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There has been much recent excitement about the possibility that some cases of psychosis may be wholly due to brain-reactive antibodies, with antibodies to N-methyl-D-aspartate receptor (NMDAR) and the voltage-gated potassium channel (VGKC)-complex reported in a few patients with first-episode psychosis (FEP).
Participants were recruited from psychiatric services in South London, UK, from 2009 to 2011 as part of the Genetics and Psychosis study. We conducted a case–control study to examine NMDAR and VGKC-complex antibody levels and rates of antibody positivity in 96 patients presenting with FEP and 98 controls matched for age and sex. Leucine-rich glioma inactiviated-1 (LGI1) and contactin-associated protein (CASPR) antibodies were also measured. Notably, patients with suspicion of organic disease were excluded.
VGKC-complex antibodies were found in both cases (n = 3) and controls (n = 2). NMDAR antibody positivity was seen in one case and one control. Either LGI1-Abs or CASPR2-Abs were found in three cases and three controls. Neuronal antibody staining, consistent with the above results or indicating potential novel antigens, was overall positive in four patients but also in six controls. Overall, antibody positivity was at low levels only and not higher in cases than in controls.
This case–control study of the prevalence of antibodies in FEP does not provide evidence to support the hypothesis that FEP is associated with an immune-mediated process in a subgroup of patients. Nevertheless, as other bio-clinical factors may influence the effect of such antibodies in a given individual, and patients with organic neurological disease may be misdiagnosed as FEP, the field requires more research to put these findings in context.
The Vasarhelyi Method of Child Art Psychotherapy (CAP) is a largely understudied psychotherapeutic modality. This study aims to describe the Vasarhelyi Method of CAP and to describe a stakeholder survey of the views and attitudes of CAP placement supervisors towards CAP among various Child and Adolescent Mental Health Services (CAMHS) teams nationwide.
A phone- and letter-based survey of 17 CAP placement supervisors who oversee CAP masters students attached to CAMHS teams was performed. A questionnaire was designed enquiring about their experiences with CAP in their clinic and their thoughts on the validity of CAP in various conditions/patient demographics. Participants received written correspondence and were asked to return the survey by post; this was followed up by a telephone call to complete missing surveys.
In all, 12 (70.6%) complete surveys were returned. Of the 12 respondents, all considered the CAP student to be a valuable member of the team. In total, 10 respondents (83.33%) stated they would make regular use of the service if it were made available to them. With regard to the therapy itself, nine respondents (75%) believed it was better for internalising symptoms than externalising symptoms. Depression, anxiety, attachment difficulties, trauma, deliberate self-harm and possible psychosomatic illnesses are the conditions viewed as receiving the most benefit from CAP. No gender difference was reported.
CAP is considered an effective modality and valuable addition to a psychotherapeutic repertoire. Further, more extensive studies are needed in this field.
Impairments in key neuropsychological domains (e.g. working memory, attention) and social cognitive deficits have been implicated as intermediate (endo) phenotypes for bipolar disorder (BD), and should therefore be evident in unaffected relatives.
Neurocognitive and social cognitive ability was examined in 99 young people (age range 16–30 years) with a biological parent or sibling diagnosed with the disorder [thus deemed to be at risk (AR) of developing BD], compared with 78 healthy control (HC) subjects, and 52 people with a confirmed diagnosis of BD.
Only verbal intelligence and affective response inhibition were significantly impaired in AR relative to HC participants; the BD participants showed significant deficits in attention tasks compared with HCs. Neither AR nor BD patients showed impairments in general intellectual ability, working memory, visuospatial or language ability, relative to HC participants. Analysis of BD-I and BD-II cases separately revealed deficits in attention and immediate memory in BD-I patients (only), relative to HCs. Only the BD (but not AR) participants showed impaired emotion recognition, relative to HCs.
Selective cognitive deficits in the capacity to inhibit negative affective information, and general verbal ability may be intermediate markers of risk for BD; however, the extent and severity of impairment in this sample was less pronounced than has been reported in previous studies of older family members and BD cases. These findings highlight distinctions in the cognitive profiles of AR and BD participants, and provide limited support for progressive cognitive decline in association with illness development in BD.
Wellness Recovery Action Planning (WRAP) is a cross-diagnostic, patient-centred, self-management intervention for psychiatric illness. WRAP utilises an individualised Wellness Toolbox, a six part structured monitoring and response system, and a crisis and post-crisis plan to promote recovery. The objective of this study was to evaluate the effect of WRAP on personal recovery, quality of life, and self-reported psychiatric symptoms.
A prospective randomised controlled trial, based on the CONSORT principles was conducted using a sample of 36 inpatients and outpatients with a diagnosis of a mental disorder. Participants were randomly allocated to Experimental Group or Waiting List Control Group conditions in a 1:1 ratio. Measures of personal recovery, personal recovery life areas, quality of life, anxiety, and depression were administered at three time points: (i) pre-intervention, (ii) post-Experimental Group intervention delivery, and (iii) 6-month follow-up. Data was analysed by available case analysis using univariate and bivariate methodologies.
