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Individuals with schizophrenia are at higher risk of physical illnesses, which are a major contributor to their 20-year reduced life expectancy. It is currently unknown what causes the increased risk of physical illness in schizophrenia.
To link genetic data from a clinically ascertained sample of individuals with schizophrenia to anonymised National Health Service (NHS) records. To assess (a) rates of physical illness in those with schizophrenia, and (b) whether physical illness in schizophrenia is associated with genetic liability.
We linked genetic data from a clinically ascertained sample of individuals with schizophrenia (Cardiff Cognition in Schizophrenia participants, n = 896) to anonymised NHS records held in the Secure Anonymised Information Linkage (SAIL) databank. Physical illnesses were defined from the General Practice Database and Patient Episode Database for Wales. Genetic liability for schizophrenia was indexed by (a) rare copy number variants (CNVs), and (b) polygenic risk scores.
Individuals with schizophrenia in SAIL had increased rates of epilepsy (standardised rate ratio (SRR) = 5.34), intellectual disability (SRR = 3.11), type 2 diabetes (SRR = 2.45), congenital disorders (SRR = 1.77), ischaemic heart disease (SRR = 1.57) and smoking (SRR = 1.44) in comparison with the general SAIL population. In those with schizophrenia, carrier status for schizophrenia-associated CNVs and neurodevelopmental disorder-associated CNVs was associated with height (P = 0.015–0.017), with carriers being 7.5–7.7 cm shorter than non-carriers. We did not find evidence that the increased rates of poor physical health outcomes in schizophrenia were associated with genetic liability for the disorder.
This study demonstrates the value of and potential for linking genetic data from clinically ascertained research studies to anonymised health records. The increased risk for physical illness in schizophrenia is not caused by genetic liability for the disorder.
Functional magnetic resonance imaging (fMRI) is a neuroimaging technique increasingly used for both patient care and clinical research. This techniche provides a space-time high-resolution able to detect small changes in regional brain activation.Ojbectives: the aim of this study was to compare patterns of regional brain activation in patients with eating disorders (ED) and healthy volunteers during emotional stimulation.
Materials and methods
A group of 13 young female ED outpatients was selected using DSM-IV criteria and 13 young healthy female volunteers with no significant differences in sociodemographic or environmental data. fMRI was used to examine the neural responses after visual stimulation with neutral and fearful images, taken from the IAPS (International Affective Picture System) and selected a region of interest (ROI) aproach to examine the function of the amygdala in emotional processing.Data processing and higher level analysis were carried out using FSL (fMRI's Software Library).
ED patients showed significantly greater rigth amygdala activation to the fearful images versus neutral images than healthy control subjects (p < 0.02)
A higher right amygdala response to processing of fearful stimuli was observed in ED patients compared to healthy volunteers. This emotional dysregulation in the affective response to unpleasant stimuli would correlate with a maladaptative response and therefore justify disruptive behaviours in this patients.
Suicide is a major public health problem, one of the leading causes of death and one of the first causes of years of life lost. It is a voluntary act that can be carried out by men and women, children and adults, rich and poor, people of every race and religion.
The aim of this text is to outline the most popular suicides and briefly discuss the representation of suicide in art. Painters such as Vincent Van Gogh, Edvard Munch, Jackson Pollock, musicians as Kurt Cobain, Jim Morrison, Janis Joplin, Jimi Hendrix, the actresses Lupe Vélez, Carole Landis, Pier Angeli, Capucine, Marylin Monroe, Lucy Gordon and the actors Heath Ledger and Freddie Prinze decided the end of their lives in different ways and at different stages.
In the literary field, we find the world renowned suicides of Socrates, Seneca and Caton. Other famous and more recent suicidal writers are Ernest Hemingway, Dylan Thomas, Virginia Woolf, Yukio Mishima, Alfonsina Stormi and Cesare Pavese among others.
Suicide has been represented in several plays and operas, not only people of flesh and blood kill themselves but also fictional characters. the love-death of Liu in Turandot and Tosca in the opera of the same name Are noteworthy, both were composed by Giacomo Puccini. In Hamlet, tragedy written by William Shakespeare, is Ophelia who dies drowning at the sea.
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.
The objective of the present study was to examine the predictive value of clinical and cognitive -including the cognitive reserve (CR) - variables on the severity of the patient's illness at one year of follow-up.
