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Mr. C, a 75-year-old man, noticed difficulty remembering names and adding numbers after wakening while on vacation. Although these problems were quite subtle, his wife was puzzled because he seemed to have no difficulty the day before. One week later, he noted that “something was wrong” but could not describe the changes in detail. He felt that his balance was “not right” and experienced difficulty keeping track of his golf scores. Over the next few months, he developed word-finding problems and had difficulty expressing himself. He was very forgetful, had trouble problem solving, was distractible, and was unable to do simple calculations. Whereas he had previously been very reserved, he started talking with others in a more open way than he would normally have done. He continued to complain of balance problems and started to notice changes in his handwriting.
Cognitive therapies are developed on the principle that specific cognitive appraisals are key determinants in the development and maintenance of mental health disorders. It is likely that particular appraisals of the coronavirus pandemic will have explanatory power for subsequent mental health outcomes in the general public. To enable testing of this hypothesis we developed a questionnaire assessing coronavirus-related cognitions.
12 285 participants completed online a 46-item pool of cognitions about coronavirus and six measures of different mental health problems. The sample was randomly split into derivation and validation samples. Exploratory factor analyses determined the factor structure, selection of items, and model fit in the derivation sample. Confirmatory factor analysis (CFA) then tested this model in the validation sample. Associations of the questionnaire with mental health outcomes were examined.
The 26-item, seven-factor, Oxford Psychological Investigation of Coronavirus Questionnaire [TOPIC-Q] was developed. CFA demonstrated a good model fit (χ2 = 2108.43, df = 278, p < 0.001, comparative fit index (CFI) = 0.950, Tucker−Lewis index (TLI) = 0.942, root mean square error of approximation (RMSEA) = 0.033, standardized root mean square residual (SRMR) = 0.038). The factors were: cognitions about (1) safety and vulnerability, (2) negative long-term impact, (3) having the virus, (4) spreading the virus, (5) social judgment, (6) negative self, and (7) being targeted. The questionnaire explained significant variance in depression (45.8%), social anxiety (37.3%), agoraphobia (23.2%), paranoia (27.3%), post-traumatic stress disorder (57.1%), and panic disorder (31.4%). Cognitions about negative long-term impact had the greatest explanatory power across disorders.
TOPIC-Q provides a method to assess appraisals of the pandemic, which is likely to prove helpful both in longitudinal studies assessing mental health outcomes and in delivery of psychological therapy.
The availability of large healthcare datasets offers the opportunity for researchers to navigate the traditional clinical and translational science research stages in a nonlinear manner. In particular, data scientists can harness the power of large healthcare datasets to bridge from preclinical discoveries (T0) directly to assessing population-level health impact (T4). A successful bridge from T0 to T4 does not bypass the other stages entirely; rather, effective team science makes a direct progression from T0 to T4 impactful by incorporating the perspectives of researchers from every stage of the clinical and translational science research spectrum. In this exemplar, we demonstrate how effective team science overcame challenges and, ultimately, ensured success when a diverse team of researchers worked together, using healthcare big data to test population-level substance use disorder (SUD) hypotheses generated from preclinical rodent studies. This project, called Advancing Substance use disorder Knowledge using Big Data (ASK Big Data), highlights the critical roles that data science expertise and effective team science play in quickly translating preclinical research into public health impact.
First episode psychosis (FEP) patients who use cannabis experience more frequent psychotic and euphoric intoxication experiences compared to controls. It is not clear whether this is consequent to patients being more vulnerable to the effects of cannabis use or to their heavier pattern of use. We aimed to determine whether extent of use predicted psychotic-like and euphoric intoxication experiences in patients and controls and whether this differs between groups.
We analysed data on patients who had ever used cannabis (n = 655) and controls who had ever used cannabis (n = 654) across 15 sites from six countries in the EU-GEI study (2010–2015). We used multiple regression to model predictors of cannabis-induced experiences and to determine if there was an interaction between caseness and extent of use.
Caseness, frequency of cannabis use and money spent on cannabis predicted psychotic-like and euphoric experiences (p ⩽ 0.001). For psychotic-like experiences (PEs) there was a significant interaction for caseness × frequency of use (p < 0.001) and caseness × money spent on cannabis (p = 0.001) such that FEP patients had increased experiences at increased levels of use compared to controls. There was no significant interaction for euphoric experiences (p > 0.5).
