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International best-practice guidelines for the management of first-episode psychosis have recommended the provision of psychoeducation for multifamily groups. While there is ample evidence of their efficacy in multiepisode psychosis, there is a paucity of evidence supporting this approach specifically for first-episode psychosis. We sought to determine whether a six-week caregiver psychoeducation programme geared specifically at first-episode psychosis improves caregiver knowledge and attitudes.
Caregivers of people with first-episode psychosis completed a 23-item adapted version of the self-report Family Questionnaire (KQ) and a 17-item adapted version of the self-report Drug Attitudes Inventory (DAI) before and after the six-week DETECT Information and Support Course (DISC). Using a Generalised Linear Repeated Measures Model, we analyzed the differences in proportions of correct answers before and after the programme.
Over a 24-month study period, 31 caregivers (13 higher socioeconomic; 13 lower socioeconomic; five unspecified socioeconomic; 19 female; 12 male) participated in the DISC programme and completed inventories before and after the course. Knowledge of psychosis and specific knowledge of medication treatment improved among caregivers overall (p < .01; effect sizes 0.78 and 0.94 respectively). There were no significant gender or socioeconomic differences in any improvement.
This study confirms that caregiver psychoeducation specifically for first-episode psychosis directly improves knowledge of the illness overall and, in particular, knowledge of medication. Gender is not a factor in this, while the lack of any socioeconomic differences dispels the myth that patients in lower socioeconomic groups are disadvantaged because their caregivers know less.
To investigate whether specific symptoms of attention deficit hyperactivity disorder (ADHD) can help identify ADHD patients with mind wandering.
Subjects were adults ages 18–55 of both sexes (n=41) who completed the Mind-Wandering Questionnaire (MWQ) and the ADHD module of the Schedule for Affective Disorders and Schizophrenia for School-Age Children Epidemiologic Version. We used Spearman’s rank correlation and Pearson’s χ2 analyses to examine associations between the ADHD module and the MWQ and receiver operator characteristic (ROC) analyses to evaluate the diagnostic efficiency of the ADHD module.
Out of the three ADHD domains, the inattentive ADHD scores had the strongest association with the MWQ (total: rs=0.34, df=39, p=0.03; inattentive: rs=0.38, df=39, p=0.02; Hyperactive: rs=0.17, df=39, p=0.28). Correlation analyses between individual items on the ADHD module and the MWQ showed that two inattention items (‘failure to pay attention to detail’ and ‘trouble following instructions’) were positively associated with total scores on the MWQ (p=0.02). These two inattention items had the strongest association with the MWQ (rs=0.45, df=38, p=0.004). ROC analyses showed that the combined score of the two significant inattention items had the highest efficiency (AUC=0.71) in classifying high-level mind wanderers as defined by scores greater than the median split on the MWQ. The combined score of the two inattention items best identified high-level mind wanderers.
Results suggest a way to operationalise mind wandering using the symptoms of ADHD.
Environmental sampling in hospitals, when required, needs to be reliable. We evaluated different methods of sampling methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase–producing Escherichia coli on 5 materials of the hospital setting. Petrifilms and contact plates were superior to swabs for all of the surfaces studied.
The Lifetime Impairment Survey, conducted in Europe, assessed impairment and symptoms of attention-deficit/hyperactivity disorder (ADHD) in childhood, and experiences of ADHD diagnosis and treatment, as recalled by adults.
Adults with ADHD and without ADHD (control group) were invited to participate in an internet-based survey and report on their childhood experiences. History of ADHD diagnosis was self-reported. Groups were compared using impairment and symptom scales.
Overall, 588 adults with ADHD and 736 without ADHD participated. Mean (standard deviation [SD]) age at diagnosis of ADHD was 20.0 (12.6) years (median 18.0) following consultation with 3.8 (5.1) doctors (median 2) over 44.6 (69.3) months (median 17.0). A total of 64.1% (377/588) of adults with ADHD reported frustration or difficulties during the diagnostic process. The ADHD group had a higher mean (SD) score versus control for general (3.3 [1.2] vs 2.1 [1.2]; p < 0.001) and school impairment (2.8 [0.7] vs 2.3 [0.6]; p < 0.001) but not home impairment (2.1 [0.5] for both groups).
The survey demonstrated that ADHD had a negative impact on all aspects of childhood investigated, as recalled by adults.
These data provide insights into childhood impairments and identify areas for improvement in the management and treatment of ADHD.
