Measuring patients' views: a bifactor model of distinct patient-reported outcomes in psychosis

Background Patient-reported outcomes (PROs) are widely used for evaluating the care of patients with psychosis. Previous studies have reported a considerable overlap in the information captured by measures designed to assess different outcomes. This may impair the validity of PROs and makes an a priori choice of the most appropriate measure difficult when assessing treatment benefits for patients. We aimed to investigate the extent to which four widely established PROs [subjective quality of life (SQOL), needs for care, treatment satisfaction and the therapeutic relationship] provide distinct information independent from this overlap. Method Analyses, based on item response modelling, were conducted on measures of SQOL, needs for care, treatment satisfaction and the therapeutic relationship in two large samples of patients with psychosis. Results In both samples, a bifactor model matched the data best, suggesting sufficiently strong concept factors to allow for four distinct PRO scales. These were independent from overlap across measures due to a general appraisal tendency of patients for positive or negative ratings and shared domain content. The overlap partially impaired the ability of items to discriminate precisely between patients from lower and higher PRO levels. We found that widely used sum scores were strongly affected by the general appraisal tendency. Conclusions Four widely established PROs can provide distinct information independent from overlap across measures. The findings may inform the use and further development of PROs in the evaluation of treatments for psychosis

Heterogeneity in patient-reported outcomes following low-intensity mental health interventions: a multilevel analysis.

BACKGROUND: Variability in patient-reported outcomes of psychological treatments has been partly attributed to therapists--a phenomenon commonly known as therapist effects. Meta-analytic reviews reveal wide variation in therapist-attributable variability in psychotherapy outcomes, with most studies reporting therapist effects in the region of 5% to 10% and some finding minimal to no therapist effects. However, all except one study to date have been conducted in high-intensity or mixed intervention groups; therefore, there is scarcity of evidence on therapist effects in brief low-intensity psychological interventions. OBJECTIVE: To examine therapist effects in low-intensity interventions for depression and anxiety in a naturalistic setting. DATA AND ANALYSIS: Session-by-session data on patient-reported outcome measures were available for a cohort of 1,376 primary care psychotherapy patients treated by 38 therapists. Outcome measures included PHQ-9 (sensitive to depression) and GAD-7 (sensitive to general anxiety disorder) measures. Three-level hierarchical linear modelling was employed to estimate therapist-attributable proportion of variance in clinical outcomes. Therapist effects were evaluated using the intra-cluster correlation coefficient (ICC) and Bayesian empirical predictions of therapist random effects. Three sensitivity analyses were conducted: 1) using both treatment completers and non-completers; 2) a sub-sample of cases with baseline scores above the conventional clinical thresholds for PHQ-9 and GAD-7; and 3) a two-level model (using patient-level pre- and post-treatment scores nested within therapists). RESULTS: The ICC estimates for all outcome measures were very small, ranging between 0% and 1.3%, although most were statistically significant. The Bayesian empirical predictions showed that therapist random effects were not statistically significantly different from each other. Between patient variability explained most of the variance in outcomes. CONCLUSION: Consistent with the only other study to date in low intensity interventions, evidence was found to suggest minimal to no therapist effects in patient-reported outcomes. This draws attention to the more prominent source of variability which is found at the between-patient level

Investigating the maximum resolution of µXRF core scanners: a 1800 year storminess reconstruction from the Outer Hebrides

