Specificities of defense mechanisms in bipolar affective disorder: relations with symptoms and therapeutic alliance.

Defense mechanisms as a central notion of psychoanalysis have inspired various levels of interest in research in psychotherapy and psychopathology. Defense specificities have only recently been investigated systematically with regard to several clinical diagnoses, such as affective and personality disorders. For the present study, 30 inpatients diagnosed with Bipolar Affective Disorder I (BD) were interviewed. An observer-rater method, the Defense Mechanisms Rating Scales (DMRS), applied to session-transcripts, of assessment of defenses was used. A matched, nonclinical control group was introduced. Defense specificities in BD encompass a set of 5 immature defenses, of which omnipotence is linked with symptom level. The level of the therapeutic alliance is predicted by mature defenses. These results are discussed with regard to the psychological vulnerability of BD, and treatment implications for psychodynamic psychotherapy with such challenging patients are evoked.

Impact of duration of untreated psychosis on pre-treatment, baseline, and outcome characteristics in an epidemiological first-episode psychosis cohort.

INTRODUCTION: To assess the impact of duration of untreated psychosis (DUP) on baseline and 18-month follow-up characteristics controlling for relevant confounders in an epidemiological first-episode psychosis (FEP) cohort. METHOD: The Early Psychosis Prevention and Intervention Centre (EPPIC) in Australia admitted 786 FEP patients from January 1998 to December 2000. Data were collected from medical files using a standardized questionnaire. Data from 636 patients were analyzed. RESULTS: Median DUP was 8.7 weeks. Longer DUP was associated with worse premorbid functioning (p<0.001), higher rate of schizophrenia-spectrum disorders (p<0.001), and younger age at onset of psychosis (p=0.004). Longer DUP was not associated with baseline variables but with a lower rate of remission of positive symptoms (p<0.001) and employment/occupation (p<0.001), a higher rate of persistent substance use (p=0.015), worse illness severity (p<0.001) and global functioning (p<0.001) at follow-up after controlling for relevant confounders, explaining approximately 5% of variance of remission of positive symptoms (p<0.001) in the total sample and 3% in schizophrenia-spectrum disorders excluding bipolar I disorder (p=0.002). Outcome was significantly worse when DUP exceeded 1-3 months. CONCLUSION: Avoiding pitfalls of non-epidemiological studies, DUP appears to be a modest independent predictor of prognosis in the medium-term. Results support the need for assertive early detection strategies.

Neuropeptide Y and corticotropin-releasing hormone in CSF mark response to antidepressive treatment with citalopram.

Neuropeptides appear to play a role in the pathophysiology of depression and electroconvulsive treatment and lithium affect these compounds in human cerebrospinal fluid (CSF) and rodent brain. Consequently, we investigated whether long-term treatment with the selective serotonin reuptake inhibitor (SSRI) citalopram (Cit) would also affect neuropeptides in CSF of depressed patients. Changes in CSF monoamine metabolites were also explored. CSF concentrations of corticotropin-releasing hormone (CRH)-like immunoreactivity (-LI), neuropeptide Y (NPY)-LI, and Cit were determined in 21 patients with major depression. Lumbar puncture was performed in the morning at baseline and was repeated after at least 4 wk of Cit treatment (40 mg/d). The severity of depression was assessed by the Hamilton Rating Scale for Depression (HAMD). Cit treatment was associated with a significant increase in NPY-LI and decrease in CRH-LI. An evaluation of the relationship between changes in concentrations of NPY-LI, CRH-LI, and the clinical response showed significant correlations between these parameters. Significant NPY and CRH changes in CSF following treatment as well as correlations to changes in HAMD support the hypothesis that these two peptides play a role in affective disorders and are markers of therapeutic response.

Luottoluokituksen informaatioarvo Suomen osakemarkkinoilla

Tutkimuksen tavoitteena on tutkia Standard & Poor's:n ja Moody's:n antamien luottoluokitusten informaatioarvoa Suomen osakemarkkinoilla. Tutkimuksessa selvitetään, millaisia vaikutuksia luottoluokituksen lasku ja nosto sekä luottoluokituksen pysyminen ennallaanaiheuttavat osakekurssiin. Aineisto koostuu 42 luottoluokitusilmoituksesta viiden vuoden aikavälillä, syyskuusta 2001 marraskuuhun 2006. Tutkimuksessa käytettiin pitkän aikavälin luottoluokituksia. Luottoluokitusilmoitusten vaikutuksia osakemarkkinoilla tutkittiin tapahtumatutkimusmenetelmän avulla. Empiiristen tulosten perusteella luottoluokituksen lasku ja näkymän heikentyminen aiheuttavat merkitseviä positiivisia epänormaaleja tuottoja. Luottoluokituksen nosto ja näkymän parantuminen eivät aiheuta markkinareaktioita. Markkinat osoittavat epänormaaleja tuottoja ennen luottoluokitusilmoitusta.

