Abstract Neurocognitive impairment predicts disability in schizophrenia, making intervention theoretically attractive as a means to minimise chronic disability. Many trials confirm that cognitive ...remediation (CR) produces meaningful, durable improvements in cognition and functioning but fewer focus on the early stages. We systematically reviewed CR trials in early schizophrenia to determine its efficacy on global cognition, functioning and symptoms. Two reviewers independently searched electronic databases to identify randomised controlled trials investigating CR following a first episode of psychosis. Eleven trials with 615 participants were identified. Random effect models revealed a non-significant effect of CR on global cognition (effect size = 0.13, 95% CI − 0.04, 0.31; p0.14), p < 0.05 in sensitivity analysis (effect size 0.19; CI 0.00, 0.38). One of seven neurocognitive domains showed a significant positive effect (verbal learning and memory) and five others showed borderline significant benefits. There was a significant effect on functioning (0.18; CI 0.01, 0.36; p < 0.05) and symptoms (0.19; CI 0.02, 0.36; p < 0.05). CR's effect on functioning and symptoms was larger in trials with adjunctive psychiatric rehabilitation and small group interventions. CR's effect sizes in early illness were smaller than those in chronic schizophrenia, perhaps because of participants' reduced scope for improvement, though trials' small number and size produces uncertain estimates of effect. However, significant benefits were seen in functioning and symptoms and moderator analyses indicate factors that may increase CR's effect. Findings here, theoretical considerations and trials in chronic schizophrenia suggest that targeting social cognition might also enhance its efficacy.
Circadian dysregulation causes sleep disturbance and impacts quality of life and functioning. Some interventions target circadian entrainment through modifying light exposure, but existing reviews of ...light interventions for sleep improvement include few studies in psychiatric populations. We examined effect of light interventions on sleep quality, duration and timing, and effect moderators. We included controlled studies in intrinsic circadian rhythm disorders (such as advanced or delayed sleep) and in neuropsychiatric disorders with assumed high prevalence of circadian dysregulation (such as affective and psychotic disorders). Articles were identified through database searching: 40 studies reporting 49 relevant intervention comparisons met inclusion criteria. Meta-analysis showed improvements in sleep continuity (ES = −0.23, p = 0.000), self-reported sleep disturbance (ES = −0.32, p = 0.014), and advancement of delayed sleep timing (ES = −0.34, p = 0.010). Although the small number of studies limited meta-regression, evening light avoidance was associated with greater increase in total sleep time. Effects of light on sleep and circadian outcomes have received limited attention in studies in psychiatric disorders, but results were promising in these groups. These findings invite further refinement and testing of light interventions to improve sleep in psychiatric disorders, with improved assessment and specification of problems, and the development and implementation of light schedule interventions for delayed sleep.
Abstract
The Lyman alpha (Ly α) line of Hydrogen is a prominent feature in the spectra of star-forming galaxies, usually redshifted by a few hundreds of km s−1 compared to the systemic redshift. This ...large offset hampers follow-up surveys, galaxy pair statistics, and correlations with quasar absorption lines when only Ly α is available. We propose diagnostics that can be used to recover the systemic redshift directly from the properties of the Ly α line profile. We use spectroscopic observations of Ly α emitters for which a precise measurement of the systemic redshift is available. Our sample contains 13 sources detected between z ≈ 3 and z ≈ 6 as part of various multi-unit spectroscopic explorer guaranteed time observations. We also include a compilation of spectroscopic Ly α data from the literature spanning a wide redshift range (z ≈ 0–8). First, restricting our analysis to double-peaked Ly α spectra, we find a tight correlation between the velocity offset of the red peak with respect to the systemic redshift, $V_{\rm peak}^{\rm red}$, and the separation of the peaks. Secondly, we find a correlation between $V_{\rm peak}^{\rm red}$ and the full width at half-maximum of the Ly α line. Fitting formulas to estimate systemic redshifts of galaxies with an accuracy of ≤100 km s−1, when only the Ly α emission line is available, are given for the two methods.
People with schizophrenia spectrum disorder diagnoses commonly have poor sleep, which predicts various negative outcomes. The problems are diverse, including substantial circadian dysregulation, ...sleep-wake timing issues, hypersomnia (excessive sleep), and more classic insomnia.
