Borderline personality in patients with poly-diagnoses treated for a Bipolar Disorder

Some patients with dysphoria, explosive behaviour, or suicidal ideation, may receive a diagnosis of, and treatment for Bipolar Disorder (BD) and, not infrequently. The coexistence of these two diagnoses has been explained in different ways. Some authors include the BPD in the bipolar spectrum; others are sceptical about the existence of real comorbidity, suggesting a misdiagnosis. This study aimed to assess the personality of this group of poly-diagnosed patients (PolyD) and hypothesised they had a pathological borderline organisation. Via the administration of the Schedler Westen Assessment Procedure (SWAP-200), we compared PolyD patients with those suffering from BPD or BD only. We performed two different MANCOVAs to test PolyD, BPD and BD patients' differences in PD-factors, Q-traits and age. The sample comprised 45 patients (Mean age=43.3, SD=15.7; Females 57.7%, N=26). BD patients (N=15) did not present any personality disorder, they had a higher functioning and Obsessive Q-traits, and a lower Histrionic PD-factor than both PolyD (N=20) and BPD (N=10) patients. Compared to PolyD patients, BD had inferior PD-Borderline, PD-Antisocial factor and Dependent-Masochistic Q-traits, but there were no other differences with BPD patients. PolyD did not differ from BPD patients in any of the PD-factors and Q-traits. Our results suggest that PolyD patients are different from BD patients and propose to consider the pathological borderline personality as a central core of their disease

Working Memory, Jumping to Conclusions and Emotion Recognition: a Possible Link in First Episode Psychosis (Fep)

Introduction A large body of literature has demonstrated that people affected by psychotic disorders show deficits in working memory, in Emotion Recognition (ER) and in data-gathering to reach a decision (Jumping To Conclusions - JTC). Aims To investigate a possible correlation between working memory, JTC and ER in FEP. Methods 41 patients and 89 healthy controls completed assessments of working memory using WAIS shortened version, JTC using the 60:40 Beads Task and ER using Degraded Facial Affect Recognition Task. Results According to the literature, cases had poorer performance in working memory tasks (Digit Span: \u3bc7,72 [ds=2,98] vs \u3bc10,14 [ds=3,10], U=865,00, p=0,00; Digit Symbol: \u3bc5,36 [ds=2,43] vs \u3bc10,05 [ds=3,10], U=455,50, p=0,00; Arithmetic: \u3bc5,46 [ds=2,76] vs \u3bc8,74 [ds=3,24], U=865,50, p=0,00; Block Design: \u3bc4,82 [ds=2,72] vs \u3bc7,60 [ds=3,18], U=912,00, p=0,00), in Beads Task (81,6% vs 51,1%, \u3c72=10,27, p=0,001, \u3bc2,53 [ds=3,57] vs \u3bc4,23 [ds=4,77], U=1171,00, p=0,006) and in DFAR (total errors: \u3bc21,62 [ds=7,43] vs \u3bc16,58 [ds=8,69], U=554,50, p=0,002). Furthermore working memory tasks in cases group correlated significantly with JTC (Digit Span: rrho=0,276, p=0,003; Digit Symbol: rrho=0,275, p=0,002; Arithmetic: rrho=0,265, p=0,003; Block Design: rrho=0,292, p=0,001), but only Digit Span with ER (rrho=-0,239; p=0,021). In addition, we found that JTC and ER were significantly associated (rrho=-0,281; p=0,004). Conclusions Data show that working memory impairments, JTC style and dysfunctions in the facial emotions recognition are phenomena strongly correlated in the group of patients. Preliminary results suggest the importance of early rehabilitation as the impairments detected may lead to difficulties in social and relational adaptation in psychotic patients

Bullying and Victimization in Overweight and Obese Outpatient Children and Adolescents: An Italian Multicentric Study

Objective Being overweight or obese is one of the most common reasons that children and adolescents are teased at school. We carried out a study in order to investigate: i) the relation between weight status and school bullying and ii) the relation between weight status categories and types of victimization and bullying in an outpatient sample of Italian children and adolescents with different degrees of overweight from minimal overweight up to severe obesity. Participants/Methods Nine-hundred-forty-seven outpatient children and adolescents (age range 6.0'14.0 years) were recruited in 14 hospitals distributed over the country of Italy. The participants were classified as normal-weight (N = 129), overweight (N = 126), moderately obese (N = 568), and severely obese (N = 124). The nature and extent of verbal, physical and relational bullying and victimization were assessed with an adapted version of the revised Olweus bully-victim questionnaire. Each participant was coded as bully, victim, bully-victim, or not involved. Results Normal-weight and overweight participants were less involved in bullying than obese participants; severely obese males were more involved in the double role of bully and victim. Severely obese children and adolescents suffered not only from verbal victimization but also from physical victimization and exclusion from group activities. Weight status categories were not directly related to bullying behaviour; however severely obese males perpetrated more bullying behaviour compared to severely obese females. Conclusions Obesity and bullying among children and adolescents are of ongoing concern worldwide and may be closely related. Common strategies of intervention are needed to cope with these two social health challenges

