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Neurotoxic effects of alcohol consumption are well-known. There is plenty of literature on frontal lobe impairment on the behavioral and structural brain imaging level. However, only few functional imaging studies investigated altered neural patterns and even less abstinence-related neural recovery. Here, we investigated if frontal lobe activity tends to normalize in patients that remain successfully abstinent.
In a cross-sectional design three patient groups (acute withdrawal, detoxified, abstinent) and healthy controls (each n = 20) performed a phonological and semantical verbal fluency task (VFT) while brain activity was measured with near-infrared spectroscopy (NIRS).
First, for the phonological condition patients in the acute withdrawal phase and also detoxified patients showed less fluency-related frontal lobe activation compared to controls despite equal performance. Second, significant linear trend effects from withdrawal patients over detoxified and abstinent patients up to healthy controls indicated more normal activation patterns in the abstinent group that did not differ from the controls. In the detoxified group brain activation increased with time since detoxification.
Our results support the assumption of an increase in frontal brain activity from alcohol dependency over abstinence up to normal functioning. Longitudinal studies are needed to further elucidate recovery processes in alcohol dependency.
This paper reviews and presents data of practical impact for those administering electroconvulsive therapy (ECT). In the first section, physical and physiological aspects of the stimulus as well as methods of stimulation are discussed. The second section deals with indications for ECT, efficacy and treatment modalities such as seizure duration, treatment frequency and total number of ECT applications. The last section is devoted to side effects, risks, comedication and comorbidity.
False-positive drug screenings have been reported for several drugs and can affect the therapeutic relationship.
We wanted to find out, which medication can cause false-positive phencyclidine drug screenings.
We systematically looked at all psychiatric inpatients with phencyclidine positive urine drug screenings using a kinetic interaction of microparticles in a solution (KIMS) based system treated in our psychiatric department between 2008 and 2013.
39 of 40 positive phencyclidine urine drug screenings could plausibly be explained as false-positives by psychopharmacologic medication. The most frequent common medication in our case series was chlorprothixene, which has not been reported as a cause for any false-positive drug screenings so far. We also found trimipramine as a medication in three cases, being structurally similar to imipramine, which has been reported before to potentially cause cross-reactivity. Other false-positive results could be explained by venlafaxine, lamotrigine, imipramine and tramadol, which have been reported to have the capacity for cross-reactivity. Chlorprothixene and venlafaxine accounted for almost 75 % of the positive screenings.
Confirmation by a second method like gas chromatography/mass spectrometry should follow positive drug screenings for phencyclidine.
Previous research revealed substantial relations between the experience of childhood adversities and the development of borderline personality disorders (BPD) in adulthood. However, research about antecedents of adolescent BPD is still in its beginnings. Moreover, there is an ongoing controversy regarding transgenerational effects of childhood adversities and potential mediators.
We aim to investigate transgenerational effects of parental childhood experiences on the development of adolescent BPD within the next generation. Hereby, we are focusing on the investigation of differential effects of maternal and paternal experiences of childhood adversities on adolescent BPD and on underlying mechanisms.
We consecutively recruited 91 female inpatients (Mage = 15.6 years) from the Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, as well as 87 mothers and 59 fathers. Childhood adversities were assessed for parents and adolescents with the German Childhood Experiences of Care and Abuse Questionnaire, adolescent BPD by means of structured clinical interviews (SKID II).
Our results are in favor of a transgenerational effect of parental childhood adversities on the development of adolescent BPD. This effect turned out to be stronger for paternal than for maternal childhood adversities. Moreover, paternal childhood adversities revealed to be related to experiences of childhood adversities within the next generation.
Our results underline the importance of taking the family environment into consideration when developing prevention and treatment programs for adolescent BPD.
The aim of this analysis is to describe medication adherence, and treatment persistence, in adults with attention deficit/hyperactivity disorder (ADHD) treated for 24 weeks with extended release methylphenidate (MPH-ER). Additionally, patient-, disorder- and treatment-related factors associated with adherence and persistence will be identified.
Post-hoc analysis of the active treatment group of a placebo-controlled, randomised, 24 week trial with MPH-ER with univariate description and multiple logistic regression models and Hosmer and Lemeshow tests.
