Epidemiology and Neuropsychiatry of Catatonia

1.1 Background Catatonia is a severe form of psychomotor disturbance associated with a range of general medical and psychiatric disorders. After almost 150 years, most of the existing literature relies on case reports and series. This has resulted in gaps in the epidemiology and neuropsychiatry of this condition. 1.2 Aims In this thesis, I aim to characterise the epidemiology, neuroimmunology, structural neuroimaging findings and EEG findings in catatonia. 1.3 Methods I conducted a narrative review of studies related to the immunological findings in catatonia and related conditions, informed by several systematic literature searches. I used anonymised electronic healthcare records from South London to further examine the epidemiology, inflammatory markers and neuroimaging of catatonia. Inpatients with catatonia were compared to inpatients without catatonia. To characterise the EEG findings, I conducted a systematic review and bivariate meta-analysis to determine its diagnostic test accuracy in determining the aetiology of catatonia. 1.4 Results A literature review found that various viral, bacterial and parasitic infections have occasionally been reported in association with catatonia. The most commonly reported form of autoimmune catatonia is NMDAR encephalitis. Using electronic healthcare records, I found that the incidence of catatonia was approximately 1 per 10,000 person-years. Serum NMDAR antibodies were more common in patients with catatonia than in a psychiatric comparison group, but other inflammatory markers were not comparably increased. Abnormalities on structural MRI scans occurred in 34% of patients with catatonia, but there was no difference in adjusted comparisons to other psychiatric patients. Neurological and other general medical conditions in the literature were usually found to be distinguishable from psychiatric catatonia using clinical electroencephalography. 1.5 Conclusions Catatonia remains an important problem in clinical and academic neuropsychiatry. There is promise for neuroimmunological and electroencephalographic biomarkers. Future research requires prospective design, relevant comparison groups and identification of more homogeneous subgroups

Assessing deficit irrigation strategies for corn using simulation

Citation: Kisekka, I., Aguilar, J. P., Rogers, D. H., Holman, J., O'Brien, D. M., & Klocke, N. (2016). Assessing deficit irrigation strategies for corn using simulation. Transactions of the Asabe, 59(1), 303-317. doi:10.13031/trans.59.11206Declining groundwater levels in the Ogallala aquifer due to withdrawals exceeding annual recharge result in diminished well capacities that eventually become incapable of meeting full crop water needs. Producers need recommendations for deficit irrigation strategies that can maximize net returns in most years under low well capacities. The objectives of this study were to (1) calibrate and validate the CERES-Maize model in DSSAT-CSM v4.6 under southwest Kansas soils and climatic conditions and (2) apply the calibrated model to assess three factors related to irrigation management: (i) the optimum plant-available water threshold to initiate irrigation for maximizing net returns, (ii) the effect of percentage soil water depletion at planting on yield, seasonal transpiration, water productivity, extractable soil water at maturity, and net returns, and (iii) the effect of late irrigation season termination on extractable soil water at physiological maturity, yield, and net returns. The CERES-Maize model in DSSAT-CSM v4.6 in conjunction with short-term experimental data and 63 years (1950 to 2013) of historical weather data were used in this study. The calibrated model was able to predict end of season grain yield with acceptable accuracy (NSE > 0.9, 0.13 < %RMSE < 0.19), indicating that the model could be used for assessing alternative management strategies for optimizing the use of limited water for irrigating corn in southwest Kansas. Irrigation scheduling based on a 50% plant-available water threshold maximized net returns compared to initiating irrigation at greater soil water content at corn prices ranging from $0.10 to$0.26 kg-1. Accounting for inter-annual variations in weather and irrigation downtime due to repairs, 14 to 17 irrigation applications of 25 mm of water each would be needed to maintain soil water at 50% of plant-available water during the season. Having soil water in the top 1.2 m of the soil profile between 0% and 25% depleted at planting maximized net returns, although it also resulted in more extractable soil water at physiological maturity. Terminating irrigation 90 or 95 days after planting depending on corn price maximized net returns and resulted in the lowest amount of extractable soil water at physiological maturity, implying that opportunities exist to mine stored soil water toward the end of the season even under deficit irrigation. We recommend that late season irrigation termination be done in conjunction with soil water monitoring and management- allowable depletion techniques to minimize potential reduction in yields. Before adopting any of the management strategies assessed in this study, producers should consider the unique yield potential constraints for their farm. The concepts explored in this analysis, which combined experimental data, computer simulation, and long-term weather data to generate optimum management recommendations, could be applied in other areas with constrained water supplies for irrigation. © 2016 American Society of Agricultural and Biological Engineers

