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Schizophrenia is a severe mental disorder striking mainly young adults and leading to life-long disability in a substantial portion of the sufferers. On the other hand, substantial knowledge about its etiology and pathogenesis is still lacking. Therefore the European Science Foundation (ESF) sponsored a meeting of a panel of European experts on schizophrenia research to discuss the state of art and future perspectives of key topics in this area. The fields covered genetics, epidemiology, animal models, molecular neuropathology and imaging. This was a first step to establish a network of European groups dedicated to Schizophrenia research. The coming calls of the frame work program will be used to strengthen this network in order to achieve substantial progress in understanding and treating this devastating illness.
Approximately 18% of adults with intellectual disabilities living in the community display behaviours that challenge. Intensive support teams (ISTs) have been recommended to provide high-quality responsive care aimed at avoiding unnecessary admissions and reducing lengthy in-patient stays.
To identify and describe the geographical distribution and characteristics of ISTs, and to develop a typology of IST service models in England.
We undertook a national cross-sectional survey of 73 ISTs. A hierarchical cluster analysis was performed based on six prespecified grouping factors (mode of referrals, size of case-load, use of outcome measures, staff composition, hours of operation and setting of service). A simplified form of thematic analysis was used to explore free-text responses.
Cluster analysis identified two models of IST provision: (a) independent and (b) enhanced provision based around a community intellectual disability service. ISTs aspire to adopt person-centred care, mostly use the framework of positive behaviour support for behaviour that challenges, and report concerns about organisational and wider context issues.
This is the first study to examine the delivery of intensive support to people with intellectual disability and behaviour that challenges. A two-cluster model of ISTs was found to have statistical validity and clinical utility. The clinical heterogeneity indicates that further evaluation of these service models is needed to establish their clinical and cost-effectiveness.
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.
Around 60 000 people in England live in mental health supported accommodation. There are three main types: residential care, supported housing and floating outreach. Supported housing and floating outreach aim to support service users in moving on to more independent accommodation within 2 years, but there has been little research investigating their effectiveness.
A 30-month prospective cohort study investigating outcomes for users of mental health supported accommodation.
We used random sampling, accounting for relevant geographical variation factors, to recruit 87 services (22 residential care, 35 supported housing and 30 floating outreach) and 619 service users (residential care 159, supported housing 251, floating outreach 209) across England. We contacted services every 3 months to investigate the proportion of service users who successfully moved on to more independent accommodation. Multilevel modelling was used to estimate how much of the outcome and cost variations were due to service type and quality, after accounting for service-user characteristics.
Overall 243/586 participants successfully moved on (residential care 15/146, supported housing 96/244, floating outreach 132/196). This was most likely for floating outreach service users (versus residential care: odds ratio 7.96, 95% CI 2.92–21.69, P < 0.001; versus supported housing: odds ratio 2.74, 95% CI 1.01–7.41, P < 0.001) and was associated with reduced costs of care and two aspects of service quality: promotion of human rights and recovery-based practice.
Most people do not move on from supported accommodation within the expected time frame. Greater focus on human rights and recovery-based practice may increase service effectiveness.
Methodological naturalism is usually regarded as compatible with a range of religious commitments on the part of scientific practitioners and it is typically assumed that methodological naturalism does not imply metaphysical naturalism. Against this, it has been argued that the cumulative success of the sciences, conducted in conformity with the principle of methodological naturalism, actually provides compelling evidence for the truth of metaphysical naturalism. In this article I assess the argument for naturalism from the history of science and suggest that it is deficient in a number of ways. There may be reasons for adopting naturalism, but the history of science is not the place to look for them.
Among phoneticians, the Vocal Profile Analysis (VPA) is one of the most widely used methods for the componential assessment of voice quality. Whether the ultimate goal of the VPA evaluation is the comparative description of languages or the characterization of an individual speaker, the VPA protocol shows great potential for different research areas of speech communication. However, its use is not without practical difficulties. Despite these, methodological studies aimed at explaining where, when and why issues arise during the perceptual assessment process are rare. In this paper we describe the methodological stages through which three analysts evaluated the voices of 99 Standard Southern British English male speakers, rated their voices using the VPA scheme, discussed inter-rater disagreements, and eventually produced an agreed version of VPA scores. These scores were then used to assess correlations between settings. We show that it is possible to reach a good degree of inter-rater agreement, provided that several calibration and training sessions are conducted. We further conclude that the perceptual assessment of voice quality using the VPA scheme is an essential tool in fields such as forensic phonetics but, foremost, that it can be adapted and modified to a range of research areas, and not necessarily limited to the evaluation of pathological voices in clinical settings.