In the sample of 241 adults with ADHD (mean age of 35.2 ± 10.1 years), 9.4% of the patients were non-adherent, taking less than 80% of the dispensed medication. Factors associated with non-adherence included age < 25 years, education level lower than secondary education, lacking family history of ADHD, lower ADHD baseline severity and lower self- and observer-rated medication efficacy. Lacking family history of ADHD, lower education level and lower self-rated medication efficacy, predicted non-adherence with a prediction accuracy of 16%. Seventeen percent of the patients discontinued early with most discontinuing within the first five weeks of the MPH-ER titration phase. Mean persistence in the discontinuing group was 63.4 ± 49.4 days. Factors associated with discontinuation included male gender, lower education level, lacking family history of ADHD and lower self- and observer-rated medication efficacy. Treatment non-response, male gender and lower education level predicted treatment discontinuation with a prediction accuracy of 22.7%.
Male adults without relatives with ADHD, with lower educational level and lower self- and observer-rated medication efficacy, who are newly treated with MPH-ER, are at increased risk of non-adherence and treatment discontinuation. Patients are at increased risk of treatment discontinuation during the medication titration phase.
The study examined the developmental trajectories of deliberate self-harm behavior (e.g. of non-suicidal self-injury, suicidality and substance use) in a community sample of 514 adolescents from 14.5 to 16.5 years of age. Data were taken from the German sample of the Saving and Empowering Young Lives in Europe study (SEYLE; Wasserman et al., 2010) and its consecutive follow-up assessments. Using general growth mixture modeling, distinctive classes for each self-harm behavior were identified. The high risk non-suicidal self-injury class as well as the high risk suicidality class demonstrated high initial values with a gradual decrease over adolescence. The substance use high risk class had a low initial value and presented acceleration with time. The high overlap between the three high-risk classes supports the notion that certain personality traits such as affective dysregulation or impulsivity may underlie these three behaviors. Compared to the low or moderate risk classes, individuals belonging to high risk classes revealed significantly higher scores in the SCID-II questionnaire for DSM-IV borderline personality disorder.
Non-suicidal self-injury (NSSI) is an increasing phenomenon among adolescents. So far, comparable data on prevalence and psychosocial correlates are still rare due to different definitions, study samples, and measures.
To investigate the prevalence and associated psychosocial factors of occasional and repetitive non-suicidal self-injury (NSSI) and its relationship to suicide attempts in a representative adolescent samples from eleven European countries.
Cross sectional assessment of adolescents was performed within the European Union funded project, Saving and Empowering Young Lives in Europe (SEYLE), which was conducted in eleven European countries. The representative sample comprised 12,068 adolescents (F/M: 6,717/5,351; mean age: 14.9±0.89) recruited from randomly selected schools. Frequency of NSSI was assessed by a modified version of the Deliberate Self-Harm Inventory (DSHI) and the Paykel Suicide Scale. Additionally, a broad range of demographic, social and psychological factors was assessed.
Overall lifetime prevalence of NSSI was 27.6%; 19.7% reported occasional NSSI and 7.8% repetitive NSSI. Lifetime prevalence ranged from 17.1% to 38.6% across countries. Suicidality, anxiety and depression had the highest odds ratios for both occasional and repetitive NSSI.
Results suggest high lifetime prevalence of NSSI in European adolescents, with significant country differences. A strong association of NSSI with both psychopathology and risk-behaviours, including family-related neglect and peer-related rejection/victimization could be found. These results, combined with the observed gender and country differences, support the need for a multidimensional approach to better understand the development of NSSI and facilitate culturally adapted prevention/intervention.
Cognitive processes are impaired in Schizophrenia (SKZ). The nature of such impairment escapes definition.
Identification of a genetic profile at risk of cognitive impairment.
Identifying a molecular pathways enriched for mutations associated with cognitive impairment.
Seven hundred and sixty-five individuals from the CATIE, M = 556, mean age = 40.93 ± 11.03 were included. Verbal memory was outcome. R and Plink served for the analyses. Inflation factor was controlled by lambda values. Input for the pathway analysis were SNPs associated with outcome (P < 0.05) genomewide.
Gender (male, P = 2.34e–05;t = –4.26) and years of education (P = 1.57e–03;t = 6.502) were associated with verbal memory. Inflammation and oxidation were associated with outcome (Table 1, adj_P < 0.01).
Being male and poorly educated were associated with poorer verbal memory. Inflammation and the arachidonic acid pathway were enriched in mutations associated with poorer verbal memory. This finding is in line with previous reports [1,2,3].
