Structure and stability of symptoms in first episode psychosis: a longitudinal network approach.

Early psychosis is characterised by heterogeneity in illness trajectories, where outcomes remain poor for many. Understanding psychosis symptoms and their relation to illness outcomes, from a novel network perspective, may help to delineate psychopathology within early psychosis and identify pivotal targets for intervention. Using network modelling in first episode psychosis (FEP), this study aimed to identify: (a) key central and bridge symptoms most influential in symptom networks, and (b) examine the structure and stability of the networks at baseline and 12-month follow-up. Data on 1027 participants with FEP were taken from the National EDEN longitudinal study and used to create regularised partial correlation networks using the 'EBICglasso' algorithm for positive, negative, and depressive symptoms at baseline and at 12-months. Centrality and bridge estimations were computed using a permutation-based network comparison test. Depression featured as a central symptom in both the baseline and 12-month networks. Conceptual disorganisation, stereotyped thinking, along with hallucinations and suspiciousness featured as key bridge symptoms across the networks. The network comparison test revealed that the strength and bridge centralities did not differ significantly between the two networks (C = 0.096153; p = 0.22297). However, the network structure and connectedness differed significantly from baseline to follow-up (M = 0.16405, p = <0.0001; S = 0.74536, p = 0.02), with several associations between psychosis and depressive items differing significantly by 12 months. Depressive symptoms, in addition to symptoms of thought disturbance (e.g. conceptual disorganisation and stereotyped thinking), may be examples of important, under-recognized treatment targets in early psychosis, which may have the potential to lead to global symptom improvements and better recovery

Sukces w terapii jąkania - czym jest i jak go osiągnąć - opinie „podwójnych ekspertów”

Jąkanie jest zjawiskiem wielowymiarowym, definiowanym na wielu płaszczyznach. W związku z tym istnieją różne podejścia do terapii tego zaburzenia, a zatem na różne sposoby można też określać zarówno cele interwencji terapeutycznej, jak to, co należy uznawać za sukces w terapii. Pomysłodawczynie tego artykułu-wywiadu – Katarzyna Węsierska i Aleksandra Boroń zaprosiły do dyskusji na ten temat osoby, które wystąpiły w roli „podwójnych ekspertów”. Gospodynie tego wywiadu za takie osoby uznały tych, którzy na co dzień mają osobiste doświadczenia z jąkaniem, a którzy jednocześnie – zawodowo lub społecznie – angażują się w działalność pomocową na rzecz osób jąkających się. Do udziału w panelu dyskusyjnym zaproszone zostały więc osoby, które reprezentują środowisko profesjonalistów – są terapeutami (logopedami, psychologami, badaczami na gruncie logopedii) lub są społecznikami na tym polu – aktywnymi działaczami ruchu samopomocowego, liderami grup wsparcia. W dyskusji udział wzięli rozmówcy z Polski: Grzegorz Chmielewski (psycholog i logopeda), Zdzisław Gładosz (lider polskiego ruchu samopomocy dla osób jąkających się), Lucyna Jankowska-Szafarska (psycholog kliniczny i liderka grupy terapeutyczno- samopomocowej) oraz goście z zagranicy: z Izraela – Benny Ravid (lider izraelskiego ruchu samopomocy), z Niemiec – Tobias Haase (aktywny działacz niemieckiego ruchu samopomocy), z USA – profesorowie Paul Blanchet i Kenneth O. St. Louis (logopedzi, badacze i liderzy lokalnych grup samopomocowych), a także z Wielkiej Brytanii – Rachel Everard (logopedka i liderka brytyjskiego ruchu samopomocy). Tematyka rozważań podjętych w rozmowach z tymi „podwójnymi ekspertami” koncentrowała się wokół takich zagadnień, jak percepcja sukcesu w terapii jąkania, określenie celów skutecznej terapii, udzielenie wskazówek/porad rodzicom dzieci z tym problemem w mowie, osobom dorosłym poszukującym pomocy i młodym logopedom, a także określenie roli grup samopomocowych w procesie terapii jąkania

Development and validation of a non-remission risk prediction model in first episode psychosis:An Analysis of 2 Longitudinal Studies

