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The consistent association between therapeutic alliance and outcome underlines the importance of identifying factors which predict the development of a positive alliance. However, only few studies have examined the association between pretreatment characteristics and alliance formation in patients with schizophrenia.
The study examined whether symptoms and insight would predict the therapeutic alliance in psychotherapy of schizophrenia. Further, the associations and differences between patient and therapist alliance ratings were studied.
Eighty patients with schizophrenia spectrum disorders received manual-based psychotherapy. Assessment of symptoms and insight was conducted at baseline, and questionnaire-based alliance ratings were obtained three weeks into treatment. Patient and therapist alliance ratings were examined separately.
Patient and therapist alliance ratings were not significantly correlated (r = 0.17). Patient ratings of the alliance were significantly higher than the ratings of their therapists (d = 0.73). More insight in psychosis significantly predicted higher patient ratings of the alliance. Less positive and negative symptoms were significant predictors of higher therapist alliance ratings.
The findings indicate that symptoms and insight have an influence on the therapeutic alliance in the treatment of schizophrenia spectrum disorders. Patients' and therapists' perceptions of the alliance do not seem to demonstrate much convergence.
To examine the impact of determinants of incident dementia in three different old age groups (75–79, 80–84, 85+years) in Germany.
Multicenter prospective AgeCoDe/AgeQualiDe cohort study with baseline and nine follow-up assessments at 1.5-year intervals.
Primary care medical record registry sample.
General practitioners’ (GPs) patients aged 75+years at baseline.
Conduction of standardized interviews including neuropsychological assessment and collection of GP information at each assessment wave. We used age-stratified competing risk regression models (accounting for the competing event of mortality) to assess determinants of incident dementia and age-stratified ordinary least square regressions to quantify the impact of identified determinants on the age at dementia onset.
Among 3027 dementia-free GP patients, n = 704 (23.3%) developed dementia during the 13-year study period. Worse cognitive performance and subjective memory decline with related worries at baseline, and the APOE ε4 allele were associated independently with increased dementia risk in all three old age groups. Worse cognitive performance at baseline was also associated with younger age at dementia onset in all three age groups. Other well-known determinants were associated with dementia risk and age at dementia onset only in some or in none of the three old age groups.
This study provides further evidence for the age-specific importance of determinants of incident dementia in old age. Such specifics have to be considered more strongly particularly with regard to potential approaches of early detection and prevention of dementia.
The individualisation of punishment is a key element in liberal narratives about international law and international relations. This narrative has become an integral part of positive international law, especially the regimes governing the use of force and the prosecution of an international crimes. Rather than punishing states or entire societies, liberals claim, punishment has become restricted to those who incurred individual guilt. To liberals, the individualisation of punishment is part of a larger process of enlightenment and civilisation that has helped to fence atavisms like revenge. We do not question the emergence of an ever more sophisticated system of individual punishment in international law. However, we argue that punitivity has been more difficult to fully channel towards individuals and away from collectives than claimed. To be sure, punitive language has by and large been banned from the laws of armed conflict. We argue, however, that the absence of a punitive vocabulary does not equal the absence of punitivity. In contrast, current state practices of using armed force are still imbued with punitivity, however silenced in the current legal framework and thus pushed underground. Realising the presence of a punitive undercurrent, we argue, adds to a more comprehensive understanding of contemporary state practices.
This paper contributes to current debates on the politicization of international politics by examining party-political contestation of peace and security missions. It is guided by two inter-related questions, (a) to what extent deployment decisions are contested amongst political parties and (b) what drives such contestation. We examine data from a new data set on parliamentary votes on deployment decisions in France, Germany, Spain, and the United Kingdom and from the Chapel Hill Expert Survey. Against conventional wisdom and in an effort to address the often-overlooked role of political parties, we find that military deployments have been systematically contested amongst political parties across Europe. Further, we find that contestation is driven by the left/right axis, as opposed to newer cleavages captured here by the so-called gal/tan axis. We also find evidence that patterns of contestation depend on parties’ positions in government or opposition, a factor we relate to bureaucratic and international pressures on the parties in office, and to political opportunities for opposition parties.
Subjective cognitive decline (SCD), the potentially earliest notable manifestation of preclinical Alzheimer's disease and other dementias, was consistently associated with lower quality of life in cross-sectional studies. The aim of this study was to investigate whether such an association persists longitudinally – particularly with health-related quality of life (HRQoL) in older individuals without cognitive impairment.