Micro x-ray fluorescence (µXRF) core scanning is capable of measuring the elemental composition of lake sediment at sub-millimetre resolution, but bioturbation and physical mixing may degrade environmental signals at such fine scales. The aim of this research is to determine the maximum possible resolution at which meaningful environmental signals may be reconstructed from lake sediments using this method. Sediment from a coastal lake in the Outer Hebrides, Scotland, has been analysed using calibrated element measurements to reconstruct storminess since AD 200. We find that a Ca/K ratio in lake-core sediments reflects the presence of fine calcium carbonate shell fragments, a constituent of sand in the catchment that is washed and blown into the lake. Variations in this ratio are significantly correlated with instrumental records of precipitation and low pressures, suggesting it is a proxy for storminess. Furthermore, identification of a c. 60-year cycle supports a climatic influence on Ca/K, as this cycle is frequently identified in reconstructions of the North Atlantic Oscillation and North Atlantic sea-surface temperature. Comparison with weather records at different resolutions and spectral analysis indicate that µXRF data from Loch Hosta can be interpreted at sub-decadal resolutions (equivalent to core depth intervals of 3–5 mm in this location). Therefore, we suggest that sub-centimetre sampling using µXRF core scanning could be beneficial in producing environmental reconstructions in many lake settings where sediments are not varved

Lake sedimentary DNA accurately records 20th Century introductions of exotic conifers in Scotland

Summary:Sedimentary DNA (sedDNA) has recently emerged as a new proxy for reconstructing past vegetation, but its taphonomy, source area and representation biases need better assessment. We investigated how sedDNA in recent sediments of two small Scottish lakes reflects a major vegetation change, using well-documented 20th Century plantations of exotic conifers as an experimental system. We used next-generation sequencing to barcode sedDNA retrieved from subrecent lake sediments. For comparison, pollen was analysed from the same samples. The sedDNA record contains 73 taxa (mainly genus or species), all but one of which are present in the study area. Pollen and sedDNA shared 35% of taxa, which partly reflects a difference in source area. More aquatic taxa were recorded in sedDNA, whereas taxa assumed to be of regional rather than local origin were recorded only as pollen. The chronology of the sediments and planting records are well aligned, and sedDNA of exotic conifers appears in high quantities with the establishment of plantations around the lakes. SedDNA recorded other changes in local vegetation that accompanied afforestation. There were no signs of DNA leaching in the sediments or DNA originating from pollen

5-HTTLPR and early childhood adversities moderate cognitive and emotional processing in adolescence

This is the final version of the article. Available from Public Library of Science via the DOI in this recordBACKGROUND: Polymorphisms in the promoter region of the serotonin transporter gene (5-HTTLPR) and exposure to early childhood adversities (CA) are independently associated with individual differences in cognitive and emotional processing. Whether these two factors interact to influence cognitive and emotional processing is not known. METHODOLOGY AND PRINCIPAL FINDINGS: We used a sample of 238 adolescents from a community study characterised by the presence of the short allele of 5-HTTLPR (LL, LS, SS) and the presence or absence of exposure to CA before 6 years of age. We measured cognitive and emotional processing using a set of neuropsychological tasks selected predominantly from the CANTAB® battery. We found that adolescents homozygous for the short allele (SS) of 5-HTTLPR and exposed to CA were worse at classifying negative and neutral stimuli and made more errors in response to ambiguous negative feedback. In addition, cognitive and emotional processing deficits were associated with diagnoses of anxiety and/or depressions. CONCLUSION AND SIGNIFICANCE: Cognitive and emotional processing deficits may act as a transdiagnostic intermediate marker for anxiety and depressive disorders in genetically susceptible individuals exposed to CA.IMG, PW, TC, PBJ, and BJS are supported by programme and project grants from the Wellcome Trust (Grant no. 074296), MRC (UK) and NIHR (UK). TC held a Senior Research Fellowship from the Department of Health, UK during this study. BJS is a member of the Behavioural and Clinical Neurosciences Institute, University of Cambridge. This work was completed within the NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) of which PBJ is Director and IMG and TC are the Adolescent Programme and Methods leaders respectively. The CLAHRC is hosted by the University of Cambridge and the Cambridge and Peterborough NHS Foundation Trust

Adolescent self-control predicts midlife hallucinatory experiences:40-year follow-up of a national birth cohort

Associations between self-control in adolescence and adult mental health are unclear in the general population; to our knowledge, no study has investigated self-control in relation to psychotic-like symptoms

Long-wavelength iteration scheme and scalar-tensor gravity

Inhomogeneous and anisotropic cosmologies are modeled withing the framework of scalar-tensor gravity theories. The inhomogeneities are calculated to third-order in the so-called long-wavelength iteration scheme. We write the solutions for general scalar coupling and discuss what happens to the third-order terms when the scalar-tensor solution approaches at first-order the general relativistic one. We work out in some detail the case of Brans-Dicke coupling and determine the conditions for which the anisotropy and inhomogeneity decay as time increases. The matter is taken to be that of perfect fluid with a barotropic equation of state.Comment: 13 pages, requires REVTeX, submitted to Phys. Rev.

