198 results
Clinician treatment choices for post-traumatic stress disorder: ambassadors survey of psychiatrists in 39 European countries
- Martina Rojnic Kuzman, Frank Padberg, Benedikt L. Amann, Meryam Schouler-Ocak, Zarko Bajic, Tarja Melartin, Adrian James, Julian Beezhold, Jordi Artigue Gómez, Celso Arango, Tihana Jendricko, Jamila Ismayilov, William Flannery, Egor Chumakov, Koray Başar, Simavi Vahip, Dominika Dudek, Jerzy Samochowiec, Goran Mihajlovic, Fulvia Rota, Gabriela Stoppe, Geert Dom, Kirsten Catthoor, Eka Chkonia, Maria João Heitor Dos Santos, Diogo Telles, Peter Falkai, Philippe Courtet, Michal Patarák, Lubomira Izakova, Oleg Skugarevski, Stojan Barjaktarov, Dragan Babic, Goran Racetovic, Andrea Fiorillo, Bernardo Carpiniello, Maris Taube, Yuval Melamed, Jana Chihai, Doina Constanta Maria Cozman, Pavel Mohr, György Szekeres, Mirjana Delic, Ramunė Mazaliauskienė, Aleksandar Tomcuk, Nataliya Maruta, Philip Gorwood
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- Journal:
- European Psychiatry / Volume 67 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 07 March 2024, e24
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Background
Considering the recently growing number of potentially traumatic events in Europe, the European Psychiatric Association undertook a study to investigate clinicians’ treatment choices for post-traumatic stress disorder (PTSD).
MethodsThe case-based analysis included 611 participants, who correctly classified the vignette as a case of PTSD, from Central/ Eastern Europe (CEE) (n = 279), Southern Europe (SE) (n = 92), Northern Europe (NE) (n = 92), and Western Europe (WE) (N = 148).
ResultsAbout 82% woulduse antidepressants (sertraline being the most preferred one). Benzodiazepines and antipsychotics were significantly more frequently recommended by participants from CEE (33 and 4%, respectively), compared to participants from NE (11 and 0%) and SE (9% and 3%). About 52% of clinicians recommended trauma-focused cognitive behavior therapy and 35% psychoeducation, irrespective of their origin. In the latent class analysis, we identified four distinct “profiles” of clinicians. In Class 1 (N = 367), psychiatrists would less often recommend any antidepressants. In Class 2 (N = 51), clinicians would recommend trazodone and prolonged exposure therapy. In Class 3 (N = 65), they propose mirtazapine and eye movement desensitization reprocessing therapy. In Class 4 (N = 128), clinicians propose different types of medications and cognitive processing therapy. About 50.1% of participants in each region stated they do not adhere to recognized treatment guidelines.
ConclusionsClinicians’ decisions for PTSD are broadly similar among European psychiatrists, but regional differences suggest the need for more dialogue and education to harmonize practice across Europe and promote the use of guidelines.
The incorporation of chlorine and cosmogenic 36Cl into speleothem carbonate
- Vanessa E. Johnston, Silvia Frisia, Andrea Borsato, Jon D. Woodhead, Frank McDermott
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- Quaternary Research / Volume 118 / March 2024
- Published online by Cambridge University Press:
- 13 December 2023, pp. 2-19
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Cave carbonate mineral deposits (speleothems) contain trace elements that are intensively investigated for their significance as palaeoclimate and environmental proxies. However, chlorine, which is abundant in marine and meteoric waters, has been overlooked as a potential palaeo-proxy, while cosmogenic 36Cl could, in principle, provide a solar irradiance proxy. Here, total Cl concentrations analysed from various speleothems were low (3–14 mg/kg), with variations linked to crystal fabrics. High-resolution synchrotron radiation micro X-ray fluorescence (μ-XRF) trace element mapping showed Cl often associated with Na, Si, and Al. We propose that speleothems incorporate Cl in two fractions: (1) water soluble (e.g., fluid inclusions) and (2) water insoluble and strongly bound (e.g., associated with detrital particulates). However, disparities indicated that alternate unidentified mechanisms for Cl incorporation were present, raising important questions regarding incorporation of many trace elements into speleothems. Our first measurements of 36Cl/Cl ratios in speleothems required large samples due to low Cl concentrations, limiting the potential of 36Cl as a solar irradiance proxy. Critically, our findings highlight a knowledge gap into how Cl and other trace elements are incorporated into speleothems, how the incorporation mechanisms and final elemental concentrations are related to speleothem fabrics, and the significance this may have for how trace elements in speleothems are interpreted as palaeoclimate proxies.
Empowerment group therapy for refugees with affective disorders: results of a multicenter randomized controlled trial
- Maren Wiechers, Michael Strupf, Malek Bajbouj, Kerem Böge, Carine Karnouk, Stephan Goerigk, Inge Kamp-Becker, Tobias Banaschewski, Michael Rapp, Alkomiet Hasan, Peter Falkai, Andrea Jobst-Heel, Ute Habel, Thomas Stamm, Andreas Heinz, Andreas Hoell, Max Burger, Tilmann Bunse, Edgar Hoehne, Nassim Mehran, Franziska Kaiser, Eric Hahn, Paul Plener, Aline Übleis, Frank Padberg
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- Journal:
- European Psychiatry / Volume 66 / Issue 1 / 2023
- Published online by Cambridge University Press:
- 17 July 2023, e64
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Background
Against the background of missing culturally sensitive mental health care services for refugees, we developed a group intervention (Empowerment) for refugees at level 3 within the stratified Stepped and Collaborative Care Model of the project Mental Health in Refugees and Asylum Seekers (MEHIRA). We aim to evaluate the effectiveness of the Empowerment group intervention with its focus on psychoeducation, stress management, and emotion regulation strategies in a culturally sensitive context for refugees with affective disorders compared to treatment-as-usual (TAU).
