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Audience costs theory posits that domestic audiences punish political leaders who make foreign threats but fail to follow through, and that anticipation of audience costs gives more accountable leaders greater leverage in crisis bargaining. We argue, contrary to the theory, that leaders are often unaware of audience costs and their impact on crisis bargaining. We emphasise the role of domestic opposition in undermining a foreign threat, note that opposition can emerge from policy disagreements within the governing party as well as from partisan oppositions, and argue that the resulting costs differ from audience costs. We argue that a leader's experience of audience costs can trigger learning about audience costs dynamics and alter future behaviour. We demonstrate the plausibility of these arguments through a case study of the 1863–4 Schleswig-Holstein crisis. Prime Minister Palmerston's threat against German intervention in the Danish dispute triggered a major domestic debate, which undercut the credibility of the British threat and contributed to both the failure of deterrence and to subsequent British inaction. Parliament formally censured Palmerston, contributing to a learning-driven reorientation in British foreign policy.
We aimed to evaluate the association between eating context patterns and ultraprocessed food consumption at two main meal occasions in a representative sample of UK adolescents. Data were acquired from 4-d food records of adolescents aged 11–18 years, who participated in the 2014–2016 UK National Diet and Nutrition Survey (n 542). The eating context was assessed considering the location of the meal (lunch and dinner) occasion, the individuals present, whether the television was on and if the food was consumed at a table. Ultraprocessed foods were identified using the NOVA classification. Exploratory factor analysis was used to identify eating context patterns for lunch and dinner. Linear regression models adjusted for the covariates were utilised to test the association between eating context patterns and the proportion of total daily energy intake derived from ultraprocessed foods. Their contribution was about 67 % to energy intake. Three patterns were retained for lunch (‘At school with friends’, ‘TV during family meal’ and ‘Out-of-home (no school)’), and three patterns were retained for dinner (‘Watching TV alone in the bedroom’, ‘TV during family meal’ and ‘Out-of-home with friends’). At lunch, there was no significant association between any of the three patterns and ultraprocessed food consumption. At dinner, the patterns ‘Watching TV alone in the bedroom’ (coefficient: 4·95; 95 % CI 1·87, 8·03) and ‘Out-of-home with friends’ (coefficient: 3·13; 95 % CI 0·21, 6·14) were associated with higher consumption of ultraprocessed food. Our findings suggest a potential relationship between the immediate eating context and ultraprocessed food consumption by UK adolescents.
Bipolar disorder (BD) is a familial psychiatric disorder associated with frontotemporal and subcortical brain abnormalities. It is unclear whether such abnormalities are present in relatives without BD, and little is known about structural brain trajectories in those at risk.
Neuroimaging was conducted at baseline and at 2-year follow-up interval in 90 high-risk individuals with a first-degree BD relative (HR), and 56 participants with no family history of mental illness who could have non-BD diagnoses. All 146 subjects were aged 12–30 years at baseline. We examined longitudinal change in gray and white matter volume, cortical thickness, and surface area in the frontotemporal cortex and subcortical regions.
Compared to controls, HR participants showed accelerated cortical thinning and volume reduction in right lateralised frontal regions, including the inferior frontal gyrus, lateral orbitofrontal cortex, frontal pole and rostral middle frontal gyrus. Independent of time, the HR group had greater cortical thickness in the left caudal anterior cingulate cortex, larger volume in the right medial orbitofrontal cortex and greater area of right accumbens, compared to controls. This pattern was evident even in those without the new onset of psychopathology during the inter-scan interval.
This study suggests that differences previously observed in BD are developing prior to the onset of the disorder. The pattern of pathological acceleration of cortical thinning is likely consistent with a disturbance of molecular mechanisms responsible for normal cortical thinning. We also demonstrate that neuroanatomical differences in HR individuals may be progressive in some regions and stable in others.
Visual and auditory signs of patient functioning have long been used for clinical diagnosis, treatment selection, and prognosis. Direct measurement and quantification of these signals can aim to improve the consistency, sensitivity, and scalability of clinical assessment. Currently, we investigate if machine learning-based computer vision (CV), semantic, and acoustic analysis can capture clinical features from free speech responses to a brief interview 1 month post-trauma that accurately classify major depressive disorder (MDD) and posttraumatic stress disorder (PTSD).
