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The prevalence of psychotic experiences (PEs) is higher in low-and-middle-income-countries (LAMIC) than in high-income countries (HIC). Here, we examine whether this effect is explicable by measurement bias.
A community sample from 13 countries (N = 7141) was used to examine the measurement invariance (MI) of a frequently used self-report measure of PEs, the Community Assessment of Psychic Experiences (CAPE), in LAMIC (n = 2472) and HIC (n = 4669). The CAPE measures positive (e.g. hallucinations), negative (e.g. avolition) and depressive symptoms. MI analyses were conducted with multiple-group confirmatory factor analyses.
MI analyses showed similarities in the structure and understanding of the CAPE factors between LAMIC and HIC. Partial scalar invariance was found, allowing for latent score comparisons. Residual invariance was not found, indicating that sum score comparisons are biased. A comparison of latent scores before and after MI adjustment showed both overestimation (e.g. avolition, d = 0.03 into d = −0.42) and underestimation (e.g. magical thinking, d = −0.03 into d = 0.33) of PE in LAMIC relative to HIC. After adjusting the CAPE for MI, participants from LAMIC reported significantly higher levels on most CAPE factors but a significantly lower level of avolition.
Previous studies using sum scores to compare differences across countries are likely to be biased. The direction of the bias involves both over- and underestimation of PEs in LAMIC compared to HIC. Nevertheless, the study confirms the basic finding that PEs are more frequent in LAMIC than in HIC.
Impairments in social cognition contribute significantly to disability in schizophrenia patients (SzP). Perception of facial expressions is critical for social cognition. Intact perception requires an individual to visually scan a complex dynamic social scene for transiently moving facial expressions that may be relevant for understanding the scene. The relationship of visual scanning for these facial expressions and social cognition remains unknown.
In 39 SzP and 27 healthy controls (HC), we used eye-tracking to examine the relationship between performance on The Awareness of Social Inference Test (TASIT), which tests social cognition using naturalistic video clips of social situations, and visual scanning, measuring each individual's relative to the mean of HC. We then examined the relationship of visual scanning to the specific visual features (motion, contrast, luminance, faces) within the video clips.
TASIT performance was significantly impaired in SzP for trials involving sarcasm (p < 10−5). Visual scanning was significantly more variable in SzP than HC (p < 10−6), and predicted TASIT performance in HC (p = 0.02) but not SzP (p = 0.91), differing significantly between groups (p = 0.04). During the visual scanning, SzP were less likely to be viewing faces (p = 0.0001) and less likely to saccade to facial motion in peripheral vision (p = 0.008).
SzP show highly significant deficits in the use of visual scanning of naturalistic social scenes to inform social cognition. Alterations in visual scanning patterns may originate from impaired processing of facial motion within peripheral vision. Overall, these results highlight the utility of naturalistic stimuli in the study of social cognition deficits in schizophrenia.
This systematic review examines the effectiveness and cost-effectiveness of behavioural health integration into primary healthcare in the management of depression and unhealthy alcohol use in low- and middle-income countries. Following PRISMA guidelines, this review included research that studied patients aged ≥18 years with unhealthy alcohol use and/or depression of any clinical severity. An exploration of the models of integration was used to characterise a typology of behavioural health integration specific for low- and middle-income countries.
Fifty-eight articles met inclusion criteria. Studies evidenced increased effectiveness of integrated care over treatment as usual for both conditions. The economic evaluations found increased direct health costs but cost-effective estimates. The included studies used six distinct behavioural health integration models.
Behavioural health integration may yield improved health outcomes, although it may require additional resources. The proposed typology can assist decision-makers to advance the implementation of integrated models.
Lateral gaze aversions which follow reflective or thought provoking questions are called conjugated lateral eye movements (CLEMs). This response was studied in 20 schizophrenic patients, 20 depressive patients and 20 healthy controls. Frontal and parietal EEG measures were recorded simultaneously with the question/answer task. There were no differences in CLEMs among the 3 groups. Schizophrenic and depressive patients demonstrated a significantly reduced EEG-power on the left and an increased power on the right in comparison with healthy controls. This may point to a functional interhemispheric ‘disconnection’ in patients. Comparative correlations revealed EEG-power increase during the occurrence of contralateral CLEMs in the whole 10 min task.
