Goal representation in children’s executive control.

International audienceImplementation of executive control over thought and action can only be guided by the goals that one desires to reach. Over the last decade, research has pointed out the central role of goal representation in executive control both during childhood and adulthood. The present paper reviews these findings, emphasizing the developmental dynamics observed during childhood. More precisely, it addresses the role of active goal maintenance in working memory, as it has been stressed by developmental and neurocognitive theoretical models. Beyond goal maintenance, the question as to how goal representations are formed in working memory has attracted research efforts lately. With age, children successfully process increasingly subtle environmental cues to infer the current task goal and when task goals need to be updated, as evidenced by the effect of cue transparency on switching and inhibition performance. In addition, the paper addresses how goal representation sheds light on the interplay between executive skills and conceptual knowledge, through the presentation of research in such domains as analogical reasoning, categorical flexibility, and class inclusion quantification. Taken together, these lines of research show that executive control development does not rely exclusively on a growing ability to implement appropriate actions, but it also depends largely on increasingly efficient identification of what such actions should be. (C) 2013 Societe francaise de psychologie. Published by Elsevier Masson SAS. All rights reserved

Social Isolation and Psychosis: Perspectives from People with Psychosis, Family Caregivers and Mental Health Professionals

This paper explores the subjective experiences of mental health practitioners, people with psychosis and carers, on social isolation and community integration of people with psychosis. Focus groups and one-to-one interviews with 80 adult participants across three sites in the UK were conducted. Audio recordings were transcribed and analysed using thematic analysis. Participants commented on various aspects that may cause social isolation or enable community integration, including institutional factors (lack of resources, hospitalisation impact), illness symptoms (e.g., paranoia; over-pathologising vs individual choice), stigma (particularly the psychosis label), and the importance of communities that foster agency and embrace change. Hospitalisation maybe be a cause for isolation and psychiatric wards should consider allowing for socialisation as a therapeutic tool. Initiatives should consider the social fabric of our communities, socioeconomic inequalities and stigmatisation. Building communities that are accepting, kind and flexible can create opportunities that could lead to independence from mental health services. [Abstract copyright: © 2022. The Author(s).

Effectiveness and cost-effectiveness of a structured social coaching intervention for people with psychosis (SCENE): protocol for a randomised controlled trial

Introduction People with psychosis tend to have smaller social networks than both people in the general population and other people with long-term health conditions. Small social networks are associated with poor quality of life. Preliminary evidence suggests that coaching patients to increase their social contacts may be effective. In this study, we assessed whether structured social coaching improves the quality of life of patients with psychosis (primary outcome) compared with an active control group, receiving information on local social activities. Methods and analysis A structured social coaching intervention was developed based on the literature and refined through stakeholder involvement. It draws on principles from motivational interviewing, solution focused therapy and structured information giving. It is provided over a 6-month period and can be delivered by a range of different mental health professionals. Its effectiveness and cost-effectiveness are assessed in a randomised controlled trial, compared with an active control group, in which participants are given an information booklet on local social activities. Participants are aged 18 or over, have a primary diagnosis of a psychotic disorder (International Classification of Disease: F20–29) and capacity to provide informed consent. Participants are assessed at baseline and at 6, 12 and 18 months after individual randomisation. The primary outcome is quality of life at 6 months (Manchester Short Assessment of Quality of Life). We hypothesise that the effects on quality of life are mediated by an increase in social contacts. Secondary outcomes are symptoms, social situation and time spent in social activities. Costs and cost-effectiveness analyses will consider service use and health-related quality of life. Ethics and dissemination National Health Service REC London Hampstead (19/LO/0088) provided a favourable opinion. Findings will be disseminated through a website, social media, scientific papers and user-friendly reports, in collaboration with a lived experience advisory panel

Staff understanding of recovery-orientated mental health practice: a systematic review and narrative synthesis

