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Negative symptoms are a key feature of several psychiatric disorders. Difficulty identifying common neurobiological mechanisms that cut across diagnostic boundaries might result from equifinality (i.e., multiple mechanistic pathways to the same clinical profile), both within and across disorders. This study used a data-driven approach to identify unique subgroups of participants with distinct reward processing profiles to determine which profiles predicted negative symptoms.
Methods
Participants were a transdiagnostic sample of youth from a multisite study of psychosis risk, including 110 individuals at clinical high-risk for psychosis (CHR; meeting psychosis-risk syndrome criteria), 88 help-seeking participants who failed to meet CHR criteria and/or who presented with other psychiatric diagnoses, and a reference group of 66 healthy controls. Participants completed clinical interviews and behavioral tasks assessing four reward processing constructs indexed by the RDoC Positive Valence Systems: hedonic reactivity, reinforcement learning, value representation, and effort–cost computation.
Results
k-means cluster analysis of clinical participants identified three subgroups with distinct reward processing profiles, primarily characterized by: a value representation deficit (54%), a generalized reward processing deficit (17%), and a hedonic reactivity deficit (29%). Clusters did not differ in rates of clinical group membership or psychiatric diagnoses. Elevated negative symptoms were only present in the generalized deficit cluster, which also displayed greater functional impairment and higher psychosis conversion probability scores.
Conclusions
Contrary to the equifinality hypothesis, results suggested one global reward processing deficit pathway to negative symptoms independent of diagnostic classification. Assessment of reward processing profiles may have utility for individualized clinical prediction and treatment.
Direct physical evidence for violent interpersonal conflict is seen only sporadically in the archaeological record for prehistoric Britain. Human remains from Charterhouse Warren, south-west England, therefore present a unique opportunity for the study of mass violence in the Early Bronze Age. At least 37 men, women and children were killed and butchered, their disarticulated remains thrown into a 15m-deep natural shaft in what is, most plausibly, interpreted as a single event. The authors examine the physical remains and debate the societal tensions that could motivate a level and scale of violence that is unprecedented in British prehistory.
Although over 100 million pregnant women worldwide are at risk of infection with SARS-CoV-2, little data exists on the impact of COVID-19 and related treatments on maternal/neonatal health.
Objectives
1) To quantify the prevalence of medication use in pregnancy to treat COVID-19; 2) To quantify and compare the risk of adverse pregnancy/neonatal outcomes in those with and without COVID-19.
Methods
In the Canadian Mother-Child population-based cohort (CAMCCO), two key sub-cohorts were identified using prospective data collection of medical services, prescription drugs, hospitalization archives data, and COVID-19 surveillance testing program (02/28/2020-2021). The first cohort included all pregnant women with at least one completed trimester of pregnancy during the study period regardless of pregnancy status (delivery, induced/planned or spontaneous abortion); this cohort was further stratified on COVID-19 status. The second cohort included all non-pregnant women (aged 15-45) with a positive COVID-19 test. COVID-19 infection in pregnant or non-pregnant women was assessed using COVID-19 test results or ICD-10CM codeU07.1 from hospital data. COVID-19 severity was categorized based on hospital admission. Women were considered exposed to COVID-19 medications if they filled at least one prescription for a medicine included in the WHO list in the 30 days pre- or 30 days post-COVID-19 positive test/diagnosis. Considering potential confounders, association between COVID-19 during pregnancy, treated vs not, and perinatal outcomes were quantified using log-binomial regression models.
Results
150,345 pregnant women (3,464 (2.3%) had COVID-19), and 112,073 non-pregnant women with COVID-19 diagnoses were included. Pregnant women with COVID-19 were more likely to have severe infections compared to non-pregnant women with COVID-19 (11.4% vs 1.6%, p< 0.001). The most frequent medications used in pregnancy to treat COVID-19 were antibacterials (13.96%), psychoanaleptics (7.35%), and medicines for obstructive airway disease (3.20%). In pregnancy COVID-19 was associated with spontaneous abortions (adjRR 1.76, 95%CI 1.3, 2.25), gestational diabetes (adjRR 1.52, 95%CI 1.18, 1.97), prematurity (adjRR 1.30, 95%CI 1.01, 1.67), NICU admissions (adjRR 1.32, 95%CI 1.10, 1.59); COVID-19 severity was increasing these risks but COVID-19 treatment with study medications reduced all risks.
