Brief intervention manual for personality disorders

This manual is designed to help services intervene early and better support young people and adults with personality disorders. It is particularly focused on clients in crisis, who have complex needs, by providing practical therapeutic techniques in the prevention and treatment of high-risk challenging behaviours. It describes a four session brief intervention that can act as the first step in a treatment journey for people with this disorder

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Parenting with personality disorder intervention: a manual for health professionals

This manual is designed to assist mental health clinicians to work effectively with parents or caregivers with a personality disorder. The aim of this intervention program, in line with the relational approach of the Project Air Strategy for Personality Disorders (Project Air Strategy for Personality Disorders, 2015), is to assist mental health clinicians to reflect on parenting with people with personality disorder. The goal is to support parents, children and families to enhance protective factors and to identify and reduce risk factors. Given the daily difficulties parenting presents for caregivers with personality disorder, this approach is likely to enhance the working alliance between the clinician and the client in treatment. Addressing parenting with people with personality disorder will likely achieve better mental health outcomes for both parent and child. It is often the case that personality disorder and parenting are not talked about together, particularly when parents are seeking treatment individually in an adult mental health service. However, personality disorder can have a profound effect on the home environment, especially on children. Parents with personality disorder may engage in more problematic parenting behaviours than other parents, such as low sensitivity and responsivity, inconsistent discipline and role-reversal (see Crandell, Patrick, & Hobson, 2003; Gratz et al., 2014; Hobson, Patrick, Crandell, Garcia-Perez, & Lee, 2005; Johnson, Cohen, Kasen, Ehrensaft, & Crawford, 2006; Macfie & Swan, 2009; Newman, Stevenson, Bergman, & Boyce, 2007; Stepp, Whalen, Pilkonis, Hipwell, & Levine, 2012; Wilson & Durbin, 2012; Zalewski et al., 2014). The possibility of intergenerational transmission of mental health disorders has been well documented (Stepp, et al., 2012), and children of parents with personality disorder may be at risk of experiencing more emotional, behavioural, social and cognitive difficulties than their peers (see Barnow, Spitzer, Grabe, Kessler, & Freyberger, 2006; Crandell, et al., 2003; Dutton, Denny-Keys, & Sells, 2011; Herr, Hammen, & Brennan, 2008; Macfie & Swan, 2009; Newman, et al., 2007; Weiss et al., 1996)

Treatment guidelines for personality disorders

These treatment guidelines are organised according to a typical sequence of a whole of service experience: from a presentation in crisis to a hospital emergency department, through to long-term treatments. Along the way, it presents guidelines for good practice in assessment, brief interventions, care planning, involving family members and carers1, and ongoing community treatment. These Australian treatment guidelines have been developed by the Project Air Strategy for Personality Disorders

Molecular characterization of novel mosquito-borne Rickettsia spp. from mosquitoes collected at the Demilitarized Zone of the Republic of Korea.

Rickettsiae are associated with a diverse range of invertebrate hosts. Of these, mosquitoes could emerge as one of the most important vectors because of their ability to transmit significant numbers of pathogens and parasites throughout the world. Recent studies have implicated Anopheles gambiae as a potential vector of Rickettsia felis. Herein we report that a metagenome sequencing study identified rickettsial sequence reads in culicine mosquitoes from the Republic of Korea. The detected rickettsiae were characterized by a genus-specific quantitative real-time PCR assay and sequencing of rrs, gltA, 17kDa, ompB, and sca4 genes. Three novel rickettsial genotypes were detected (Rickettsia sp. A12.2646, Rickettsia sp. A12.2638 and Rickettsia sp. A12.3271), from Mansonia uniformis, Culex pipiens, and Aedes esoensis, respectively. The results underscore the need to determine the Rickettsia species diversity associated with mosquitoes, their evolution, distribution and pathogenic potential

Percent sequence identity of the mosquito genotypes to <i>Rickettsia</i> species with validly published names and other mosquito rickettsial strains provided in the GenBank.

<p>Percent sequence identity of the mosquito genotypes to <i>Rickettsia</i> species with validly published names and other mosquito rickettsial strains provided in the GenBank.</p

Map of the northern part of Gyeonggi province denoting collection sites of mosquitoes at NNSC (Neutral Nations Supervisory Commission camp adjacent to the Panmunjeom), Daeseongdong (located inside the Demilitarized Zone), Warrior Base (US Army training site) and Tongilchon (beef farm) located 2 km and 3 km, respectively from the MDL southern boundary of the Demilitarized Zone.

<p>Map of the northern part of Gyeonggi province denoting collection sites of mosquitoes at NNSC (Neutral Nations Supervisory Commission camp adjacent to the Panmunjeom), Daeseongdong (located inside the Demilitarized Zone), Warrior Base (US Army training site) and Tongilchon (beef farm) located 2 km and 3 km, respectively from the MDL southern boundary of the Demilitarized Zone.</p