Objective
To perform a meta‐analysis on studies reporting prevalence of Toxoplasma gondii (T. gondii) infection in any psychiatric disorder compared with healthy controls. Our secondary objective was ...to analyze factors possibly moderating heterogeneity.
Method
A systematic search was performed to identify studies into T. gondii infection for all major psychiatric disorders versus healthy controls. Methodological quality, publication bias, and possible moderators were assessed.
Results
A total of 2866 citations were retrieved and 50 studies finally included. Significant odds ratios (ORs) with IgG antibodies were found in schizophrenia (OR 1.81, P < 0.00001), bipolar disorder (OR 1.52, P = 0.02), obsessive–compulsive disorder (OR 3.4, P < 0.001), and addiction (OR 1.91, P < 0.00001), but not for major depression (OR 1.21, P = 0.28). Exploration of the association between T. gondii and schizophrenia yielded a significant effect of seropositivity before onset and serointensity, but not IgM antibodies or gender. The amplitude of the OR was influenced by region and general seroprevalence. Moderators together accounted for 56% of the observed variance in study effects. After controlling for publication bias, the adjusted OR (1.43) in schizophrenia remained significant.
Conclusion
These findings suggest that T. gondii infection is associated with several psychiatric disorders and that in schizophrenia reactivation of latent T. gondii infection may occur.
Previous research has established the relationship between cannabis use and psychotic disorders. Whether cannabis use is related to transition to psychosis in patients at ultra-high risk (UHR) for ...psychosis remains unclear. The present study aimed to review the existing evidence on the association between cannabis use and transition to psychosis in UHR samples.
A search of PsychInfo, Embase and Medline was conducted from 1996 to August 2015. The search yielded 5559 potentially relevant articles that were selected on title and abstract. Subsequently 36 articles were screened on full text for eligibility. Two random-effects meta-analyses were performed. First, we compared transition rates to psychosis of UHR individuals with lifetime cannabis use with non-cannabis-using UHR individuals. Second, we compared transition rates of UHR individuals with a current DSM-IV cannabis abuse or dependence diagnosis with lifetime users and non-using UHR individuals.
We found seven prospective studies reporting on lifetime cannabis use in UHR subjects (n = 1171). Of these studies, five also examined current cannabis abuse or dependence. Lifetime cannabis use was not significantly associated with transition to psychosis odds ratio (OR) 1.14, 95% confidence interval (CI) 0.856-1.524, p = 0.37. A second meta-analysis yielded an OR of 1.75 (95% CI 1.135-2.710, p = 0.01), indicating a significant association between current cannabis abuse or dependence and transition to psychosis.
Our results show that cannabis use was only predictive of transition to psychosis in those who met criteria for cannabis abuse or dependence, tentatively suggesting a dose-response relationship between current cannabis use and transition to psychosis.
Investigation of treatments that effectively treat adults with post-traumatic stress disorder from childhood experiences (Ch-PTSD) and are well tolerated by patients is needed to improve outcomes for ...this population.
The purpose of this study was to compare the effectiveness of two trauma-focused treatments, imagery rescripting (ImRs) and eye movement desensitisation and reprocessing (EMDR), for treating Ch-PTSD.
We conducted an international, multicentre, randomised clinical trial, recruiting adults with Ch-PTSD from childhood trauma before 16 years of age. Participants were randomised to treatment condition and assessed by blind raters at multiple time points. Participants received up to 12 90-min sessions of either ImRs or EMDR, biweekly.
A total of 155 participants were included in the final intent-to-treat analysis. Drop-out rates were low, at 7.7%. A generalised linear mixed model of repeated measures showed that observer-rated post-traumatic stress disorder (PTSD) symptoms significantly decreased for both ImRs (d = 1.72) and EMDR (d = 1.73) at the 8-week post-treatment assessment. Similar results were seen with secondary outcome measures and self-reported PTSD symptoms. There were no significant differences between the two treatments on any standardised measure at post-treatment and follow-up.
