Transition to first episode psychosis in ultra high risk populations: Does baseline functioning hold the key?

BackgroundBaseline functioning has been found to be a strong predictor of transition to psychosis in ultra high risk populations. However, the time course of functioning may enhance prediction. We investigated whether there were different patterns of functioning over time and whether particular temporal patterns were related to baseline characteristics and psychosis outcome.MethodFunctional data was assessed at baseline and after 3 to 6 year follow-up in an ultra high risk sample (n = 158; 92 female, mean age = 19.28 (SD = 3.33), range = 14–29). Using the median score of the GAF and the QLS scale, a ‘High’ and ‘Low’ group (comprising of subjects functioning above or below median at both baseline and follow-up) and a ‘Deterioration’ group and ‘Improving’ group were created.ResultsChi-square analyses showed that the Low and Deteriorating functioning groups were the most likely to develop first-episode psychosis (FEP). Importantly, UHR individuals with deteriorating functioning were at higher risk of transition than those whose functioning was low at baseline but improved over time (GAF: X² = 5.10, df = 1, p = .02; QLS: X² = 9.13, df = 1, p = .003). Binary logistic regression analyses showed that a decline in functioning was more strongly associated with FEP (GAF: p = < .0001; QLS: p < .0001) than the level of baseline functioning (GAF: p = .005; QLS: p = .09). The deteriorating group could not be distinguished from the High group in terms of baseline symptomatology.DiscussionWith the addition of the ‘low functioning’ criterion to the UHR criteria, we may miss out on some true positive cases. Limiting our attention to baseline poor functioning may therefore distort the picture in terms of risk for psychosis.     

The long-term stability of temperament traits measured after a suicide attempt. A 5-year follow-up of ratings of Karolinska Scales of Personality (KSP)

The main aim of the present study was to investigate whether or not temperament dimensions are stable over time. Twenty-six patients (21 women and five men) filled in the Karolinska Scales of Personality (KSP) both at admission after a suicide attempt (index) and at follow-up 5 years later. KSP changes were significantly associated with low severity of psychiatric symptoms and no reported reattempts at follow up. There were significant changes of all five groups of KSP, most prominently in anxiety-related scales. At index, KSP scores did not differ between those who later would repeat a suicide attempt (repeaters) and not, but repeaters more often tended to have a personality disorder and their 24-h urinary cortisol tended to be lower. In this limited sample, repeaters seem to have a protracted high anxiety level as mirrored by high and stable KSP scores over time.     

Prototypical Affective Microsequences in Psychotherapeutic Interaction

In this article a new approach for the microanalytic study of cognitive-affective regulatory processes in psychotherapeutic interaction is presented. Of central importance are the communicative components of affective regulatory processes that are directly observable, particularly facial expressions which were coded with the Facial Action Coding System (FACS) by Ekman and Friesen (1978). These data are represented graphically in the form of a process pilot and related to theoretical concepts about affective regulatory processes in such a way that an integrated model of the affective regulatory processes can be formulated for selected sequences. Such sequences are designated prototypical affective microsequences. Their role in the affective regulation of client-therapist interaction is worked out and discussed by means of an example. It can be shown that so-called successful microsequences with often-recurring smiles and laughter of both client and therapist are necessary to give the client a basic sense of security, thus enabling productive work.     

Consensual Sadomasochistic Sex (BDSM): The Roots, the Risks, and the Distinctions Between BDSM and Violence

Depression and cognitive disorders, including dementia and mild cognitive impairment, are common in the elderly. Depression is also a common feature of cognitive impairment although the symptoms of depression in cognitive impairment differ from depression without cognitive impairment. Pre-morbid depression approximately doubles the risk of subsequent dementia. There are two predominant, though not mutually exclusive, constructs linking pre-morbid depression to subsequent cognitive impairment: Alzheimer’s pathology and the vascular depression hypothesis. When evaluating a patient with depression and cognitive impairment, it is important to obtain caregiver input and to evaluate for alternative etiologies for depressive symptoms such as delirium. We recommend a sequential approach to the treatment of depression in dementia patients: (1) a period of watchful waiting for milder symptoms, (2) psychosocial treatment program, (3) a medication trial for more severe symptoms or failure of psychosocial interventions, and (4) possible ECT for refractory symptoms.     