Psychosis is a major mental illness with first onset in young adults. The prognosis is poor in around half of the people affected, and difficult to predict. The few tools available to predict prognosis have major weaknesses which limit their use in clinical practice. We aimed to develop and validate a risk prediction model of symptom nonremission in first-episode psychosis. Our development cohort consisted of 1027 patients with first-episode psychosis recruited between 2005 and 2010 from 14 early intervention services across the National Health Service in England. Our validation cohort consisted of 399 patients with first-episode psychosis recruited between 2006 and 2009 from a further 11 English early intervention services. The one-year nonremission rate was 52% and 54% in the development and validation cohorts, respectively. Multivariable logistic regression was used to develop a risk prediction model for nonremission, which was externally validated. The prediction model showed good discrimination C-statistic of 0.73 (0.71, 0.75) and adequate calibration with intercept alpha of 0.12 (0.02, 0.22) and slope beta of 0.98 (0.85, 1.11). Our model improved the net-benefit by 15% at a risk threshold of 50% compared to the strategy of treating all, equivalent to 15 more detected nonremitted first-episode psychosis individuals per 100 without incorrectly classifying remitted cases. Once prospectively validated, our first episode psychosis prediction model could help identify patients at increased risk of nonremission at initial clinical contact.</p

Understanding the burden of interstitial lung disease post-COVID-19: the UK Interstitial Lung Disease-Long COVID Study (UKILD-Long COVID)

Introduction The COVID-19 pandemic has led to over 100 million cases worldwide. The UK has had over 4 million cases, 400 000 hospital admissions and 100 000 deaths. Many patients with COVID-19 suffer long-term symptoms, predominantly breathlessness and fatigue whether hospitalised or not. Early data suggest potentially severe long-term consequence of COVID-19 is development of long COVID-19-related interstitial lung disease (LC-ILD). Methods and analysis The UK Interstitial Lung Disease Consortium (UKILD) will undertake longitudinal observational studies of patients with suspected ILD following COVID-19. The primary objective is to determine ILD prevalence at 12 months following infection and whether clinically severe infection correlates with severity of ILD. Secondary objectives will determine the clinical, genetic, epigenetic and biochemical factors that determine the trajectory of recovery or progression of ILD. Data will be obtained through linkage to the Post-Hospitalisation COVID platform study and community studies. Additional substudies will conduct deep phenotyping. The Xenon MRI investigation of Alveolar dysfunction Substudy will conduct longitudinal xenon alveolar gas transfer and proton perfusion MRI. The POST COVID-19 interstitial lung DiseasE substudy will conduct clinically indicated bronchoalveolar lavage with matched whole blood sampling. Assessments include exploratory single cell RNA and lung microbiomics analysis, gene expression and epigenetic assessment. Ethics and dissemination All contributing studies have been granted appropriate ethical approvals. Results from this study will be disseminated through peer-reviewed journals. Conclusion This study will ensure the extent and consequences of LC-ILD are established and enable strategies to mitigate progression of LC-ILD

Acceptance and Speech Work: The Challenge

AbstractThis paper explores issues involved in working on acceptance and speech in stuttering therapy. The authors have interests in person-centred counselling, mindfulness and disability studies and these areas underpin the discussion. A variety of definitions of acceptance are given, followed by a brief discussion on how it relates to the process of change. This is explored from a range of perspectives including mindfulness (Kabat-Zinn, 1996), acceptance and commitment therapy (ACT) (Harris, 2009), compassion-focussed therapy (Gilbert, 2010) and person-centred therapy (Rogers, 1951). Acceptance work is then discussed more specifically in the context of stammering therapy. Throughout this paper we use the term ‘speech work’ to describe both stuttering modification strategies and fluency skills or fluency-shaping

Multi-seasonal effects of warming and elevated CO₂ on the physiology, growth and production of mature, field grown, Shiraz grapevines

