The impact of neuropsychological functioning and coping style on perceived stress in individuals with first-episode psychosis and healthy controls

Stress is implicated in the development and course of psychotic illness, but the factors that influence stress levels are not well understood. The aim of this study was to examine the impact of neuropsychological functioning and coping styles on perceived stress in people with first-episode psychosis (FEP) and healthy controls (HC). Thirty-four minimally treated FEP patients from the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia, and 26 HC participants from a similar demographic area participated in the study. Participants completed a comprehensive neuropsychological test battery as well as the Coping Inventory for Stressful Situations (task-, emotion- and avoidance-focussed coping styles) and Perceived Stress Scale (PSS). Linear regressions were used to determine the contribution of neuropsychological functioning and coping style to perceived stress in the two groups. In the FEP group, higher levels of emotion-focussed and lower levels of task-focussed coping were associated with elevated stress. Higher premorbid IQ and working memory were also associated with higher subjective stress. In the HC group, higher levels of emotion-focussed coping, and contrary to the FEP group, lower premorbid IQ, working memory and executive functioning, were associated with increased stress. Lower intellectual functioning may provide some protection against perceived stress in FEP.

Enhanced cortisol suppression following administration of low-dose dexamethasone in first-episode psychosis patients

OBJECTIVE Impaired regulation of the hypothalamic-pituitary-adrenal (HPA) axis and hyper-activity of this system have been described in patients with psychosis. Conversely, some psychiatric disorders such as post-traumatic stress disorder (PTSD) are characterised by HPA hypo-activity, which could be related to prior exposure to trauma. This study examined the cortisol response to the administration of low-dose dexamethasone in first-episode psychosis (FEP) patients and its relationship to childhood trauma. METHOD The low-dose (0.25 mg) Dexamethasone Suppression Test (DST) was performed in 21 neuroleptic-naive or minimally treated FEP patients and 20 healthy control participants. Childhood traumatic events were assessed in all participants using the Childhood Trauma Questionnaire (CTQ) and psychiatric symptoms were assessed in patients using standard rating scales. RESULTS FEP patients reported significantly higher rates of childhood trauma compared to controls (p = 0.001) and exhibited lower basal (a.m.) cortisol (p = 0.04) and an increased rate of cortisol hyper-suppression following dexamethasone administration compared to controls (33% (7/21) vs 5% (1/20), respectively; p = 0.04). There were no significant group differences in mean cortisol decline or percent cortisol suppression following the 0.25 mg DST. This study shows for the first time that a subset of patients experiencing their first episode of psychosis display enhanced cortisol suppression. CONCLUSIONS These findings suggest there may be distinct profiles of HPA axis dysfunction in psychosis which should be further explored.

Cortisol and dehydroepiandrosterone-sulphate levels correlate with symptom severity in first-episode psychosis

Dehydroepiandrosterone (DHEA) and its sulphate form (DHEA) are neuroactive steroids with antiglucocorticoid properties. An imbalance in the ratio of cortisol to DHEA(S) has been implicated in the pathophysiology of stress-related psychiatric disorders. This study prospectively investigated circulating cortisol, DHEAS and their ratio in first-episode psychosis (FEP) patients compared to healthy controls, and their relationship to perceived stress, psychotic, negative and mood symptoms. METHODS: Blood cortisol and DHEAS levels were obtained in 39 neuroleptic-naïve or minimally-treated FEP patients and 25 controls. Twenty-three patients and 15 controls received repeat assessments after 12 weeks. Perceived stress was assessed using the Perceived Stress Scale and symptoms were assessed in patients using standard rating scales. RESULTS: At baseline, no differences were observed in cortisol, DHEAS or the cortisol/DHEAS ratio between patients and controls. There were also no group differences in the change in these biological variables during the study period. Within FEP patients, decreases in cortisol and the cortisol/DHEAS ratio over time were directly related to the improvement in depression (r = 0.45; p = 0.031, r = 0.52; p = 0.01), negative (r = 0.51; p = 0.006, r = 0.55; p = 0.008) and psychotic symptoms (cortisol only, r = 0.53; p = 0.01). Perceived stress significantly correlated with DHEAS (r = 0.51; p = 0.019) and the cortisol/DHEAS ratio (r = -0.49; p = 0.024) in controls, but not patients, possibly reflecting an impaired hormonal response to stress in FEP patients. CONCLUSIONS: These findings further support the involvement of the stress system in the pathophysiology of psychotic disorders, with implications for treatment strategies that modulate these neurosteroids.