ImRs and EMDR treatments were found to be effective in treating PTSD symptoms arising from childhood trauma, and in reducing other symptoms such as depression, dissociation and trauma-related cognitions. The low drop-out rates suggest that the treatments were well tolerated by participants. The results from this study provide evidence for the use of trauma-focused treatments for Ch-PTSD.
Patients with schizophrenia have a higher mortality risk than patients suffering from any other psychiatric disorder. Previous research is inconclusive regarding the association of antipsychotic ...treatment with long-term mortality risk. To this aim, we systematically reviewed the literature and performed a meta-analysis on the relationship between long-term mortality and exposure to antipsychotic medication in patients with schizophrenia. The objectives were to (i) determine long-term mortality rates in patients with schizophrenia using any antipsychotic medication; (ii) compare these with mortality rates of patients using no antipsychotics; (iii) explore the relationship between cumulative exposure and mortality; and (iv) assess causes of death. We systematically searched the EMBASE, MEDLINE and PsycINFO databases for studies that reported on mortality and antipsychotic medication and that included adults with schizophrenia using a follow-up design of more than 1 year. A total of 20 studies fulfilled our inclusion criteria. These studies reported 23,353 deaths during 821,347 patient years in 133,929 unique patients. Mortality rates varied widely per study. Meta-analysis on a subgroup of four studies showed a consistent trend of an increased long-term mortality risk in schizophrenia patients who did not use antipsychotic medication during follow-up. We found a pooled risk ratio of 0.57 (LL:0.46 UL:0.76 p value <0.001) favouring any exposure to antipsychotics. Statiscal heterogeneity was found to be high (Q = 39.31, I 2 = 92.37%, p value < 0.001). Reasons for the increased risk of death for patients with schizophrenia without antipsychotic medication require further research. Prospective validation studies, uniform measures of antipsychotic exposure and classified causes of death are commendable.
Sudden gains, defined as large and stable improvements in symptom severity during psychological treatment, have consistently been found to be associated with better outcomes across treatments and ...diagnoses. Yet, insights on coherent predictors of sudden gains and on emotional changes around sudden gains in post-traumatic stress disorder (PTSD) are lacking. We aimed at replicating a measure of intraindividual variability as a predictor for sudden gains and testing its independence from change during treatment. Furthermore, we expected changes in emotions of guilt, shame and disgust prior to sudden gains to predict sudden gains. Data from a pre-registered randomized controlled trial (RCT) of eye-movement desensitization and reprocessing (emdr) and Imagery Rescripting (ImRs) for PTSD in 155 adult survivors of childhood abuse were used. Intraindividual variability of PTSD symptoms in both treatments did not predict sudden gains status and was not independent of change during treatment. In the EMDR condition, levels of shame during treatment predicted sudden gains and shame decreased shortly before a sudden gain in both treatments. Reductions in all emotions during sudden gains were significantly higher for participants with sudden gains than for comparable intervals in non-sudden gainers. Our findings do not support the predictive validity of intraindividual variability for sudden gains. The decrease of guilt, shame and disgust during sudden gains warrants further research on their role as a mechanism of treatment change for PTSD.
Post-traumatic stress disorder (PTSD) that originates from childhood trauma experiences can develop into a chronic condition that has lasting effects on an individual's functioning and quality of ...life. While there are evidence-based guidelines for treating adult onset PTSD, treatments for adults with childhood trauma-related PTSD (Ch-PTSD) are varied and subject to ongoing debate. This study will test the effectiveness of two trauma-focused treatments, imagery rescripting (ImRs) and eye movement desensitisation and reprocessing (EMDR) in participants with Ch-PTSD. Both have been found effective in treatment of adult PTSD or mixed onset PTSD and previous research indicates they are well-tolerated treatments. However, we know less about their effectiveness for treating Ch-PTSD or their underlying working mechanisms.
