Context. GRS 1915+105 being one of the brightest transient black hole binaries (BHBs) in the X-rays offers a unique testbed for the study of the connection between accretion and ejection mechanisms ...in BHBs. In particular, this source can be used to study the accretion disc wind and its dependence on the state changes in BHBs.
Aims. Our aim is to investigate the origin and geometry of the accretion disc wind in GRS 1915+105. This study will provide a basis for planning future observations with the X-ray Imaging Spectroscopy Mission (XRISM), and may also provide important parameters for estimating the polarimetric signal with the upcoming Imaging X-ray Polarimetry Explorer (IXPE).
Methods. We analysed the spectra of GRS 1915+105 in the soft ϕ and hard χ classes using the high-resolution spectroscopy offered by Chandra HETGS. In the soft state, we find a series of wind absorption lines that follow a non-linear dependence of velocity width, velocity shift, and equivalent width with respect to ionisation, indicating a multiple component or stratified outflow. In the hard state we find only a faint Fe XXVI absorption line. We model the absorption lines in both the states using a dedicated magneto-hydrodynamic (MHD) wind model to investigate a magnetic origin of the wind and to probe the cause of variability in the observed line flux between the two states.
Conclusions. The MHD disc wind model provides a good fit for both states, indicating the possibility of a magnetic origin of the wind. The multiple ionisation components of the wind are well characterised as a stratification of the same magnetic outflow. We find that the observed variability in the line flux between soft and hard states cannot be explained by photo-ionisation alone but is most likely due to a large (three orders of magnitude) increase in the wind density. We find the mass outflow rate of the wind to be comparable to the accretion rate, suggesting an intimate link between accretion and ejection processes that lead to state changes in BHBs.
Functional status could predict development of bipolar disorder (BD) or have clinical significance. The relationship between BD risk and functioning is poorly understood. We undertook a systematic ...review examining the global and social functioning of those at risk for BD.
We examined observational studies comparing a risk sample with healthy controls or full-threshold BD participants, using measures of global or social functioning. Risk status included family history of BD, meeting risk criteria, or having prodromal symptomatology, or premorbid functioning of persons with BD. Medline, PsycINFO, and Embase were searched. The Newcastle-Ottawa Scale for Cross-Sectional Studies was used to assess quality. Meta-analyses were performed where possible.
7215 studies were screened and 40 studies were included (8474 participants). Risk samples had poorer functioning than controls, and superior functioning to participants with BD. Meta-analysis indicated poorer global functioning among persons with familial risk compared to healthy controls (mean global functional difference: 5.92; 95 % confidence interval: 7.90, 3.95; mean premorbid functioning difference: 2.31; 95 % confidence interval: 0.70, 3.92). Studies with higher proportions of female participants had slightly poorer global functioning. High heterogeneity was attributable functional measures and potentially functionally differential subgroups within the risk samples.
Broader measures of functioning, such as neurocognition and behavioural measures, were excluded. Measures of global functioning are limited by conflating functioning and symptoms.
Functioning in the BD risk populations is intermediate to that of healthy controls and persons with BD, indicating their value in definitions of BD risk, in itself a likely heterogeneous state.
•People at risk of bipolar disorder function poorly compared to healthy controls and better than people with bipolar disorder•Meta-analysis found a modest decrease in functioning in familial risk samples compared to healthy controls•Studies with more female participants had slightly poorer functional scores•Heterogeneity may have reflected choice of measure and potentially subgroups within risk samples
We report on the detection of X-ray polarisation in the black-hole X-ray binary Swift J1727.8−1613 during its dim hard spectral state by the Imaging X-ray Polarimetry Explorer (IXPE). This is the ...first detection of X-ray polarisation at the transition from the soft to the hard state in an X-ray binary. We find an averaged 2–8 keV polarisation degree of (3.3 ± 0.4)% and a corresponding polarisation angle of 3° ±4°, which matches the polarisation detected during the rising stage of the outburst, in September–October 2023, within 1 σ uncertainty. The observational campaign complements previous studies of this source and enables comparison of the X-ray polarisation properties of a single transient across the X-ray hardness-intensity diagram. The complete recovery of the X-ray polarisation properties, including the energy dependence, came after a dramatic drop in the X-ray polarisation during the soft state. The new IXPE observations in the dim hard state at the reverse transition indicate that the accretion properties, including the geometry of the corona, appear to be strikingly similar to the bright hard state during the outburst rise despite the X-ray luminosities differing by two orders of magnitude.