This paper reports on a mixed methods expert opinion study based on the principles of Delphi methodology. The study examines and explores opinion on the optimal contents and format for an occupational therapy intervention to improve poor sleep in this population. Views of clinical and academic topic experts (n = 56), were elicited, examined and explored in three rounds, views from previous rounds being presented back to participants in subsequent rounds. Participants with relevant personal experience (n = 26) then rated and commented on suggestions, with a focus on acceptability. Descriptive statistics and graphs of ratings were triangulated with qualitative content analysis of free-text.
Participants emphasised the central importance of intervention personalisation, although the manner and extent of personalisation suggested varied. Many components and domains were acknowledged as important, with the challenge being how to keep such an intervention simple, brief, and feasible for end-users, for sustainable implementation. The strongest consensus was to address evening routine, daytime activity, and environmental interventions. Relaxation, mindfulness, thermoregulation, sensory factors, and cognitive or psychological approaches were rated as less important. There was disagreement on whether to include time in bed restriction, and how to address napping, as well as how far to address medication timing. Clinicians and researchers advocated some version of stimulus control, but participants with personal experience reported low levels of acceptability for this, describing entirely negative experiences using 'the 15-minute rule' (part of stimulus control).
These results are informative for clinicians treating sleep problems in people with schizophrenia and related conditions, as well as for decision makers considering the potential contribution of the profession of occupational therapy toward sleep treatment.
To quantify the magnitude of deficits in theory of mind (ToM) and facial emotion recognition among patients with multiple sclerosis (MS) relative to healthy controls.
An electronic database search of ...Ovid MEDLINE, PsycINFO, and Embase was conducted from inception to April 1, 2016. Eligible studies were original research articles published in peer-reviewed journals that examined ToM or facial emotion recognition among patients with a diagnosis of MS and a healthy control comparison group. Data were independently extracted by 2 authors. Effect sizes were calculated using Hedges g.
Twenty-one eligible studies were identified assessing ToM (12 studies) and/or facial emotion recognition (13 studies) among 722 patients with MS and 635 controls. Deficits in both ToM (g = -0.71, 95% confidence interval CI -0.88 to -0.55, p < 0.001) and facial emotion recognition (g = -0.64, 95% CI -0.81 to -0.47, p < 0.001) were identified among patients with MS relative to healthy controls. The largest deficits were observed for visual ToM tasks and for the recognition of negative facial emotional expressions. Older age predicted larger emotion recognition deficits. Other cognitive domains were inconsistently associated with social cognitive performance.
Social cognitive deficits are an overlooked but potentially important aspect of cognitive impairment in MS with potential prognostic significance for social functioning and quality of life. Further research is required to clarify the longitudinal course of social cognitive dysfunction, its association with MS disease characteristics and neurocognitive impairment, and the MS-specific neurologic damage underlying these deficits.
We examine substructure and mass segregation in the massive OB association Cygnus OB2 to better understand its initial conditions. Using a well-understood Chandra X-ray selected sample of young ...stars, we find that Cyg OB2 exhibits considerable physical substructure and has no evidence for mass segregation, both indications that the association is not dynamically evolved. Combined with previous kinematical studies we conclude that Cyg OB2 is dynamically very young, and what we observe now is very close to its initial conditions: Cyg OB2 formed as a highly substructured, unbound association with a low volume density (<100 stars pc−3). This is inconsistent with the idea that all stars form in dense, compact clusters. The massive stars in Cyg OB2 show no evidence for having formed particularly close to one another, nor in regions of higher than average density. Since Cyg OB2 contains stars as massive as ∼100 M, this result suggests that very massive stars can be born in relatively low-density environments. This would imply that massive stars in Cyg OB2 did not form by competitive accretion, or by mergers.
