Prediction of psychosis in clinical high-risk patients by the Schizotypal Personality Questionnaire. Results of the EPOS project

OBJECTIVE: Schizotypal features indicate proneness to psychosis in the general population. It is also possible that they increase transition to psychosis (TTP) among clinical high-risk patients (CHR). Our aim was to investigate whether schizotypal features predict TTP in CHR patients. METHODS: In the EPOS (European Prediction of Psychosis Study) project, 245 young help-seeking CHR patients were prospectively followed for 18 months and their TTP was identified. At baseline, subjects were assessed with the Schizotypal Personality Questionnaire (SPQ). Associations between SPQ items and its subscales with the TTP were analysed in Cox regression analysis. RESULTS: The SPQ subscales and items describing ideas of reference and lack of close interpersonal relationships were found to correlate significantly with TTP. The co-occurrence of these features doubled the risk of TTP. CONCLUSIONS: Presence of ideas of reference and lack of close interpersonal relations increase the risk of full-blown psychosis among CHR patients. This co-occurrence makes the risk of psychosis very high.

The Strauss and Carpenter Prognostic Scale in subjects clinically at high risk of psychosis

Objective:  To investigate the predictive value of the Strauss and Carpenter Prognostic Scale (SCPS) for transition to a first psychotic episode in subjects clinically at high risk (CHR) of psychosis. Method:  Two hundred and forty-four CHR subjects participating in the European Prediction of Psychosis Study were assessed with the SCPS, an instrument that has been shown to predict outcome in patients with schizophrenia reliably. Results:  At 18-month follow-up, 37 participants had made the transition to psychosis. The SCPS total score was predictive of a first psychotic episode (P < 0.0001). SCPS items that remained as independent predictors in the Cox proportional hazard model were as follows: most usual quality of useful work in the past year (P = 0.006), quality of social relations (P = 0.006), presence of thought disorder, delusions or hallucinations in the past year (P = 0.001) and reported severity of subjective distress in past month (P = 0.003). Conclusion:  The SCPS could make a valuable contribution to a more accurate prediction of psychosis in CHR subjects as a second-step tool. SCPS items assessing quality of useful work and social relations, positive symptoms and subjective distress have predictive value for transition. Further research should focus on investigating whether targeted early interventions directed at the predictive domains may improve outcomes.

Cannabis use and age at onset of symptoms in subjects at clinical high risk for psychosis

Numerous studies have found a robust association between cannabis use and the onset of psychosis. Nevertheless, the relationship between cannabis use and the onset of early (or, in retrospect, prodromal) symptoms of psychosis remains unclear. The study focused on investigating the relationship between cannabis use and early and high-risk symptoms in subjects at clinical high risk for psychosis.

Three-dimensional surface reconstruction within noncontact diffuse optical tomography using structured light

A main field in biomedical optics research is diffuse optical tomography, where intensity variations of the transmitted light traversing through tissue are detected. Mathematical models and reconstruction algorithms based on finite element methods and Monte Carlo simulations describe the light transport inside the tissue and determine differences in absorption and scattering coefficients. Precise knowledge of the sample's surface shape and orientation is required to provide boundary conditions for these techniques. We propose an integrated method based on structured light three-dimensional (3-D) scanning that provides detailed surface information of the object, which is usable for volume mesh creation and allows the normalization of the intensity dispersion between surface and camera. The experimental setup is complemented by polarization difference imaging to avoid overlaying byproducts caused by inter-reflections and multiple scattering in semitransparent tissue.