FEP patients are particularly sensitive to increased psychotic-like, but not euphoric experiences, at higher levels of cannabis use compared to controls. This suggests a specific psychotomimetic response in FEP patients related to heavy cannabis use. Clinicians should enquire regarding cannabis related PEs and advise that lower levels of cannabis use are associated with less frequent PEs.
We used British national survey data to test specific hypotheses that mood instability 1) is associated with psychosis and individual psychotic phenomena, 2) predicts the later emergence of auditory hallucinations and paranoid ideation, and 3) mediates the link between child sexual abuse and psychosis.
We analysed data from the 2000 and 2007 UK national surveys of psychiatric morbidity (N=8580 and 7403 respectively). The 2000 survey included an 18-month follow-up of a subsample (N=2406). Mood instability was assessed from the Structured Clinical Interview for DSMIV Axis II (SCID-II) questionnaire. Our dependent variables comprised auditory hallucinations, paranoid ideation, the presence of psychosis overall, and a 15-item paranoia scale
Mood Instability was strongly associated in cross-sectional analyses with psychosis (2000 OR: 7.5; 95% CI: I 4.1–13.8; 2007: OR 21.4; CI 9.7–41.2), paranoid ideation (2000: OR: 4.7; CI 4.1–5.4; 2007: OR 5.7; CI 4.9–6.7), auditory hallucinations (2000: OR: 3.4; CI 2.6–4.4; 2007: OR 3.5; CI 2.7–4.7) and paranoia total score (2000: Coefficient: 3.6;CI 3.3–3.9), remaining so after adjustment for current mood state. Baseline mood instability significantly predicted 18-month inceptions of paranoid ideation (OR: 2.3;CI 1.6–3.3) and of auditory hallucinations (OR: 2.6;CI 1.5–4.4). Finally it mediated a third of the total association of child sexual abuse with psychosis and persecutory ideation, and a quarter of that with auditory hallucinations.
Mood instability is a prominent feature of psychotic experience, and may have a role in its genesis. Targeting mood instability could lead to innovative treatments for psychosis.
Over the past two decades, numerous methodologies have been developed with the specific goal of reducing the placebo effect in CNS trials. This presentation will discuss how three of these strategies, Central Ratings, use of the SAFER interview, and use of Sequential Parallel Comparison Design (SPCD), in combination, may offer a’triple safety’ net that ensures maximum reduction of the risk of a failed trial. Central Ratings have been shown to reduce variability in ratings by limiting the pool of raters for a given trial, ensuring consistent high reliability and calibration of raters, and reduction of expectation bias due to blinding and independence from the site. Novel study designs such as SPCD have been shown to significantly reduce the overall placebo response rate of the trial by pooling data from both phases of the trial, given the marked reduction in placebo response in the placebo non-responders of phase 2 of these trials. Finally, the use of highly experienced, independent remote interviewers to administer diagnostic and treatment history checks such as the SAFER interview and to perform unbiased assessment of baseline symptom severity improves the quality of subject selection, preventing the randomization of subjects with inadequate severity of illness or without the appropriate diagnosis or treatment history. This presentation will review the evidence in support of the utility of combining these three common methodological approaches to reduce the placebo response in CNS trials, providing a’triple safety’ net for CNS trials and the opportunity to enhance signal detection.
Psychosis and adult Attention Deficit Hyperactivity Disorder (ADHD) have shared attributes, but evidence that they are associated is sparse and inconsistent.
We tested hypotheses that 1] adult ADHD symptoms are associated with psychosis and individual psychotic symptoms 2] links between ADHD symptoms and psychosis are mediated by prescribed ADHD medications, use of illicit drugs, and dysphoric mood (depression and anxiety).
The Adult Psychiatric Morbidity Survey 2007 (N=7403) provided data for regression and multiple mediation analyses. ADHD symptoms were coded from the ADHD Self-Report Scale (ASRS). Dependent variables comprised auditory hallucinations, paranoid ideation, and identified psychosis.