Data were derived from follow-up 2–6 of the prospective Germany Study on Ageing, Cognition and Dementia in Primary Care (AgeCoDe) covering a total six-year observation period. We used linear mixed effects models to estimate the effect of SCD on HRQoL measured by the EQ-5D visual analogue scale (EQ VAS).
Of 1,387 cognitively unimpaired individuals aged 82.2 years (SD = 3.2) on average, 702 (50.6%) reported SCD and 230 (16.6%) with SCD-related concerns. Effect estimates of the linear mixed effects models revealed lower HRQoL in individuals with SCD (unadjusted: –3.7 points on the EQ VAS, 95%CI = –5.3 to –2.1; SE = 0.8; p < 0.001; adjusted: –2.9 points, 95%CI = –3.9 to –1.9; SE = 0.5; p < 0.001) than in individuals without SCD. The effect was most pronounced in SCD with related concerns (unadjusted: –5.4, 95%CI = –7.6 to –3.2; SE = 1.1; p < 0.001; adjusted: –4.3, 95%CI = –5.8 to –2.9, SE = 0.7; p < 0.001).
SCD constitutes a serious issue to older cognitively unimpaired individuals that is depicted in persisting lower levels of HRQoL beyond depressive symptoms and functional impairment. Therefore, SCD should be taken seriously in clinical practice.
Most of the previous studies attempted to disentangle the relationship between disability and depressive symptoms were limited to observation periods of only few years. Moreover, evidence is missing regarding the complex co-occurrence of disability and depressive symptoms in old age in Germany. In order to close the research gap, we aimed at disentangling the complex co-occurrence of disability and depressive symptoms in old age in Germany over a longer time frame.
Based on data from a representative survey of the German general population aged 75 years and older, the course of disability as well as depressive symptoms was observed every 1.5 years over six waves. While disability was quantified by the Lawton and Brody Instrumental Activities of Daily Living scale, the Geriatric Depression Scale was used to measure depressive symptoms. Taking into account the complex co-occurrence of depressive symptoms and disability, a panel vector autoregressive model was used. By taking the first differences, unobserved heterogeneity was taken into account.
In the total sample and in both sexes, we revealed a robust positive association between an initial change in depressive symptoms and subsequent changes in disability. No robust association between an initial change in disability and a subsequent change in depressive symptoms was detected.
Our findings highlight the importance of changes in depressive symptoms for future changes in disability in old age.
The notion that states’ foreign and security policies are not exclusively driven by material interests is now firmly established. Whose ideas matter and in what way, however, has remained subject to debate. We advance this debate by studying the crisis diplomacy of liberal democracies towards North Korea during four crises around the country’s violation of international norms between 1993 and 2009. Although liberal democracies share a common perception of North Korea’s nuclear programme as a threat to international peace and security, they differ widely in either confronting or accommodating North Korea. We examine the explanatory power of two ideational driving forces behind the foreign policy of liberal democracies: the ideological orientation of the government, on the one hand, and a country’s political culture, on the other. Our analysis of 22 liberal democracies demonstrates that different domestic cultures of dealing with norm violations have a significant impact on crisis diplomacy: countries with punitive domestic cultures tend to adopt confrontational policies towards international norm violators; while left governments are not more accommodationist than right governments. Ideational differences across states are thus more pronounced than those within states.
Neuropeptide S (NPS) is a novel central acting neuropeptide that modulates several brain functions. NPS has shown strong anxiolytic-like effects and interactions with other central transmitter systems, including serotonin and glutamate. A coding variation (Asn107Ile) of the NPS receptor gene (NPSR1) was associated with panic disorder and schizophrenia. Based on these encouraging findings, the present study aimed at exploring a potential role of NPSR1 in obsessive–compulsive disorder (OCD). A sample of 232 OCD patients was successfully genotyped for the NPSR1 Asn107Ile variant (rs324981). Age at onset was taken into account to address the heterogeneity of the OCD phenotype. The NPSR1 genotype significantly affected age at onset of the OCD patients, with a mean age at onset approximately 4 yr earlier in homozygous carriers of the low-functioning Asn107 variant compared to patients with at least one Ile107 variant (p = 0.032). Case–control analyses with 308 healthy control subjects reveal a highly significant association of the Asn107 variant with early onset OCD (odds ratio = 2.36, p = 0.0004) while late onset OCD or the OCD group as a whole were unrelated to the NPSR1 genotype. Based on our association finding relating NPSR1 genotype to early onset OCD, we suggest a differential role of the NPS system in OCD. In particular, the early onset OCD subtype seems to be characterized by a genetically driven low NPS tone, which might affect other OCD-related transmitter systems, including the serotonin and glutamate systems. In agreement with preclinical research, we suggest that NPS may be a promising pharmacological candidate with anti-obsessional properties.
