Language ability and adult homelessness.

BACKGROUND: People experiencing homelessness are at increased risk of neurological disorder due to multiple factors such as substance abuse, infection, and higher rates of serious mental illness and traumatic brain injury. This could affect cognitive and language skills. Indeed, past research has suggested that certain language-related skills tend to be lower in people experiencing homelessness. However, that research has compared homeless samples with age-matched normative samples and not with samples of people from similar socio-economic backgrounds. Therefore, it is unclear whether homelessness is even a relevant factor, or if adults who are homeless tend to have appropriate linguistic skills relative to their social and educational background. AIMS: To compare the language skills of a group of adults with histories of homelessness with an education-matched control group. It was hypothesized that participants with histories of homelessness would have worse language performance than their matched controls. METHODS & PROCEDURES: A quasi-experimental design was employed involving 17 adults with histories of homelessness, mainly rough sleeping, in the city of Quito in Ecuador, and a sample of 16 adults who had never been homeless. All were assessed with measures of head injury, substance dependence, affective disorder and language skills. A paired-sample analysis was performed on homeless and control participants matched for educational background, used as an index of socio-economic background. OUTCOMES & RESULTS: The mean years of formal education was low in both the homeless sample (mean = 5.82 years) and the control sample (mean = 6.75 years). There were no differences between the groups for any demographic or clinical factors, nor for a measure of expected or 'premorbid' ability based on single-word reading, nor for current non-verbal cognitive functioning. In contrast, the homeless group scored significantly worse than the control group on measures of auditory comprehension and oral expression. CONCLUSIONS & IMPLICATIONS: Adults with histories of homelessness may have worse language skills than would be expected based on their educational backgrounds and non-verbal cognitive abilities. It is possible that some of this lower language ability is pathological, in the form of either a developmental language disorder or an acquired impairment. As such, some adults who are homeless may benefit from therapy directed at clinical language disorders.

Curious CXR.

A 98-year-old man with 2 days of headache, nausea, malaise and unsteadiness was referred to the ED by his GP with a suspicion of an intracranial bleed. His medical history included atrial fibrillation (AF) (taking warfarin). Observations were SpO2 95% on air, RR24, HR88, BP210/104, GCS14, Temp 34.3. On examination he had bilateral creps and was sleepy but not confused. A septic screen was undertaken and intravenous ceftriaxone given. His CTH was essentially normal. His CXR is shown in figure 1 emermed;36/7/442/F1F1F1Figure 1Anteropsterior(AP) CXR at presentation. QUESTION: What is the diagnosis?Acute collapse and consolidation secondary to pneumonia.Spontaneous haemothorax.Acute consolidation with underlying old TB.Traumatic lung contusions.

Personality disorder in a probation cohort: Demographic, substance misuse and forensic characteristics.

BACKGROUND: The occurrence of personality disorder among community supervised offenders may have important implications for their management. There is, however, a dearth of contextual information on personality disorder in such populations. AIMS: This study aimed to identify demographic, substance use and forensic features that distinguish community-sentenced offenders with personality disorder from those without. METHODS: One hundred and seventy-three offenders under community supervision were screened for personality disorder using the Standardised Assessment of Personality--Abbreviated Scale. Alcohol and drug misuse, demographic and forensic data were also recorded. RESULTS: Nearly half of the sample (82, 47%) had probable personality disorder. Compared with those without personality disorder, they were younger, more likely to be unemployed, less likely to be divorced, more likely to have been convicted of robbery and more likely to be alcohol or illicit drug misusers, as well as under drug rehabilitation requirements. Multivariate analyses confirmed that only alcohol and drug abuse were independently associated with personality disorder in this group, and only the latter was significant. CONCLUSIONS: In this broadly representative sample of offenders serving community sentences in a defined geographical area, those with personality disorder were not more likely to attract higher risk of recidivism ratings, but they were more likely to have problems with heavy alcohol and/or illicit drug misuse.

Trends in use of electroconvulsive therapy in South London from 1949 to 2006.