C-reactive protein (CRP) is a candidate biomarker for major depressive disorder (MDD), but it is unclear how peripheral CRP levels relate to the heterogeneous clinical phenotypes of the disorder.
To explore CRP in MDD and its phenotypic associations.
We recruited 102 treatment-resistant patients with MDD currently experiencing depression, 48 treatment-responsive patients with MDD not currently experiencing depression, 48 patients with depression who were not receiving medication and 54 healthy volunteers. High-sensitivity CRP in peripheral venous blood, body mass index (BMI) and questionnaire assessments of depression, anxiety and childhood trauma were measured. Group differences in CRP were estimated, and partial least squares (PLS) analysis explored the relationships between CRP and specific clinical phenotypes.
Compared with healthy volunteers, BMI-corrected CRP was significantly elevated in the treatment-resistant group (P = 0.007; Cohen's d = 0.47); but not significantly so in the treatment-responsive (d = 0.29) and untreated (d = 0.18) groups. PLS yielded an optimal two-factor solution that accounted for 34.7% of variation in clinical measures and for 36.0% of variation in CRP. Clinical phenotypes most strongly associated with CRP and heavily weighted on the first PLS component were vegetative depressive symptoms, BMI, state anxiety and feeling unloved as a child or wishing for a different childhood.
CRP was elevated in patients with MDD, and more so in treatment-resistant patients. Other phenotypes associated with elevated CRP included childhood adversity and specific depressive and anxious symptoms. We suggest that patients with MDD stratified for proinflammatory biomarkers, like CRP, have a distinctive clinical profile that might be responsive to second-line treatment with anti-inflammatory drugs.
Declaration of interest
S.R.C. consults for Cambridge Cognition and Shire; and his input in this project was funded by a Wellcome Trust Clinical Fellowship (110049/Z/15/Z). E.T.B. is employed half time by the University of Cambridge and half time by GlaxoSmithKline; he holds stock in GlaxoSmithKline. In the past 3 years, P.J.C. has served on an advisory board for Lundbeck. N.A.H. consults for GlaxoSmithKline. P.d.B., D.N.C.J. and W.C.D. are employees of Janssen Research & Development, LLC., of Johnson & Johnson, and hold stock in Johnson & Johnson. The other authors report no financial disclosures or potential conflicts of interest.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
To develop and pilot a clinician-rated outcome scale to evaluate symptomatic outcomes in liaison psychiatry services. Three hundred and sixty patient contacts with 207 separate individuals were rated using six subscales (mood, psychosis, cognition, substance misuse, mind–body problems and behavioural disturbance) plus two additional items (side-effects of medication and capacity to consent for medical treatment). Each item was rated on a five-point scale from 0 to 5 (nil, mild, moderate, severe and very severe).
The liaison outcome measure was acceptable and easy to use. All subscales showed acceptable interrater reliability, with the exception of the mind–body subscale. Overall, the measure appears to show stability and sensitivity to change.
The measure provides a useful and robust way to determine symptomatic change in a liaison mental health setting, although the mind–body subscale requires modification.
This preliminary study considers the implications of where students of Aboriginal descent sat in a teacher education classroom, its significance in relation to the space of the classroom, the importance of the place to the individual and its links to creating a climate of cultural safety in the classroom. Six students from two cohorts of varying sizes were interviewed as to why they sat where they did in the classroom and why the place where they sat remained relatively stable. The study uses quotations from the students and reflectively seeks to understand their experience in the class. Risking themselves in a university context which itself is the product of the very colonisers who created the conditions for cultural genocide through residential schools. It is tentatively concluded that where First People sit in the classroom maybe reflective of the territory to which they belong.
