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It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
Aims
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Method
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
Results
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Conclusions
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
According to conventional wisdom, a great power engaging in international retrenchment regularly incurs tremendous costs. Following its withdrawal from a commitment abroad, the argument goes, windows of opportunity emerge that rivals exploit to their benefit, thus imposing significant costs on the retrenching great power. I argue that pundits and policymakers consistently overestimate the dangers associated with strategic withdrawals: great powers can – and in the past frequently have – successfully engaged in international retrenchment without creating opportunities for their rivals to gain significant strategic benefits. To make this case, I develop a new typology of international retrenchment strategies based on the kind and degree of disengagement they entail and demonstrate that most types do not regularly pave the way for rival gains. I support my argument through a series of plausibility probes: the Soviet retrenchment from Romania in the 1950s; the US retrenchment from Korea in the 1970s; and the US retrenchment from Western Europe in the 1990s.
There seems to exist a general consensus on how to conceptualize cooperation in the field of international relations (IR). We argue that this impression is deceptive. In practice, scholars working on the causes of international cooperation have come to implicitly employ various understandings of what cooperation is. Yet, an explicit debate about the discipline's conceptual foundations never materialized, and whatever discussion occurred did so only latently and without much dialog across theoretical traditions. In this paper, we develop an updated conceptual framework by exploring the nature of these differing understandings and situating them within broader theoretical conversations about the role of cooperation in IR. Drawing on an array of studies in IR and philosophy, our framework distinguishes between three distinct types of cooperative state interactions – cooperation through tacit policy coordination (‘minimal’ cooperation), cooperation through explicit policy coordination (‘thin’ cooperation), and cooperation based on joint action (‘thick’ cooperation). The framework contributes to better theorization about cooperation in two main ways: it allows scholars across theoretical traditions to identify important sources of disagreement and previously unnoticed theoretical common ground; and the conceptual disaggregation it provides grants scholars crucial theoretical leverage by enabling type-specific causal theorization.
While fetal alcohol spectrum disorder (FASD) has primarily been thought of as a neurodevelopmental condition, research is beginning to highlight its ‘whole-body’ implications. Accordingly, the current study sought to provide a snapshot of potential health issues. Caregivers of children (median age of 12 years) with an FASD diagnosis were invited to participate in an online survey. Information relating to sample demographics, FASD status of the child and health outcomes were collected. The prevalence of health conditions reported in the FASD sample was compared against national prevalence data. Multiple linear regression utilising a stepwise approach was used to investigate potential predictors of the number of diagnosed health conditions. Survey data were from an international cohort (n = 197), with the majority of respondents based in Australia (40.2%) or the United States (27.7%). The most commonly reported diagnosed health conditions were eye conditions (44.7%), asthma (34.5%), heart conditions (34.0%) and skin conditions (27.4%). Binomial testing indicated the proportion of children diagnosed with these disorders was generally higher in the current FASD population, compared to national prevalence data. Indicators of metabolic dysfunction including diabetes and obesity were not significantly different compared to national prevalence data. Age of FASD diagnosis, existence of comorbid mental health conditions and the primary caregiver being in paid work were identified as being associated with the prevalence of diagnosed health conditions. Overall, the study has provided an up-to-date snapshot of health problems reported in a sample of children with FASD, confirming their increased risk of adverse health outcomes.
Self-interacting dark matter (SIDM) is promising to solve or at least mitigate small-scale problems of cold collisionless dark matter. N-body simulations have proven to be a powerful tool to study SIDM within the astrophysical context. However, it turned out to be difficult to simulate dark matter (DM) models that typically scatter about a small angle, for example, light mediator models. We developed a novel numerical scheme for this regime of frequent self-interactions that allows for N-body simulations of systems like galaxy cluster mergers or even cosmological simulations. We have studied equal and unequal mass mergers of galaxies and galaxy clusters and found significant differences between the phenomenology of frequent self-interactions and the commonly studied large-angle scattering (rare self-interactions). For example, frequent self-interactions tend to produce larger offsets between galaxies and DM than rare self-interactions.
