Age at onset, course of illness and response to psychotherapy in bipolar disorder: Results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

Background. The course of bipolar disorder progressively worsens in some patients. Although responses to pharmacotherapy appear to diminish with greater chronicity, less is known about whether patients' prior courses of illness are related to responses to psychotherapy.

The effects of a course of intranasal oxytocin on social behaviors in youth diagnosed with autism spectrum disorders: A randomized controlled trial

Background There is increasing interest in oxytocin as a therapeutic to treat social deficits in autism spectrum disorders (ASD). The aim of this study was to investigate the efficacy of a course of oxytocin nasal spray to improve social behavior in youth with ASD. Methods In a double-blind, placebo-controlled trial across two Australian university sites between February 2009 and January 2012, 50 male participants aged between 12 and 18 years, with Autistic or Asperger's Disorder, were randomized to receive either oxytocin (n = 26) or placebo (n = 24) nasal sprays (either 18 or 24 International Units), administered twice-daily for 8 weeks. Participants were assessed at baseline, after 4- and 8-weeks of treatment, and at 3-month follow-up. Primary outcomes were change in total scores on the caregiver-completed Social Responsiveness Scale and clinician-ratings on the Clinical Global Impressions-Improvement scale. Secondary assessments included caregiver reports of repetitive and other developmental behaviors and social cognition. Clinical trial registration: Australian New Zealand Clinical Trials Registry www.anzctr.org.au ACTRN12609000513213. Results Participants who received oxytocin showed no benefit following treatment on primary or secondary outcomes. However, caregivers who believed their children received oxytocin reported greater improvements compared to caregivers who believed their child received placebo. Nasal sprays were well tolerated and there was no evidence of increased side effects resulting from oxytocin administration. Conclusions This is the first evaluation of the efficacy for a course of oxytocin treatment for youth with ASD. Although results did not suggest clinical efficacy, further research is needed to explore alternative delivery methods, earlier age of intervention, and the influence of caregiver expectation on treatment response.

Latex dilution reaction during the tapping flow course of Hevea brasiliensis and the effect of Ethrel stimulation

The latex dilution reaction during the tapping flow course has been well documented and associated with the facilitation of tapping latex flow. However, its underlying mechanism has not experimentally examined. The latex total solid content, osmotic potential and phloem turgor pressure change during the tapping flow course were simultaneously measured to investigate the cause of water movement during the tapping flow course. It was found that there are three different stages for the laticifer water equilibrium during the tapping flow course. The tapping-induced rapid turgor pressure drop is the cause of the first stage water influx into laticifers, while osmoregulation prevails during water exchange in the second and third stages of tapping flow. Meanwhile, aquaporin expressions were, for the first time, investigated during the tapping flow course. The rapid transcript up-regulation of HbPIP1, HbPIP2;1 and HbPIP2;3 contributes to the latex dilution reaction. However, their activity gating cannot be ruled out. Ethrel stimulation can significantly dilute the corresponding latex fractions during the tapping flow course due to its up-regulations of HbPIP1, HbPIP2;1 and HbPIP2;3. Nevertheless, the latex dilution reaction pattern for the Ethrel treated trees did not change, except for a lower degree of dilution compared with the un-treated trees. All these results suggest that both phloem turgor pressure and aquaporins are involved in the latex dilution reaction during the tapping flow course.

A phenomenological analysis of the experience of security and contentment for latency aged children in shared-time parenting arrangements

This study explored the lived experience of security and contentment, and their absence, for latency-aged children (aged 8-12) living in shared-time parenting arrangements following their parents' separation. A descriptive phenomenological methodology was utilized (Giorgi, 1985, 2009; Giorgi & Giorgi, 2003, 2008). Sixteen children living in shared-time were interviewed about their experiences of two phenomena: "feeling secure and content living in shared-time" and "not feeling secure and content living in shared-time." The eight richest protocols were selected for analysis. The two resultant general structures and their core constituents are presented, and individual variations discussed. Central to each phenomenon is the parent/s' capacity, or incapacity, to create and sustain a physical and emotional space in which the child feels secure and held in the mind, feels the arrangements are responsive to their needs, feels free to access the "absent" parent, and experiences integration between the two parental homes. Implications for phenomenological human science research are considered, including the use of descriptive phenomenology with children.