Tertullian is widely regarded as having originated the expression Credo quia absurdum (est) (I believe because it is absurd) and the phrase often appears in contemporary polemics about the rationality of religious belief. Patristic scholars have long pointed out that Tertullian never said this or meant anything like it. However, little scholarly attention has been paid to the circumstances in which this specific phrase came into existence and why, in spite of its dubious provenance, it continues to be regarded by many as a legitimate characterization of religious faith. This paper shows how Tertullian's original expression—“It is certain, because impossible”—was first misrepresented and modified in the early modern period. In seventeenth century England a “credo” version—I believe because it is impossible—became the common form of Tertullian's maxim. A further modification, building on the first, was effected by the Enlightenment philosophe Voltaire, who added the “absurdity condition” and gave us the modern version of the paradox: I believe because it is absurd. These modifications played a significant role in Enlightenment representations of religion as irrational, and signal the beginning of a new understanding of faith as an epistemic vice. This doubtful maxim continues to play a role in debates about the cognitive status of religious faith, and its failure to succumb to the historical evidence against it is owing to its ongoing rhetorical usefulness in such debates.
In February of the year 1616 a group of advisers to the Holy Office met in Rome to consider the Copernican teaching that the Earth moved around a stationary Sun. They concluded that this theory was ‘foolish and absurd in philosophy’, and that it explicitly contradicted many passages of Holy Scripture ‘according to the literal meaning of the words’. For the latter reason the doctrine was declared formally heretical. While it was the name of Copernicus that appeared in the official decree of the Holy Office, and Copernicus's De revolutionibus (1543) that was then placed on the Index of Prohibited Books, the chief target of the decree was the brilliant astronomer and mathematician Galileo Galilei (1564–1642). The famous Florentine, who for several years had openly championed the motion of the Earth, was specifically warned at this time against teaching or defending this controversial theory – a theory that was deemed to be at odds with the biblical witnesses. At first Galileo seemed content to comply with the wishes of the ecclesiastical authorities, but eventually, in 1632, he published his Dialogue on the Two Chief World Systems which, in spite of its dialogue form, set out a relatively unambiguous case for Copernicanism. In the following year Galileo was tried in Rome and convicted of ‘vehement suspicion of heresy’. On 22 June 1633, in a room adjoining the church of Santa Maria sopra Minerva, he read a humiliating retraction of his views concerning the motion of the Earth. He was placed under house arrest for the remainder of his life and his Dialogue was added to the Index, where it stayed until 1835.
The well-known story of Galileo lends a certain credence to the idea that throughout history there has been a perennial struggle between a rational and enlightened scientific world-view on the one hand and the forces of religious oppression on the other. It must be said that, amongst historians of science, the myth of an ongoing conflict between science and religion now finds few, if any, adherents. Nevertheless, on the face of it the Galileo affair does suggest that the victories of the new seventeenth-century science – ‘natural philosophy’ as it was then known – were won only against a determined opposition from those who believed that the literal words of Scripture were the sole authority in scientific matters.
Objectives: Huntington’s disease (HD) is a neurodegenerative disorder that produces a bias toward risky, reward-driven decisions in situations where the outcomes of decisions are uncertain and must be discovered. However, it is unclear whether HD patients show similar biases in decision-making when learning demands are minimized and prospective risks and outcomes are known explicitly. We investigated how risk decision-making strategies and adjustments are altered in HD patients when reward contingencies are explicit. Methods: HD (N=18) and healthy control (HC; N=17) participants completed a risk-taking task in which they made a series of independent choices between a low-risk/low reward and high-risk/high reward risk options. Results: Computational modeling showed that compared to HC, who showed a clear preference for low-risk compared to high-risk decisions, the HD group valued high-risks more than low-risk decisions, especially when high-risks were rewarded. The strategy analysis indicated that when high-risk options were rewarded, HC adopted a conservative risk strategy on the next trial by preferring the low-risk option (i.e., they counted their blessings and then played the surer bet). In contrast, following a rewarded high-risk choice, HD patients showed a clear preference for repeating the high-risk choice. Conclusions: These results indicate a pattern of high-risk/high-reward decision bias in HD that persists when outcomes and risks are certain. The allure of high-risk/high-reward decisions in situations of risk certainty and uncertainty expands our insight into the dynamic decision-making deficits that create considerable clinical burden in HD. (JINS, 2016, 22, 426–435)
The United Nations Commission on the Limits of the Continental Shelf is expected to play an essential role in delineating the rights of the Arctic states to seabed resources in the Arctic Ocean. In this article, the authors look to the effect of scientific discourse on Commission authority. The authors argue that in addition to the conferral of its authority by the United Nations Convention on the Law of the Sea, the Commission draws its authority in the Arctic from the way its regulatory frameworks, aimed at containing or closing off disputes about jurisdiction and sovereign rights, correlate with discursive practices used by transnational networks to reach scientific agreement.