MethodAt level 3 of the MEHIRA project, 149 refugees and asylum seekers with clinically relevant depressive symptoms were randomized to the Empowerment group intervention or TAU. Treatment comprised 16 therapy sessions conducted over 12 weeks. Effects were measured with the Patient Health Questionnaire-9 (PHQ-9) and the Montgomery–Åsberg Depression Rating Scale (MÅDRS). Further scales included assessed emotional distress, self-efficacy, resilience, and quality of life.
ResultsIntention-to-treat analyses show significant cross-level interactions on both self-rated depressive symptoms (PHQ-9; F(1,147) = 13.32, p < 0.001) and clinician-rated depressive symptoms (MÅDRS; F(1,147) = 6.91, p = 0.01), indicating an improvement in depressive symptoms from baseline to post-intervention in the treatment group compared to the control group. The effect sizes for both scales were moderate (d = 0.68, 95% CI 0.21–1.15 for PHQ-9 and d = 0.51, 95% CI 0.04–0.99 for MÅDRS).
ConclusionIn the MEHIRA project comparing an SCCM approach versus TAU, the Empowerment group intervention at level 3 showed effectiveness for refugees with moderately severe depressive symptoms.
Shared sorrow, shared costs: cost-effectiveness analysis of the Empowerment group therapy approach to treat affective disorders in refugee populations
- Michael Strupf, Andreas Hoell, Malek Bajbouj, Kerem Böge, Maren Wiechers, Carine Karnouk, Inge Kamp-Becker, Tobias Banaschewski, Andreas Meyer-Lindenberg, Michael Rapp, Alkomiet Hasan, Peter Falkai, Ute Habel, Andreas Heinz, Paul Plener, Franziska Kaiser, Stefanie Weigold, Nassim Mehran, Aline Übleis, Frank Padberg
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- Journal:
- BJPsych Open / Volume 9 / Issue 4 / July 2023
- Published online by Cambridge University Press:
- 22 June 2023, e113
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Background
Refugees and asylum seekers (RAS) in Germany need tailored and resource-oriented mental healthcare interventions.
AimsTo evaluate the cost-effectiveness of group psychotherapy for RAS with moderate depressive symptoms.
MethodThis is a post hoc cost-effectiveness analysis of Empowerment group psychotherapy that was embedded in a stratified stepped and collaborative care model (SCCM) from the multicentre randomised controlled MEHIRA trial. One hundred and forty-nine participants were randomly assigned to SCCM or treatment as usual (TAU) and underwent Empowerment (i.e. level 3 of the SCCM for adults) or TAU. Effects were measured with the nine-item Patient Health Questionnaire (PHQ-9) and quality adjusted life-years (QALY) post-intervention. Health service and intervention costs were measured. Incremental cost-effectiveness ratios (ICER) were estimated and net monetary benefit (NMB) regressions with 95% confidence intervals were performed. Cost-effectiveness was ascertained for different values of willingness to pay (WTP) using cost-effectiveness acceptability curves for probable scenarios. Trial registration number: NCT03109028 on ClinicalTrials.gov.
ResultsHealth service use costs were significantly lower for Empowerment than TAU after 1 year. Intervention costs were on average €409.6. Empowerment led to a significant change in PHQ-9 scores but not QALY. Bootstrapped mean ICER indicated cost-effectiveness according to PHQ-9 and varied considerably for QALY in the base case. NMB for a unit reduction in PHQ-9 score at WTP of €0 was €354.3 (€978.5 to −€269.9). Results were confirmed for different scenarios and varying WTP thresholds.
ConclusionsThe Empowerment intervention was cost-effective in refugees with moderate depressive symptoms regarding the clinical outcome and led to a reduction in direct healthcare consumption. Concerning QALYs, there was a lack of confidence that Empowerment differed from TAU.
European interprofessional postgraduate curriculum in palliative care: A narrative synthesis of field interviews in the region of Middle, Eastern, and Southeastern Europe and Central and West Asia
- Piret Paal, Cornelia Brandstötter, Frank Elsner, Stefan Lorenzl, Jürgen Osterbrink, Andreas Stähli
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- Palliative & Supportive Care , First View
- Published online by Cambridge University Press:
- 22 December 2022, pp. 1-10
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Objectives
In 2018, a study was conducted in the Eastern and South-eastern Europe and Central Asia. National leaders of palliative care were asked to describe developments in postgraduate education in their region. They were asked whether the introduction of a European curriculum would be useful in their country. The aim was to explore the structures of postgraduate education at country level in order to define the barriers and opportunities.
MethodsThis is an ethnographic study based on semi-structured field interviews. A thematic analysis was chosen for data extraction and a narrative synthesis for the systematic presentation and critical discussion of the results.
ResultsThirty-two interviews were recorded in 23 countries. The analysis revealed 4 main themes: (1) general barriers to access, (2) necessary to improve palliative care education, (3) palliative care core curriculum – the theoretical framework, and (4) challenges in implementation. These main themes were complemented by 19 subthemes.
Significance of resultsPalliative care is understood as a universal idea, which in practice means accepting social pluralism and learning to respect unique individual needs. This makes teaching palliative care a very special task because there are no golden standards for dealing with each individual as they are. In theory, a European curriculum recommendation is useful to convince governments and other key stakeholders of the importance of postgraduate education. In practice, such a curriculum needs to be adapted to the constraints of health services and human resources. Validated quality assessment criteria for palliative care education are crucial to advance postgraduate education.
