Social psychiatry and psychiatric epidemiology functional impairment among people with severe and enduring mental disorder in rural Ethiopia: a cross-sectional study

Purpose: Evidence regarding functional impairment in people with severe mental disorders (SMD) is sparse in low and middle-income countries. The aim of this study was to identify factors associated with functional impairment in people with enduring SMD in a rural African setting. Methods: A cross-sectional study was conducted at the baseline of a health service intervention trial. A total of 324 participants were recruited from an existing communityascertained cohort of people with SMD (n= 218), and attendees at the Butajira General Hospital psychiatric clinic (n= 106). Inclusion criteria defined people with SMD who had ongoing need for care: those who were on psychotropic medication, currently symptomatic or had a relapse in the preceding two years. The World Health Organization Disability Assessment schedule (WHODAS-2.0) and the Butajira Functioning Scale (BFS), were used to assess functional impairment. Multivariable negative binomial regression models were fitted to investigate the association between demographic, socio-economic and clinical characteristics, and functional impairment. Results: Increasing age, being unmarried, rural residence, poorer socio-economic status, symptom severity, continuous course of illness, medication side effects and internalized stigma were associated with functional impairment across self reported and caregiver responses for both the WHODAS and the BFS. Diagnosis per se was not associated consistently with functional impairment. Conclusion: To optimize functioning in people with chronic SMD in this setting, services need to target residual symptoms, poverty, medication side effects and internalized stigma. Testing the impact of community interventions to promote recovery will be useful. Advocacy for more tolerable treatment options is warranted

Comorbid substance abuse and brain morphology in recent-onset psychosis

The aim of the presented study was to compare schizophrenia and schizoaffective patients early in the course of the disease with and without comorbid substance abuse disorder (SUD vs. NSUD) with regard to brain morphology. In a prospective design 41 patients (20 SUD vs. 21 NSUD) diagnosed as recent-onset schizophrenia or schizoaffective disorder consecutively admitted to hospital received standardized psychopathological evaluation (BPRS, SANS, MADRS, CGI, GAF) and MRI scanning with volumetric measurement of superior temporal gyrus (STG), amygdala-hippocampal complex, and cingulum. Patients with SUD (primarily cannabis) were significantly younger, predominantly male and had a lower socioeconomic status. Despite less attentional impairment (SANS subscore) and elevated anxiety/depression (BPRS subscore) in patients with SUD compared to NSUD, no other psychopathological differences could be detected. There were no differences in the assessed temporolimbic brain morphology between the two subgroups. In conclusion, in this study substance abuse in recent-onset psychosis had no effect on brain morphology and the earlier onset of psychosis in patients with comorbid SUD could not be explained by supposed accentuated brain abnormalities in temporolimbic regions

Structure détaillée de l’écoulement pendant la transition

Detailed flow field in transition. Study of the development of a disturbance created in a laminar boundary layer at the stage following the range of validity of the linear approximation and ending with the explosive generation of “turbulent spots”. Use of a set of hot wire anemometers to measure the fine structure of the phenomenon.La transition laminaire-turbulent passe par de nombreuses phases bien distinctes. Les théories de l'instabilité en régime laminaire, à base des techniques de petites perturbations, sont bien comprises mais elles ne représentent le phénomène que pendant les phases initiales. L'investigation expérimentale de la structure fine de l'écoulement, utilisant un plus grand nombre de sondes à fil chaud, a permis de mettre en évidence certains détails sur la manière dont la couche tourbillonnaire localisée évolue. L'instabilité secondaire de la couche à gradient de vitesse paraît conduire à la longue à la rupture et à la formation d'un foyer turbulent.Kovasznay L. S. G. Structure détaillée de l’écoulement pendant la transition. In: Les instabilités en hydraulique et en mécanique des fluides. Compte rendu des huitièmes journées de l'hydraulique; Lille, 8-10 juin 1964. Tome 1, 1965