Cannabis consumption and the risk of psychosis

Summary Objectives: Cannabis is the most widely used illicit drug globally and its use has been linked to an increased risk for psychotic disorders. An association between cannabis consumption and psychotic symptoms was consistently reported by several studies. This case-control study aimed to widen the current findings about the impact of cannabis exposure on the risk of psychosis, by investigating the pattern of cannabis consumption in a sample of first-episode of psychosis (FEP) patients compared to healthy controls. Material and methods: 68 individuals who presented for the first time to mental health services of Palermo (Italy) with an ICD-10 diagnosis of psychotic disorders and 74 healthy were enrolled as part of the Sicilian Genetics and Psychosis study. Psychopathological assessment and diagnosis were carried out by the Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Socio-demographic data were collected by the modified version of the Medical Research Council (MRC) socio-demographic scale. All participants were interviewed using the Cannabis Experience Questionnaire \u2013 Modified Version to obtain a detailed assessment of lifetime patterns of cannabis and other illicit drug consumption. Logistic regression was applied to investigate the relationships between various aspects of cannabis use (lifetime use, age at first use, duration, and frequency of use) and case-control status while controlling for potential confounders. Results: Patients started cannabis consumption about 3 years earlier than the control group (t = 3.1, p = 0.002) and were 8 times more likely to having started using cannabis before 15 years (adjusted OR = 8.0, 95% CI 2.4-27) than controls. Furthermore cases were more likely to smoke more frequently than controls (adjusted OR = 4.4, 95% CI 1.08-18). We did not find a difference in duration of cannabis use between cases and controls. Conclusions: The findings suggest that cannabis exposure, and especially daily cannabis consumption, is associated with the risk for psychosis; however, the retrospective study design does not allow drawing firm conclusions about causality

Validation of the Italian version of the Devaluation consumers' Scale and the Devaluation Consumers Families Scale

Objectives: This study aimed to assess the psychometric properties of the Italian versions of the Devaluation of Consumers Scale (DCS) and the Devaluation of Consumer Families Scale (DCFS), two short-scales examining public stigma towards people with mental disorders and their relatives. Methods: The scales were administered to 117 individuals with a clinical diagnosis of affective or non-affective psychoses (ICD 10 criteria F20-29, F30-33). Translation procedures were carried out according to accepted standards. Internal reliability was assessed using Cronbach's alpha coefficient. Convergent validity was evaluated in terms of correlation with the Global Functioning Scale (GAF) and with the Questionnaire on Users' Opinions (QUO). Known-group validity was assessed comparing patients at first-episode of psychosis and patients with a history of psychosis of at least 3 years (long-term psychosis). Results: The overall Cronbach's alpha value was 0.85 for DCS and 0.81 for DCFS; subscales' alpha values ranged from 0.80 to 0.55 for DCS, and from 0.68 to 0.55 for DCFS. Negative correlations were found between the Italian DCS and the DCFS total score and the QUO affective problems (DCS -0.33; DCFS -0.235) and social distance subscales (DCS -0.290; DCFS -0.356). Moreover, the GAF positively correlated with some of the DCS and DCFS subscales. Patients with long-term psychosis had higher scores in most DCS and DCFS subscales. Conclusion: The Italian translation of DCF and DCFS showed good internal consistency, known-group validity, and convergent validity. These psychometric properties support their application in routine clinical practice in Italy as well as their use in international studies

Quantification of the Relative Age Effect in Three Indices of Physical Performance