Association of loneliness and social network size in adulthood with childhood maltreatment: Analyses of a population-based and a clinical sample
- Matthias A. Reinhard, Stephanie V. Rek, Tabea Nenov-Matt, Barbara B. Barton, Julia Dewald-Kaufmann, Katharina Merz, Richard Musil, Andrea Jobst, Eva-Lotta Brakemeier, Katja Bertsch, Frank Padberg
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- Journal:
- European Psychiatry / Volume 65 / Issue 1 / 2022
- Published online by Cambridge University Press:
- 05 September 2022, e55
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Background
Perceived loneliness and objective social network size are related but distinct factors, which negatively affect mental health and are prevalent in patients who have experienced childhood maltreatment (CM), for example, patients with persistent depressive disorder (PDD) and borderline personality disorder (BPD). This cross-diagnostic study investigated whether loneliness, social network size, or both are associated with self-reported CM.
MethodsLoneliness and social network size were assessed in a population-based sample at two time points (Study 1, N = 509), and a clinical group of patients with PDD or BPD (Study 2, N = 190) using the UCLA Loneliness Scale and the Social Network Index. Further measures were the Childhood Trauma Questionnaire, and standard depression rating scales. Linear regression analyses were applied to compare associations of loneliness or social network size with CM. Multiple mediation analyses were used to test the relative importance of loneliness and social network size in the relationship between CM and depressive symptoms.
ResultsIn both studies, loneliness showed a stronger association than social network size with CM. This was particularly marked for emotional neglect and emotional abuse. Loneliness but not social network size mediated the relationship between CM and depressive symptoms.
ConclusionsLoneliness is particularly associated with self-reported CM, and in this respect distinct from the social network size. Our results underline the importance of differentiating both psychosocial constructs and suggest focusing on perceived loneliness and its etiological underpinnings by mechanism-based psychosocial interventions.
10 - Membership Categorisation Analysis
- from Part III - Language Awareness in Education and Training
- Edited by Erika Darics, Rijksuniversiteit Groningen, The Netherlands
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- Language Awareness in Business and the Professions
- Published online:
- 28 July 2022
- Print publication:
- 04 August 2022, pp 183-203
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Summary
This chapter outlines an approach to the study of categorisation in language practice grounded in the work of American sociologist Harvey Sacks known as Membership Categorisation Analysis. MCA proposes that categories and their associated ‘normative orders’ are not simply stored in people’s heads; they are used as part of the accomplishment of practical tasks in various social settings. Thus, MCA focuses on how categories are used to do things within talk and text, such as criticising, complaining, praising, encouraging, inviting, commending, blaming, and so on. Moreover, we also propose that power relations can be central to the study of categories. We demonstrate this in a political context through analysis of a political speech made by the previous British Prime Minister, Theresa May. We show that May’s category-based reasoning about social injustice was used to appeal to a sense of social solidarity and moral responsibility of ‘the fortunate’ to help the ‘less fortunate’ in society. We conclude that MCA has value for students and practitioners of language because no other approach comes as close to the study of how categories are used in talk and text in real-life situations.
Transmission of SARS-CoV-2 among children and staff in German daycare centres
- Julika Loss, Juliane Wurm, Gianni Varnaccia, Anja Schienkiewitz, Helena Iwanowski, Anne-Kathrin Mareike Loer, Jennifer Allen, Barbara Wess, Angelika Schaffrath Rosario, Stefan Damerow, Tim Kuttig, Hanna Perlitz, Anselm Hornbacher, Bianca Finkel, Carolin Krause, Jan Wormsbächer, Anna Sandoni, Ulrike Kubisch, Kiara Eggers, Andreas Nitsche, Aleksandar Radonic, Kathrin Trappe, Oliver Drechsel, Kathleen Klaper, Andrea Franke, Antje Hüther, Udo Buchholz, Walter Haas, Lothar H. Wieler, Susanne Jordan
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- Journal:
- Epidemiology & Infection / Volume 150 / 2022
- Published online by Cambridge University Press:
- 08 July 2022, e141
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In daycare centres, the close contact of children with other children and employees favours the transmission of infections. The majority of children <6 years attend daycare programmes in Germany, but the role of daycare centres in the SARS-CoV-2 pandemic is unclear. We investigated the transmission risk in daycare centres and the spread of SARS-CoV-2 to associated households. 30 daycare groups with at least one recent laboratory-confirmed SARS-CoV-2 case were enrolled in the study (10/2020–06/2021). Close contact persons within daycare and households were examined over a 12-day period (repeated SARS-CoV-2 PCR tests, genetic sequencing of viruses, symptom diary). Households were interviewed to gain comprehensive information on each outbreak. We determined primary cases for all daycare groups. The number of secondary cases varied considerably between daycare groups. The pooled secondary attack rate (SAR) across all 30 daycare centres was 9.6%. The SAR tended to be higher when the Alpha variant was detected (15.9% vs. 5.1% with evidence of wild type). The household SAR was 53.3%. Exposed daycare children were less likely to get infected with SARS-CoV-2 than employees (7.7% vs. 15.5%). Containment measures in daycare programmes are critical to reduce SARS-CoV-2 transmission, especially to avoid spread to associated households.
