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The Hierarchical Taxonomy of Psychopathology (HiTOP) is a classification system that seeks to organize psychopathology using quantitative evidence – yet the current model was established by narrative review. This meta-analysis provides a quantitative synthesis of literature on transdiagnostic dimensions of psychopathology to evaluate the validity of the HiTOP framework.
Published studies estimating factor-analytic models from diagnostic and statistical manual of mental disorders (DSM) diagnoses were screened. A total of 120,596 participants from 35 studies assessing 23 DSM diagnoses were included in the meta-analytic models. Data were pooled into a meta-analytic correlation matrix using a random effects model. Exploratory factor analyses were conducted using the pooled correlation matrix. A hierarchical structure was estimated by extracting one to five factors representing levels of the HiTOP framework, then calculating congruence coefficients between factors at sequential levels.
Five transdiagnostic dimensions fit the DSM diagnoses well (comparative fit index = 0.92, root mean square error of approximation = 0.07, and standardized root-mean-square residual = 0.03). Most diagnoses had factor loadings >|0.30| on the expected factors, and congruence coefficients between factors indicated a hierarchical structure consistent with the HiTOP framework.
A model closely resembling the HiTOP framework fit the data well and placement of DSM diagnoses within transdiagnostic dimensions were largely confirmed, supporting it as valid structure for conceptualizing and organizing psychopathology. Results also suggest transdiagnostic research should (1) use traits, narrow symptoms, and dimensional measures of psychopathology instead of DSM diagnoses, (2) assess a broader array of constructs, and (3) increase focus on understudied pathologies.
Efficient algorithm integration is a key issue in aerial robotics. However, only a few integration solutions rely on a cognitive approach. Cognitive approaches break down complex problems into independent units that may deal with progressively lower-level data interfaces, all the way down to sensors and actuators. A cognitive architecture defines information flow among units to produce emergent intelligent behavior. Despite the improvements in autonomous decision-making, several key issues remain open. One of these issues is the selection, coordination, and decision-making related to the several specialized tasks required for fulfilling mission objectives. This work addresses decision-making for the cognitive unmanned-aerial-vehicle architecture coined as ARCog. The proposed architecture lays the groundwork for the development of a software platform aligned with the requirements of the state-of-the-art technology in the field. The system is designed to provide high-level decision-making. Experiments prove that ARCog works correctly in its target scenario.
Clinical and Translational Science Award (CTSA) TL1 trainees and KL2 scholars were surveyed to determine the immediate impact of the COVID-19 pandemic on training and career development. The most negative impact was lack of access to research facilities, clinics, and human subjects, plus for KL2 scholars lack of access to team members and need for homeschooling. TL1 trainees reported having more time to think and write. Common strategies to maintain research productivity involved time management, virtual connections with colleagues, and shifting to research activities not requiring laboratory/clinic settings. Strategies for mitigating the impact of the COVID-19 pandemic on training and career development are described.
Community engagement is important for reaching vulnerable populations in the coronavirus disease 2019 (COVID-19) pandemic. A risk communication framework was implemented by a community-engaged research (CEnR) partnership in Southeast Minnesota to address COVID-19 prevention, testing, and socioeconomic impacts. Bidirectional communication between Communication Leaders and community members within their social networks was used by the partnership to refine messages, leverage resources, and advise policy makers. Over 14 days, messages were delivered by 24 Communication Leaders in 6 languages across 9 electronic platforms to 9882 individuals within their networks. CEnR partnerships may effectively implement crisis and emergency risk communication to vulnerable populations in a pandemic.
Hyponatraemia occurs in 4% of schizophrenic patients. Dilutional hyponatraemia, due to inappropriate retention of water and excretion of sodium, occurs with different psychotropic medications and could lead to hippocampal dysfunction. This complication is usually asymptomatic but can cause severe problems, as lethargy and confusion, difficult to diagnose in mentally ill patients.
To describe a case of a patient with psychotropic poli-therapy, admitted three times due to hyponatremia and the pharmacological changes that improved his condition.
