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Post-traumatic mechanisms are theorised to contribute to voice-hearing in people with psychosis and a history of trauma. Phenomenological links between trauma and voices support this hypothesis, as they suggest post-traumatic processes contribute to the content of, and relationships with, voices. However, research has included small samples and lacked theory-based comprehensive assessments.
Method
In people with distressing voices (n = 73) who experienced trauma prior to voice-hearing, trauma–voice links were assessed both independently and dependently (descriptions were presented and rated separately and together, respectively) by both participants and researchers. A structured coding frame assessed four types of independent links (i.e. victimisation type, physiological-behavioural, emotional, and cognitive response themes including negative self-beliefs) and three types of dependent links: relational (similar interaction with/response to, voice and trauma); content (voice and trauma content are exactly the same); and identity (voice identity is the same as perpetrator).
Results
Independent links were prevalent in participants (51–58%) and low to moderately present in researcher ratings (8–41%) for significant themes. Identification of negative self-beliefs in trauma was associated with a significantly higher likelihood of negative self-beliefs in voices [participants odds ratio (OR) 9.8; researchers OR 4.9]. Participants and researchers also reported many dependent links (80%, 66%, respectively), most frequently relational links (75%, 64%), followed by content (60%, 25%) and identity links (51%, 22%).
Conclusion
Trauma appears to be a strong shaping force for voice content and its psychological impact. The most common trauma–voice links involved the experience of cognitive-affective psychological threat, embodied in relational experiences. Trauma-induced mechanisms may be important intervention targets.
The subsistence practices of Holocene communities living in the Nile Valley of Central Sudan are comparatively little known. Recent excavations at Khor Shambat, Sudan, have yielded well-defined Mesolithic and Neolithic stratigraphy. Here, for the first time, archaeozoological, palaeobotanical, phytolith and dental calculus studies are combined with lipid residue analysis of around 100 pottery fragments and comparative analysis of faunal remains and organic residues. This holistic approach provides valuable information on changes in adaptation strategies, from Mesolithic hunter-gatherers to Neolithic herders exploiting domesticates. A unique picture is revealed of the natural environment and human subsistence, demonstrating the potential wider value of combining multiple methods.
Adolescent diet, physical activity and nutritional status are generally known to be sub-optimal. This is an introduction to a special issue of papers devoted to exploring factors affecting diet and physical activity in adolescents, including food insecure and vulnerable groups.
Setting
Eight settings including urban, peri-urban and rural across sites from five different low- and middle-income countries.
Design:
Focus groups with adolescents and caregivers carried out by trained researchers.
Results:
Our results show that adolescents, even in poor settings, know about healthy diet and lifestyles. They want to have energy, feel happy, look good and live longer, but their desire for autonomy, a need to ‘belong’ in their peer group, plus vulnerability to marketing exploiting their aspirations, leads them to make unhealthy choices. They describe significant gender, culture and context-specific barriers. For example, urban adolescents had easy access to energy dense, unhealthy foods bought outside the home, whereas junk foods were only beginning to permeate rural sites. Among adolescents in Indian sites, pressure to excel in exams meant that academic studies were squeezing out physical activity time.
Conclusions:
Interventions to improve adolescents’ diets and physical activity levels must therefore address structural and environmental issues and influences in their homes and schools, since it is clear that their food and activity choices are the product of an interacting complex of factors. In the next phase of work, the Transforming Adolescent Lives through Nutrition consortium will employ groups of adolescents, caregivers and local stakeholders in each site to develop interventions to improve adolescent nutritional status.
A biographic summary of the research of Dr Graham Charles George Argent (born 15 May 1941, died 24 April 2019) is presented, summarising his research career. Expedition information, including dates, collection number series and the names of collaborators, is given, as is a list of his publications, annotated with taxonomic decisions and the names of new species described within them.
The Composite International Diagnostic Interview (CIDI) was used to assess the prevalence of psychiatric disorders in a French population of 46 inpatients with diabetes mellitus. According to DSM-III-R criteria, 52.2% of subjects presented at least one psychiatric diagnosis in their lifetime and 41.3% did so less than six months before the study. Affective and anxiety disorders represented at least 83% of the psychiatric diagnoses. The risk for those disorders seems to be restricted to a predisposed group as only one of the 16 subjects who had suffered from an anxiety or depressive episode within the previous six months had never experienced such an episode before.