Suivi neurodéveloppemental à 5ans des extrêmes prématurés et détection des difficultés sur le plan des fonctions exécutives [Detection of executive function disorders with a standard neurodevelopmental follow-up of premature children].

INTRODUCTION: A significant proportion of prematurely born children encounter behavioral difficulties, such as attention deficit or hyperactivity, which could be due to executive function disorders. AIMS: To examine whether the standard neurodevelopmental assessment offered to premature children in Switzerland recognizes executive function disorders. METHODS: The study population consisted of 49 children born before 29 weeks of gestation who were examined between 5 and 6 years of age with a standard assessment, with additional items to assess executive functioning. Children with severe neurodevelopmental impairment were excluded (mental retardation, cerebral palsy, autism). Standard assessment consisted in the Kaufman Assessment Battery for Children (K-ABC), which comprises three subscales: sequential processes (analysis of sequential information), simultaneous processes (global analysis of visual information), and composite mental processes (CMP) (result of the other two scales), as well as a behavioral evaluation using the standardized Strengths and Difficulties Questionnaire (SDQ). Executive functioning was assessed with tasks evaluating visual attention, divided attention, and digit memory as well as with a specialized questionnaire, the Behavior Rating Index of Executive Functions (BRIEF), which evaluates several aspects of executive function (regulation, attention, flexibility, working memory, etc). RESULTS: Children were divided according to their results on the three K-ABC scales (< or>85), and the different neuropsychological tasks assessing executive function were compared between the groups. The CMP did not differentiate children with executive difficulties, whereas a score<85 on the sequential processes was significantly associated with worse visual and divided attention. There was a strong correlation between the SDQ and the BRIEF questionnaires. For both questionnaires, children receiving psychotherapy had significantly higher results. Children who presented behavioral problems assessed with the SDQ presented significantly higher scores on the BRIEF. CONCLUSION: A detailed analysis of the standard neurodevelopmental assessment allows the identification of executive function disorders in premature children. Children who performed below 85 on the sequential processes of the K-ABC had significantly more attentional difficulties on the neuropsychological tasks and therefore have to be recognized and carefully followed. Emotional regulation had a strong correlation with behavioral difficulties, which were suitably assessed with the SDQ, recognized by the families, and treated.

Análisis de la evaluación única y continuada en Biofarmacia y Farmacocinética-I

La construcción del Espacio Europeo de Educación Superior (EEES) tiene como objetivo disponer de un espacio abierto en el que no existan obstáculos a la movilidad de estudiantes, titulados, profesores y personal de administración. El sistema se articula en torno al reconocimiento de titulaciones y otras calificaciones de educación superior, la transparencia (un sistema de titulaciones comprensibles y comparables organizado en tres ciclos) y la cooperación europea en la garantía de la calidad Ante este gran reto, la enseñanza universitaria ha tenido que reorganizarse y los planes de estudio de cada facultad han tenido que adaptarse a las nuevas exigencias del EEES. Además las metodologías docentes centran su interés en un seguimiento más tutorizado del alumno, para garantizar su aprendizaje, no sólo en la adquisición de conocimientos sino también de competencias.

Cardiorespiratory and Cardiac Autonomic Responses to 30-15 Intermittent Fitness Test in Team Sport Players