Religiosity and spirituality are transcultural parameter of human experience with a complex, multidimensional construct. However, research shows religious commitment and practices being not only important for the personal beliefs, but also for physical and mental health. Findings suggest also other personal beliefs, such as magical ideation and paranormal beliefs similarly influencing psychiatric disorders and mental health. However, these factors are far more multidimensional than once thought.
Objectives
The objective of the study is the investigation of the relation of religiosity/spirituality, magical ideation and paranormal beliefs in anxiety disorders and the specification of potential differences in beliefs between OCD and other anxiety disorders.
Methods
Unselected patients with OCD and other anxiety disorders as core diagnosis have been equally assessed within the first week after admission with self-rating tests including the Brief Multidimensional Measure of Religiosity/Spirituality (BMMRS), Magical Ideation Scale (MIS) and Revised Paranormal Beliefs Scale (RPBS).
Results
80 patients have been recruited and classified in three groups: OCD, other anxiety disorders and healthy control group. All groups reached in average not significantly deviating RPBS, MIS and BMMRS total scores. However, the three personal belief scales did show an interesting relation to each other. RPBS score correlated significantly with BMMRS (r = .34, p < .01) and with MIS score (r = .56, p < .01), while MIS total scores have shown a significant relationship with almost every subscale of the BMMRS.
Conclusion
This study verifies a significant positive correlation between paranormal beliefs, overall religiosity and magical ideation.
There is widespread evidence that schizophrenic symptomatology is best represented by three syndromes (positive, negative, disorganized). Both the disorganized and negative syndrome have been found to correlate with several neurocognitive dysfunctions. However, previous studies investigated samples predominantly treated with typical neuroleptics, which frequently induce parkinsonian symptoms that are hard to disentangle from primary negative symptoms and may have inflated correlations with neurocognition. A newly developed psychopathological instrument called the Positive and Negative and Disorganized Symptoms Scale (PANADSS) was evaluated in 60 schizophrenic patients. Forty-seven participants treated with atypical neuroleptics performed several neurocognitive tasks.
A three-factor solution of schizophrenic symptomatology emerged. Negative symptomatology was associated with diminished creative verbal fluency and digit span backward, whereas disorganization was significantly correlated with impaired Stroop, WCST and Trail-Making Test B performance.
Data suggest that disorganization is associated with tasks that demand executive functioning. Previous findings reporting correlations between negative symptomatology and neurocognition may have been confounded by the adverse consequences of typical neuroleptics.
In the last decades the relationship between religiosity/spirituality (R/S), personal beliefs and mental health has been extensively studied, indicating a significant correlation of these variables. However, the specific relation of R/S to anxiety disorders has been less investigated.
Objective
The objective of this prospective study is the investigation of the relation of R/S, magical ideation (MI) and paranormal beliefs (PB) to anxiety disorders in general and OCD in particular, in order to specifically determine a possible impact of these variables on psychopathology scores. In addition, the relation between R/S, PB and MI can be systematically investigated.
Design & method
Unselected samples with OCD and other anxiety disorders have been equally assessed within the first week after admission with a face-to-face interview including the following instruments: MINI, HAMD, HAMA and Y-BOCS, OCI-R, STAI, Brief Multidimensional Measure of Religiosity/Spirituality, Magical Ideation Scale and Revised Paranormal Beliefs Scale. Forty healthy participants with no psychiatric history served as controls.
Results
Groups did not differ in any aspect of R/S, MI, or PB. Almost all scales referring to R/S, PB and MI were positively correlated to each other. The results showed a strong positive correlation between high scores of negative religious coping and high psychopathology scores in depression and anxiety. On the other hand, there was a significant positive correlation between MI scores and initial OCD and anxiety scores.
Conclusion
This study verifies a significant correlation between personal beliefs and psychopathology in OCD and anxiety disorders. Implications for further research are discussed.
