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Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
Anorexia nervosa (AN) is characterized by an overgeneralization of food/body-related autobiographical memories (AM). This is regarded as an emotion regulation strategy with adverse long-term effects implicated in disorder maintenance and treatment resistance. Therefore, we aimed to examine neural correlates of food/body-related AM-recall in AN.
Twenty-nine female patients with AN and 30 medication-free age-sex-matched normal-weight healthy controls (HC) underwent functional magnetic resonance imaging while recalling AMs in response to food/body-related and neutral cue words. To control for general knowledge retrieval, participants engaged in a semantic generation and riser detection task.
In comparison to HC, patients with AN generated fewer and less specific AMs in response to food/body-related words, but not for neutral cue words. Group comparisons revealed reduced activation in regions associated with self-referential processing and memory retrieval (precuneus and angular gyrus) during the retrieval of specific food/body-related AM in patients with AN. Brain connectivity in regions associated with memory functioning and executive control was reduced in patients with AN during the retrieval of specific food/body-related AM. Finally, resting-state functional connectivity analysis revealed no differences between groups, arguing against a general underlying disconnection of brain networks implicated in memory and emotional processing in AN.
These results indicate impaired neural processing of food/body-related AM in AN, with a reduced involvement of regions involved in self-referential processing. Our findings are discussed as possible neuronal correlates of emotional avoidance in AN and provide new insights of AN-pathophysiology underscoring the importance of targeting dysfunctional emotion regulation strategies during treatment.
Engagement with members is an important issue for the Royal College of Psychiatrists (RCPsych) and an area for ongoing development. This is an issue that extends to Psychiatry trainees and the Psychiatric Trainees’ Committee (PTC) has adopted increasing engagement as one of its key aims. Divisional representatives in different areas of the UK had noted that trainees had limited knowledge of the PTC or its roles and projects both within the College and local areas. To improve this it was decided to pilot a project that established a social media platform for trainees to improve communication between the PTC, it's representatives and trainees. It was decided that Workplace (a professional version of Facebook) would be used. This had already been established in the Severn Deanery.
Northern Ireland (NI) and the East of England (EoE) deaneries were selected as pilot areas for the project. Preparation for the project included collaboration with trainees from the Severn deanery and meeting with the RCPsych Digital team. A scoping questionnaire was circulated to trainees in each deanery.
Following this, two closed groups were initiated on Workplace in August 2019 for Northern Ireland and East of England trainees.
Results from the survey sent prior to the social media pages being established indicated there was appetite among trainees for the project. The pages were established in July 2019. The pilot project was promoted by representatives.
In the initial phases, approximately 40% of trainees signed up. Information regarding college and local events, committee meeting updates and training opportunities was disseminated on the platform. There was evidence of early use by trainees outside of the representative group.
This however was not sustained and gradually use of the platform reduced over the pilot period, both in postings and membership. A further questionnaire circulated in July 2020 highlighted trainees’ concerns relating to the platform, including concerns around data protection and a high number of notifications associated with the Workplace medium. The ultimate impact on engagement was also felt to be minimal.
Following feedback and increasing usage costs by Workplace, it was decided not to continue with a nationwide role out of the project. COVID-19 has seen the successful use of platforms such as Microsoft Teams and these may be considered in the future, given their integration with existing trust systems.
Patients in medium secure hospitals may be at particularly increased risk of coronavirus disease 2019 (COVID-19) infection and complications. We undertook a service evaluation involving all current in-patients within a single, English medium secure hospital to describe the uptake of the COVID-19 vaccine among this population. Data regarding capacity to consent to the vaccine, acceptance/refusal of this (and reasons for refusal) and demographics was retrospectively collected from the patients’ clinical records and analysed. In total, 85 patients (92.4% of eligible patients) had capacity to decide if they wanted the COVID-19 vaccine. Of these 68 (80.0%) consented and 17 (20.0%) declined to consent. A similar proportion of patients aged under and over 40 years old consented to have the vaccine. Those from a Black Asian minority ethnic background were more likely to decline the vaccine than White British patients. The reasons for capacitous refusal appeared similar to those seen in the general population.
There are numerous health effects associated with excess sugar-sweetened beverage (SSB) consumption. Interventions aimed at reducing population-level consumption require understanding of the relevant barriers and facilitators. This study aimed to identify the variables with the strongest relationship with intentions to reduce SSB consumption from a suite of variables derived from the literature.