To broadcast the intermittent hyponatraemia and polydipsia (PIP), a not rare condition, suffered by treated schizophrenic patients and discuss its physiopathology and treatment thorough a case report.
A 56-year schizophrenic male was admitted for presenting disorganized behavior, agitation, auditory hallucinations, disorientation, ataxia, vomits and urinary retention. He was on clomipramine, haloperidol and clotiapine (recently added), quetiapine, fluphenazine and clonazepam. After water restriction his symptoms improved and he was discharged. Twenty-five days later, he was readmitted for presenting the same symptoms and after water restriction, he was discharged. Five days later, he was again admitted and transferred to the psychiatric ward.
Haloperidol, fluphenazine and clomipramine were replaced by clozapine. These changes lead him to normalize the hypoosmolality and reduce his water-voracity. Endocrinology team did not label this episode of SIADH due to its borderline blood and urine parameters.
Hyponatremia is frequent in schizophrenic patients and may have severe consequences. Therefore, a prompt recognition and treatment is warranted.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The origin of malnutrition in older age is multifactorial and risk factors may vary according to health and living situation. The present study aimed to identify setting-specific risk profiles of malnutrition in older adults and to investigate the association of the number of individual risk factors with malnutrition.
Data of four cross-sectional studies were harmonized and uniformly analysed. Malnutrition was defined as BMI < 20 kg/m2 and/or weight loss of >3 kg in the previous 3–6 months. Associations between factors of six domains (demographics, health, mental function, physical function, dietary intake-related problems, dietary behaviour), the number of individual risk factors and malnutrition were analysed using logistic regression.
Community (CD), geriatric day hospital (GDH), home care (HC), nursing home (NH).
CD older adults (n 1073), GDH patients (n 180), HC receivers (n 335) and NH residents (n 197), all ≥65 years.
Malnutrition prevalence was lower in CD (11 %) than in the other settings (16–19 %). In the CD sample, poor appetite, difficulties with eating, respiratory and gastrointestinal diseases were associated with malnutrition; in GDH patients, poor appetite and respiratory diseases; in HC receivers, younger age, poor appetite and nausea; and in NH residents, older age and mobility limitations. In all settings the likelihood of malnutrition increased with the number of potential individual risk factors.
The study indicates a varying relevance of certain risk factors of malnutrition in different settings. However, the relationship of the number of individual risk factors with malnutrition in all settings implies comprehensive approaches to identify persons at risk of malnutrition early.
Using photometric data available in the literature we want to identify the massive stars members of the metal-poor irregular galaxy IC 10 and the clusters and associations that they form. The census of the clusters and associations of these objects is needed to provide information about age and environment on this galaxy that is apparently going through a starburst phase.
Optimizing TMS treatment for Depression - The 19 Minute Dash™ protocol
NeuroStar transcranial magnetic stimulation (TMS) is an effective treatment for patients with major depressive disorder. Due to the treatment session duration, a reduced treatment time would promote patients’ comfort and convenience. Also, shorter treatment sessions of retained efficacy and safety would increase access to treatment. This reduction could be accomplished by decreasing the time between TMS pulse sequences, the intertrain interval (ITI).
Meta-analysis of TMS delivered using varying treatment parameters, particularly the ratio of train duration (“on-time”) to ITI (“off-time”). PubMed and SCOPUS databases were searched through March 30, 2015 using the terms: “transcranial magnetic stimulation”, “TMS”, “rTMS”, “inter-train interval”, “inter-stimulus interval”, and “cortical spread”. Three hundred and one articles were identified comprising a total of 3359 patients. Clinical outcomes were reported as the proportion of patients achieving response defined as 50% reduction in baseline score on the primary outcome measure in each study. Treatment risk was assessed by the frequency of adverse events reported, and specifically considering the incidence of seizures.
This analysis confirms prior reports that the variables which impact treatment efficacy are the number of treatmentsessions, the number of pulses per session and the percent motor threshold. Varying the train duration/ITI (on-time/off-time) ratio over a broad range from 2.0 to 14 did not impact efficacy or safety.
