1,721,231 research outputs found
A prospective evaluation of involuntary admission from the viewpoint of service users
No full textIntroduction:
Involuntary admission is often a traumatic experience for patients and it is associated with
negative attitudes which can persist after the episode of illness has abated.
Aims:
The aims of the study were to prospectively assess attitudes to care and treatment both at
involuntary admission and when the individual had recovered to their baseline and to identify
clinical predictors of attitudes.
Methods
Consecutively admitted involuntary patients across three psychiatric admission units were
invited to participate in the study. Comprehensive assessments of attitudes and a range of
clinical measures, including symptoms, functioning, insight and care experiences, were
obtained at admission and 3 months after discharge. Attitudes were assessed using the Client
Assessment of Treatment scale (CAT) and a study specific Attitudes Scale to capture aspects
of care and treatment specific to involuntary admission. Multiple linear regression modelling
was used to identify the optimal explanatory variables for attitudes towards care during acute
admission and at the point of recovery to baseline.
Results:
Two hundred and sixty three individual presentations were included at baseline and onehundred
and fifty six (59%) also completed follow-up assessments. Individuals improved
significantly over time both clinically and in their attitudes to their involuntary admission and
treatment. At follow-up, 65.3% stated that they believed that their involuntary admission was
necessary.
A multiple linear main effects regression model demonstrated that at baseline having greater
awareness of illness (b = 0.041, p < 0.001), being older (b = 0.009, p = 0.003), having had
fewer numbers of previous involuntary admissions (b = -0.036, p = 0.001), not having a
lifetime history of illicit substance abuse (b = -0.247, p = 0.048) and having a history of
lifetime alcohol abuse (b = 0.249, p = 0.015) was associated with more positive attitudes
towards involuntary admission and care, adjusting for multiple other factors. Furthermore
greater awareness of illness at baseline (b = 0.042, p = 0.006), male gender (b = -0.280, p =
0.045), not having a history of illicit drug use (b = -0.443, p = 0.012), being older (b = 0.012,
p = 0.014) and having a diagnosis of a non psychotic illness (b = 0.653, p = 0.050) were
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associated with more positive attitudes towards involuntary treatment and care at follow up.
Over time having a greater improvement in awareness of illness (b = 0.022, p < 0.001), male
gender (b = -0.281, p = 0.014) as well as having a diagnosis of a non psychotic illness (b =
0.732, p = 0.009) was associated with more positive attitudes to involuntary treatment and
care. There was no significant association between experiencing coercive practices such as
seclusion, restraint or forced intramuscular medication and attitudes towards care.
Conclusion:
At the point of recovery most patients considered their involuntary admission as necessary at
the time. Positive attitudes towards involuntary admission and care both at the point of acute
admission and at recovery are better predicted by factors related to the illness and its
treatability, such as awareness of illness and level of symptoms, than factors related to the
service received or extent of coercion employed. Patients who are likely to have persistently
negative attitudes to their care could be identified during the admission phase by their clinical
characteristics and potentially targeted with additional support to ameliorate their negative
experiences
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Progression of neuroanatomical abnormalities in psychotic disorder and the effect of psychotropic medication
No full textIntroduction: Schizophrenia is a particularly severe and disabling mental disorder affecting 20 million people worldwide. The vast majority of structural and diffusion neuroimaging studies on neuroanatomy and cognition have been conducted cross-sectionally and it remains unclear whether risk factors, treatments or associated illness effects are driving changes.
The overarching theme of this thesis is to longitudinally examine elements of neuroanatomical progression and its cognitive or clinical correlates in samples of patients across different phases of psychosis spanning first episode of illness and treatment refractory schizophrenia, using structural and diffusion MRI techniques. Specifically, Manuscript 1 aims to assess whether impaired executive functioning and emotional intelligence at first presentation of psychotic episode are associated with progressive prefrontal and orbitofrontal cortical thinning and whether negative symptom severity is linked to progressive prefrontal cortical thinning in the years following the first-episode of psychosis. Manuscript 2 and 3, using a unique sample of treatment-resistant clozapine-naïve schizophrenia patients, investigate whether subcortical structures, white matter microstructure and structural network organisation demonstrate any progressive changes after 6 months of clozapine treatment and whether any such changes are related to clinical variables including treatment response and amount of clozapine taken.