Relationship between vocational status and perceived stress and daily hassles in first-episode psychosis: An exploratory study

PURPOSE Vocational recovery is a primary treatment goal of young people with first-episode psychosis (FEP), yet treatment in this domain is often delayed due to concerns that it might be too stressful. This study aimed to examine whether a relationship exists between vocational status and level of perceived stress and daily hassles in FEP. METHODS Forty-seven FEP participants were recruited upon admission to the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne. Demographics, psychopathology, perceived stress (Perceived Stress Scale; PSS) and daily hassles (Hassles Scale; HS) were measured. RESULTS Regarding vocational status, 19 participants were unemployed, 13 were employed, 14 were students, and 1 reported 'home duties'. ANOVAs and post hoc tests comparing the first three groups on perceived stress and daily hassles revealed that the mean PSS Total and mean PSS Distress scores of the employed group were significantly lower than those of the unemployed and student groups. Regarding hassles scores, the employed group had a significantly lower mean Hassles Intensity score than the unemployed group. Results were largely unchanged when covariates were included. There were no significant differences between the three groups in levels of anxiety, negative or positive symptoms. The employed group reported lower depression than the student group, but this finding disappeared after controlling for gender. CONCLUSIONS These results provide preliminary evidence supporting the notion that working or studying is not associated with increased perceived stress or daily hassles in FEP. The findings require replication in larger samples and in different phases of psychosis.

The effect of atypical antipsychotics on pituitary gland volume in patients with first-episode psychosis: A longitudinal MRI study

BACKGROUND: Pituitary volume is currently measured as a marker of hypothalamic-pituitary-adrenal hyperactivity in patients with psychosis despite suggestions of susceptibility to antipsychotics. Qualifying and quantifying the effect of atypical antipsychotics on the volume of the pituitary gland will determine whether this measure is valid as a future estimate of HPA-axis activation in psychotic populations. AIMS: To determine the qualitative and quantitative effect of atypical antipsychotic medications on pituitary gland volume in a first-episode psychosis population. METHOD: Pituitary volume was measured from T1-weighted magnetic resonance images in a group of 43 first-episode psychosis patients, the majority of whom were neuroleptic-naive, at baseline and after 3months of treatment, to determine whether change in pituitary volume was correlated with cumulative dose of atypical antipsychotic medication. RESULTS: There was no significant baseline difference in pituitary volume between subjects and controls, or between neuroleptic-naive and neuroleptic-treated subjects. Over the follow-up period there was a negative correlation between percentage change in pituitary volume and cumulative 3-month dose of atypical antipsychotic (r=-0.37), i.e. volume increases were associated with lower doses and volume decreases with higher doses. CONCLUSIONS: Atypical antipsychotic medications may reduce pituitary gland volume in a dose-dependent manner suggesting that atypical antipsychotic medication may support affected individuals to cope with stress associated with emerging psychotic disorders.

Pituitary volume and early treatment response in drug-naïve first-episode psychosis patients

BACKGROUND: An early response to antipsychotic treatment in patients with psychosis has been associated with a better course and outcome. However, factors that predict treatment response are not well understood. The onset of schizophrenia and related disorders has been associated with increased levels of stress and hyper-activation of the hypothalamic-pituitary-adrenal (HPA) axis. This study examined whether pituitary volume at the onset of psychosis may be a potential predictor of early treatment response in first-episode psychosis (FEP) patients. METHODS: We investigated the relationship between baseline pituitary volume and symptomatic treatment response over 12 weeks using mixed model analysis in a sample of 42 drug-naïve or early treated FEP patients who participated in a controlled dose-finding study of quetiapine fumarate. Logistic regression was used to examine predictors of treatment response. Pituitary volume was measured from magnetic resonance imaging scans that were obtained upon entry into the trial. RESULTS: Larger pituitary volume was associated with less improvement in overall psychotic symptoms (Brief Psychiatric Rating Scale (BPRS) P=0.031) and positive symptoms (BPRS positive symptom subscale P=0.010). Regardless of gender, patients with a pituitary volume at the 25th percentile (413 mm(3)) were approximately three times more likely to respond to treatment by week 12 than those at the 75th percentile (635 mm(3)) (odds ratio=3.07, CI: 0.90-10.48). CONCLUSION: The association of baseline pituitary volumes with early treatment response highlights the importance of the HPA axis in emerging psychosis. Potential implications for treatment strategies in early psychosis are discussed.