(1) determine which antipsychotic side effects (SE) schizophrenic patients consider the most distressing during treatment with typical antipsychotics, (2) measure the impact of actual and past SE on patients' attitude toward antipsychotics and (3) assess the influence of both on adherence.
Methods
The 213 schizophrenics, treated with conventional antipsychotics, were recruited in two psychiatric hospitals in Hamburg. Subjects were assessed about type and severity of present and past side effects and their attitude and adherence to antipsychotic treatment.
Results
The 82 (39%) patients presented present SE while 131 (61%) did not. Sexual dysfunctions (P<0.001), extrapyramidal (P<0.05) and psychic side effects (P<0.05) were rated as significantly subjectively more distressing than sedation or vegetative side effects. Patients presenting with present SE compared with patients without present SE had a significantly more negative general attitude toward antipsychotics (P<0.05), were more doubtful about their efficacy (P<0.01) and were less likely to encourage a relative to take such a medication in case of need (P<0.001). A regression analysis indicated that nonadherence was mainly influenced by negative general and efficacy attitudes toward antipsychotics and the experience of past or present antipsychotic side effects.
Conclusions
All antipsychotic side effects, present or past, can have a durable negative impact on patient's attitude toward antipsychotic treatment and adherence. Non-adherence is mainly determined, among other factors, by these negative attitudes, which are partly influenced by the experience of past or present antipsychotic-induced side effects.
Until recently, psychological therapy for schizophrenia was considered inefficient or even harmful by many clinicians. The reservation against psychotherapy is partly rooted in the assumption that delusions are not amenable to psychological understanding. However, meta-analyses suggest that cognitive intervention is effective in ameliorating schizophrenia symptoms. In addition, evidence has accumulated that cognitive biases, such as jumping to conclusions (JTC), are involved in the pathogenesis of schizophrenia positive symptoms, particularly delusions. A recently developed group program, called metacognitive training (MCT), is presented targeting cognitive biases. The MCT is a hybrid of psychoeducation, cognitive remediation and cognitive-behavioural therapy. Patients are taught strategies how to identify and defuse “cognitive traps”. The program can be downloaded at no cost at www.uke.de/mkt and is currently available in more than 20 languages. New evidence on the feasibility and efficacy of the MCT is presented. At the end, a novel individualized variant entitled MCT+ is demonstrated targeting individual delusional ideas. A random-controlled study asserts the efficacy of the MCT+ to reduce JTC as well as delusion severity and conviction.
Schizophrenia is a severe and debilitating disorder compromising multiple aspects of everyday functioning and quality of life, such as independent living, interpersonal relations and vocational functioning. Apart from premorbid functioning and psychopathological symptoms, social and non-social cognitive factors negatively influence functional outcomes in patients. On the other hand, recent research implicates specific types of biased thinking styles (e.g. jumping-to-conclusions, liberal acceptance) in at least some clinical dimensions of schizophrenia. So far, the impact of such cognitive biases on the functional outcome of the disorder has not been investigated.
Aims
The present study aimed to assess the relative contribution of cognitive biases and other well established factors, including psychopathology and neuropsychological deficits, on functional outcomes in patients with schizophrenia.
Method
Participants were 160 inpatients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder, recruited from the inpatient units of two University hospitals (Hamburg and Heidelberg). Key exclusion criteria were current substance dependence, severe brain damage, and IQ < 70. Patients were assessed at baseline on measures of
(a) premorbid IQ,
(b) psychopathology and severity of illness,
(c) cognitive biases,
(d) attention and verbal memory, and
(e) social cognition/Theory of Mind. Functional outcome at six months consisted in a composite factor computed from a quality-of-life measure (WHOQOL), as well as information on marital, housing and vocational status.
Results and conclusions
A multiple linear regression analysis was performed with functional outcome as dependent variable and the above-mentioned factors assessed at baseline as predictors. Results will be discussed.