Serum-antibodies against an organ specific CNS antigen as well as against serotonin and gangliosides (Gm 1) were analysed by ELISA in 34 patients with schizophrenia, ten patients with schizoaffective psychosis and 13 patients with major depressive disorder. Sixty-two patients with various rheumatic disorders and 32 blood donors were included in the study as controls. Sixty-two percent of the 13 patients with major depressive disorder had antibodies to serotonin and 69% to gangliosides, whereas antibody positive sera was only found in 38% of the 34 patients with schizophrenia. The same antibodies were found in only 6% (antibodies to serotonin) and 13% (antibodies to gangliosides) of the 32 blood donors and in a similar frequency in patients with schizoaffective psychosis. Organ specific antibodies to CNS-antigen could not be detected in the psychiatric patient group at any significant level. It is speculated that auto-immune reactions towards a serotonin receptor may be involved in the etiopathogenesis of major depressive disorder.
This paper reviews and presents data of practical impact for those administering electroconvulsive therapy (ECT). In the first section, physical and physiological aspects of the stimulus as well as methods of stimulation are discussed. The second section deals with indications for ECT, efficacy and treatment modalities such as seizure duration, treatment frequency and total number of ECT applications. The last section is devoted to side effects, risks, comedication and comorbidity.
From December 1–31, 1997, the Department of Psychiatry and Psychotherapy in co-operation with the Department of Information Technology, University of Tübingen, Germany, organised the first virtual congress on psychiatry in the Internet. The congress was aimed at facilitating exchange of results of psychiatric studies and ideas and at stimulating discussion among interested colleagues. Almost 100 participants from 17 countries on four continents took part in this event. Sixteen contributions were presented and discussed. The problems and opportunities of this medium in the organisation and running of congresses are presented and discussed. The experience gained in this congress suggests that the Internet will find increasing use as a medium for medical congresses within the next few years.
Sera from patients with major depressive disorder and paranoid schizophrenia were screened for antinuclear antibodies (antigens: ds-DNA, ENA, histone H3) and circulating immune complexes (CIC-Cq1) by ELISA. Controls were healthy blood donors. Only a few of the patients' sera were positive for anti-ds-DNA and anti-ENA antibodies. There was no significant result. In paranoid schizophrenia 20.5% of sera were positive for antibodies against histone H3. In the case of CIC-Cql, 7% of the patients with major depressive disorder and 11 % of those with paranoid schizophrenia were positive. Controls showed positive sera in 39%. This study disagrees with former studies which could demonstrate a series of antinuclear antibodies in mental disorders. In the case of antihistone antibodies, the present results could indicate an autoimmune process in a subgroup of schizophrenic patients.
Studies in the general population show cannabis use has a beneficial effect on metabolic disorders. Given the increased cardiometabolic risk in patients with psychotic disorders, as well as their prevalent use of cannabis, we aim to investigate whether such effects are also evident in these patients.
3176 patients with chronic psychotic disorders from mental health institutions in the Netherlands were included in the study. With multivariate regression analyses we examined the effects of cannabis use on metabolic risk factors; BMI, waist circumference, blood pressure (BP), cholesterol, HDL-C, LDL-C, triglycerides, glucose and HbA1c. Age, sex, smoking, alcohol use and antipsychotic drugs were included as confounders. Next, we examined change in metabolic risk factors after one-year follow up for cannabis users, non-users, discontinuers and starters.
We found a significant negative association between cannabis use and BMI (p=0.003), waist circumference (p>0.001), diastolic BP (p=0.015) and HbA1c (0.004). One year later, patients who had discontinued their cannabis use had a greater increase of BMI (p=0.002) and waist circumference (p=0.011) than other patients. They also had a greater increase of diastolic BP than non-users (p=0.036) or starters (p=0.004).
