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Obesity is highly prevalent and disabling, especially in individuals with severe mental illness including bipolar disorders (BD). The brain is a target organ for both obesity and BD. Yet, we do not understand how cortical brain alterations in BD and obesity interact.
We obtained body mass index (BMI) and MRI-derived regional cortical thickness, surface area from 1231 BD and 1601 control individuals from 13 countries within the ENIGMA-BD Working Group. We jointly modeled the statistical effects of BD and BMI on brain structure using mixed effects and tested for interaction and mediation. We also investigated the impact of medications on the BMI-related associations.
BMI and BD additively impacted the structure of many of the same brain regions. Both BMI and BD were negatively associated with cortical thickness, but not surface area. In most regions the number of jointly used psychiatric medication classes remained associated with lower cortical thickness when controlling for BMI. In a single region, fusiform gyrus, about a third of the negative association between number of jointly used psychiatric medications and cortical thickness was mediated by association between the number of medications and higher BMI.
We confirmed consistent associations between higher BMI and lower cortical thickness, but not surface area, across the cerebral mantle, in regions which were also associated with BD. Higher BMI in people with BD indicated more pronounced brain alterations. BMI is important for understanding the neuroanatomical changes in BD and the effects of psychiatric medications on the brain.
Why is misleading partisan content believed and shared? An influential account posits that political partisanship pervasively biases reasoning, such that engaging in analytic thinking exacerbates motivated reasoning and, in turn, the acceptance of hyperpartisan content. Alternatively, it may be that susceptibility to hyperpartisan content is explained by a lack of reasoning. Across two studies using different participant pools (total N = 1,973 Americans), we had participants assess true, false, and hyperpartisan news headlines taken from social media. We found no evidence that analytic thinking was associated with judging politically consistent hyperpartisan or false headlines to be accurate and unbiased. Instead, analytic thinking was, in most cases, associated with an increased tendency to distinguish true headlines from both false and hyperpartisan headlines (and was never associated with decreased discernment). These results suggest that reasoning typically helps people differentiate between low and high quality political news, rather than facilitate belief in misleading content. Because social media play an important role in the dissemination of misinformation, we also investigated willingness to share headlines on social media. We found a similar pattern whereby analytic thinking was not generally associated with increased willingness to share hyperpartisan or false headlines. Together, these results suggest a positive role for reasoning in resisting misinformation.
A substantial body of evidence suggests that favoring reason over intuition (employing an analytic cognitive style) is associated with reduced belief in God. In the current work, we address outstanding issues in this literature with two studies examining the relationship between analytic cognitive style (as measured by performance on the Cognitive Reflection Test) and belief in God. First, prior research focused on Judeo-Christian cultures, and it is uncertain whether the results generalize to other religious systems or beliefs. Study 1 helps to address this question by documenting a negative correlation between CRT performance and belief in God, r = −.18, in a sample of 513 participants from India, a majority Hindu country. Second, among 150 participants from the United Kingdom, Gervais et al. (2018) reported the first and (to date) only evidence for a positive relationship between CRT and belief in God. In Study 2, we assess the robustness of this result by recruiting 547 participants from the United Kingdom. Unlike Gervais et al., using the same items, we find a negative correlation between CRT and belief in God (r = −.19). Our results add further support to the argument that analytic thinking undermines belief in God.
Only a limited number of patients with major depressive disorder (MDD) respond to a first course of antidepressant medication (ADM). We investigated the feasibility of creating a baseline model to determine which of these would be among patients beginning ADM treatment in the US Veterans Health Administration (VHA).
A 2018–2020 national sample of n = 660 VHA patients receiving ADM treatment for MDD completed an extensive baseline self-report assessment near the beginning of treatment and a 3-month self-report follow-up assessment. Using baseline self-report data along with administrative and geospatial data, an ensemble machine learning method was used to develop a model for 3-month treatment response defined by the Quick Inventory of Depression Symptomatology Self-Report and a modified Sheehan Disability Scale. The model was developed in a 70% training sample and tested in the remaining 30% test sample.
In total, 35.7% of patients responded to treatment. The prediction model had an area under the ROC curve (s.e.) of 0.66 (0.04) in the test sample. A strong gradient in probability (s.e.) of treatment response was found across three subsamples of the test sample using training sample thresholds for high [45.6% (5.5)], intermediate [34.5% (7.6)], and low [11.1% (4.9)] probabilities of response. Baseline symptom severity, comorbidity, treatment characteristics (expectations, history, and aspects of current treatment), and protective/resilience factors were the most important predictors.