Horbat Kur — 2011 Preliminary Report

Published in English and Hebrew

Report on 2010-2013 Excavations at Horvat Kur, Galilee

Four seasons of excavations at Horvat Kur in the Galilee (250570/754485) have exposed the remains of a broadhouse synagogue from the Byzantine period. The building was entered through a portico on the west or a doorway on the south. The fill beneath the portico included the discarded remains of a once colored mosaic as well as more than 1000 coins. A low bench of basalt stones (some of which were plastered) runs along the interior walls, interrupted only by a stone bemah in the center of the southern wall. The synagogue is thus oriented toward Jerusalem. Near the bemah, an ornamented limestone seat was found in situ atop the bench. The building underwent several changes and repairs in the course of its lifespan. On either side of the bemah, north-south rows of columns rested on stylobate. A basalt stone table was found in re-use in the eastern stylobate. Nicknamed “the Horvat Kur stone,” this monolith features geometric figures on three sides and figurative representations on one side. Its original function is as yet subject of research. A narrow test-trench into the sediment of a cistern located outside the northern wall of the synagogue has produced nearly thirty intact vessels of the early Byzantine period, mostly cooking pots and water jars. In addition a dense sequence of pollen samples has been taken. Preliminary interpretation of these finds indicates that the Horvat Kur synagogue illustrates Byzantine synagogue construction, decoration, and use in the setting of a Galilean village of modest economic circumstances.

Short-term functional outcome and premorbid adjustment in clinical high-risk patients. Results of the EPOS project

PURPOSE In patients with schizophrenia, premorbid psychosocial adjustment is an important predictor of functional outcome. We studied functional outcome in young clinical high-risk (CHR) patients and how this was predicted by their childhood to adolescence premorbid adjustment. METHODS In all, 245 young help-seeking CHR patients were assessed with the Premorbid Adjustment Scale, the Structured Interview for Prodromal Syndromes (SIPS) and the Schizophrenia Proneness Instrument (SPI-A). The SIPS assesses positive, negative, disorganised, general symptoms, and the Global Assessment of Functioning (GAF), the SPI-A self-experienced basic symptoms; they were carried out at baseline, at 9-month and 18-month follow-up. Transitions to psychosis were identified. In the hierarchical linear model, associations between premorbid adjustment, background data, symptoms, transitions to psychosis and GAF scores were analysed. RESULTS During the 18-month follow-up, GAF scores improved significantly, and the proportion of patients with poor functioning decreased from 74% to 37%. Poor premorbid adjustment, single marital status, poor work status, and symptoms were associated with low baseline GAF scores. Low GAF scores were predicted by poor premorbid adjustment, negative, positive and basic symptoms, and poor baseline work status. The association between premorbid adjustment and follow-up GAF scores remained significant, even when baseline GAF and transition to psychosis were included in the model. CONCLUSION A great majority of help-seeking CHR patients suffer from deficits in their functioning. In CHR patients, premorbid psychosocial adjustment, baseline positive, negative, basic symptoms and poor working/schooling situation predict poor short-term functional outcome. These aspects should be taken into account when acute intervention and long-term rehabilitation for improving outcome in CHR patients are carried out.

The Kinneret Regional Project Excavations of a Byzantine Synagogue at Horvat Kur, Galilee, 2010-2013: A Preliminary Report

The article presents the preliminary results from four seasons of excavations at Horvat Kur in the Galilee. The excavations conducted by the Kinneret Regional Project have exposed the remains of a broad-house synagogue from the Byzantine period. The most important finds include an elevated platform (i. e., a bemah) that supported a chest holding Torah scrolls, an ornamented limestone seat that was probably used by the leader of the congregation, and a basalt stone table that features geometric figures on three sides and figurative representations on one side. The Horvat Kur synagogue represents a valuable example of the diversity of Galilean synagogues that were built or renovated between the 5th and the 7th centuries C.E.

EPA guidance on the early intervention in clinical high risk states of psychoses

This guidance paper from the European Psychiatric Association (EPA) aims to provide evidence-based recommendations on early intervention in clinical high risk (CHR) states of psychosis, assessed according to the EPA guidance on early detection. The recommendations were derived from a meta-analysis of current empirical evidence on the efficacy of psychological and pharmacological interventions in CHR samples. Eligible studies had to investigate conversion rate and/or functioning as a treatment outcome in CHR patients defined by the ultra-high risk and/or basic symptom criteria. Besides analyses on treatment effects on conversion rate and functional outcome, age and type of intervention were examined as potential moderators. Based on data from 15 studies (n = 1394), early intervention generally produced significantly reduced conversion rates at 6- to 48-month follow-up compared to control conditions. However, early intervention failed to achieve significantly greater functional provements because both early intervention and control conditions produced similar positive effects. With regard to the type of intervention, both psychological and pharmacological interventions produced significant effects on conversion rates, but not on functional outcome relative to the control conditions. Early intervention in youth samples was generally less effective than in predominantly adult samples. Seven evidence-based recommendations for early intervention in CHR samples could have been formulated, although more studies are needed to investigate the specificity of treatment effects and potential age effects in order to tailor interventions to the individual treatment needs and risk Status.