Discontinuation of cannabis use increased metabolic risk. To stop cannabis use is often an important treatment goal, because it reduces psychotic symptoms. However, physicians should be aware of the increased metabolic risk in patients who discontinue the use of cannabis. Extra attention should be paid to monitoring and treatment of metabolic parameters in these patients to prevent cardiovascular diseases and premature cardiovascular mortality.
The effectiveness of systematic quality improvement initiatives in psychiatric care remains unclear.
To elucidate the adherence to recommended evidence-based guidelines in clinical practice.
To examine whether the quality of care among patients hospitalized with schizophrenia has changed following the implementation of a systematic monitoring and auditing program of hospital performance measures.
In a nationwide population-based cohort study, we identified 14,228 patients admitted to Danish psychiatric departments between 2004 and 2011 and registered in The Danish Schizophrenia Registry. The registry systematically monitors and audits the adherence to clinical guideline recommended processes of care at all Danish psychiatric hospital departments treating patients with schizophrenia.
The overall proportion of all relevant recommended processes of care delivered to the patients increased from 64 % to 76 % between 2004 and 2011. The adherence to a number of individual processes of care increased over time, including assessment of psychopathology using a diagnostic interview (Relative risk (RR) 2.01, 95 % CI: 1.50; 2.69), contact with relatives (RR 1.44, 95 % CI: 1.27; 1.62), psychoeducation (RR 1.33, 95 % CI: 1.18; 1.48), psychiatric aftercare (RR 1.06 95 % CI: 1.01; 1.11) and suicide risk assessment (RR 1.31, 95 % CI: 1.20; 1.43). However, improvements were not observed for all assessed processes of care and substantial variation remained between the hospitals.
Quality of care improved substantially from 2004 to 2011 among patients hospitalized with schizophrenia at Danish hospitals. However, continued efforts to reduce performance variation between hospitals are warranted.
Spouses resemble each other for psychopathology, but data regarding spousal resemblance in externalizing psychopathology, and data regarding spousal resemblance across different syndromes (e.g. anxiety in wives and attention deficit/hyperactivity disorder [ADHD] in husbands) are limited. Moreover, knowledge is lacking regarding spousal resemblance in parents of children with psychiatric disorders. We investigated and compared spousal resemblance within and across internalizing and externalizing symptom domains in parents of children with and without psychopathology.
Symptoms of depression, anxiety, avoidant personality, ADHD, and antisocial personality were assessed with the Adult Self Report in 728 mothers and 544 fathers of 778 children seen in child and adolescent psychiatric outpatient clinics and in 2075 mothers and 1623 fathers of 2784 children from a population-based sample. Differences in symptom scores and spousal correlations between the samples were tested.
Parents in the clinical sample had higher symptom scores than in the population-based sample. In both samples, correlations within and across internalizing and externalizing domains of psychopathology were significant. Importantly, correlations were significantly higher in the clinical sample (P = 0.03). Correlations, within and across symptoms, ranged from 0.14 to 0.30 in the clinical sample and from 0.05 to 0.23 in the population-based sample.
This large study shows that spousal resemblance is not only present within but also across symptom domains. Especially in the clinical sample, ADHD symptoms in fathers and antisocial personality symptoms in mothers were correlated with a range of psychiatric symptoms in their spouses. Clinicians need to be alert of these multiple affected families.
The prenatal detection of structural cardiac malformations has greatly benefited from the advances in echo Doppler technology and the in-depth training of specialists in this area. This opens up new possibilities, now and in the future, for developing in utero therapies. It also allows a better knowledge of the underlying mechanisms and developmental timing that lead to structural congenital heart disease (CHD), based on a marked progress involving genetic and epigenetic causes. Gene mutations are discovered in the fetus and parents, and pathways can be unraveled using mouse transgene technology. Epigenetic causes are also receiving attention, but have thus far been underestimated as approximately 85% of CHD is determined to have a multifactorial background that combines a genetic susceptibility with epigenetic influences. Studies in animal models, including chicken, quail, zebrafish, and even more primitive Chordates, contribute relevant data. In essence, cardiac development shows basic similarities of the major processes involved between species. Therefore mechanisms unraveled in animal models can be reliably used in understanding normal human cardiac development and CHD .