Abstract Background Transition to psychotic disorder has been the traditional outcome of interest for research in the at-risk mental state (ARMS). However, there is growing recognition that ...individuals with ARMS may function poorly regardless of whether they develop psychosis. We aimed to review the literature to determine whether there are specific factors associated with, or predictive of, functional impairment in the ARMS population. Method An electronic database search of MEDLINE, PsycINFO and Embase from inception until May 2014 was conducted using keyword search terms synonymous with the at-risk mental state and functioning. Eligible studies were original peer-reviewed English language research articles with populations that met validated at-risk diagnostic criteria and examined the cross-sectional or longitudinal association between any variable and a measure of functioning. Results Seventy-two eligible studies were identified. Negative symptoms and neurocognitive impairment were associated with poor functioning in cross-sectional studies. Negative and disorganised symptoms, neurocognitive deficits and poor functioning at baseline were predictive of poor functional outcome in longitudinal studies. Positive symptoms were unrelated to functioning in both cross-sectional and longitudinal studies. Functional disability was persistent and resistant to current treatments. Conclusions Negative and disorganised symptoms and cognitive deficits pre-date frank psychotic symptoms and are risk factors for poor functioning. This is consistent with a subgroup of ARMS individuals potentially having neurodevelopmental schizophrenia. Treatments aimed at improving functioning must be considered a priority on par with preventing transition to psychosis in the development of future interventions in the ARMS group.
We observed Hubble Deep Field South with the new panoramic integral-field spectrograph MUSE that we built and have just commissioned at the VLT. The data cube resulting from 27 h of integration ...covers one arcmin2 field of view at an unprecedented depth with a 1σ emission-line surface brightness limit of 1 × 10-19 erg s-1 cm-2 arcsec-2, and contains ~90 000 spectra. We present the combined and calibrated data cube, and we performed a first-pass analysis of the sources detected in the Hubble Deep Field South imaging. We measured the redshifts of 189 sources up to a magnitude I814 = 29.5, increasing the number of known spectroscopic redshifts in this field by more than an order of magnitude. We also discovered 26 Lyα emitting galaxies that are not detected in the HST WFPC2 deep broad-band images. The intermediate spectral resolution of 2.3 Å allows us to separate resolved asymmetric Lyα emitters, O ii3727 emitters, and C iii1908 emitters, and the broad instantaneous wavelength range of 4500 Å helps to identify single emission lines, such as O iii5007, Hβ, and Hα, over a very wide redshift range. We also show how the three-dimensional information of MUSE helps to resolve sources that are confused at ground-based image quality. Overall, secure identifications are provided for 83% of the 227 emission line sources detected in the MUSE data cube and for 32% of the 586 sources identified in the HST catalogue. The overall redshift distribution is fairly flat to z = 6.3, with a reduction between z = 1.5 to 2.9, in the well-known redshift desert. The field of view of MUSE also allowed us to detect 17 groups within the field. We checked that the number counts of O ii3727 and Lyα emitters are roughly consistent with predictions from the literature. Using two examples, we demonstrate that MUSE is able to provide exquisite spatially resolved spectroscopic information on the intermediate-redshift galaxies present in the field. Thisunique data set can be used for a wide range of follow-up studies. We release the data cube, the associated products, and the source catalogue with redshifts, spectra, and emission-line fluxes.
Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and ...then developed consensus criteria and guidelines.
A systematic review of randomized antipsychotic clinical trials in treatment-resistant schizophrenia was performed, and definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed through 1) a multiphase, mixed methods approach, 2) identification of key criteria via an online survey, and 3) meetings to achieve consensus.
Of 2,808 studies identified, 42 met inclusion criteria. Of these, 21 studies (50%) did not provide operationalized criteria. In the remaining studies, criteria varied considerably, particularly regarding symptom severity, prior treatment duration, and antipsychotic dosage thresholds; only two studies (5%) utilized the same criteria. The consensus group identified minimum and optimal criteria, employing the following principles: 1) current symptoms of a minimum duration and severity determined by a standardized rating scale; 2) moderate or worse functional impairment; 3) prior treatment consisting of at least two different antipsychotic trials, each for a minimum duration and dosage; 4) systematic monitoring of adherence and meeting of minimum adherence criteria; 5) ideally at least one prospective treatment trial; and 6) criteria that clearly separate responsive from treatment-resistant patients.
There is considerable variation in current approaches to defining treatment resistance in schizophrenia. The authors present consensus guidelines that operationalize criteria for determining and reporting treatment resistance, adequate treatment, and treatment response, providing a benchmark for research and clinical translation.
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