OBJECTIVES: Electroconvulsive therapy (ECT) remains the most acutely effective treatment for severe depression, but its use has declined since its introduction more than 70 years ago. To provide some historical perspective on changes in ECT practice, the objective of the present study was to identify trends in ECT practice in selected teaching hospitals in South London, UK, between 1949 and 2006. METHODS: Annual rates of ECT for 1949-1970 were estimated from the contemporary hospital reports of the Maudsley and Bethlem Royal hospitals in South London, UK. Case notes were also retrospectively reviewed to calculate annual rates of ECT administration and extract demographic and clinical information for approximately every 5 years between 1987 and 2006. RESULTS: The annual rate of ECT peaked at 35% of total admission in 1956 and declined gradually thereafter to 10.8% by 1970 and fell below 2.2% from 1991 onward. Depressed and female patients were more likely to receive ECT. Compared to previous years, patients were more severely ill and treatment resistant in 2006, whereas ethnic minorities made up 30% of patients receiving ECT compared to approximately 14% in the preceding years. CONCLUSIONS: Currently, ECT seems to be provided increasingly late in more severe illness episodes. The ethnicity of patients receiving ECT in South London may be becoming more representative of the background population, but ECT is being used relatively more frequently for nonaffective disorders in ethnic minorities.

Epidemiological survey of suicide ideation and acts and other deliberate self-harm among offenders in the community under supervision of the Probation Service in England and Wales.

BACKGROUND: There is a dearth of information on suicidal thoughts and acts or other acts of deliberate self-harm by offenders under community supervision. AIMS: The objective of this study is to estimate lifetime and one month prevalence of deliberate self-harm and to determine ongoing risk among offenders in the community under probation supervision. METHODS: One hundred and seventy-three randomly selected offenders under supervision by the probation service in one county in England were screened for mental illness. All 88 screened cases and a one-in-five sample of non-cases were interviewed according to the Mini International Neuropsychiatric Inventory Module-B. False negatives (n = 17) were used to weight calculations and estimate prevalence for the whole group. RESULTS: A third of the interviewed sample (n = 56) had a lifetime history of suicide attempts, and 9 (5%) had self-harmed in the month prior to interview. Lifetime suicide history was associated with suicidal ideation and deliberate self-harm in the prior month. CONCLUSIONS AND IMPLICATIONS: Our adjusted findings indicate that 25-40% of offenders serving all or part of their sentence in the community have a lifetime history of self-harm, which is similar to the rate among prisoners, and are at very much higher risk of further such acts or completed suicide than the general population. At a time of change in delivery of probation services the implications are that rates of suicide and other forms of deliberate self-harm should be continually assessed in all probation areas, particularly with reference to service changes;the relationship between deliberate acts of self-harm, suicidal ideation and completion of suicide should be investigated prospectively in larger studies;probation services are likely to need mental health expertise to manage these risks.

Executive function and adult homelessness, true impairment or frontal lobology?

Homelessness is associated with multiple risk factors for neurocognitive impairment. Past research with people experiencing homelessness has described "frontal lobe" dysfunction including behavioral disorders and executive cognitive impairments. In the current study, 72 adults experiencing homelessness were assessed with a standardized assessment of executive function, and interviewed regarding neurological and psychiatric history. When compared to a control sample of 25 never-homeless participants, and controlling for level of education, there was little evidence for executive dysfunction in the sample of people experiencing homelessness. Levels of substance abuse, past head injury, and post-traumatic stress disorder were notably high. However, there were no statistically significant associations between cognitive task performance and clinical or substance abuse variables. Gambling was surprisingly infrequent, but risk-taking behavior among intravenous drug users was common. Though in neither case was it linked to executive function. Overall, there was little evidence for executive impairment in this sample of people experiencing homelessness. I suggest that past research has often used inappropriate criteria for "normal" performance, particularly comparing people experiencing homelessness to control data of relatively high education level. This has led to elements of "frontal lobology," that is, clinical neuroscience research that tends to overly link non-typical or pathological behavior to frontal lobe impairment. When appropriate comparisons are made, controlling for education level, as in this study, associations between executive function impairments and adult homelessness may be weaker than previously reported.