Using polygenic scores and clinical data for bipolar disorder patient stratification and lithium response prediction: machine learning approach – CORRIGENDUM
- Micah Cearns, Azmeraw T. Amare, Klaus Oliver Schubert, Anbupalam Thalamuthu, Joseph Frank, Fabian Streit, Mazda Adli, Nirmala Akula, Kazufumi Akiyama, Raffaella Ardau, Bárbara Arias, JeanMichel Aubry, Lena Backlund, Abesh Kumar Bhattacharjee, Frank Bellivier, Antonio Benabarre, Susanne Bengesser, Joanna M. Biernacka, Armin Birner, Clara Brichant-Petitjean, Pablo Cervantes, HsiChung Chen, Caterina Chillotti, Sven Cichon, Cristiana Cruceanu, Piotr M. Czerski, Nina Dalkner, Alexandre Dayer, Franziska Degenhardt, Maria Del Zompo, J. Raymond DePaulo, Bruno Étain, Peter Falkai, Andreas J. Forstner, Louise Frisen, Mark A. Frye, Janice M. Fullerton, Sébastien Gard, Julie S. Garnham, Fernando S. Goes, Maria Grigoroiu-Serbanescu, Paul Grof, Ryota Hashimoto, Joanna Hauser, Urs Heilbronner, Stefan Herms, Per Hoffmann, Andrea Hofmann, Liping Hou, Yi-Hsiang Hsu, Stephane Jamain, Esther Jiménez, Jean-Pierre Kahn, Layla Kassem, Po-Hsiu Kuo, Tadafumi Kato, John Kelsoe, Sarah Kittel-Schneider, Sebastian Kliwicki, Barbara König, Ichiro Kusumi, Gonzalo Laje, Mikael Landén, Catharina Lavebratt, Marion Leboyer, Susan G. Leckband, Mario Maj, the Major Depressive Disorder Working Group of the Psychiatric Genomics Consortium, Mirko Manchia, Lina Martinsson, Michael J. McCarthy, Susan McElroy, Francesc Colom, Marina Mitjans, Francis M. Mondimore, Palmiero Monteleone, Caroline M. Nievergelt, Markus M. Nöthen, Tomas Novák, Claire O'Donovan, Norio Ozaki, Vincent Millischer, Sergi Papiol, Andrea Pfennig, Claudia Pisanu, James B. Potash, Andreas Reif, Eva Reininghaus, Guy A. Rouleau, Janusz K. Rybakowski, Martin Schalling, Peter R. Schofield, Barbara W. Schweizer, Giovanni Severino, Tatyana Shekhtman, Paul D. Shilling, Katzutaka Shimoda, Christian Simhandl, Claire M. Slaney, Alessio Squassina, Thomas Stamm, Pavla Stopkova, Fasil TekolaAyele, Alfonso Tortorella, Gustavo Turecki, Julia Veeh, Eduard Vieta, Stephanie H. Witt, Gloria Roberts, Peter P. Zandi, Martin Alda, Michael Bauer, Francis J. McMahon, Philip B. Mitchell, Thomas G. Schulze, Marcella Rietschel, Scott R. Clark, Bernhard T. Baune
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- Journal:
- The British Journal of Psychiatry / Volume 221 / Issue 2 / August 2022
- Published online by Cambridge University Press:
- 04 May 2022, p. 494
- Print publication:
- August 2022
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Age-related brain deviations and aggression
- Nathalie E. Holz, Dorothea L. Floris, Alberto Llera, Pascal M. Aggensteiner, Seyed Mostafa Kia, Thomas Wolfers, Sarah Baumeister, Boris Böttinger, Jeffrey C. Glennon, Pieter J. Hoekstra, Andrea Dietrich, Melanie C. Saam, Ulrike M. E. Schulze, David J. Lythgoe, Steve C. R. Williams, Paramala Santosh, Mireia Rosa-Justicia, Nuria Bargallo, Josefina Castro-Fornieles, Celso Arango, Maria J. Penzol, Susanne Walitza, Andreas Meyer-Lindenberg, Marcel Zwiers, Barbara Franke, Jan Buitelaar, Jilly Naaijen, Daniel Brandeis, Christian Beckmann, Tobias Banaschewski, Andre F. Marquand
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- Journal:
- Psychological Medicine / Volume 53 / Issue 9 / July 2023
- Published online by Cambridge University Press:
- 22 April 2022, pp. 4012-4021
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Background
Disruptive behavior disorders (DBD) are heterogeneous at the clinical and the biological level. Therefore, the aims were to dissect the heterogeneous neurodevelopmental deviations of the affective brain circuitry and provide an integration of these differences across modalities.
MethodsWe combined two novel approaches. First, normative modeling to map deviations from the typical age-related pattern at the level of the individual of (i) activity during emotion matching and (ii) of anatomical images derived from DBD cases (n = 77) and controls (n = 52) aged 8–18 years from the EU-funded Aggressotype and MATRICS consortia. Second, linked independent component analysis to integrate subject-specific deviations from both modalities.
ResultsWhile cases exhibited on average a higher activity than would be expected for their age during face processing in regions such as the amygdala when compared to controls these positive deviations were widespread at the individual level. A multimodal integration of all functional and anatomical deviations explained 23% of the variance in the clinical DBD phenotype. Most notably, the top marker, encompassing the default mode network (DMN) and subcortical regions such as the amygdala and the striatum, was related to aggression across the whole sample.
ConclusionsOverall increased age-related deviations in the amygdala in DBD suggest a maturational delay, which has to be further validated in future studies. Further, the integration of individual deviation patterns from multiple imaging modalities allowed to dissect some of the heterogeneity of DBD and identified the DMN, the striatum and the amygdala as neural signatures that were associated with aggression.
