Factor structure of the Bern Psychopathology Scale in a sample of patients with schizophrenia spectrum disorders.

BACKGROUND The Bern Psychopathology Scale (BPS) is based on a system-specific approach to classifying the psychopathological symptom pattern of schizophrenia. It consists of subscales for three domains (language, affect and motor behaviour) that are hypothesized to be related to specific brain circuits. The aim of the study was to examine the factor structure of the BPS in patients with schizophrenia spectrum disorders. METHODS One hundred and forty-nine inpatients with schizophrenia spectrum disorders were recruited at the Department of Psychiatry II, Ulm University, Germany (n=100) and at the University Hospital of Psychiatry, Bern, Switzerland (n=49). Psychopathology was assessed with the BPS. The VARCLUS procedure of SAS(®) (a type of oblique component analysis) was used for statistical analysis. RESULTS Six clusters were identified (inhibited language, inhibited motor behaviour, inhibited affect, disinhibited affect, disinhibited language/motor behaviour, inhibited language/motor behaviour) which explained 40.13% of the total variance of the data. A binary division of attributes into an inhibited and disinhibited cluster was appropriate, although an overlap was found between the language and motor behaviour domains. There was a clear distinction between qualitative and quantitative symptoms. CONCLUSIONS The results argue for the validity of the BPS in identifying subsyndromes of schizophrenia spectrum disorders according to a dimensional approach. Future research should address the longitudinal assessment of dimensional psychopathological symptoms and elucidate the underlying neurobiological processes.

Preclinical atherosclerosis and inflammation in 61-year-old men with newly diagnosed diabetes and established diabetes.

OBJECTIVE The aim of this study was to investigate the occurrence of subclinical atherosclerosis and underlying mechanisms in men with newly diagnosed diabetes and established diabetes compared with healthy control subjects. RESEARCH DESIGN AND METHODS In a population-based study of 61-year-old Caucasian men (n = 271) with established diabetes (n = 50) and newly diagnosed diabetes (n = 24) and healthy control subjects (n = 197), standard risk factors and highly sensitive (hs) C-reactive protein (CRP) were measured. Ultrasound measurements of intima-media thickness (IMT) were performed bilaterally in the common carotid artery, and a composite measure was calculated from common carotid and carotid bulb IMT (composite IMT). The plaque status was assessed. RESULTS Composite IMT and carotid plaque size increased gradually among the healthy control subjects, newly diagnosed diabetic patients, and established diabetic patients (P for trend < or =0.001, respectively). CRP was higher in newly and established diabetes (NS between diabetes groups) compared with healthy control subjects (P < 0.001). Total cholesterol levels were lower in newly diagnosed diabetes (5.51 +/- 1.13 mmol/l, P < 0.05) and established diabetes (5.45 +/- 1.15 mmol/l, P < 0.01) compared with those of healthy control subjects (5.77 +/- 1.03 mmol/l). In men with diabetes (n = 74), diabetes onset status (newly diagnosed versus established), waist-to-hip ratio (WHR), and serum triglycerides, but not CRP, explained 16% of the variance in composite IMT. CONCLUSIONS This is the first study to show increased preclinical atherosclerotic changes (IMT and plaque size) and increased inflammation (hs-CRP) in men with newly diagnosed diabetes as well as in patients with established diabetes compared with healthy control subjects. WHR, diabetes onset status (newly diagnosed versus established), and triglycerides, but not CRP, were independent correlates of carotid artery IMT in men with diabetes.

Adult Asylum Seekers from the Middle East Including Syria in Central Europe: What Are Their Health Care Problems?

