Diagnostic stability among chronic patients with functional psychoses: an epidemiological and clinical study

<p>Abstract</p> <p>Background</p> <p>Diagnostic stability and illness course of chronic non-organic psychoses are complex phenomena and only few risk factors or predictors are known that can be used reliably. This study investigates the diagnostic stability during the entire course of illness in patients with non-organic psychoses and attempts to identify non-psychopathological risk factors or predictors.</p> <p>Method</p> <p>100 patients with functional psychosis were initially characterised using the Operational Criteria Checklist for Psychotic Illness and Affective Illness (OPCRIT), medical records and health registers. To study the stability of diagnoses (i.e. shifts per time), we used registry data to define four measures of diagnostic variation that were subsequently examined in relation to four possible measures of time (i.e. observation periods or hospitalisation events). Afterwards, we identified putative co-variables and predictors of the best measures of diagnostic stability.</p> <p>Results</p> <p>All four measures of diagnostic variation are very strongly associated with numbers-of-hospitalisations and less so with duration-of-illness, duration-of-hospitalisation and with year-of-first-admission. The four measures of diagnostic variation corrected for numbers-of-hospitalisations were therefore used to study the diagnostic stability. Conventional predictors of illness course – e.g. age-of-onset and premorbid-functioning – are not significantly associated with stability. Only somatic-comorbidity is significantly associated with two measures of stability, while family-history-of-psychiatric-illness and global-assessment-of-functioning (GAF) scale score show a trend. However, the traditional variables age-of-first-admission, civil-status, first-diagnosis-being-schizophrenia and somatic-comorbidity are able to explain two-fifth of the variation in numbers-of-hospitalisations.</p> <p>Conclusion</p> <p>Diagnostic stability is closely linked with the contact between patient and the healthcare system. This could very likely be due to fluctuation of disease manifestation over time or presence of co-morbid psychiatric illness in combination with rigid diagnostic criteria that are unable to capture the multiple psychopathologies of the functional psychoses that results in differential diagnoses and therefore diagnostic instability. Not surprisingly, somatic-comorbidity was found to be a predictor of diagnostic variation thereby being a non-psychiatric confounder.</p

Technical Note: Mesocosm approach to quantify dissolved inorganic carbon percolation fluxes

Dissolved inorganic carbon (DIC) fluxes across the vadose zone are influenced by a complex interplay of biological, chemical and physical factors. A novel soil mesocosm system was evaluated as a tool for providing information on the mechanisms behind DIC percolation to the groundwater from unplanted soil. Carbon dioxide partial pressure (<i>p</i>CO₂), alkalinity, soil moisture and temperature were measured with depth and time, and DIC in the percolate was quantified using a sodium hydroxide trap. Results showed good reproducibility between two replicate mesocosms. The <i>p</i>CO₂ varied between 0.2 and 1.1%, and the alkalinity was 0.1–0.6 meq L⁻¹. The measured cumulative effluent DIC flux over the 78-day experimental period was 185–196 mg L⁻¹ m⁻² and in the same range as estimates derived from <i>p</i>CO₂ and alkalinity in samples extracted from the side of the mesocosm column and the drainage flux. Our results indicate that the mesocosm system is a promising tool for studying DIC percolation fluxes and other biogeochemical transport processes in unsaturated environments

Dexamethasone inhibits IL-9 production by human T cells

BACKGROUND: Interleukin 9 (IL-9) is produced by activated CD4+ T cells. Its effects include stimulation of mucus production, enhanced mast cell proliferation, enhanced eosinophil function, and IgE production. These effects are consistent with a role in allergic diseases. Glucocorticoids have potent anti-inflammatory effects, including suppression of cytokine synthesis, and are widely used in the treatment of allergic conditions. METHODS: We examined the effect of the glucocorticoid dexamethasone (Dex) on IL-9 mRNA expression and protein secretion with real-time RT-PCR and ELISA. Peripheral blood mononuclear cells (PBMC) were prepared from human volunteers and activated with OKT3. CD4+ T cells were purified from PBMC and activated with OKT3 plus PMA. RESULTS: IL-9 mRNA abundance and protein secretion were both markedly reduced following treatment of activated PBMC with Dex. mRNA levels were reduced to 0.7% of control values and protein secretion was reduced to 2.8% of controls. In CD4+ T cells, Dex reduced protein secretion to a similar extent. The IC(50 )value of Dex on mRNA expression was 4 nM. CONCLUSION: These results indicate that IL-9 production is very markedly inhibited by Dex. The findings raise the possibility that the beneficial effects of glucocorticoids in the treatment of allergic diseases are in part mediated by inhibition of IL-9 production

Body Topography Parcellates Human Sensory and Motor Cortex

The cytoarchitectonic map as proposed by Brodmann currently dominates models of human sensorimotor cortical structure, function, and plasticity. According to this model, primary motor cortex, area 4, and primary somatosensory cortex, area 3b, are homogenous areas, with the major division lying between the two. Accumulating empirical and theoretical evidence, however, has begun to question the validity of the Brodmann map for various cortical areas. Here, we combined in vivo cortical myelin mapping with functional connectivity analyses and topographic mapping techniques to reassess the validity of the Brodmann map in human primary sensorimotor cortex. We provide empirical evidence that area 4 and area 3b are not homogenous, but are subdivided into distinct cortical fields, each representing a major body part (the hand and the face). Myelin reductions at the hand-face borders are cortical layer-specific, and coincide with intrinsic functional connectivity borders as defined using large-scale resting state analyses. Our data extend the Brodmann model in human sensorimotor cortex and suggest that body parts are an important organizing principle, similar to the distinction between sensory and motor processing

Laudatores Temporis Acti, or Why Cosmology is Alive and Well - A Reply to Disney

A recent criticism of cosmological methodology and achievements by Disney (2000) is assessed. Some historical and epistemological fallacies in the said article have been highlighted. It is shown that---both empirically and epistemologically---modern cosmology lies on sounder foundations than it is portrayed. A brief historical account demonstrates that this form of unsatisfaction with cosmology has had a long tradition, and rather meagre results in the course of the XX century.Comment: 11 pages, no figures; a criticism of astro-ph/0009020; Gen. Rel. Grav., accepted for publicatio

Intermediate Wakimoto modules for Affine sl(n+1)

We construct certain boson type realizations of affine sl(n+1) that depend on a parameter r. When r=0 we get a Fock space realization of Imaginary Verma modules appearing in the work of the first author and when r=n they are the Wakimoto modules described in the work of Feigin and Frenkel

Emergence of Order in Textured Patterns

A characterization of textured patterns, referred to as the disorder function \bar\delta(\beta), is used to study properties of patterns generated in the Swift-Hohenberg equation (SHE). It is shown to be an intensive, configuration-independent measure. The evolution of random initial states under the SHE exhibits two stages of relaxation. The initial phase, where local striped domains emerge from a noisy background, is quantified by a power law decay \bar\delta(\beta) \sim t^{-{1/2} \beta}. Beyond a sharp transition a slower power law decay of \bar\delta(\beta), which corresponds to the coarsening of striped domains, is observed. The transition between the phases advances as the system is driven further from the onset of patterns, and suitable scaling of time and \bar\delta(\beta) leads to the collapse of distinct curves. The decay of $\bar\delta(\beta)$ during the initial phase remains unchanged when nonvariational terms are added to the underlying equations, suggesting the possibility of observing it in experimental systems. In contrast, the rate of relaxation during domain coarsening increases with the coefficient of the nonvariational term.Comment: 9 Pages, 8 Postscript Figures, 3 gif Figure