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Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
We aimed to evaluate the prevalence, clinical determinants, and consequences (falls and hospitalization) of frailty in older adults with mental illness.
Retrospective clinical cohort study.
We collected the data in a specialized psychogeriatric ward, in Boston, USA, between July 2018 and June 2019.
Two hundred and fourty-four inpatients aged 65 years old and over.
Psychiatric diagnosis was based on a multi-professional consensus meeting according to DSM-5 criteria. Frailty was assessed according to two common instruments, that is, the FRAIL questionnaire and the deficit accumulation model (aka Frailty Index [FI]). Multiple linear regression analyses were conducted to evaluate the association between frailty and sample demographics (age, female sex, and non-Caucasian ethnicity) and clinical characteristics (dementia, number of clinical diseases, current infection, number of psychotropic, and non-psychotropic medications in use). Multiple regression between frailty assessments and either falls or number of hospital admissions in the last 6 and 12 months, respectively, were analyzed and adjusted for covariates.
Prevalence of frailty was high, that is, 83.6% according to the FI and 55.3% according to the FRAIL questionnaire. Age, the number of clinical (somatic) diseases, and the number of non-psychotropic medications were independently associated with frailty identified by the FRAIL. Dementia, current infection, the number of clinical (somatic) diseases, and the number of non-psychotropic medications were independently associated with frailty according to the FI. Falls were significantly associated with both frailty instruments. However, we found only a significant association for the number of hospital admissions with the FI.
Frailty is highly prevalent among geriatric psychiatry inpatients. The FRAIL questionnaire and the FI may capture different forms of frailty dimensions, being the former probably more associated with the phenotype model and the latter more associated with multimorbidity.
In Sunan and Taiwan land reform was implementd by campaign, and in both the early to middle stages of the campaign were remarkably similar. Both conducted training, temporarily expanded the state bureaucracy with young recruits, and engaged in massive propaganda to convince the public of the desirability and necessity of land reform. Both also desired active rural participation in land reform. The ways in which land reform was publicly performed and rural participation invited in were very different: in Sunan participation was a mass public event that vilified targets and concluded with the merging of state and crowd while in Taiwan public participation was solicited through the procedural drama of limited public elections to Farm Tenancy Committees.
After presenting the fundamentals of Weberian-institutionalist and Gramsciian-culturalist approaches to understanding the state, this introduction suggests that it is possible to combine the two. Focusing on the unusually successful cases of state building of the “revolutionary” People’s Republic of China in Sunan and the “conservative” Republic of China in Taiwan in the early 1950s, it suggests that the “hows” of state building policy implementation are as important as the “whats.” Both regimes resorted to overlapping and shifting modalities of bureaucratic rule making and campaign mobilization, differing substantively in how these repertoires were performed and communicated to citizens at large.
In the introduction to this volume, I suggested that in the current literature on state building and state formation there is a gap between Weberian and Gramscian approaches that might be usefully bridged. Weberians assume that, with the right kinds of institutional design, good choices on the part of political leaders, and sufficient resources, effective state institutions with necessary state capacity will follow. Gramscians tend to sidestep questions of capacity to concentrate on the realm of ideas, cultural practices, and the ways in which individuals negotiate the “everyday state.” I posit that by linking “softer” concerns about culture and practices with “harder” questions of state formation, we might better understand the processes by which the state’s administrative institutions come to function under the challenging circumstances in which most states in the developing world find themselves.
All states need competent and loyal state administrators to both reflect the state and implement its policies. Although the People’s Republic of China in Sunan and the Republic of China in Taiwan were unalterably politically opposed to each other, the ways in which they labeled and conceived of their administrators exhibited surprising overlaps. Both used ganbu (cadre) alongside more neutral terms like civil servant or state personnel in the early 1950s. Both presumed that individuals in state service needed to exhibit “virtue” (loyalty and engaging in work in the “right” way), “talent” (functional and technical competence) and continuous self-cultivation. The two regimes diverged in how they fostered these positive attributes in their state administrators: the PRC in Sunan sent thousands for party-mandated training, and selected “talent” according to enthusiasm and conducting campaigns in the right way while the ROC in Taiwan was enamoured of regular systems of examination and annual evaluation for entry and promotion.
Because the Chinese Communist Party had implemented land reform in the countryside and the Guomindang had signally failed to do so prior to 1949, the PRC in Sunan and the ROC in Taiwan staked much of their legitimacy on successful implementation of land reform in the early 1950s. Both presumed that land reform was popular and necessary as a base for development in the future and social justice in the present. But in neither Sunan nor Taiwan was land reform particularly popular or demanded from below; land reform was imposed from above by outsiders. In Sunan, land reform proceeded according to categories of exploiting and exploited classes developed in North China that had little to do with rural realities. In Taiwan, tenancy was already in steep decline, but the Guomindang felt it necessary to demonstrate that their peaceful and gradualist version of land reform was sharply different from the violent and extreme expropriation across the Strait
While both the PRC in Sunan and the ROC in Taiwan had judicial systems that presumed the guilt of the accused and offered lenience to those who came forward and confessed, both were in practice arbitrary. In Sunan promises of lenience for those who registered were abruptly cancelled with the “high tide” of the Campaign to Suppress Counterrevolutionaries, and in Taiwan the extension of lenience was notoriously inconsistent. The ways in which the state in Sunan and Taiwan implemented campaigns against subversion were, however, very different. In Sunan, the accused were paraded in front of a large audience in public accusation sessions and directly confronted by their victims’ tales of sorrow, whipping up the crowd into enthusiasm for the state’s just retribution; in Taiwan the accused were spirited away by shadowy security organizations, held incognito in prisons, and sentenced according to (martial) “law” in performances of procedure put on by the state for itself.
Terror is always experienced subjectively, making it very difficult to assess its impact. Both the PRC in Sunan and the ROC in Taiwan engaged in strenuous actions to establish internal security and harden previously soft borders, and both deliberately used campaigns of fear to extend their reach deep into society. The PRC did so in Sunan with an openly named campaign: the Campaign to Suppress Counterrevolutionaries while the ROC in Taiwan engaged in a series of vicious police actions against suspected Communists and subversives. While the confirmed numbers of victims are elusive, in either raw numbers or as a percentage of the population, the Campaign to Suppress Counterrevolutionaries dispatched more victims in Sunan than the White Terror did in Taiwan. But in Taiwan, no social group was immune, and violent repression fell much more unpredictably than it did in Sunan.