EPA guidance on the early detection of clinical high risk states of psychoses

The aim of this guidance paper of the European Psychiatric Association is to provide evidence-based recommendations on the early detection of a clinical high risk (CHR) for psychosis in patients with mental problems. To this aim, we conducted a meta-analysis of studies reporting on conversion rates to psychosis in non-overlapping samples meeting any at least any one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria. Further, effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates were examined. Conversion rates in the identified 42 samples with altogether more than 4000 CHR patients who had mainly been identified by UHR criteria and/or the basic symptom criterion ‘cognitive disturbances’ (COGDIS) showed considerable heterogeneity. While UHR criteria and COGDIS were related to similar conversion rates until 2-year follow-up, conversion rates of COGDIS were significantly higher thereafter. Differences in onset and frequency requirements of symptomatic UHR criteria or in their different consideration of functional decline, substance use and co-morbidity did not seem to impact on conversion rates. The ‘genetic risk and functional decline’ UHR criterion was rarely met and only showed an insignificant pooled sample effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for an early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states.

Silta- ja rumpurakenteiden aukkomitoitus

Ilmastomallien mukaan sademäärät kasvavat kaikkialla suomessa. Sadeolojen ennustetaan äärevöityvän eli yhtäältä esiintyy pitkiä kuivia kausia ja toisaalta rankkasateet voimistuvat ja toistuvat nykyistä useammin. Etelä-Suomessa talviaika lyhenee ja lumipeite jää ohuemmaksi. Vesisateiden osuus kokonaissadannasta kasvaa ja tämä lisää talviaikaisia valuntoja. Etelä-Suomessa lumipeitteen ohenemisen vuoksi sulamisvesistä syntyvä kevätylivirtaama jää nykyistä pienemmäksi ja vuotuinen ylivirtaama-ajankohta sattuu useammin muuksi kuin kevääksi. Pohjois-Suomessa talviaikaiset sateet ovat tulevaisuudessakin suurimmaksi osaksi lunta. Vaikka lumipeitteinen aika lyhenee sielläkin, sademäärien kasvu saattaa lisätä lumipeitteen vesiarvoja ja kasvattaa sulamisvesien aiheuttamia kevätylivirtaamia (RATU, Water Adapt). Tämä korostaa silta- ja rumpuaukkojen riittävän mitoittamisen tärkeyttä. Useimmat ELY-keskukset ovat luopuneet aukkolausuntojen antamisesta. Oppaan tarkoituksena on antaa aukkomitoituksia tekeville henkilöille tietoa laskentaperusteista ja hyväksi koetuista toimintatavoista. Oppaan avulla on mahdollista luoda yhtenäinen käytäntö silta- ja rumpuaukkojen mitoituksessa. Samalla sen toivotaan korostavan hyvän suunnittelun merkitystä siltojen ja rumpujen rakentamisessa. Tämän oppaan pohjana on ollut siltojen ja rumpujen mitoitusta koskeva osa vesihallituksen vuoden 1986 julkaisusta ”Maankuivatuksen suunnittelu I osa”, joka on korvattu vuonna 2015 päivitetyllä julkaisulla ”Maan-kuivatuksen ja kastelun suunnittelu”. Opas sisältää tietoa sillan ja rummun vesiaukon mitoittamisesta. Suosittelemalla nykyistä harvemmin esiintyviä mitoitusvirtaamia pyritään pienentämään riskejä. Ohjeita aukon aiheuttaman padotuksen määrittämiseksi on selkeytetty. Oppaassa on kiinnitetty aiempaa enemmän huomiota myös aukkorakenteiden haitallisten ympäristövaikutusten ehkäisyyn. Taustalla on yhteiseurooppalaisen vesipolitiikan vaatimus vapaasta ja yhtenäisestä uomajatkumosta. Sen tila ei voi olla ekologisesti hyvä, jos silta- ja rumpurakenteet katkaisevat jatkumon. Suomen ympäristökeskus on julkaissut oppaan alun perin vuonna 2007 nimellä ”Silta- ja rumpulausunnot – Luonnos oppaaksi”. Julkaisun tekemiseen on osallistunut asiantuntijoita Suomen ympäristökeskuksesta ja ELY-keskuksista sekä konsulttina yli-insinööri Raimo K. Nissinen. Peruskuivatuksen ja ojitustoimitusten toimintamalliryhmä on päivittänyt opasta ottaen huomioon vuonna 2012 voimaan tulleen vesilainsäädännön uudistuksen (587 / 2011) sekä aluehallinnossa ja ympäristöhallinnossa tapahtuneet