Conclusions
Severity of COVID-19 was greater in pregnancy. Antibacterials, psychoanaleptics, and medicines for obstructive airway disease were the most used overall. Severe COVID-19 in pregnancy was associated with higher risks of adverse maternal, and neonatal outcomes.
With increased international concern over the pervasive plastic pollution problem, early negotiations to develop a legally binding instrument to end plastic pollution (“the Plastics Treaty”) were supported by 175 member countries toward a sustainable plastics future. Defining features of the plastics treaty by UNEP member countries began in Punta del Este, Uruguay in November 2022 during the first session of the Intergovernmental Negotiating Committee (INC-1). However, INC-1 ended with many unanswered questions regarding the structure, scope, and targets of the treaty. Sixty-seven member countries, including members of the High Coalition Ambition, submitted their objectives, guiding principles, and expectations for the treaty before the INC-2 negotiations while also suggesting measures for its effective implementation. This paper compiles submissions of the 67 member countries and evidence-based policymaking approaches that have been described in peer-reviewed and gray literature following INC-1, but before the INC-2 negotiations in Paris, France in June 2023. Recommendations for developing an effective plastics treaty by most member countries include incorporating the complete life cycle of plastics, promotion of transparency in global trade through uniform labeling measures, capping virgin plastic production, incorporating extended producer responsibility to develop a circular economy, and addressing hazardous chemicals in plastics. Suggested implementation measures include building a multilateral fund, supporting smaller countries with technology transfer, improving local stakeholder engagement, developing subsidiary bodies, and regular national reporting. Encouragingly, many of these national plans were proposed in the Zero Draft document released in September 2023 before INC-3 in Nairobi, Kenya in November 2023 and further developed in the revised draft text which served as the provisional agenda at INC-4 in April 2024 in Ottawa, Canada.
Background: Adherence to healthy lifestyle behaviours or to prescribed medication requires perseverance with stamina, and this is captured by Grit, a non-cognitive trait defined as perseverance and passion for long-term goals. Despite predicting cognitive decline and physical, emotional, and social functioning, Grit remains poorly understood and its neural substrates are unknown in cognitive aging. Methods: Ninety-five cognitively unimpaired older adults with a family history of Alzheimer’s disease were recruited through the PREVENT-AD longitudinal cohort. Participants completed tests that assess grit and conscientiousness and underwent resting-state functional magnetic resonance imaging (fMRI). Multivariate pattern analyses (MVPA), a rigorous data-driven whole-brain approach, were used to examine if resting-state functional connectivity of connectome-wide voxels were associated with grit scores, controlling for age, sex, APOE ε4 carriership, mean displacement, and conscientiousness. Results: Our analyses identified two large (≥54 voxels) and statistically significant (p<0.01 corrected for family-wise error) clusters in the right ventrolateral prefrontal cortex and the left orbitofrontal cortex underlying grit. Conclusions: Being the first to identify functional neural correlates supporting grit in the aging population while accounting for the variance of conscientiousness, our study provides unique insights into the construct which has important applications in adherence to clinical and empirical neurological interventions as well as in successful aging.
National Action Plans (NAPs) are a possible implementation measure for the Global Plastics Treaty, through a NAP-based approach. Their effectiveness in other international agreements is contested, and their current format allows for weak, voluntary measures with limited accountability. By analysing stakeholder and country submissions to the Intergovernmental Negotiating Committee (INC) secretariat ahead of INC-2 negotiations in Paris, June 2023, conducting a literature review, and interviewing key actors, this study aims to determine the support that governments and stakeholders have for a NAP-based approach in the Treaty, and identify the key enablers needed to ensure that NAP-based approaches, if adopted in the Treaty, are effective. Results indicate that by INC-2, more than 85% of countries supported a NAP-based approach, suggesting a high chance of this approach being selected as the means of implementation of the Treaty. However, interviewees and literature reviews indicate that NAPs in their current form are not likely to be effective at delivering ambitious Treaty targets. Six key enablers to improve the effectiveness of plastics NAPs are identified. These enablers should be integrated into any plastics NAPs both independently, and as potential requirements of the Treaty to ensure that NAP-based approaches are effective and have the impact intended.
