Age matters in the prevalence and clinical significance of ultra‐high‐risk for psychosis symptoms and criteria in the general population: Findings from the BEAR and BEARS‐kid studies

Early detection of psychosis is an important topic in psychiatry. Yet, there is limited information on the prevalence and clinical significance of high‐risk symptoms in children and adolescents as compared to adults. We examined ultra‐high‐risk (UHR) symptoms and criteria in a sample of individuals aged 8‐40 years from the general population of Canton Bern, Switzerland, enrolled from June 2011 to May 2014. The current presence of attenuated psychotic symptoms (APS) and brief intermittent psychotic symptoms (BLIPS) and the fulfillment of onset/worsening and frequency requirements for these symptoms in UHR criteria were assessed using the Structured Interview for Psychosis Risk Syndromes. Additionally, perceptive and non‐perceptive APS were differentiated. Psychosocial functioning and current non‐psychotic DSM‐IV axis I disorders were also surveyed. Well‐trained psychologists performed assessments. Altogether, 9.9% of subjects reported APS and none BLIPS, and 1.3% met all the UHR requirements for APS. APS were related to more current axis I disorders and impaired psychosocial functioning, indicating some clinical significance. A strong age effect was detected around age 16: compared to older individuals, 8‐15‐year olds reported more perceptive APS, that is, unusual perceptual experiences and attenuated hallucinations. Perceptive APS were generally less related to functional impairment, regardless of age. Conversely, non‐perceptive APS were related to low functioning, although this relationship was weaker in those below age 16. Future studies should address the differential effects of perceptive and non‐perceptive APS, and their interaction with age, also in terms of conversion to psychosis.     

Persistence of psychosis spectrum symptoms in the Philadelphia Neurodevelopmental Cohort: a prospective two‐year follow‐up

Prospective evaluation of youths with early psychotic‐like experiences can enrich our knowledge of clinical, biobehavioral and environmental risk and protective factors associated with the development of psychotic disorders. We aimed to investigate the predictors of persistence or worsening of psychosis spectrum features among US youth through the first large systematic study to evaluate subclinical symptoms in the community. Based on Time 1 screen of 9,498 youth (age 8‐21) from the Philadelphia Neurodevelopmental Cohort, a subsample of participants was enrolled based on the presence (N=249) or absence (N=254) of baseline psychosis spectrum symptoms, prior participation in neuroimaging, and current neuroimaging eligibility. They were invited to participate in a Time 2 assessment two years on average following Time 1. Participants were administered the Structured Interview for Prodromal Syndromes, conducted blind to initial screen status, along with the Schizotypal Personality Questionnaire and other clinical measures, computerized neurocognitive testing, and neuroimaging. Clinical and demographic predictors of symptom persistence were examined using logistic regression. At Time 2, psychosis spectrum features persisted or worsened in 51.4% of youths. Symptom persistence was predicted by higher severity of subclinical psychosis, lower global functioning, and prior psychiatric medication at baseline. Youths classified as having psychosis spectrum symptoms at baseline but not at follow‐up nonetheless exhibited comparatively higher symptom levels and lower functioning at both baseline and follow‐up than typically developing youths. In addition, psychosis spectrum features emerged in a small number of young people who previously had not reported significant symptoms but who had exhibited early clinical warning signs. Together, our findings indicate that varying courses of psychosis spectrum symptoms are evident early in US youth, supporting the importance of investigating psychosis risk as a dynamic developmental process. Neurocognition, brain structure and function, and genomics may be integrated with clinical data to provide early indices of symptom persistence and worsening in youths at risk for psychosis.     

