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Most measures of anxious avoidance are limited to disorder-specific mechanisms and ignore the measurement of courage/approach responding in confronting fearful situations.
The purpose of the present study was to construct and validate a self-report assessment of the tendency towards avoidant or approach responding in fearful situations, the Response to Fearful Situations Scale (RFSS).
Method and Results:
In Study 1 (n = 241), exploratory factor analysis resulted in two factors, avoidance and approach. Study 2 (n = 423) replicated the two-factor structure and established test–re-test reliability. In Study 3 (n = 44), the RFSS demonstrated predictive validity on a behavioural avoidance task. In Studies 4 (n = 253) and 5 (n = 256), the RFSS was associated with clinical symptoms above existing measures of avoidance.
These results validate the use of the RFSS as a transdiagnostic measure of avoidance and approach.
This project will work closely with existing service partners involved in street level services and focus on testing and evaluating three approaches for street level interventions for youth who are homeless and who have severe or moderate mentally illness. Youth will be asked to choose their preferred service approach:
Housing First related initiatives focused on interventions designed to move youth to appropriate and available housing and ongoing housing supports.
Treatment First initiatives to provide Mental Health/Addiction supports and treatment solutions, and; Simultaneous attention to both Housing and Treatment Together
Our primary objective is to understand the service delivery preferences of homeless youth and understand the outcomes of these choices. Our research questions include:
1. Which approaches to service are chosen by youth?
2. What are the differences and similarities between groups choosing each approach?
3. What are the critical ingredients needed to effectively implement services for homeless youth from the perspectives of youth, families and service providers?
Focus groups with staff and family members will occur to assist in understanding the nature of each of service approach, changes that evolve within services, & facilitators and barriers to service delivery. This work will be important in determining which approach is chosen by youth and why. Evaluating the outcomes with each choice will provide valuable information about outcomes for the service options chosen by youth. This assist in better identifying weaknesses in the services offered and inform further development of treatment options that youth will accept.
This study assesses the relationship of EEG to several aspects of 3 year symptomatic and functional outcome in first episode psychosis.
One hundred and seventeen patients with first episode psychosis had their baseline EEG classified by modified Mayo Clinic criteria as normal, essentially normal or dysrhythmia. Socio-demographic variables, duration of illness and of untreated psychosis and premorbid adjustment were also recorded. Positive and negative symptoms of psychoses, depression, anxiety and global functioning were rated on entry and after three years of treatment.
Patients with a dysrhythmic EEG at entry into treatment showed significantly greater persistence in both positive and negative symptoms of psychoses as well as anxiety and depression over three years. These findings were independent of duration of untreated illness or premorbid adjustment.
An abnormal baseline EEG in patients with first episode psychosis is associated with a poorer symptomatic outcome at three year follow-up.
To determine if substance abuse significantly increases the risk of relapse in first episode psychosis patients over a two year follow-up even after adherence to medication is improved.
Relapse was based on ratings on the Scale for Assessment of Positive Symptoms and weekly ratings on Life Chart Schedule (WHO). Predictor variables included gender, duration of untreated psychosis (DUP), duration of untreated illness from the time of first psychiatric symptoms (DUI), age of onset, pre-morbid adjustment, co-morbid diagnosis of substance abuse at one year, time to remission of psychotic symptoms and adherence to medication. Univariate analyses were followed by logistic regression for rate of relapse and survival analysis with Cox proportional hazard regression was used for time to relapse as the dependent variable.
Of the 207 patients, 162 achieved remission of positive symptoms and were treated and followed for two years. Relapse rates were relatively low (21.6% in the first and 13.8% in 2nd year, respectively) with 33 weeks as the mean time to relapse. Relapse rates were significantly higher for patients with a co-morbid diagnosis of substance abuse (OR= 2.59, CI 1.28-5.21), especially for the second year (OR=3.66, CI 1.30-10.27) and for those with shorter DUI (OR=0.437, CI 0.209-0.914) after controlling for other predictors. Likelihood of relapse during follow-up was associated only with a co-morbid diagnosis of substance abuse (HR= 2.49, p=.01, CI 1.21-5.10).
Specialized treatment of substance abuse may further reduce risk of relapse even after improving adherence to medication.
Recent research suggests the existence of at least two separable domains of negative symptoms in schizophrenia and related psychotic disorders. One of the domains reflects diminished expression including affective flattening and poverty of speech and the second consists of apathy as reflected in diminished motivation and social interest. It has been suggested that these domains may have different underlying etiologies and differ in their significance for recovery. There has been little investigation of the course of these two domains during treatment. We will present the results of a five year prospective study of the course of these negative symptom domains in 132 first episode patients who were followed from the initiation of treatment. Results show a significantly greater prevalence of the apathy domain than reduced expressiveness. When it occurred, apathy was also of longer duration than reduced expressiveness and showed stronger correlations with psychosocial functioning . Examination of the longitudinal course of each domain of negative symptoms revealed differences in temporal relationships other symptoms.