Arrhythmia is a potentially fatal side effect of antipsychotics. A biologic predictive tool to prevent it is missing.
Identification of a genetic profile at risk for antipsychotic induced arrhythmia.
Identifying a molecular pathway enriched for antipsychotic induced QT-modifications.
Seven hundred and sixty-five SKZ individuals, M = 556, age = 40.93 ± 11.03 were included. QT-variation was a phase-specific created variable. A nested mixed regression served in R for clinical and molecular pathway analyses. Plink served for genetic analyses. Quality checking was standard, inflation factor was controlled by lambda values.
Quetiapine and Perphenazine were associated with QT variation (P = 0.002; Estimate = 5.79 and P = 5.67e-06; Estimate = 8.96 respectively). No other significant association was detected. No inflation was detected. Axon guidance and Collagen biosynthesis (Table 1) were associated with QT variation at a conservative (adjusted) P value < 0.01.
Two molecular pathways were identified as possibly involved in QT modifications during antispsychotic treatment in SKZ patients. Previous evidence supports a role of the same pathways in cardiac disorders [1,2]. Interaction of specific SNPs with the drugs will be focus of further research.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Norovirus (NoV) infections occur very frequently yet are rarely diagnosed. In Denmark, NoV infections are not under surveillance. We aimed to collect and describe existing laboratory-based NoV data. National NoV laboratory data were collected for 2011–2018, including information on patient identification number, age and sex, requesting physician, analysis date and result. We defined positive patient-episodes by using a 30-day time window and performed descriptive and time series analysis. Diagnostic methods used were assessed through a survey. We identified 15 809 patient-episodes (11%) out of 142 648 tested patients with an increasing trend, 9366 in 2011 vs. 32 260 in 2018. This corresponded with a gradual introduction of polymerase chain reaction analysis in laboratories. The highest positivity rate was in patients aged <5 years (15%) or >85 years (17%). There was a large difference in test performance over five Danish geographical regions and a marked seasonal variation with peaks from December to February. This is the first analysis of national NoV laboratory data in Denmark. A future laboratory-based surveillance system may benefit public health measures by describing trend, burden and severity of seasons and possibly pinpoint hospital outbreaks.
This paper outlines a pilot validation study of the newly developed Behavioural Couple Therapy Scale for Depression (BCTS-D). The BCTS-D aims to assess therapist competence in delivering behavioural couple therapy (BCT) and provide therapists with summative and formative feedback on their performance. Completed by both therapist and supervisor, this will aid therapists’ reflection on practice and improve performance. This paper will report on two stages in the development of the BCTS-D: (a) a study evaluating content validity, face validity and usability and (b) a focus group examining usability and utility. Both parts of the study were conducted in the context of a BCT training course and included 20 participants who were either BCT supervisors or BCT trainees. Results suggest that the BCTS-D has good face validity, content validity and usability, and provides a useful tool for promoting self-reflection and providing formative feedback. The studies also provided insight into the strengths of the scale and into areas of refinement, and a number of modifications were undertaken to improve the BCTS-D in response to feedback collected. Future research will need to focus on evaluating the psychometric properties of the BCTS-D and continue to adapt the scale to its users’ needs.
Key learning aims
(1) Readers will understand the importance of measuring therapists’ competence to improve practice.
(2) Readers will understand the development of the BCTS-D scale and its initial psychometric properties.
(3) Readers will know how to use the BCTS-D in everyday clinical practice.
(4) Readers will know about the challenges of developing a therapist competence measure within a real-world clinical context.
The repetitive use of ALS inhibitors for smallflower umbrella sedge (Cyperus difformis L.) control has selected for herbicide-resistant (R) populations that threaten the sustainability of rice (Oryza sativa L.) production and demand alternative control measures be developed. A better understanding of seedling recruitment patterns at the field level is required to optimize the timing and efficacy of control measures. Therefore, a population-based threshold model was developed for optimizing germination prediction in multiple acetolactate synthase (ALS)-R and ALS-susceptible (ALS-S) C. difformis biotypes and applied to field-level emergence predictions. Estimated base temperatures (Tb) ranged from 16.5 to 17.6 C with no clear pattern between biotypes; such values are higher than Tb values of other important rice weeds, as well as for rice. Germination rates increased linearly from 16 to 33.7 C. ALS-R seeds germinate faster due to smaller median thermal times to germination (θT(50)) while also displaying lower germination synchronicity across water potentials. Interestingly, ALS-R biotypes were capable of germinating under lower moisture availability, as indicated by their lower (more negative) base water potential values (Ψb(50)) for seed germination; Ψb(50) values ranged from −0.24 to −1.13 MPa. In-field soil germination measurements found thermal times to emergence varied across three water regimes (daily water, flooded, or saturated). Seedling emergence under the daily water treatment was fastest; however, total seedling density was lower than for the other water regimes. In order to optimize springtime C. difformis seedling emergence, soil moisture should be kept around field capacity, as germination is hindered at lower moisture contents. By predicting when most of the seed population germinates, the thermal-time model can address issues regarding the optimal timing for herbicide applications, thereby allowing for improved C. difformis management in rice fields.