20-year trajectories of positive and negative symptoms after the first psychotic episode in patients with schizophrenia spectrum disorder: results from the OPUS study

This study aimed to identify the 20-year trajectories of positive and negative symptoms after the first psychotic episode in a sample of patients with an ICD-10 diagnosis of schizophrenia spectrum disorder, and to investigate the baseline characteristics and long-term outcomes associated with these trajectories. A total of 373 participants in the OPUS trial were included in the study. Symptoms were assessed at baseline and after 1, 2, 5, 10 and 20 years using the Scales for the Assessment of Positive and Negative Symptoms. We used latent class growth mixture modelling to identify trajectories, and multinominal regression analyses to investigate predictors of membership to identified trajectories. Five trajectories of positive symptoms were identified: early continuous remission (50.9% of the sample), stable improvement (18.0%), intermittent symptoms (10.2%), relapse with moderate symptoms (11.9%), and continuous severe symptoms (9.1%). Substance use disorder (odds ratio, OR: 2.83, 95% CI: 1.09-7.38, p=0.033), longer duration of untreated psychosis (OR: 1.02, 95% CI: 1.00-1.03, p=0.007) and higher level of negative symptoms (OR: 1.60, 95% CI: 1.07-2.39, p=0.021) were predictors of the relapse with moderate symptoms trajectory, while only longer duration of untreated psychosis (OR: 1.01, 95% CI: 1.00-1.02, p=0.030) predicted membership to the continuous severe symptoms trajectory. Two trajectories of negative symptoms were identified: symptom remission (51.0%) and continuous symptoms (49.0%). Predictors of the continuous symptoms trajectory were male sex (OR: 3.03, 95% CI: 1.48-6.02, p=0.002) and longer duration of untreated psychosis (OR: 1.01, 95% CI: 1.00-1.02, p=0.034). Trajectories displaying continuous positive and negative symptoms were linked to lower neurocognition, as measured by the Brief Assessment of Cognition in Schizophrenia (BACS) (z-score: –0.78, CI: –1.39 to –0.17, for continuous positive symptoms; z-score: –0.33, CI: –0.53 to –0.13, for continuous negative symptoms). The same trajectories were also linked to higher use of antipsychotic medication at 20-year follow-up (continuous positive symptoms: 78%; continuous negative symptoms: 67%). These findings suggest that the majority of patients with first-episode schizophrenia spectrum disorder have a trajectory with early stable remission of positive symptoms. Long duration of untreated psychosis and comorbid substance abuse are modifiable predictors of poor trajectories for positive symptoms in these patients. In about half of patients, negative symptoms do not improve over time. These symptoms, in addition to being associated with poor social and neurocognitive functioning, may prevent patients from seeking help.     

Heider's "Anthropological Models of Incest Laws in the United States": A Comment

In his analysis of U.S. legal prohibitions of marriage with relatives, Heider rejects the Old Testament model as an explanation of the configuration of current state laws. Although Heider's statement is generally accurate, the statutes seem to express two basic models, an attenuated Biblical and a Western American pattern. These patterns are the inverse of each other with regard to prohibition of first-cousin marriage and marriage between affines. Historical review of statutes reveals a trend from Biblical to Western American patterns. The historical perspective suggests that confounding the two models may have weakened Heider's analysis.     

The influence of illness‐related variables,personal resources and context‐related factors on real‐life functioning of people with schizophrenia

In people suffering from schizophrenia, major areas of everyday life are impaired, including independent living, productive activities and social relationships. Enhanced understanding of factors that hinder real‐life functioning is vital for treatments to translate into more positive outcomes. The goal of the present study was to identify predictors of real‐life functioning in people with schizophrenia, and to assess their relative contribution. Based on previous literature and clinical experience, several factors were selected and grouped into three categories: illness‐related variables, personal resources and context‐related factors. Some of these variables were never investigated before in relationship with real‐life functioning. In 921 patients with schizophrenia living in the community, we found that variables relevant to the disease, personal resources and social context explain 53.8% of real‐life functioning variance in a structural equation model. Neurocognition exhibited the strongest, though indirect, association with real‐life functioning. Positive symptoms and disorganization, as well as avolition, proved to have significant direct and indirect effects, while depression had no significant association and poor emotional expression was only indirectly and weakly related to real‐life functioning. Availability of a disability pension and access to social and family incentives also showed a significant direct association with functioning. Social cognition, functional capacity, resilience, internalized stigma and engagement with mental health services served as mediators. The observed complex associations among investigated predictors, mediators and real‐life functioning strongly suggest that integrated and personalized programs should be provided as standard treatment to people with schizophrenia.     