Bipolar affective disorder (BD) is a severe, recurrent and disabling disorder with devastating consequences for individuals, families and society. Although these hazards and costs provide a ...compelling rationale for development of early detection and early intervention strategies in BD, the development of at-risk criteria for first episode mania is still in an early stage of development. In this paper we review the literature with respect to the clinical, neuroantomical and neuropsychological data, which support this goal. We also describe our recently developed bipolar at-risk criteria (BAR). This criteria comprises the peak age range of the first onset of bipolar disorder, genetic risk, presenting with sub-threshold mania, cyclothymic features or depressive symptoms. An initial pilot evaluation of the BAR criteria in 22 subjects indicated conversion rates to proxies of first-episode mania of 23% within 265 days on average, and high specificity and sensitivity of the criteria. If prospective studies confirm the validity of the BAR criteria, then the criteria would have the potential to open up new avenues of research for indicated prevention in BD and might therefore offer opportunities to ameliorate the severity of, or even prevent BD.
Objective
Most patients with first episode psychosis (FEP) are neither studying nor employed (have a poor functional status) when first accessing care. Knowledge of the characteristics of patients ...with poor functioning and the features influencing functional status over time may pave the way to better treatment.
Method
A medical file audit was used to collect data on premorbid, entry, treatment and 18-month outcome characteristics on 661 FEP patients who consecutively attended the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia, between 1998 and 2000. Functional status was ascertained using the modified vocational status index and was rated at baseline (poor or good) and according to its evolution over the treatment period (stable good, stable poor, deteriorating or improved functional status).
Results
52.0% of patients had a poor functional status at service entry. They were more likely to be male with a non-affective psychosis. They also had lower levels of premorbid global functioning and education, and were more likely to have self-reported histories of learning disability, forensic issues, traumatic experiences and substance use. At service entry, they had more severe symptoms and poorer global functioning. 37% of these patients maintained a poor functional status at discharge, and 18% of those with a good functional status at service entry experienced a decline.
Conclusions
Although psychosocial interventions might assist a young person with FEP with working towards functional goals, for some, the impact of factors such as ongoing substance use and forensic issues on functional status needs to be addressed.
Background
Given the likelihood of progressive illness in bipolar disorder (BD), it is important to understand the benefits and risks of interventions administered early in illness course. We ...conducted a systematic review of the effectiveness of interventions in the early course of BD I or II.
Methods
We completed a systematic search on MEDLINE, PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL and Google Scholar from 1/1/1979 till 14/9/2022. We included controlled trials examining intervention effects on symptomatic, course, functional and tolerability outcomes of patients in the ‘early course’ of BD I or II. We classified patients to be in early course if they (a) were seeking help for the first time for a manic episode, (b) had a lifetime history of up to 3 manic episodes, or (c) had up to 6 lifetime mood episodes. Evidence quality was assessed using the GRADE approach.
Results
From 4135 unique publications we included 25 reports representing 2212 participants in 16 randomized studies, and 17,714 participants from nine non-randomized studies. Available evidence suggested that in early illness course, lithium use was associated with lower recurrence risk compared with other mood stabilizers. Mood stabilizers were also associated with better global functioning, compared with the use of antipsychotics in the medium term. While summative findings regarding psychological therapies were limited by heterogeneity, family-focused and cognitive-behavioral interventions were associated with reduced recurrence risk or improved symptomatic outcomes. There was some evidence that the same pharmacological interventions were more efficacious in preventing recurrences when utilized in earlier rather than later illness course.
Conclusions and recommendations
While there are promising initial findings, there is a need for more adequately powered trials to examine the efficacy and tolerability of interventions in youth and adults in early illness course. Specifically, there is a compelling need to compare the relative benefits of lithium with other pharmacological agents in preventing recurrences. In addition to symptomatic outcomes, there should be a greater focus on functional impact and tolerability. Effective pharmacological and psychological interventions should be offered to those in early course of BD, balancing potential risks using shared decision-making approaches.
Abstract
Background
First-episode psychosis (FEP) may lead to a progressive, potentially disabling and lifelong chronic illness; however, evidence suggests that the illness course can be improved if ...appropriate treatments are given at the early stages. Nonetheless, the efficacy of antipsychotic medications is suboptimal, particularly for negative and cognitive symptoms, and more efficacious and benign treatments are needed. Previous studies have shown that the antioxidant amino acid
N
-acetylcysteine (NAC) reduces negative symptoms and improves functioning in chronic schizophrenia and bipolar disorder. Research is scarce as to whether NAC is beneficial earlier in the course of illness. The primary aim of this study is to determine the efficacy of treatment with adjunctive NAC (2 g/day for 26 weeks) compared with placebo to improve psychiatric symptoms in young people experiencing FEP. Secondary aims are to explore the neurobiological mechanisms underpinning NAC and how they relate to various clinical and functional outcomes at 26- and 52-week follow-ups.