Using polygenic scores and clinical data for bipolar disorder patient stratification and lithium response prediction: machine learning approach
- Micah Cearns, Azmeraw T. Amare, Klaus Oliver Schubert, Anbupalam Thalamuthu, Joseph Frank, Fabian Streit, Mazda Adli, Nirmala Akula, Kazufumi Akiyama, Raffaella Ardau, Bárbara Arias, Jean-Michel Aubry, Lena Backlund, Abesh Kumar Bhattacharjee, Frank Bellivier, Antonio Benabarre, Susanne Bengesser, Joanna M. Biernacka, Armin Birner, Clara Brichant-Petitjean, Pablo Cervantes, Hsi-Chung Chen, Caterina Chillotti, Sven Cichon, Cristiana Cruceanu, Piotr M. Czerski, Nina Dalkner, Alexandre Dayer, Franziska Degenhardt, Maria Del Zompo, J. Raymond DePaulo, Bruno Étain, Peter Falkai, Andreas J. Forstner, Louise Frisen, Mark A. Frye, Janice M. Fullerton, Sébastien Gard, Julie S. Garnham, Fernando S. Goes, Maria Grigoroiu-Serbanescu, Paul Grof, Ryota Hashimoto, Joanna Hauser, Urs Heilbronner, Stefan Herms, Per Hoffmann, Andrea Hofmann, Liping Hou, Yi-Hsiang Hsu, Stephane Jamain, Esther Jiménez, Jean-Pierre Kahn, Layla Kassem, Po-Hsiu Kuo, Tadafumi Kato, John Kelsoe, Sarah Kittel-Schneider, Sebastian Kliwicki, Barbara König, Ichiro Kusumi, Gonzalo Laje, Mikael Landén, Catharina Lavebratt, Marion Leboyer, Susan G. Leckband, Mario Maj, the Major Depressive Disorder Working Group of the Psychiatric Genomics Consortium, Mirko Manchia, Lina Martinsson, Michael J. McCarthy, Susan McElroy, Francesc Colom, Marina Mitjans, Francis M. Mondimore, Palmiero Monteleone, Caroline M. Nievergelt, Markus M. Nöthen, Tomas Novák, Claire O'Donovan, Norio Ozaki, Vincent Millischer, Sergi Papiol, Andrea Pfennig, Claudia Pisanu, James B. Potash, Andreas Reif, Eva Reininghaus, Guy A. Rouleau, Janusz K. Rybakowski, Martin Schalling, Peter R. Schofield, Barbara W. Schweizer, Giovanni Severino, Tatyana Shekhtman, Paul D. Shilling, Katzutaka Shimoda, Christian Simhandl, Claire M. Slaney, Alessio Squassina, Thomas Stamm, Pavla Stopkova, Fasil Tekola-Ayele, Alfonso Tortorella, Gustavo Turecki, Julia Veeh, Eduard Vieta, Stephanie H. Witt, Gloria Roberts, Peter P. Zandi, Martin Alda, Michael Bauer, Francis J. McMahon, Philip B. Mitchell, Thomas G. Schulze, Marcella Rietschel, Scott R. Clark, Bernhard T. Baune
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- Journal:
- The British Journal of Psychiatry / Volume 220 / Issue 4 / April 2022
- Published online by Cambridge University Press:
- 28 February 2022, pp. 219-228
- Print publication:
- April 2022
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Background
Response to lithium in patients with bipolar disorder is associated with clinical and transdiagnostic genetic factors. The predictive combination of these variables might help clinicians better predict which patients will respond to lithium treatment.
AimsTo use a combination of transdiagnostic genetic and clinical factors to predict lithium response in patients with bipolar disorder.
MethodThis study utilised genetic and clinical data (n = 1034) collected as part of the International Consortium on Lithium Genetics (ConLi+Gen) project. Polygenic risk scores (PRS) were computed for schizophrenia and major depressive disorder, and then combined with clinical variables using a cross-validated machine-learning regression approach. Unimodal, multimodal and genetically stratified models were trained and validated using ridge, elastic net and random forest regression on 692 patients with bipolar disorder from ten study sites using leave-site-out cross-validation. All models were then tested on an independent test set of 342 patients. The best performing models were then tested in a classification framework.
ResultsThe best performing linear model explained 5.1% (P = 0.0001) of variance in lithium response and was composed of clinical variables, PRS variables and interaction terms between them. The best performing non-linear model used only clinical variables and explained 8.1% (P = 0.0001) of variance in lithium response. A priori genomic stratification improved non-linear model performance to 13.7% (P = 0.0001) and improved the binary classification of lithium response. This model stratified patients based on their meta-polygenic loadings for major depressive disorder and schizophrenia and was then trained using clinical data.
ConclusionsUsing PRS to first stratify patients genetically and then train machine-learning models with clinical predictors led to large improvements in lithium response prediction. When used with other PRS and biological markers in the future this approach may help inform which patients are most likely to respond to lithium treatment.
Impaired self-awareness of cognitive deficits in Parkinson's disease relates to cingulate cortex dysfunction
- Franziska Maier, Andrea Greuel, Marius Hoock, Rajbir Kaur, Masoud Tahmasian, Frank Schwartz, Ilona Csoti, Frank Jessen, Alexander Drzezga, Thilo van Eimeren, Lars Timmermann, Carsten Eggers
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- Journal:
- Psychological Medicine / Volume 53 / Issue 4 / March 2023
- Published online by Cambridge University Press:
- 23 September 2021, pp. 1244-1253
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Background
Impaired self-awareness of cognitive deficits (ISAcog) has rarely been investigated in Parkinson's disease (PD). ISAcog is associated with poorer long-term outcome in other diseases. This study examines ISAcog in PD with and without mild cognitive impairment (PD-MCI), compared to healthy controls, and its clinical-behavioral and neuroimaging correlates.
MethodsWe examined 63 PD patients and 30 age- and education-matched healthy controls. Cognitive state was examined following the Movement Disorder Society Level II criteria. ISAcog was determined by subtracting z-scores (based on controls' scores) of objective tests and subjective questionnaires. Neural correlates were assessed by structural magnetic resonance imaging (MRI) and 2-[fluorine-18]fluoro-2-deoxy-d-glucose-positron emission tomography (FDG-PET) in 47 patients (43 with MRI) and 11 controls. We analyzed whole-brain glucose metabolism and cortical thickness in regions where FDG-uptake correlated with ISAcog.