Incidence and course of adolescent deliberate self-harm in Victoria, Australia, and Washington State

PURPOSE: There have been few longitudinal studies of deliberate self-harm (DSH) in adolescents. This cross-national longitudinal study outlines risk and protective factors for DSH incidence and persistence. METHODS: Seventh and ninth grade students (average ages 13 and 15 years) were recruited as state-representative cohorts, surveyed, and then followed up 12 months later (N = 3,876), using the same methods in Washington State and Victoria, Australia. The retention rate was 99% in both states at follow-up. A range of risk and protective factors for DSH were examined using multivariate analyses. RESULTS: The prevalence of DSH in the past year was 1.53% in Grade 7 and .91% in Grade 9 for males and 4.12% and 1.34% for Grade 7 and Grade 9 females, respectively, with similar rates across states. In multivariate analyses, incident DSH was lower in Washington State (odds ratio [OR] = .67; 95% confidence interval [CI] = .45-1.00) relative to Victoria 12 months later. Risk factors for incident DSH included being female (OR = 1.93; CI = 1.35-2.76), high depressive symptoms (OR = 3.52; CI = 2.37-5.21), antisocial behavior (OR = 2.42; CI = 1.46-4.00), and lifetime (OR = 1.85; CI = 1.11-3.08) and past month (OR = 2.70; CI = 1.57-4.64) alcohol use relative to never using alcohol. CONCLUSIONS: Much self-harm in adolescents resolves over the course of 12 months. Young people who self-harm have high rates of other health risk behaviors associated with family and peer risks that may all be targets for preventive intervention.

Affective instability and the course of bipolar depression: results from the STEP-BD randomised controlled trial of psychosocial treatment

BACKGROUND: Little is known about predictors of recovery from bipolar depression. AIMS: We investigated affective instability (a pattern of frequent and large mood shifts over time) as a predictor of recovery from episodes of bipolar depression and as a moderator of response to psychosocial treatment for acute depression. METHOD: A total of 252 out-patients with DSM-IV bipolar I or II disorder and who were depressed enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) and were randomised to one of three types of intensive psychotherapy for depression (n = 141) or a brief psychoeducational intervention (n = 111). All analyses were by intention-to-treat. RESULTS: Degree of instability of symptoms of depression and mania predicted a lower likelihood of recovery and longer time until recovery, independent of the concurrent effects of symptom severity. Affective instability did not moderate the effects of psychosocial treatment on recovery from depression. CONCLUSIONS: Affective instability may be a clinically relevant characteristic that influences the course of bipolar depression.

Caminhos e obstáculos para o acesso à justiça: "o caso do Programa Mediação de Conflitos em Minas Gerais"

Objetivamos, nesse trabalho, demonstrar alguns caminhos e obstáculos relacionados ao acesso à Justiça a partir da execução do Programa Mediação de Conflitos do Estado de Minas Gerais. O tema do acesso à Justiça tem sido foco de amplos estudos sobre o processo de democratização do direito no Brasil. Pesquisadores do campo das ciências sociais e humanas têm dedicado suas produções ao objetivo de compreender o fenômeno do direito e a sua forma de organização-aplicação no país. As diversas iniciativas de descentralização dos serviços jurídicos – diante da necessidade de ampliá-los, especialmente para a população de baixa renda – veem provocando amplas reflexões sobre o sistema político e de justiça no caso brasileiro, com especial atenção aos dilemas encontrados nas características históricas e culturais do país, permitindo diferenciá-los e aproximá-los de outros contextos nacionais. A ascendente vocação do princípio democrático amplia e faz crescer a institucionalização do direito na vida social, contemplando espaços que ainda não se faziam tão expressos por ele, jurisdicionando principalmente, a esfera da vida privada. Este conjunto de elementos é essencial ao presente trabalho, uma vez que apresentamos o desenvolvimento e a prática do Programa Mediação de Conflitos. Buscamos apresentar a criação deste programa desde sua origem, como projeto de pesquisa-ação a partir da concepção do pluralismo jurídico e do “direito achado na rua”. Sua formulação, realizada por meio de reflexões advindas de um grupo de professores do campo do direito da Universidade Federal de Minas Gerais, que durante a década de 90 criaram um programa de extensão desta mesma universidade – denominado “Polos de Cidadania” – nos levou a compreensão do seu percurso e dos caminhos adotados. Discutimos os principais desafios na execução de métodos de informalização da justiça e de mecanismos de resolução de conflitos, como o procedimento da mediação. Trata-se de um estudo qualitativo em que alguns dados socioeconômicos foram incorporados para fins analíticos. Destacamos, sobretudo, o percurso desta experiência por seus idealizadores; apresentamos alguns resultados relacionados aos dados já produzidos por esta prática e quem são os operadores desta experiência atualmente – os mediadores; e buscamos identificar quais são as percepções daqueles que foram atendidos por este programa – suas falas e histórias pessoais – e quais são os caminhos indicados por este segmento social para que o “acesso à Justiça” se torne algo possível de realizar.