Is there a symptomatic distinction between the affective psychoses and schizophrenia? A machine learning approach.

Dubiety exists over whether clinical symptoms of schizophrenia can be distinguished from affective psychosis, the assumption being that absence of a "point of rarity" indicates lack of nosological distinction, based on prior group-level analyses. Advanced machine learning techniques, using unsupervised (hierarchical clustering) and supervised (regularized logistic regression algorithm and nested-cross-validation) were applied to a dataset of 202 patients with functional psychosis (schizophrenia n = 120, affective psychosis, n = 82). Patients were initially assessed with the Present State Examination (PSE), and followed up 2.5 years later, when DSM III diagnoses were applied (independent of initial PSE). Based on PSE syndromes, unsupervised learning discriminated depressive (approximately unbiased probability, AUP = 0.92) and mania/psychosis (AUP = 0.94) clusters. The mania/psychosis cluster further split into two groups - a mania (AUP = 0.84) and a psychosis cluster (AUP = 0.88). Supervised machine learning classified schizophrenia or affective psychosis with 83.66% (95% CI = 77.83% to 88.48%) accuracy. Area under the ROC curve (AUROC) was 89.14%. True positive rate for schizophrenia was 88.24% (95%CI = 81.05-93.42%) and affective psychosis 77.11% (95%CI = 66.58-85.62). Classification accuracy and AUROC remained high when PSE syndromes corresponding to affective symptoms (those that corresponded to the depressive and mania clusters) were removed. PSE syndromes, based on clinical symptoms, therefore discriminated between schizophrenia and affective psychosis, suggesting validity to these diagnostic constructs.

Effects of psilocybin therapy on personality structure.

OBJECTIVE: To explore whether psilocybin with psychological support modulates personality parameters in patients suffering from treatment-resistant depression (TRD). METHOD: Twenty patients with moderate or severe, unipolar, TRD received oral psilocybin (10 and 25 mg, one week apart) in a supportive setting. Personality was assessed at baseline and at 3-month follow-up using the Revised NEO Personality Inventory (NEO-PI-R), the subjective psilocybin experience with Altered State of Consciousness (ASC) scale, and depressive symptoms with QIDS-SR16. RESULTS: Neuroticism scores significantly decreased while Extraversion increased following psilocybin therapy. These changes were in the direction of the normative NEO-PI-R data and were both predicted, in an exploratory analysis, by the degree of insightfulness experienced during the psilocybin session. Openness scores also significantly increased following psilocybin, whereas Conscientiousness showed trend-level increases, and Agreeableness did not change. CONCLUSION: Our observation of changes in personality measures after psilocybin therapy was mostly consistent with reports of personality change in relation to conventional antidepressant treatment, although the pronounced increases in Extraversion and Openness might constitute an effect more specific to psychedelic therapy. This needs further exploration in future controlled studies, as do the brain mechanisms of postpsychedelic personality change.

Effectiveness of lifestyle interventions for preventing harmful weight gain among young adults from lower socioeconomic status and ethnically diverse backgrounds: a systematic review.

The incidence of overweight and obesity are increasing with each successive generation of young adults. Associated co-morbidities will emerge at an earlier age unless weight gain is prevented. Evidence has demonstrated young adults (aged 18-35 years) from low socioeconomic and ethnically diverse backgrounds are at greater risk of overweight or obesity, yet it is unclear how to effectively intervene in this population. This systematic review aimed to assess the effectiveness of lifestyle interventions conducted in this population. Thirty studies reporting on lifestyle interventions for prevention of weight gain were identified from eight electronic databases searched. Six interventions included subgroup analyses to determine if ethnicity moderated weight change, and two included subgroup analyses to determine if socioeconomic status had an effect on change in weight. Five of these six studies were effective in preventing weight gain, and subgroup analyses showed no differences in effect by ethnicity. Of these five studies, two included a subgroup analysis that showed socioeconomic status to have no effect on weight outcome. Despite the promising results from these five lifestyle interventions utilizing online and mobile components to effectively reach and prevent weight gain in this priority population, the evidence base of high quality trials is limited.

The dopamine hypothesis of bipolar affective disorder: the state of the art and implications for treatment.