The Misguided Veneration of Averageness in Clinical Neuroscience: A Call to Value Diversity over Typicality.

Research and practice in clinical neurosciences often involve cognitive assessment. However, this has traditionally used a nomothetic approach, comparing the performance of patients to normative samples. This method of defining abnormality places the average test performance of neurologically healthy individuals at its center. However, evidence suggests that neurological 'abnormalities' are very common, as is the diversity of cognitive abilities. The veneration of central tendency in cognitive assessment, i.e., equating typicality with healthy or ideal, is, I argue, misguided on neurodiversity, bio-evolutionary, and cognitive neuroscientific grounds. Furthermore, the use of average performance as an anchor point for normal performance is unreliable in practice and frequently leads to the mischaracterization of cognitive impairments. Examples are explored of how individuals who are already vulnerable for socioeconomic reasons can easily be over-pathologized. At a practical level, by valuing diversity rather than typicality, cognitive assessments can become more idiographic and focused on change at the level of the individual. The use of existing methods that approach cognitive assessment ideographically is briefly discussed, including premorbid estimation methods and informant reports. Moving the focus away from averageness to valuing diversity for both clinical cognitive assessments and inclusion of diverse groups in research is, I argue, a more just and effective way forward for clinical neurosciences.

Evidence for an amodal domain-general object recognition ability.

A general object recognition ability predicts performance across a variety of high-level visual tests, categories, and performance in haptic recognition. Does this ability extend to auditory recognition? Vision and haptics tap into similar representations of shape and texture. In contrast, features of auditory perception like pitch, timbre, or loudness do not readily translate into shape percepts related to edges, surfaces, or spatial arrangement of parts. We find that an auditory object recognition ability correlates highly with a visual object recognition ability after controlling for general intelligence, perceptual speed, low-level visual ability, and memory ability. Auditory object recognition was a stronger predictor of visual object recognition than all control measures across two experiments, even though those control variables were also tested visually. These results point towards a single high-level ability used in both vision and audition. Much work highlights how the integration of visual and auditory information is important in specific domains (e.g., speech, music), with evidence for some overlap of visual and auditory neural representations. Our results are the first to reveal a domain-general ability, o, that predicts object recognition performance in both visual and auditory tests. Because o is domain-general, it reveals mechanisms that apply across a wide range of situations, independent of experience and knowledge. As o is distinct from general intelligence, it is well positioned to potentially add predictive validity when explaining individual differences in a variety of tasks, above and beyond measures of common cognitive abilities like general intelligence and working memory.

Performance on the continuous performance test under parametric increase of working memory load in schizophrenia.

We asked 24 schizophrenia patients and 24 healthy comparison subjects to complete a parametric working memory version of the continuous performance test. Patients exhibited a relatively rapid performance decline with increasing working memory demands. We suggest an interaction between sustained attention and working memory abnormalities in schizophrenia.

Predictors of high functional disability and mortality at 3 months in patients with status epilepticus.

PURPOSE: There are differences in epidemiology, etiology, and outcome in status epilepticus (SE) between developing and developed countries, which limits generalizability. We evaluated factors related to outcome at 3 months in SE patients in a developing country- Ecuador. METHODS: Retrospective analysis of a prospectively collected dataset of patients treated for SE at a single hospital over 4 years, recording on 107 patients and 109 episodes, including clinical, demographic, and prognosis assessments. RESULTS: Hospital mortality was 33%, and 38% at 3 months. Glasgow Coma Scale score pretreatment ≤12 (odds ratio = 7.7), Charlson Index of comorbidities ≥3 (odds ratio = 5.6) and brain lesion (odds ratio = 6.4) predicted high disability. History of epilepsy was associated with favorable outcome in general, and showed a positive impact on survival rates (odds ratio = 0.3), while Glasgow Coma Scale scores pretreatment ≤12 (odds ratio = 4.1) and refractory SE (odds ratio = 2.1) were associated with reduced survival rates. Acute symptomatic etiology was the most common cause of SE (58%). Etiologies with structural brain lesion showed a significantly lower survival rate (Log ranks = 0.04 and 0.003) compared to other groups. CONCLUSION: Mortality rate at 3 months for SE patients was high. Glasgow Coma Scale, Charlson Index, and brain lesions were associated with unfavorable outcome, including mortality. Overall, the results were similar to those reported in more developed countries, but some differences, including overall higher mortality, prevalence of nonconvulsive SE, and lack of association of age with outcome were evident.