A study was conducted on a group of 73 patients suffering from major depressive disorder (DSMIII) compared with 120 normal subjects using a subscale of physical pleasure (Fawcett Clark pleasure capacity scale-physical pleasure, FCPCS-PP). The major depressives were significantly more anhedonic than the normals and the distribution of the FCPCS-PP scores in these subjects was unimodal.
The transplant representations of patients waiting for a kidney transplantation have been studied recently. Our hypotheses is that these representations can be measured with a questionnaire and differ between recipients from living or cadaveric donor. As result of lack of clinical standardized instrument,we developed the Transplant Representation Questionnaire(TRQ) of 19 items in 4 degrees.
Objective:
Compare results on the TRQ in patients waiting for a kidney transplantation from cadaveric or living donor.
Methods:
390 patients included in waiting list for kidney transplantation with cadaveric or living donor were assessed with the TRQ. Since the beginning of the study, 170 patients were transplanted, 148 (87%) with cadaveric donor (CD group), and 22 (13%) with living donor (LD group). The principal component analysis has been performed on 390 patients.
Results:
The Principal component analysis of the TRQ has shown 2 factors.The factor “Donor” refers to the recipient concerns about the donor (11 items).The factor “Transplant” refers to the negative attitude of the recipient about the transplanted organ (8 items). The LD group was younger and had more social support than the CD group. It had also higher scores on the “donor” factor and similar scores on the “transplant” factor.
Discussion:
As compared to patients waiting for transplantation with cadaveric donor, patients waiting for transplantation with living donor have more concerns about the donor, and similar representations of their future transplant. Our preliminary results should be confirmed in more powerful studies. Further studies will assess prospectively the transplant representations after transplantation.
This objectives of this study were three-fold: retrospectively evaluate anxiolytic/hypnotic consumption by psychiatric inpatients, identify the risk factors of prolonged intakes, and prospectively measure the impact of hospitalisation on the use of those drugs. Three hundred and seventy-six patients hospitalised in 11 psychiatric departments in the Paris region were studied using a structured interview for the anxiolytic/hypnotic treatments, DSM-III-R criteria, GHQ-12, HAD, Spiegel's questionnaire, COVI's anxiety scale and the CGI. Eighty-five per cent of the patients had taken one anxiolytic/hypnotic or more in the 3 months preceding hospitalisation. Hospitalisation induced little change in anxiolytic/hypnotic use: dosage frequency increased from 77% to 84% between the week preceding hospitalisation and that preceding discharge; 26% of consumers were taking at least two anxiolytics or two hypnotics in the first period vs. 23% in the second. The absence of withdrawal during hospitalisation was related to the high age and a diagnosis of depression rather than schizophrenia, to the existence of continuous intake over the 3 months preceding hospitalisation and to higher drug doses during the 7 days preceding hospitalisation. Prescription of treatment at the end of hospitalisation in previously non-user subjects was related to a higher HAD anxiety score at discharge.
Une étude prospective, contrôlée et randomisée a été réalisée sur 320 suicidants ayant regagné leur domicile après passage au SAU de Bicêtre. Elle a comparé le protocole de prise en charge habituel (groupe G1) au protocole « OSTA » (G2). Celui-ci comporte trois appels téléphoniques au patient (à j8–j15, M1 et M3) 2,3, un appel téléphonique au professionnel référent (M3) et la mise à disposition d’un numéro d’appel téléphonique pour le patient et son référent. Une évaluation téléphonique finale à un an (M12) a été effectuée dans les deux groupes.
Résultats:
– le taux d’adhésion aux rappels téléphonique est important. Un contact téléphonique a été établi dans 85,5 % des cas à j8–j15, 80,9 % des cas à M1 et 72,4 % des cas à j8–j15 et à M1 ;
– le taux de récidive suicidaire à un an ne diffère significativement pas entre G1 et G2 : 14,5 % vs 14,0 % (analyse en « intention de traiter »), 14,5 % vs 11,5 % (analyse « per protocole ») ;
– l’initiation d’un suivi ambulatoire (ISA), au plus tard dans le mois suivant le mois de la TS, ne diffère également pas entre les deux groupes : 31,0 % (G1) vs 24,2 % (G2) ;
– il existe une forte perte d’information lors du recueil à M12.
