The Early Recognition Inventory ERIraos detects at risk mental states of psychosis with high sensitivity

The identification of patients carrying an increased risk of psychosis is one of the most important demands in schizophrenia research. Currently used diagnostic instruments mainly focus on either attenuated psychotic symptoms and brief limited intermittent psychotic symptoms or solely cognitive basic symptoms. The “Early Recognition Inventory based on IRAOS” (ERIraos) has been developed as a comprehensive assessment of both symptom groups within one scale. We compared the results obtained by ERIraos with an international standard instrument, the “Comprehensive Assessment of At Risk Mental States” (CAARMS) and applied both scales in a sample of 121 outpatients positively tested on a screening checklist for at risk mental states (ARMS). Subsamples were classified as first episode of psychosis, late ARMS with prevalent attenuated psychotic symptoms and/or brief limited intermittent psychotic symptoms, earlier stages of ARMS presenting cognitive basic symptoms as well as a vulnerability group, also differing regarding mean age and psychosocial functioning. Our results point to a higher sensitivity of ERIraos compared to scales that mainly focus on attenuated psychotic symptoms and brief limited intermittent psychotic symptoms. A detailed assessment of cognitive basic symptoms seems to be important in early detection, might be an important focus for therapeutic interventions in ARMS patients and might sustain attempts to alleviate cognitive dysfunction in schizophrenia.     

Cue-Induced Smoking Urges Deplete Cigarette Smokers’ Self-Control Resources

Background

Exposure to smoking-related cues leads to increased urge to smoke in regular cigarette smokers and resisting these urges requires considerable self-control.

Purpose

Adopting a resource depletion model, two studies tested the hypothesis that resisting smoking urges depletes self-control resources.

Methods

Adopting a within-participants randomized cross-over design, participants (study 1, N?=?19; study 2, N?=?32) were exposed to smoking-related (study 1: smoking images; study 2: cigarette cue-exposure task) and neutral (study 1: neutral images; study 2: drinking-straw task) cues with presentation order randomized. After each cue set, participants completed self-control tasks (study 1: handgrip task; study 2: handgrip and Stroop tasks), performance on which constituted dependent measures of self-control.

Results

Self-control task performance was significantly impaired when exposed to smoking-related cues compared to neutral cues. No significant presentation-order effects, or interaction effects between stimulus and presentation order, were found.

Conclusions

Findings corroborate our hypothesis that resisting smoking urges depletes cigarette smokers’ self-control resources and suggests that self-control capacity is governed by a limited resource.     

Spatial MEG Laterality maps for language: Clinical applications in epilepsy

Functional imaging is increasingly being used to provide a noninvasive alternative to intracarotid sodium amobarbitol testing (i.e., the Wada test). Although magnetoencephalography (MEG) has shown significant potential in this regard, the resultant output is often reduced to a simplified estimate of laterality. Such estimates belie the richness of functional imaging data and consequently limit the potential value. We present a novel approach that utilizes MEG data to compute “complex laterality vectors” and consequently “laterality maps” for a given function. Language function was examined in healthy controls and in people with epilepsy. When compared with traditional laterality index (LI) approaches, the resultant maps provided critical information about the magnitude and spatial characteristics of lateralized function. Specifically, it was possible to more clearly define low LI scores resulting from strong bilateral activation, high LI scores resulting from weak unilateral activation, and most importantly, the spatial distribution of lateralized activation. We argue that the laterality concept is better presented with the inherent spatial sensitivity of activation maps, rather than being collapsed into a one‐dimensional index. Hum Brain Mapp, 2013. © 2012 Wiley Periodicals, Inc.     

Ethische Probleme im Umgang mit Reanimation und Patientenverfügung in der Notaufnahme

Background

Despite established structures for clinical ethics consultation, emergency medical professionals continually face problems when making decisions about life-prolonging procedures either in the emergency room or already in the preclinical setting. A particularly difficult decision is that of resuscitation with and without existing advance directives. Culmination points of such decisions are the emergency rooms.

Methods

The working group Ethics in Emergency and Acute Medicine of the DGINA (German Association of Interdisciplinary Emergency and Acute Medicine) conducted a survey among DGINA members about how this problem is handled in emergency departments.

Results

Of the emergency medicine professionals replying, 58.2?% see problems when dealing with resuscitation and 48.7?% when dealing with advance directives. In the opinion of 50?%, the reaction to this problem is often adequate. A clinical ethics committee is considered very useful or advisable by 73.4?%, but in only 7.3?% of the responders had a clinical ethics committee visited the emergency room. Written decision aids for such situations in the emergency room were considered reasonable by 71.2?% of the responders.

Discussion

The result shows a remarkable sensitivity to the subject among the survey participants, but also the awareness that established structures of clinical ethics consultation, such as ethics committees or ethics councils, do not work here. Nevertheless, the desire for ethical support in such situations, for example by written recommendations, is expressed in the survey, which is a focus area of the working group for Ethics in the Emergency and Acute Mmedicine of the DGINA. The survey illustrates how German emergency departments deal with this problem, thus, confirming and supplementing the contemporary literature.     

Interaction between prenatal stress and dopamine D4 receptor genotype in predicting aggression and cortisol levels in young adults

Rationale

Considerable evidence suggests that genetic factors combine with environmental influences to impact on the development of aggressive behavior. A genetic variant that has repeatedly been reported to render individuals more sensitive to the presence of adverse experiences, including stress exposure during fetal life, is the seven-repeat allele of the dopamine D4 receptor (DRD4) gene.

Objectives

The present investigation concentrated on the interplay of prenatal maternal stress and DRD4 genotype in predicting self-reported aggression in young adults. As disruption of the hypothalamic-pituitary-adrenal system has been discussed as a pathophysiological pathway to aggression, cortisol stress reactivity was additionally examined.

