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Employment and relationship are crucial for social integration. However, individuals with major psychiatric disorders often face challenges in these domains.
Aims
We investigated employment and relationship status changes among patients across the affective and psychotic spectrum – in comparison with healthy controls, examining whether diagnostic groups or functional levels influence these transitions.
Method
The sample from the longitudinal multicentric PsyCourse Study comprised 1260 patients with affective and psychotic spectrum disorders and 441 controls (mean age ± s.d., 39.91 ± 12.65 years; 48.9% female). Multistate models (Markov) were used to analyse transitions in employment and relationship status, focusing on transition intensities. Analyses contained multiple multistate models adjusted for age, gender, job or partner, diagnostic group and Global Assessment of Functioning (GAF) in different combinations to analyse the impact of the covariates on the hazard ratio of changing employment or relationship status.
Results
The clinical group had a higher hazard ratio of losing partner (hazard ratio 1.46, P < 0.001) and job (hazard ratio 4.18, P < 0.001) than the control group (corrected for age/gender). Compared with controls, clinical groups had a higher hazard of losing partner (affective group, hazard ratio 2.69, P = 0.003; psychotic group, hazard ratio 3.06, P = 0.001) and job (affective group, hazard ratio 3.43, P < 0.001; psychotic group, hazard ratio 4.11, P < 0.001). Adjusting for GAF, the hazard ratio of losing partner and job decreased in both clinical groups compared with controls.
Conclusion
Patients face an increased hazard of job loss and relationship dissolution compared with healthy controls, and this is partially conditioned by the diagnosis and functional level. These findings underscore a high demand for destigmatisation and support for individuals in managing their functional limitations.
In the inherently noisy real world, we can rarely have full certainty about what we have just seen or heard. Thus, making a perceptual decision on sensory information, and simultaneously tracking our varying levels of certainty in these decisions (i.e., metacognitive abilities) are crucial components of everyday life.
Hallucinations, such as confidently reporting a human voice or face when none was present, are a hallmark of psychotic disorders but also occur among the normal population. Particularly in patients with psychotic disorders, these misperceptions are linked to confident beliefs in their actual existence. However, whether patients’ confidence is only increased during such erroneous perceptions and whether perceptual and metacognitive decisions arise from supramodal mechanisms across sensory modalities remains unknown.
Objectives
In the laboratory, we tested perceptual and metacognitive decisions under varying levels of sensory certainty in healthy adults and patients with psychotic disorders admitted to a psychiatry ward (Ncon=32, Npat=12; age = 19-49; F2x.x diagnoses).
Methods
Specifically, participants had to detect human voices or faces against briefly presented noisy backdrops and subsequently rate their confidence in the accuracy of their perceptual decision (Fig 1A,B,C). We further hypothesised that probabilistic cues prior to blocks of trials can bias participants’ choices and hallucination probability (i.e., confident false alarms).
Results
Patients exhibited higher perceptual sensitivity in the auditory than the visual task, alongside a generally stronger decision bias towards fewer ‘voice/face’ choices (Fig 2A,B). This bias was more pronounced in the visual domain. Decision performance was overall higher on the auditory task but lower for patients (predicted minimum > 55%; Fig 2C). Strong correlations between auditory accuracy and PANSS hallucination scores of patients and LSHS scores of healthy participants suggest an effect of these hallucinatory experiences on accurate perception.
Metacognitive abilities were reduced in patients across both modalities: They exhibited general overconfidence, which was stronger for incorrect trials (Fig 3A). Patients’ confidence ratings were inversely related to the probability of choosing ‘voice/face’. Combining both perceptual and confidence decisions, patients showed higher hallucinations probability in the auditory task, particularly in more difficult trials (i.e., with less informative sensory evidence; Fig 3B).
Image:
Image 2:
Image 3:
Conclusions
In sum, patients with psychotic disorders exhibit increased decision bias accompanied by increased confidence, and thus a reduced fidelity in their metacognitive abilities. The modality differences are in line with phenomenology and reported hallucination rates. These results suggest stronger priors in psychotic disorders resulting in worse perceptual acuity and assessment of this perception.
Obesity is highly prevalent and disabling, especially in individuals with severe mental illness including bipolar disorders (BD). The brain is a target organ for both obesity and BD. Yet, we do not understand how cortical brain alterations in BD and obesity interact.
Methods:
We obtained body mass index (BMI) and MRI-derived regional cortical thickness, surface area from 1231 BD and 1601 control individuals from 13 countries within the ENIGMA-BD Working Group. We jointly modeled the statistical effects of BD and BMI on brain structure using mixed effects and tested for interaction and mediation. We also investigated the impact of medications on the BMI-related associations.
