Stability and development of psychotic symptoms and the use of antipsychotic medication - long-term follow-up.

BACKGROUND: Few studies have evaluated the development in the use of antipsychotic medication and psychotic symptoms in patients with first-episode psychosis on a long-term basis. Our objective was to investigate how psychotic symptoms and the use of antipsychotic medication changed over a 10-year period in a cohort of patients with first-episode psychosis. METHOD: The study is a longitudinal prospective cohort study over 10 years with follow-ups at years 1, 2, 5 and 10. A total of 496 patients with first-episode psychosis were included in a multi-centre study initiated between 1998 and 2000 in Copenhagen and Aarhus, Denmark. RESULTS: At all follow-ups, a large proportion (20-30%) of patients had remission of psychotic symptoms without use of antipsychotic medication at the time of the follow-up. Patients who were in this group at the 5-year follow-up had an 87% [95% confidence interval (CI) 77-96%] chance of being in the same group at the 10-year follow-up. This stability was also the case for patients who had psychotic symptoms and were treated with antipsychotic medication at year 5, where there was a 67% (95% CI 56-78%) probability of being in this group at the consecutive follow-up. CONCLUSIONS: A large group of patients with psychotic illness were in remission without the use of antipsychotic medication, peaking at year 10. Overall there was a large degree of stability in disease courses over the 10-year period. These results suggest that the long-term outcome of psychotic illness is heterogeneous and further investigation on a more individualized approach to long-term treatment is needed.

Measuring euthymia within the Neuroticism Scale from the NEO Personality Inventory: A Mokken analysis of the Norwegian general population study for scalability.

BACKGROUND: Whereas the Eysenck Neuroticism Scale only contains items covering negative mental health to measure dysthymia, the NEO Personality Inventory (NEO-PI) contains neuroticism items covering both negative mental health and positive mental health (or euthymia). The consequence of wording items both positively and negatively within the NEO-PI has never been psychometrically investigated. The aim of this study was to perform a validation analysis of the NEO-PI neuroticism scale. METHODS: Using a Norwegian general population study we examined the structure of the negatively and positively formulated items by principal component analysis (PCA). The scalability of the identified two groups of euthymia versus dysthymia items was examined by Mokken analysis. RESULTS: With a response rate of 90%, 1082 individuals with a completed NEO-PI were available. The PCA identified the neuroticism scale as the most distinct where 14 items had acceptable loadings for the euthymia subscale, another 14 items for the dysthymia subscale. However, the Mokken analysis coefficient of homogeneity only found acceptable scalability for the euthymia subscale. LIMITATIONS: A comparison with the Eysenck Neuroticism Scale was not performed. CONCLUSION: The NEO-PI neuroticism scale contains two subscales consisting of items worded in an opposite direction where only the positive euthymia items have an acceptable scalability.

Conducting research in everyday psychiatric settings: identifying the challenges to meaningful evaluation.

A distinction is often made between research into the efficacy of a treatment, i.e. whether it can be shown to work under ideal conditions, and research into the effectiveness of a treatment, i.e. whether it can be shown to work within a routine health service or usual clinical practice. The purpose of this article is to use descriptive information collected from personnel on the implementation and evaluation of a psychological intervention as a way to highlight some of the challenges faced when conducting research within everyday clinical settings. A psychological intervention for low self-esteem was evaluated within a standard inpatient ward for dual diagnosis patients. Descriptive information was collected from interviews to identify the challenges encountered during the research process. A qualitative analysis of interview content was undertaken to identify the major themes. Personnel described a range of patient variables, staff characteristics and organizational factors that hindered the research process. A detailed account of these factors along with potential solutions that can facilitate research in clinical settings is provided. Conducting research within clinical settings requires considerable planning and monitoring throughout the whole research process. Particular attention should be given to the impact of patient characteristics, staff variables and organizational context when designing and implementing research protocols. The value of this type of research within everyday clinical settings has significant implications for improving patient treatment and outcomes across psychiatric services.

Movement of the velum during speech and singing in classically trained singers.