Shortening the ITI to 11 seconds does not impact the safety and antidepressant effectiveness of the NeuroStar TMS and would result in shortening of each treatment session from approximately 37.5 to 19 minutes.
NeuroStar transcranial magnetic stimulation (TMS) is an effective acute treatment for patients with major depressive disorder (MDD). In order to further understand use of the NeuroStar in a clinical setting, Neuronetics has established a patient treatment and outcomes registry to collect and analyze utilization information on patients receiving treatment with the NeuroStar.
Individual NeuroStar providers are invited to participate in the registry and agree to provide their de-identified patient treatment data. The NeuroStar has an integrated electronic data management system (TrakStar) which allows for the data collection to be automated. The data collected for the registry include Demographic Elements (age, gender), Treatment Parameters, and Clinical Ratings. Clinical assessments are: Clinician Global Impression - Severity of Illness (CGI-S) and thePatient Health Questionnaire 9-item (PHQ-9). De-identified patient data is uploaded to Registry server; an independent statistical service then creates final data reports.
Over 500 patients have entered the NeuroStar Outcomes Registry since Sept 2016. Mean patient age: 48.0 (SD±16.0); 64% Female. Baseline PHQ-9, mean 18.8 (SD±5.0.) Response/Remission Rate, PHQ-9: 61%/33% CGI-S: 78%/59%.
For the initial 500 patients in the Outcomes Registry, approximately 2/3 patients achieve respond and 1/3 patients achieve remission with an acute course of NeuroStar. These treatment outcomes consistent with NeuroStar open-label study data (Carpenter, 2012). The TrakStar data management system makes large scale data collection feasible. The NeuroStarOutcomes Registry is ongoing, and expected to reach 6000 outpatients from more than 47 clinical sites in 36 months.
There is limited data on the recovery of factors associated with decisional capacity in patients with psychosis.
To study the relationship between changes in mental capacity, symptoms and global functioning using structured measures during treatment for psychosis.
Fifty-six patients with psychosis were assessed for capacity to consent to treatment on admission and at 6 and 12 weeks following treatment. The MacArthur Competence Assessment Tool – Treatment, the Positive and Negative Symptom Scale and the Global Assessment of Functioning Scale were used to measure mental capacities, symptom severity and global functioning respectively. Treating consultants rated capacity to consent, masked to these measures.
Greater impairments on all measures were found in patients assessed as lacking capacity. These improved with treatment over 12 weeks with significant effect sizes (0.5 to 0.6). Stronger correlations between mental capacities, positive symptoms (-0.47) and global functioning (0.56) were noted in the first 6 weeks.
Impairments in capacity in acute stages of psychosis are related to symptom severity and functional impairment. They improve during treatment, particularly in the first 6 weeks.
The experience of trauma could be considered a central event in one’s life, such that it could be a core component of one’s identity and life story. Indeed, trauma memories are well-remembered, vivid, intense, and easily accessible (Berntsen & Rubin, 2006). The present study investigated the mediating role of sensory-based trauma memory quality in the relationship between centrality of event and mental health outcomes among child and adolescent survivors of a natural disaster (N = 225) in its immediate aftermath. Results of mediation analyses revealed that centrality of trauma event is related to symptoms of acute stress disorder and depression through sensory-based trauma memory quality (indirect effect 95% C.I. [.06, .11] and [.04, .10], respectively). These findings support the contention that centrality of event is associated to heightened accessibility and vividness of sensory-based trauma memory quality, which in turn is related to an increase in trauma-related symptoms in the immediate aftermath of a natural disaster, where the reminders of trauma are particularly salient in the survivors’ environment and daily activities.
Dementia is a neurodegenerative syndrome that interferes with multiple aspects of life, including cognition, daily functioning, and behavior. Despite the large heterogeneity in symptom development, these three domains are seldom studied simultaneously. This study investigates how trajectories of these domains are interrelated within individuals over time, and how they in turn are related to dementia severity and quality of life (QoL).