A study was held with 45 patients with first episode psychosis (FEP) from 3 main hospitals in the Basque Country (Spain). All patients underwent cognitive, clinical, and functional assessments at baseline and at 6 months follow-up. The cognitive measures included were: the Stroop test, Vocabulary sub-test from WAIS-III, the WCST, and Trail Making Test. The clinical and functional measures included were: Positive and Negative Syndrome Scale (PANSS), Young Mania Scale, Montgomery-Asberg Depression scale, and CGI (Clinical Global Impression).
Six-months follow-up data were available for 29 patients. Regression analysis was performed with the 6-month follow-up CGI measure as a dependent variable. Results showed that after controlling for CGI at baseline, -PANSS Negative Symptoms Scale (B = 0.47, p ≤ .05) and the CR measure -Vocabulary from WAIS-III- (B = 0.36, p ≤ .05) were the only two which significantly predicted severity of illness after 6 months (R2 = 0.44) and remained significant when CGI at base line was controlled in the regression analysis. The rest variables did not reach statistical significance.
These findings emphasize that CR have a role on outcome in first episode psychosis, and enhance that exist a relation between cognition and clinical measures in psychosis.
Basque Government, Health Department (2008111010); EITB-Maratoia (BIO 09/EM/015).
Diagnosis of schizophrenia spectrum disorders (SSD) may be difficult in clinical practice, particularly during the first episodes of early-onset psychosis (FE-EOP).
To develop a Support Vector Machine (SVM) algorithm as a predictive tool for diagnostic outcome in patients with FE-EOP, based on clinical and biomedical data at the emergence of the illness.
Two-year, prospective longitudinal study, where 81 patients (9-17 years of age) with a FE-EOP and stable diagnosis at follow-up and 41 age and sex-matched healthy controls (HC) were included. Structured diagnostic interviews, clinical and cognitive scales, a MRI scan and biochemical tests were conducted at baseline. Three SVM classification algorithms were developed (SSD vs HC group, non-SSD vs HC group, and SSD vs non-SSD group). Jackknifing was used to validate the algorithms and to calculate performance estimates. Enhanced-Recursive Feature Elimination was performed in order to gain information about the predictive weight for diagnosis of each variable.
The SSD-versus-non-SSD classifier achieved an overall accuracy of 83.1%, sensitivity of 86.6% and specificity of 77.8%. The variables during a FE-EOP with higher predictive value for a diagnosis of SSD were clinical variables such as negative symptoms preceding or during the psychotic onset, poor insight and duration of illness until first psychiatric contact. Biochemical, neuroimaging, and cognitive variables at baseline did not provide any additional predictive value.
SVM may serve as a predictive tool for early diagnosis of SSD during a FE-EOP. The most discriminative variables during a FE-EOP for a future diagnosis of SSD are clinical variables.
Pain medication misuse is commonly found in patients under headache treatment and may produce co-morbid anxiety and depressive symptomatology. Management of this issue requires a comprehensive and integrative treatment including psychotherapy. Group interventions have been scarcely studied in addictive disorders, those interventions aims to decrease drug misuse and improve related psychiatric symptoms.
To study the efficacy of group interventions base on cognitive-behavior approach in patients with pain medication misuse.
Patients with pain medication misuse were included and were evaluated with BDI, STAI, SF36 and HIT scales (basal and at the end of treatment sessions). Patients were recruited from headache outpatient unit. Twelve sessions of one hour were performed with a cognitive-behavior approach (weekly).
We present preliminary results about the efficacy of group interventions in patients with pain medication misuse. Descriptive results pre- and post- treatment were analyzed in depressive symptoms (M = 20.14, SD = 12.25; M = 14.67, SD = 19.50) and in areas of quality of life: physical functioning (M = 48.75, SD = 31.13; M = 60.50, SD = 41.68), bodily pain (M = 12, SD = 9.25; M = 42.75, SD = 34.09), general health perceptions (M = 25.75, SD = 16.96; M = 44.25, SD = 22.33), vitality (M = 33.75, SD = 13.82; M = 48, SD = 34.82).
Pain medication misuse is commonly found in chronic headache patients, consequently worst outcomes for both pathologies. Group interventions may be useful in management of pain, anxiety and other comorbidities. Furthermore, it may favor drug use decrease and even abstinence.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The death rate due to suicide in elderly people is particularly high. As part of suicide selective prevention measures for at-risk populations, the WHO recommends training “gatekeepers”.