Although antipsychotic medication still represents the treatment of choice for schizophrenia, its objective impact on symptoms is only in the medium effect size range. Hence, clinical researchers are intensively looking for complementary therapeutic options. Cognitive research has elucidated a number of cognitive biases in schizophrenia that seem to play a crucial role in the formation and maintenance of the disorder: jumping to conclusions, attributional biases, a bias against disconfirmatory evidence, overconfidence in errors, and distorted theory of mind. Metacognitive training for schizophrenia patients (MCT) is a group intervention that seeks to sharpen the awareness of schizophrenia patients on these biases. The training is available in 25 languages at no cost via www.uke.de/mkt/. The talk will also present a new treatment program called MCT+ which is a hybrid of MCT and individualized cognitive-behavioral therapy. Results assert that MCT and MCT+ are feasible interventions. According to randomized controlled trials, metacognitive intervention leads to an accelerated symptom improvement and alleviates some cognitive biases (particularly jumping to conclusions) in patients relative to active control interventions.
Studies indicate that patient-rated outcomes and symptomatic remission as defined by the remission in schizophrenia working group rely on different assumptions. The aim of this observational study was to assess symptomatic remission by patients with schizophrenia, family members and psychiatrists and to compare their assessments with standardized criteria and clinical measures.
Methods
One hundred and thirty-one patients with schizophrenia (DSM-IV), family members and psychiatrists assessed remission within the European Group on Functional Outcomes and Remission in Schizophrenia (EGOFORS) project. Symptoms (Positive and Negative Syndrome Scale [PANSS]), functional outcome (Functional Recovery Scale in Schizophrenia [FROGS]), subjective well-being (SWN-K) and demographic characteristics were investigated.
Results
Remission assessed by psychiatrists showed the best accordance with standardized remission (80%), followed by remission assessed by family members (52%) and patients (43%). Only in 18%, patients, relatives and psychiatrists agreed in their assessments. Good subjective well-being was most important for remission estimated by patients, good subjective well-being and symptom reduction by family members, and finally better symptom scores, well-being and functioning by psychiatrists.
Discussion
Self- and expert-rated clinical outcomes differ markedly, with a preference on the patients’ side for subjective outcome. Symptomatic remission as assessed by the standardized criteria plays a secondary role for patients and relatives in daily clinical practice. A more thorough consideration of patients’ and caregivers’ perspectives should supplement the experts’ assessment.
Persistent psychotic symptoms represent a major challenge for psychiatric care. Basic research has shown that psychotic symptoms are associated with cognitive biases. Metacognitive training (MCT) aims at helping patients to become aware of these biases and to improve problem-solving. Fifty-two participants fulfilling diagnostic criteria of schizophrenia or schizoaffective disorders and persistent delusions and stabilized antipsychotic medication were enrolled in this study. Following baseline assessment patients were randomized either to treatment as usual (TAU) conditions or TAU + MCT. The intervention consisted of eight weekly 1-hour sessions (maximum: 8 hours). Participants were assessed at 8 weeks and 6-months later by blind assessors. Participants were assessed with the Psychotic Symptoms Rating Scales (PSYRATS) and the positive subscale of the PANSS. Between-group differences in post- and pre-test values were significant at a medium effect size in favor of the MCT for the PSYRATS delusion scale and the positive scale of the PANSS both at post and follow-up. The results of this study indicate that MCT training has a surplus antipsychotic effect for patients suffering from schizophrenia-related disorders who demonstrate only a partial response to antipsychotic treatment and that the effect of the intervention persists for at least 6 months after the intervention.
Studies reported close associations between functional outcome and symptomatic remission as defined by the Remission in Schizophrenia Working Group. This observational study was aimed at the investigation of deficits in daily functioning, symptoms and subjective well-being in remitted and non-remitted patients with schizophrenia.
Methods
Symptoms (PANSS), functional outcome (FROGS, GAF), subjective well-being (SWN-K) and other characteristics were assessed in 131 patients with schizophrenia (DSM-IV) within the European Group on Functional Outcomes and Remission in Schizophrenia (EGOFORS) project.