Methods

As part of an epidemiological cohort study, prenatal maternal stress was assessed by maternal interview 3 months after childbirth. Between the ages of 19 and 23 years, 298 offspring (140 males, 158 females) completed the Young Adult Self-Report to measure aggressive behavior and were genotyped for the DRD4 gene. At 19 years, 219 participants additionally underwent the Trier Social Stress Test to determine cortisol reactivity.

Results

Extending earlier findings with respect to childhood antisocial behavior, the results revealed that, under conditions of higher prenatal maternal stress, carriers of the DRD4 seven-repeat allele displayed more aggression in adulthood (p?=?0.032). Moreover, the same conditions which seemed to promote aggression were found to predict attenuated cortisol secretion (p?=?0.028).

Conclusions

This is the first study to indicate a long-term impact of prenatal stress exposure on the cortisol stress response depending on DRD4 genotype.     

Increased transplant-related morbidity and mortality in CMV-seropositive patients despite highly effective prevention of CMV disease after allogeneic T-cell-depleted stem cell transplantation

We evaluated the efficacy, toxicity, and outcome of preemptive ganciclovir (GCV) therapy in 80 cytomegalovirus (CMV)-seropositive patients allografted between 1991 and 1996 and compared their outcome to 35 seronegative patients allografted during the same period. Both cohorts were comparable with respect to diagnosis and distribution of high- versus standard-risk patients. All patients received a stem cell graft from an HLA-identical sibling donor, and grafts were partially depleted of T cells in 109 patients. Patients were monitored for CMV antigenemia by leukocyte expression of the CMV-pp65 antigen. Fifty-two periods of CMV reactivation occurring in 30 patients were treated preemptively with GCV. A favorable response was observed in 48 of 50 periods, and only 2 patients developed CMV disease: 1 with esophagitis and 1 with pneumonia. Ten of 30 treated patients developed GCV-related neutropenia (less than 0.5 x 10(9)/L), which was associated with a high bilirubin at the start of GCV therapy. Overall survival at 5 years was 64% in the CMV-seronegative cohort and 40% in the CMV-seropositive cohort (P =.01). Increased treatment-related mortality accounted for inferior survival. CMV seropositivity proved an independent risk factor for developing acute graft-versus-host disease, and acute graft-versus-host disease predicted for higher treatment-related mortality and worse overall survival in a time-dependent analysis. We conclude that, although CMV disease can effectively be prevented by preemptive GCV therapy, CMV seropositivity remains a strong adverse risk factor for survival following partial T-cell-depleted allogeneic stem cell transplantation.     

A prospective multicentre screening study on multidrug-resistant organisms in intensive care units in the Dutch–German cross-border region, 2017 to 2018: the importance of healthcare structures

BackgroundAntimicrobial resistance poses a risk for healthcare, both in the community and hospitals. The spread of multidrug-resistant organisms (MDROs) occurs mostly on a local and regional level, following movement of patients, but also occurs across national borders.AimThe aim of this observational study was to determine the prevalence of MDROs in a European cross-border region to understand differences and improve infection prevention based on real-time routine data and workflows.MethodsBetween September 2017 and June 2018, 23 hospitals in the Dutch (NL)–German (DE) cross-border region (BR) participated in the study. During 8 consecutive weeks, patients were screened upon admission to intensive care units (ICUs) for nasal carriage of meticillin-resistant Staphylococcus aureus (MRSA) and rectal carriage of vancomycin-resistant Enterococcus faecium/E. faecalis (VRE), third-generation cephalosporin-resistant Enterobacteriaceae (3GCRE) and carbapenem-resistant Enterobacteriaceae (CRE). All samples were processed in the associated laboratories.ResultsA total of 3,365 patients were screened (median age: 68 years (IQR: 57–77); male/female ratio: 59.7/40.3; NL-BR: n = 1,202; DE-BR: n = 2,163). Median screening compliance was 60.4% (NL-BR: 56.9%; DE-BR: 62.9%). MDRO prevalence was higher in DE-BR than in NL-BR, namely 1.7% vs 0.6% for MRSA (p = 0.006), 2.7% vs 0.1% for VRE (p < 0.001) and 6.6% vs 3.6% for 3GCRE (p < 0.001), whereas CRE prevalence was comparable (0.2% in DE-BR vs 0.0% in NL-BR ICUs).ConclusionsThis first prospective multicentre screening study in a European cross-border region shows high heterogenicity in MDRO carriage prevalence in NL-BR and DE-BR ICUs. This indicates that the prevalence is probably influenced by the different healthcare structures.     

The action of chelating agents and local anesthetics on the terminal stages of immune hemolysis

The participation of metal ions between C8 and C9 during the final stages of immune hemolysis could not be verified. EA, EAC1-7, and EAC1-8 all lyse completely when tested with 40 mM or higher concentrations of phenanthroline derivatives, only some of which are metal chelators. Only those phenanthrolines that carry a nitrogen in the No. 1 position and are also uncharged are lytic. 1.7-phenanthroline, not a chelator, lyses EAC1-8 more readily than EA and EAC1-7, suggesting an influence of the C5b-8 complex on this type of lysis. Unlike C9 lysis of EAC 1-8, phenanthroline induced lysis of EAC 1-8 cannot be inhibited by incubation with anti-C8, indicating different binding sites for C9 and phenanthrolines.The phenanthrolines neither protect nor promote hypotonic lysis, as do local anesthetics which are known to perturb primarily the membrane lipid phase. Likewise, sublytic drug concentrations do not modify immune hemolysis.