Emergence of Chironomidae from Findley Lake and two ponds in the Cascade Mountains,U.S.A.

From Findley Lake and two ponds in the Cascade Mountains (U.S.A.) Chironomidae started to emerge as soon as the ice thawed in 1972 and 1973. The 1051 Chironomidae that emerged per m² from Findley Lake included 307 individuals ofTanytarsus and 358 ofProcladius. Tanytarsus outnumberedChironomus at all depths from 0 to 19.3 m. The 1506 Chironomidae that emerged per m² from the 4.5 m deep pond included 997 individuals ofTanytarsus. The 1490 Chironomidae that emerged per m² from the 2 m deep pond included 1363 Tanytarsus. The emerging biomass was 216 and 186 mg dry weight per m² in Findley Lake and the 4.5 m deep pond, respectively, and only 78 mg in the 2 m deep pond. Most species had their maximum emergence where there was organic detritus from the surrounding forest.Orthocladius emerged from sand bottom at 2.7 to 5.2 m depth.Stictochironomus emerged from mud and sand at 8.4 m depth.Chironomus emerged from soft mud at 15 to 27.5 m depth.     

The severity of psychiatric disorders

The issue of the severity of psychiatric disorders has great clinical importance. For example, severity influences decisions about level of care, and affects decisions to seek government assistance due to psychiatric disability. Controversy exists as to the efficacy of antidepressants across the spectrum of depression severity, and whether patients with severe depression should be preferentially treated with medication rather than psychotherapy. Measures of severity are used to evaluate outcome in treatment studies and may be used as meaningful endpoints in clinical practice. But, what does it mean to say that someone has a severe illness? Does severity refer to the number of symptoms a patient is experiencing? To the intensity of the symptoms? To symptom frequency or persistence? To the impact of symptoms on functioning or on quality of life? To the likelihood of the illness resulting in permanent disability or death? Putting aside the issue of how severity should be operationalized, another consideration is whether severity should be conceptualized similarly for all illnesses or be disorder specific. In this paper, we examine how severity is characterized in research and contemporary psychiatric diagnostic systems, with a special focus on depression and personality disorders. Our review shows that the DSM‐5 has defined the severity of various disorders in different ways, and that researchers have adopted a myriad of ways of defining severity for both depression and personality disorders, although the severity of the former was predominantly defined according to scores on symptom rating scales, whereas the severity of the latter was often linked with impairments in functioning. Because the functional impact of symptom‐defined disorders depends on factors extrinsic to those disorders, such as self‐efficacy, resilience, coping ability, social support, cultural and social expectations, as well as the responsibilities related to one's primary role function and the availability of others to assume those responsibilities, we argue that the severity of such disorders should be defined independently from functional impairment.     

When the Patient Remains in Danger: Psychotherapy in U.S. Combat Zones

Much of the literature on the psychological treatment of victims of violence focuses on demographic populations that do not represent the majority of victims. Part of the origin of this problem is that the prototypical victim and the prototypical perpetrator are often the same. Young, poor, minority males often constitute both the victim and the perpetrator class in America. As a group, these individuals, while disproportionately thought of as suitable for incarceration, are not thought of as good candidates for psychological treatment. However, their suffering is real, unrelenting and often not addressed. Therapists face significant barriers, in the patient, in society and in themselves, in trying to help these individuals. This article examines the issues of racism, drugs, ongoing danger, class inequalities, misogyny and the blended victim/perpetrator, all of which complicate engagement and understanding between therapist and patient.     

Economic Custom in a Competitive Marketplace

Dyadic, reciprocal equilibrating relationships, such as trading partnerships in agrarian markets, have been reported from many societies. Data from a competitive marketplace in St. Louis, Missouri is analyzed in a multiple regression to test for the existence of such relationships between merchants and consumers. The interpretation of variables representing each firm's price level and consistency of stock reveals that economic custom is important even in this competitive marketplace.     