In search of good probability assessors: An experimental comparison of elicitation rules for confidence judgments

In this paper, we use an experimental design to compare the performance of elicitation rules for subjective beliefs. Contrary to previous works in which elicited beliefs are compared to an objective benchmark, we consider a purely subjective belief framework (confidence in one’s own performance in a cognitive task and a perceptual task). The performance of different elicitation rules is assessed according to the accuracy of stated beliefs in predicting success. We measure this accuracy using two main factors: calibration and discrimination. For each of them, we propose two statistical indexes and we compare the rules’ performances for each measurement. The matching probability method provides more accurate beliefs in terms of discrimination, while the quadratic scoring rule reduces overconfidence and the free rule, a simple rule with no incentives, which succeeds in eliciting accurate beliefs. Nevertheless, the matching probability appears to be the best mechanism for eliciting beliefs due to its performances in terms of calibration and discrimination, but also its ability to elicit consistent beliefs across measures and across tasks, as well as its empirical and theoretical properties.

Scoring rules and abnormally low bids criteria in construction tenders: A taxonomic review

In the global construction context, the Best Value or Most Economically Advantageous Tender is becoming a widespread approach for contractor selection, as an alternative to other traditional awarding criteria such as the Lowest Price. In these multi-attribute tenders, the owner or auctioneer solicits proposals containing both a price bid and additional technical features. Once the proposals are received, each bidder's price bid is given an economic score according to a scoring rule, generally called an Economic Scoring Formula (ESF) and a technical score according to pre-specified criteria. Eventually, the contract is awarded to the bidder with the highest weighted overall score (economic + technical). However, Economic Scoring Formula selection by auctioneers is invariably and paradoxically a highly intuitive process in practice, involving few theoretical or empirical considerations, despite having being considered traditionally and mistakenly as objective, due to its mathematical nature. This paper provides a taxonomic classification of a wide variety of ESF and Abnormally Low Bid Criteria (ALBC) gathered in several countries with different tendering approaches. Practical implications concern the optimal design of price scoring rules in construction contract tenders, as well as future analyses of the effects of ESF and ALBC on competitive bidding behaviour.

Fire design rules for load bearing cold-formed steel frame walls exposed to realistic design fire curves

Light gauge Steel Frame (LSF) walls are extensively used in the building industry due to the many advantages they provide over other wall systems. Although LSF walls have been used widely, fire design of LSF walls is based on approximate prescriptive methods based on limited fire tests. Also these fire tests were conducted using the standard fire curve [1] and the applicability of available design rules to realistic design fire curves has not been verified. This paper investigates the accuracy of existing fire design rules in the current cold-formed steel standards and the modifications proposed by previous researchers. Of these the recently developed design rules by Gunalan and Mahendran [2] based on Eurocode 3 Part 1.3 [3] and AS/NZS 4600 [4] for standard fire exposure [1] were investigated in detail to determine their applicability to predict the axial compression strengths and fire resistance ratings of LSF walls exposed to realistic design fire curves. This paper also presents the fire performance results of LSF walls exposed to a range of realistic fire curves obtained using a finite element analysis based parametric study. The results from the parametric study were used to develop a simplified design method based on the critical hot flange temperature to predict the fire resistance ratings of LSF walls exposed to realistic fire curves. Finally, the stud failure times (fire resistance rating) obtained from the fire design rules and the simplified design method were compared with parametric study results for LSF walls lined with single and double plasterboards, and externally insulated with rock fibres under realistic fire curves.

Global rules on conflict-of-laws matters in international insolvency law cases: An Australian perspective

The 2012 Report “Transnational Insolvency: Global Principles for Co-operation in International Insolvency Cases” – commissioned by The American Law Institute in conjunction with The International Insolvency Institute – annexed 23 “Global Rules on Conflict-of-Laws Matters in International Insolvency Cases”. These proposed “Global Rules” are intended to “serve as legislative recommendations” to (inter alia) promote uniformity and greater certainty in the unpredictable area of conflict of laws. This article provides a brief commentary upon the 23 proposed Global Rules from an Australian perspective (comparing the effect and intent of each rule with the current Australian conflict-of-laws position) and offers some conclusions as to the merits of the “Global Rules” initiative.