Higher ASRS total score was significantly associated with psychosis (O.R: 1.11; 95% CI 1.02-1.20; p = 0.013), paranoid ideation (O.R:1.12; CI 1.09-1.14; p<0.001) and auditory hallucinations (O.R 1.11; CI 1.08-1.15; p<0.001) even after controlling for socio-demographic variables, verbal IQ, autism spectrum disorder traits, childhood conduct problems, hypomanic mood and dysphoric mood. The link between higher ADHD symptoms and psychosis variables was significantly mediated by dysphoric mood (psychosis, 21%; paranoid ideation, 23%; auditory hallucination, 11%), but not by prescribed ADHD medication or use of amphetamine, cocaine or cannabis.
Higher levels of adult ADHD symptoms and psychosis are linked, and dysphoric mood may form part of the mechanism. Those with greater levels of ADHD symptoms in adulthood may be at higher risk of psychosis. Our analyses contradict the clinical view that the main explanation for people with ADHD symptoms developing psychosis is abuse of illicit drugs or ADHD medications.
Daily use of high-potency cannabis has been reported to carry a high risk for developing a psychotic disorder. However, the evidence is mixed on whether any pattern of cannabis use is associated with a particular symptomatology in first-episode psychosis (FEP) patients.
We analysed data from 901 FEP patients and 1235 controls recruited across six countries, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. We used item response modelling to estimate two bifactor models, which included general and specific dimensions of psychotic symptoms in patients and psychotic experiences in controls. The associations between these dimensions and cannabis use were evaluated using linear mixed-effects models analyses.
In patients, there was a linear relationship between the positive symptom dimension and the extent of lifetime exposure to cannabis, with daily users of high-potency cannabis having the highest score (B = 0.35; 95% CI 0.14–0.56). Moreover, negative symptoms were more common among patients who never used cannabis compared with those with any pattern of use (B = −0.22; 95% CI −0.37 to −0.07). In controls, psychotic experiences were associated with current use of cannabis but not with the extent of lifetime use. Neither patients nor controls presented differences in depressive dimension related to cannabis use.
Our findings provide the first large-scale evidence that FEP patients with a history of daily use of high-potency cannabis present with more positive and less negative symptoms, compared with those who never used cannabis or used low-potency types.
There are high rates of obesity and low self-esteem in patients with psychosis. The occurrence of negative voice content directly about appearance is therefore plausible. Derogatory comments about appearance are likely to be distressing, increase depression and contribute to social withdrawal.
To systematically assess the occurrence of voice content regarding appearance and identify correlates.
Sixty patients experiencing verbal auditory hallucinations at least once a week in the context of non-affective psychosis completed a measure assessing positive and negative voice content about appearance. They also completed assessments about body image, self-esteem, psychiatric symptoms and well-being.
Fifty-five (91.7%) participants reported hearing voices comment on their appearance. A total of 54 (90%) patients reported negative voice content about their appearance with 30 (50%) patients experienced negative appearance comments on a daily basis. The most common negative comment was ‘the voices tell me that I am ugly’ (n = 48, 80%). There were 39 (65%) patients who reported positive voice content on appearance. The most frequent positive comment was ‘I look as nice as other people’ (n = 26, 43.3%). Negative voice content about appearance was associated with body image concerns, paranoia, voice hearing severity, depression, worry, negative self-beliefs and safety-seeking behaviours. Positive appearance voice content was associated with greater body esteem and well-being and lower levels of depression and insomnia.
Voice content about appearance is very common for patients seen in clinical services. Negative voice content may reflect – and subsequently reinforce – negative beliefs about one's appearance, low self-esteem, worry and paranoia.
The period before the formation of a persecutory delusion may provide causal insights. Patient accounts are invaluable in informing this understanding.
To inform the understanding of delusion formation, we asked patients about the occurrence of potential causal factors – identified from a cognitive model – before delusion onset.
A total of 100 patients with persecutory delusions completed a checklist about their subjective experiences in the weeks before belief onset. The checklist included items concerning worry, images, low self-esteem, poor sleep, mood dysregulation, dissociation, manic-type symptoms, aberrant salience, hallucinations, substance use and stressors. Time to reach certainty in the delusion was also assessed.
