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“High utilizing” schizophrenic patients are a problem in routine inpatient care.
A complex intervention with improved cooperation between in- and outpatient services was applied to 46 “high utilizing” patients after discharge from inpatient care during an intervention phase of 6 months. The study was controlled by a matched group of 47 patients receiving treatment as usual.
The goal of this study was to prevent rehospitalizations and thus optimize satisfaction with treatment and quality of life in patients suffering from schizophrenia.
The intervention was based on a computerized decision support module. Eight psychiatrists in private practices were supplied with this software to obtain guideline-based recommendations according to current psychopathology and clinical state. A local hospital project team arranged specifically suggested interventions. Moderator variables such as socio-demographical aspects or influences of certain interventions to rehospitalization rate were analyzed
Sociodemographical aspects showed no differences between both groups. The rehospitalization rate and the mean length of inpatient treatment were reduced to nearly 50% (Interventiongroup). The rate of readmissions increased in the control group, leading to a difference of 23% between both groups. Cost effectiveness was higher in the interventiongroup than in the controlgroup.
The most important single factor was the participation in coping skills training, but only the guideline consistent complex therapies caused the significant overall result. Satisfaction increased during 6 months and remained constant during 12 months of follow up. The project described an important step to gain evidence for integrated care for patients with schizophrenia.
Purpose of this study was to assess subjective well-being in schizophrenia inpatients and to find variables predictive for response and remission of subjective well-being.
The subjective well-being under neuroleptic treatment scale (SWN-K) was used in 232 schizophrenia patients within a naturalistic multicenter trial. Early response was defined as a SWN-K total score improvement of 20% and by at least 10 points within the first 2 treatment weeks, response as an improvement in SWN-K total score of at least 20% and by at least 10 points from admission to discharge and remission in subjective well-being as a total score of more or equal to 80 points at discharge. Logistic regression and CART analyses were used to determine valid predictors of subjective well-being outcome.
Twenty-nine percent of the patients were detected to be SWN-K early responders, 40% fulfilled criteria for response in subjective well-being and 66% fulfilled criteria for remission concerning subjective well-being. Among the investigated predictors, SWN-K early improvement and the educational status were significantly associated with SWN-K response. The SWN-K total score at baseline showed a significant negative predictive value for response. Baseline SWN-K total score, PANSS global subscore, and side effects as well as the educational status were found to be significantly predictive for remission.
Depressive symptoms should be radically treated and side effects closely monitored to improve the patient's subjective well-being. The important influence of subjective well-being on overall treatment outcome could be underlined.
To examine the predictive validity of early improvement in a naturalistic sample of inpatients and to identify the criterion that best defines early improvement.
Two hundred and forty-seven inpatients who fulfilled ICD-10 criteria for schizophrenia were assessed with the Positive And Negative Syndrome Scale (PANSS) at admission and at biweekly intervals until discharge from hospital. Remission was defined according to the recently proposed consensus criteria, response as a reduction of at least 40% in the PANNS total score from admission to discharge.
Receiver operating characteristic (ROC) analyses showed that early improvement (reduction of the PANSS total score within the first 2 weeks of treatment) predicts remission (AUC = 0.659) and response (AUC = 0.737) at discharge. A 20% reduction in the PANSS total score within the first 2 weeks was the most accurate cut-off for the prediction of remission (total accuracy: 65%; sensitivity: 53%; specificity: 76%), and a 30% reduction the most accurate cut-off for the prediction of response (total accuracy: 76%; sensitivity: 47%; specificity: 90%).
The findings of clinical drug trials that early improvement is a predictor of subsequent treatment response were replicated in a naturalistic sample. Further studies should examine whether patients without early improvement benefit from an early change of antipsychotic medication.
Psychotic and psychotic-like experiences (PLEs) are frequently found in the general population when assessed with self-report questionnaires. It is not clear how these assessments can help to predict the future development of mental disorders. The degree of certainty in appraisal or the experience-related distress may add prognostic power of clinical PLE assessments. This study was designed to provide baseline data of PLEs in a representative sample, which will be monitored for the future development.
We studied the frequency of PLEs in a representative sample of 4483 participants of the German population recruited through the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH). Participants were asked if they had had psychotic or psychosis-like experiences over their lifetime. We used the psychosis section of the Composite International Diagnostic Interview (CIDI), the Launay-Slade Hallucination Scale (LSHS) and the Peter's Delusion Inventory (PDI).
33.3% of the participants endorsed at least one item of the CIDI psychosis scale, 68.8% of the PDI and 49.0% of the LSHS. In the PDI assessments, conspiracy-related delusional experiences were most often experienced as distressing, while religious beliefs were experienced less distressing, but with high levels of conviction.