Dans le groupe G2, la prise en compte de l’ensemble des données collectées à j8–j15, M1, M3 et M12, montre un taux de récidive suicidaire de 19,4 % (vs 14,0 % selon les seules données M12), mais aussi un taux d’ISA de 70,6 % (vs 24,2 %).
Discussion et conclusion
Ces résultats sont confrontés aux données récentes de la littérature [1]. La discussion porte sur la méthodologie la plus appropriée à l’évaluation des effets de la veille sanitaire et aux moyens de contrôler les effets de l’évaluation sur les variables étudiées.
Since reports have underscored that panic attacks (PA) may be an identifiable state occurring in schizophrenia, we studied the symptomatology of PA in a group of schizophrenic patients. Of 40 patients (21 males and 19 females) attending a clinic for maintenance therapy of schizophrenia, 19 (36.8%) had a lifetime history of PA. Seven among those 19 patients (36.8%) had or had had spontaneous panic attacks, not related to phobic fears or delusional fears, and for the 12 remaining patients, the PA were related to paranoid ideas. Moreover, the paranoid subtype of schizophrenia tends to be more often associated with a history of panic attack than other subtypes of schizophrenia (52.6% vs 23.8%; χ2 = 3.5, P = .06). It seems that there are at least two types of PA in schizophrenic patients. The first one could be independent from the psychotic feature, with no psychopathological link. The second kind of PA could be directly related to a schizophrenic disorder, and found in patients with the paranoid subtype.
La prise en charge des internes en situation de souffrance psychique comporte plusieurs étapes. La première est celle de la reconnaissance de l’état de souffrance par le sujet lui-même et/ou par son entourage proche. La seconde consiste à aider l’interne à s’adresser à la ou aux personne(s) la(les) plus qualifiée(s) pour analyser avec lui la situation et/ou lui apporter l’aide requise. Une troisième étape consiste à mettre en œuvre les moyens thérapeutiques et/ou de prévention nécessaires avec l’ensemble des personnes ressources. Chacune de ces étapes comporte des obstacles qu’il importe de connaître pour les surmonter : difficulté à reconnaître l’état de souffrance ; difficulté à faire la part entre un simple trouble de l’adaptation lié à une situation professionnelle particulière et un trouble psychique nécessitant l’intervention d’un spécialiste ; difficultés d’accès aux spécialistes, mais aussi difficultés rencontrées dans la mise en œuvre d’éventuelles mesures de prévention dans le lieu de stage, enfin. Chacune de ces étapes peut impliquer l’intervention de multiples intervenants (famille et amis, pairs, enseignants, coordonnateur, psychologues, psychiatres), dont il importe de coordonner l’action dans le respect de la plus grande confidentialité. Le syndicat des internes des hôpitaux de Paris (SIHP) a mis en œuvre depuis le début de l’année 2015 et en concertation avec le coordonnateur du DES de psychiatrie un dispositif d’aide aux internes en souffrance psychique intitulé « SOS-Psychiatrie ». Cette initiative permet à un interne en souffrance psychique de s’adresser, dans un premier temps, à un pair en la personne d’un membre du SIHP. L’interne pourra alors être orienté vers une des consultations d’évaluation organisées par les services de psychiatrie du réseau, avant d’être si besoin redirigé vers un suivi. Depuis sa création, 6 internes ont pu bénéficier de ce dispositif.
L’internat est une période de stress chronique élevé pour les étudiants en médecine qui doivent relever le défi d’apprendre à travailler en équipe, de devenir des médecins compétents, responsables et empathiques, dans un climat parfois compétitif. Les premières études analysant la prévalence des troubles psychiatriques chez les internes dans les années 1960 retrouvaient une prévalence de la dépression d’environ 30 %. Des travaux récents retrouvent des taux identiques ainsi qu’une augmentation significative de la prévalence du burn-out et des symptômes anxieux au cours de l’internat . Cependant, il semblerait que les internes souffrant de troubles psychiatriques se tournent peu vers les professionnels de santé , alors même que l’aggravation des symptômes retentit sur leur fonctionnement, notamment professionnel. Actuellement, il n’existe pas en France de recommandation claire quant à la prise en charge médicale et universitaire des internes en souffrance psychique, malgré des résultats encourageant d’interventions individuelles ou groupales . L’Association française fédérative des étudiants en psychiatrie a donc mené une enquête auprès des représentants des internes en psychiatrie de chaque subdivision et des coordonnateurs locaux du diplôme d’études spécialisées (DES) de psychiatrie. Ce travail, présenté pour la première fois, a pour but de décrire les dispositions médicales et universitaires prises pour les internes en souffrance et celles souhaitées. L’objectif final de cette étude est d’élaborer des recommandations nationales et consensuelles aidant à la prise en charge spécifique de ces étudiants. Le professeur Hardy apportera son regard avec sa double expertise de coordonnateur du DES de psychiatrie de Paris-IDF et de psychiatre intéressé par les troubles affectifs et les facteurs de risques psychosociaux. L’approche sociologique de Madame Penchaud viendra enrichir cette session où elle présentera une revue de la littérature en sciences sociales sur les motivations présidant au choix de la filière psychiatrique et proposera une analyse compréhensive de l’expérience et l’apprentissage professionnel des internes en psychiatrie.