Most commonly it took patients several months to reach delusion certainty (n = 30), although other patients took a few weeks (n = 24), years (n = 21), knew instantly (n = 17) or took a few days (n = 6). The most frequent experiences occurring before delusion onset were: low self-confidence (n = 84); excessive worry (n = 80); not feeling like normal self (n = 77); difficulties concentrating (n = 77); going over problems again and again (n = 75); being very negative about the self (n = 75); images of bad things happening (n = 75); and sleep problems (n = 75). The average number of experiences occurring was high (mean 23.5, s.d. = 8.7). The experiences clustered into six main types, with patients reporting an average of 5.4 (s.d. = 1.0) different types.
Patients report numerous different experiences in the period before full persecutory delusion onset that could be contributory causal factors, consistent with a complex multifactorial view of delusion occurrence. This study, however, relied on retrospective self-report and could not determine causality.
The diurnal feeding patterns of dairy cows affects the 24 h robot utilisation of pasture-based automatic milking systems (AMS). A decline in robot utilisation between 2400 and 0600 h currently occurs in pasture-based AMS, as cow feeding activity is greatly reduced during this time. Here, we investigate the effect of a temporal variation in feed quality and quantity on cow feeding behaviour between 2400 and 0600 h as a potential tool to increase voluntary cow trafficking in an AMS at night. The day was allocated into four equal feeding periods (0600 to 1200, 1200 to 1800, 1800 to 2400 and 2400 to 0600 h). Lucerne hay cubes (CP = 19.1%, water soluble carbohydrate = 3.8%) and oat, ryegrass and clover hay cubes with 20% molasses (CP = 11.8%, water soluble carbohydrate = 10.7%) were offered as the ‘standard’ and ‘preferred’ (preference determined previously) feed types, respectively. The four treatments were (1) standard feed offered ad libitum (AL) throughout 24 h; (2) as per AL, with preferred feed replacing standard feed between 2400 and 0600 h (AL + P); (3) standard feed offered at a restricted rate, with quantity varying between each feeding period (20:10:30:60%, respectively) as a proportion of the (previously) measured daily ad libitum intake (VA); (4) as per VA, with preferred feed replacing standard feed between 2400 and 0600 h (VA + P). Eight non-lactating dairy cows were used in a 4 × 4 Latin square design. During each experimental period, treatment cows were fed for 7 days, including 3 days habituation and 4 days data collection. Total daily intake was approximately 8% greater (P < 0.001) for the AL and AL + P treatments (23.1 and 22.9 kg DM/cow) as compared with the VA and VA + P treatments (21.6 and 20.9 kg DM/cow). The AL + P and VA treatments had 21% and 90% greater (P < 0.001) dry matter intake (DMI) between 2400 and 0600 h, respectively, compared with the AL treatment. In contrast, the VA + P treatment had similar DMI to the VA treatment. Our experiment shows ability to increase cow feeding activity at night by varying feed type and quantity, though it is possible that a penalty to total DMI may occur using VA. Further research is required to determine if the implementation of variable feed allocation on pasture-based AMS farms is likely to improve milking robot utilisation by increasing cow feeding activity at night.
Open dialogue is an integrative approach to the organisation of specialist mental health services and therapeutic meetings.
This qualitative study sought to explore service users' and clinicians’ experiences of network meetings during the implementation of open dialogue in a modified version, for a UK-based mental health service.
In total 19 participants were interviewed (8 service users and 11 clinicians) and an inductive thematic analysis of the data was conducted.
Four dominant themes were identified: (1) open dialogue delivery, (2) the impact of open dialogue principles; (3) intense interactions and enhanced communication, and (4) organisational challenges. Clinicians considered open dialogue as a preferred, but challenging way of working, while being therapeutic. The data indicated that service users' experiences of network meetings were mixed. There was a wide variety of service user views as to what the purpose of a network meeting was and for some witnessing reflective conversations felt strange. However, the majority described feeling listened to and understood, excluding one service user who described their experience as distressing. Clinicians expressed an authentic self in their interactions with service users and both service users and clinicians described network meetings as emotionally expressive, although this was described as overwhelming at times.
The results of this thematic analysis indicate that service users' and clinicians’ experiences of open dialogue warrant further investigation. The intensity of interactions in network meetings should be carefully considered with service users before gaining consent to commence treatment. Implementation of open dialogue should be monitored to assess clinician- and service-level adherence to the principles of the approach.