Results:
BMI and BD additively impacted the structure of many of the same brain regions. Both BMI and BD were negatively associated with cortical thickness, but not surface area. In most regions the number of jointly used psychiatric medication classes remained associated with lower cortical thickness when controlling for BMI. In a single region, fusiform gyrus, about a third of the negative association between number of jointly used psychiatric medications and cortical thickness was mediated by association between the number of medications and higher BMI.
Conclusions:
We confirmed consistent associations between higher BMI and lower cortical thickness, but not surface area, across the cerebral mantle, in regions which were also associated with BD. Higher BMI in people with BD indicated more pronounced brain alterations. BMI is important for understanding the neuroanatomical changes in BD and the effects of psychiatric medications on the brain.
We bound from below the complexity of the top Chern class $\lambda _g$ of the Hodge bundle in the Chow ring of the moduli space of curves: no formulas for $\lambda _g$ in terms of classes of degrees 1 and 2 can exist. As a consequence of the Torelli map, the 0-section over the second Voronoi compactification of the moduli of principally polarized abelian varieties also cannot be expressed in terms of classes of degree 1 and 2. Along the way, we establish new cases of Pixton's conjecture for tautological relations. In the log Chow ring of the moduli space of curves, however, we prove $\lambda _g$ lies in the subalgebra generated by logarithmic boundary divisors. The proof is effective and uses Pixton's double ramification cycle formula together with a foundational study of the tautological ring defined by a normal crossings divisor. The results open the door to the search for simpler formulas for $\lambda _g$ on the moduli of curves after log blow-ups.
A Concise History of Albania charts the history of Albania and its people, within their Balkan and European contexts. It shows the country's journey from its ancient past, still shrouded in mystery and controversy, through its difficult transition from a particularly brutal form of communism to an evolving form of democracy and a market economy. Bernd Fischer and Oliver Schmitt challenge some of the traditional narratives concerning the origins of the Albanians, and the relations between Albanians and their Balkan neighbours. This authoritative and up-to-date single-volume history analyses the political, social, economic, and cultural developments which led to the creation of the Albanian state and the modern nation, as well as Albania's more recent experience with authoritarianism, war, and communism. It greatly contributes to our understanding of the challenges facing contemporary Albanians, as well as the issues confronting the region as a whole as it attempts to grapple with one of the last remaining significant ethnic issues in the Balkans.
Chapter 1 discusses the basics of Albanian history. Is it a history of a space or of an ethnic community? The spatial expansion and spatial concepts as well as the definition of the term Albanian are discussed. The history of Albanophones in the southwestern Balkans is the focus of this section. Albanian history prior to 1912 is not the history of a state, but of Albanians and their diverse contacts with other language groups with whom they lived in close contact and with whom they shared extentive cultural exchanges. Due to the lack of written sources, the Albanian language has been the most important document in understanding Albanian cultural history. In addition, the modern national self-image of Albanians is based on language. Accordingly, the linguistic dimension of Albanian history is discussed in some detail. Closely related to this are politically sensitive questions of settlement and migration history: Where did the ancestors of contemporary Albanians live in antiquity? Are they autochthonous or immigrant? We develop a model of the history of cultural integration in the southwestern Balkans in the context of these questions.
Chapter 5 describes the transformation of a section of Arnavutluk into the modern Albanian state. The new independent Albania was proclaimed by the predominantly Sunni elite when Ottoman rule collapsed in the First Balkan War in 1912 and Albanian settlement areas seemed on the verge of being divided between Serbia, Montenegro and Greece. With the onset of the First World War, the fledgling state was faced with foreign occupation, and threats to its territorial integrity and to its very existence. The chapter examines how in the immediate aftermath of the war, Albanian leaders, meeting at the Congress of Lushnjë, struggled to create a functioning state apparatus but were quickly faced with political conflict which led to coups, assassinations and general instability. In this chaos, power was dominated by those with independent access to armed forces, resulting in the rise of the tribal leader Ahmet Zogu. Fearing his increasing authoritarianism, opposing forced mounted a revolution which ousted Zogu and allowed the construction of a short-lived generally progressive regime. Within six months, however, a counter-revolution brought Zogu back to power.