Background Forced displacement related to persecution and violent conflict has reached a new peak in recent years. The primary aim of this study is to provide an initial overview of the acute and chronic health care problems of asylum seekers from the Middle East, with special emphasis on asylum seekers from Syria. Methods Our retrospective data analysis comprised adult patients presenting to our emergency department between 01.11.2011 and 30.06.2014 with the official resident status of an “asylum seeker” or “refugee” from the Middle East. Results In total, 880 patients were included in the study. Of these, 625 (71.0%) were male and 255 (29.0%) female. The median age was 34 (range 16–84). 222 (25.2%) of our patients were from Syria. The most common reason for presentation was surgical (381, 43.3%), followed by medical (321, 36.5%) and psychiatric (137, 15.6%). In patients with surgical presentations, trauma-related problems were most common (n = 196, 50.6%). Within the group of patients with medical presentation, acute infectious diseases were most common (n = 141, 43.9%), followed by neurological problems (n = 70, 21.8%) and gastrointestinal problems (n = 47, 14.6%). There were no differences between Syrian and non-Syrian refugees concerning surgical or medical admissions. The most common chronic disorder of unclear significance was chronic gastrointestinal problems (n = 132, 15%), followed by chronic musculoskeletal problems (n = 108, 12.3%) and chronic headaches (n = 78, 8.9%). Patients from Syria were significantly younger and more often suffered from a post-traumatic stress disorder than patients of other nationalities (p<0.0001, and p = 0.05, respectively). Conclusion Overall a remarkable number of our very young group of patients suffered from psychiatric disorders and unspecified somatic symptoms. Asylum seekers should be carefully evaluated when presenting to a medical facility and physicians should be aware of the high incidence of unspecified somatic symptoms in this patient population.In general, there is no major difference between asylum seekers from Syria when compared to other nationalities of asylum seekers from the Middle East.

Determinants of stimulated salivary flow among haematopoietic stem cell transplantation recipients.

OBJECTIVES The aetiology of hyposalivation in haematopoietic stem cell transplantation (HSCT) recipients is not fully understood. This study examined the effects of treatment-related aetiological factors, particularly medications, on stimulated salivary flow in HSCT recipients. SUBJECTS AND METHODS Adult HSCT recipients (N = 118, 66 males, 27 autologous and 91 allogeneic transplants) were examined. Stimulated whole salivary flow rates (SWSFR) were measured before HSCT and at 6 and 12 months post-HSCT. Linear regression models were used to analyse the associations of medications and transplant-related factors with salivary flow rates, which were compared to salivary flow rates of generally healthy controls (N = 247). RESULTS The SWSFR of recipients were lower pre-HSCT (mean ± standard deviation, 0.88 ± 0.56 ml/min; P < 0.001), 6 months post-HSCT (0.84 ± 0.61; P < 0.001) and 12 months post-HSCT (1.08 ± 0.67; P = 0.005) than the SWSFR of controls (1.31 ± 0.65). In addition, hyposalivation (<0.7 ml/min) was more frequent among HSCT recipients pre-HSCT (P < 0.001), 6 months post-HSCT (P < 0.001) and 12 months post-HSCT (P = 0.01) than among controls. The SWSFR was observed to improve over time being significantly higher 12 months post-HSCT compared to pre-HSCT (P < 0.001). The observed decrease of salivary flow could not be explained by the examined transplant-related factors and medications. CONCLUSIONS Decreased stimulated salivary flow rates could not be explained by the examined factors alone; these findings indicate that hyposalivation in HSCT recipients exhibits a multifactorial aetiology. CLINICAL RELEVANCE All HSCT recipients should be considered to be at high risk of hyposalivation and consequent oral diseases, and they should be treated accordingly.

Outcomes after early administration of plasma exchange in pediatric central nervous system inflammatory demyelination.

The use of plasma exchange has been described in steroid-refractory central nervous system inflammatory demyelination in adults, but less has been published regarding its use in children and adolescents. We describe 12 children treated with plasma exchange for acute severe central nervous system inflammatory demyelination. The clinical attack leading to plasma exchange included symptomatic spinal cord lesions in 10 and symptomatic brainstem lesions in 2 children. Diagnosis was acute transverse myelitis in 6, relapsing-remitting multiple sclerosis in 5, and acute disseminated encephalomyelitis in 1 child. Adverse events related to plasma exchange necessitating intervention were observed in 3 children. Median Expanded Disability Status Scale score at plasma exchange start was 7.5 (range 4-9.5). At 3 months, 7 children were ambulatory without aid (Expanded Disability Status Scale score of ≤4). This retrospective study suggests that plasma exchange can be effective in ameliorating symptoms in severe pediatric central nervous system inflammatory demyelination, although lack of randomization or control group limits the ability to attribute this outcome entirely to plasma exchange.

