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Palaeolandscape reconstructions at the German North Sea coast are essential for the understanding of coastal changes and dynamic landscape-forming processes. This study contributes to reconstructing Holocene coastal changes in the back-barrier area of the East Frisian island of Norderney and draws conclusions on the local palaeogeography. Five sediment cores were analysed in terms of sedimentology (grain-size distribution), geochemistry (TOC, TIC, N, C/N), microfauna (foraminifers and ostracods) and 13 radiocarbon dates. In order to identify driving environmental factors and support the facies interpretation, multivariate statistics (PCA) were carried out. Additional cores from the surrounding area (WASA Project and ‘Landesamt für Bergbau, Energie und Geologie’ (LBEG) Hannover) enabled correlation of the investigated cores over a transect of ~6 km, showing six depositional environments, which can be used for landscape reconstruction. Deposition starts with periglacial (aeolian and glaciofluvial) Pleistocene sediments, with subsequent pedogenesis followed by swamp conditions that develop into a salt marsh. The overlying tidal-flat sediments are partially cut by (fossil and recent) channel deposits. A hiatus at the base of the tidal-flat deposits that spans some 3000 years hints at their reworking caused by a combination of antrophogenic coastal protection measures and the impact of storms. Furthermore, based on the profile correlation and the age data, a widespread salt-marsh area with a minimum age of ~4000 cal BP is defined for the ‘Hohes Riff’ in the southwestern back-barrier of Norderney Island.
The neuropeptide oxytocin is proposed as a promising therapy for social dysfunction by modulating amygdala-mediated social-emotional behavior. Although clinical trials report some benefits of chronic treatment, it is unclear whether efficacy may be influenced by dose frequency or genotype.
In a randomized, double-blind, placebo-controlled pharmaco-functional magnetic resonance imaging trial (150 male subjects), we investigated acute and different chronic (every day or on alternate days for 5 days) intranasal oxytocin (24 international units) effects and oxytocin receptor genotype-mediated treatment sensitivity on amygdala responses to face emotions. We also investigated similar effects on resting-state functional connectivity between the amygdala and prefrontal cortex.
A single dose of oxytocin-reduced amygdala responses to all face emotions but for threatening (fear and anger) and happy faces, this effect was abolished after daily doses for 5 days but maintained by doses given every other day. The latter dose regime also enhanced associated anxious-arousal attenuation for fear faces. Oxytocin effects on reducing amygdala responses to face emotions only occurred in AA homozygotes of rs53576 and A carriers of rs2254298. The effects of oxytocin on resting-state functional connectivity were not influenced by either dose-frequency or receptor genotype.
Infrequent chronic oxytocin administration may be therapeutically most efficient and its anxiolytic neural and behavioral actions are highly genotype-dependent in males.
Infection prevention and control (IPC) workflows are often retrospective and manual. New tools, however, have entered the field to facilitate rapid prospective monitoring of infections in hospitals. Although artificial intelligence (AI)–enabled platforms facilitate timely, on-demand integration of clinical data feeds with pathogen whole-genome sequencing (WGS), a standardized workflow to fully harness the power of such tools is lacking. We report a novel, evidence-based workflow that promotes quicker infection surveillance via AI-assisted clinical and WGS data analysis. The algorithm suggests clusters based on a combination of similar minimum inhibitory concentration (MIC) data, timing of sample collection, and shared location stays between patients. It helps to proactively guide IPC professionals during investigation of infectious outbreaks and surveillance of multidrug-resistant organisms and healthcare-acquired infections. Methods: Our team established a 1-year workgroup comprised of IPC practitioners, clinical experts, and scientists in the field. We held weekly roundtables to study lessons learned in an ongoing surveillance effort at a tertiary care hospital—utilizing Philips IntelliSpace Epidemiology (ISEpi), an AI-powered system—to understand how such a tool can enhance practice. Based on real-time case discussions and evidence from the literature, a workflow guidance tool and checklist were codified. Results: In our workflow, data-informed clusters posed by ISEpi underwent triage and expert follow-up analysis to assess: (1) likelihood of transmission(s); (2) potential vector(s) identity; (3) need to request WGS; and (4) intervention(s) to be pursued, if warranted. In a representative sample (spanning October 17, 2019, to November 7, 2019) of 67 total isolates suggested for inclusion in 19 unique cluster investigations, we determined that 9 investigations merited follow-up. Collectively, these 9 investigations involved 21 patients and required 115 minutes to review in ISEpi and an additional 70 minutes of review outside of ISEpi. After review, 6 investigations were deemed unlikely to represent a transmission; the other 3 had potential to represent transmission for which interventions would be performed. Conclusions: This study offers an important framework for adaptation of existing infection control workflow strategies to leverage the utility of rapidly integrated clinical and WGS data. This workflow can also facilitate time-sensitive decisions regarding sequencing of specific pathogens given the preponderance of available clinical data supporting investigations. In this regard, our work sets a new standard of practice: precision infection prevention (PIP). Ongoing effort is aimed at development of AI-powered capabilities for enterprise-level quality and safety improvement initiatives.