Our findings show frequent endorsement of lifetime psychotic or psychotic-like experiences in the general population in self-report questionnaires with varying degrees of distress and conviction. This provides the needed baseline assessment for follow-up studies observing the development of mental disorders with a view to determine the predictive values of these tests.
Psychiatric comorbidity is an important aspect of neurological disorders. It affects about 30-50% of neurologic patients but is frequently underrecognized.
Our objective was to determine the prevalence and severity of the symptoms of mental disorders in neurologic in-patients.
Between May and September 2014, all neurologic in-patients of a university neurologic center were asked to complete two self report questionnaires for assessing symptoms of mental disorders, namely the Beck Depression Inventory (BDI) and the Brief Symptom Inventory (BSI), which allow to assess a range of nine different psychiatric domains. We performed a multivariate covariance analysis in order to relate the type and frequency of symptoms of mental disorders with the neurological discharge diagnosis, while age, gender, and duration of in-patient treatment served as putative covariates.
Of all responders (n = 157), 51% stated to have suffered from psychological distress within the past seven days, and 43% indicated depressive symptoms (21% mild, 17% moderate, 5% severe). The mean global severity index GSI (M = 0.64, SD = 0.52) exceeded the 1 SD range of healthy persons but was lower than that of psychiatric in-patients known from the literature. Furthermore, our subanalysis revealed different patterns of symptoms of mental disorders between neurologic patients with degenerative, vascular, demyelinating or epileptic disoders.
Psychometric measurement is useful to characterize the burden of the symptoms of mental disorders and will be used to further develop the psychiatric liaison services.
Aim was to examine depressive symptoms in acutely ill schizophrenia patients on a single symptom basis and to evaluate their relationship with positive, negative and general psychopathological symptoms.
Two hundred and seventy-eight patients suffering from a schizophrenia spectrum disorder were analysed within a naturalistic study by the German Research Network on Schizophrenia. Using the Calgary Depression Scale for Schizophrenia (CDSS) depressive symptoms were examined and the Positive and Negative Syndrome Scale (PANSS) was applied to assess positive, negative and general symptoms. Correlation and factor analyses were calculated to detect the underlying structure and relationship of the patient’s symptoms.
The most prevalent depressive symptoms identified were depressed mood (80%), observed depression (62%) and hopelessness (54%). Thirty-nine percent of the patients suffered from depressive symptoms when applying the recommended cut-off of a CDSS total score of > 6 points at admission. Negligible correlations were found between depressive and positive symptoms as well as most PANSS negative and global symptoms despite items on depression, guilt and social withdrawal. The factor analysis revealed that the factor loading with the PANSS negative items accounted for most of the data variance followed by a factor with positive symptoms and three depression-associated factors.
The naturalistic study design does not allow a sufficient control of study results for the effect of different pharmacological treatments possibly influencing the appearance of depressive symptoms.
Results suggest that depressive symptoms measured with the CDSS are a discrete symptom domain with only partial overlap with positive or negative symptoms.
Positive symptoms are a useful predictor of aggression in schizophrenia. Although a similar pattern of abnormal brain structures related to both positive symptoms and aggression has been reported, this observation has not yet been confirmed in a single sample.
To study the association between positive symptoms and aggression in schizophrenia on a neurobiological level, a prospective meta-analytic approach was employed to analyze harmonized structural neuroimaging data from 10 research centers worldwide. We analyzed brain MRI scans from 902 individuals with a primary diagnosis of schizophrenia and 952 healthy controls.
The result identified a widespread cortical thickness reduction in schizophrenia compared to their controls. Two separate meta-regression analyses revealed that a common pattern of reduced cortical gray matter thickness within the left lateral temporal lobe and right midcingulate cortex was significantly associated with both positive symptoms and aggression.
These findings suggested that positive symptoms such as formal thought disorder and auditory misperception, combined with cognitive impairments reflecting difficulties in deploying an adaptive control toward perceived threats, could escalate the likelihood of aggression in schizophrenia.
Laser-based compact MeV X-ray sources are useful for a variety of applications such as radiography and active interrogation of nuclear materials. MeV X rays are typically generated by impinging the intense laser onto ~mm-thick high-Z foil. Here, we have characterized such a MeV X-ray source from 120 TW (80 J, 650 fs) laser interaction with a 1 mm-thick tantalum foil. Our measurements show X-ray temperature of 2.5 MeV, flux of 3 × 1012 photons/sr/shot, beam divergence of ~0.1 sr, conversion efficiency of ~1%, that is, ~1 J of MeV X rays out of 80 J incident laser, and source size of 80 m. Our measurement also shows that MeV X-ray yield and temperature is largely insensitive to nanosecond laser contrasts up to 10−5. Also, preliminary measurements of similar MeV X-ray source using a double-foil scheme, where the laser-driven hot electrons from a thin foil undergoing relativistic transparency impinging onto a second high-Z converter foil separated by 50–400 m, show MeV X-ray yield more than an order of magnitude lower compared with the single-foil results.