ResultsPD-MCI patients (N = 23) showed significantly more ISAcog than controls and patients without MCI (N = 40). When all patients who underwent FDG-PET were examined, metabolism in the bilateral superior medial frontal gyrus, anterior and midcingulate cortex negatively correlated with ISAcog (FWE-corrected p < 0.001). In PD-MCI, ISAcog was related to decreased metabolism in the right superior temporal lobe and insula (N = 13; FWE-corrected p = 0.023) as well as the midcingulate cortex (FWE-corrected p = 0.002). Cortical thickness was not associated with ISAcog in these regions. No significant correlations were found between ISAcog and glucose metabolism in controls and patients without MCI.
ConclusionsSimilar to Alzheimer's disease, the cingulate cortex seems to be relevant in ISAcog in PD. In PD-MCI patients, ISAcog might result from a disrupted network that regulates awareness of cognition and error processes.
Characterisation of age and polarity at onset in bipolar disorder
- Janos L. Kalman, Loes M. Olde Loohuis, Annabel Vreeker, Andrew McQuillin, Eli A. Stahl, Douglas Ruderfer, Maria Grigoroiu-Serbanescu, Georgia Panagiotaropoulou, Stephan Ripke, Tim B. Bigdeli, Frederike Stein, Tina Meller, Susanne Meinert, Helena Pelin, Fabian Streit, Sergi Papiol, Mark J. Adams, Rolf Adolfsson, Kristina Adorjan, Ingrid Agartz, Sofie R. Aminoff, Heike Anderson-Schmidt, Ole A. Andreassen, Raffaella Ardau, Jean-Michel Aubry, Ceylan Balaban, Nicholas Bass, Bernhard T. Baune, Frank Bellivier, Antoni Benabarre, Susanne Bengesser, Wade H Berrettini, Marco P. Boks, Evelyn J. Bromet, Katharina Brosch, Monika Budde, William Byerley, Pablo Cervantes, Catina Chillotti, Sven Cichon, Scott R. Clark, Ashley L. Comes, Aiden Corvin, William Coryell, Nick Craddock, David W. Craig, Paul E. Croarkin, Cristiana Cruceanu, Piotr M. Czerski, Nina Dalkner, Udo Dannlowski, Franziska Degenhardt, Maria Del Zompo, J. Raymond DePaulo, Srdjan Djurovic, Howard J. Edenberg, Mariam Al Eissa, Torbjørn Elvsåshagen, Bruno Etain, Ayman H. Fanous, Frederike Fellendorf, Alessia Fiorentino, Andreas J. Forstner, Mark A. Frye, Janice M. Fullerton, Katrin Gade, Julie Garnham, Elliot Gershon, Michael Gill, Fernando S. Goes, Katherine Gordon-Smith, Paul Grof, Jose Guzman-Parra, Tim Hahn, Roland Hasler, Maria Heilbronner, Urs Heilbronner, Stephane Jamain, Esther Jimenez, Ian Jones, Lisa Jones, Lina Jonsson, Rene S. Kahn, John R. Kelsoe, James L. Kennedy, Tilo Kircher, George Kirov, Sarah Kittel-Schneider, Farah Klöhn-Saghatolislam, James A. Knowles, Thorsten M. Kranz, Trine Vik Lagerberg, Mikael Landen, William B. Lawson, Marion Leboyer, Qingqin S. Li, Mario Maj, Dolores Malaspina, Mirko Manchia, Fermin Mayoral, Susan L. McElroy, Melvin G. McInnis, Andrew M. McIntosh, Helena Medeiros, Ingrid Melle, Vihra Milanova, Philip B. Mitchell, Palmiero Monteleone, Alessio Maria Monteleone, Markus M. Nöthen, Tomas Novak, John I. Nurnberger, Niamh O'Brien, Kevin S. O'Connell, Claire O'Donovan, Michael C. O'Donovan, Nils Opel, Abigail Ortiz, Michael J. Owen, Erik Pålsson, Carlos Pato, Michele T. Pato, Joanna Pawlak, Julia-Katharina Pfarr, Claudia Pisanu, James B. Potash, Mark H Rapaport, Daniela Reich-Erkelenz, Andreas Reif, Eva Reininghaus, Jonathan Repple, Hélène Richard-Lepouriel, Marcella Rietschel, Kai Ringwald, Gloria Roberts, Guy Rouleau, Sabrina Schaupp, William A Scheftner, Simon Schmitt, Peter R. Schofield, K. Oliver Schubert, Eva C. Schulte, Barbara Schweizer, Fanny Senner, Giovanni Severino, Sally Sharp, Claire Slaney, Olav B. Smeland, Janet L. Sobell, Alessio Squassina, Pavla Stopkova, John Strauss, Alfonso Tortorella, Gustavo Turecki, Joanna Twarowska-Hauser, Marin Veldic, Eduard Vieta, John B. Vincent, Wei Xu, Clement C. Zai, Peter P. Zandi, Psychiatric Genomics Consortium (PGC) Bipolar Disorder Working Group, International Consortium on Lithium Genetics (ConLiGen), Colombia-US Cross Disorder Collaboration in Psychiatric Genetics, Arianna Di Florio, Jordan W. Smoller, Joanna M. Biernacka, Francis J. McMahon, Martin Alda, Bertram Müller-Myhsok, Nikolaos Koutsouleris, Peter Falkai, Nelson B. Freimer, Till F.M. Andlauer, Thomas G. Schulze, Roel A. Ophoff
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- Journal:
- The British Journal of Psychiatry / Volume 219 / Issue 6 / December 2021
- Published online by Cambridge University Press:
- 25 August 2021, pp. 659-669
- Print publication:
- December 2021
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Background
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.