Sportmotorische Leistungsfähigkeit und schulische Leistung – Zum mediierenden Effekt der exekutiven Funktionen

Introduction: Da die exekutiven Funktionen in enger Verbindung mit schulischer Leistung stehen (Diamond, 2007) interessiert aus sportwissenschaftlicher Sicht, welchen Beitrag Sport und Bewegung zu dessen Erhöhung leisten kann. Direkte Zusammenhänge zwischen den Konstrukten sportmotorische Leistungsfähigkeit, exekutive Funktionen und schulische Leistung scheinen empirisch hinreichend belegt. Offen bleibt hingegen wie sich der Zusammenhang gestaltet wobei des Öfteren Mediations- und Moderationseffekte diskutiert (Alfermann & Linde, 2012), selten jedoch statistisch getestet werden. Ob die exekutiven Funktionen als potentieller Mediator zwischen sportmotorischer Leistungsfähigkeit und schulischer Leistung fungiert, ist Gegenstand des vorliegenden Beitrags. Methods: Im Rahmen der Studie „Sport und Kognition“ (SpuK) wurden insgesamt 110 Schülerinnen und Schüler (56.8% ♀; 7.90±0.43 Jahre) in ihren exekutiven Funktionen (EF) getestet. Zusätzlich wurde die sportmotorische Leistungsfähigkeit (SMLF) und die schulische Leistung (SL) durch Einschätzung der Lehrperson erhoben. Um die Annahme zu prüfen, ob die schulische Leistung vorwiegend mediiert über die exekutiven Funktionen durch die sportmotorische Leistung vorhergesagt werden kann, wurde eine Mediatoranalyse (Fairchild & McQuillin, 2010) berechnet. Results: Das Strukturgleichungsmodell mit 2(7, N=95)=3.057, p=.880; CFI>.99 weist eine hohe Anpassungsgüte auf. Erwartungsgemäss gibt es innerhalb des Mediationsmodells keinen signifikanten Zusammenhang zwischen SMLF und SL (Sprache) (β=-.12, p=.869). Während der Zusammenhang von SMLF auf EF signifikant ausfällt (β=.69, p= .026), zeigt sich der Zusammenhang von EF auf SL (Sprache) als nicht signifikant (β=.68, p=.515). Daher zeigt sich weder der direkte Effekt (p=.124) von SMLF auf SL noch der indirekte Effekte (p=.472) von SMLF auf SL über EF signifikant. Die geprüfte Mediation muss somit verworfen werden. Discussion/Conclusion: Obwohl starke Zusammenhänge von SMLF und EF als auch von EF und SL (Sprache) und gleichzeitig ein schwacher direkter Zusammenhang von SMLF und SL die theoretische Annahme der Mediation stützen, kann der indirekte Effekt keine Signifikanz ausweisen, was zu einer Ablehnung der Mediationshypothese führt. Erklären lässt sich dieser Befund durch eine zu geringfügige Stichprobe einerseits und durch eine unzureichende Datenqualität aufgrund inadäquat operationalisierter Messmethoden zur Einschätzung der schulischen Leistung andererseits. Zukünftige Studien sollten zur Messung der schulischen Leistung auf objektive Messmethoden zurückgreifen. References: Alfermann, D., & Linde, K. (2012). Physische Aktivität und kognitive Leistungsfähigkeit. In R. Fuchs & W. Schlicht (Hrsg.), Seelische Gesundheit und sportliche Aktivität (S.294-314). Göttingen: Hogrefe. Diamond, A., Barnett, W. S., Thomas, J., & Munro, S. (2007). Preschool program improves cognitive control. Science, 318, 1387-1388. Fairchild, A. J., & McQuillin, S. D. (2010). Evaluating mediation and moderation effects in school psychology: A presentation of methods and review of current practice. Journal of School Psychology, 48, 53-84.

Leaving Home: Philo of Alexandria on the Exodus.

For Jewish-Hellenistic authors writing in Egypt, the Exodus story posed unique challenges. After all, to them Egypt was, as Philo of Alexandria states, their fatherland. How do these authors come to terms with the biblical story of liberation from Egyptian slavery and the longing for the promised land? In this chapter I am taking a close look at Philo’s detailed discussion of the Exodus and locate it within the larger context of Jewish-Hellenistic literature (Wisdom of Solomon, Ezekiel’s Exagoge). In Philo’s rewriting of the Exodus the destination of the journey is barely mentioned. Contrary to the biblical narrative, in the scene of the burning bush, as retold by Philo, God does not tell Moses where to go. Philo’s main concern is what happens in Egypt: both in biblical times and in his own days. The Exodus is nevertheless important to Philo: He reads the story allegorically as a journey from the land of the body to the realms of the mind. Such a symbolic reading permitted him to control the meaning of the Exodus and to stay, literally and figuratively, in Egypt.