WRAP had a significant effect on two personal recovery life areas measured by the Mental Health Recovery Star: (i) addictive behaviour and (ii) identity and self-esteem. WRAP did not have a significant effect on personal recovery (measured by the Mental Health Recovery Measure), quality of life, or psychiatric symptoms.
Findings indicate that WRAP improves personal recovery in the areas of (i) addictive behaviour and (ii) identity and self-esteem. Further research is required to confirm WRAP efficacy in other outcome domains. Efforts to integrate WRAP into recovery-orientated mental health services should be encouraged and evaluated.
Anti-N-methyl-d-aspartate (NMDA) receptor encephalitis is an autoimmune condition caused by immunoglobulin (Ig)G antibodies directed against the NR1 subunit of the NMDA glutamate receptor. Approximately 65% of cases present with psychiatric symptoms, particularly psychosis. It remains to be established whether anti-NMDA receptor antibodies can cause a ‘purely’ psychotic illness without overt neurological symptoms.
We conducted a systematic literature search to establish what proportion of patients with schizophrenia and related psychoses have antibodies directed against the NMDA receptor. Studies were included if (a) subjects had a diagnosis of schizophrenia, schizophrenia spectrum disorder or first-episode psychosis (FEP) using standard criteria, (b) serum was analysed for the presence of anti-NMDA receptor antibodies; and (c) the purpose of the study was to look for the presence of anti-NMDA receptor antibodies in patients with a primary psychiatric diagnosis without clinical signs of encephalitis.
Seven studies were included, comprising 1441 patients, of whom 115 [7.98%, 95% confidence interval (CI) 6.69–9.50] were anti-NMDA receptor antibody positive. Of these, 21 (1.46%, 95% CI 0.94–2.23) patients were positive for antibodies of the IgG subclass. Prevalence rates were greater in cases than controls only for IgG antibodies; other subclasses are of less certain aetiological relevance. There was significant heterogeneity in terms of patient characteristics and the antibody assay used.
A minority of patients with psychosis are anti-NMDA receptor antibody positive. It remains to be established whether this subset of patients differs from antibody-negative patients in terms of underlying pathology and response to antipsychotic treatment, and whether immunomodulatory treatments are effective in alleviating psychotic symptoms in this group.
Stable perovskite and metastable post-perovskite NaCoF3 were deformed in pure-shear geometry in a deformation-DIA press with radiographic monitoring of the sample strain. In isothermal experiments where there was no transformation, post-perovskite was found to be 5 times weaker than perovskite. In temperature-ramping experiments where post-perovskite transformed to perovskite during the deformation experiment the initial post-perovskite sample was 5–10 times weaker than perovskite under comparable conditions and their strengths converged during the transformation, being equal on completion of the transformation. These results confirm recent findings which show that postperovskite is weaker than perovskite, regardless of the prior history of the sample.
The present paper examines the effect of the type of supplement given to grazing ewes in early lactation on the performance of ewes and lambs on temperate sown pastures. Lactating ewes grazed perennial ryegrass pastures at either low- or high-herbage masses, between days 8 and 96 of lactation. On the low-herbage mass treatments, ewes were either unsupplemented or received either an energy supplement (sugarbeet pulp) or a protein supplement (1:1 sugarbeet pulp:formaldehyde-treated soyabean meal) between days 8 and 50 of lactation. The provision of supplements or the higher herbage mass led to increases in live weight (LW) and body condition score of ewes during days 8–50 of lactation, while unsupplemented ewes on the low-herbage mass treatment lost LW and had lower body condition scores. After supplementation finished, previously supplemented ewes or those grazing the higher herbage mass lost LW and condition, while unsupplemented ewes grazing the low-herbage mass gained both LW and condition. Non-treatment factors such as ewe dentition score significantly affected ewe and lamb LW gains. Regression analyses indicated that lamb LW gains between days 8 and 50 of lactation were 40–60 g/d greater in lambs from supplemented ewes or ewes grazing the higher herbage mass cf. unsupplemented ewes. Overall, there was no difference in the response of ewes or lambs to the type of supplement. Milk yields were estimated in a subset of ewes (replicate 4). Ewes on the high-herbage mass treatment or those supplemented with protein had higher milk yields than those on the low-herbage mass treatment or those given the energy supplement. Supplemented ewes in this replicate had higher metabolizable energy intakes (MEIs). Measurements of digesta flow in a further subset of ewes indicated that both supplements resulted in greater ruminal and post-ruminal supplies of energy and protein than in the unsupplemented ewes at the lower herbage mass, but differences in ruminal and post-ruminal nutrient provision between the supplements were less than had been intended. It is suggested that this is the reason for there being no statistical difference in the performance of ewes and lambs in response to the type of supplement.
