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National guidance cautions against low-intensity interventions for people with personality disorder, but evidence from trials is lacking.
To test the feasibility of conducting a randomised trial of a low-intensity intervention for people with personality disorder.
Single-blind, feasibility trial (trial registration: ISRCTN14994755). We recruited people aged 18 or over with a clinical diagnosis of personality disorder from mental health services, excluding those with a coexisting organic or psychotic mental disorder. We randomly allocated participants via a remote system on a 1:1 ratio to six to ten sessions of Structured Psychological Support (SPS) or to treatment as usual. We assessed social functioning, mental health, health-related quality of life, satisfaction with care and resource use and costs at baseline and 24 weeks after randomisation.
A total of 63 participants were randomly assigned to either SPS (n = 33) or treatment as usual (n = 30). Twenty-nine (88%) of those in the active arm of the trial received one or more session (median 7). Among 46 (73%) who were followed up at 24 weeks, social dysfunction was lower (−6.3, 95% CI −12.0 to −0.6, P = 0.03) and satisfaction with care was higher (6.5, 95% CI 2.5 to 10.4; P = 0.002) in those allocated to SPS. Statistically significant differences were not found in other outcomes. The cost of the intervention was low and total costs over 24 weeks were similar in both groups.
SPS may provide an effective low-intensity intervention for people with personality disorder and should be tested in fully powered clinical trials.
Cognitive impairment is a core feature of major depressive disorder (MDD). Cognitive remediation may improve cognition in MDD, yet so far, the underlying neural mechanisms are unclear. This study investigated changes in intrinsic neural activity in MDD after a cognitive remediation trial.
In a longitudinal design, 20 patients with MDD and pronounced cognitive deficits and 18 healthy controls (HC) were examined using resting-state functional magnetic resonance imaging. MDD patients received structured cognitive remediation therapy (CRT) over 5 weeks. The whole-brain fractional amplitude of low-frequency fluctuations was computed before the first and after the last training session. Univariate methods were used to address regionally-specific effects, and a multivariate data analysis strategy was employed to investigate functional network strength (FNS).
MDD patients significantly improved in cognitive function after CRT. Baseline comparisons revealed increased right caudate activity and reduced activity in the left frontal cortex, parietal lobule, insula, and precuneus in MDD compared to HC. In patients, reduced FNS was found in a bilateral prefrontal system at baseline (p < 0.05, uncorrected). In MDD, intrinsic neural activity increased in right inferior frontal gyrus after CRT (p < 0.05, small volume corrected). Left inferior parietal lobule, left insula, left precuneus, and right caudate activity showed associations with cognitive improvement (p < 0.05, uncorrected). Prefrontal network strength increased in patients after CRT, but this increase was not associated with improved cognitive performance.
Our findings support the role of intrinsic neural activity of the prefrontal cortex as a possible mediator of cognitive improvement following CRT in MDD.
This volume explores the diverse ways in which the Book of Psalms profoundly influenced medieval English literature and culture, through a series of connected overviews and special case studies. A number of recent studies have highlighted the Psalter's reception in Early Modern English (and wider European culture), while three monographs by contributors to this volume offer focused studies of the Psalter in individual periods of medieval English literature: Jane Toswell's The Anglo-Saxon Psalter, Annie Sutherland's English Psalms in the Middle Ages: 1300–1450and Michael P. Kuczynski's Prophetic Song: The Psalms as Moral Discourse in Late Medieval England. But as yet no single study has sought to offer a comprehensive survey of English responses to the Book of Psalms from the conversion of the Anglo-Saxons to the cusp of the Reformation. By bringing work by experts on both Old and Middle English literature into dialogue, this volume breaks down the traditional disciplinary binaries of pre- and post-Conquest English, late medieval and Early Modern, as well as emphasizing the complex and fascinating relationship between Latin and the vernacular languages of England. In order to encourage the reader to make connections both across and within these various periods and languages, the book is arranged thematically rather than chronologically, with three sections designed to offer a variety of perspectives on the Psalms and medieval English literature.
Section I (Translation) focuses on the development of English psalm translation from its beginnings in Old English interlinear glosses in Latin psalters through the multilingual psalters of the Anglo-Norman era to the stand-alone vernacular psalters of the fourteenth and fifteenth centuries. Concentrating on the Psalter as a book, this section charts the emergence of English as a scriptural language in the medieval period.
Section II (Adaptation) considers how medieval English prose and verse writers draw on the Psalms as a source of literary inspiration. Demonstrating how the Psalter could be adapted and redeployed within the context of medieval worship and prayer, it begins with a discussion of the first adaptation of the entire Psalter into English verse, before turning to a consideration of the development of the abbreviated psalter tradition. This section also addresses the wider influence of psalmic language and imagery on Old English praise and lament poetry, and on Middle English alliterative verse.
The Book of Psalms had a profound impact on English literature from the Anglo-Saxon to the late medieval period. This collection examines the various ways in which they shaped medieval English thoughtand contributed to the emergence of an English literary canon. It brings into dialogue experts on both Old and Middle English literature, thus breaking down the traditional disciplinary binaries of both pre- and post-Conquest English and late medieval and Early Modern, as well as emphasizing the complex and fascinating relationship between Latin and the vernacular languages of England. Its three main themes, translation, adaptation and voice, enable a rich variety of perspectives on the Psalms and medieval English literature to emerge.
Tamara Atkin is Senior Lecturer in Late Medieval and Early Renaissance Literature at Queen Mary University of London; Francis Leneghan is Associate Professor of Old English at The University of Oxford and a Fellow of St Cross College, Oxford.
Contributors: Daniel Anlezark, Mark Faulkner, Vincent Gillespie, Michael P. Kuczynski, David Lawton, Francis Leneghan, Jane Roberts, Mike Rodman Jones, Elizabeth Solopova, Lynn Staley, AnnieSutherland, Jane Toswell, Katherine Zieman.
Globally, the Series 2 – Series 3 boundary of the Cambrian System coincides with a major carbon isotope excursion, sea-level changes and trilobite extinctions. Here we examine the sedimentology, sequence stratigraphy and carbon isotope record of this interval in the Cambrian strata (Durness Group) of NW Scotland. Carbonate carbon isotope data from the lower part of the Durness Group (Ghrudaidh Formation) show that the shallow-marine, Laurentian margin carbonates record two linked sea-level and carbon isotopic events. Whilst the carbon isotope excursions are not as pronounced as those expressed elsewhere, correlation with global records (Sauk I – Sauk II boundary and Olenellus biostratigraphic constraint) identifies them as representing the local expression of the ROECE and DICE. The upper part of the ROECE is recorded in the basal Ghrudaidh Formation whilst the DICE is seen around 30m above the base of this unit. Both carbon isotope excursions co-occur with surfaces interpreted to record regressive–transgressive events that produced amalgamated sequence boundaries and ravinement/flooding surfaces overlain by conglomerates of reworked intraclasts. The ROECE has been linked with redlichiid and olenellid trilobite extinctions, but in NW Scotland, Olenellus is found after the negative peak of the carbon isotope excursion but before sequence boundary formation.