Method: Manuscript 1. 1.5T structural MRI images were acquired at baseline and after 3.5 years for 20 individuals with first-episode psychosis (FEP) and 18 healthy volunteers (HC). At baseline and follow-up, the longitudinal pipeline of Freesurfer was employed to parcellate prefrontal cortex and the MATRICS Consensus Cognitive Battery (MCCB) was used to assess executive functioning and emotional intelligence. At both timepoints the severity of negative and positive symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS). Baseline cognitive performance was compared between diagnostic groups using Multivariate Analysis of Covariance (MANCOVA). Partial correlations investigated relationships between cognition and negative symptoms at baseline and cortical thickness change over time.
Manuscript 2 & 3. Thirty-three patients with treatment-resistant schizophrenia (TRS) and 31 healthy volunteers successfully participated at both baseline, prior to clozapine initiation in patients, and 6 months follow-up clinical assessments and structural MRI scanning (Manuscript 2). Of these 64 participants, diffusion MRI data were available at both time points for 22 patients and 23 healthy controls (Manuscript 3).
The severity of positive and negative symptoms was assessed at both time points using the PANSS, the Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS). Social, occupational and psychological functioning was assessed using a Global Assessment of Functioning Score. In Manuscript 2 the longitudinal pipeline of Freesurfer v.5.3.0 was employed to bilaterally segment eight subcortical regions-of-interest: lateral ventricle, thalamus, hippocampus, caudate, putamen, globus pallidus, amygdala and nucleus accumbens. Two-way repeated MANCOVA was used to assess group differences in subcortical volumes over time and partial correlations to determine association with clinical variables. In Manuscript 3 the Tract-based spatial statistics approach (TBSS) was used to compare changes over time between groups in fractional anisotropy (FA). Changes in structural network organisation and subnetwork connectivity weighted by FA and number of streamlines (NOS) were assessed using graph theory and network-based statistics.
Results: In Manuscript 1 we demonstrated that patients in their first-episode of psychotic illness perform significantly worse on several tests assessing different aspects of executive functions compared to healthy controls, including category fluency, attention, working memory and reasoning & problem solving. The poorer performance at baseline in spatial working memory was a significant predictor of loss of total prefrontal cortical thickness in the initial years after illness onset. We also found that impairment of emotional intelligence at illness onset was significantly associated with a progressive reduction of orbitofrontal thickness in patients after their first-episode of psychosis. Finally, we demonstrated a correlation between neuroanatomical progression and clinical variables, specifically, worsening of negative symptoms was associated with prefrontal thickness reduction as the illness progresses.
In Manuscript 2, in treatment-resistant schizophrenia patients we showed a substantial progressive volumetric reduction of the thalamus, hippocampus, caudate, putamen and enlargement of lateral ventricles over a 6-month period compared to controls. Furthermore, patients who had the greatest symptomatic and functional improvement displayed the largest thalamo-striatal reductions. We also found that patients who were exposed to higher amounts of clozapine displayed a greater reduction of thalamus volume. In Manuscript 3, treatment-resistant schizophrenia patients showed progressive focal FA abnormalities in the white matter of key anterior tracts, such as genu and body of the corpus callosum and bilaterally in the anterior and superior corona radiata compared to controls. The brain structural network organisation was preserved in patients compared to controls. The FA reduction was independent of any clinical measures or serum level of clozapine.
Conclusion: Taken together our results indicate that at onset of psychosis working memory and emotional intelligence impairment represents a trait marker of progressive prefrontal thinning as the illness progresses, while worsening of negative symptoms is associated with prefrontal thickness reduction over time, indicating a functional consequence of anatomical progression in psychosis. In those with the chronic treatment-resistant stage of the illness, there is a consistent progressive volume reduction in several subcortical structures as well as progressive focal abnormalities in the white matter microstructure of key anterior tracts, but a preserved brain structural network. However, our findings suggest a divergence of neuroanatomical progression, where progressive atrophy in the thalamo-striatal circuits are linked to clinical and functional improvement, whereas no such association is found with longitudinal progression in lateral ventricles, hippocampus and white matter. This thesis confirms the importance of investigating the neurocognitive dimension at illness onset in order to enhance understanding of the functional consequences of illness progression as well as identifying potential markers at illness onset. It also highlights the potential role of the thalamo-striatal circuits in tracking recovery in treatment-resistant schizophrenia patients, suggesting that its investigation using large scale longitudinal design studies could significantly contribute to the identification of biomarkers in refractory schizophrenia
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Quality of life in psychotic illness: baseline and prospective determinants in first episode and chronic psychosis cohorts
No full textAbstract
The overall aim of this thesis was to longitudinally assess determinants of quality of life in first episode and chronic psychosis patient cohorts.