Neurobehavioural and cognitive function is linked to childhood trauma in homeless adults.

OBJECTIVES: To describe levels of traumatic childhood events in a sample of homeless individuals and to assess the contribution of traumatic events to neurobehavioural traits (measured with the Frontal Systems Behaviour Scale, FrSBe) and general cognitive function (IQ). DESIGN: A sample of 55 homeless adults was recruited from homeless services in the city of Sheffield, UK. All were interviewed to acquire substance misuse information, record experiences of childhood trauma, and assess cognitive and neurobehavioural traits. METHODS: Experiences of abuse and neglect were assessed with the Childhood Trauma Questionnaire. Participants also completed the Wechsler Abbreviated Scale of Intelligence and the FrSBe, which was completed with respect to current behaviour and conduct prior to homelessness. RESULTS: Around three-quarters of the sample scored in the clinically significant range for current neurobehavioural impairment. They also reported high levels of impairment when rating retrospectively for the period before they were homeless. The mean group IQ was below average at 88. Abuse or neglect during their upbringing was reported by 89% of the sample. Emotional abuse, emotional neglect, and physical neglect were all positively correlated with total FrSBe scores. Sexual abuse, emotional neglect, and physical neglect were all negatively correlated with IQ. The associations between trauma and IQ and neurobehavioural traits appear generally unrelated to the presence of substance misuse in the sample. CONCLUSION: Our homeless sample displayed relatively low IQ with high levels of neurobehavioural impairment. Our evidence suggests that these neuropsychological factors may, in part, constitute a long-term consequence of childhood trauma.

Comparison of electroconvulsive therapy practice between London and Bengaluru.

OBJECTIVE: To compare electroconvulsive therapy (ECT) practice between London in the United Kingdom and Bengaluru in India. METHODS: A retrospective case note study was conducted to compare patterns of referrals for ECT in university teaching hospitals in London (n = 46) and Bengaluru (n = 345) during a 1-year period. Further comparison of ECT practice was made for a consecutive series of depressed patients between London (n = 104) and Bengaluru (n = 125). RESULTS: The rates of ECT referral were 0.9% of total annual admissions at the London site and 8.2% at the Bengaluru site. At the Bengaluru site, a higher proportion of patients were referred for ECT with a diagnosis of schizophrenia (P < 0.0001). Compared to the Bengaluru sample, depressed patients treated with ECT in London (n = 104) were older with more treatment resistance (P < 0.0001), had longer inpatient stays, and were less responsive to ECT. CONCLUSIONS: The practice of ECT differed substantially between the London and Bengaluru sites. The relatively limited use of ECT in London reflects local treatment guidelines and may reflect the stigma associated with ECT. Electroconvulsive therapy is more widely used in Bengaluru with good outcomes. Further cross-cultural research is required to study the reasons for such contrasting practices and what constitutes the optimal practice of ECT for health systems in different countries.

Brief communication: Reliability of the D-KEFS Tower Test in samples of children and adolescents in Ecuador.

The Tower Test in the Delis-Kaplan Executive Function System (D-KEFS) is a widely-used assessment of executive function in young people. It is similar to other Towers of Hanoi type tasks, for which doubts regarding the reliability of the test have been previously raised. Here, we present data on the internal consistency, unidimensionality, and test-retest reliability of the D-KEFS Towers Test based on an Ecuadorian sample of 264 children and adolescents. In general, the Tower Test appeared to have poor reliability. This may be caused by the combination of very simple and more difficult trials within the same assessment. Nevertheless, one measure, the Time-Per-Move Ratio, appeared to be sufficiently reliable for clinical or research use, and neuropsychological studies have suggested that the Time-Per-Move Ratio may also be the performance measure most sensitive to neurological impairment.