Results
A significant better level of functioning was measured for remitted versus non-remitted patients, though remitted patients still showed areas with an inadequate level of functioning. Functional deficits were most often seen in social relations (40%), work (29%) and daily life activities (17%). Best functioning was assessed for self-care, self-control, health management and medical treatment. A moderate to severe level of disorganization and emotional distress was observed in 38% and impaired subjective well-being in 29% of patients defined as being in symptomatic remission.
Discussion
The results confirm a close association between symptomatic remission and functional outcome. However, deficits in different areas of functioning, symptoms and well-being underline the need for combined outcome criteria for patients with schizophrenia.
Neuropsychological deficits represent a core feature of schizophrenia that has been repeatedly associated with poor symptomatic outcomes. In recent years, there has been increased interest in higher-order cognitive biases (e.g. jumping-to-conclusions, liberal acceptance) as mediators of clinical symptoms, especially delusions, in patients with schizophrenia. So far, the impact of such cognitive biases on the symptomatic outcomes of the disorder has not been investigated.
Aims
The present study aimed to assess the contribution of cognitive biases and other well established factors, including severity of psychopathology and neuropsychological deficits, on symptomatic outcomes after an index hospitalization in patients with schizophrenia.
Method
Participants were 160 inpatients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder, recruited from the inpatient units of two University hospitals (Hamburg and Heidelberg). Key exclusion criteria were current substance dependence, severe brain damage, and IQ < 70. Patients were assessed at baseline on measures of psychopathology and severity of illness (PANSS, duration of illness, number of hospitalizations prior to the index admission), cognitive biases (e.g., jumping-to-conclusions, overconfidence for memory errors), as well as attention and verbal memory. At six months after admission, patients were divided into a good- and a poor-outcome group based on their PANSS scores.
Results and conclusions
Good- and poor-outcome patients were compared on severity of psychopathology at admission, cognitive biases, and neuropsychological performance, by means of a multiple analysis of covariance, with age, gender, and premorbid IQ serving as covariates. Results will be discussed.
Self-monitoring biases and overconfidence in incorrect judgments have been suggested as playing a role in schizophrenia spectrum disorders. Little is known about whether self-monitoring biases may contribute to early risk factors for psychosis. In this study, action self-monitoring (i.e., discrimination between imagined and performed actions) was investigated, along with confidence in judgments among ultra-high risk (UHR) for psychosis individuals and first-episode psychosis (FEP) patients.
Methods
Thirty-six UHR for psychosis individuals, 25 FEP patients and 33 healthy controls (CON) participated in the study. Participants were assessed with the Action memory task. Simple actions were presented to participants verbally or non-verbally. Some actions were required to be physically performed and others were imagined. Participants were asked whether the action was presented verbally or non-verbally (action presentation type discrimination), and whether the action was performed or imagined (self-monitoring). Confidence self-ratings related to self-monitoring responses were obtained.
Results
The analysis of self-monitoring revealed that both UHR and FEP groups misattributed imagined actions as being performed (i.e., self-monitoring errors) significantly more often than the CON group. There were no differences regarding performed actions as being imagined. UHR and FEP groups made their false responses with higher confidence in their judgments than the CON group. There were no group differences regarding discrimination between the types of actions presented (verbal vs non-verbal).
Conclusions
A specific type of self-monitoring bias (i.e., misattributing imagined actions with performed actions), accompanied by high confidence in this judgment, may be a risk factor for the subsequent development of a psychotic disorder.