This perspective explains why the lack of regulation around bioplastics remains a hurdle for the successful development and implementation of a legally binding agreement (the Global Plastics Treaty) by the United Nations Environment Assembly to curb plastic pollution by 2024. For example, bioplastics have been marketed to consumers as the panacea solution to our plastic waste crisis. Of the >400 million tonnes of plastics produced each year, <1% are bioplastics, but the market value of bioplastics is expected to grow. The rapid growth of the environmentally ‘sustainable’ plastic market has resulted in an overwhelming variety of products with different properties and labels, which has led to widespread public confusion, particularly about disposal guidelines. The umbrella term of ‘bioplastics’ describes plastics that can be fully or partially sourced from biological matter, unlike conventional petroleum-based plastics. Within this family of plastics, products can be ‘biodegradable’, ‘oxo-biodegradable’ and ‘compostable’ depending on their chemical composition and the external conditions required at disposal (end-of-life). However, cases of petroleum-based biodegradable plastics have been referred to as bioplastics, which is inaccurate. Overall, this lack of regulation remains a hurdle for the successful development and implementation of the Global Plastics Treaty.
Samples of cuttings from the Borchard A-2 well, Imperial Valley, California, were collected over a measured borehole temperature interval 135° to 275°C. The <0.5-µm (e.s.d.) fraction was separated using high-gradient magnetic separation (HGMS) to create a nonmagnetic fraction rich in illite and a magnetic fraction rich in chlorite. Chlorite was less easily separated from illite in lower temperature samples (<200°C), presumably due to the presence of polymineralic grains of chlorite and illite. Grains in higher temperature samples were more nearly monomineralic and more easily separated.
The chlorite is the IIb polytype. The thickness of coherent scattering domains of chlorite increased until 220°C and then remained constant. The amount of 7-Å interstratified material increased downhole until 195°C and then decreased. Over the same temperature interval, the illite polytypes varied systematically from 1Md (135° to 175°C) to 1M + 2M1 (230° to 275°C) and coherent scattering domains in the mineral became thicker to about 200°C and then remained constant in thickness. The percentage of illite in mixed-layer illite/smectite (I/S) increased from 40% at 135°C to 100% at temperature >205°C; ordering in the I/S changes from R0 to R1 between 135° and 155°C, and from R1 to R ≥ 3 at temperatures >155°C.
The concurrent structural changes in chlorite and illite indicate a general improvement in the overall structural order of the clay minerals with increasing temperature. Differences between chlorite and illite suggest that the minerals may have reacted differently to changing conditions or that they may have formed by different mechanisms. The exclusive occurrence of IIb chlorite at temperatures as low as 135°C extends the limit of IIb chlorite stability to temperatures lower than previous estimates.
The oxidation of As(III) to As(V) by K-birnessite was examined at different temperatures, pHs, and birnessite/As(III) ratios. Experiments ranged in duration from 5 to 64 hr, and solution and solid products were determined at several intervals. All experiments showed that the reaction produced large amounts of K+ to solution and very little Mn2+. As(V) was released to solution and incorporated into the K-birnessite. The oxidation was initially rapid and then slowed. The oxidation of As(III) was probably facilitated initially by autocatalytic Mn-As(V) reactions occurring mostly in the interlayer, in which large amounts of As(V) and K+ could be easily released to solution. The reaction also slowed when interlayer Mn was exhausted by forming Mn-As(V) complexes. Mn(IV) could only be acquired from the octahedral sheets of the birnessite. The two-stage reaction process proposed here depended on the layered structure of birnessite, the specific surface, and presence of exchangeable cations in K-birnessite.
Traditionally genetics is said to be the science of heredity. At least this was how William Bateson defined it in 1906. Today this is no longer the case. Since about ten years ago. when biologists learned to extract genes from cells, to transfer them from cell to cell, to dissect them, to analyze them biochemically, in short to manipulate them, the term genetics has tended rather to designate the science of the action of genes in cells. (This is what was formerly called physiological genetics). In any case this is the form of genetics which today is in the forefront of biological research. (This is also called molecular genetics). This kind of genetics is also in the forefront in the media, because of its present or potential applications, in the realms of biotechnology, genetic therapy and so on.