Introduction: Endotracheal intubation (ETI) is a lifesaving procedure commonly performed by emergency department (ED) physicians that may lead to patient discomfort or adverse events (e.g., unintended extubation) if sedation is inadequate. No ED-based sedation guidelines currently exist, so individual practice varies widely. This study's objective was to describe the self-reported post-ETI sedation practice of Canadian adult ED physicians. Methods: An anonymous, cross-sectional, web-based survey featuring 7 common ED scenarios requiring ETI was distributed to adult ED physician members of the Canadian Association of Emergency Physicians (CAEP). Scenarios included post-cardiac arrest, hypercapnic and hypoxic respiratory failure, status epilepticus, polytrauma, traumatic brain injury, and toxicology. Participants indicated first and second choice of sedative medication following ETI, as well as bolus vs. infusion administration in each scenario. Data was presented by descriptive statistics. Results: 207 (response rate 16.8%) ED physicians responded to the survey. Emergency medicine training of respondents included CCFP-EM (47.0%), FRCPC (35.8%), and CCFP (13.9%). 51.0% of respondents work primarily in academic/teaching hospitals and 40.4% work in community teaching hospitals. On average, responding physicians report providing care for 4.9 ± 6.8 (mean ± SD) intubated adult patients per month for varying durations (39.2% for 1–2 hours, 27.8% for 2–4 hours, and 22.7% for ≤1 hour). Combining all clinical scenarios, propofol was the most frequently used medication for post-ETI sedation (38.0% of all responses) and was the most frequently used agent except for the post-cardiac arrest, polytrauma, and hypercapnic respiratory failure scenarios. Ketamine was used second most frequently (28.2%), with midazolam being third most common (14.5%). Post-ETI sedation was provided by > 98% of physicians in all situations except the post-cardiac arrest (26.1% indicating no sedation) and toxicology (15.5% indicating no sedation) scenarios. Sedation was provided by infusion in 74.6% of cases and bolus in 25.4%. Conclusion: Significant practice variability with respect to post-ETI sedation exists amongst Canadian emergency physicians. Future quality improvement studies should examine sedation provided in real clinical scenarios with a goal of establishing best sedation practices to improve patient safety and quality of care.
The cognitive process of worry, which keeps negative thoughts in mind and elaborates the content, contributes to the occurrence of many mental health disorders. Our principal aim was to develop a straightforward measure of general problematic worry suitable for research and clinical treatment. Our secondary aim was to develop a measure of problematic worry specifically concerning paranoid fears.
An item pool concerning worry in the past month was evaluated in 250 non-clinical individuals and 50 patients with psychosis in a worry treatment trial. Exploratory factor analysis and item response theory (IRT) informed the selection of scale items. IRT analyses were repeated with the scales administered to 273 non-clinical individuals, 79 patients with psychosis and 93 patients with social anxiety disorder. Other clinical measures were administered to assess concurrent validity. Test-retest reliability was assessed with 75 participants. Sensitivity to change was assessed with 43 patients with psychosis.
A 10-item general worry scale (Dunn Worry Questionnaire; DWQ) and a five-item paranoia worry scale (Paranoia Worries Questionnaire; PWQ) were developed. All items were highly discriminative (DWQ a = 1.98–5.03; PWQ a = 4.10–10.7), indicating small increases in latent worry lead to a high probability of item endorsement. The DWQ was highly informative across a wide range of the worry distribution, whilst the PWQ had greatest precision at clinical levels of paranoia worry. The scales demonstrated excellent internal reliability, test-retest reliability, concurrent validity and sensitivity to change.
The new measures of general problematic worry and worry about paranoid fears have excellent psychometric properties.
Local attitudes towards carnivores often reflect the degree of damage they are perceived to cause. Consequently, understanding the interactions between people and these species is essential to conservation efforts. This study investigated local perceptions of three Cerrado canid species and current chicken management practices, to identify the potential damage they cause and how this relates to peoples’ attitudes towards these species. Results from structured interviews at 50 ranches in Goiás, Brazil, highlighted that general knowledge about Cerrado canids differed significantly by species, with interviewees unable to correctly answer questions about the hoary fox Lycalopex vetulus and crab-eating fox Cerdocyon thous in comparison to the maned wolf Chrysocyon brachyurus. Chicken coops were identified as the most effective method for preventing predation, yet only 44% of respondents employed this method. Using a perceived predation measure, interviewees reported chicken predation by all three Cerrado canids even though most of these events were stated to occur during the day, outside the species’ active periods. Reported predation events were a strong predictor of attitude. Participants who experienced predation events reported they did not like having a Cerrado canid on their property. However, 86% of the respondents agreed that Cerrado canids should nevertheless be protected. Our findings support the need to incorporate the human dimension in canid and broader carnivore conservation issues.