Snow petrel stomach-oil deposits as a new biological archive of Antarctic sea ice

Where snow petrels forage is predominantly a function of sea ice. They spit stomach oil in defence, and accumulated deposits at nesting sites are providing new opportunities to reconstruct their diet, and, in turn, the sea-ice environment over past millennia

Diagnostic change 10 years after a first episode of psychosis

Background. A lack of an aetiologically based nosology classification has contributed to instability in psychiatric diag-noses over time. This study aimed to examine the diagnostic stability of psychosis diagnoses using data from an inci-dence sample of psychosis cases, followed up after 10 years and to examine those baseline variables which were associated with diagnostic change. Method. Data were examined from the ÆSOP and ÆSOP-10 studies, an incidence and follow-up study, respectively, of a population-based cohort of first-episode psychosis cases from two sites. Diagnosis was assigned using ICD-10 and DSM-IV-TR. Diagnostic change was examined using prospective and retrospective consistency. Baseline variables asso-ciated with change were examined using logistic regression and likelihood ratio tests. Results. Slightly more (59.6%) cases had the same baseline and lifetime ICD-10 diagnosis compared with DSM-IV-TR (55.3%), but prospective and retrospective consistency was similar. Schizophrenia, psychotic bipolar disorder and drug-induced psychosis were more prospectively consistent than other diagnoses. A substantial number of cases with other diagnoses at baseline (ICD-10, n = 61; DSM-IV-TR, n = 76) were classified as having schizophrenia at 10 years

Biological and psychosocial risk factors for psychotic major depression

AIMS: Few studies have investigated risk factors for psychotic major depression (PMD). We aimed to investigate the biological and psychosocial risk factors associated with PMD compared with other psychotic disorders. METHODS: Based on the aetiology and ethnicity in schizophrenia and other psychoses (ÆSOP) study, we used a case-control study to identify and recruit, at baseline and 10-year follow-up, all first episode cases of psychosis, presenting for the first time to specialist mental health services in defined catchment areas in the UK. Population-based controls were recruited from the same areas. Data were collected on: sociodemographics; social isolation; childhood adversity; life events; minor physical anomalies; and neurological soft signs. RESULTS: Living alone (aOR = 2.26, CI = 1.21-4.23), basic level qualification (aOR = 2.89, CI = 1.08-7.74), being unemployed (aOR = 2.12, CI = 1.13-3.96), having contact with friends less than monthly (aOR = 4.24, CI = 1.62-11.14), having no close confidants (aOR = 4.71, CI = 2.08-10.68), having experienced childhood adversity (aOR = 2.57, CI = 1.02-6.44), family history of mental illness (aOR = 10.68, CI = 5.06-22.52), family history of psychosis (aOR = 12.85, CI = 5.24-31.51), and having more neurological soft signs (aOR = 1.15, CI = 1.07-1.24) were all associated with a follow-up diagnosis of PMD and schizophrenia. Few variables associated with PMD were also associated with a diagnosis of bipolar disorder. Minor physical anomalies were associated with a follow-up diagnosis of schizophrenia and bipolar disorder, but not PMD. CONCLUSIONS: Risk factors associated with PMD appear to overlap with those for schizophrenia, but less so for bipolar disorder. Future work on the differential aetiology of PMD, from other psychoses is needed to find the 'specifier' between PMD and other psychoses. Future research on aetiology in PMD, and perhaps other psychoses, should account for diagnostic change.status: publishe