The heavy atom content and distribution in chlorite were estimated using the relative intensities of basal X-ray powder diffraction (XRD) peaks. For these peaks to be meaningful, however, corrections had to be made for the effects of sample thickness, sample length, and preferred orientation of the mineral grains, all of which are 2θ dependent. The effects of sample thickness were corrected for by a simple formula. The effects of sample length were accounted for by using rectangular samples and by ensuring that the sample intersected the X-ray beam through the range of diffraction angles of interest. Preferred orientation of mineral grains were either measured directly or estimated. Estimated values were quicker and easier to obtain and were within 5% of measured values. A comparison of the compositional parameters of chlorite estimated before correcting for these sample effects with those estimated after the corrections had been applied indicate that the uncorrected values differed from the corrected values by as much as 55% of the latter values. Mounts of a single sample prepared by different filter-membrane peel and porous-plate techniques yielded widely different compositions until the measurements were corrected for sample effects. Analyses in triplicate indicated that the XRD intensity ratio 003/001 is preferred for calculating heavy atom distributions and abundances in chlorite because of the relative strength of the 001 peak.
At first glance, the formulation of the principle of inertia—not. yet complete with Galileo, more precise with Gassendi, finally systematic with Newton—seems to constitute but one of the aspects of a process of deep transformations at the end of which traditional cosmology was replaced by various world systems. These transformations—or, to use a more classic term, this “ scientific revolution” —have been the object of numerous works, a list, of which would alone fill the pages of a thick volume. But the principle of inertia itself, a principle about which can be said without exaggeration that it expressed the essence of this revolution at the same time as it stimulated it, has perhaps not received all the attention it deserves. And especially the impact of this principle on Western culture has not been fully measured. True, Alexandre Koyré has always insisted on the fact that, by reducing movement to a state like that of the state of rest, the principle of inertia expressed a new vision of the world more than a scientific result. But his admirable analyses deal more with the slow advent of the priciple of inertia among the natural philosophers who preceded, accompanied and then followed Galileo than with the theological, philosophical and literary impact of this principle. Moreover, by examining this impact, we discover that it is necessary to make a distinction between Euclidian space and absolute space, a distinction which is frequently implicit with certain scientific historians, but, and this must be emphasized, is more often ignored.
Since the initial studies of chlorite polytypes, it has been suggested that the stability of the various polytypes may be a function of the temperature at which the mineral formed; however, few studies have been performed in which polytypes of chlorite in a specific suite of samples have been determined and correlated with temperature. A review of the reported occurrences of type I chlorite indicates that other factors, including grain size of the host rock, may be at least as important as temperature in controlling the stability of these polytypes. Results of systematic studies in areas of diagenesis and very low-grade metamorphism suggest that type-II chlorite is stable at temperatures well below 200°C and that it can form as the initial chlorite phase without passing through any intermediate polytypic stages. The conditions under which type-I polytypes occur are somewhat restricted, and cognizance of those restrictions will help to direct future studies of chlorite polytype transformations. These studies should focus on the structural details of polytype transformations; on the relationship of polytype stability to pressure, composition and kinetics; and on experimental calibration of the transformations.
The structure of a disordered IIb Mg-chamosite was studied using Rietveld refinement techniques and powder X-ray diffraction (CuKα, 18–120° 2θ in 0.02° 2θ increments). The refinement in space group CĪ yielded high precision lattice parameters (a = 5.36982(5)Å, b = 9.3031(9)Å, c = 14.2610(6)Å, α = 90.315(5)°, β = 97.234(7)°, γ = 90.022(9)°) and atomic coordinates very similar to previous studies. However, the presence of semi-random stacking in this specimen created a situation in which not all atoms could be precisely located: the positions of the octahedral cations and anions which repeat at intervals of ±b/3 could be uniquely determined in three dimensions whereas only the z parameter of the other atoms could be refined. The reasonable appearance of the final model, despite the fact that many of the atom positions could be located in only one dimension, may have resulted because all of the atoms in this structure except O(5) repeat at intervals which are very nearly ±b/3.
Waste generation and subsequent plastic pollution pose a major threat to both human and environmental health. Furthering our understanding of waste at individual levels can inform future waste reduction strategies, education and policies. This study explores the components and perceptions among individuals using survey data combined with a mini-review. An online Qualtrics survey was distributed pre-COVID-19 following a global social media challenge, Futuristic February, which directed participants to collect their nonperishable waste during February 2020. Participants were asked about their waste generation, perceptions toward waste and plastic pollution issues, and environmental worldview using the New Ecological Paradigm (NEP) scale (n = 50). We also conducted a mini-review of eight waste and plastic pollution statements from our survey in both popular media and scientific journal articles. Survey results indicated participants had an overall pro-ecological worldview (M = 4.32, SD = 0.88) and reported cardboard and paper (66%) as the most commonly occurring nonperishable waste category. Across categories, food packaging was the most common waste type. Participants were most uncertain about statements focusing on bioplastic or biodegradable plastic, respectively (44% and 30%), while the statement on microplastic toxicity obtained 100% mild or strong agreement among participants. Uncertainty for reviewed statements varied depending on the topic and group. Popular media and scholarly articles did not always agree, possibly due to differences in communication of uncertainty or terminology definitions. These results can inform future policy and educational campaigns around topics of misinformation.