The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
Molecular characterization of pediatric low-grade glioma (pLGG) over the last decade has identified recurrent alterations, most commonly involving BRAF, and less frequently other pathways including MYB and MYBL1. Many of these molecular markers have been exploited clinically to aid in diagnosis and treatment decisions. However, their frequency and prognostic significance remain unknown. Further, a significant portion of cases do not have any of these alterations and what underlies these cases remains unknown. To address this we compiled a cohort of 562 patients diagnosed at SickKids from 1990-2017. We identified molecular alterations in 454 cases (81% of the cohort). The most frequent events were those involving BRAF; either as fusions (most commonly with KIAA1549 (30%)) or V600E mutations (17%) and NF-1 (22%). Less frequently, we identified recurrent FGFR1 fusions and mutations (3%), MYB/MYBL alterations (2%), H3F3AK27M (2%) or IDH1R132H (0.5%) mutations, as well as other novel rare events. Survival analysis revealed significantly better progression-free survival (PFS) and overall survival (OS) of KIAA1549-BRAF fused patients compared to BRAFV600E with 10-year OS 97.7% (95%, CI 95.5-100) and 83.9% (95%, CI 72.5-95.6), respectively. In addition to survival, molecular alterations predicted differences in response to conventional therapeutics; BRAF fused patients showed a 46% response-rate, versus only 14% in V600E patients. pLGGs harboring H3F3AK27M progressed early with median PFS of 11 months. In patients with MYB/MYBL1, FGFR1/FGFR2 alterations, we observed only one death (FGFR1N546K case). The work here represents the largest cohort of pLGGs with molecular profiling and their impact on the clinical behaviour of the disease.
Introduction: It is critical for planning, clinical care and resource optimization to understand patterns of emergency department (ED) utilization. Individuals who have experienced adverse childhood experiences (ACE) are known to have more unhealthy behaviors and worse health outcomes as adults and therefore may be more frequent ED users. Adverse childhood experiences include physical, sexual and emotional abuse or neglect, substance abuse in the family, witnessing violence, having a parent incarcerated or parents getting divorced or separated. To date there are few studies exploring the relationship between ACE and ED utilization. Methods: This a mixed qualitative and quantitative study. It includes analysis of data collected through a survey, a retrospective chart review and focus group discussions. The survey was administered to a convenience sample of adult patients (CTAS 2 -5) presenting to EDs in Kingston Ontario, and consisted of two validated tools that measured exposure to ACE and resiliency. Demographic data and ED utilization frequency for 12 months prior to the index visit were extracted from an electronic medical record for each patient completing the survey. A sample of participants with a high ACE burden (ACE score > 4) were invited to participate in focus groups to explore their experiences of care in the ED. Demographic, ED utilization and health status data were summarized and statistically significant patterns between high ACE and lower ACE patients were determined using Chi2t or t-tests. Transcripts from the focus groups were thematically analyzed using NVivo software by 2 independent researchers. Results: 1693 surveys were collected, 301 (18%) were deemed to have a high ACE score, data analysis is ongoing. The primary outcome is the relationship between ACE and the frequency of ED utilization among adult patients presenting to EDs in Kingston, ON. Secondary outcomes include evaluating the role of resilience as a potential mitigating factor, describing the demographics of high ACE burden frequent ED visitors, and the experiences of care for individuals with high ACE burden in the ED. These outcomes will be utilized to inform hypotheses for future studies and potential interventions aimed at optimizing ED utilization and patient care experience. Conclusion: This study provides novel insight into the relationship between ACE burden and ED utilization while also describing the demographics and experiences of care for ED patients with a high ACE score. Data analysis is on-going.