Although there have been many cross-sectional studies of the relationships between social support and level of functioning for individuals with psychotic disorders, there have been few reported prospective studies.
To examine the importance of social support early in the treatment of individuals with a psychotic disorder as a predictor of functional status at five year follow-up.
Social support of 132 patients with a psychotic disorder was assessed at the time of entry into treatment and one year later. Five year functional outcomes were assessed using the General Assessment of Function (GAF), number of weeks of full-time occupation and weeks on a disability pension during the fourth and fifth year of follow-up.
Social functioning assessed at initiation of treatment and at one year were significant predictors of general functioning, use of disability pension and full-time occupation at five year follow-up. This relationship was independent of other predictors such as gender, age of onset, treatment delay and early symptoms.
Level of social support is an independent predictor of five year outcome for patients at early stages of treatment of psychosis. These findings provide further evidence the probable value of interventions that increase supportiveness of the social environment of those with psychotic disorders.
There is evidence that social support predicts self-esteem and related moods for individuals with psychotic disorders. There has, however, been little investigation of relative importance of specific components of social support.
Evidence from social psychology suggests that perceived relational evaluation (PRE) or the extent to which individuals see others as valuing them, is a particularly important determinant of self-esteem and mood.
The current study compared the importance of PRE and other types of social support, in predicting self-esteem and depressive mood, anxiety and anger hostility in a sample of patients in an early intervention program for psychotic disorders.
One hundred and two patients of the Prevention and Early Intervention Program for Psychoses (PEPP) in London, Ontario completed measures of PRE, appraisal, tangible and general emotional social support, self-esteem and mood. in addition, ratings of positive and negative symptoms were completed for all participants.
In general, perceived relational evaluation was the most important predictor of self-esteem and mood. These relationships were not a result of confounding with positive or negative symptoms.
The extent to which an individual perceives himself or herself as being positively valued by those in his or her immediate social environment is a particularly important component of social support in predicting self-esteem and affect of individuals with a psychotic disorder
This paper describes initial experimental results from an extreme ultraviolet (EUV) radiation-pulsed atom probe microscope. Femtosecond-pulsed coherent EUV radiation of 29.6 nm wavelength (41.85 eV photon energy), obtained through high harmonic generation in an Ar-filled hollow capillary waveguide, successfully triggered controlled field ion emission from the apex of amorphous SiO2 specimens. The calculated composition is stoichiometric within the error of the measurement and effectively invariant of the specimen base temperature in the range of 25 K to 150 K. Photon energies available in the EUV band are significantly higher than those currently used in the state-of-the-art near-ultraviolet laser-pulsed atom probe, which enables the possibility of additional ionization and desorption pathways. Pulsed coherent EUV light is a new and potential alternative to near-ultraviolet radiation for atom probe tomography.
Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT) failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit from psychotherapy and if psychotherapy improves PVT performance.
Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline, post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPT with TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standard cutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was considered valid (PVT-Pass).
Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Fail group. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rate of valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition.
Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement following treatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit from neuropsychological assessment after, rather than before, treatment.
We review the various functional cognitive disorders (FCDs) – complaints about memory function or another cognitive process in the absence of relevant neuropathology. These are increasingly coming to the attention of psychiatrists and neurologists and FCD encompasses some newly recognised conditions in addition to classic types such as pseudodementia and psychogenic amnesia. The clinical features, neuropsychological findings and treatment are presented and discussed.
After reading this article you will be able to:
• describe clinical features of FCD and how it differs from neurodegenerative causes of cognitive impairment
• be able to subclassify cases of FCD using the proposed nosology
• understand how to discuss the diagnosis with the patient and explain how the symptoms arise.
Depression is a common, serious, but under-recognised problem in multiple sclerosis (MS). The primary objective of this study was to assess whether a rapid visual analogue screening tool for depression could operate as a quick and reliable screening method for depression, in patients with MS.
Patients attending a regional MS outpatient clinic completed the Emotional Thermometer 7 tool (ET7), the Hospital Anxiety and Depression Scale – Depression Subscale (HADS-D) and the Major Depression Inventory (MDI) to establish a Diagnostic and Statistical Manual, 4th edition (DSM-IV) diagnosis of Major Depression. Full ET7, briefer subset ET4 version and depression and distress thermometers alone were compared with HADS-D and MDI. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and receiver operating characteristic (ROC) curve were calculated to compare the performance of all the screening tools.