Nicotine has been proposed to be a cognitive enhancer, particularly in schizophrenia patients. So far, the published studies of nicotine effects on antisaccade performance in schizophrenia patients only tested participants who were deprived smokers. Thus, we aimed to test both smoking and non-smoking patients as well as healthy controls in order to extend previous findings. Moreover, we employed a paradigm using standard and delayed trials. We hypothesized that, if nicotine is a genuine cognitive enhancer, its administration would improve antisaccade performance both in smoking and non-smoking participants. A total of 22 patients with schizophrenia (12 smokers and 10 non-smokers) and 26 controls (14 smokers and 12 non-smokers) completed the study. The effects of a nicotine patch (14 mg for smokers, 7 mg for non-smokers) on antisaccade performance were tested in a randomized, double-blind, placebo-controlled, cross-over trial. Schizophrenia patients made significantly more antisaccade errors than controls (p = 0.03). Both patients and controls made fewer antisaccade errors in the delayed trials than in the standard trials (p < 0.0001). Nicotine significantly reduced antisaccade error rate in the standard trials, but not in the delayed trials (p = 0.02). Smoking status did not influence the nicotine effect on antisaccade error rate (p = 0.10) indicating an equal procognitive effect of nicotine in smokers and non-smokers. Overall the present findings indicate that beneficial effects of nicotine on antisaccade performance are not confined to smoking schizophrenia patients. Instead, the findings likely represent genuine nicotine-induced enhancement of cognitive performance.
Embedded wafer-level ball grid array (eWLB) is investigated as a low-cost plastic package for automotive radar applications in the 76–81 GHz range. Low transmission losses from chip to package and board are achieved by appropriate circuit and package design. Special measures are taken to effectively remove the heat from the package and to optimize the package process to achieve automotive quality targets. A 77 GHz radar chip set in eWLB package is developed, which can be applied on the system board using standard solder reflow assembly. These radar MMICs provide excellent radio frequency (RF) performance for the next generation automotive radar sensors. The potential for even higher system integration is shown by a radar transceiver with antennas integrated in the eWLB package. These results demonstrate that eWLB technology is an attractive candidate to realize low-cost radar systems and to enable radar safety affordable for everyone in the near future.
Dixon et al. have highlighted the importance of a political conceptualisation of intergroup relations that challenges individualising models of social change. As important as this paper is for the development of critical debates in psychology, we can detect at least three issues that warrant further discussion: (a) the cultural and historical conditions of structural inequality and its perception, (b) the marginalisation of post-colonial works on collective mobilisation, and (c) acknowledging the complex perspectives and politics of those targeted by prejudice.
Major depressive disorder (MDD) is accompanied by both cognitive impairments and a hyperactivity of the hypothalamic–pituitary–adrenocortical (HPA) system, resulting in an enhanced glucocorticoid secretion. Cortisol acts via mineralocorticoid and glucocorticoid receptors densely located in the hippocampus, a brain area that is important regarding cognitive functions and especially memory functions. Recently, a variant (rs1545843) affecting transcription of the human SLC6A15 gene has been associated with depression in a genome-wide association study. In an animal model, the neuronal amino acid transporter SLC6A15 was found to be decreased in stress-susceptible mice. Against the background of stress impacting on the activity of the HPA axis, we have investigated alterations of adrenocorticotropic hormone (ACTH) and cortisol secretion in the combined dexamethasone/corticotrophin-releasing hormone (Dex/CRH) test as well as memory and attention performance in a sample of 248 patients with unipolar depression and 172 healthy control subjects genotyped for rs1545843. MDD patients carrying the depression-associated AA genotype showed enhanced maximum and area under the curve ACTH and cortisol answers (p = 0.03) as well as an impaired memory and impaired sustained attention performance (p = 0.04) compared to carriers of at least one G allele. No effects of the SLC6A15 variant were found in the healthy control group. Our findings argue for a role of the SLC6A15 gene in ACTH and cortisol secretion during the Dex/CRH test and furthermore in the occurrence of cognitive impairments in unipolar depression.