Methods/design
ENACT is a 26-week, randomised controlled trial of adjunctive NAC versus placebo, with a 26-week non-treatment follow-up period, for FEP. We will be recruiting 162 young people aged 15–25 years who have recently presented to, and are being treated at, the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia. The primary outcome is the Total Score on the Positive and Negative Syndrome Scale which will be administered at baseline, and weeks 4, 8, 12, 26 (primary endpoint), and 52 (end of study). Secondary outcomes include: symptomatology, functioning, quality of life, neurocognition, blood-derived measures of: inflammation, oxidative and nitrosative stress, and magnetic resonance spectroscopy measures of glutathione concentration.
Discussion
Targeted drug development for FEP to date has generally not involved the exploration of neuroprotective agents. This study has the potential to offer a new, safe, and efficacious treatment for people with FEP, leading to better treatment outcomes. Additionally, the neuroprotective dimension of this study may lead to a better long-term prognosis for people with FEP. It has the potential to uncover a novel treatment that targets the neurobiological mechanisms of FEP and, if successful, will be a major advance for psychiatry.
Trial registration
Australian New Zealand Clinical Trials Registry, ID: ACTR
N12618000413224
. Registered on 21 March 2018.
Background
Specialised early intervention (SEI) programs have offered individuals with psychotic disorders and their families new hope for improving illness trajectories and outcomes. The Early ...Psychosis Prevention and Intervention Centre (EPPIC) was one of the first SEI programs developed in the world, providing services for young people experiencing their first episode of psychosis.
Methods
We conducted a narrative synthesis of controlled and uncontrolled studies that have been conducted at EPPIC.
Discussion
The history of the EPPIC model is first described. This is followed by a discussion of clinical research emerging from EPPIC, including psychopharmacological, psychotherapeutic trials and outcome studies. Neurobiological studies are also described. Issues pertaining to the conduct of clinical research and future research directions are then described. Finally, the impact of the EPPIC model on the Australian environment is discussed.
The Cadmium–Zinc–Telluride (CZT) Imager on board AstroSat is a hard X-ray imaging spectrometer operating in the energy range of 20–100 keV. It also acts as an open hard X-ray monitor above 100 keV ...capable of detecting transient events like the Gamma-ray Bursts (GRBs). Additionally, the instrument has the sensitivity to measure hard X-ray polarization in the energy range of 100–400 keV for bright on-axis sources like Crab and Cygnus X-1 and bright GRBs. As hard X-ray instruments like CZTI are sensitive to cosmic rays in addition to X-rays, it is required to identify and remove particle induced or other noise events and select events for scientific analysis of the data. The present CZTI data analysis pipeline includes algorithms for such event selection, but they have certain limitations. They were primarily designed for the analysis of data from persistent X-ray sources where the source flux is much less than the background and thus are not best suited for sources like GRBs. Here, we re-examine the characteristics of noise events in CZTI and present a generalized event selection method that caters to the analysis of data for all types of sources. The efficacy of the new method is reviewed by examining the Poissonian behavior of the selected events and the signal to noise ratio for GRBs.
The Cadmium Zinc Telluride (CZT) Imager onboard AstroSat consists of pixelated CZT detectors, which are sensitive to hard X-rays above 20 keV. The individual pixels are triggered by ionising events ...occurring in them, and the detectors operate in a self-triggered mode, recording each event separately with information about its time of incidence, detector co-ordinates, and channel that scales with the amount of ionisation. The detectors are sensitive not only to photons from astrophysical sources of interest, but also prone to a number of other events like background X-rays, cosmic rays, and noise in detectors or the electronics. In this work, a detailed analysis of the effect of cosmic rays on the detectors is made and it is found that cosmic rays can trigger multiple events which are closely packed in time (called ‘bunches’). Higher energy cosmic rays, however, can also generate delayed emissions, a signature previously seen in the PICsIT detector on-board INTEGRAL. An algorithm to automatically detect them based on their spatial clustering properties is presented. Residual noise events are examined using examples of Gamma Ray Bursts as target sources.
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