We used data from a longitudinal clinical cohort study, including 331 dementia patients. Cognitive status was measured using the Mini-Mental State Examination, daily functioning was measured with the disability assessment for dementia and neuropsychiatric symptoms (NPS) were scored using the neuropsychiatric inventory. We investigated the relationships in the time course of the various dementia domains using random effects multilevel models and parallel-process growth models.
Changes in cognition and daily functioning were highly correlated over time (r = 0.85, p < 0.01), as were changes in NPS and functioning (r = −0.60, p < 0.01), while changes in cognition and NPS were not (r = −0.20, p = 0.06). All three domains were strongly associated with dementia severity over time (p < 0.01). Decreased functioning and increased NPS were both associated with decreased QoL (β = 2.97, p < 0.01 and β = −2.41, p < 0.01, respectively), while cognition was not (β = 0.01, p = 0.93).
This study demonstrates the heterogeneity of dementia progression between individuals and between different dementia domains within individuals. To improve our understanding of dementia progression, future research should embrace a broader perspective encompassing multiple outcome measures along with the patient's profile, including neurological factors as well as physical, social, and psychiatric health.
Approximately half of the variation in wellbeing measures overlaps with variation in personality traits. Studies of non-human primate pedigrees and human twins suggest that this is due to common genetic influences. We tested whether personality polygenic scores for the NEO Five-Factor Inventory (NEO-FFI) domains and for item response theory (IRT) derived extraversion and neuroticism scores predict variance in wellbeing measures. Polygenic scores were based on published genome-wide association (GWA) results in over 17,000 individuals for the NEO-FFI and in over 63,000 for the IRT extraversion and neuroticism traits. The NEO-FFI polygenic scores were used to predict life satisfaction in 7 cohorts, positive affect in 12 cohorts, and general wellbeing in 1 cohort (maximal N = 46,508). Meta-analysis of these results showed no significant association between NEO-FFI personality polygenic scores and the wellbeing measures. IRT extraversion and neuroticism polygenic scores were used to predict life satisfaction and positive affect in almost 37,000 individuals from UK Biobank. Significant positive associations (effect sizes <0.05%) were observed between the extraversion polygenic score and wellbeing measures, and a negative association was observed between the polygenic neuroticism score and life satisfaction. Furthermore, using GWA data, genetic correlations of -0.49 and -0.55 were estimated between neuroticism with life satisfaction and positive affect, respectively. The moderate genetic correlation between neuroticism and wellbeing is in line with twin research showing that genetic influences on wellbeing are also shared with other independent personality domains.
The rapid development of early cities at different dates in many regions of the world affected their hinterlands profoundly. Ancient Egypt, in many periods a territorial state unlike the typical city-state configuration of the other regions in most periods, presents some of the largest monuments and the longest timespan for investigation, but its urbanism is imperfectly understood. Classic Maya performances were strongly sonic, with anticipation fortified by blasts of trumpet or conch, the pounding of large drums or tapping of smaller ones under the arm, whistles and maracas, singing, and the musical collisions of shells on the king's body. Secular performances in Southeast Asia could involve hundreds or thousands of urban residents as participants and as spectators. Public movement was generally toward a restricted space: ceremonies within a royal court could only ever have small numbers of participants and be observed by relatively few.
Bulk structures of un-stabilized ZrO2-x with x in the 0 ≤ x ≤ 0.44 range under ambient pressure exist in three different structures (monoclinic, tetragonal and cubic). At ambient temperature and elevated pressures above 3.5 GPa, zirconia, at these compositions, a fourth phase is found, the orthorhombic structure. A dilute sol-gel method was used to produce nanoscale zirconia particles containing the unstabilized orthorhombic cotunnite structure for use in this project. Extensive characterization of this material indicates that the critical factor in determining the synthesized structures appears to be the number and placement of oxygen vacancies. These results also indicate that surface energy alone is not the controlling factor in determining the crystal structure synthesized.