The role of growth factors in diabetic peripheral neuropathy

Peripheral neuropathy afflicts 60% of all diabetic patients. Underlying the clinical disorder is the loss or degeneration of neurons, Schwann cells, and neuronal fibers. This degenerative pathology has prompted interest in the potential of growth factors as a therapy in diabetic neuropathy. Three lines of evidence support the theory that growth factors may be important in this disorder: (1) endogenous growth factors promote survival and health of neurons, (2) expression levels of growth factors are altered in diabetic neuropathy and peripheral neuron injury, and (3) growth factors induce neuronal regeneration in in vitro and in vivo models of diabetic injury. This review surveys the roles of several growth factors in diabetic neuropathy, including the neurotrophins, insulin-like growth factors, cytokine-like growth factors, and vascular endothelial growth factor. These growth factors are examined in terms of their expression during peripheral nerve injury and their protective and regenerative effects on peripheral neurons. Growth factor-mediated neuroprotective signaling is discussed, particularly in relation to the recent research, suggesting that diabetic neuropathy-induced degeneration stems from oxidative stress. Finally, the potential of growth factors as therapeutic agents is addressed, including an assessment of past growth factor clinical trials and other potential avenues of growth factor therapy.     

Recognition of facial expressions of emotion by patients with dementia of the Alzheimer type

Bilateral amygdala damage has been linked with an inability to recognise facial expressions of emotion, particularly the expression of fear. Patients with Alzheimer's disease (AD) suffer from atrophy of the amygdala at an early stage of the disease. It was therefore predicted that AD patients would have more difficulty in two tasks of processing facial expressions of emotion. Thirteen patients diagnosed with probable AD referred to the Oxford Project to Investigate Memory and Ageing (OPTIMA) and 13 age-matched controls enrolled in the programme participated in the study. Participants were shown two tasks, one involved recognising and labelling a target expression, the other matching a target expression with one of four others. The results showed that compared with the controls, the patients were not impaired in recognising any facial expressions of emotion in the labelling task, but were impaired in matching three facial expressions of emotion in the second task. It was speculated that the impairment in the matching task could have been a result of visuospatial dysfunction rather than one of processing emotions.     

Hippocampal and amygdala changes in patients with major depressive disorder and healthy controls during a 1-year follow-up

BACKGROUND: Although the hippocampus has been found to be smaller in patients with depression, prospective longitudinal in vivo studies are necessary to investigate whether depression can result in a further diminution of hippocampal volumes or whether a smaller hippocampal volume predisposes an individual to the development of depression. METHOD: Thirty patients with DSM-IV major depressive disorder as well as 30 healthy control subjects matched for age, gender, and handedness were examined at admission to the hospital and 1 year later using a documentation of the medical history and high-resolution magnetic resonance imaging (MRI) for the presence of depression and to determine changes in hippocampal as well as amygdala volumes. Patients were enrolled from March 2000 to August 2002. RESULTS: No significant hippocampal and amygdala volume changes were observed in patients or controls between baseline and 1-year follow-up investigations. However, the subgroup of patients who were nonremitted at the time of the follow-up investigation showed significantly reduced left and right hippocampal volumes at both baseline and the 1-year follow-up compared with remitted patients. Moreover, the right hippocampal volumes of nonremitted patients were significantly smaller compared with matched healthy controls. CONCLUSION: These results do not support the hypothesis that hippocampal volumes diminish during the 1-year follow-up period. However, smaller hippocampal volumes may be related to a poor clinical outcome after 1 year.     

Generation of embryonic stem cells and transgenic mice expressing green fluorescence protein in midbrain dopaminergic neurons

We have generated embryonic stem (ES) cells and transgenic mice with green fluorescent protein (GFP) inserted into the Pitx3 locus via homologous recombination. In the central nervous system, Pitx3-directed GFP was visualized in dopaminergic (DA) neurons in the substantia nigra and ventral tegmental area. Live primary DA neurons can be isolated by fluorescence-activated cell sorting from these transgenic mouse embryos. In culture, Pitx3-GFP is coexpressed in a proportion of ES-derived DA neurons. Furthermore, ES cell-derived Pitx3-GFP expressing DA neurons responded to neurotrophic factors and were sensitive to DA-specific neurotoxin N-4-methyl-1, 2, 3, 6-tetrahydropyridine. We anticipate that the Pitx3-GFP ES cells could be used as a powerful model system for functional identification of molecules governing mDA neuron differentiation and for preclinical research including pharmaceutical drug screening and transplantation. The Pitx3 knock-in mice, on the other hand, could be used for purifying primary neurons for molecular studies associated with the midbrain-specific DA phenotype at a level not previously feasible. These mice would also provide a useful tool to study DA fate determination from embryo- or adult-derived neural stem cells.