Socio-economic status, executive functions, and theory of mind ability in adolescents: Relationships with language ability and cortisol.

Socio-economic status (SES) is linked to the development of cognitive abilities, particularly language and executive processes. It is unclear whether these represent a single or independent correlates. We studied 110 Ecuadorian youths aged 12-17 with measures of SES, language, executive function, and theory of mind (ToM), a.k.a. mentalizing. A subsample gave hair samples to estimate recent cortisol levels. Restricting analyses to reliable measures, SES was highly associated with language skill, and to a lesser extent with executive function and ToM performance. However, those latter associations were attenuated and non-significant when language ability was controlled for statistically. Systemic cortisol levels were not associated with SES, but were significantly and negatively correlated with ToM, independent of variation in language skills. We conclude that language development underlies most of the impact of SES on executive function and ToM ability of adolescents, but that stress-related cortisol may have an independent, direct effect on mentalizing.

Predisposing factors and impact of healthcare-associated infections in patients with status epilepticus.

BACKGROUND: Few studies have evaluated the incidence, predisposing factors and impact of healthcare-associated infections (HCAIs) in relation to outcomes among patients with status epilepticus (SE). OBJECTIVE: To investigate the variables associated with development of HCAIs among patients with SE and the impact of factors relating to HCAIs on mortality at three months. METHODS: This study was a retrospective analysis on our prospectively collected dataset, from November 2015 to January 2019. The sample included all consecutive patients diagnosed with SE who were treated at Hospital Eugenio Espejo during that period. In total, 74 patients were included. Clinical variables such as age, etiology of SE, Charlson comorbidity index (CCI), hospital length of stay, refractory SE (RSE) and outcomes were analyzed. RESULTS: HCAIs were diagnosed in 38 patients (51.4%), with a preponderance of respiratory tract infection (19; 25.7%). Prolonged hospital length of stay (OR=1.09; 95%CI 1.03-1.15) and CCI≥2 (OR=5.50; 95%CI 1.37-22.10) were shown to be independent variables relating to HCAIs. HCAIs were associated with an increased risk of mortality at three months, according to Cox regression analysis (OR=2.23; 95%CI 1.08-4.58), and with infection caused by Gram-negative microorganisms (OR=3.17; 95%CI 1.20-8.39). Kaplan-Meier curve analysis demonstrated that HCAIs had a negative impact on the survival rate at three months (log rank=0.025). CONCLUSIONS: HCAIs are a common complication among Ecuadorian patients with SE and were related to a lower survival rate at three months. Prolonged hospital length of stay, RSE and CCI≥2 were associated with the risk of developing HCAIs.

Differential associations of neurobehavioral traits and cognitive ability to academic achievement in higher education.

BACKGROUND: People vary between each other on several neurobehavioral traits, which may have implications for understanding academic achievement. METHODS: University-level Psychology or Engineering students were assessed for neurobehavioral traits, intelligence, and current psychological distress. Scores were compared with their grade point average (GPA) data. RESULTS: Factors associated with higher GPA differed markedly between groups. For Engineers, intelligence, but not neurobehavioral traits or psychological distress, was a strong correlate of grades. For Psychologists, grades were not correlated with intelligence but they were with the neurobehavioral traits of executive dysfunction, disinhibition, apathy, and positive schizotypy. However, only the latter two were associated independently of psychological distress. Additionally, higher mixed-handedness was associated with higher GPA in the combined sample. CONCLUSIONS: Neurological factors (i.e., neurobehavioral traits and intelligence), are differentially associated with university-level grades, depending on the major studied. However, mixed-handedness may prove to be a better general predictor of academic performance across disciplines.

Methohexitone, propofol and etomidate in electroconvulsive therapy for depression: a naturalistic comparison study.