N = 81 patients admitted to an emergency department (ED) of a Level-1 Trauma Unit following a life-threatening traumatic event participated in an open-ended qualitative interview with a para-professional about their experience 1 month following admission. A deep neural network was utilized to extract facial features of emotion and their intensity, movement parameters, speech prosody, and natural language content. These features were utilized as inputs to classify PTSD and MDD cross-sectionally.
Both video- and audio-based markers contributed to good discriminatory classification accuracy. The algorithm discriminates PTSD status at 1 month after ED admission with an AUC of 0.90 (weighted average precision = 0.83, recall = 0.84, and f1-score = 0.83) as well as depression status at 1 month after ED admission with an AUC of 0.86 (weighted average precision = 0.83, recall = 0.82, and f1-score = 0.82).
Direct clinical observation during post-trauma free speech using deep learning identifies digital markers that can be utilized to classify MDD and PTSD status.
Contemporary interdependence perspectives posit that intimates are more likely to remain in a relationship to the extent that they are committed to that relationship, and that they tend to be more committed to the extent that they a) are currently satisfied with the relationship, b) believe they do not currently have more desirable alternatives to the relationship, and c) have previously invested resources into the relationship. At times, though, intimates may expect that their relationship satisfaction, alternatives, and investments will increase or decrease in the future, and research on decision-making suggests that such expectations may determine their relationship commitment more than their current or past experiences do. In this chapter, we first identify factors (e.g., plans to improve the relationship, personality, gender) that may cause intimates’ expected experiences to diverge from their current experiences. Next, we review theoretical and empirical work suggesting that intimates’ relationship commitment should be determined more by their expected experiences than by their current or past experiences. Finally, we introduce a new measure of expected relationship satisfaction, alternatives, and investments designed for future research into these ideas.
Although sheep are known to be seasonal breeders and give birth in winter, not all of them follow this trend. A few breeds can be mated and give birth all year round, meaning that mothers and neonates will have to face contrasting climatic conditions. The aim of this study was to test whether lambing season affects maternal and neonatal behaviors in D’man sheep. During four different lambing seasons (winter, autumn, summer and spring), periparturient ewes (n = 111) and their lambs (n = 213) were kept under 24-h-video surveillance in order to record postpartum behaviors. Mother-young preference was tested around 48 h after parturition. Lamb vigor was studied by the determination of birth weight, early postnatal behavior and rectal temperature at birth and 48 h later. Litter expulsion time was not affected by lambing season, but birth weight was biased against summer and winter born lambs. Ewes provided a higher intensity of care to their offspring in winter: latency for grooming was shorter and time spent grooming was longer compared to lambing in spring and summer (P = 0.01 in all cases). On the other hand, lambs were the most active in spring as they were faster to extend their hind legs (P = 0.01), stand up (P = 0.04) and reach the udder (P = 0.04). Rectal temperature at 48 h was affected by season of birth (P < 0.001) with higher values observed in summer. Glycemia variation between birth and 48 h was the lowest in spring born lambs and plasma levels increased less in spring born lambs than in winter (P < 0.0001), autumn (P < 0.0001) and summer born lambs (P < 0.0001). In the choice test, mothers clearly preferred their own young and no season effect was detected except that in the first minute of the test they spent less time near their own young in winter than in the other seasons (P = 0.04). Lambs also chose their mother successfully without any major effect of the season however, but winter born lambs were the least vocal (P = 0.01). Overall, this study show that maternal care, lamb behavior and vigor vary lightly according to seasons, albeit not in a consistent manner. In conclusion, a season is no more detrimental than another for the onset of mother-young relationships.
L’utilisation prolongée et les associations de benzodiazépines (BZD) anxiolytiques et hypnotiques exposent à des risques à court et long terme (dépendance, démence, troubles psychomoteurs…). Selon la Haute Autorité de santé (HAS), il n’y a pas lieu d’associer une BZD et un apparenté (zopiclone ou zolpidem) le soir.