Improved shear design rules of cold-formed steel beams

Light gauge cold-formed steel sections have been developed as more economical building solutions to the alternative heavier hot-rolled sections in the commercial and residential markets. Cold-formed lipped channel beams (LCB), LiteSteel beams (LSB) and triangular hollow flange beams (THFB) are commonly used as flexural members such as floor joists and bearers while rectangular hollow flange beams (RHFB) are used in small scale housing developments through to large building structures. However, their shear capacities are determined based on conservative design rules. For the shear design of cold-formed steel beams, their elastic shear buckling strength and the potential post-buckling strength must be determined accurately. Hence experimental and numerical studies were conducted to investigate the shear behaviour and strength of LCBs, LSBs, THFBs and RHFBs. Improved shear design rules including the direct strength method (DSM) based design equations were developed to determine the ultimate shear capacities of these open and hollow flange steel beams. An improved equation for the higher elastic shear buckling coefficient of cold-formed steel beams was proposed based on finite element analysis results and included in the design equations. A new post-buckling coefficient was also introduced in the design equations to include the available post-buckling strength of cold-formed steel beams. This paper presents the details of this study on cold-formed steel beams subject to shear, and the results. It proposes generalised and improved shear design rules that can be used for any type of cold-formed steel beam.

Who Rules Japan? Popular Participation in the Japanese Legal Process

"The dramatic growth of the Japanese economy in the postwar period, and its meltdown in the 1990s, has attracted sustained interest in the power dynamics underlying the management of Japan’s administrative state. Scholars and commentators have long debated over who wields power in Japan, asking the fundamental question: who really governs Japan? This important volume revisits this question by turning its attention to the regulation and design of the Japanese legal system. With essays covering the new lay-judge system in Japanese criminal trials, labour dispute resolution panels, prison policy, gendered justice, government lawyers, welfare administration and administrative transparency, this comprehensive book explores the players and processes in Japan’s administration of justice."--publisher website

Introduction: Who rules Japan?

This chapter reviews the debate about who governs Japan and considers the implications of legal system reforms initiated by the Justice System Reform Council report of 2001.

Towards simple rules heuristics for IT business value

The business value of IT (BVIT) has been a prominent and central research topic in the IS discipline. Due to continuous and unpredictable technology and business changes, a more dynamic perspective on IT business value that includes organizational learning is required. We suggest that simple rules heuristics can address this challenge. The simple rules heuristics approach has been introduced by Eisenhardt and co-authors (Bingham & Eisenhardt, 2011; Bingham, Eisenhardt, & Furr, 2007; Eisenhardt & Sull, 2001) to better understand strategic decision making for capturing superabundant, heterogeneous, fastmoving opportunities. They argue that explicit organizational learning can translate accumulated experience into increasingly effective heuristics for strategic processes in highvelocity environments. We make three main contributions by exploring the suitability of a simple rules heuristics approach for the creation of IT business value: (1) we propose six types of simple rules heuristics for capturing IT-based opportunities in dynamic environments, including synergy heuristics as specifically relevant in an IT context, (2) we show how a simple rules heuristics approach can advance our understanding of dynamics and organizational learning for BVIT, and; (3) we introduce the strategic logic of opportunity to BVIT.

Sharing social space with strangers: Setting, signalling and policing informal rules of driving etiquette

Recent research suggests that aggressive driving may be influenced by driver perceptions of their interactions with other drivers in terms of ‘right’ or ‘wrong’ behaviour. Drivers appear to take a moral standpoint on ‘right’ or ‘wrong’ driving behaviour. However, ‘right’ or ‘wrong’ in the context of road use is not defined solely by legislation, but includes informal rules that are sometimes termed ‘driving etiquette’. Driving etiquette has implications for road safety and public safety since breaches of both formal and informal rules may result in moral judgement of others and subsequent behaviours designed to punish the ‘offender’ or ‘teach them a lesson’. This paper outlines qualitative research that was undertaken with drivers to explore their understanding of driving etiquette and how they reacted to other drivers’ observance or violation of their understanding. The aim was to develop an explanatory framework within which the relationships between driving etiquette and aggressive driving could be understood, specifically moral judgement of other drivers and punishment of their transgression of driving etiquette. Thematic analysis of focus groups (n=10) generated three main themes: (1) courtesy and reciprocity, and the notion of two-way responsibility, with examples of how expectations of courteous behaviour vary according to the traffic interaction; (2) acknowledgement and shared social experience: ‘giving the wave’; and (3) responses to breaches of the expectations/informal rules. The themes are discussed in terms of their roles in an explanatory framework of the informal rules of etiquette and how interactions between drivers can reinforce or weaken a driver’s understanding of driver etiquette and potentially lead to driving aggression.