Funding: Philips Healthcare provided support for this study.
Disclosures: Alan Doty and Juan Jose Carmona report salary from Philips Healthcare.
Early life stress has been associated with emotional dysregulations and altered architecture of limbic-prefrontal brain systems engaged in emotional processing. Serotonin regulates both, developmental and experience-dependent neuroplasticity in these circuits. Central serotonergic biosynthesis rates are regulated by Tryptophan hydroxylase 2 (TPH2) and transgenic animal models suggest that TPH2-gene associated differences in serotonergic signaling mediate the impact of aversive early life experiences on a phenotype characterized by anxious avoidance.
The present study employed an imaging genetics approach that capitalized on individual differences in a TPH2 polymorphism (703G/T; rs4570625) to determine whether differences in serotonergic signaling modulate the effects of early life stress on brain structure and function and punishment sensitivity in humans (n = 252).
Higher maltreatment exposure before the age of 16 was associated with increased gray matter volumes in a circuitry spanning thalamic-limbic-prefrontal regions and decreased intrinsic communication in limbic-prefrontal circuits selectively in TT carriers. In an independent replication sample, associations between higher early life stress and increased frontal volumes in TT carriers were confirmed. On the phenotype level, the genotype moderated the association between higher early life stress exposure and higher punishment sensitivity. In TT carriers, the association between higher early life stress exposure and punishment sensitivity was critically mediated by increased thalamic-limbic-prefrontal volumes.
The present findings suggest that early life stress shapes the neural organization of the limbic-prefrontal circuits in interaction with individual variations in the TPH2 gene to promote a phenotype characterized by facilitated threat avoidance, thus promoting early adaptation to an adverse environment.
The quality of mental health services is crucial for the effectiveness and efficiency of mental healthcare systems, symptom reduction, and quality of life improvements in persons with mental illness. In recent years, particularly care coordination (i.e., the integration of care across different providers and treatment settings) has received increased attention and has been put into practice. Thus, we focused on care coordination in this update of a previous European Psychiatric Association (EPA) guidance on the quality of mental health services.
We conducted a systematic meta-review of systematic reviews, meta-analyses, and evidence-based clinical guidelines focusing on care coordination for persons with mental illness in three literature databases.
We identified 23 relevant documents covering the following topics: case management, integrated care, home treatment, crisis intervention services, transition from inpatient to outpatient care and vice versa, integrating general and mental healthcare, technology in care coordination and self-management, quality indicators, and economic evaluation. Based on the available evidence, we developed 15 recommendations for care coordination in European mental healthcare.
Although evidence is limited, some concepts of care coordination seem to improve the effectiveness and efficiency of mental health services and outcomes on patient level. Further evidence is needed to better understand the advantages and disadvantages of different care coordination models.