Random-digit dialling of landline and mobile phones was used to survey adults using computer-assisted telephone interviews. The outcome variable was ‘likelihood of reducing SSB consumption in next 6 months’, and the predictor variables were demographics, SSB attitudes and behaviour, health risk perceptions and social/environmental exposure.
A subsample of 1630 regular SSB consumers from a nationally representative sample of 3430 Australian adults (38 % female, 51 % aged 18–45 years, 56 % overweight or obese).
Respondents indicated that they were ‘not at all’ (30·1 %), ‘somewhat’ (43·9 %) and ‘very likely’ (25·3 %) to reduce SSB consumption. Multivariate nominal logistic regressions showed that perceiving future health to be ‘very much’ at risk was the strongest predictor of intention to reduce SSB consumption (OR = 8·1, 95 % CI 1·8, 37·0, P < 0·01). Other significant predictors (P < 0·01) included self-perceptions about too much consumption, habitual consumption, difficulty reducing consumption and likelihood of benefitting from reduced consumption.
Health risk perceptions had the strongest relationship with intentions to reduce consumption. Age and consumption perceptions were also predictors in the multivariate models, whereas social/environmental exposure variables were not. Interventions may seek to incorporate strategies to denormalise consumption practices and increase knowledge about perceived susceptibility to health risks.
The chapter concludes the book bu summarising the main points and indicating future directions and possible applications. We suggest applications such as disordered dialogue (e.g., involving young children or people with autism) and remote conferencing facilities.
The chapter discusses how motor control theory can be applied to language production in dialogue. We develop the theory starting with control of individual speech production using self-monitoring supported by forward speech models. We then show how the production system supports interpretation of a partner's speech through simulation, as in other forms of action. Finally we show how the combination of forward modelling for comprehension and production supports distributed control of dialogue.
Linguistic interaction between two people is the fundamental form of communication, yet almost all research in language use focuses on isolated speakers and listeners. In this innovative work, Garrod and Pickering extend the scope of psycholinguistics beyond individuals by introducing communication as a social activity. Drawing on psychological, linguistic, philosophical and sociological research, they expand their theory that alignment across individuals is the basis of communication, through the model of a 'shared workspace account'. In this workspace, interlocutors are actors who jointly manipulate and control the interaction and develop similar representations of both language and social context, in order to achieve communicative success. The book also explores dialogue within groups, technologies, as well as the role of culture more generally. Providing a new understanding of cognitive representation, this trailblazing work will be highly influential in the fields of linguistics, psychology and cognitive linguistics.
The chapter presents the theory of interactive alignment and primarily focuses on the alignment of linguistic representations underlying the utterances that each speaker contributes to the dialogue. Such representations enable interlocutors to formulate phrases, words, or gestures that move the dialogue forward. We also consider two dimensions of alignment (focal vs. global, and linguistic vs. dialogue model) and how alignment relates to reference and the role of dialogue routines in support of alignment.
The chapter shows how interlocutors achieve alignment of dialogue models -- that is, both situation models and dialogue game models. Such alignment is the basis of successful dialogue. We discuss the importance of co-reference for alignment of situation models. We then consider the role of meta-representation of aiignment in dialogue and how this controls what people choose to say next. We consider the relationship between focal alignment of dialogue models and what is in the shared workspace. Finally, we discuss the relationship between alignment and common ground.
The chapter discusses efficient use of the limited shared workspace and how interlocutors work together to achieve it. We introduce the notion of commentary (both positive and negative) that reflects interlocutors' confidence in focal alignment. We show how positive commentary leads directly to succinct expressions and negative commentary leads to fuller expressions. As a result, positive and negative commentary promote alignment while minimizing collaborative effort.
The chapter discusses cooperative joint activities such as a man and woman jointly constructing a piece of flat-pack furniture. It describes the shared workspace framework for how pairs of individuals can jointly execute such activities. The framework assumes a limited capacity workspace reflecting what the actors jointly attend to at any moment. For cooperative joint activities in general the workspace contains meaningful entities and behaviours that offer joint affordances to the interactants.The combination of the individuals and the shared workspace captures non-monadic aspects of cognition such as alignment and synchrony.