Recently, the neuropeptide S (NPS) neurotransmitter system has been identified as a promising psychopharmacological drug target given that NPS has shown anxiolytic-like and stress-reducing properties and memory-enhancing effects in rodent models. NPS binds to the G-protein-coupled receptor encoded by the neuropeptide S receptor gene (NPSR1). A functional variant within this gene leads to an amino-acid exchange (rs324981, Asn107Ile) resulting in a gain-of-function in the Ile107 variant which was recently associated with panic disorder in two independent studies. A potential psychopharmacological effect of NPS on schizophrenia psychopathology was demonstrated by showing that NPS can block NMDA antagonist-induced deficits in prepulse inhibition. We therefore explored a potential role of the NPSR1 Asn107Ile variation in schizophrenia. A case-control sample of 778 schizophrenia patients and 713 healthy control subjects was successfully genotyped for NPSR1 Asn107Ile. Verbal declarative memory and acoustic startle response were measured in subsamples of the schizophrenia patients. The case-control comparison revealed that the low-functioning NPSR1 Asn107 variant was significantly associated with schizophrenia (OR 1.19, p=0.017). Moreover, specifically decreased verbal memory consolidation was found in homozygous Asn107 carriers while memory acquisition was unaffected by NPSR1 genotype. The schizophrenia patients carrying the Ile107 variant demonstrated significantly reduced startle amplitudes but unaffected prepulse inhibition and habituation. The present study confirms findings from rodent models demonstrating an effect of NPS on memory consolidation and startle response in schizophrenia patients. Based on these findings, we consider NPS as a promising target for antipsychotic drug development.
The mixed-conducting perovskite oxide Ba0.5Sr0.5Co0.8Fe0.2O3-δ (BSCF), given its outstanding oxygen ionic and electronic transport properties, is considered a promising material composition for oxygen transport membranes (OTM) operated at high temperatures.
Its long-term stability under operating conditions is, however, still an important issue. Although the incompatibility of BSCF with CO2-containing atmospheres can be avoided by appropriate means (oxyfuel processes in the absence of carbon dioxide), the thermal as well as the chemical stability of BSCF itself are still under thorough investigation.
This work is focused on the stability of BSCF in the targeted temperature range for OTM applications (700…900 °C) and in atmospheres with low oxygen contents. Previous studies in literature suggest limited chemical stability below oxygen partial pressures pO2 of around 10-6 bar.
By using a coulometric titration method based on a zirconia “oxygen pump” setup, precise control of the oxygen partial pressure pO2 between 1 bar and 10-18 bar was facilitated. Combining electrical measurements on dense ceramic bulk samples performed as a function of pO2 with an XRD phase composition study of single phase BSCF powders subjected to various pO2 treatments, an assessment of the chemical stability of BSCF is facilitated as a function of oxygen partial pressure. It could thus be shown that the pO2 stability limit is considerably lower than previously assumed in literature.
Over the last two decades, there has been a ‘democratic turn’ in peace and conflict research, that is, the peculiar impact of democratic politics on a wide range of security issues has attracted more and more attention. Many of these studies are inspired by Immanuel Kant's famous essay on ‘Perpetual Peace’. In this article, we present a critical discussion of the ‘democratic distinctiveness programme’ that emerged from the Democratic Peace debate and soon spread to cover a wider range of foreign policy issues. The bulk of this research has to date been based on an overly optimistic reading of a ‘Kantian peace’. In particular, the manifold forms of violence that democracies have exerted, have been treated either as a challenge to the Democratic Peace proposition or as an undemocratic contaminant and pre-democratic relict. In contrast, we argue that forms of ‘democratic violence’ should no longer be kept at arm's length from the democratic distinctiveness programme but instead should be elevated to a main field of study. While we acknowledge the benefits of this expanding research programme, we also address a number of normative pitfalls implied in this scholarship such as lending legitimacy to highly questionable foreign policy practices by Western democracies. We conclude with suggestions for a more self-reflexive and ‘critical’ research agenda of a ‘democratically turned’ peace and conflict studies, inspired by the Frankfurt school tradition.