Vector competence of Virginia mosquitoes for Zika and Cache Valley viruses.

BACKGROUND: Vector-borne diseases are a major public health concern and cause significant morbidity and mortality. Zika virus (ZIKV) is the etiologic agent of a massive outbreak in the Americas that originated in Brazil in 2015 and shows a strong association with congenital ZIKV syndrome in newborns. Cache Valley virus (CVV) is a bunyavirus that causes mild to severe illness in humans and ruminants. In this study, we investigated the vector competence of Virginia mosquitoes for ZIKV and CVV to explore their abilities to contribute to potential outbreaks. METHODS: To determine vector competence, mosquitoes were fed a blood meal comprised of defibrinated sheep blood and virus. The presence of midgut or salivary gland barriers to ZIKV infection were determined by intrathoracic inoculation vs oral infection. After 14-days post-exposure, individual mosquitoes were separated into bodies, legs and wings, and saliva expectorant. Virus presence was detected by plaque assay to determine midgut infection, dissemination, and transmission rates. RESULTS: Transmission rates for Ae. albopictus orally infected (24%) and intrathoracically inoculated (63%) with ZIKV was similar to Ae. aegypti (48% and 71%, respectively). Transmission rates of ZIKV in Ae. japonicus were low, and showed evidence of a midgut infection barrier demonstrated by low midgut infection and dissemination rates from oral infection (3%), but increased transmission rates after intrathoracic inoculation (19%). Aedes triseriatus was unable to transmit ZIKV following oral infection or intrathoracic inoculation. CVV transmission was dose-dependent where mosquitoes fed high titer (ht) virus blood meals developed higher rates of midgut infection, dissemination, and transmission compared to low titer (lt) virus blood meals. CVV was detected in the saliva of Ae. albopictus (ht: 68%, lt: 24%), Ae. triseriatus (ht: 52%, lt: 7%), Ae. japonicus (ht: 22%, lt: 0%) and Ae. aegypti (ht: 10%; lt: 7%). Culex pipiens and Cx. restuans were not competent for ZIKV or CVV. CONCLUSIONS: This laboratory transmission study provided further understanding of potential ZIKV and CVV transmission cycles with Aedes mosquitoes from Virginia. The ability for these mosquitoes to transmit ZIKV and CVV make them a public health concern and suggest targeted control programs by mosquito and vector abatement districts.

Effects of mother-offspring and father-offspring dynamics on emerging adults' adjustment: The mediating role of emotion regulation.

The present study tested a theoretical model of emotion regulation between parent-offspring dynamics and emerging adults' adjustment. The mediating role of emotion regulation strategies, including cognitive reappraisal and expressive suppression, were investigated for the effects of mother-offspring and father-offspring dynamics on emerging adults' adjustment. A sample of 352 Chinese emerging adults in Hong Kong (230 female, 121 male) participated in this study. Participants were asked to complete a set of self-reported questionnaires. Findings based on structural equation modeling indicated that greater mother-offspring intimacy and father-offspring intimacy predicted emerging adults' better cognitive reappraisal and psychological, social, and general health. Greater mother-offspring conflict also predicted more expressive suppression and poorer psychological and social functioning. Distinctive mediation pathways as a function of parents' gender were identified. These findings enrich the literature for parent-offspring dynamics and emotion regulation as explanatory processes of emerging adults' adjustment.

The content and process of self-stigma in people with mental illness.

Although many individuals with mental illness may self-concur with the "content" of stigmatizing thoughts at some point in their lives, they may have varying degrees of habitual recurrence of such thoughts, which could exacerbate their experience of self-stigma and perpetuate its damaging effects on their mental health. Although it is important to understand the "process" of how self-stigmatizing thoughts are sustained and perpetuated over time, no research to date has conceptualized and distinguished the habitual process of self-stigma from its cognitive content. Thus, the present study aims to develop and validate a measure of the habitual process of self-stigma-the Self-stigmatizing Thinking's Automaticity and Repetition Scale (STARS). In this study, 189 individuals with mental illness completed the STARS, along with several explicit (self-report) and implicit (response latency) measures of theoretically related constructs. Consistent with theories of mental habit, an exploratory factor analysis of the STARS items identified a 2-factor structure that represents the repetition (4 items) and automaticity (4 items) of self-stigmatization. The reliability of the STARS was supported by a Cronbach's α of .90, and its validity was supported by its significant correlations with theoretical predictors (content of self-stigma, experiential avoidance, and lack of mindfulness), expected outcomes (decreased self-esteem, life satisfaction, and recovery), and the Brief Implicit Association Tests measuring the automatic processing of self-stigmatizing information. With the validation of the STARS, future research can consider both the content and process of self-stigma so that a richer picture of its development, perpetuation, and influence can be captured. (PsycINFO Database Record

Associations of symptoms, neurocognition, and metacognition with insight in schizophrenia spectrum disorders.