Hala Sultan Tekke is a large Bronze Age city located on the southeastern littoral of Cyprus. The city flourished from approximately 1650 BC to 1150 BC according to the archaeological evidence. Since 2010, Swedish excavations have exposed four new city quarters (CQ1–4) with three occupational phases, the 14C dating of which is of highest importance also for other contemporaneous cultures. The finds demonstrate vast intercultural connections in the Mediterranean and even with southern Scandinavia. In 2014, roughly 500 m to the east of CQ1, one of the richest cemeteries on the island was discovered. According to the archaeological evidence, the finds from the city date mainly to the 13th and 12th centuries BC. However, many of the wealthy tombs and the offering pits from the cemetery are considerably older with the oldest finds dating to the 16th century BC. This raises the question where the city quarters belonging to the oldest finds from the cemetery are situated. The radiocarbon (14C) dates from Hala Sultan Tekke have much influence on the dating of related sites because of numerous imports from a vast area. We present here new 14C data obtained in the course of the current excavations, which add to sets of already existing data.
Smallflower umbrella sedge is a prolific C3 weed commonly found in rice fields in 47 countries. The increasing infestation of herbicide-resistant smallflower umbrella sedge populations threatens rice production. Our objectives for this study were to characterize thermal requirements for germination of smallflower umbrella sedge seeds from rice fields in California and to parameterize a population thermal-time model for smallflower umbrella sedge germination. Because the use of modeling techniques is hampered by the lack of thermal-time model parameters for smallflower umbrella sedge seed germination, trials were carried out by placing field-collected seeds in a thermogradient table set at constant temperatures of 11.7 to 41.7 C. Germination was assessed daily for 30 d, and the whole experiment was repeated a month later. Using probit regression analysis, thermal time to median germination [θT(50)], base temperature for germination (Tb), and SD of thermal times for germination [σθT(50)] were estimated from germination data, and model parameters were derived using the Solver tool in Microsoft Excel®. Germination rates increased linearly below the estimated optimum temperatures of 33.5 to 36 C. Estimated Tb averaged 16.7 C, whereas θT(50) equaled 17.1 degree-days and σθT(50) was only 0.1 degree-day. The estimated Tb for smallflower umbrella sedge is remarkably higher than that of japonica and indica types of rice, as well as Tb of important weeds in the Echinochloa complex. Relative to the latter, smallflower umbrella sedge has lower thermal-time requirements to germination and greater germination synchronicity. However, it would also initiate germination much later because of its higher Tb, given low soil temperatures early in the rice growing season in California. When integrated into weed growth models, these results might help optimize the timing and efficacy of smallflower umbrella sedge control measures.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
In 2013, the national surveillance case definition for West Nile virus (WNV) disease was revised to remove fever as a criterion for neuroinvasive disease and require at most subjective fever for non-neuroinvasive disease. The aims of this project were to determine how often afebrile WNV disease occurs and assess differences among patients with and without fever. We included cases with laboratory evidence of WNV disease reported from four states in 2014. We compared demographics, clinical symptoms and laboratory evidence for patients with and without fever and stratified the analysis by neuroinvasive and non-neuroinvasive presentations. Among 956 included patients, 39 (4%) had no fever; this proportion was similar among patients with and without neuroinvasive disease symptoms. For neuroinvasive and non-neuroinvasive patients, there were no differences in age, sex, or laboratory evidence between febrile and afebrile patients, but hospitalisations were more common among patients with fever (P < 0.01). The only significant difference in symptoms was for ataxia, which was more common in neuroinvasive patients without fever (P = 0.04). Only 5% of non-neuroinvasive patients did not meet the WNV case definition due to lack of fever. The evidence presented here supports the changes made to the national case definition in 2013.