Massive, early-type stars have been detected as radio sources for many decades. Their thermal winds radiate free–free continuum and in binary systems hosting a colliding-wind region, non-thermal emission has also been detected. To date, the most abundant data have been collected from frequencies higher than 1 GHz. We present here the results obtained from observations at 325 and 610 MHz, carried out with the Giant Metrewave Radio Telescope, of all known Wolf-Rayet and O-type stars encompassed in area of
15 sq degrees centred on the Cygnus region. We report on the detection of 11 massive stars, including both Wolf-Rayet and O-type systems. The measured flux densities at decimeter wavelengths allowed us to study the radio spectrum of the binary systems and to propose a consistent interpretation in terms of physical processes affecting the wide-band radio emission from these objects. WR 140 was detected at 610 MHz, but not at 325 MHz, very likely because of the strong impact of free–free absorption (FFA). We also report—for the first time—on the detection of a colliding-wind binary system down to 150 MHz, pertaining to the system of WR 146, making use of complementary information extracted from the Tata Institute of Fundamental Research GMRT Sky Survey. Its spectral energy distribution clearly shows the turnover at a frequency of about 600 MHz, that we interpret to be due to FFA. Finally, we report on the identification of two additional particle-accelerating colliding-wind binaries, namely Cyg OB2 12 and ALS 15108 AB.
We will present results of a systematic review of the effectiveness of methylphenidate in the treatment of adult ADHD. Furthermore, we will discuss the influence of methods on the results of meta analyses.
We searched Medline, PsycINFO and CCTR to identify randomised controlled clinical trials comparing methylphenidate with placebo in the treatment of adult ADHD. Studies were summarized with meta-analytic methods. Subgroup analyses were conducted with respect to parallel group vs. cross-over trials and self vs. observer ratings. The relationship between dosage and effect size was explored by weighted regression analysis. The results were tested for publication bias, and several sensitivity analyses were conducted.
Nineteen studies met the inclusion criteria of which 17 were included in the meta-analysis. The overall effect size was significant at d=0.42 different from zero, but this was only half the size expected on the basis of a previous meta-analysis. No significant differences could be observed in the subgroup analyses. The regression analysis showed no significant influence of mean daily dose on effect size.
These results contradict findings of a previous meta-analysis and challenge guideline recommendations. Differences between populations of children and adults and methodological issues in meta-analyses are discussed.
Chinese trials were rarely included in western meta-analyses. This systematic review investigates the efficacy of venlafaxine in the treatment of major depression (MDD) in Chinese populations.
Chinese databases (VIP and CNKI) were searched for blinded randomised clinical trials (RCTs) comparing venlafaxine with any other pharmacotherapy and/or placebo. Quality of included studies was assessed with the Jadad scale. Furthermore, fulfilment of the CONSORT items was recorded. Final mean HAM-D scores and response rates were extracted and combined using a fixed-effects model. Subgroup analyses by drug class were performed to assess further differences.
23 blinded RCTs were included in the analyses. Six compared venlafaxine with selective serotonin reuptake inhibitors (SSRIs), 15 with tricyclic antidepressants (TCAs) and two with tetracyclic antidepressants. The average Jadad score was 2.7 and on average 55% of all CONSORT items were reported. On average, 36 patients were randomised per group. Only three trials included more than 80 patients per group.
Mean final HAMD scores were significantly lower in the venlafaxine groups compared to TCA (Hedges’ g 0.14, 95%-CI, 0.01-0.26), but not in comparison to SSRI treated groups (Hedges’ g 0.05, 95%-CI, -0.12-0.21). These findings were confirmed by analyses of response rates. (MH RR Ven vs. TCA: 1.11, 95%-CI, 1.04-1.18, Ven vs. SSRI: 1.01, 95%-CI, 0.93-1.11).
These results suggest that venlafaxine is significantly more effective than TCAs, but not than SSRIs in depressive Chinese populations. However, large high quality trials are needed to verify these findings.
