Mental health problems in people with learning disabilities: prevention, assessment and management

This guideline covers preventing, assessing and managing mental health problems in people with learning disabilities in all settings (including health, social care, education, and forensic and criminal justice). It aims to improve assessment and support for mental health conditions, and help people with learning disabilities and their families and carers to be involved in their care

A pragmatic randomised controlled trial assessing the non-inferiority of counselling for depression versus cognitive-behaviour therapy for patients in primary care meeting a diagnosis of moderate or severe depression (PRaCTICED): Study protocol for a randomised controlled trial.

BACKGROUND: NICE guidelines state cognitive behavioural therapy (CBT) is a front-line psychological treatment for people presenting with depression in primary care. Counselling for Depression (CfD), a form of Person-Centred Experiential therapy, is also offered within Improving Access to Psychological Therapies (IAPT) services for moderate depression but its effectiveness for severe depression has not been investigated. A full-scale randomised controlled trial to determine the efficacy and cost-effectiveness of CfD is required. METHODS: PRaCTICED is a two-arm, parallel group, non-inferiority randomised controlled trial comparing CfD against CBT. It is embedded within the local IAPT service using a stepped care service delivery model where CBT and CfD are routinely offered at step 3. Trial inclusion criteria comprise patients aged 18 years or over, wishing to work on their depression, judged to require a step 3 intervention, and meeting an ICD-10 diagnosis of moderate or severe depression. Patients are randomised using a centralised, web-based system to CfD or CBT with each treatment being delivered up to a maximum 20 sessions. Both interventions are manualised with treatment fidelity tested via supervision and random sampling of sessions using adherence/competency scales. The primary outcome measure is the Patient Health Questionnaire-9 collected at baseline, 6 and 12 months. Secondary outcome measures tap depression, generic psychological distress, anxiety, functioning and quality of life. Cost-effectiveness is determined by a patient service receipt questionnaire. Exit interviews are conducted with patients by research assessors blind to treatment allocation. The trial requires 500 patients (250 per arm) to test the non-inferiority hypothesis of -2 PHQ-9 points at the one-sided, 2.5% significance level with 90% power, assuming no underlying difference and a standard deviation of 6.9. The primary analysis will be undertaken on all patients randomised (intent to treat) alongside per-protocol and complier-average causal effect analyses as recommended by the extension to the CONSORT statement for non-inferiority trials. DISCUSSION: This large-scale trial utilises routinely collected outcome data as well as specific trial data to provide evidence of the comparative efficacy and cost-effectiveness of Counselling for Depression compared with Cognitive Behaviour Therapy as delivered within the UK government's Improving Access to Psychological Therapies initiative. TRIAL REGISTRATION: Controlled Trials ISRCTN Registry, ISRCTN06461651 . Registered on 14 September 2014

Color categories: Evidence for the cultural relativity hypothesis

The question of whether language affects our categorization of perceptual continua is of particular interest for the domain of color where constraints on categorization have been proposed both within the visual system and in the visual environment. Recent research (Roberson, Davies, & Davidoff, 2000; Roberson et al., in press) found substantial evidence of cognitive color differences between different language communities, but concerns remained as to how representative might be a tiny, extremely remote community. The present study replicates and extends previous findings using additional paradigms among a larger community in a different visual environment. Adult semi-nomadic tribesmen in Southern Africa carried out similarity judgments, short-term memory and long-term learning tasks. They showed different cognitive organization of color to both English and another language with the five color terms. Moreover, Categorical Perception effects were found to differ even between languages with broadly similar color categories. The results provide further evidence of the tight relationship between language and cognition

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Russian blues reveal effects of language on color discrimination

English and Russian color terms divide the color spectrum differently. Unlike English, Russian makes an obligatory distinction between lighter blues (“goluboy”) and darker blues (“siniy”). We investigated whether this linguistic difference leads to differences in color discrimination. We tested English and Russian speakers in a speeded color discrimination task using blue stimuli that spanned the siniy/goluboy border. We found that Russian speakers were faster to discriminate two colors when they fell into different linguistic categories in Russian (one siniy and the other goluboy) than when they were from the same linguistic category (both siniy or both goluboy). Moreover, this category advantage was eliminated by a verbal, but not a spatial, dual task. These effects were stronger for difficult discriminations (i.e., when the colors were perceptually close) than for easy discriminations (i.e., when the colors were further apart). English speakers tested on the identical stimuli did not show a category advantage in any of the conditions. These results demonstrate that (i) categories in language affect performance on simple perceptual color tasks and (ii) the effect of language is online (and can be disrupted by verbal interference)

Whorf hypothesis is supported in the right visual field but not the left

The question of whether language affects perception has been debated largely on the basis of cross-language data, without considering the functional organization of the brain. The nature of this neural organization predicts that, if language affects perception, it should do so more in the right visual field than in the left visual field, an idea unexamined in the debate. Here, we find support for this proposal in lateralized color discrimination tasks. Reaction times to targets in the right visual field were faster when the target and distractor colors had different names; in contrast, reaction times to targets in the left visual field were not affected by the names of the target and distractor colors. Moreover, this pattern was disrupted when participants performed a secondary task that engaged verbal working memory but not a task making comparable demands on spatial working memory. It appears that people view the right (but not the left) half of their visual world through the lens of their native language, providing an unexpected resolution to the language-and-thought debate

Perceiving the average hue of color arrays

The average of a color distribution has special significance for color coding (e.g., to estimate the illuminant) but how it depends on the visual representation (e.g., perceptual versus cone-opponent) or nonlinearities (e.g., categorical coding) is unknown.Wemeasured the perceived average of two colors shown alternated in spatial arrays. Observers adjusted the components until the average equaled a specified reference hue. Matches for red, blue–red, or yellow–green were consistent with the arithmetic mean chromaticity, while blue–green settings deviated toward blue. The settings show little evidence for categorical coding, and cannot be predicted from the scaled appearances of the individual components. © 2014 Optical Society of America OCIS codes: (330.0330) Vision, color, and visual optics; (330.1690) Color; (330.1720) Color vision

Misconceptions about colour categories

The origin of colour categories and their relationship to colour perception have been the prime example for testing the influence of language on perception and thought (Sapir-Whorf hypothesis) and more generally for investigating the biological, ecological and cultural determination of human cognition (nature-nurture debate). These themes are central to a broad range of disciplines, including vision research, neuroscience, cognitive psychology, developmental science, cultural anthropology, linguistics, computer science, and philosophy. Unfortunately, though, it has been tacitly taken for granted that the conceptual assumptions and methodological practices from the dawn of empirical research on colour categorisation are the gold standard for current colour category research. Here, we show that these assumptions and practices are obsolete and flawed and have led to four fundamental and widespread misconceptions about colour categorisation: 1.) that colour perception is inherently categorical; 2.) that English Basic Colour Terms correspond to universal categories that are the end point of a fixed evolutionary sequence; 3.) that the prototypes of English basic colour terms are perceptually salient and qualify as focal colours; and 4.) that colour category research essentially revolves around the universalism-realism debate. State-of-the-art research on colour categorisation provides new, more sophisticated approaches and allows for rectifying those four statements. At the same time, some of the questions underlying those statements are not convincingly answered yet and constitute major challenges to future research. The critical considerations on colour categorisation may be transferred to research on other kinds of perceptual categorisation to inspire new, more general research questions