In total, 190 patients were included. ET4 performed well as a ‘rule-out’ screening step (sensitivity 0.91, specificity 0.72, NPV 0.98, PPV 0.32). ET4 performance was comparable to HADS-D (sensitivity 0.96, specificity 0.77, NPV 0.99, PPV 0.37) without need for clinician scoring. The briefer ET4 performed as well as the full ET7.
ET are quick, sensitive and useful screening tools for depression in this MS population, to be complemented by further questioning or more detailed psychiatric assessment where indicated. Given that ET4 and ET7 perform equally well, we recommend the use of ET4 as it is briefer. It has the potential to be widely implemented across busy neurology clinics to assist in depression screening in this under diagnosed group.
Pulsed coherent extreme ultraviolet (EUV) radiation is a potential alternative to pulsed near-ultraviolet (NUV) wavelengths for atom probe tomography. EUV radiation has the benefit of high absorption within the first few nm of the sample surface for elements across the entire periodic table. In addition, EUV radiation may also offer athermal field ion emission pathways through direct photoionization or core-hole Auger decay processes, which are not possible with the (much lower) photon energies used in conventional NUV laser-pulsed atom probe. We report preliminary results from what we believe to be the world’s first EUV radiation-pulsed atom probe microscope. The instrument consists of a femtosecond-pulsed, coherent EUV radiation source interfaced to a local electrode atom probe tomograph by means of a vacuum manifold beamline. EUV photon-assisted field ion emission (of substrate atoms) has been demonstrated on various insulating, semiconducting, and metallic specimens. Select examples are shown.
Forecast accuracy is typically measured in terms of a given loss function. However, as a consequence of the use of misspecified models in multiple model comparisons, relative forecast rankings are loss function dependent. In order to address this issue, a novel criterion for forecast evaluation that utilizes the entire distribution of forecast errors is introduced. In particular, we introduce the concepts of general-loss (GL) forecast superiority and convex-loss (CL) forecast superiority; and we develop tests for GL (CL) superiority that are based on an out-of-sample generalization of the tests introduced by Linton, Maasoumi, and Whang (2005, Review of Economic Studies 72, 735–765). Our test statistics are characterized by nonstandard limiting distributions, under the null, necessitating the use of resampling procedures to obtain critical values. Additionally, the tests are consistent and have nontrivial local power, under a sequence of local alternatives. The above theory is developed for the stationary case, as well as for the case of heterogeneity that is induced by distributional change over time. Monte Carlo simulations suggest that the tests perform reasonably well in finite samples, and an application in which we examine exchange rate data indicates that our tests can help identify superior forecasting models, regardless of loss function.
Prenatal maternal obesity has been linked to adverse childhood neuropsychiatric outcomes, including increased symptoms of attention deficit hyperactivity disorder (ADHD), internalizing and externalizing problems, affective disorders and neurodevelopmental problems but few studies have studied neuropsychiatric outcomes among offspring born to very severely obese women or assessed potential familial confounding by maternal psychological distress.
We evaluated neuropsychiatric symptoms in 112 children aged 3–5 years whose mothers had participated in a longitudinal study of obesity in pregnancy (50 very severe obesity, BMI ⩾40 kg/m2, obese class III and 62 lean, BMI 18.5–25 kg/m2). The mothers completed the Conners’ Hyperactivity Scale, Early Symptomatic Syndrome Eliciting Neurodevelopmental Clinical Examination Questionnaire (ESSENCE-Q), Child's Sleep Habits Questionnaire (CSHQ), Strengths and Difficulties Questionnaire (SDQ), and Child Behavior Checklist (CBCL) to assess child neuropsychiatric symptoms. Covariates included child's sex, age, birthweight, gestational age, socioeconomic deprivation levels, maternal age, parity, smoking status during pregnancy, gestational diabetes and maternal concurrent symptoms of anxiety and depression assessed using State Anxiety of Spielberger State-Trait Anxiety Index (STAI) and General Health Questionnaire (GHQ), respectively.
Children exposed to prenatal maternal very severe obesity had significantly higher scores in the Conners’ Hyperactivity Scale; ESSENCE-Q; total sleep problems in CSHQ; hyperactivity, conduct problems and total difficulties scales of the SDQ; higher externalizing and total problems, anxious/depressed, aggressive behaviour and other problem syndrome scores and higher DSM-oriented affective, anxiety and ADHD problems in CBCL. Prenatal maternal very severe obesity remained a significant predictor of child neuropsychiatric problems across multiple scales independent of demographic factors, prenatal factors and maternal concurrent symptoms of anxiety and depression.
Prenatal maternal very severe obesity is a strong predictor of increased neuropsychiatric problems in early childhood.