Although these results are promising, parallel models to predict response to alternative treatments based on data collected before initiating treatment would be needed for such models to help guide treatment selection.
Fewer than half of patients with major depressive disorder (MDD) respond to psychotherapy. Pre-emptively informing patients of their likelihood of responding could be useful as part of a patient-centered treatment decision-support plan.
This prospective observational study examined a national sample of 807 patients beginning psychotherapy for MDD at the Veterans Health Administration. Patients completed a self-report survey at baseline and 3-months follow-up (data collected 2018–2020). We developed a machine learning (ML) model to predict psychotherapy response at 3 months using baseline survey, administrative, and geospatial variables in a 70% training sample. Model performance was then evaluated in the 30% test sample.
32.0% of patients responded to treatment after 3 months. The best ML model had an AUC (SE) of 0.652 (0.038) in the test sample. Among the one-third of patients ranked by the model as most likely to respond, 50.0% in the test sample responded to psychotherapy. In comparison, among the remaining two-thirds of patients, <25% responded to psychotherapy. The model selected 43 predictors, of which nearly all were self-report variables.
Patients with MDD could pre-emptively be informed of their likelihood of responding to psychotherapy using a prediction tool based on self-report data. This tool could meaningfully help patients and providers in shared decision-making, although parallel information about the likelihood of responding to alternative treatments would be needed to inform decision-making across multiple treatments.
Lee and Schwarz interpret meta-analytic research and replication studies as providing evidence for the robustness of cleansing effects. We argue that the currently available evidence is unconvincing because (a) publication bias and the opportunistic use of researcher degrees of freedom appear to have inflated meta-analytic effect size estimates, and (b) preregistered replications failed to find any evidence of cleansing effects.
Boyer & Petersen (B&P) argue that folk-economic beliefs are widespread – shaped by evolved cognitive systems – and they offer exemplar beliefs to illustrate their thesis. In this commentary, we highlight evidence of substantial variation in one of these exemplars: beliefs about immigration. Contra claims by B&P, we argue that the balance of this evidence suggests the “folk” may actually hold positive beliefs about the economic impact of immigration.
Singh's cultural evolutionary theory of shamanism is impressive, but it does not explain why some people become shamans while others do not. We propose that individual differences in where people lie on a “psychosis continuum” could play an important causal role.
Firestone & Scholl's (F&S) critique of putative empirical evidence for the cognitive penetrability of perception focuses on studies of neurologically normal populations. We suggest that a comprehensive exploration of the cognition–perception relationship also incorporate work on abnormal perception and cognition. We highlight the prominence of these issues in contemporary debates about the formation and maintenance of delusions.
The Institute Ice Stream (IIS) rests on a reverse-sloping bed, extending >150 km upstream into the ~1.8 km deep Robin Subglacial Basin, placing it at the threshold of marine ice-sheet instability. Understanding IIS vulnerability has focused on the effect of grounding-line melting, which is forecast to increase significantly this century. Changes to ice-flow dynamics are also important to IIS stability, yet little is known about them. Here we reveal that the trunk of the IIS occurs downstream of the intersection of three discrete subglacial features; a large ‘active’ subglacial lake, a newly-discovered sharp transition to a zone of weak basal sediments and a major tectonic rift. The border of IIS trunk flow is confined by the sediment on one side, and by a transition between basal melting and freezing at the border with the Bungenstock Ice Rise. By showing how basal sediment and water dictate present-day flow of IIS, we reveal that ice-sheet stability here is dependent on this unusual arrangement.
To determine the prevalence and acquisition of extended-spectrum β-lactamases (ESBLs), plasmid-mediated AmpCs (pAmpCs), and carbapenemases (“MDR Enterobacteriaceae”) colonizing children admitted to a pediatric intensive care unit (PICU).
Admission and weekly thereafter rectal surveillance swabs were collected on all pediatric patients during a 6-month study period. Routine phenotypic identification and antibiotic susceptibility testing were performed. Enterobacteriaceae displaying characteristic resistance profiles underwent further molecular characterization to identify genetic determinants of resistance likely to be transmitted on mobile genetic elements and to evaluate relatedness of strains including DNA microarray, multilocus sequence typing, repetitive sequence-based PCR, and hsp60 sequencing typing.