In this paper, we study the shape and dynamics of helical coherent structures found in the flow field of an annular swirling jet undergoing vortex breakdown. The flow field is studied by means of time-resolved tomographic particle image velocimetry measurements. The obtained flow fields are analysed using both classic and spectral proper orthogonal decomposition. Despite the simple geometrical set-up of the annular jet, the flow field is very complex. Two distinct large-scale helical flow structures are identified: a single and a double helix, both co-rotating with the swirl direction, and it is revealed that these structures are not higher harmonics of each other. The structures have a relatively low energy content which makes it hard to separate them from other dynamics of the flow field, notably turbulent motions. Because of this, classic proper orthogonal decomposition fails to identify both structures properly. Spectral proper orthogonal decomposition, on the other hand, allows them to be identified accurately when the filter size is set at around eight times the precession period. The precession frequencies of the single and double helices correspond to Strouhal numbers of 0.273 and $0.536\pm 0.005$, respectively. A global stability analysis of the mean flow field shows that these structures correspond to two separate global modes. The precessing frequencies obtained by the stability analysis and the related spatial structures match very well with the experimental observations. The current work extends our knowledge on turbulent vortex breakdown and on mean field global stability theory in general. It leads to the following conclusions. Firstly, single- and double-helix vortex breakdown are both manifestations of global modes. Previous studies have shown that both $m=1$ and $m=2$ modes can coexist in swirling jets. However, the $m=2$ mode has been identified as a second harmonic of the first mode, while this study identifies both as two independent global modes. Secondly, this work shows that the simultaneous occurrence of multiple helical global modes is possible within a turbulent flow and their shapes and frequencies are very well predicted by mean field stability analysis. The latter finding is of general interest as it applies to a wide class of fluid problems dominated by multiple oscillatory structures.
Maternal insufficiency during fetal development can have long-lasting effects on the offspring, most notably on nephron endowment. In polycystic kidney disease (PKD), variability in severity of disease is observed and maternal environment may be a modifying factor. In this study, we first established that in a rodent model of PKD, the Lewis polycystic kidney (LPK) rat’s nephron numbers are 25% lower compared with wildtype animals. We then investigated the effects of prenatal and postnatal maternal environment on phenotype and nephron number. LPK pups born from and raised by homozygous LPK dams (control) were compared with LPK pups cross-fostered onto heterozygous LPK dams to improve postnatal environment; with LPK pups born from and raised by heterozygous LPK dams to improve both prenatal and postnatal environment and with LPK pups born from and raised by Wistar Kyoto-LPK heterozygous dams to improve both prenatal and postnatal environment on a different genetic background. Improvement in both prenatal and postnatal environment improved postnatal growth, renal function and reduced blood pressure, most notably in animals with different genetic background. Animals with improved postnatal environment only showed improved growth and blood pressure, but to a lesser extent. All intervention groups showed increased nephron number compared with control LPK. In summary, prenatal and postnatal environment had significant effect in delaying progression and reducing severity of PKD, including nephron endowment.
Alcohol consumption around the time of conception is highly prevalent in Western countries. Exposure to ethanol levels during gestation has been associated with altered development of the mesolimbic reward pathway in rats and increased propensity to addiction, however the effect of exposure only around the time of conception is unknown. The current study investigated the effects of periconceptional alcohol exposure (PC:EtOH) on alcohol and palatable food preferences and gene expression in the ventral tegmental area (VTA) and the nucleus accumbens of the adult offspring. Rats were exposed to a liquid diet containing ethanol (EtOH) (12.5% vol/vol) or a control diet from 4 days before mating until 4 days after mating. PC:EtOH had no effect on alcohol preference in either sex. At 15 months of age, however, male PC:EtOH offspring consumed more high-fat food when compared with male control offspring, but this preference was not observed in females. Expression of the dopamine receptor type 1 (Drd1a) was lower in the VTA of male PC:EtOH offspring compared with their control counterparts. There was no effect of PC:EtOH on mRNA expression of the µ-opioid receptor, tyrosine hydroxylase (Th), dopamine receptor type 2 (Drd2) or dopamine active transporter (Slc6a3). These data support the hypothesis that periconceptional alcohol exposure can alter expression of key components of the mesolimbic reward pathway and heighten the preference of offspring for palatable foods and may therefore increase their propensity towards diet-induced obesity. These results highlight the importance of alcohol avoidance when planning a pregnancy.