Sprays are a class of multiphase flows which exhibit a wide range of drop size and velocity scales spanning several orders of magnitude. The objective of the current work is to experimentally investigate the prospect of dynamical similarity in these flows. We are also motivated to identify a choice of length and time scales which could lead towards a universal description of the drop size and velocity spectra. Towards this end, we have fabricated a cohort of geometrically similar pressure swirl atomizers using micro-electromechanical systems (MEMS) as well as additive manufacturing technology. We have characterized the dynamical characteristics of the sprays as well as the drop size and velocity spectra (in terms of probability density functions, p.d.f.s) over a wide range of Reynolds (
) and Weber numbers (
) using high-speed imaging and phase Doppler interferometry, respectively. We show that the dimensionless Sauter mean diameter (
) scaled to the boundary layer thickness in the liquid sheet at the nozzle exit (
) exhibits self-similarity in the core region of the spray, but not in the outer zone. In addition, we show that global drop size spectra in the sprays show two distinct characteristics. The spectra from varying
collapse onto a universal p.d.f. for drops of size
, a residual effect of
persists in the size spectra. We explain this characteristic by the fact that the physical mechanisms that cause large drops is different from that which is responsible for the small drops. Similarly, with the liquid sheet velocity at the nozzle exit (
) as the choice of velocity scale, we show that drops moving with a velocity
collapse onto a universal p.d.f., while drops with
exhibit a residual effect of
. From these observations, we suggest that physically accurate models for drop size and velocity spectra should rely on piecewise descriptions of the p.d.f. rather than invoking a single mathematical form for the entire distribution. Finally, we show from a dynamical modal analysis that the conical liquid sheet flapping characteristics exhibit a sharp transition in Strouhal number (
) at a critical
Achieving a consistent level of robot utilisation throughout 24 h maximises automatic milking system (AMS) utilisation. However, levels of robot utilisation in the early morning hours are typically low, caused by the diurnal feeding behaviour of cows, limiting the inherent capacity and total production of pasture-based AMS. Our objective was to determine robot utilisation throughout 24 h by dairy cows, based on milking frequency (MF; milking events per animal per day) in a pasture-based AMS. Milking data were collected from January and February 2013 across 56 days, from a single herd of 186 animals (Bos taurus) utilising three Lely A3 robotic milking units, located in Tasmania, Australia. The dairy herd was categorised into three equal sized groups (n=62 per group) according to the cow’s mean daily MF over the duration of the study. Robot utilisation was characterised by an interaction (P< 0.001) between the three MF groups and time of day, with peak milking time for high MF cows within one h of a fresh pasture allocation becoming available, followed by the medium MF and low MF cows 2 and 4 h later, respectively. Cows in the high MF group also presented for milking between 2400 and 0600 h more frequently (77% of nights), compared to the medium MF group (57%) and low MF group (50%). This study has shown the formation of three distinct groups of cows within a herd, based on their MF levels. Further work is required to determine if this finding is replicated across other pasture-based AMS farms.
We present observations of 50 deg2 of the Mopra carbon monoxide (CO) survey of the Southern Galactic Plane, covering Galactic longitudes l = 300–350° and latitudes |b| ⩽ 0.5°. These data have been taken at 0.6 arcmin spatial resolution and 0.1 km s−1spectral resolution, providing an unprecedented view of the molecular clouds and gas of the Southern Galactic Plane in the 109–115 GHz J = 1–0 transitions of 12CO, 13CO, C18O, and C17O.
We present a series of velocity-integrated maps, spectra, and position-velocity plots that illustrate Galactic arm structures and trace masses on the order of ~106 M⊙ deg−2, and include a preliminary catalogue of C18O clumps located between l = 330–340°. Together with the information about the noise statistics of the survey, these data can be retrieved from the Mopra CO website and the PASA data store.