A Schema Therapy Based Milieu in Secure Residential Youth Care:Effects on Aggression, Group Climate, Repressive Staff Interventions, and Team Functioning

Group care workers of residential youth care settings face the challenge of creating a warm and involved treatment climate against the demands and restrictions of the treatment setting. We tested the effects of SafePath, a milieu-based intervention based on Schema Therapy principles, during the first year of implementation on two secure residential treatment units compared to two control units. Staff’s daily reports on 139 individual patients were coded on use of schema mode language (implementation check), occurrences of aggression (primary outcome) and repressive staff interventions. In addition, repeated questionnaires were filled out by patients (n = 87) on group climate and by staff (n = 50) on team functioning. Compared to the control units, SafePath units showed higher improvements in group climate and repressive interventions. Both SafePath and control units showed decreased aggression over time. Team functioning was consistently better in the SafePath units compared to the care-as-usual units from baseline through 12 months. In conclusion, a Schema Therapy based milieu as implemented with SafePath may contribute to a warm and supportive group climate with less repressive interventions in secure residential youth care

In Critically Ill Patients, Serum Procalcitonin Is More Useful in Differentiating between Sepsis and SIRS than CRP, Il-6, or LBP

We studied the usefulness of serum procalcitonin (PCT), interleukin-6 (IL-6), lipopolysaccharide binding protein (LBP) levels and C-reactive protein (CRP) levels, in differentiating between systemic inflammatory response syndrome (SIRS) and sepsis in critically ill patients. Methods. In this single centre prospective observational study we included all consecutive patients admitted with SIRS or sepsis to the ICU. Blood samples for measuring CRP, PCT, IL-6 and LBP were taken every day until ICU discharge. Results. A total of 76 patients were included, 32 with sepsis and 44 with SIRS. Patients with sepsis were sicker on admission and had a higher mortality. CRP, PCT, IL-6 and LBP levels were significantly higher in patients with sepsis as compared to SIRS. With PCT levels in the first 24 hours after ICU admission <2 ng/mL, sepsis was virtually excluded (negative predictive value 97%). With PCT >10 ng/mL, sepsis with bacterial infection was very likely (positive predictive value 88%). PCT was best at discriminating between SIRS and sepsis with the highest area under the ROC curve (0.95, 95% CI 0.90–0.99). Discussion. This study showed that PCT is more useful than LBP, CRP and IL-6 in differentiating sepsis from SIRS

Age at onset as stratifier in idiopathic Parkinson’s disease – effect of ageing and polygenic risk score on clinical phenotypes

Several phenotypic differences observed in Parkinson’s disease (PD) patients have been linked to age at onset (AAO). We endeavoured to find out whether these differences are due to the ageing process itself by using a combined dataset of idiopathic PD (n = 430) and healthy controls (HC; n = 556) excluding carriers of known PD-linked genetic mutations in both groups. We found several significant effects of AAO on motor and non-motor symptoms in PD, but when comparing the effects of age on these symptoms with HC (using age at assessment, AAA), only positive associations of AAA with burden of motor symptoms and cognitive impairment were significantly different between PD vs HC. Furthermore, we explored a potential effect of polygenic risk score (PRS) on clinical phenotype and identified a significant inverse correlation of AAO and PRS in PD. No significant association between PRS and severity of clinical symptoms was found. We conclude that the observed non-motor phenotypic differences in PD based on AAO are largely driven by the ageing process itself and not by a specific profile of neurodegeneration linked to AAO in the idiopathic PD patients