Many persons with schizophrenia experience poor insight and, as a result, are at risk for treatment non-adherence and numerous negative outcomes. However, to date, the etiology of poor insight has not yet been fully elucidated. One recent theory concerning the roots of poor insight in schizophrenia has proposed that it may result, in part, from impairments in metacognition, or the capacity to think about thinking. The present study thus aims to examine whether metacognition is associated with insight even after controlling for the effects of psychiatric symptomatology and neurocognition. In this study, 95 adults with a schizophrenia spectrum disorder were assessed on measures of insight (i.e., awareness of symptoms, treatment needs, and illness consequences), psychiatric symptoms (i.e., positive symptoms, negative symptoms, and general psychopathology), neurocognitive functions (i.e., executive function, memory, and attention), and metacognitive capacities (i.e., self-reflectivity and theory of mind). Univariate correlations followed by stepwise multiple regressions, which controlled for symptoms and neurocognition, indicated that both self-reflectivity and theory of mind were significantly linked with awareness of symptoms; theory of mind was linked with awareness of treatment needs; and self-reflectivity was linked with awareness of illness consequences. Importantly, these findings suggest that metacognitive capacities may be related to insight independent of concurrent psychiatric symptoms and neurocognitive deficits. Moreover, awareness of different facets of the illness may require contributions from different components of metacognition. Future research should investigate how existing metacognitive skill training programs could potentially be tailored, or modified, to help persons with schizophrenia to develop and enhance insight.

Attentional Bias Associated with Habitual Self-Stigma in People with Mental Illness.

As habitual self-stigma can have a tremendous negative impact on people with mental illness, it is of paramount importance to identify its risk factors. The present study aims to examine the potential contributory role of attentional bias in habitual self-stigma. People with mental illness having strong (n = 47) and weak (n = 47) habitual self-stigma completed a computerized emotional Stroop task which included stigma-related, positive, and non-affective words as stimuli. The strong habit group was found to exhibit faster color-naming of stigma-related words (compared to non-affective words), whereas the weak habit group showed no difference in the speed of response to different stimuli. These findings suggest that people with stronger habitual self-stigma may be more able to ignore the semantic meaning of stigma-related words and focus on the color-naming task. Moreover, people with stronger habitual self-stigma may have greater attentional avoidance of stigma-related material. The present study is the first to demonstrate a specific relationship between habitual self-stigma and biased processing of stigma-related information. In order to further determine the role and the nature of attentional bias in habitual self-stigma, future research should employ a broader range of experimental paradigms and measurement techniques to examine stigma-related attentional bias in people with mental illness.

Cardio-metabolic health risks in indigenous populations of Southeast Asia and the influence of urbanization.