AimsTo examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
MethodGenome-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.
ResultsEarlier 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.
ConclusionsAAO 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.
HOW COVID-19 ENABLED A GLOBAL STUDENT DESIGN TEAM TO ACHIEVE BREAKTHROUGH INNOVATION
- Jenny Victoria Elfsberg, Christian Johansson, Martin Frank, Andreas Larsson, Tobias Larsson, Larry Leifer
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- Journal:
- Proceedings of the Design Society / Volume 1 / August 2021
- Published online by Cambridge University Press:
- 27 July 2021, pp. 1705-1714
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This is a qualitative single case study of a geographically distributed student team that experienced a quite different graduate course, compared to previous year's. This was due to the restrictions placed upon them following coronavirus lockdowns. With already ongoing research, and continuous development of the course, the authors had documented individual reflections and identified patterns and behaviours that seemingly determined the quality of the end result, as well as the students expectations and experiences. Semi-structured interviews, surveys and the author's individual reflection notes were already in place as part of the larger research scope and when the student team during the covid-19 year showed unexpected performance and results, the authors decided to pause the larger research scope and focus on this unique single case and capture those learnings. Not knowing how the Covid-19 situation evolves and leaning on insights from previous years, as well as this unique year, the aim with this paper is to describe the unique Covid-19 year amd share knowledge that can help improve and evolve the development of this longlived collaborative graduate student course, and other similar distributed team contexts.
Part Two
- Lou Andreas-Salomé
- Translated by Frank Beck, Raleigh Whitinger
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- Book:
- Anneliese's House
- Published by:
- Boydell & Brewer
- Published online:
- 26 May 2022
- Print publication:
- 15 June 2021, pp -
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Chapter XVI
- Lou Andreas-Salomé
- Translated by Frank Beck, Raleigh Whitinger
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- Anneliese's House
- Published by:
- Boydell & Brewer
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- 26 May 2022
- Print publication:
- 15 June 2021, pp 157-166
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Summary
After a long sleep and a hearty breakfast at her parents’ seaside cottage, Gitta awakened with a burning interest in everything around her. Skirts tucked up and barefoot, she ranged through the water, searching diligently for starfish, crabs, mussels — even simple pebbles, wondrously shimmering in the brine, attracted her like jewelry — until the next morning had transformed her treasures, as if they were still mysteriously bound to the sea, into something quite unsightly — which only made her more eager for the magic of the sea. Most magical of all for her was the marvel of the jellyfish, which seemed to reflect the lovely lines and colors of heaven and earth in their infinite intricacies of light blue, crimson, pale green, deep violet, or sun-bright hues. Like someone who goes to the theater or learns of tragic turns of fate, Gitta was caught up in the dramatic fortunes of the seaside jellyfish. There was a day for each kind of sea dweller. Depending on the weather, the starfish, the jellyfish, or even blue mussels lay on the beach. Then, suddenly, giant colonies of jellyfish would cover the sand, by the hundreds of thousands — and, while in the infinite waves they had all lived the same existence, it was only in this close community that they met the most varied range of fates: some drawn mercifully back to the bosom of the sea; some broken up under human tread; others slowly sucked down into the sand, leaving only a rune-like imprint as a mysterious inscription. Gitta could devote hours on end to these creatures marked by fate.
Sometimes, she would lie face down, somewhere by the water, intent upon thinking through her “marriage mistake,” as she called her complex situation. But, after a while, she would find herself propped up on her hands, fascinated by the remarkable leaps of the sand fleas or, at most, baking the finest little cakes out of the moist sand — identical copies of Frau Lüdecke’s.
At the outset, Anneliese had thought it was partly Gitta's heartache that made her turn to these childish pursuits and speak less and less of her marital situation.
Chapter I
- Lou Andreas-Salomé
- Translated by Frank Beck, Raleigh Whitinger
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- Book:
- Anneliese's House
- Published by:
- Boydell & Brewer
- Published online:
- 26 May 2022
- Print publication:
- 15 June 2021, pp 1-10
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Summary
The house stood on a hillside, overlooking the town in the valley and the long stretch of mountains beyond. From the country road that climbed through the hill's woods in a wide curve, you stepped right into the middle story, as if it were at ground level — so deeply was the little white house nestled into the slope.
But perched up there it had a freer view out over the terraced garden and across the broad expanse below, gazing down with many bright window-eyes and with boldly protruding bays — extensions of original rooms that had been found too confining. This undeniably made for whimsical architecture, but it gave the house an impression of grace and lightness — almost as if it were just resting there.
From the top floor above the central bay, a balcony jutted far out over the tree-planted, wintry garden, enclosed by a stone wall, old and moss-covered. The balcony door stood wide open, despite the early morning hour, and on the threshold, its backside carefully pointed back into the warm room, sat a small, aged, female dog blinking sleepily at the hungry birds that occasionally flitted by, observing them as a spoiled child of the house might look out at begging street folk. Of course, she herself was the result of the widest range of dog breeds treating themselves to nothing less than an aristocratic love-tryst, as evidenced by her dachshund legs, her pug torso, and her terrier head — a diversity capped off by the piglet-style, curly tail at her other end. But by far the most remarkable thing about the little monster was the fact that its name was Salomo. That astonished everyone except the daughter of the family, who had insisted on that name of masculine and royal wisdom, even after Salomo had come straying her way in a highly pregnant state, whereupon he had given birth to four healthy pinschers.
The birds were carrying on with a tremendous racket. Finches and blue tits, robins and linnets, warblers and others flocked together around the suet that had been put out on the balcony — free hanging to discourage the contending field sparrows — along with a bowl of water, set above a few glowing coals on a potsherd to keep it from freezing.