In order to assess the impact of gatekeeper training for members of staff, we carried out a controlled quasi-experimental study over the course of one year, comparing 12 nursing homes where at least 30% of the staff had undergone gatekeeper training with 12 nursing homes without trained staff. We collected data about the residents considered to be suicidal, their management further to being identified, as well as measures taken at nursing home level to prevent suicide.
The two nursing home groups did not present significantly different characteristics. In the nursing homes with trained staff, the staff were deemed to be better prepared to approach suicidal individuals. The detection of suicidal residents relied more on the whole staff and less on the psychologist alone when compared to nursing homes without trained staff. A significantly larger number of measures were taken to manage suicidal residents in the trained nursing homes. Suicidal residents were more frequently referred to the psychologist. Trained nursing homes put in place significantly more suicide prevention measures at an institutional level.
Having trained gatekeepers has an impact not only for the trained individuals but also for the whole institution where they work, both in terms of managing suicidal residents and routine suicide prevention measures.
The aim of the study was to describe the psychopharmacological treatments received by inpatients diagnosed with spectrum disorders schizophrenia and other psychotic disorders in Dr. Rodriguez Lafora Hospital. It is an observational, descriptive and retrospective study. We collected information about patients aged 18 to 64 who were hospitalized during the month of January of 2015 in the acute psychiatric hospitalization by Selene software. We reviewed treatments and number of psychiatric re-hospitalization six months later and we analyzed the results by SPSS software. From a sample of 51 inpatients, 15 of them were diagnosed with disorders of the spectrum of schizophrenia and other psychotic disorders. Of the patients, 13.3% was treated with haloperidol, 26.7% with olanzapine, 26.7% with risperidone although it was modified by paliperidone in mental health center, 6.7% with quetiapine, 6.7% with amisulpride, 13.3% with oral paliperidone and 13.3% patients with intramuscular paliperidone. Of these, 40% are readmitted to hospital. Patients were readmitted due to ineffectiveness and adverse effects of haloperidol, olanzapine, risperidone. 73.3% of inpatients were treated with monotherapy. Of the patients, 26.7% were treated with polytherapy, who received olanzapine, risperidone and amisulpride. It would be important to use psychoactive substances that allow monotherapy to reduce adverse effects and psychiatric re-hospitalization.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Flow complexity is related to a number of phenomena in science and engineering and has been approached from the perspective of chaotic dynamical systems, ergodic processes or mixing of fluids, just to name a few. To the best of our knowledge, all existing methods to quantify flow complexity are only valid for infinite time evolution, for closed systems or for mixing of two substances. We introduce an index of flow complexity coined interlacing complexity index (ICI), valid for a single-phase flow in an open system with inlet and outlet regions, involving finite times. ICI is based on Shannon’s mutual information (MI), and inspired by an analogy between inlet–outlet open flow systems and communication systems in communication theory. The roles of transmitter, receiver and communication channel are played, respectively, by the inlet, the outlet and the flow transport between them. A perfectly laminar flow in a straight tube can be compared to an ideal communication channel where the transmitted and received messages are identical and hence the MI between input and output is maximal. For more complex flows, generated by more intricate conditions or geometries, the ability to discriminate the outlet position by knowing the inlet position is decreased, reducing the corresponding MI. The behaviour of the ICI has been tested with numerical experiments on diverse flows cases. The results indicate that the ICI provides a sensitive complexity measure with intuitive interpretation in a diversity of conditions and in agreement with other observations, such as Dean vortices and subjective visual assessments. As a crucial component of the ICI formulation, we also introduce the natural distribution of streamlines and the natural distribution of world-lines, with invariance properties with respect to the cross-section used to parameterize them, valid for any type of mass-preserving flow.
Understanding patterns in plant and herbivorous insect diversity across spatial and temporal scales is fundamental to ecology, but comparative multi-taxonomic studies in tropical seasonally dry forests remain scarce. In 36 sites, distributed over three forest age classes (5–10 y, 10–30 y, >100 y) and three seasonal forest types (dry, intermediate, humid), we sampled plants of different stem diameter classes while caterpillars were sampled across vertically distributed forest layers during three seasons over the year. We recorded 299 plant species and 485 caterpillar morphospecies. For large woody plants, species numbers showed a gradually increasing trend with forest age in the intermediate and humid forest types, while the main portion of explained variation in overall species turnover was accounted for by the forest type × forest age interaction (21.3–23.1% of 44.4–48.7%). Ordinations and multivariate pairwise comparisons suggested a faster but also very distinct successional development of species diversity of large plants in the driest compared with humid and intermediate forest types. In contrast, highest species numbers of small plants in the undergrowth was often found in the 5–10 y-old vegetation across forest types, whereas forest type was the major factor in overall species turnover (contributing 24.2% of 48.7% explained variation). Caterpillar species turnover was most correlated to species turnover of small plants; however, variation in caterpillar species diversity appears to be mostly regulated by seasonal cues, and to a lesser extent by patterns of regional turnover and local diversity of undergrowth plant species.