– Évaluer les habitudes de prescription des BZD et de leurs apparentés hypnotiques dans une population de patients suivis en psychiatrie hospitalière.
– Suivre sur 6 années l’évolution de ces pratiques de prescription et l’émergence d’alternatives thérapeutiques aux BZD.
– Établir un parallèle avec les recommandations et les actualités de la littérature au sujet de ces risques pendant cette même période.
L’étude rétrospective a été réalisée au centre hospitalier Henri-Laborit (Poitiers) en sélectionnant les ordonnances informatisées comportant des BZD et/ou apparentés sur une période allant du 1er janvier 2008 au 31 décembre 2013, par tranche d’une année. Les associations de ces molécules et leurs posologies ont été répertoriées.
L’analyse de 6511 ordonnances a notamment mis en évidence que la prescription de zolpidem ou zopiclone seuls, sans association à une benzodiazépine, est majoritaire (77,5 % des ordonnances en moyenne) jusqu’en 2010. Puis elle diminue fortement (plus que 38 % en 2013) et elle est inférieure à celle de benzodiazépine seule pendant les 3 années suivantes. Parallèlement, le nombre total d’ordonnances dans cet hôpital est en constante augmentation. L’association de benzodiazépine et d’apparentés sur une même ordonnance reste peu courante, dans 2 % des prescriptions en moyenne, mais la prise des deux se situe le soir dans 91 % des cas (69–100 %).
L’étude montre une diminution de prescription d’hypnotiques apparentés aux BZD, allant de pair avec les mises en garde sur leurs effets indésirables et aux actions de l’HAS. Leur association en soirée à des BZD reste présente et une étude prospective auprès des prescripteurs pour connaître leur choix d’alternative thérapeutique est nécessaire.
Treatment of schizophrenia with antipsychotic drugs is frequently sub-optimal. One reason for this may be heterogeneity between patients with schizophrenia. The objectives of this study were to identify patient, disease and treatment attributes that are important for physicians in choosing an antipsychotic drug, and to identify empirically subgroups of patients who may respond differentially to antipsychotic drugs. The survey was conducted by structured interview of 744 randomly-selected psychiatrists in four European countries who recruited 3996 patients with schizophrenia. Information on 39 variables was collected. Multiple component analysis was used to identify dimensions that explained the variance between patients. Three axes, accounting for 99% of the variance, were associated with disease severity (64%), socioeconomic status (27%) and patient autonomy (8%). These dimensions discriminated between six discrete patient subgroups, identified using ascending hierarchical classification analysis. The six subgroups differed regarding educational level, illness severity, autonomy, symptom presentation, addictive behaviors, comorbidities and cardiometabolic risk factors. Subgroup 1 patients had moderately severe physician-rated disease and addictive behaviours (23.2%); Subgroup 2 patients were well-integrated and autonomous with mild to moderate disease (6.7%); Subgroup 3 patients were less well-integrated with mild to moderate disease, living alone (11.2%); Subgroup 4 patients were women with low education levels (5.4%), Subgroup 5 patients were young men with severe disease (36.8%); and Subgroup 6 patients were poorly-integrated with moderately severe disease, needing caregiver support (16.7%). The presence of these subgroups, which require confirmation and extension regarding potentially identifiable biological markers, may help individualizing treatment in patients with schizophrenia.
Anxiety and depression are often interlinked as demonstrated by clinical, epidemiological, psychopharmacological and even genetic studies. However, robust biochemical and electrophysiological evidence for linkage or separation of mood and anxiety disorders is scarce. Brain stem auditory evoked potentials (BASEP) can easily and non-invasivly be measured in psychiatric patients and reflect neurophysiological processes in the brain stem. The aim of the present study was to evaluate BASEP in drug-free patients suffering from panic disorder or major depression and to compare these to healthy controls. Patients (n = 26; panic = 16, depression = 10) were diagnosed according to Diagnostic and Statistical Manual (DSM)-III-R criteria assessed by the Hamilton Anxiety and Hamilton Depression Scales, and all underwent 3 weeks of medications washout. All subjects (n = 36) completed the study. N3 latency was decreased in the patient group (P < 0.05), N3-5 interval was lengthened (P < 0.05), the N3 latency correlated with anxiety scores and depression scores correlated with the N3 and N5 latency periods. In conclusion, our small sample demonstrated shared electrophysiological variables in panic disorder and depression, further supporting the concept of spectrum disorder.