Evaluating 854 swabs from unique children, the overall prevalence of colonization with an MDR Enterobacteriaceae upon admission to the PICU based on β-lactamase gene identification was 4.3% (n=37), including 2.8% ESBLs (n=24), 1.3% pAmpCs (n=11), and 0.2% carbapenemases (n=2). Among 157 pediatric patients contributing 603 subsequent weekly swabs, 6 children (3.8%) acquired an incident MDR Enterobacteriaceae during their PICU stay. One child acquired a pAmpC (E. coli containing blaDHA) related to an isolate from another patient.
Approximately 4% of children admitted to a PICU were colonized with MDR Enterobacteriaceae (based on β-lactamase gene identification) and an additional 4% of children who remained in the PICU for at least 1 week acquired 1 of these organisms during their PICU stay. The acquired MDR Enterobacteriaceae were relatively heterogeneous, suggesting that a single source was not responsible for the introduction of these resistance mechanisms into the PICU setting.
Current multiple sclerosis (MS) treatment is only partially effective and not all patients respond well. The goal in this study was to evaluate minocycline for its safety, tolerability, and MRI impact as a potential therapy over 36 months after a three month run-in in ten relapsing-remitting (RR) MS patients.
Clinical assessments were at three month intervals until six months, then at six month intervals. Three Tesla MRI was performed monthly during the run-in and first six months of treatment, then at 12, 24, and 36 months.
Treatment was safe and well tolerated. Annualized relapse rate was 1.2 during the run-in and 0.25 during treatment. The proportion of active scans was lower during the first six months of treatment (5.6%, p<0.001) and during the extension (8.7%, p= 0.002) than during the run-in (47.5%). Consistent with these outcomes, mean T2 lesion volume remained stable over three years and percent brain volume change was reduced during year three (-0.37%) of minocycline treatment.
This trial is limited by small sample and no control group but suggests that minocycline is safe and potentially beneficial in RRMS. This supports further investigation of its efficacy.
In 1976, David Sugden and Brian John developed a classification for Antarctic landscapes of glacial erosion based upon exposed and eroded coastal topography, providing insight into the past glacial dynamics of the Antarctic ice sheets. We extend this classification to cover the continental interior of Antarctica by analysing the hypsometry of the subglacial landscape using a recently released dataset of bed topography (BEDMAP2). We used the existing classification as a basis for first developing a low-resolution description of landscape evolution under the ice sheet before building a more detailed classification of patterns of glacial erosion. Our key finding is that a more widespread distribution of ancient, preserved alpine landscapes may survive beneath the Antarctic ice sheets than has been previously recognized. Furthermore, the findings suggest that landscapes of selective erosion exist further inland than might be expected, and may reflect the presence of thinner, less extensive ice in the past. Much of the selective nature of erosion may be controlled by pre-glacial topography, and especially by the large-scale tectonic structure and fluvial valley network. The hypotheses of landscape evolution presented here can be tested by future surveys of the Antarctic ice sheet bed.
A consensus conference on the reasons for the undertreatment of depression was organized by the National Depressive and Manic Depressive Association (NDMDA) on January 17–18,1996. The target audience included health policymakers, clinicians, patients and their families, and the public at large. Six key questions were addressed: (1) Is depression undertreated in the community and in the clinic? (2) What is the economic cost to society of depression? (3) What have been the efforts in the past to redress undertreatment and how successful have they been? (4) What are the reasons for the gap between our knowledge of the diagnosis and treatment of depression and actual treatment received in this country? (5) What can we do to narrow this gap? (6) What can we do immediately to narrow this gap?
Long-acting injectable formulations of antipsychotics are treatment alternatives to oral agents.
To assess the efficacy of aripiprazole once-monthly compared with oral aripiprazole for maintenance treatment of schizophrenia.
A 38-week, double-blind, active-controlled, non-inferiority study; randomisation (2:2:1) to aripiprazole once-monthly 400 mg, oral aripiprazole (10–30 mg/day) or aripiprazole once-monthly 50mg (a dose below the therapeutic threshold for assay sensitivity). (Trial registration: clinicaltrials.gov, NCT00706654.)
A total of 1118 patients were screened, and 662 responders to oral aripiprazole were randomised. Kaplan–Meier estimated impending relapse rates at week 26 were 7.12% for aripiprazole once-monthly 400mg and 7.76% for oral aripiprazole. This difference (−0.64%, 95% CI −5.26 to 3.99) excluded the predefined non-inferiority margin of 11.5%. Treatments were superior to aripiprazole once-monthly 50mg (21.80%, P⩽0.001).
Aripiprazole once-monthly 400mg was non-inferior to oral aripiprazole, and the reduction in Kaplan–Meier estimated impending relapse rate at week 26 was statistically significant v. aripiprazole once-monthly 50 mg.