Stigma against mental illness and the mentally ill is well known. However, stigma against psychiatrists and mental health professionals is known but not discussed widely. Public attitudes and also those of other professionals affect recruitment into psychiatry and mental health services. The reasons for this discriminatory attitude are many and often not dissimilar to those held against mentally ill individuals. In this Guidance paper we present some of the factors affecting the image of psychiatry and psychiatrists which is perceived by the public at large. We look at the portrayal of psychiatry, psychiatrists in the media and literature which may affect attitudes. We also explore potential causes and explanations and propose some strategies in dealing with negative attitudes. Reduction in negative attitudes will improve recruitment and retention in psychiatry. We recommend that national psychiatric societies and other stakeholders, including patients, their families and carers, have a major and significant role to play in dealing with stigma, discrimination and prejudice against psychiatry and psychiatrists.
Schizoaffective disorder is a common diagnosis in mental health services. The present article aims to provide an overview of diagnostic reliability, symptomatology, outcome, neurobiology and treatment of schizoaffective disorder.
Literature was identified by searches in “Medline” and “Cochrane Library”.
The diagnosis of schizoaffective disorder has a low reliability. There are marked differences between the current diagnostic systems. With respect to psychopathological symptoms, no clear boundaries were found between schizophrenia, schizoaffective disorder and affective disorders. Common neurobiological factors were found across the traditional diagnostic categories. Schizoaffective disorder according to ICD-10 criteria, but not to DSM-IV criteria, shows a more favorable outcome than schizophrenia. With regard to treatment, only a small and heterogeneous database exists.
Due to the low reliability and questionable validity there is a substantial need for revision and unification of the current diagnostic concepts of schizoaffective disorder. If future diagnostic systems return to Kraepelin's dichotomous classification of non-organic psychosis or adopt a dimensional diagnostic approach, schizoaffective disorder will disappear from the psychiatric nomenclature. A nosological model with multiple diagnostic entities, however, would be compatible with retaining the diagnostic category of schizoaffective disorder.
Attempts to reduce high utilisation of psychiatric inpatient care by targeting the critical time of hospital discharge have been rare. In Germany, until now no such intervention has been implemented, let alone subjected to a clinical trial.
“Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services” (NODPAM) is a multicentre RCT conducted in five psychiatric hospitals in Germany (Günzburg, Düsseldorf, Regensburg, Greifswald, and Ravensburg). Subjects asked to provide informed consent to participate have to be of adult age with a primary diagnosis of schizophrenia or affective disorder, and a defined high utilisation of psychiatric care during two years prior to the current admission. Subjects are asked to provide detailed outcome data at four measurement points during a period of 18 months. Recruitment (which started in April 06) is still ongoing. Thus, baseline data of about 350 participants will be presented.
Recruitment has been quite successful and the study has been generally well accepted by participating patients and their clinicians in in- and outpatient treatment settings. Subjects showed substantial initial impairment on outcome measures (e.g. needs, psychopathology, quality of life, and level of functioning) and high utilisation of mental health care. Further results on conduct and feasibility of the trial will be presented.
The first phase of this mulicentre trial was promising. The potential of this study to strengthen the integration of mental health care provision in Germany will be discussed.
CT findings in 17 patients and MRI in one patient with post partum psychiatric disorder (PPPD; psychosis: n = 17, depressive neurosis: n = 1) were compared with randomly selected CT scans in non-PPPD patients matched for age and sex. In the PPPD group, 13 examinations (controls: 8) revealed one or several abnormal findings such as sulcal widening, ventricular enlargement and asymmetry. There was a higher prevalence of abnormal CT/MRI findings in the PPPD group (trend, P < 0.1).
There are significant differences in psychiatric training across Europe. In the light of the current direction of Europe (without borders with free movement of workforce) it is inevitable to harmonize at least basic standards of psychiatric education across Europe. Ideally by working in partnership with relevant national and international bodies (European Union of Medical Specialists, Board of Psychiatry - UEMS, European Psychiatric Association - EPA and European Federation of Psychiatric Trainees - EFPT). A qualitative data analysis on the most important challenges of psychiatric trainees across Europe, carried out by the EFPT in 2009, revealed several interesting findings which might be of interest not only for trainees, but for all involved in the process of psychiatric education. As the most important issue trainees reported the imperfect structure of the training programs and problems with implementation of new ones. That is why new training programs based on a competency based framework are being developed lately in number of countries (e.g. United Kingdom, Ireland, Netherlands). However, not only the structure of the training and its implementation remains an issue, trainees are concerned also with topics related to working conditions, insufficient training opportunities, lack of supervision, funding and availability of psychotherapy courses, etc. Based on these findings EFPT will undertake specific actions which in cooperation with other organizations shall lead in the future to better postgraduate training opportunities in Europe.