Preliminary data suggest that patients who suffer from both bipolar disorder (BD) and alcohol dependence (AD) may be more vulnerable to cognitive dysfunction than patients with a single diagnosis, especially during periods that are clinically unstable.
The purpose of this study was to examine the cognitive recovery of dually-diagnosed patients during remission from an acute mood disturbance.
The study aimed to replicate our previous comparison of cognitive functioning between BD patients with and without AD, while on the inpatient unit, and to extend this investigation in a longitudinal design post-discharge.
Fifty-five adult inpatients with bipolar I disorder completed a neuropsychological battery, mood measures and substance abuse measures upon discharge from the hospital and at a 3 month follow up. Analyses provided group comparisons on these measures between patients who presented with co-occurrence of AD (n = 21) in the year prior to hospital admission and patients without a Substance Use Disorder (SUD; n = 34).
Compared to patients without SUD, dually-diagnosed patients scored significantly more poorly on measures of visual memory, verbal memory and executive functioning both at hospital discharge and follow-up. They also exhibited more limited recovery of these functions over the course of this period. Mood symptoms decreased in both groups from discharge to follow up.
Patients with co-occurring BD and AD may suffer from more severe cognitive dysfunction and less favorable recovery of cognitive deficits than BD patients without SUD over the course of remission from a mood episode.
Individuals grieving a suicide death (suicide survivors) may be at risk for psychiatric complications and suicidal behaviors. Support groups may provide valuable resource for survivors, who often do not seek out mental health treatment. Social support and self regulation which are at the nature of the support groups can facilitate growth from crisis.
Objectives & aims
The objective of the present study was to investigate the effectiveness of support groups for suicide survivors. The specific aims were to assess the relationship between group participation and stress related growth and to assess the role of self regulation and social support as mediating variables.
74 suicide survivors belonged to one of two groups: 32 survivors who participate in a support group, compared with 42 survivors who did not participate. All participants completed questionnaires covering of self regulation, social support and stress related growth.
Survivors who participated in a support group showed better recovery from stress than those who didn’t participate. The effect was stronger in survivors who lost their offspring. A hierarchical regression indicates that time past from the event as well as self regulation and social support explained more than 33% of the variance of stress related growth.
Support groups for suicide survivors are a helpful intervention tool and can serve as a powerful form of primary and secondary prevention. Social support as well as self disclosure to other survivors can facilitate growth from crisis and diminish feelings of guilt, shame and other psychiatric complications.
Abnormal premorbid personality has long been considered to be an important feature of patients who develop schizophrenia, or schizophrenic-like psychoses late in life. Schizoid and paranoid personality traits in particular are repeatedly reported to have preceded the development of psychosis by many years. Such personality abnormalities have been viewed as part of a schizophrenic spectrum disorder, causally invoked in the aetiology of psychosis, or even regarded as an adaptive protection of vulnerable individuals against psychotic breakdown. An ICD-10 diagnosable personality disorder, however, is seen in only about 50% of patients who develop a paranoid psychosis late in life. The premorbid personality abnormalities encountered in late-onset paranoid states and delusional disorder are different from those reported in schizophrenia and there appears to be a genetic basis for these differences. The role of such personality disturbance in the aetiology of psychosis is controversial but probably only minor.
Early intervention in psychosis constitutes an important opportunity to change the classic limited outcome associated with the patients who suffer of psychotic disease.
Based on literature review the authors analyse the evidence for early intervention in first psychotic episode.