The Galway First Episode Psychosis Cohort
Background:
In this study, first episode psychosis (FEP) patients were followed up after a minimum of three years in order to determine the extent to which clinical and morphometric indices were associated with quality of life (QoL).
Method:
45 patients were recruited into the study and a proportion of these (n=32) underwent clinical and neuroimaging investigations at both baseline and follow up.
Results:
Lower QoL was predicted clinically by higher baseline negative symptoms and improvement in negative symptoms predicted higher QoL 3 years later. From a neuroimaging perspective, left lateral ventricular volume enlargement over the follow up period was associated with lower QoL.
Conclusions:
This study demonstrated that it was the trajectory of clinical and morphometric measures over time, particularly with respect to negative symptoms and left lateral ventricular volume, that are most associated with QoL as an outcome measure. Such measures may represent markers of a neuroprogressive process that ultimately determines the functional outcome after the onset of psychotic illness.
QoL of long-stay psychiatric patients transferred into the community
Background: This study comprised a cohort of former long-stay institutionalised patients who were subsequently transferred into local community settings.
Method: 87 former long-stay psychiatric patients, the majority of whom had a diagnosis of schizophrenia, were assessed at baseline (one month prior to hospital closure) and 10 years later on a range of QoL and functional measures. The QoL measure (Quality of Life Scale) was only conducted at the follow up period.
Results: Improvements were noted for both QoL and social functioning at 10 year follow up. Linear regression analysis found that baseline social behaviour predicted QoL at follow up.
Conclusion: This study demonstrates that transfer into the community from a psychiatric institution is associated with long-term improvement in QoL and social functioning, even in individuals who have spent large periods of time in such environments. Those patients who demonstrated the greatest improvement in QoL had higher baseline social skills
Quality of life in psychotic illness: baseline and prospective determinants in first episode and chronic psychosis cohorts
No full textAbstract The overall aim of this thesis was to longitudinally assess determinants of quality of life in first episode and chronic psychosis patient cohorts. The Galway First Episode Psychosis Cohort Background: In this study, first episode psychosis (FEP) patients were followed up after a minimum of three years in order to determine the extent to which clinical and morphometric indices were associated with quality of life (QoL). Method: 45 patients were recruited into the study and a proportion of these (n=32) underwent clinical and neuroimaging investigations at both baseline and follow up. Results: Lower QoL was predicted clinically by higher baseline negative symptoms and improvement in negative symptoms predicted higher QoL 3 years later. From a neuroimaging perspective, left lateral ventricular volume enlargement over the follow up period was associated with lower QoL. Conclusions: This study demonstrated that it was the trajectory of clinical and morphometric measures over time, particularly with respect to negative symptoms and left lateral ventricular volume, that are most associated with QoL as an outcome measure. Such measures may represent markers of a neuroprogressive process that ultimately determines the functional outcome after the onset of psychotic illness. QoL of long-stay psychiatric patients transferred into the community Background: This study comprised a cohort of former long-stay institutionalised patients who were subsequently transferred into local community settings. Method: 87 former long-stay psychiatric patients, the majority of whom had a diagnosis of schizophrenia, were assessed at baseline (one month prior to hospital closure) and 10 years later on a range of QoL and functional measures. The QoL measure (Quality of Life Scale) was only conducted at the follow up period. Results: Improvements were noted for both QoL and social functioning at 10 year follow up. Linear regression analysis found that baseline social behaviour predicted QoL at follow up. Conclusion: This study demonstrates that transfer into the community from a psychiatric institution is associated with long-term improvement in QoL and social functioning, even in individuals who have spent large periods of time in such environments. Those patients who demonstrated the greatest improvement in QoL had higher baseline social skills
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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