Informal caregiving is an integral part of the care of people with severe
mental illness, but the support needs of those providing such care are
not often met.
To determine whether interventions provided to people caring for those
with severe mental illness improve the experience of caring and reduce
We conducted a systematic review and meta-analyses of randomised
controlled trials (RCTs) of interventions delivered by health and social
care services to informal carers (i.e. family or friends who provide
support to someone with severe mental illness).
Twenty-one RCTs with 1589 carers were included in the review. There was
evidence suggesting that the carers' experience of care was improved at
the end of the intervention by psychoeducation (standardised mean
difference −1.03, 95% CI −1.69 to −0.36) and support groups (SMD =–1.16,
95% CI −1.96 to −0.36). Psychoeducation had a benefit on psychological
distress more than 6 months later (SMD =–1.79, 95% CI −3.01 to −0.56) but
not immediately post-intervention. Support interventions had a beneficial
effect on psychological distress at the end of the intervention (SMD
=–0.99, 95% CI −1.48 to −0.49) as did problem-solving bibliotherapy (SMD
=–1.57, 95% CI −1.79 to −1.35); these effects were maintained at
follow-up. The quality of the evidence was mainly low and very low.
Evidence for combining these interventions and for self-help and
self-management was inconclusive.
Carer-focused interventions appear to improve the experience of caring
and quality of life and reduce psychological distress of those caring for
people with severe mental illness, and these benefits may be gained in
first-episode psychosis. Interventions for carers should be considered as
part of integrated services for people with severe mental health
This book is published in 2014 – the year South Africa celebrates two decades of democracy. It offers an account of complex and often bewildering transformations in Johannesburg – South Africa's premier city – since the end of apartheid. We focus on the city's physical form, but relate this to trends across the economic, political, social and cultural domains, thus attempting to bridge scholarly traditions that tend to emphasise either the ‘material’ or ‘cultural’ dimensions of the city.
Our major contribution to the already diverse and lively literature on Johannesburg is to provide a multi-layered analysis of urban change, drawing on new and updated sources of empirical data, and informed by the perspectives of a range of scholars. Our primary aim is to understand change in post-apartheid South Africa, but clearly Johannesburg's story has the potential to inform understandings of the processes shaping urban space globally.
The book is the first product of a larger initiative of engagement with change in the Gauteng city-region that includes the other major metropolitan hubs, and places that are more marginal to our spatial imaginations. The initiative is a collaborative one, involving the School of Architecture and Planning at the University of the Witwatersrand, Johannesburg and the Gauteng City-Region Observatory (GCRO), as well as contributions from many scholars across different institutions.
As the book has been a number of years in the making, we have had assistance from a range of agencies and individuals. The GCRO, the South African Research Chairs’ Initiative of the National Research Foundation and the School of Architecture and Planning provided financial and institutional support for the project. The substantive content comes, of course, from the considerable efforts and insights of the contributors, and we offer them our heartfelt thanks. We are also grateful to the anonymous reviewers who provided us with perceptive comments. Wits University Press provided professional guidance and the gentle reassurance we needed from time to time. Our sincere thanks go to the publishing team – Veronica Klipp, Roshan Cader, Mary Ralphs, Andrew Joseph and Peter Bosman. The forbearance of our colleagues in the GCRO and the School of Architecture and Planning, and of our friends and families, is deeply appreciated, thank you.