This essay provides a summary and critical appraisal of Risa Goluboff's Vagrant Nation: Police Power, Constitutional Change, and the Making of the 1960s, a book that interweaves the stories of an eclectic cast of characters who were the targets of vagrancy law prosecutions with stories of the lawyers who challenged these prosecutions. In charting the demise of what she terms a “vagrancy law regime,” Goluboff provides insights on the major social and political developments of the 1940s through the 1970s, including the labor movement, the black freedom struggle, the antiwar movement, and the sexual revolution. Goluboff's most significant achievement is her ability to identify in seemingly scattered challenges to vagrancy law a coherent and historically significant episode of constitutional change. Although I question whether the book delivers on its promise to reframe the way we understand the “long 1960s,” Vagrant Nation nonetheless offers a model of how to integrate social history and doctrinal history into a compelling narrative of constitutional change.
Dwarf galaxies enable us to study early phases of galaxy evolution and are key to many open questions about the hierarchical structure of the Universe. The Large and Small Magellanic Cloud (LMC and SMC) are the most luminous dwarf galaxy satellites of the Milky Way (MW). They are most likely gravitationally bound to each other, and their last interaction occurred about 200 Myr ago. Also, they are in an early phase of minor merging with the MW and will impact the Galactic structure in the future because of their relatively large mass. However, there are still major uncertainties regarding their origin and their interactions with one another and with the Milky Way. We cross-correlated the VMC and Gaia DR2 data to select a sample of stars that likely belong to the Magellanic Bridge, a feature formed of gas and stars which is connecting the LMC and the SMC. We removed potential MW foregound stars using a combination of parallax and colour-magnitude criteria and calculated the proper motions of the Bridge member stars. Our analysis supports a motion of star towards the LMC, which was found to be in good agreement with a dynamical simulation, of the SMC being stripped by the LMC.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
Coho salmon (Oncorhynchus kisutch), Chinook salmon (Oncorhynchus tshawytscha) and steelhead (Oncorhynchus mykiss) in Puget Sound and the Strait of Georgia have exhibited declines in marine survival over the last 40 years. While the cause of these declines is unknown, multiple factors, acting cumulatively or synergistically, have likely contributed. To evaluate the potential contribution of a broad suite of drivers on salmon survival, we used qualitative network modelling (QNM). QNM is a conceptually based tool that uses networks with specified relationships between the variables. In a simulation framework, linkages are weighted and then the models are subjected to user-specified perturbations. Our network had 33 variables, including: environmental and oceanographic drivers (e.g., temperature and precipitation), primary production variables, food web components from zooplankton to predators and anthropogenic impacts (e.g., habitat loss and hatcheries). We included salmon traits (survival, abundance, residence time, fitness and size) as response variables. We invoked perturbations to each node and to suites of drivers and evaluated the responses of these variables. The model showed that anthropogenic impacts resulted in the strongest negative responses in salmon survival and abundance. Additionally, feedbacks through the food web were strong, beginning with primary production, suggesting that several food web variables may be important in mediating effects on salmon survival within the system. With this model, we were able to compare the relative influence of multiple drivers on salmon survival.
The SkyMapper Transient survey (SMT) is exploring variability in the southern sky by performing (a) a rolling search to discover and study supernovæ, and (b) a Target of Opportunity programme that uses the robotic SkyMapper Telescope at Siding Spring Observatory. The supernova survey is obtaining a non-targeted sample of Type Ia supernovæ (SNe Ia) at low redshifts, z < 0.1, and studying other interesting transients found with the search strategy. We have a Target of Opportunity programme with an automatic response mechanism to search for optical counterparts to gravitational-wave and fast radio-burst events; it benefits from SkyMapper’s large field of view of 5.7 sq. deg. and a rapid data reduction pipeline.
We present first results of the SMT survey. The SMT pipeline can process and obtain potential candidates within 12 hours of observation. It disentangles real transients from processing artefacts using a machine-learning algorithm. To date, SMT has discovered over 60 spectroscopically confirmed supernovæ, several peculiar objects, and over 40 SNe Ia including one (SNIa 2016hhd) which was found within the first few days of explosion. We have also participated in searches for optical counterparts of gravitational waves, fast radio bursts and other transients, and have published observations of the optical counterpart of the gravitational-wave event GW170817. We also participate in coordinated observations with the Deeper Wider Faster programme, and the Kepler K2 cosmology project.