Chapter V
- Lou Andreas-Salomé
- Translated by Frank Beck, Raleigh Whitinger
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- Book:
- Anneliese's House
- Published by:
- Boydell & Brewer
- Published online:
- 26 May 2022
- Print publication:
- 15 June 2021, pp 35-44
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Summary
Balduin soon found himself on his way down to see Branhardt, who apparently had gone straight to the clinic after his consulting trip and would not come home until evening.
After the conversation with his mother that morning, he felt doubly driven to see his father — who thought so much more soberly than she did — who did not expect that every one of his son's high hopes would be realized but would stand by him until his confidence was justified by the young man's actions. Balduin saw both parents as the embodiment of all he so urgently wished to be! Who else on earth could make that possible for him? After all, their life was in his blood — that was the firm, fixed bedrock of his life, though all else might make him confused and unsure. That calming certainty filled his heart as he walked along.
His good mood diminished as he approached the clinic area. He had always been exceptionally sensitive to certain impressions, and his father's quarters did nothing to help, not only by their close proximity to the clinics themselves, but because they deliberately lacked anything that could have imparted a comforting touch of the personal — intended, perhaps, to express his father's principle that comfort was to await him at home, with his family —?
While Balduin was waiting, they were starting to serve breakfast. Branhardt had indeed gone from the railway station to the clinic, where he was still busy. If only he’d come —!
A son's love, when it involves such need, such dependency, loses all the poetry of free feelings, Balduin thought. How much better it was for Gitta, in the natural simplicity of her child's love.
Already his sense of himself was losing its poetry, like an unwatered flower left too long in the sun. With each passing minute, his mood wilted away, his original impatience now strangely pierced by a stinging fear.
The awareness he had impressed upon himself so forcefully on the way to town — that he depended on his father — suddenly entangled him in the misconception that he was a confined, imprisoned person who clearly would rather be free but was now fidgeting about like a fly caught in the finest of cobwebs.
Chapter IV
- Lou Andreas-Salomé
- Translated by Frank Beck, Raleigh Whitinger
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- Book:
- Anneliese's House
- Published by:
- Boydell & Brewer
- Published online:
- 26 May 2022
- Print publication:
- 15 June 2021, pp 27-34
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Summary
The small addition with a wooden veranda, above the “trunk room,” was next to Branhardt's study, separated from it by a double door and fitted with large, multi-paned sash windows that let in the sunshine from all sides and afforded a lovely view of the hills across the valley. Plants spent the winter there on boards and benches, and there was a small iron stove for them. Beside it, a door opened out onto the roofed veranda — just big enough for one comfortable armchair — from which a wooden stairway dropped steeply into the garden.
Anneliese thought this should be Balduin's domain during the day, and since they were expecting his return tomorrow, she was getting it ready for him. She had the plants and most of the racks removed and his books placed on the main shelf. She went over the pale-green oil paint of the walls with a moist cloth, covered the old garden table with dark-green baize, drew some polka-dot muslin along the lower windowpanes, and then brought in a few wicker chairs kept on the balcony in the summer. That left no room for a bed.
Yet, as she worked at making the room pleasant and comfortable, she quietly wished this were not necessary. She admitted to herself how much she longed for a son who would stand by her, cheerful and strong, in the bloom of manhood — his father's youthful mirror, and one day, the “support in old age” one routinely wishes for.
Was it natural that she had to be so anxious about shielding him from disturbances? That she was already worried that his bedroom next to theirs was too close to the stairway and all the comings and goings? It was also too close to the guest room, for which a visitor had just announced herself: Renate, a friend of Anneliese since childhood, who was rather lively in manner and generally expected more consideration than she was inclined to show.
As fresh as Anneliese's heart had been when she began her work, such reflections had tired her by the time she went upstairs to dust herself off and remove her apron.
Chapter III
- Lou Andreas-Salomé
- Translated by Frank Beck, Raleigh Whitinger
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- Book:
- Anneliese's House
- Published by:
- Boydell & Brewer
- Published online:
- 26 May 2022
- Print publication:
- 15 June 2021, pp 19-26
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Summary
With a red ribbon around his neck, right about where he was no longer a terrier but not yet a pug, Salomo rode along to the station, with people staring in wonder as he went by — which put him in a happy mood. He liked red ribbons; and, besides, Gitta wanted to see him looking festive when she arrived.
At the last minute, Anneliese saw Branhardt coming to the train — even though it was at a time when normally he could hardly get free — and even though Salomo's show of emotion made it seem almost impossible to greet Gitta in human fashion.
She returned home as fashionably svelte as when she had left, but also, despite her slim, still childlike figure, in the same good health, so refreshing to Branhardt's doctorly eye. He had just time enough to wait for the baggage and pack his wife, daughter, and Salomo into a hansom cab — but at the last moment he jumped in with them.
That was ill advised, since every move took him farther away from the clinics. But then — as Anneliese often noted — something about Gitta made people careless.
And she didn't have to say anything of interest to do that. When she was three or four years old, he had listened to her just as tolerantly while she read to him, her tone serious but with the newspaper held upside-down — and later, too, when she would confide in him about truly pointless matters.
Anneliese sometimes said she had not known that dubious side of him until she bore him this daughter.
At home, up in Gitta's room, next to her parents’ bedroom, Anneliese noticed the one thing about her daughter that had changed, when she took off her hat to reveal that, yet again — as so many times before — her hair was cut differently. The girl's dark-blonde hair, nothing less than luxuriant and with a slight wave, was remarkably amenable to all experiments.
As she unpacked, Gitta chatted with her “mama” while moving about her room. Its floor was covered with dropcloths, rather unaesthetically, to protect a belatedly applied coat of varnish.