The present study addresses two questions: (a) Is the action and/or posture of the velopharyngeal valve conducive to allow significant resonance during Western tradition classical singing? (b) How do the actions of the velopharyngeal valve observed in this style of singing compare with normal speech? A photodetector system was used to observe the area function of the velopharyngeal port during speech and classical style singing. Identical speech samples were produced by each subject in a normal speaking voice and then in the low, medium, and high singing ranges. Results indicate that in these four singers the velopharyngeal port was closed significantly longer in singing than in speaking samples. The amount of time the velopharyngeal port was opened was greatest in speech and diminished as the singer ascended in pitch. In the high voice condition, little or no opening of the velopharyngeal port was measured.

The effect of subglottal resonance upon vocal fold vibration.

An experiment with excised larynges was undertaken to investigate the interaction between acoustic pressures in a pseudotrachea and the amplitude of vibration of the vocal folds. Pressure was measured beneath the vocal folds at three specific moments of the vibratory cycle: (a) when the superior margin of the vocal folds began to separate, (b) when the vocal folds were maximally apart, and (c) when the inferior margin of the vocal folds began to touch. Results indicate that in half the larynges investigated, the maximum amplitude of vibration increased as a function of: (a) increased positive pressure at the moment of opening, and (b) reduced subglottal pressure when the vocal folds were maximally apart. The implications of these experiments regarding involuntary register transitions related to trachea resonance are discussed in light of a previously proposed register theory.

Use of sufficient hemodilution to prevent coagulopathies following surgical correction of cyanotic heart disease.

During surgical correction of cyanotic heart disease with associated polycythemia, sufficient reduction of hemoglobin and hematocrit values has proved effective in preventing postoperative coagulopathies. Three groups of surgical patients were studied: Group I--a control group consisting of 75 adults undergoing uncomplicated correction of acquired heart disease and requiring no blood or blood component transfusion; Group II--15 patients with tetralogy of Fallot whose intraoperative hemoglobin values remained above 10 gm/dl with conventional hemodilution techniques; and Group III--21 cyanotic surgical patients whose intraoperative hemoglobin values were lowered to less than 10 gm/dl with sufficient hemodilution. Group III was further broken down into a subgroup of six patients (Group IIIa) who underwent sequential laboratory determinations, as in Group I. In Group IIIa, postoperative coagulation function tests were only slightly more abnormal than in the nonpolycythemic control group (Group I). Patients in Group III (who had ample hemodilution) experienced 45% less bleeding and required 54% fewer blood components than those in Group II (who underwent conventional hemodilution).

Alteration of coagulation and selected clinical chemistry parameters in patients undergoing open heart surgery without transfusions.

Alteration of coagulation status and certain clinical chemistry laboratory determinations of 75 adult patients undergoing cardiopulmonary bypass procedures for acquired heart disease was studied during and after surgery. None of the patients was given transfusions of blood or blood components. With hemodilution, the mean hematocrit value dropped from 38% to 28% during the procedure. Fibrin degradation products and euglobulin lysis time were transiently abnormal. Factor V diminished somewhat during the procedure, whereas factors VIII and IX increased after surgery. Clottable fibrinogen values decreased slightly, but increased to an abnormally high value at 24 and 48 hours. Mean value of platelet counts decreased from 194,000 to 144,000/microliter immediately after surgery. Knowledge of expected deviation of coagulation factors and certain clinical chemistry tests following open heart surgery is helpful in evaluating the status of the postoperative patient.

Stability of factors V and VIII in thawed fresh frozen plasma units.

Factors V and VIII, commonly regarded as unstable in unfrozen plasma, were assayed at various intervals up to 24 hours using plasma from 20 thawed fresh frozen plasma (FFP) units. Comparisons were made between units stored at 4 and 25 C. The mean factor V value did not significantly change during the postthaw test period. Mean factor VIII activity prior to freezing was 121 per cent, dropped to 89 per cent four hours after thawing, and gradually decreased to 67 per cent at 24 hours. There was no difference between those units stored at 4 C and those stored at 25 C after thawing; therefore, refrigeration does not appear necessary for factor V or VIII stability up to 24 hours after thawing.