Vainoamisrikoksen tunnusmerkistön vaaraelementtiä koskeva tahallisuusvaatimus – tarkastelussa käräjäoikeuksien vuonna 2014 antamien vainoamistuomioiden tahallisuusperustelut

Vainoaminen on ollut rikoslain (RL, 19.12.1889/39) mukaan rangaistavaa 1.1.2014 alkaen. Hallituksen esityksen (HE 19/2013 vp) mukaan kyse on abstraktista vaarantamisrikoksesta, joka edellyttää tahallisuutta. Oikeuskirjallisuudessa ei kuitenkaan vallitse yksimielisyyttä siitä, tulisiko abstrakteihin vaarantamisrikoksiin liittää laisinkaan tahallisuusvaatimusta: yhtäältä on katsottu, että abstrakti vaara on olosuhde, joten sen yhteydessä voi puhua olosuhdetahallisuudesta, toisaalta taas abstrakti vaara on nähty pikemminkin rangaistavuuden objektiivisena edellytyksenä, jolloin kyse ei ole olosuhteesta. Problemaattista on se, ettei vainoamisen kriminalisointia koskevissa lain esitöissä oikeastaan avata sitä, miten tunnusmerkistön vaaraelementtiä tulisi arvioida tahallisuusvaatimuksen kannalta. Tätä taustaa vasten lähden tarkastelemaan, onko käräjäoikeuksien vuonna 2014 antamissa niin sanotuissa vainoamistuomioissa arvioitu tunnusmerkistön vaaraelementtiä koskevaa tahallisuusvaatimusta ja jos on, millaisia tahallisuuskäsityksiä tuomioiden perusteluista on löydettävissä. Toisekseen olen kiinnostunut siitä, miten vainoamistuomioiden perusteluista tekemäni havainnot ilmentävät tarvetta miettiä vaaraelementtiä koskevien tahallisuusperustelujen esittämistapaa. Metodisilta lähtökohdiltaan tutkimukseni on siten lainopillista eli oikeusdogmaattista, mutta oikeuskäytännön mukana olosta johtuen tutkimuksessani on vahva empiirinen ote, joka näkyy keräämäni aineiston analysoimisena. Vainoamistuomioiden perusteluissa pääosin arvioidaan vaaraelementtiä koskevaa tahallisuutta, mutta käytetyistä tahallisuuskäsitteistä ei ole löydettävissä systematiikkaa: käytetty tahallisuuskäsite saattoi olla harhaanjohtava, epäselvä tai tunnusmerkistöön sopimaton eikä selkeästi kiinnittynyt mihinkään yleisesti tunnettuun tahallisuusteoriaan. Muutamien tuomioiden perusteluissa ei ollut lainkaan käytetty mitään tahallisuuskäsitettä, vaikka vastaaja oli katsottu syylliseksi. Vaaraelementtiä koskevat tahallisuusperustelut olivat siten enemmän tai vähemmän puutteellisia, enkä katso, että ne kovin hyvin täyttävät tuomioiden perustelemiselle lainsäädännössä asetettuja yleisiä laatuvaatimuksia eli perustelujen ymmärrettävyyttä, laajuutta ja avoimuutta. Katson, että vainoamisrikoksen tunnusmerkistön erityispiirteenä vaaraelementtiä koskevassa tahallisuusarvioinnissa ovat näyttöön liittyvät kysymykset ja erityisesti asianomistaja-näkökulman painottuminen. On epäselvää, missä määrin asianomistajan subjektiivisia tuntemuksia olisi painotettava vaaraelementtiä koskevassa tahallisuusarvioinnissa