BACKGROUND: Methohexitone has been the most widely used anaesthetic for electroconvulsive therapy (ECT). However, recent scarcity and erratic availability has led to use of other anaesthetics with differing effects upon ECT. We compared treatment parameters and response to ECT in patients anaesthetised with different anaesthetics in a routine clinical setting. METHODS: This was a naturalistic retrospective casenote analysis of 81 consecutive courses of ECT (total 659 treatments) for major depression. RESULTS: Three anaesthetics were compared: methohexitone (n=34), propofol (n=13) and etomidate (n=34). Mean seizure duration was lowest (p<0.0001) for propofol. However, mean stimulus charge was highest in the propofol group (p<0.0001) who required a greater increase in stimulus charge during the course of treatment and also experienced a greater proportion of failed seizures (

Preliminary Validation of a Free-to-Use, Brief Assessment of Adult Intelligence for Research Purposes: The Matrix Matching Test.

The concept of intelligence as a measurable trait of intellectual function continues to be an important issue in psychology. Traditionally, a core field of differential psychology and widely employed in applied settings, it is also important in various research fields. Here, I describe development of a new assessment of general intelligence of adults that has no language component and can be administered in about 10 minutes. A total sample of 176 adult participants, from various settings, was assessed with a set of matrix tasks that involved either visuospatial (fluid) or semantic (crystallized) reasoning. The internal consistency was acceptable (α = .748), and there was good four-week test-retest reliability ( r = .931). Concurrent validity was demonstrated by a high correlation between the new test and the (seven-subtest version) Wechsler Adult Intelligence Scale-IV (WAIS-IV) scores ( r = .889). A principal component analysis also suggested that the new test measures the same latent construct as the WAIS-IV-thought to be general intelligence. Predictive validity was shown in a subsample of 60 undergraduates by a medium-sized correlation between test scores and grade point average data ( r = .396). These preliminary results suggest that the Matrix Matching Test may be a useful research tool.

Response suppression, strategy application, and working memory in the prediction of academic performance and classroom misbehavior: A neuropsychological approach.

BACKGROUND: Neurological illness can produce a disorganization of behavior, including verbal disinhibition, despite apparent preserved intelligence. Neuropsychological tests of such behavioral control mechanisms may predict real-world performance of healthy people, such as success or misbehavior in educational contexts. METHOD: In two separate studies, we examined how the Hayling Test of verbal response suppression predicts grades and classroom misbehavior. RESULTS: Verbal suppression errors and spontaneous strategy use were significant predictors of undergraduate grades. Using a modified version of the Hayling Test designed to reduce strategic responding with high school students (mean age 16), higher grades were predicted by shorter response suppression latencies and better working memory scores, and classroom misbehavior was predicted by lower working memory scores. CONCLUSION: Verbal response suppression and spontaneous strategy use, both closely linked to disorganized behavior in neuropsychological patients, predict academic achievement but seem unrelated to classroom misbehavior, which is associated with weakness in working memory.

Modulation of striatum based non-declarative and medial temporal lobe based declarative memory predicts academic achievement at university level.

BACKGROUND: There is a dearth of research on the roles of non-declarative (implicit) learning linked to the striatum and declarative (explicit) learning associated with the medial temporal lobes as predictors of academic attainment. METHODS: Participants were 120 undergraduate students, studying Psychology or Engineering, who completed several long-term memory tests. RESULTS: There was a significant interaction between the groups (Psychology or Engineering) and task type (declarative or non-declarative): Engineers performed better at declarative and psychologists at non-declarative learning. Furthermore, non-declarative but not declarative learning scores were significant correlates of academic achievement (r = 0.326, p < .05). Moreover, competitive modulation (activation of non-declarative learning in conjunction with deactivation of declarative learning) was a significant predictor of future academic achievement in both psychology (r = 0.264, p < .05) and Engineering (r = 0.300, p < .05) groups. CONCLUSIONS: The results confirm that these declarative and non-declarative systems interact competitively and that the extent of this competition may have implications for understanding educational attainment.