Chapter 7 describes events in Albania during the Second World War. During this critical period, two different Albanias are constructed. Following the Italian invasion a series of puppet regimes are installed which initially gain some support as Rome invests heavily in much-needed infrastructure and general development. Mussolini hopes to gain further support by encouraging "Greater Albania" dreams through his ultimately disastrous invasion of Greece. The chapter examines the formation of the Albanian Communist Party and the resultant growth in resistance movements. With the Italian collapse, the Germans invade and occupy Albania, constructing their own puppet regimes that gain only limited support. As the end of the war nears, the resistance degenerates into civil war. With the help of extensive British aid, the communist-dominated partisans, as the only national movement and the only group untainted by collaboration, are victorious and construct a new regime. The chapter concludes with an evaluation of the profound impact of the war.
Chapter 4 describes developments in the nineteenth century when the Ottoman empire initiated military and administrative reforms in response to military defeats, particularly against Russia. In the southwestern Balkans, Albanian Sunnis resisted any change in their privileged position vis-à-vis the Christian population. Sunni Albanians were among the conservative and anti-reform forces in the Ottoman empire. When Christian nation-states emerged in the Balkans following the uprisings in Greece and Serbia, major European powers intervened ever more arressively in the Ottoman Balkans. In that context, Christians and Bektashi Muslims began to design an Albanian national program. These national activists struggled to overcome both religious differences and distinct regional special identities. The loss of territory by the Ottomans in the Balkans after the Berlin Congress (1878) also mobilized the Sunnis, who increasingly feared the collapse of the empire. The Albanian Balkan provinces of the Ottoman empire developed into a laboratory for competing identity politics by local actors and the major European powers.
Chapter 6 traces Albania’s descent into authoritarianism under the regimes of Zogu. Albania is first transformed into a republic with Zogu as president wielding considerable executive power. Within four years he abandoned the republic and created a monarchy and ruled as King Zog with unfettered power. With politics removed as a obstacle to unity and stability, Zog proceeded to attempt to create a nation out of disparate religious and cultural communities. The results are mixed at best as desperate economic conditions drove the king into increasing dependence on Mussolini’s Italy. The funds obtained are poorly allocated and necessary reforms, like agrarian reform, are not implemented as the king relied too heavily on the support of major landowners. The Italians, in the meantime, insinuated themselves into most aspects of government and the administration to the extent that Albania became little more than an Italian colonial outpost. Not satisfied with anything less that complete control, Mussolini is finally convinced by German moves elsewhere in the Balkans, and by his foreign minister’s insistence that Albania contained vast riches in terms of natural resources, to invade and annex Albania, driving the king and his family into exile. The chapter concludes with an evaluation of the achievements and failures of the Zog era.
Chapter 2 traces Albanian history through the Roman and Byzantine periods. The ancestors of contemporary Albanians were well integrated into these empires. The Latin influence on the Albanian language is correspondingly strong. In late antiquity, the Roman empire recruited an important part of its elite from the southwestern Balkans. The arrival of Slavic groups in the Balkans led to the collapse of state administration and the church and thus to a cultural turning point that was much more profound than in Western Europe. It was not until the ninth century that Byzantium was primarily re-Christianized. The Albanians came under the influence of the new Slavic states in the Balkans. Urban communities flourished particularly along the coast. The region was closely intertwined with the Venetian-Adriatic culture, but also with Byzantine civilization. With the decline of Byzantium, the southwestern Balkan region splintered into numerous small dominions. Venice, the Kingdom of Naples and, from the end of the fourteenth century, the Ottomans vied for influence. Albania was one of the first areas in the Balkans conquered by the Ottomans and nowhere was the resistance to the new empire as fierce as in Albania. Georg Kastriota Scanderbeg, who is revered as a national hero today, is symbolic of this resistence.
Chapter 3 describes how profoundly the Ottoman conquest changed Albania. Devastation and flight completely altered the settlement structures, especially in the north. Albanians fled not only to Italy but also into the mountains, where they organized themselves into tribal structures. On the plains and especially in the south, many people came to terms with the new empire. Islamized Albanians became an essential pillar of the Ottoman military and administrative structures. Until around 1600 the southwestern Balkans remained mostly Christian, either Orthodox or Catholic. In the course of the seventeenth century, most Albanians converted to Islam for various reasons making the region even more religiously diverse. In addition to Sunni Islam, the Bektashi dervish order, which had absorbed Shiite and Christian influences, also established itself. In the early modern period, three religious cultures coexisted side by side, Orthodox, Catholic, and Muslim, whose adherents maintained cultural contacts not only with each other, but also with their co-religionists outside the area. The southwestern Balkans formed a peripheral zone of the empire. The imperial administration could barely control the mountain regions in a sustainable way. The result was a legal pluralism, with many Albanians, especially in the mountain areas, seeing customary law as a pillar of their identity and their special political position.