Catatonia in the peripartum: A cohort study using electronic health records

BACKGROUND: Due to limited existing literature available on the presentation and treatment of catatonia in the peripartum, this retrospective descriptive cohort study aimed to examine demographic data, catatonic features, diagnoses pre- and post-catatonic episodes, treatment and the presence of obstetric complications. METHODS: Individuals with catatonia were identified in a previous study using anonymised electronic healthcare records from a large mental health trust in South-East London. The presence of features from the Bush-Francis Catatonia Screening Instrument was coded by the investigators and longitudinal data were extracted from structured fields and free text. RESULTS: 21 individuals were identified from the larger cohort, each of whom experienced one episode of catatonia in the postpartum period, and all had had an inpatient psychiatric admission. 13 patients (62 %) presented after their first pregnancy and 12 (57 %) experienced obstetric complications. 11 (53 %) attempted breastfeeding and 10 (48 %) received a diagnosis of a depressive disorder following the episode of catatonia. The majority presented with immobility or stupor, mutism, staring and withdrawal. All were treated with antipsychotics and 19 (90 %) received benzodiazepines. CONCLUSIONS: This study suggests that signs and symptoms of catatonia during the peripartum are similar to other catatonic presentations. However, the postpartum may be a period of high risk for catatonia and obstetric factors, such as birth complications, may be relevant

Delivering sustainable, resilient and liveable cities via transformed governance

In the context of steadily declining Natural Capital and universal recognition of the imperative to reverse this trend before we get to the point that nature is not able to restore itself, cities have a crucial role to play. The UK Government commissioned a comprehensive study into the value of biodiversity, and by extension nature, reinforcing “why we should change our ways”—yet what is missing is the “how?”. This paper uniquely describes both the “how?” and a conclusive demonstration of the remarkable benefits of implementing it in a city. Critical to this process, it took a UK Parliamentary Inquiry to reveal that nature has become invisible within the economy, yet the ecological ecosystem services nature provides have enormous benefits to both people and the economy. Therefore integration—or seamless weaving—of urban greenspace and nature into people's lives and the places where they live, work, and spend their leisure time is vital. Moreover, what nature does not provide must be provided by engineered systems, and these have an economic cost; put another way, there are enormous cost savings to be made by taking advantage of what nature provides. In addressing these issues, this paper is the definitive paper from a 20-year portfolio of research on how to bring about transformative change in the complex system-of-systems that make up our cities, providing as it does the crucial in-depth research into the many diverse strands of governance—the last link in a chain of the creation, testing and proof of efficacy of methodologies underpinning a theory and practice of change for infrastructure and cities. The impact of this portfolio of research on Birmingham is two-fold: the Star Framework that placed natural environment considerations at the heart of all decision-making in the city, and the successful bid for the largest of the UK Future Parks Accelerator awards. While both are transformative in their different ways, yet mutually supportive, the latter enabled the design of a suite of system interventions from which the value of Birmingham's greenspaces is estimated to rise from £11.0 billion to £14.4 billion—a remarkable return on investment from the research's conceptualization of Birmingham's urban greenspace as a “business” (with its associated business models). In achieving this, the necessary enablers of thinking and practicing systemically, seamlessly working across disciplinary boundaries, an unusually strong focus on both the aspirations of all stakeholders and the context in question to define “the problem,” and the testing of proposed system intervention(s) both now and in the future have been iteratively combined. However, it is the critical enabling steps of identifying the complete range of value-generating opportunities that the interventions offer, formulating them into alternative business models to underpin the case for change and ensuring that they are synergistic with all the dimensions of governance that yielded the profound outcomes sought

Antibodies in the Diagnosis, Prognosis, and Prediction of Psychotic Disorders.

Blood-based biomarker discovery for psychotic disorders has yet to impact upon routine clinical practice. In physical disorders antibodies have established roles as diagnostic, prognostic and predictive (theranostic) biomarkers, particularly in disorders thought to have a substantial autoimmune or infective aetiology. Two approaches to antibody biomarker identification are distinguished: a top-down approach, in which antibodies to specific antigens are sought based on the known function of the antigen and its putative role in the disorder, and emerging bottom-up or omics approaches that are agnostic as to the significance of any one antigen, using high-throughput arrays to identify distinctive components of the antibody repertoire. Here we review the evidence for antibodies (to self-antigens as well as infectious organism and dietary antigens) as biomarkers of diagnosis, prognosis, and treatment response in psychotic disorders. Neuronal autoantibodies have current, and increasing, clinical utility in the diagnosis of organic or atypical psychosis syndromes. Antibodies to selected infectious agents show some promise in predicting cognitive impairment and possibly other symptom domains (eg, suicidality) within psychotic disorders. Finally, infectious antibodies and neuronal and other autoantibodies have recently emerged as potential biomarkers of response to anti-infective therapies, immunotherapies, or other novel therapeutic strategies in psychotic disorders, and have a clear role in stratifying patients for future clinical trials. As in nonpsychiatric disorders, combining biomarkers and large-scale use of bottom-up approaches to biomarker identification are likely to maximize the eventual clinical utility of antibody biomarkers in psychotic disorders