The evidence for the effectiveness of interventions in early psychosis can be considered in two stages:
1. first stage before the onset of full symptoms of psychosis, in people with high risk of developing psychosis or in the prodrome phase of the illness;
2. second stage includes the therapeutic focus on the period after the first psychotic episode, reducing the duration of untreated psychosis (DUP) and ameliorate the recovery.
Preventing psychosis by intervene in the prodrome or in people with high risk of developing psychosis remains ethically contentious because of the non-specificity of the symptoms. by the contrary there is evidence that early and specialised intervention in first psychotic episode improves outcome. Besides the controversy of the relation between long DUP and poor outcome, there is agreement that clinicians should identify and treat psychosis early with a great impact in patients and their family's life. Effective care during first psychotic episode includes proactive engagement and initiation of low doses of antipsychotics and psychosocial treatments, aiming for maximal symptomatic and functional recovery and the prevention of relapse.
There is evidence that early intervention in first psychotic episode improve clinical effectiveness over standard care. Further studies are important to make evidence more robust.
Low bone mineral density (BMD) is a major public health issue leading to fractures, pain and disability. The association between psychosis and low bone density has been suggested in the last years.
The authors review the literature in Medline database using the words ‘bone mineral density’, ‘psychosis’, ‘antipsychotic’, ‘schizophrenia’, ‘bipolar disorder’ and ‘psychiatry disorders’.
Some studies show elevated prevalence of changes in BMD in patients with psychiatry disorders, namely psychosis. These changes are multifactorial, due to therapeutic factors and/or to the disorder per se. The low BMD induced by some antipsychotic drugs has been attributed mostly to hyperprolactinaemia and its consequences. Lithium, carbamazepine, sodium valproate and the use of thyroid-stimulating hormone-suppressive doses of L-thyroxin used in bipolar disorder also have a negative impact on bone health. Patients with psychosis could be vulnerable to bone abnormalities even without treatment, environmental factors like smoking, sedentary lifestyle, decreased exposure to sunlight, alcoholism, dietary deficiencies and polydipsia are partially responsible for that. Also genetic factors (vitamin D receptor gene, estrogen receptor gene etc.) and biological factors (gender, decreased of peak bone mass, abnormalities in immune-inflammatory mechanisms, hypercortisolemia stress-induced etc.) contribute to the abnormalities in bone dynamics in psychosis.
The association between low BMD and psychosis has been demonstrated in literature, understanding all the factors involved in this process will help the development of preventive and treatment strategies. A large study including first psychotic episode patients could be useful to distinguish between disorder and drug induced factors of low BMD in psychosis.
Catatonic schizophrenia has been described as being decreasing in prevalence. We present a case of a 16 year-old-girl, previously healthy, who develops catatonic schizophrenia in a 5 months period.
we present the case of a 16-year-old girl, previously healthy, with family history of schizophrenia, develops 5 months prior to hospital admittance isolation from friends and odd behaviour, like suddenly standing still and speechless (thought blocking). She maintains these attitudes and 3 months after, develops delirious thoughts of death with agitation (screaming and undressing). One month prior to admittance she becomes diskinetic and mute, with loss of sphincter control. She is medicated by a neurologist with olanzapine 5mg od and valproate 200mg bid. As her clinical state worsens, she is brought to a central hospital, where she has MRI and lumbar puncture normal. She is observed by neurologists and psychiatrists in the emergency room. Against the psychiatrist opinion, she is admitted to the neurology ward. After repeating MRI and lumbar puncture and searching for neurotrophic viruses and prions´ disease, which all turn out negative, she is proposed for electroconvulsivetherapy (ECT) and transferred to a psychiatric ward.
She is submitted to 14 ECT and medicated with seroquel 300 bid with dramatic improvement.
this case illustrates the secondary role psychiatry is sometimes appointed to in contemporary medicine. Catatonic schizophrenia is a rare disorder and an even rarer form of presentation of schizophrenia. Nevertheless, it exists, and should be taken into account in the differential diagnosis of diskinesia.
Treatment adherence is crucial to the therapeutic success in psychiatric disorders. Evaluating factors involved in treatment adherence will allow to modify treatment strategies for greater compliance. the aim of the study was to evaluate factors involved in treatment adherence, including subjective patients’ satisfaction.
