality rates than the general population. In addition to a higher mortality rate from suicide, they also have a higher prevalence of other physical disorders.
The purpose of this consensus is to establish recommendations for diagnostic procedures and clinical interventions in order to control the risk factors which have repercussions on the physical health of the patients.
After carrying out a systematic review of medical co-morbidity and mortality rates in bipolar disorder, two multidisciplinary consensus meetings were held in which 31 psychiatrists and 11 experts from other medical specialities participated.
Working groups were formed for each speciality for the purposes of adapting the guidelines applied in the general population to these patients.
The bibliographical review revealed an increased risk of hypertension, obesity, smoking, pulmonary diseases, migraine and HIV infection. There is evidence of higher mortality rates from cardiovascular and respiratory diseases and infections, as well as from suicide. The expert group reached consensus on a series of basic measures for detecting medical co-morbidity. The resulting recommendations will be validated by Spanish Psychiatry and General Medicine Associations.
The physical health of patients with bipolar disorder could be improved. It is hoped that the publication of this consensus will have an impact in terms of better psychosocial functioning, quality of life and life expectancy for these patients in Spain.
Chronic Fatigue Syndrome (CFS) is characterized by severe fatigue associated with pain, sleep disturbance, attentional impairment and headaches. Evidence points towards a prominent role for Central Nervous System in its pathogenesis, and alterations in serotoninergic and dopaminergic neurotransmission have been described.
Attention-deficit Hyperactivity Disorder (ADHD) courses with inattention, impulsivity, and hyperactivity. It affects children and persists into adulthood in 50% of patients. Dopamine transporter abnormalities lead to impaired neurotransmission of catecholaminergic frontal-subcortical-cerebellar circuits.
To describe the prevalence of ADHD in a sample of CFS patients, and the clinical implications of the association.
To study the relationship between CFS and ADHD.
The initial sample consisted of 142 patients, of whom 9 were excluded because of severe psychopathology or incomplete evaluation. All the patients (age 49 ± 87; 94,7 women) received CFS diagnoses according to Fukuda criteria. ADHD was assessed with a diagnostic interview (CAADID), ADHD Rating Scale and the scale WURS, for childhood diagnose. The scales FIS-40, HAD, STAI and Pluthik Risk of Suicide (RS) were administrated.
38 patients (28,8%) were diagnosed of childhood ADHD (4 combined, 22 hyperactive-impulsive, 12 inattentive) and persisted into adulthood in 28 (21,1%; 5 combined, 4 hyperactive-impulsive, 19 inattentive). There were no differences in Fukuda criteria profile and FIS-40 between groups. ADHD patients scored higher in HAD-Anxiety (9,88 ± 4,82 vs. 12,57 ± 3,49; p = 0,007), HAD-Depression (9,69 ± 4,84 vs. 12,04 ± 4,53; p = 0,023), STAI-E (30,55 ± 14,53 vs. 38,41 ± 11,35; p = 0,012), and RS (6,13 ± 3,48 vs. 8,49 ± 3,07; p = 0,002).
ADHD is frequent in CFS patients and it is associated with more severe clinical profile.
To synthesize the available knowledge on gynaecological and obstetric comorbidities in patients with bipolar disorder (BD).
Relevant studies were identified by a MEDLINE search from 1966 to January 2008, and supplemented by a manual review of reference lists of the articles identified and previous review articles. We included studies with any design, in patients with BD as diagnosed by any criteria, with sample size ≥30 patients, and reporting any measure of frequency or association as regards the comorbidities. When available, priority was given to comparative studies.
We identified 4 studies: 3 were comparative; 1 was cross-sectional and 3 were retrospective cohort studies; 1 was population-based study; and 4 used a convenience sample. A retrospective study reported an increased risk of pregnancy complications in patients with BD (OR1.23, 95%CI 1.06-1.44) but not of labor/delivery or neonatal complications; as compared to controls, patients with BD had an increased risk of placenta previa (OR2.04, 95% CI 1.11-3.73), antepartum hemorrhage (OR 1.66, 95%CI 1.15-2.39), and drug side-effects (OR 3.94, 95%CI 1.46-10.62). In another retrospective study, patients with BD had an increased risk of endometriosis (OR: 1.93, 95%CI 1.37-2.70), inflammatory disease of ovary (OR 2.17, 95%CI 1.84-2.57), and disorders of menstruation (OR 1.79, 95%CI 1.56-2.05). In a cross-sectional study, gynaecological disorders were more common in patients with BD than in patients with schizophrenia (4% vs 1.3%).
Although the information is scanty, available data suggest that patients with BD might have an increased risk of gynaecological and obstetric comorbidities/complications.
Antipsychotic therapy is the cornerstone of the treatment of schizophrenia and other psychoses. Although clinical guidelines tend to recommend the use of antipsychotics in monotherapy, combination of two or more antipsychotics (that is, polytherapy) is a common habit in clinical practice.
To assess differences in antipsychotic combination profile between patients with schizophrenia and patients with other psychoses.
A total of 241 patients (40.2% females, mean age 39.7+/−13.0 years) consecutively admitted during 2009 to a psychiatric inpatient ward with diagnosis of schizophrenia and other psychoses were assessed.
145 (60.2%) patients were diagnosed with schizophrenia while 96 patients (39.8%) were diagnosed with other psychoses (schizoaffective disorder n = 35, delusional disorder n = 8, schizophreniform disorder n = 8, brief psychotic disorder n = 13, psychotic disorder not otherwise specified n = 27, and other psychoses n = 5). Out of the total sample, polytherapy was used in 150 (62.2%) patients. A total of 100 (69.0%) patients with schizophrenia were on polytherapy, compared to 52.1% of those with other psychoses (p = 0.008). After controlling for age and gender, the association between a diagnosis of schizophrenia and being in polytherapy remained significant (p = 0.046).
Patients diagnosed with schizophrenia are more prone to be in polytherapy than those with other psychoses.