Bipolar affective disorder is a common neuropsychiatric disorder. Although its neurobiological underpinnings are incompletely understood, the dopamine hypothesis has been a key theory of the pathophysiology of both manic and depressive phases of the illness for over four decades. The increased use of antidopaminergics in the treatment of this disorder and new in vivo neuroimaging and post-mortem studies makes it timely to review this theory. To do this, we conducted a systematic search for post-mortem, pharmacological, functional magnetic resonance and molecular imaging studies of dopamine function in bipolar disorder. Converging findings from pharmacological and imaging studies support the hypothesis that a state of hyperdopaminergia, specifically elevations in D2/3 receptor availability and a hyperactive reward processing network, underlies mania. In bipolar depression imaging studies show increased dopamine transporter levels, but changes in other aspects of dopaminergic function are inconsistent. Puzzlingly, pharmacological evidence shows that both dopamine agonists and antidopaminergics can improve bipolar depressive symptoms and perhaps actions at other receptors may reconcile these findings. Tentatively, this evidence suggests a model where an elevation in striatal D2/3 receptor availability would lead to increased dopaminergic neurotransmission and mania, whilst increased striatal dopamine transporter (DAT) levels would lead to reduced dopaminergic function and depression. Thus, it can be speculated that a failure of dopamine receptor and transporter homoeostasis might underlie the pathophysiology of this disorder. The limitations of this model include its reliance on pharmacological evidence, as these studies could potentially affect other monoamines, and the scarcity of imaging evidence on dopaminergic function. This model, if confirmed, has implications for developing new treatment strategies such as reducing the dopamine synthesis and/or release in mania and DAT blockade in bipolar depression.

Airway obstruction in heart disease.

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Reversible airway obstruction in rheumatic mitral valve disease.

Lung function was studied in 24 patients with advanced mitral stenosis scheduled for mitral valve replacement (MVR), and revealed an obstructive ventilatory pattern. Forty per cent of the patients had a forced expiratory volume in 1 s (FEV1)<60% of that predicted in the preoperative period. Twenty-five per cent of those operated upon showed a similar pattern up to 110 weeks postoperatively. A blind study of the effect of placebo and beta2 agonist (salbutamol) inhalation was performed preoperatively and 6 months postoperatively, to evaluate the reversibility of airflow obstruction in these patients, flow volume curve and body plethysmographic measurement of airway resistance (Rex) and intrathoracic gas volume (VTG). Patients in the pre and postoperative period showed a significant difference between the placebo and the beta2 agonist responses for FEV1, FEV1 as percentage of FVC (FEV1% FVC), peak expiratory flow rate (PEFR), flow rate of 50% of expiratory vital capacity (Vmax50), Rex and VTG (P<0.001). We conclude that salbutamol inhalation improves obstructive impairment in patients with MVR pre- and postoperatively.

A clinicoepidemiological study of heart disease in schoolchildren of Menoufia, Egypt.

This study was conducted to determine the prevalence of rheumatic heart disease (RHD) and congenital heart disease (CHD) in primary schoolchildren of Menoufia, Egypt and to study the relationship between these two problems and socioeconomic conditions. A total of 8000 children were screened for cardiac disease in their schools. Children with confirmed RHD and CHD in addition to 200 healthy children (controls) were visited at their homes to assess their social environment and other factors according to a designed questionnaire. We found prevalence rates of 3.4/1000 and 2.6/1000 for the RHD and CHD respectively. The most common cardiac defects were double mitral and pulmonary stenosis in the RHD and CHD groups respectively. Nineteen (39.6%) of the patients were diagnosed for the first time during the study. Penicillin prophylaxis was received by only four (14.8%) of the RHD children and none of the CHD children. The number of other affected siblings, increased multiparity, repeated abortion, and intake of contraceptives by mothers were significantly higher in families of the children with CHD. The proportion of illiterate, unskilled, and heavy smoking fathers was higher in the two patient groups. Family income was lowest in the RHD group, while increased crowding index and low whole social environment were significantly related to both RHD and CHD. Effective programs at the community and health service levels are needed in Menoufia to solve the problem of heart disease in schoolchildren in the immediate future.

Pulmonary function before and sequentially after valve replacement surgery with correlation to preoperative hemodynamic data.

Hemodynamic results after valve replacement surgery are well documented, but there are few follow-up studies on pulmonary function. Pulmonary function and hemodynamic studies were made, preoperatively, in 149 patients with predominant, mitral, aortic or combined mitral and aortic stenosis. A sequential postoperative follow-up of the pulmonary function was performed on 88 patients for as long as 125 wk after valve replacement. All patients had reduced preoperative values for forced vital capacity (FVC), single-breath carbon monoxide diffusing capacity (DLCO), forced expiratory volume in one second, peak expiratory flow rate, and maximal flow after exhalation of 75, 50, and 25% of FVC, and increased total airway resistance, resistance during expiration, and residual volume. The aortic group tended toward more normal values. There was significant correlation between the pulmonary function parameters and the hemodynamic data. In the early postoperative period (10 wk), deterioration of pulmonary function was significant in the aortic group and variable in the mitral and the combined groups; these responses correlated with preoperative hemodynamic and pulmonary function status. Between 10 to 125 wk, all patients showed progressive improvement, especially among those in the mitral group. Patients who died during or soon after mitral valve replacement were found to have significantly lower FVC and DLCO and significantly higher peripheral vascular resistance and cardiothoracic ratio. It is concluded that deterioration in pulmonary function is correlated to severity of cardiac dysfunction, and is reversible late after surgery, except in very advanced cases that have poor prognosis.