La dépression du post-partum (DPP) est une pathologie multifactorielle survenant chez 13 à 15 % des femmes dans l’année suivant l’accouchement . Les évènements de vie stressants ont été identifiés comme facteur de risque. Parallèlement, le recours aux traitements pour infertilité ne cesse de croître . Actuellement en France, 1 naissance sur 40 est issue de la procréation médicalement assistée (PMA). Lors de la procédure, le parcours peut être une source de stress chez la femme . Nous avons émis l’hypothèse que le risque de symptômes dépressifs et/ou DPP après aide médicale à la conception pourrait être majoré.
Méthodes
Nous avons réalisé une revue de la littérature des études comparant la survenue de symptômes dépressifs dans le post-partum et/ou DPP entre traitement pour infertilité et grossesse spontanée à partir des bases de données Pubmed, ISI Web of Knowledge et PsycINFO jusqu’en décembre 2014. Nous avons ensuite effectué une méta-analyse des données disponibles sur DPP et aide à la conception, et une méta-analyse secondaire se focalisant sur la PMA (logiciel RevMan5).
Résultats
Notre revue de la littérature, prenant en compte 18 études, ne met pas en évidence de risque majoré de symptômes dépressifs et/ou de DPP après traitement pour infertilité. Notre méta-analyse sur la DPP, prenant en compte 8 études (n = 2451), ne montre pas de différence significative entre aide médicale à la conception et grossesse spontanée (OR = 0,93 [0,67–1,31], z = 0,40, p = 0,69), sans hétérogénéité entre les études. La méta-analyse secondaire concernant les PMA, sur 6 études (n = 1773), ne retrouve également pas d’association (OR = 1,04 [0,71–1,52], z = 0,18, p = 0,86).
Discussion
Notre étude ne montre pas de risque majoré de DPP après aide médicale à la conception. D’autres études sont nécessaires afin de mieux connaître les spécificités des DPP après traitement pour infertilité (selon la technique utilisée, l’origine ou la nature de l’infertilité).
In the United Kingdom, compliance with guidelines on physical health monitoring of patients prescribed clozapine is poor. Our community team established a ‘clozapine clinic’, led by junior doctors, to monitor the physical health of this population.
Aims
The aims of this audit were:
– to ascertain levels of compliance with guidelines on the physical health monitoring of patients taking clozapine;
– to compare the current level of compliance with that prior to the establishment of the clinic.
Methods
Eleven standards were drawn from National Institute for Health and Care Excellence guidelines and the Maudsley Prescribing Guidelines in Psychiatry.
Three audit cycles were conducted: two prior to the establishment of the clinic and one after. In each cycle, searches of patient records were conducted and blood results were reviewed. This was supplemented by telephone calls to general practitioners to ensure a complete data set.
Analysis was conducted in Microsoft Excel™ and changes between the cycles were analysed using a two-tailed Z-score.
Results
Each audit cycle included 28–30 patients. In the current cycle compliance levels varied between 66% (annual ECG recording) and 100% (monthly full blood count). The average compliance level was 73% across all standards. This represents an overall improvement on previous audit cycles. Since the clinic was established there has been a statistically significant improvement in compliance with annual monitoring of weight (P = 0.147), body mass index (P = 0.0178), and ECG monitoring (P = 0.0244).
Conclusions
Improvements in the care of a vulnerable population may be achieved through setting clear standards, regular audit, and harnessing the leadership and enthusiasm of junior doctors.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Most suicide attempters are referred to community health professionals (CHP) after discharge from emergency department (ED). Thereafter, outpatient treatment engagement (OTE) is often poor. Strengthening it seems likely to reduce the risk of repeat suicidal behaviour.