Buchheit, M, Al Haddad, H, Millet GP, Lepretre, PM, Newton, M, and Ahmaidi, S. Cardiorespiratory and cardiac autonomic responses to 30-15 Intermittent Fitness Test in team sport players. J Strength Cond Res 23(1): xxx-xxx, 2009-The 30-15 Intermittent Fitness Test (30-15IFT) is an attractive alternative to classic continuous incremental field tests for defining a reference velocity for interval training prescription in team sport athletes. The aim of the present study was to compare cardiorespiratory and autonomic responses to 30-15IFT with those observed during a standard continuous test (CT). In 20 team sport players (20.9 +/- 2.2 years), cardiopulmonary parameters were measured during exercise and for 10 minutes after both tests. Final running velocity, peak lactate ([La]peak), and rating of perceived exertion (RPE) were also measured. Parasympathetic function was assessed during the postexercise recovery phase via heart rate (HR) recovery time constant (HRRtau) and HR variability (HRV) vagal-related indices. At exhaustion, no difference was observed in peak oxygen uptake (&OV0312;o2peak), respiratory exchange ratio, HR, or RPE between 30-15IFT and CT. In contrast, 30-15IFT led to significantly higher minute ventilation, [La]peak, and final velocity than CT (p < 0.05 for all parameters). All maximal cardiorespiratory variables observed during both tests were moderately to well correlated (e.g., r = 0.76, p = 0.001 for &OV0312;o2peak). Regarding ventilatory thresholds (VThs), all cardiorespiratory measurements were similar and well correlated between the 2 tests. Parasympathetic function was lower after 30-15IFT than after CT, as indicated by significantly longer HHRtau (81.9 +/- 18.2 vs. 60.5 +/- 19.5 for 30-15IFT and CT, respectively, p < 0.001) and lower HRV vagal-related indices (i.e., the root mean square of successive R-R intervals differences [rMSSD]: 4.1 +/- 2.4 and 7.0 +/- 4.9 milliseconds, p < 0.05). In conclusion, the 30-15IFT is accurate for assessing VThs and &OV0312;o2peak, but it alters postexercise parasympathetic function more than a continuous incremental protocol.

Expanding view of phenotype and oxidative stress in Friedreich's ataxia patients with and without idebenone

Summary: Friedreich's ataxia (FRDA), the most common autosomal recessive ataxia, is characterised by progressive ataxia with dysarthria of speech, loss of deep-tendon reflexes, impaired vibratory and proprioceptive sensations and corticospinal weakness with a Babinski's sign. Patients eventually also develop kyphoscoliosis, cardiomyopathy and diabetes mellitus. The disease is a GAA repeat disorder resulting in severely reduced levels of frataxin, with secondary increased sensitivity to oxidative stress. The anti-oxidative drug, idebenone, is effective against FRDA-associated cardiomyopathy. We provide detailed clinical, electrophysiological and biochemical data from 20 genetically confirmed FRDA patients and have analysed the relation-ship between phenotype, genotype and malondialdehyde (MDA), which is a marker of superoxide formation. We assessed the effects of idebenone biochemically by measuring blood M DA and clinically by serial measurements of the International Cooperative Ataxia Rating Scale (ICARS). The GAA repeat length influenced the age at onset (p <0.001), the severity of ataxia (p= 0.02), the presence of cardiomyopathy (p =0.04) and of low-frequency hearing loss (p = 0.009). Multilinear regression analysis showed (p = 0.006) that ICARS was dependent on the two variables of disease duration (p = 0.01) and size of the GAA expansion (p = 0.02). We found no correlation to bilateral palpebral ptosis visual impairment, diabetes mellitus or skeletal deformities, all of which appear to be signs of disease progression rather than severity. We discuss more thoroughly two underrecognised clinical findings: palpebral ptosis and GAA length-dependent low-frequency hearing loss. The average ICARS remained unchanged in 10 patients for whom follow-up on treatment was available (mean 2.9 years), whereas most patients treated with idebenone reported an improvement in dysarthria (63%), hand dexterity (.58%) and fatigue (47%) after taking the drug for several weeks or months. Oxidative stress analysis showed an unexpected increase in blood MDA levels in patients on idebenone (p = 0.04), and we discuss the putative underlying mechanism for this result, which could then explain the unique efficacy of idebenone in treating the FRDA-associated cardiomyopathy, as opposed to other antioxidative drugs. Indeed, idebenone is not only a powerful stimulator of complexes II and III of the respiratory chain, but also an inhibitor of complex I activity, then promoting superoxide formation. Our preliminary clinical observations are the first to date supporting an effect of idebenone in delaying neurological worsening. Our MDA results point to the dual effect of idebenone on oxidative stress and to the need for controlled studies to assess its potential toxicity at high doses on the one hand, and to revisit the exact mechanisms underlying the .physiopathology of Friedreich's ataxia on the other hand, while recent reports suggest non-oxidative pathophysiology of the disease.

