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There is increasing interest in the clinical and aetiological overlap between autism spectrum disorders and schizophrenia spectrum disorders, reported to co-occur at both diagnostic and trait levels. Individually, sub-clinical autistic and psychotic traits are associated with poor clinical outcomes, including increased depressive symptomatology, self-harming behaviour and suicidality. However, the implications when both traits co-occur remain poorly understood. The study aimed to (1) examine the relationship between autistic and psychotic traits and (2) determine if their co-occurrence increases depressive symptomatology, self-harm and suicidality.
Cross-sectional data from a self-selecting (online and poster advertising) sample of the adult UK population (n = 653) were collected using an online survey. Validated self-report measures were used to assess sub-clinical autistic and psychotic traits, depressive symptomatology, self-harming behaviour and suicidality. Correlation and regression analyses were performed.
A positive correlation between sub-clinical autistic and positive psychotic traits was confirmed (rs = 0.509, p < 0.001). Overall, autistic traits and psychotic traits were, independently, significant predictors of depression, self-harm and suicidality. Intriguingly, however, depression was associated with a negative interaction between the autistic domain attention to detail and psychotic traits.
This study supports previous findings that sub-clinical autistic and psychotic traits are largely independently associated with depression, self-harm and suicidality, and is novel in finding that their combined presence has no additional effect on depression, self-harm or suicidality. These findings highlight the importance of considering both autistic and psychotic traits and their symptom domains in research and when developing population-based depression prevention and intervention strategies.
In the 1990s criteria were developed to detect individuals at high and imminent risk of developing a psychotic disorder. These are known as the at risk mental state, ultra high risk or clinical high risk criteria. Individuals meeting these criteria are symptomatic and help-seeking. Services for such individuals are now found worldwide. Recently Psychological Medicine published two articles that criticise these services and suggest that they should be dismantled or restructured. One paper also provides recommendations on how ARMS services should be operate.
In this paper we draw on the existing literature in the field and present the perspective of some ARMS clinicians and researchers.
Many of the critics' arguments are refuted. Most of the recommendations included in the Moritz et al. paper are already occurring.
ARMS services provide management of current problems, treatment to reduce risk of onset of psychotic disorder and monitoring of mental state, including attenuated psychotic symptoms. These symptoms are associated with a range of poor outcomes. It is important to assess them and track their trajectory over time. A new approach to detection of ARMS individuals can be considered that harnesses broad youth mental health services, such as headspace in Australia, Jigsaw in Ireland and ACCESS Open Minds in Canada. Attention should also be paid to the physical health of ARMS individuals. Far from needing to be dismantled we feel that the ARMS approach has much to offer to improve the health of young people.
Despite knowing for many decades that depressive psychopathology is common in first-episode schizophrenia spectrum disorders (FES), there is limited knowledge regarding the extent and nature of such psychopathology (degree of comorbidity, caseness, severity) and its demographic, clinical, functional and treatment correlates. This study aimed to determine the pooled prevalence of depressive disorder and caseness, and the pooled mean severity of depressive symptoms, as well as the demographic, illness, functional and treatment correlates of depressive psychopathology in FES.
This systematic review, meta-analysis and meta-regression was prospectively registered (CRD42018084856) and conducted in accordance with PRISMA and MOOSE guidelines.
Forty studies comprising 4041 participants were included. The pooled prevalence of depressive disorder and caseness was 26.0% (seven samples, N = 855, 95% CI 22.1–30.3) and 43.9% (11 samples, N = 1312, 95% CI 30.3–58.4), respectively. The pooled mean percentage of maximum depressive symptom severity was 25.1 (38 samples, N = 3180, 95% CI 21.49–28.68). Correlates of depressive psychopathology were also found.
At least one-quarter of individuals with FES will experience, and therefore require treatment for, a full-threshold depressive disorder. Nearly half will experience levels of depressive symptoms that are severe enough to warrant diagnostic investigation and therefore clinical intervention – regardless of whether they actually fulfil diagnostic criteria for a depressive disorder. Depressive psychopathology is prominent in FES, manifesting not only as superimposed comorbidity, but also as an inextricable symptom domain.
Environmental and biological factors contribute to sleep development during infancy. Parenting plays a particularly important role in modulating infant sleep, potentially via the serotonin system, which is itself involved in regulating infant sleep. We hypothesized that maternal neglect and serotonin system dysregulation would be associated with daytime sleep in infant rhesus monkeys. Subjects were nursery-reared infant rhesus macaques (n = 287). During the first month of life, daytime sleep-wake states were rated bihourly (0800–2100). Infants were considered neglected (n = 16) if before nursery-rearing, their mother repeatedly failed to retrieve them. Serotonin transporter genotype and concentrations of cerebrospinal fluid 5-hydroxyindoleacetic acid (5-HIAA) were used as markers of central serotonin system functioning. t tests showed that neglected infants were observed sleeping less frequently, weighed less, and had higher 5-HIAA than non-neglected nursery-reared infants. Regression revealed that serotonin transporter genotype moderated the relationship between 5-HIAA and daytime sleep: in subjects possessing the Ls genotype, there was a positive correlation between 5-HIAA and daytime sleep, whereas in subjects possessing the LL genotype there was no association. These results highlight the pivotal roles that parents and the serotonin system play in sleep development. Daytime sleep alterations observed in neglected infants may partially derive from serotonin system dysregulation.
The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)–pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D–pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (Prace difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (Prace difference=0·56). Among EA, the 25(OH)D–FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.
