El proceso transdiagnóstico del perfeccionismo

The transdiagnostic approach to theory and treatment of psychological disorders is gainingincreasing interest. A transdiagnostic process is one that occurs across disorders and explainstheir onset or maintenance. The purpose of this review is to provide evidence that perfectionism isa transdiagnostic process that it is elevated in anxiety disorders, eating disorders, depression, obsessivecompulsive personality disorder and somatoform disorders. Data are also reviewed to showthat perfectionism can explain aetiology as it is a prospective predictor of depression and eatingdisorders. Perfectionism is also demonstrated to predict poorer outcome to treatment for anxietydisorders, eating disorders and depression, suggesting the need for specific treatment of perfectionism.Evidence is provided to demonstrate that perfectionism can be successfully treated with cognitivebehavioural therapy which results in reduction in psychopathologies. Clinical guidelines areoutlined to assist in treatment planning for individuals with elevated perfectionism.Abstract: The transdiagnostic approach to theory and treatment of psychological disorders is gainingincreasing interest. A transdiagnostic process is one that occurs across disorders and explainstheir onset or maintenance. The purpose of this review is to provide evidence that perfectionism isa transdiagnostic process that it is elevated in anxiety disorders, eating disorders, depression, obsessivecompulsive personality disorder and somatoform disorders. Data are also reviewed to showthat perfectionism can explain aetiology as it is a prospective predictor of depression and eatingdisorders. Perfectionism is also demonstrated to predict poorer outcome to treatment for anxietydisorders, eating disorders and depression, suggesting the need for specific treatment of perfectionism.Evidence is provided to demonstrate that perfectionism can be successfully treated with cognitivebehavioural therapy which results in reduction in psychopathologies. Clinical guidelines areoutlined to assist in treatment planning for individuals with elevated perfectionism.Resumen: El enfoque transdiagnóstico sobre la teoría y el tratamiento de los trastornos psicológicosestá generando un interés creciente en la literatura. Un proceso transdiagnóstico es aquel quese da a través de los trastornos y explica su inicio o mantenimiento. El objetivo de esta revisiónconsiste en aportar evidencia sobre el perfeccionismo como un proceso transdiagnóstico que seencuentra elevado en los trastornos de ansiedad, los trastornos alimentarios, la depresión, el trastornode personalidad obsesivo-compulsivo y los trastornos somatoformes. Revisamos la evidenciaempírica para mostrar que el perfeccionismo puede explicar la etiología como predictor prospectivode la depresión y los trastornos alimentarios. También se ha demostrado que el perfeccionismopredice un peor resultado terapéutico del tratamiento de los trastornos de ansiedad, los trastornosalimentarios y la depresión, sugiriendo la necesidad de un tratamiento específico del perfeccionismo.Proporcionamos evidencia para demostrar que el perfeccionismo puede ser tratado con éxitomediante terapia cognitivo conductual y que el tratamiento del perfeccionismo produce reduccionesen un rango amplio de psicopatologías. Se describen directrices clínicas para asistir en la planificacióndel tratamiento en individuos con elevados niveles de perfeccionismo

Coming of age: A reflection of the first 21 years of cognitive behaviour therapy for perfectionism

It has been 21 years since the publication of the cognitive behavioural model of clinical perfectionism that underpins cognitive behaviour therapy (CBT) for perfectionism. The notion of clinical perfectionism and CBT for perfectionism has been controversial. Despite 15 randomised controlled trials which have demonstrated the efficacy of CBT for perfectionism in reducing perfectionism and symptoms of anxiety, depression and eating disorders, strong responses to this work continue to appear in the literature. In this article, we examine the evolution and controversy surrounding clinical perfectionism, the efficacy of CBT for perfectionism, and future directions for the concept of perfectionism and its treatment. Future research should aim to provide independent evaluations of treatment efficacy, compare CBT for perfectionism to active treatments, conduct dismantling trials to examine the effective components of treatment, and examine the causal processes involved in perfectionism. We provide recommendations for future pathways to support innovation in theory, understanding, and treatment of perfectionism with a view towards improving clinical outcomes

The development of co-designed parent-supported cognitive behaviour therapy for perfectionism in adolescents with eating disorders: initial feasibility and acceptability

BACKGROUND: Perfectionism is significantly associated with symptoms of eating disorders in adolescents. Studies to date have not examined parent-supported CBT for perfectionism in eating disorders (CBT-P-ED). We co-designed the treatment and conducted a feasibility trial. METHODS: Eight parents of adolescents with eating disorders (M age = 48.75 years, 100% female) engaged in three co-design workshops to create a parent-supported CBT-P-ED self-help intervention. A further 10 parents (M age 41.8 years, 50% female) and their adolescent offspring (n = 10, M age 15.4 years, 60% female, 50% with self-reported diagnosis of anorexia nervosa) participated in a feasibility trial and provided feedback on the intervention. RESULTS: The parents who engaged in the co-design workshops suggested several areas to optimise the perfectionism intervention, including using plain language, the impact of parental perfectionism, how to engage with their adolescent in treatment and the importance of increasing eating disorder specific material. Feedback from the feasibility trial suggested that the intervention was acceptable and feasible with 100% of parents and adolescents saying it was useful, and no attrition. CONCLUSIONS: Parent-supported CBT-P-ED appears to be feasible. Future research is now required in a randomised controlled trial