Abstract: Industry concerns in Australia about the impacts of climate change have, to date, focused on the effects of warming, particularly shorter maturation periods. The effects of elevated CO2 concentration (eCO2) on C3 plant physiology have been extensively studied and suggest that eCO2 impacts on viticulture could affect grapevine shoot growth, fruit production and fruit composition. We previously used open top chambers (OTC) with an active heating system to study the effects of elevated air temperature (eTemp) on mature grapevines in the field. This system was augmented with the ability to elevate atmospheric CO2 and established in a mature Shiraz vineyard in a factorial combination of eTemp and eCO2. Three seasons of observations on the eTemp only treatment corroborated our previous study; all aspects of phenology were advanced, but leaf function was largely unaffected. In contrast, the effects of eCO2 on phenology were small in the first season, but increased over the subsequent two seasons. Interactive effects of the treatments on gas exchange were observed; photosynthesis rates were significantly higher in the eCO2+eTemp treatment, compared to eCO2 alone, suggesting that the likely future climate will have a larger impact on viticulture than might be predicted from experiments examining only one of these factors

Consensus Guidelines for Assessing Stuttering

This project developed consensus guidelines for assessment procedures for people who stutter across the lifespan. Twelve expert clinicians and researchers provided descriptions of their assessment approaches during diagnostic evaluations with persons who stutter (PWS). Iterative content analysis identified six core areas of a comprehensive evaluation of stuttering and PWS; these were: (1) stuttering-related background information; (2) speech, language, and temperament development (especially for younger clients); (3) speech fluency and stuttering behaviors; (4) reactions to stuttering by the speaker; (5) reactions to stuttering by people in the speaker’s environment, and (6) adverse impact caused by stuttering. These guidelines can help speech-language pathologists to design and perform appropriate stuttering assessments, and to do so with confidence. Example procedures will be discussed

Consensus guidelines for the assessments of individuals who stutter across the lifespan

Purpose: This project sought to develop consensus guidelines for clinically meaningful, comprehensive assessment procedures for people who stutter across the lifespan. Method: Twelve expert clinicians and researchers who have written extensively about stuttering provided detailed descriptions of the type of data that they routinely collect during diagnostic evaluations of preschool children, school-age children, adolescents, and adults who stutter. Iterative content analysis, with repeated input from the respondents, was used to identify core areas that reflect common domains that these experts judge to be important for evaluating stuttering for varying age groups. Results: Six core areas were identified as common components of a comprehensive evaluation of stuttering and people who stutter. These areas should be included to varying degrees depending upon the age and needs of the client or family. The core areas include the following: (a) stuttering-related background information; (b) speech, language, and temperament development (especially for younger clients); (c) speech fluency and stuttering behaviors; (d) reactions to stuttering by the speaker; (e) reactions to stuttering by people in the speaker’s environment; and (f) adverse impact caused by stuttering. Discussion: These consensus recommendations can help speech-language pathologists who are uncertain about appropriate stuttering assessment procedures to design and conduct more thorough evaluations, so that they will be better prepared to provide individualized and comprehensive treatment for people who stutter across the lifespan

Prevalence of treatment resistance and clozapine use in early intervention services.

Treatment resistance causes significant burden in psychosis. Clozapine is the only evidence-based pharmacologic intervention available for people with treatment-resistant schizophrenia; current guidelines recommend commencement after two unsuccessful trials of standard antipsychotics. This paper aims to explore the prevalence of treatment resistance and pathways to commencement of clozapine in UK early intervention in psychosis (EIP) services. Data were taken from the National Evaluation of the Development and Impact of Early Intervention Services study (N = 1027) and included demographics, medication history and psychosis symptoms measured by the Positive and Negative Syndrome Scale (PANSS) at baseline, 6 months and 12 months. Prescribing patterns and pathways to clozapine were examined. We adopted a strict criterion for treatment resistance, defined as persistent elevated positive symptoms (a PANSS positive score ≥16, equating to at least two items of at least moderate severity), across three time points. A total of 143 (18.1%) participants met the definition of treatment resistance of having continuous positive symptoms over 12 months, despite treatment in EIP services. Sixty-one (7.7%) participants were treatment resistant and eligible for clozapine, having had two trials of standard antipsychotics; however, only 25 (2.4%) were prescribed clozapine over the 12-month study period. Treatment-resistant participants were more likely to be prescribed additional antipsychotic medication and polypharmacy, instead of clozapine. Prevalent treatment resistance was observed in UK EIP services, but prescription of polypharmacy was much more common than clozapine. Significant delays in the commencement of clozapine may reflect a missed opportunity to promote recovery in this critical period