The study included in- and outpatients who met the criteria according to DSM-IV TR of schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, psychosis not otherwise specified, brief psychotic disorder and bipolar disorder. the following questionnaires were applied:
1. Demographic and clinical questionnaire;
2. Treatment Satisfaction Questionnaire for Medication Version II (TSQM vII);
3. Medication Adherence Rating Scale (MARS);
4. Schedule for Assessment of Insight (SAI);
5. World Health Organization Quality of Life-BREF Scale (WHOQoL-BREF).
TSQM vII is a self-reporting questionnaire to assess the major dimensions of patients’ satisfaction with their medication, includes 11 items that make up three specific scales (effectiveness, side-effects and convenience).
Twenty patients, between 18 and 65 years of age, were included. an interview was made and the 5 questionnaires were applied. the statistical analysis, using Regression Analysis Stepwise, showed a significant positive correlation between medication adherence, evaluated by MARS, and treatment effectiveness to the patients, evaluated by TSQMvII effectiveness scale (p=0.028). the correlations between the others parameters were not statistically significant.
In this study the authors found that the self-experience of treatment effectiveness, which is a major dimension for treatment satisfaction, had a positive correlation with treatment adherence. Strategies to enhance subjective treatment effectiveness are needed to improve medication adherence.
In Europe, in the late 19th century and the first half of the 20th century, new nosologic categories were formulated that could not be framed within Manic-Depressive Psycosis or Kraeplins' Demencia Praecox: Bouffée delirante by the French, Cycloid Psychosis by the German, Reactive and Schizophreniform Psychosis by the Scandinavians. These are concepts that are currently classified in the ICD-10 under Acute and Transitory Psychotic Disorders.
Cycloid Psychosis are characterized by an abrupt onset and polimorfic symptomatology namely delusions, hallucinations in every sensory modality, confusion, akinesia or hyperkinesia, feelings of ecstasy, which can vary with time. They have a recurring course, rapid remission followed by the reinstatement of the premorbid personality.
We present a case study of a female, 26 year old patient. The first psychotic episode occurred 2 years ago and was followed by complete recovery. Recently, there was a recrudescence of the symptomatology. She presented with a polimorfic symptoms, alternating between mutism and psychomotor agitation, disorientation, incoherent speech and almost total insomnia. There was an absence of response to antipsychotic medication. Therefore, the patient was submitted to electroconvulsive therapy with an overall improvement of symptoms, maintaining some puerility. The aim of this case study was to draw attention to the diagnosis of Cycloid Psychosis, and it confirms the efficacy of electroconvulsive therapy in its treatment.
Cognitive deficits are a core feature of the first psychotic episode patients and could be an obstacle to functional ability. Cognitive stimulation could be a promising method to surpass neuropsychological deficits.
–to implement an online training protocol to stable first psychotic episode outpatients;
–to assess adherence to the intervention;
–to measure neurocognitive, psychopathological and functional outcomes pre- and post-training.
To investigate the feasibility of an online-based resource for cognitive stimulation (COGWEB®) and explore possible benefits in different domains.
Fifteen patients were enrolled from the Early Psychosis Intervention Program (PROFIP) at the Department of Psychiatry of Santa Maria Hospital, Lisbon. The training consisted on 30-40-minute online sessions performed every weekday during 6 months at home. Assessments were performed at baseline and after program completion and included: psychopathological scores; personal and social functioning scores; Clinical Global Impression and a neuropsychological battery.
Every participant had some kind of impairment on baseline. Mean training time was 36 h. Six patients left the program before completion (half of them because they got employed). The program showed overall good feasibility and safety with no reported significant psychiatric occurrences or hospitalizations. Results regarding final neuropsychological, psychopathological and functioning showed a tendency for stability or improvement on an individual case analysis.
Our results show that cognitive training using an online-based stimulation software is a feasible intervention for first-episode psychosis patients with possible benefits for this population. However, results should be analyzed very carefully because of different participant trajectories and of study limitations.
Disclosure of interest
The authors have not supplied their declaration of competing interest.