In dimensional understanding of psychosis, auditory verbal hallucinations
(AVH) are unitary phenomena present on a continuum from non-clinical
voice hearing to severe mental illness. There is mixed evidence for this
approach and a relative absence of research into subjective experience of
AVH in early psychosis.
To conduct primary research into the nature of subjective experience of
AVH in first-episode psychosis.
A phenomenological study using diary and photo-elicitation qualitative
techniques investigating the subjective experience of AVH in 25 young
people with first-episode psychosis.
AVH are characterised by: (a) entity, as though from a living being with
complex social interchange; and (b) control, exerting authority with
ability to influence. AVH are also received with passivity, often
accompanied by sensation in other modalities.
A modern detailed phenomenological investigation, without presupposition,
gives results that echo known descriptive psychopathology. However, novel
findings also emerge that may be features of AVH in psychosis not
currently captured with standardised measures.
Autism and psychotic disorders such as schizophrenia co-occur more frequently than would be expected by chance alone. Exactly why this should be remains unclear, but a better understanding would have important implications for diagnosis, treatment and for biological explanations of both conditions.
Covalent functionalisation of collagen has been shown to be a promising strategy
to adjust the mechanical properties of highly swollen collagen hydrogels. At the
same time, secondary interactions between for example, amino acidic terminations
or introduced functional groups also play an important role and are often
challenging to predict and control. To explore this challenge, 4-vinylbenzyl
chloride (4VBC) and methacrylic anhydride (MA) were reacted with type I
collagen, and the swelling and rheological properties of resulting
photo-activated hydrogel systems investigated. 4VBC-based hydrogels showed
significantly increased swelling ratio, in light of the lower degree of collagen
functionalisation, with respect to methacrylated collagen networks, whilst
rheological storage moduli were found to be comparable between the two systems.
To explore the role of benzyl groups in the mechanical properties of the
4VBC-based collagen system, model chemical force microscopy (CFM) was carried
out in aqueous environment with an aromatised probe against an aromatised
gold-coated glass slide. A marked increase in adhesion force
(F: 0.11±0.01 nN) was measured between aromatised
samples, compared to the adhesion force observed between the non-modified probe
and a glass substrate (F: 2.64±1.82 nN). These results
suggest the formation of additional and reversible π-π
stacking interactions in aromatic 4VBC-based networks and explain the remarkable
rheological properties of this system in comparison to MA-based hydrogels.
The conservation of biodiversity is an increasingly challenging endeavour. Current pressures from a growing human population have led to concerns of a sixth mass extinction event, bringing mounting pressure to find effective ways of conserving biodiversity (Barnosky et al., 2011). However, our ability to meet this challenge is affected by the fact that not everyone supports conservation objectives. People naturally have different interests and priorities, some of which may be diametrically opposed to conservation objectives. In some cases, these differences lead to damaging and costly conflicts that we see emerging across the world and which present major challenges to modern conservation (MacDonald and Service, 2007).
At a cursory glance, the conflicts that surface around conservation often appear to be about impact: the impact of carnivores on livestock; the impact of wind farms on birds; or the impact of protected areas on livelihoods. Consequently, a common approach to these problems has been to build robust science and develop an evidence base to understand these impacts and find ways of reducing them, often through technical solutions. This approach, however, rarely works for the simple reason that many of these conflicts are about much more than impact. So even if we can develop the science to quantify impacts and show how they can be reduced, the conflicts can stubbornly persist. Indeed, beneath the surface of any of the conflicts discussed in this book is a complex layering of diverse issues related to different world views, issues of trust, power imbalances or latent historical issues – issues that lie well outside the sphere of the natural sciences. So, if we really want to understand and tackle these thorny problems, we need insights from other disciplines as well as from the practitioners specialising in resolving conflicts.
The growing recognition of the complexity within conflicts has led many authors to suggest more cross-disciplinary approaches, especially through better integration of ecological and social science (Manfredo and Dayer, 2004; Sillero-Zubiri et al., 2007; Treves, 2009; Dickman, 2010; White and Ward, 2010).
The world is undergoing rapid change from increasing human pressure. The scale and intensity of this change are deeply worrying from a conservation perspective. For example, we see severe threats to species, habitat and ecosystems from poaching (Maisels et al., 2013), the illegal use of poison (Ogada, 2014), overharvesting (Pinsky and Palumbi, 2014) and agricultural expansion (Laurance et al., 2014). In this book we have focused on how those who represent conservation arguments (conservationists) can respond to these types of challenges. These conservation conflicts arise because one side is passionate about the need to conserve biological diversity, whether for moral, intrinsic or anthropocentric reasons, and the other side may be more focused on different objectives related to human livelihoods and well-being. That is not to say that those arguing for human livelihoods do not recognise the need to conserve biodiversity, and vice versa, but each side may question the relative importance of the arguments, or the specific objectives, or the methods used to achieve those objectives. What is clear is that conservationists are antagonists in these conflicts, and this realisation is important because in order to navigate a path out of destructive conflict, conservationists will need to recognise their role in these issues, address the roots of the problem and be clear about their objectives and about how they engage with the other parties (Redpath et al., 2014).
Throughout the book, we have presented a range of richly complex and multilayered examples. Each has its own idiosyncrasies, but together they expose general principles and highlight what is needed to map and manage conservation conflicts. In this final chapter we build on these perspectives and draw out the principles and steps towards collaborative conflict management. While we recognise that conflicts may be a force for good (Coser, 1956), the conflicts presented here are more often damaging and costly both to humans and biodiversity.