IREM is an international multicentre randomised controlled trial involving seven sites across Australia, Germany and the Netherlands. We aim to recruit 142 participants (minimum of n = 20 per site), who will be randomly assigned to treatment condition. Assessments will be conducted before treatment until 1-year follow-up. Assessments before and after the waitlist will assess change in time only. The primary outcome measure is change in PTSD symptom severity from pre-treatment to 8-weeks post-treatment. Secondary outcome measures include change in severity of depression, anger, trauma-related cognitions, guilt, shame, dissociation and quality of life. Underlying mechanisms of treatment will be assessed on changes in vividness, valence and encapsulated belief of a worst trauma memory. Additional sub-studies will include qualitative investigation of treatment experiences from the participant and therapists' perspective, changes in memory and the impact of treatment fidelity on outcome measures.
The primary aims of this study are to compare the effectiveness of EMDR and ImRs in treating Ch-PTSD and to investigate the underlying working mechanisms of the two treatments. The large-scale international design will make a significant contribution to our understanding of how these treatments address the needs of individuals with Ch-PTSD and therefore, potentially improve their effectiveness.
Australian New Zealand Clinical Trials Registry ACTRN12614000750684 . Registered 16 July 2014.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract The aim of this review is to describe the potential relationship between multisensory disintegration and self-disorders in schizophrenia spectrum disorders. Sensory processing impairments ...affecting multisensory integration have been demonstrated in schizophrenia. From a developmental perspective multisensory integration is considered to be crucial for normal self-experience. An impairment of multisensory integration is called ‘perceptual incoherence’. We theorize that perceptual incoherence may evoke incoherent self-experiences including depersonalization, ambivalence, diminished sense of agency, and ‘loosening of associations’ between thoughts, feelings and actions that lie within the framework of ‘self-disorders’ as described by Sass and Parnas (2003) . We postulate that subconscious attempts to restore perceptual coherence may induce hallucinations and delusions. Increased insight into mechanisms underlying ‘self-disorders’ may enhance our understanding of schizophrenia, improve recognition of early psychosis, and extend the range of therapeutic possibilities.
Introduction
Increasing evidence shows that impaired neuroplasticity and high inflammation play a crucial role in the pathophysiology of schizophrenia. Prospective studies demonstrated that patients ...with high inflammation usually have a poor treatment response and clinical practice learns that negative symptoms are challenging to treat. The predictive value of biomarkers for negative symptoms in patients with schizophrenia has sparsely been explored.
Objectives
Here, we investigated whether biomarkers are associated with negative symptoms at baseline, and whether biomarkers could predict negative symptoms after six years in patients with schizophrenia.
Methods
We investigated serum biomarkers in an epidemiological study on schizophrenia (N, baseline=110; N, follow-up=65). Negative symptoms were measured using the Positive and Negative Syndrome Scale. Biomarkers (N=189) were measured with a multi-analyte profiling platform and analysed using linear regression models, adjusted for site, age, gender, ethnicity, anti-inflammatory agents, smoking, cardiovascular disease and diabetes, and adjusted for multiple comparisons (q, Benjamini-Hochberg procedure).
Results
In particular, decreased platelet-derived growth factor (PDGF) (responsible for proliferation of oligodendrocytes) was associated with more negative symptoms at baseline and follow-up (figure). Several other biomarkers associated with inflammation, neuroplasticity and metabolism correlated with the severity of negative symptoms cross-sectionally and/or prospectively. Figure. Biomarkers for Negative Symptoms in Schizophrenia.
Conclusions
Although our sample size at follow-up was limited, we feel that these analyses contribute to further research of possible predictive biomarkers for negative symptoms in schizophrenia. During the conference we will elaborate our findings with applied machine learning techniques which might shed more light on the predictive value of biomarkers for negative symptoms in schizophrenia.
Disclosure
No significant relationships.
The General Functioning 12‐item subscale (GF12) of The McMaster Family Assessment Device (FAD) has been validated as a single index measure to assess family functioning. This study reports on the ...reliability and validity of using only the six positive items from the General Functioning subscale (GF6+). Existing data from two Western Australian studies, the Raine Study (RS) and the Western Australian Child Health Survey (WACHS), was used to analyze the psychometric properties of the GF6+ subscale. The results demonstrated that the GF6+ subscale had virtually equivalent psychometric properties and was able to identify almost all of the same families who had healthy or unhealthy levels of functioning as the full GF12 subscale. In consideration of the constraints faced by large‐scale population‐based surveys, the findings of this study support the use of a GF6+ subscale from the FAD, as a quick and effective tool to assess the overall functioning of families.