Anxiety in pregnancy and after giving birth (the perinatal period) is highly prevalent but under-recognised. Robust methods of assessing perinatal anxiety are essential for services to identify and treat women appropriately.
Aims
To determine which assessment measures are most psychometrically robust and effective at identifying women with perinatal anxiety (primary objective) and depression (secondary objective).
Method
We conducted a prospective longitudinal cohort study of 2243 women who completed five measures of anxiety and depression (Generalized Anxiety Disorder scale (GAD) two- and seven-item versions; Whooley questions; Clinical Outcomes in Routine Evaluation (CORE-10); and Stirling Antenatal Anxiety Scale (SAAS)) during pregnancy (15 weeks, 22 weeks and 31 weeks) and after birth (6 weeks). To assess diagnostic accuracy a sample of 403 participants completed modules of the Mini-International Neuropsychiatric Interview (MINI).
Results
The best diagnostic accuracy for anxiety was shown by the CORE-10 and SAAS. The best diagnostic accuracy for depression was shown by the CORE-10, SAAS and Whooley questions, although the SAAS had lower specificity. The same cut-off scores for each measure were optimal for identifying anxiety or depression (SAAS ≥9; CORE-10 ≥9; Whooley ≥1). All measures were psychometrically robust, with good internal consistency, convergent validity and unidimensional factor structure.
Conclusions
This study identified robust and effective methods of assessing perinatal anxiety and depression. We recommend using the CORE-10 or SAAS to assess perinatal anxiety and the CORE-10 or Whooley questions to assess depression. The GAD-2 and GAD-7 did not perform as well as other measures and optimal cut-offs were lower than currently recommended.
Scholars, policymakers, and citizens alike remain invested in the impact of infectious diseases worldwide. Studies have found that emerging diseases and disease outbreaks burden global economies and public health goals. This article explores the potential link between measles outbreaks and various forms of civil unrest, such as demonstrations, riots, strikes, and other anti-government violence, in four central African countries from 1996 to 2005. Using a difference-in-differences model, we examine whether disease outbreaks have a discernible impact on the prevalence of civil unrest. While our findings indicate that the relationship between disease and civil unrest is not as strong as previously suggested, we identify a notable trend that warrants further investigation. These results have significant implications for health and policy officials in understanding the complex interplay between state fragility, civil unrest, and the spread of disease.
There is increasing recognition of cognitive and pathological heterogeneity in early-stage Alzheimer’s disease and other dementias. Data-driven approaches have demonstrated cognitive heterogeneity in those with mild cognitive impairment (MCI), but few studies have examined this heterogeneity and its association with progression to MCI/dementia in cognitively unimpaired (CU) older adults. We identified cluster-derived subgroups of CU participants based on comprehensive neuropsychological data and compared baseline characteristics and rates of progression to MCI/dementia or a Dementia Rating Scale (DRS) of <129 across subgroups.
Participants and Methods:
A hierarchical cluster analysis was conducted using 11 baseline neuropsychological test scores from 365 CU participants in the UCSD Shiley-Marcos Alzheimer’s Disease Research Center (age M=71.93 years, SD=7.51; 55.9% women; 15.6% Hispanic/Latino/a/x/e). A discriminate function analysis was then conducted to test whether the individual neuropsychological scores predicted cluster-group membership. Cox regressions examined the risk of progression to consensus diagnosis of MCI or dementia, or to DRS score <129, by cluster group.