Discerning dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) is one of the most common and challenging differential diagnoses at the memory clinic. Although the neuropsychiatric manifestations have been widely reported as one of the main key points in the differential diagnosis between these two diseases, to date no neuropsychiatric questionnaire has been specifically devised for this purpose.
We administered the Neuropsychiatric Inventory (NPI) and the Columbia University Scale for Psychopathology in Alzheimer's Disease (CUSPAD) to a memory clinic sample of 80 patients with probable DLB and 85 age- and severity-matched patients with probable AD. Diagnosis of probable DLB was supported with a positive dopamine transporter SPECT scan. We examined the usefulness of these two neuropsychiatric tools designed for AD in the differential diagnosis between DLB and AD. We also investigated the correlations between psychotic symptoms and measures of cognitive and functional decline.
Auditory hallucinations were very specific of DLB and were usually preceded by visual hallucinations. Misinterpretation of real visual stimuli (illusions) was more frequent in DLB. Delusions were both quantitatively and qualitatively different between DLB and AD: delusional misidentifications were significantly more characteristic of DLB, while paranoid delusions did not show specificity for DLB.
Neuropsychiatric tools are useful to discriminate DLB from AD. Hallucinations and delusions are not only more frequent in DLB than in AD but also have distinct qualitative characteristics and patterns of progression that can help clinicians to make a more accurate differential diagnosis.
We present the first results of a comprehensive photometric O-star survey performed with a robotic twin refractor at the Universitätssternwarte Bochum located near Cerro Armazones in Chile. For three high-mass stars, Pismis 24-1, CPD − 51∘ 8946, and HD 319702, we determined the period through the Lafler-Kinman algorithm and modelled the light curves within the framework of the Roche geometry. We introduce a newly discovered eclipsing high-mass binary HD 319702 that shows well-defined eclipses favouring a detached configuration with a period of 2.0 days and an orbital inclination of 67.5∘. Combining our photometric result with the primary spectral type O8 III(f) (T1 = 34 000 K) we derive a temperature of T2 = 25 200 K for the secondary component.
In the Mexican state of Chiapas the rainforest has been cleared, to make way for crops and extensive cattle ranching, at an annual rate of 12.4% since 2002. The conservation status of the Endangered black howler monkey Alouatta pigra in these fragmented landscapes in north-eastern Chiapas has not previously been examined. We therefore surveyed A. pigra populations in the municipality of Playas de Catazajá during 2004–2006 to obtain population and habitat data for this species in 115 fragments of remnant vegetation. A geographical information system was used to determine the variables (fragment size, and distances to the nearest fragment, human settlement and water body) that could be used to generate an index of habitat potential for A. pigra. We estimated a population of 659 individuals and a mean troop size of 5.0 ± SE 2.3. The adult male : female ratio was 1 : 1.4, the adult female : juvenile ratio 1 : 0.6 and adult female : immature ratio 1 : 0.8. The index of habitat potential indicates that 12% of the fragments have a high conservation potential for A. pigra. This index is a valuable tool for evaluating the conservation status of this species and its habitat, and can be expanded to include additional variables, thus allowing for a more comprehensive assessment.
In this study, we characterized 8 new isolates obtained from healthy but congenitally infected calves using a BALB/c mouse model. Neospora caninum-infected mice survived without exhibiting any clinical signs of disease. Nevertheless, differences among isolates in parasite organ distribution, parasite burden and the severity of histopathological lesions were determined. Mice infected with the Nc-Spain 5H, Nc-Spain 7 and Nc-Spain 9 isolates showed higher parasite burdens and more severe brain lesions during the late phase of infection compared to mice infected with the Nc-Spain 2H, Nc-Spain 3H or Nc-Spain 6 isolates. Furthermore, differences in the immunoglobulin IgG1 and IgG2a isotype kinetics induced by these isolates were observed, with a more rapid IgG2a response seen in mice infected with the Nc-Spain 2H and Nc-Spain 3H isolates. These results confirm the intra-species variability of N. caninum pathogenicity.