Background: Mental health policy is for staff to transform their practice towards a recovery orientation. Staff understanding of recovery-orientated practice will influence the implementation of this policy. The aim of this study was to conduct a systematic review and narrative synthesis of empirical studies identifying clinician and manager conceptualisations of recovery-orientated practice. Methods: A systematic review of empirical primary research was conducted. Data sources were online databases (n = 8), journal table of contents (n = 5), internet, expert consultation (n = 13), reference lists of included studies and references to included studies. Narrative synthesis was used to integrate the findings. Results: A total of 10,125 studies were screened, 245 full papers were retrieved, and 22 were included (participants, n = 1163). The following three conceptualisations of recovery-orientated practice were identified: clinical recovery, personal recovery and service-defined recovery. Service-defined recovery is a new conceptualisation which translates recovery into practice according to the goals and financial needs of the organisation. Conclusions: Organisational priorities influence staff understanding of recovery support. This influence is leading to the emergence of an additional meaning of recovery. The impact of service-led approaches to operationalising recovery-orientated practice has not been evaluated. Trial Registration: The protocol for the review was pre-registered (PROSPERO 2013: CRD42013005942)

Preferences for befriending schemes: a survey of patients with severe mental illness

This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Reference Number RP-PG-0611-20002). The funding body was not involved in, and did not influence, the design of the study, data collection, analysis or interpretation of the data. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health

DNA Methylation of the First Exon Is Tightly Linked to Transcriptional Silencing

Tissue specific patterns of methylated cytosine residues vary with age, can be altered by environmental factors, and are often abnormal in human disease yet the cellular consequences of DNA methylation are incompletely understood. Although the bodies of highly expressed genes are often extensively methylated in plants, the relationship between intragenic methylation and expression is less clear in mammalian cells. We performed genome-wide analyses of DNA methylation and gene expression to determine how the pattern of intragenic methylation correlates with transcription and to assess the relationship between methylation of exonic and intronic portions of the gene body. We found that dense exonic methylation is far more common than previously recognized or expected statistically, yet first exons are relatively spared compared to more downstream exons and introns. Dense methylation surrounding the transcription start site (TSS) is uncoupled from methylation within more downstream regions suggesting that there are at least two classes of intragenic methylation. Whereas methylation surrounding the TSS is tightly linked to transcriptional silencing, methylation of more downstream regions is unassociated with the magnitude of gene expression. Notably, we found that DNA methylation downstream of the TSS, in the region of the first exon, is much more tightly linked to transcriptional silencing than is methylation in the upstream promoter region. These data provide direct evidence that DNA methylation is interpreted dissimilarly in different regions of the gene body and suggest that first exon methylation blocks transcript initiation, or vice versa. Our data also show that once initiated, downstream methylation is not a significant impediment to polymerase extension. Thus, the consequences of most intragenic DNA methylation must extend beyond the modulation of transcription magnitude

Evidence of a causal and modifiable relationship between kidney function and circulating trimethylamine N-oxide

The host-microbiota co-metabolite trimethylamine N-oxide (TMAO) is linked to increased cardiovascular risk but how its circulating levels are regulated remains unclear. We applied "explainable" machine learning, univariate, multivariate and mediation analyses of fasting plasma TMAO concentration and a multitude of phenotypes in 1,741 adult Europeans of the MetaCardis study. Here we show that next to age, kidney function is the primary variable predicting circulating TMAO, with microbiota composition and diet playing minor, albeit significant, roles. Mediation analysis suggests a causal relationship between TMAO and kidney function that we corroborate in preclinical models where TMAO exposure increases kidney scarring. Consistent with our findings, patients receiving glucose-lowering drugs with reno-protective properties have significantly lower circulating TMAO when compared to propensity-score matched control individuals. Our analyses uncover a bidirectional relationship between kidney function and TMAO that can potentially be modified by reno-protective anti-diabetic drugs and suggest a clinically actionable intervention for decreasing TMAO-associated excess cardiovascular risk

Participation in leisure activities and quality of life of people with psychosis in England: a multi-site cross-sectional study.