Objectives
To identify the predictive factors of OTE.
Methods
Multicentre prospective study in true life conducted in adult patients (≥18) in 4 EDs of the Southern Paris region. Patients were referred to CHP. OTE was assessed by telephone calls at 1 and 3 months. OTE at 1 month was defined as having booked 1 appointment; OTE at 3 months as having attended 2 appointments and booked another one.
Results
One hundred and fifty-five patients were assessed at 1 month and 144 at 3 months. OTE at 1 and 3 months was observed in 58% and 51% respectively. A multivariate analysis showed factors significantly predictive of OTE at 1 month: a psychiatric follow-up before the suicide attempt (SA), ≥2 psychiatric interviews during the stay at ED, appointment with CHP booked before discharge from the ED; and at 3 months: college or university education, absence of alcohol intake during the SA, psychiatric follow-up before the SA, appointment with CHP booked before discharge from the ED.
Conclusions
This multicentre prospective study highlights the benefit of booking outpatient appointment before discharge from ED; of allowing patient to benefit from at least two psychiatric interviews; of being particularly cautious with patients who took alcohol concomitantly to their SA, patients with low level of academic achievement and patients without psychiatric follow-up.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
OBJECTIVES/SPECIFIC AIMS: Transforming growth factor-beta (TGFβ) is a genetic modifier of cystic fibrosis (CF) lung disease. TGFβ’s pulmonary levels in young CF patients and its mechanism of action in CF are unknown. We examined TGFβ levels in children with CF and investigated responses of human airway epithelial cells (AECs) and mice to TGFβ. METHODS/STUDY POPULATION: TGFβ levels in bronchoalveolar lavage fluid from CF patients (n=15) and non-CF control patients (n=21)<6 years old were determined by ELISA. CF mice and non-CF mice were intratracheally treated with an adenoviral TGFβ1 vector or PBS; lungs were collected for analysis at day 7. Human CF and non-CF AECs were treated with TGFβ or PBS for 24 hours then collected for analysis. RESULTS/ANTICIPATED RESULTS: Young CF patients had higher bronchoalveolar lavage fluid TGFβ than non-CF controls (p=0.03). Mouse lungs exposed to TGFβ demonstrated inflammation, goblet cell hyperplasia, and decreased CFTR expression. CF mice had greater TGFβ-induced lung mechanics abnormalities than controls; both CF human AECs and CF mice showed higher TGFβ induced MAPK and PI3K signaling compared with controls. DISCUSSION/SIGNIFICANCE OF IMPACT: For the first time, we show increased TGFβ levels very early in CF. TGFβ drives CF lung abnormalities in mouse and human models; CF models are more sensitive to TGFβ’s effects. Understanding the role of TGFβ in promoting CF lung disease is critical to developing patient specific treatments.
The small-scale fisheries sector in many Pacific islands is facing increasing challenges in relation to resource availability, economic opportunity, and demographic and social pressure. In particular, intensifying cash-oriented livelihood strategies can exacerbate existing vulnerabilities and threaten food security and resource conservation. In this paper the authors develop a bio-economic model and a quantitative measure of resilience in order to explore the interaction between socio-economic and ecological dynamics, and to analyze the potential role that cooperation and collective arrangements can play in this interaction to maintain the viability of the system. Based on the case of the system known as wantok typically found in the Solomon Islands, numerical examples are used to explore the potential gain that cooperation between fishers can bring in terms of subsistence, profitability and ecological performances, as well as the resilience of the whole system to shocks.
RF-plasma MBE was used to epitaxially grow 4 – 100-nm-thick metallic
β-Nb2N thin films on hexagonal SiC substrates. When the
N/Nb flux ratios are greater than one, the most critical parameter for
high-quality β-Nb2N is the substrate temperature. The X-ray
diffraction (XRD) of films grown between 775 °C and 850 °C
demonstrates pure β-Nb2N phase formation which was also
confirmed by X-ray photoelectron spectroscopy and transmission electron
microscopy measurements. Using the (0002) and (21$\bar 3$1) XRD peaks of a β-Nb2N film grown at 850
°C reveals a 0.68% lattice mismatch to the 6H-SiC substrate. This
suggests that β-Nb2N can be used for high-quality
metal/semiconductor heterostructures that cannot be fabricated at present.