La subescala de funcionamiento general de 12 puntos (GF12) de la herramienta de evaluación familiar (FAD) de McMaster se validó como herramienta de índice único para evaluar el funcionamiento familiar. En este estudio se informa sobre la fiabilidad y la validez de utilizar solo los seis puntos positivos de la subescala de funcionamiento general (GF6+). Se utilizaron datos existentes de dos estudios de Australia Occidental, el estudio Raine (Raine Study, RS) y la “Encuesta sobre la salud infantil de Australia Occidental” (Western Australian Child Health Survey, WACHS) para analizar las propiedades psicométricas de la subescala GF6+. Los resultados demostraron que la subescala GF6+ tiene propiedades psicométricas prácticamente equivalentes y que pudo identificar casi todas las mismas familias que tenían niveles saludables o poco saludables de funcionamiento que la subescala completa GF12. En vista de las limitaciones que enfrentan las encuestas poblacionales masivas, los resultados de este estudio respaldan el uso de una subescala GF6+ del FAD como herramienta rápida y eficaz para evaluar el funcionamiento saludable general de las familias.
麦克马斯特家庭评估策略(FAD)的一般功能12项亚尺度(GF12)已被验证为评估家庭功能的单一指标量度。本项研究报告了仅使用一般功能亚尺度中六个正面向(GF6+)的可靠性和有效性。我们使用从两项西澳大利亚研究中得出的现有数据, 即雷恩研究(RS)和西澳大利亚儿童健康调查(WACHS),分析了GF6+亚尺度的心理测量属性。结果显示,GF6+亚尺度有与GF12亚尺度几乎对等的心理测量属性,并且可以确认出几乎全部有健康或不健康功能水平的家庭。鉴于大规模人口调查面临的制约,本项研究的发现支持使用FAD中GF6+亚尺度作为一种快速有效的评估家庭整体健康功能的工具。
Many communities in the Midwestern United States obtain their drinking water from shallow alluvial wells that are vulnerable to contamination by NO3-N from the surrounding agricultural landscape. The ...objective of this research was to assess cropping systems with the potential to produce a reasonable return for farmers while simultaneously reducing the risk of NO3-N movement into these shallow aquifers. From 2009 to 2013 we conducted a field experiment in northwest Iowa in which we evaluated five cropping systems for residual (late fall) soil NO3-N content and profitability. Soil samples were taken annually from the top 30 cm of the soil profile in June and August, and from the top 180 cm in November (late fall). The November samples were divided into 30 cm increments for analysis. Average residual NO3-N content in the top 180 cm of the soil profile following the 2010 to 2013 cropping years was 134 kg ha-1 for continuous maize (Zea mays L.) with a cereal rye (Secale cereale L.) cover crop, 18 kg ha-1 for perennial grass, 60 kg ha-1 for a three year oat (Avena sativa L.)-alfalfa (Medicago sativa L.)-maize rotation, 85 kg ha-1 for a two year oat/red clover (Trifolium pratense L.)-maize rotation, and 90 kg ha-1 for a three year soybean (Glycine max (L.) Merr.)-winter wheat (Triticum aestivum L.)-maize rotation. However, residual NO3-N in the 90 to 180 cm increment of the soil profile was not significantly higher in the oat-alfalfa-maize cropping system than the perennial grass system. For 2010 to 2013, average profit ($ ha-1 yr-1) was 531 for continuous corn, 347 for soybean-winter wheat-maize, 264 for oat-alfalfa-maize, 140 for oat/red clover-maize, and -384 (loss) for perennial grass. Considering both residual soil NO3-N and profitability data, the oat-alfalfa-maize rotation performed the best in this setting. However, given current economic pressures widespread adoption is likely to require changes in public policy.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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