Background Leisure activities can improve quality of life in the general population. For people with psychosis, negative symptoms (e.g. being unmotivated, difficulty in sticking with activities) are often a barrier to engaging in social leisure activities. However, we do not know if participation in leisure activities is associated with quality of life in this group and, whether psychosocial interventions should aim to increase leisure activities. Aim This study investigates participation in social leisure activities of people with psychosis and whether their participation is associated with better quality of life. Methods A cross-sectional survey was conducted in 6 NHS mental health trusts. Adults aged 18–65 (N = 533) with a diagnosis of a psychosis-related condition (ICD-10 F20-29) were recruited from outpatient secondary mental health services. Several measures were used including an adapted version of the Time Use Survey (TUS), the Social contacts assessment (SCA) and Manchester Short Assessment of Quality of Life (MANSA). A Structural Equation Model (SEM) was used to explore the relationships between participation in leisure activities and quality of life, and whether social contacts mediated the link. Results Participants attended an average of 2.42 (SD = 1.47) leisure activities in the last 7 days. Their quality of life increased with the number of leisure activities they attended. Participation in leisure activities was positively associated with quality of life in people with psychosis (B = 0.104, SE = 0.051, p = 0.042, 95% CI [0.003 to 0.204]). Leisure activities predicted social contacts, but the link between social contacts and the quality of life was not significant. After controlling for sociodemographic factors, being female and unemployed were negatively linked with quality of life (B = − 0.101, SE = 0.048, p = 0.036, 95% CI [− 0.196 to − 0.006; B = − 0.207, SE = 0.050, p = 0.001, 95% CI [− 0.305 to − 0.108, respectively]. Conclusion People with psychosis who attend more leisure activities have a higher quality of life. Quality of life was lower amongst female and unemployed participants who attended leisure activities. Intervention which helps improve participation in leisure activities may be beneficial for people with psychosis

Patient and public involvement in developing and testing mental health‑care interventions : strategies and reflections from Three Research Programs

Patient and public involvement (PPI) is valued and widely practiced in mental health research but in different ways. We present three research programs, aiming to develop and test mental healthcare interventions and we discuss their PPI strategies and activities. In all these programs, PPI has been sought from their initial conception and design and has helped their management, intervention development processes, quantitative and qualitative evaluations, and in the assessment of PPI activities themselves. The programs focus on different groups (patients with chronic depression, patients with psychotic disorders, and carers) and develop different interventions. Comparing these programs offers the opportunity to appreciate different models of involvement. These, for example, range from training lived experience collaborators to analyze qualitative data directly to asking them to comment on findings; from involving lived experience collaborators in the design of new interventions to involving them in intervention adaptation to a particular group or circumstance; and from carrying out formal PPI evaluations to collecting informal feedback during meetings. Even in the diversity of programs and PPI activities presented, common themes could be identified in relation to: specifying (and ideally co-designing) expectations and role of contributors; making bureaucratic procedures as user-friendly as possible; appropriately choosing or blending online and offline meetings; and designing flexible and inclusive arrangements to maximize participation. Our experiences contribute to a growing evidence base that can help researchers to develop meaningful, enjoyable, and constructive collaborations with people with lived experience. These collaborations will keep clinical mental health research relevant, impactful, and tailored to patients’ needs

Who wants more social contacts? A cross-sectional study of people with psychotic disorders in England

Many people with psychosis have few social contacts which can significantly reduce quality of life. While the symptoms of psychosis are thought to contribute to social isolation, they could also lead to the perception that patients are uninterested in increasing their social contacts or in socialisation interventions. Hence, those who most need support to reduce isolation may be less likely to receive it. Despite this, studies have yet to identify the characteristics of patients who do and do not want to increase their social contacts. A cross-sectional study was conducted with 548 participants with psychosis in community mental health teams across England, covering urban and rural areas. Logistic regression analysis was used to determine predictors of wanting to vs. not wanting to increase social contacts. Content analysis was used to explore reasons. The majority (68%) of participants reported a desire for more social contacts, which was significantly associated with lower quality of life. While people with lower quality of life were more likely to express a desire for more contacts, they were less likely to feel confident in increasing them. Reasons for not wanting to increase contacts were related either to perceived barriers or to feeling content with current circumstances. It may be concluded that people with psychosis who have a lower quality of life and little confidence in socialising have a greater desire for more social contacts. Hence, contrary to traditional beliefs, they are likely to be motivated to engage with support to reduce isolation if it is offered