Do parents and children know each other? A study about agreement on personality within families

Se estudiaron las relaciones entre autoevaluaciones y heteroevaluaciones de cuestionarios de personalidad en contextos familiares españoles. 336 matrimonios evaluaron la personalidad de uno de sus hijos. Al mismo tiempo, cada hijo se autoevaluaba. Se aplicaron los marcadores de Goldberg. En una segunda muestra, 120 estudiantes universitarios evaluaron la personalidad de ambos padres. Al mismo tiempo, ambos padres se autoevaluaron. Se aplicaron los marcadores de Goldberg y el NEO-PI-R. Se replica el grado de acuerdo encontrado en otras culturas, siendo las correlaciones entre autoevaluaciones y heteroevaluaciones de alrededor de 0.40, y con tamaños del efecto de las diferencias de medias no grandes. Se observa que: 1) los hijos son más acertados que los padres; 2) el grado de acuerdo es más alto para el NEO-PI-R que para los marcadores de Goldberg, especialmente en el factor de Apertura a la Experiencia; y 3) la variable sexo no afectó a los resultados. Se discuten las implicaciones y las limitaciones del presente estudio.

Patterns and factors associated with low adherence to psychotropic medications during pregnancy-a cross-sectional, multinational web-based study.

BACKGROUND: No previous studies have explored how closely women follow their psychotropic drug regimens during pregnancy. This study aimed to explore patterns of and factors associated with low adherence to psychotropic medication during pregnancy. METHODS: Multinational web-based study was performed in 18 countries in Europe, North America, and Australia. Uniform data collection was ensured via an electronic questionnaire. Pregnant women were eligible to participate. Adherence was measured via the 8-item Morisky Medication Adherence Scale (MMAS-8). The Beliefs about Prescribed Medicines Questionnaire (BMQ-specific), the Edinburgh Postnatal Depression Scale (EPDS), and a numeric rating scale were utilized to measure women's beliefs, depressive symptoms, and antidepressant risk perception, respectively. Participants reporting use of psychotropic medication during pregnancy (n = 160) were included in the analysis. RESULTS: On the basis of the MMAS-8, 78 of 160 women (48.8%, 95% CI: 41.1-56.4%) demonstrated low adherence during pregnancy. The rates of low adherence were 51.3% for medication for anxiety, 47.2% for depression, and 42.9% for other psychiatric disorders. Smoking during pregnancy, elevated antidepressant risk perception (risk≥6), and depressive symptoms were associated with a significant 3.9-, 2.3-, and 2.5-fold increased likelihood of low medication adherence, respectively. Women on psychotropic polytherapy were less likely to demonstrate low adherence. The belief that the benefit of pharmacotherapy outweighed the risks positively correlated (r = .282) with higher medication adherence. CONCLUSIONS: Approximately one of two pregnant women using psychotropic medication demonstrated low adherence in pregnancy. Life-style factors, risk perception, depressive symptoms, and individual beliefs are important factors related to adherence to psychotropic medication in pregnancy.

What interventions facilitate client progress through the assimilation model? A task analysis of interventions in the psychodynamic treatment of depression.

A variation of task analysis was used to build an empirical model of how therapists may facilitate client assimilation process, described in the Assimilation of Problematic Experiences Scale. A rational model was specified and considered in light of an analysis of therapist in-session performances (N = 117) drawn from six inpatient therapies for depression. The therapist interventions were measured by the Comprehensive Psychotherapeutic Interventions Rating Scale. Consistent with the rational model, confronting interventions were particularly useful in helping clients elaborate insight. However, rather than there being a small number of progress-related interventions at lower levels of assimilation, therapists' use of interventions was broader than hypothesized and drew from a wide range of therapeutic approaches. Concerning the higher levels of assimilation, there was insufficient data to allow an analysis of the therapist's progress-related interventions.

Paper Surface Image Processing for Roughness Quality Measurement

Diplomityössä on käsitelty paperin pinnankarkeuden mittausta, joka on keskeisimpiä ongelmia paperimateriaalien tutkimuksessa. Paperiteollisuudessa käytettävät mittausmenetelmät sisältävät monia haittapuolia kuten esimerkiksi epätarkkuus ja yhteensopimattomuus sileiden papereiden mittauksissa, sekä suuret vaatimukset laboratorio-olosuhteille ja menetelmien hitaus. Työssä on tutkittu optiseen sirontaan perustuvia menetelmiä pinnankarkeuden määrittämisessä. Konenäköä ja kuvan-käsittelytekniikoita tutkittiin karkeilla paperipinnoilla. Tutkimuksessa käytetyt algoritmit on tehty Matlab® ohjelmalle. Saadut tulokset osoittavat mahdollisuuden pinnankarkeuden mittaamiseen kuvauksen avulla. Parhaimman tuloksen perinteisen ja kuvausmenetelmän välillä antoi fraktaaliulottuvuuteen perustuva menetelmä.