Choline is an essential nutrient and can also be obtained by de novo synthesis via an oestrogen responsive pathway. Choline can be oxidised to the methyl donor betaine, with short-term supplementation reported to lower plasma total homocysteine (tHcy); however, the effects of longer-term choline supplementation are less clear. We investigated the effect of choline supplementation on plasma concentrations of free choline, betaine and tHcy and B-vitamin status in postmenopausal women, a group more susceptible to low choline status. We also assessed whether supplementation altered plasma lipid profiles. In this randomised, double-blinded, placebo-controlled study, forty-two healthy postmenopausal women received 1 g choline per d (as choline bitartrate), or an identical placebo supplement with their habitual diet. Fasting blood samples were collected at baseline, week 6 and week 12. Administration of choline increased median choline and betaine concentrations in plasma, with significant effects evident after 6 weeks of supplementation (P < 0·001) and remaining significant at 12 weeks (P < 0·001); no effect was observed on folate status or on plasma lipids. Choline supplementation induced a median (25th, 75th percentile) change in plasma tHcy concentration at week 6 of − 0·9 ( − 1·6, 0·2) μmol, a change which, when compared to that observed in the placebo group 0·6 ( − 0·4, 1·9) μmol, approached statistical significance (P = 0·058). Choline supplementation at a dose of 1 g/d significantly increases the circulating concentration of free choline, and can also significantly increase the concentration of the methyl donor, betaine, thereby potentially enhancing the betaine–homocysteine methyltransferase-mediated remethylation of tHcy. This trial was registered at http://www.controlled-trials.com/ISRCTN82708510.
The thermal diffusivity of diopside, jadeite and enstatite were measured at simultaneous pressures and temperatures of up to 7 GPa and 1200 K using the X-radiographic Ångström method. The measurements herein show that the pressure dependency of thermal diffusivity in pyroxenes is significantly greater than in olivine or garnet and that in the MORB-layer of a subducting slab the thermal diffusivity of pyroxenes are a factor of 1.5 greater than that of olivine. The temperature dependence of all the data sets is well described by a low-order polynomial fit to 1/K and the pressure dependence is exponential in 1/K, formulations which are consistent with the damped harmonic oscillator model for thermal properties.
The use of animal models figures prominently in mental health research and can play an especially important role in our efforts to understand developmental psychopathologies. The vast majority of animal research is conducted with rodents, and a typical approach involves experimentally re-creating behavioral, psychological, or neurobiological conditions that share some similarities with human psychopathologies or their biological substrates. For example, human depression can be experimentally modeled as learned helplessness in rodents, and tested in a forced swimming paradigm. In this task, a rat is placed in a water tank for a given period of time. After the rat's efforts at escaping from the tank through swimming have failed, some animals stop struggling, exhibiting behavioral passivity and neuroendocrine changes that share some similarities with those observed in people who suffer from clinical depression.
A different approach to modeling human psychopathologies involves identifying similar pathologies that occur naturally in animals. This approach is particularly powerful if conditions similar to human mental disorders are identified in animals that are closest and most similar to us, such as the anthropomorphic primates (i.e., the Old World monkeys and apes). In this chapter, we illustrate this approach by reviewing research on the natural occurrence of infant abuse in nonhuman primate populations, and by discussing how this research can help us understand the causes and developmental consequences of child maltreatment in humans (see also Maestripieri, 1999; Maestripieri & Carroll, 1998a; Sanchez, 2006).
In this study we investigated the development of the hypothalamic–pituitary–adrenal (HPA) axis in 21 group-living rhesus monkeys infants that were physically abused by their mothers in the first few months of life and in 21 nonabused controls. Cortisol and adrenocorticotropin hormone (ACTH) responses to a corticotropin-releasing hormone (CRH) challenge were assessed at 6-month intervals during the subjects' first 3 years of life. Abused infants exhibited greater cortisol responses to CRH than controls across the 3 years. Abused infants also exhibited blunted ACTH secretion in response to CRH, especially at 6 months of age. Although there were no significant sex differences in abuse experienced early in life, females showed a greater cortisol response to CRH than males at all ages. There were no significant sex differences in the ACTH response to CRH, or significant interactions between sex and abuse in the ACTH or cortisol response. Our findings suggest that early parental maltreatment results in greater adrenocortical, and possibly also pituitary, responsiveness to challenges later in life. These long-term alterations in neuroendocrine function may be one the mechanisms through which infant abuse results in later psychopathologies. Our study also suggests that there are developmental sex differences in adrenal function that occur irrespective of early stressful experience. The results of this study can enhance our understanding of the long-term effects of child maltreatment as well as our knowledge of the development of the HPA axis in human and nonhuman primates.