The Gemini Planet Imager (GPI) is a high contrast coronagraph designed to directly image exoplanets and circumstellar disks. GPI includes a polarimetry mode designed to characterize dust grains and enhance the contrast of scattered, polarized light by a factor of 100. Reflections and birefringence of optics within the optical train induce a polarization signature that needs to be measured a priori and calibrated out during data reduction. Here we report on the results of an extensive laboratory characterization campaign of the polarimetry mode. The linear instrumental polarization has been measured in 4 GPI passbands and found to be between 3.5 ± 0.3 % at 1.0 micron and 1.1 ± 0.3 % at 2.0 microns. Modulation efficiency has been measured to be 94% at 1.0 micron increasing to 97% at 2.0 microns. Stability has been shown to better than 0.6% over timescales of ~ 3 months and over cool down cycles. The tests show that GPI passes all polarimetry design requirements and should be able to measure circumstellar disk linear polarization to 1% accuracy.
We contrast the current, clinically based framework for behavior disorder against a life course framework, as an alternative structure upon which to map the variations in onset and stability of clinical symptomatology known to take place in adult life. This alternative developmental framework is used as a base around which to understand known variations in rates of alcohol abuse/dependence over the life course and to review existing schemes for the evaluation of developmental variation in “caseness.” From this work, it was proposed that symptom structure be regarded as a mass of greater or lesser breadth, with properties of extensiveness in time and life course invasiveness, as a function of where in the life course the symptomatology first emerged, and the degree to which the mass sustained itself in developmental time. This framework guided the construction of a time-based measure of alcohol related symptomatology, called the Lifetime Alcohol Problems Score (LAPS). The LAPS discriminated among a variety of alcohol-specific and nonalcohol-specific measures of alcohol-related difficulty, including diagnosis of alcohol dependence, having been in treatment, level of other psychopathology, and measures of family disorganization. The measure has potential applicability for prospective studies, and in estimating clinical prognosis. The utility of the paradigm as a framework within which to conceptualize the emergence, ebb, and flow of other behavior disorders is also discussed.
The clinical features of a fatal case of the neuroleptic malignant syndrome are presented. The fatal episode was a recurrence of the syndrome after a milder episode 3 months earlier. Prescription of neuroleptics was continued unchanged following the latter, as a correct diagnosis was not made at the time. The case emphasises the importance of early recognition of the syndrome and the possibility of spontaneous remission of symptoms despite continued neuroleptic treatment.
Those aspects of today's China I consider basic to a proper understanding of that country now, and which I also believe will persist into the foreseeable future–possibly -to the end of the century–are the following:
China is now more "China" than at any time since 1949, but by no means less socialist for that.
It is embarked on a path that will probably make it the most significant economic and politico-cultural power in the Asia/Pacific Region by the turn of the century.
In its handling of its foreigjn relations China is moving away from some recognizable patterns of the past and developing a character tjiat will make it both easier and tougher to deal with as times goes on.
The visit of the Australian Labour Party (ALP) delegation to China in July this year provided an interesting and representative example of Chinese diplomacy in action.* Although the ALP is in opposition, the delegation was dealt with by China as the representatives of a possible future Australian government, and its leader, Gough Whitlam, as the alternative Australian Prime Minister. The discussions were pitched accordingly. The visit also had some general relevance because of the importance China now attaches to relations with “small” powers, including countries like Australia (which see themselves rather as middle powers); indeed, China's new diplomatic contacts with such powers illustrate the whole thrust of China's global diplomacy in 1971. The Australian case is interesting also because in Australia, as in the United States and a number of other countries, the “China problem” has been such a central issue in foreign policy that it has spilled over into a complex involvement in domestic politics.
The Chinese Communist Party and the “Overseas Chinese Problem”
The “Overseas Chinese problem” in South-East Asia is most commonly understood to be a problem which confronts the governments and indigenous peoples of the region, or other governments which have an interest in South-East Asia, or sometimes the Overseas Chinese themselves. It is seldom perceived as a “problem” for the Chinese Government, except in so far as China is thought to have encountered certain obstacles to political and economic exploitation of a relationship which appears deceptively simple, and which seems to offer very considerable advantages to the Chinese Communist Party (CCP). Yet the evolution of China's Overseas Chinese policy since 1949 reveals a growing awareness on the part of the CCP that there were many intractable problems associated with its overseas population, both in the pursuit of foreign policies in South-East Asia and in the very nature of the Overseas Chinese relationship with China.
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