Efficacy of modern antipsychotics in placebo-controlled trials in bipolar depression: a meta-analysis.

Randomized, controlled trials have demonstrated efficacy for second-generation antipsychotics in the treatment of acute mania in bipolar disorder. Despite depression being considered the hallmark of bipolar disorder, there are no published systematic reviews or meta-analyses to evaluate the efficacy of modern atypical antipsychotics in bipolar depression. We systematically reviewed published or registered randomized, double-blind, placebo-controlled trials (RCTs) of modern antipsychotics in adult bipolar I and/or II depressive patients (DSM-IV criteria). Efficacy outcomes were assessed based on changes in the Montgomery-Asberg Depression Rating Scale (MADRS) during an 8-wk period. Data were combined through meta-analysis using risk ratio as an effect size with a 95% confidence interval (95% CI) and with a level of statistical significance of 5% (p<0.05). We identified five RCTs; four involved antipsychotic monotherapy and one addressed both monotherapy and combination with an antidepressant. The two quetiapine trials analysed the safety and efficacy of two doses: 300 and 600 mg/d. The only olanzapine trial assessed olanzapine monotherapy within a range of 5-20 mg/d and olanzapine-fluoxetine combination within a range of 5-20 mg/d and 6-12 mg/d, respectively. The two aripiprazole placebo-controlled trials assessed doses of 5-30 mg/d. Quetiapine and olanzapine trials (3/5, 60%) demonstrated superiority over placebo (p<0.001). Only 2/5 (40%) (both aripiprazole trials) failed in the primary efficacy measure after the first 6 wk. Some modern antipsychotics (quetiapine and olanzapine) have demonstrated efficacy in bipolar depressive patients from week 1 onwards. Rapid onset of action seems to be a common feature of atypical antipsychotics in bipolar depression. Comment in The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version.Destroy user interface controlEfficacy of modern antipsychotics in placebo-controlled trials in bipolar depression: a meta-analysis--results to be interpreted with caution.

Keskinopeusalueella toimivan induktiomoottori - puhallinkäytön suorituskyvyn mittaus alipainekäytössä

Keskinopeusalueella toimivaa massiiviroottorista epätahtimoottoria voidaan käyttää teollisissa puhaltimissa, joissa on tärkeää saavuttaa normaalia korkeampi pyörimisnopeus ja paine-ero. Usein tällaisella puhaltimella saavutetaan parempi hyötysuhde ja säädettävyys kuin vanhoilla volumetrisilla pumpuilla. Paperikoneiden vedenpoistossa käytetty alipaineen tuotto muodostaa erään sovelluskohteen tällaiselle puhallinkäytölle. Työssä esitellään tällaiseen sovelluskohteeseen suunnitellun puhaltimen ja sitä käyttävän massiiviroottorisen epätahtikoneen testausmenetelmät niiden ominaisuuksien määrittämiseksi, sekä siihen tarvittavan mittalaitteiston vaatimukset. Puhaltimen osalta esitetään täydellinen laskenta perustuen LTKK:ssa 20.10.2000 - 27.10.2000 välisenä aikana suoritettuun puhaltimen testiajoon.

Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks.

OBJECTIVE: The objective was to compare a brief interdisciplinary psychotherapeutic intervention to standard care as treatments for patients recently diagnosed with severe motor conversion disorder or nonepileptic attacks. METHODS: This randomized controlled trial of 23 consecutive patients compared (a) an interdisciplinary psychotherapeutic intervention group receiving four to six sessions by a consultation liaison psychiatrist, the first and last sessions adding a neurological consultation and a joint psychiatric and neurological consultation, and (b) a standard care group. After intervention, patients were assessed at 2, 6 and 12 months with the Somatoform Dissociation Questionnaire (SDQ-20), Clinical Global Impression scale, Rankin scale, use of medical care, global mental health [Montgomery and Asberg Depression Rating Scale, Beck Depression Inventory, mental health component of Short Form (SF)-36] and quality of life (SF-36). We calculated linear mixed models. RESULTS: Our intervention brought a statistically significant improvement of physical symptoms [as measured by the SDQ-20 (P<.02) and the Clinical Global Impression scale (P=.02)] and psychological symptoms [better scores on the mental health component of the SF-36 (P<.05) and on the Beck Depression Inventory (P<.05)] and a reduction in new hospital stays after intervention (P<.05). CONCLUSION: A brief psychotherapeutic intervention taking advantage of a close collaboration with neurology consultants in the setting of consultation liaison psychiatry appears effective.