The relative age effect (RAE) describes the relationship between an individual's birth month and their level of attainment in sports. There is a clustering of birth dates just after the cutoff used for selection in age-grouped sports, and it is hypothesized that such relatively older sportspeople may enjoy maturational and physical advantages over their younger peers. There is, however, little empirical evidence of any such advantage. This study investigated whether schoolchildren's physical performance differed according to which quarter of the school year they were born in. Mass, stature, body mass index, cardiorespiratory fitness, strength, and power were measured in 10 to 16 year olds (n = 8,550, 53% male). We expressed test performance as ageand sex-specific z-scores based on reference data with age rounded down to the nearest whole year and also as units normalized for body mass. We then compared these values between yearly birth quarters. There were no significant main effects for differences in anthropometric measures in either sex. Girls born in the first quarter of the school year were significantly stronger than those born at other times when handgrip was expressed as a zscore. As z-scores, all measures were significantly higher in boys born in either the first or second yearly quarters. Relative to body mass, cardiorespiratory fitness was higher in boys born in the first quarter and power was higher in those born in the second quarter. The RAE does not appear to significantly affect girls' performance test scores when they are expressed as z-score or relative to body mass. Boys born in the first and second quarters of the year had a significant physical advantage over their relatively younger peers. These findings have practical bearing if coaches use fitness tests for talent identification and team selection. Categorizing test performance based on rounded down values of whole-year age may disadvantage children born later in the selection year. These relatively younger children may be less to gain selection for teams or training programmes. © 2013 National Strength and Conditioning Association

Changes of body weight and body composition in obese patients with prader–willi syndrome at 3 and 6 years of follow-up: A retrospective cohort study

Few short-term studies of weight loss have been performed in adult patients with Prader–Willi syndrome (PWS) undergoing metabolic rehabilitation. We performed a retrospective cohort study of 45 adult obese PWS patients undergoing a long-term multidisciplinary metabolic rehabilitation program based on diet and physical activity. Body composition was evaluated by dual-energy X-ray absorptiometry in 36 (80%) patients. The mean (95% CI) weight change was −3.6 (−7.6 to 0.4, p = 0.08) kg at 3 years and −4.6 (−8.5 to −0.8, p = 0.02) kg at 6 years, and that of BMI was −1.7 (−3.4 to 0.1, p = 0.06) kg/m2 at 3 years and −2.1 (−3.8 to −0.4, p = 0.02) kg/m2 at 6 years. A decrease of about 2% in fat mass per unit of body mass was observed, which is in line with the expectations for moderate weight loss. A possibly clinically relevant decrease in total and low-density lipoprotein cholesterol was also observed. These long-term results are important for patients with PWS, which is characterized by severe hyperphagia, behavioral disturbances, and cognitive impairment and is generally considered “resistant” to classical weight loss interventions

Interpreting planners' talk about change: An exploratory study.

Talk by planners about major changes (‘reform’) in a particular planning regime is the focus of this article. Change in planning in the United Kingdom has been a recurrent theme in planning practice and research. However, there is little looking at practitioners both in the public and the private sectors in relation to change. Also, theory development has been limited and the interpretive link between institutional change, organisational change and planners’ situated agency could be strengthened. This article aims to add new dimensions to the current debate by looking at planners in both the public and the private sectors in Wales; by adopting a more open-ended approach requiring planners to generate ideas and display a perspective on planning; and by linking theories of institutional and organisational change with the model of actors’ agency developed by Bevir and Rhodes to form an interpretive frame. With reflections stemming from an exploratory case in Wales, the article seeks also to contribute to debates on planning in the United Kingdom and beyond, reaching to new-institutionalist theory and interpretive ontologie

From total destruction to complete survival: dust processing at different evolutionary stages in the supernova remnant Cassiopeia A

The expanding ejecta of supernova remnants (SNRs) are believed to form dust in dense clumps of gas. Before the dust can be expelled into the interstellar medium and contribute to the interstellar dust budget, it has to survive the reverse shock that is generated through the interaction of the preceding supernova blast wave with the surrounding medium. The conditions under which the reverse shock hits the clumps change with remnant age and define the dust survival rate. To study the dust destruction in the SNR Cassiopeia A, we conduct magnetohydrodynamical simulations of the evolution of a supernova blast wave and of the reverse shock. In a second step, we use these evolving conditions to model clumps that are disrupted by the reverse shock at different remnant ages. Finally, we compute the amount of dust that is destroyed by the impact of the reverse shock. We find that most of the dust in the SNR is hit by the reverse shock within the first 350 yr after the SN explosion. While the dust destruction in the first 200 yr is almost complete, we expect greater dust survival rates at later times and almost total survival for clumps that are first impacted at ages beyond 1000 yr. Integrated over the entire evolution of the SNR, the dust mass shows the lowest survival fraction (17 per cent) for the smallest grains (1 nm) and the highest survival fraction (28 per cent) for the largest grains (1000 nm)