Results:
Cluster analysis identified 5 groups: All-Average (n=139), Low-Visuospatial (n=46), Low-Executive (n=51), Low-Memory/Language (n=83), and Low-All Domains (n=46). The discriminant function analysis using the neuropsychological measures to predict group membership into these 5 clusters correctly classified 85.2% of the participants. Subgroups had unique demographic and clinical characteristics. Relative to the All-Average group, the Low-Visuospatial (hazard ratio [HR] 2.39, 95% CI [1.03, 5.56], p=.044), Low-Memory/Language (HR 4.37, 95% CI [2.24, 8.51], p<.001), and Low-All Domains (HR 7.21, 95% CI [3.59, 14.48], p<.001) groups had greater risk of progression to MCI/dementia. The Low-Executive group was also twice as likely to progress to MCI/dementia compared to the AllAverage group, but did not statistically differ (HR 2.03, 95% CI [0.88,4.70], p=.096). A similar pattern of results was found for progression to DRS score <129, with the Low-Executive (HR 2.82, 95% CI [1.26, 6.29], p=.012), Low-Memory/Language (HR 3.70, 95% CI [1.80, 7.56], p<.001) and Low-All Domains (HR 5.79, 95% CI [2.74, 12.27], p<.001) groups at greater risk of progression to a DRS score <129 than the All-Average group. The Low-Visuospatial group was also twice as likely to progress to DRS <129 compared to the All-Average group, but did not statistically differ (HR 2.02, 95% CI [0.80, 5.06], p=.135).
Conclusions:
Our results add to a growing literature documenting heterogeneity in the earliest cognitive and pathological presentations associated with Alzheimer’s disease and related disorders. Participants with subtle memory/language, executive, and visuospatial weaknesses all declined at faster rates than the All-Average group, suggesting that there are multiple pathways and/or unique subtle cognitive decline profiles that ultimately lead to a diagnosis of MCI/dementia. These results have important implications for early identification of individuals at risk for MCI/dementia. Given that the same classification approach may not be optimal for everyone, determining profiles of subtle cognitive difficulties in CU individuals and implementing neuropsychological test batteries that assess multiple cognitive domains may be a key step towards an individualized approach to early detection and fewer missed opportunities for early intervention.
Transcranial magnetic stimulation (TMS) is an effective treatment for individuals with pharmacoresistant major depressive disorder (MDD), yet identifying which patients best respond remains an important area of inquiry. The Brief Symptom Inventory (BSI-18) serves as a screen for psychological distress, providing measures across three separate domains (e.g., somatization, depression, and anxiety) and one composite score (i.e., global severity index). The psychometric properties of the BSI-18 have been validated across multiple studies; however, it has sparsely been used to track changes in patient symptoms in response to intervention. Assessing patient symptom severity across these domains is imperative since these symptoms can negatively influence cognitive functioning. Accordingly, the current study utilized the BSI-18 to measure psychological distress across these different domains in patients receiving TMS treatment. We hypothesized that all domains of the BSI-18 would see a significant decrease after treatment, that elevated scores in specific domains would predict a less favorable response to treatment, and that measurement of depressive symptoms will be consistent across measures of similar scope.
Participants and Methods:
Veterans (n=94) with MDD and met standard clinical TMS criteria were administered the BSI-18 before and after receiving an adequate dose of treatment (e.g., 30 sessions). Paired Samples T-test were used to compare the pre-treatment and post-treatment scores across domains.
Results:
The results of paired sample t-tests indicated a statistically significant reduction in measures of global psychological distress (t(93) = 7.99, p < .001, Cohen's d =.82), as well as depressive (t(93) = 8.34, p < .001, d = .86), anxious (t(93) = 7.64, p < .001, d = .79), and somatic symptoms (t(92) = 5.29, p < .001, d = .55) after receiving treatment. Individuals with elevated levels of anxiety (e.g., BSI-A>63) saw a significant reduction in depressive (t(62) = 8.15, p < .001, d = 1.03), anxious (t(62) = 8.34, p < .001, d = 1.05) and somatic (t(61) = 4.94, p < .001, d = .63) symptoms. Lastly, two measures of depressive symptoms, the BSI-D and PHQ-9, had a statistically significant strong, positive relationship before (r=.66) and after (r=.88) treatment (all n=65 and p<.001).
Conclusions:
The BSI-18 can detect changes in different domains of psychological distress as a function of TMS treatment. Unexpectedly, TMS patients with elevated levels of anxiety responded well to treatment despite comorbid anxiety often being associated with less favorable outcomes in treatment trials. The positive relationship of the BSI-D and PHQ-9 before and after treatment suggests the use of the BSI as a valid, additional measure of depressive symptoms.