Despite considerable advances in the evidence-based treatments, the long-term management of depressive disorders remains a challenge. Many depressive disorders follow a chronic or recurrent course. Substantial proportions of patients end treatment, especially those with residual symptoms, leave treatment with considerable risk for relapses and/or persistent psychosocial impairment. Long-term strategies are needed that can effectively help patients minimize the negative consequences of their illness without imposing a too much of an extra burden. We present the protocol of a multi-center RCT on the efficacy of an Internet based disease management strategy for the specific health conditions in recurrent depression. 234 patients who are treated for their minimum third episode of a major depression (MD) in one of the six participating centers will participate post-treatment in one of two internet delivered interventions or usual care alone. The interventions continue over 12 months and consist of supportive monitoring, an online forum for peer support, and individual crisis management either with or without personal clinical support. Primary outcome of the trial is the ratio of “well” to “unwell weeks” over a 24-month observation period after index treatment assessed with the Longitudinal Interval Follow-Up Evaluation. We would like to discuss the new options that information and communication technology offers for long-term disease management strategies for patients with recurrent depression and invite for a discussion about strategies for other chronic mental disorders.
Both schizophrenia and ultra high risk (UHR) patients show reduced neurocognitive performance compared to matched healthy control subjects. In the current study we compared neurocognitive performance at baseline and follow up between UHR patients who made the transition to psychosis and patients who did not.
Patients were eligible for the study when they met criteria for one or more of the following groups: Attenuated symptoms or brief limited intermitted psychotic symptoms or a first degree family member with a psychotic disorder and reduced functioning or basic symptoms. We assessed 216 UHR patients (166 males, mean age: 22,6 SD 5,2) with a neuropsychological test battery composed of the National adult reading test (premorbid IQ), California verbal memory test (verbal memory), spatial working memory test, verbal fluency first letter and categories (executive functioning), finger tapping test (motor speed) and continuous performance test (sustained attention). Data were collected in 7 participating centres of EPOS. Follow up was at 9 months.
37 UHR patients made the transition to psychosis (25 males, mean age 21,5 SD 4,8). The only test that showed a significant difference between the transition and non transition group at baseline was verbal fluency categories (t= 2.79, p = 0.006).
Patients who later make the transition to psychosis perform significantly worse on verbal fluency categories than patients who do not make the transition to psychosis. Verbal fluency may contribute to an improved prediction of psychosis in UHR patients. Follow up results will also be presented.
Even if technology and information are omnipresent, they rarely meet harmoniously. Either the lack of sufficient means prevents good information to reach its target or the technology is too complex to integrate flawlessly in the daily workflow.
The use and misuse of information technologies (internet, email, e-learning, social networks) has recently significantly increased among psychiatrists and patients and the changes in behavior of communication and seeking informations are real challenges.
Using the European Federation of Psychiatric Trainees network, the self-questionnaires concerning the usage of information technologies and the local patients-therapists communication were distributed among psychiatric trainees of 31 European countries.
A review of the results of this study, as well as recommendations about netiquette and useful websites for psychiatrists and scientists will be presented in detail.
Regional cerebral blood flow (rCBF) values were measured by single photon emission computed tomography (SPECT) in different regions of the brain in 27 patients with DAT. Significant correlations were found between rCBF in left parieto-temporooccipital regions and psychometric test scores. Patients with hemisphere asymmetry in SPECT performed worse on psychometric tests. SPECT did not permit prediction of or differentiation between depressive and psychotic symptoms.