The localization of the MM isozyme of creatine phosphokinase on the surface membrane of myocardial cells and its functional coupling to ouabain-inhibited (Na+,K+)-ATPase

A rat heart plasma membrane preparation isolated in a sucrose medium and some of its enzymatic properties have been investigated.It has been shown that a rat heart plasma membrane fraction contains high creatine phosphokinase activity which can not be diminished by repeated washing with sucrose solution. Creatine phosphokinase extracted from a plasma membrane fraction with potassium chloride and 0.01% deoxycholate solution is electrophoretically identical to MM isoenzyme of creatine phosphokinase. Under the conditions where (Na⁺,K⁺)-ATPase is activated by addition of Na⁺,K⁺ and MgATP, creatine phosphokinase of plasma membrane fraction is able to maintain a low ADP concentration in the medium if creatine phosphate is present. The rate of creatine release is dependent upon MgATP concentration in accordance with the kinetic parameters of the (Na⁺,K⁺)-ATPase and is significantly inhibited by ouabain (0.5 mM). The rate of creatine release is also dependent on creatine phosphate concentration in conformance with the kinetic parameters of MM isozyme of creatine phosphokinase,It is concluded that in intact heart cells the plasma membrane creatine phosphokinase may ensure effective utilization of creatine phosphate for immediate rephosphorylation of ADP produced in the (Na⁺,K⁺)-ATPase reaction.     

北京植物园不同功能型植物叶经济谱

通过对北京植物园不同功能型植物的叶片光合参数、叶绿素荧光参数、叶面积、叶干质量以及叶氮含量等性状参数进行测定,分析了不同功能型植物的叶经济谱.结果表明: 生活型中草本植物、生活史中一年生植物、光合型中C4植物靠近叶经济谱中快速投资-收益型物种的一端,而生活型中乔木和灌木、生活史中多年生植物、光合型中C3植物位于缓慢投资-收益型物种的一端,表明不同功能型植物通过叶片性状间的权衡采取不同的环境适应策略,验证了不同功能型植物叶经济谱的存在.不同功能型植物叶片性状具有明显差异,其中不同生活型间的叶片比叶面积(SLA)、叶氮含量(N_mass)、最大净光合速率(A_mass)、光合氮利用效率(PNUE)均表现出草本植物>藤本植物>灌木>乔木;不同生活史间一年生植物的SLA、N_mass、A_mass、PNUE均显著高于多年生植物;不同光合型间植物的A_mass、PNUE、PSⅡ实际光化学效率(Φ_PSⅡ)均表现出C4>C3.N_mass、A_mass、SLA两两之间呈显著正相关,而PSⅡ有效光化学量子产量(F_v′/F_m′)与SLA呈显著负相关;PNUE与SLA呈显著正相关.     

Native American Sovereignty and Natural Resource Management

The relationship between Native Americans and the Euro-American settlers has evolved from the latter seeking to end the separate identity of the former to one in which the U.S. government uses Native rights to control large-scale resource problems. This new relationship arose out of a need to control water in Western states for irrigation, but has expanded into other areas. The Navajo sheep reductions of the 1930s and 1940s may be seen as an instance of this relationship. Concerns about siltation behind the Hoover Dam justified a program that dramatically transformed the Navajo economy. A second case concerns conflict over a caribou herd in northwestern Alaska. The conflict eventually led to the Federal government taking management of fish and game on Federal lands back from the state government. Both these cases show the development of a technocracy, based on Federal trusteeship over Native resources, concerned with the control of nature similar to that observed in Wittfogel's writings on Chinese irrigation.     

A new type of collapsible insect-surveillance light trap for sampling Diptera

The newly designed Army Collapsible Insect Surveillance trap for nocturnal collection of flying Diptera that are attracted by light is described. A polyvinyl chloride construction increases durability, while the capability to collapse from a height of 92.1 cm to 24.1 cm facilitates transportation and storage.