Ability of verbal autopsy data to detect deaths due to uncontrolled hyperglycaemia:testing existing methods and development and validation of a novel weighted score

Objectives: Verbal autopsy (VA) is a useful tool to ascertain cause of death where no other mechanisms exist. We aimed to assess the utility of VA data to ascertain deaths due to uncontrolled hyperglycaemia and to develop a weighted score (WS) to specifically identify cases. Cases were identified by a study or site physician with training in diabetes. These diagnoses were also compared with diagnoses produced by a standard computer algorithm (InterVA-4). Setting: This study was done using VA data from the Health and Demographic Survey sites in Agincourt in rural South Africa. Validation of the WS was done using VA data from Karonga in Malawi. Participants: All deaths from ages 1 to 49 years between 1992 and 2015 and between 2002 and 2016 from Agincourt and Karonga, respectively. There were 8699 relevant deaths in Agincourt and 1663 in Karonga. Results: Of the Agincourt deaths, there were 77 study physician classified cases and 58 computer algorithm classified cases. Agreement between study physician classified cases and computer algorithm classified cases was poor (Cohen’s kappa 0.14). Our WS produced a receiver operator curve with area under the curve of 0.952 (95% CI 0.920 to 0.985). However, positive predictive value (PPV) was below 50% when the WS was applied to the development set and the score was dominated by the necessity for a premortem diagnosis of diabetes. Independent validation showed the WS performed reasonably against site physician classified cases with sensitivity of 86%, specificity of 99%, PPV of 60% and negative predictive value of 99%. Conclusion: Our results suggest that widely used VA methodologies may be missing deaths due to uncontrolled hyperglycaemia. Our WS may offer improved ability to detect deaths due to uncontrolled hyperglycaemia in large populations studies where no other means exist

Conserved Helix-Flanking Prolines Modulate Intrinsically Disordered Protein:Target Affinity by Altering the Lifetime of the Bound Complex.

Appropriate integration of cellular signals requires a delicate balance of ligand-target binding affinities. Increasing the level of residual structure in intrinsically disordered proteins (IDPs), which are overrepresented in these cellular processes, has been shown previously to enhance binding affinities and alter cellular function. Conserved proline residues are commonly found flanking regions of IDPs that become helical upon interacting with a partner protein. Here, we mutate these helix-flanking prolines in p53 and MLL and find opposite effects on binding affinity upon an increase in free IDP helicity. In both cases, changes in affinity were due to alterations in dissociation, not association, rate constants, which is inconsistent with conformational selection mechanisms. We conclude that, contrary to previous suggestions, helix-flanking prolines do not regulate affinity by modulating the rate of complex formation. Instead, they influence binding affinities by controlling the lifetime of the bound complex

The GstLAL Search Analysis Methods for Compact Binary Mergers in Advanced LIGO's Second and Advanced Virgo's First Observing Runs

After their successful first observing run (September 12, 2015 - January 12, 2016), the Advanced LIGO detectors were upgraded to increase their sensitivity for the second observing run (November 30, 2016 - August 26, 2017). The Advanced Virgo detector joined the second observing run on August 1, 2017. We discuss the updates that happened during this period in the GstLAL-based inspiral pipeline, which is used to detect gravitational waves from the coalescence of compact binaries both in low latency and an offline configuration. These updates include deployment of a zero-latency whitening filter to reduce the over-all latency of the pipeline by up to 32 seconds, incorporation of the Virgo data stream in the analysis, introduction of a single-detector search to analyze data from the periods when only one of the detectors is running, addition of new parameters to the likelihood ratio ranking statistic, increase in the parameter space of the search, and introduction of a template mass-dependent glitch-excision thresholding method.Comment: 12 pages, 7 figures, to be submitted to Phys. Rev. D, comments welcom

COVID-19 impacts on food systems in fisheries-dependent island communities

Policies designed to contain the COVID-19 pandemic have impacted food systems worldwide. How impacts played out in local food systems, and how these affected the lived experiences of different people is only just coming to light. We conducted a structured analysis of the impacts of COVID-19 containment policies on the food systems of small-scale fishing communities in Kenya, Papua New Guinea, and Saint Lucia, based on interviews with men and women fishers, fish traders, and community leaders. Participants reported that containment policies lead indirectly to reduced volumes of food, lower dietary diversity, increased consumption of traditional foods, and reduced access to fish for food and income. Although the initiating policy and food and nutrition security outcomes often appeared similar, we found that the underlying pathways and feedbacks causing these impacts were different based on local context. Incorporating knowledge of how context-specific factors shape food system outcomes may be key to tailoring strategies to mitigate the ongoing impacts of COVID-19 and designing timely, strategic interventions for future systemic shocks