BACKGROUND: South East Asia (SEA) is home to over 30 tribes of indigenous population groups who are currently facing rapid socio-economic change. Epidemiological transition and increased prevalence of non-communicable diseases (NCD) has occured. In Peninsular Malaysia, the Orang Asli (OA) indigenous people comprise 0 · 6% (150,000) of the population and live in various settlements. OA comprise three distinct large tribes with smaller sub-tribes. The three large tribes include Proto-Malay (sub-tribes: Orang Seletar and Jakun), Senoi (sub-tribes: Mahmeri and Semai), and Negrito (sub-tribes: Jehai, Mendriq and Batek). METHODS: We studied the health of 636 OA from seven sub-tribes in the Peninsular. Parameters that were assessed included height, weight, BMI and waist circumference whilst blood pressure, cholesterols, fasting blood glucose and HbA1c levels were recorded. We then analysed cardio-metabolic risk factor prevalences and performed multiple pair-wise comparisons among different sub-tribes and socio-economic clusters. RESULTS: Cardio-metabolic risk factors were recorded in the seven sub-tribes.. Prevalence for general and abdominal obesity were highest in the urbanized Orang Seletar (31 · 6 ± 5 · 7%; 66 · 1 ± 5 · 9%). Notably, hunter gatherer Jehai and Batek tribes displayed the highest prevalence for hypertension (43 · 8 ± 9 · 29% and 51 · 2 ± 15 · 3%) despite being the leanest and most remote, while the Mendriq sub-tribe, living in the same jungle area with access to similar resources as the Batek were less hypertensive (16.3 ± 11.0%), but displayed higher prevalence of abdominal obesity (27.30 ± 13.16%). CONCLUSIONS: We describe the cardio-metabolic risk factors of seven indigenous communities in Malaysia. We report variable prevalence of obesity, cholesterol, hypertension and diabetes in the OA in contrast to the larger ethnic majorities such as Malays, Chinese and Indians in Malaysia These differences are likely to be due to socio-economic effects and lifestyle changes. In some sub-tribes, other factors including genetic predisposition may also play a role. It is expected that the cardio-metabolic risk factors may worsen with further urbanization, increase the health burden of these communities and strain the government's resources.

The mediating role of self-stigma and unmet needs on the recovery of people with schizophrenia living in the community.

PURPOSE: For people with schizophrenia living in the community and receiving outpatient care, the issues of stigma and discrimination and dearth of recovery-oriented services remain barriers to recovery and community integration. The experience of self-stigma and unmet recovery needs can occur regardless of symptom status or disease process, reducing life satisfaction and disrupting overall well-being. The present study examined the mediating role of self-stigma and unmet needs in the relationship between psychiatric symptom severity and subjective quality of life. METHODS: Structural equation modeling and mediation analyses were conducted based on a community sample of 400 mental health consumers with schizophrenia spectrum disorders in Hong Kong. RESULTS: The model of self-stigma and unmet needs as mediators between symptom severity and subjective quality of life had good fit to the data (GFI = .93, CFI = .93, NNFI = .92, RMSEA = .06, χ(2)/df ratio = 2.62). A higher level of symptom severity was significantly associated with increased self-stigma (R (2) = .24) and a greater number of unmet needs (R (2) = .53). Self-stigma and unmet needs were in turn negatively related to subjective quality of life (R (2) = .45). CONCLUSIONS: It is essential that service providers and administrators make greater efforts to eliminate or reduce self-stigma and unmet recovery needs, which are associated with the betterment of the overall quality of life and long-term recovery. Both incorporating empowerment and advocacy-based interventions into recovery-oriented services and providing community-based, person-centered services to people based on personally defined needs are important directions for future recovery-oriented efforts.

Common factors: evidence-based practice and recovery.

The authors of this Open Forum argue that the evidence-based practice movement has not paid adequate attention to the wealth of evidence that supports a central role for the so-called common factors that constitute a therapeutic alliance between practitioner and patient. They also suggest that progress might be made in improving the quality of community-based care for persons with serious mental illnesses and addictions if training programs returned to an emphasis on helping practitioners develop the skills involved in cultivating trusting and empathic relationships with the people they serve. The authors draw connections between the skills needed for such relationships and the skills involved in providing recovery-oriented care and peer support, two recent developments that call for a reinvestment in basic relationship-building skills for all behavioral health practitioners.

Shared decision making in the recovery of people with schizophrenia: the role of metacognitive capacities in insight and pragmatic language use.

In the development of consumer-centered care for mental health consumers with schizophrenia, one key ingredient is consumer participation in health care decisions together with their healthcare providers, termed "shared decision making" (SDM). SDM requires consumers to form a number of complex ideas about themselves and their providers then use that knowledge to make sense of the illness and reach medical and psychosocial decisions. However, metacognitive deficits widely observed in schizophrenia might lead to poor insight and pragmatic language deficits in some consumers, disrupting the whole process by which a personal and consensually valid narrative account of psychiatric challenges is synthesized and flexibly evolved. Given the current understanding that it is possible to improve metacognition, in this article we summarize how Metacognitive Training (MCT) and individual psychotherapy could potentially be tailored, or modified, to help consumers to develop metacognitive capacities with an end goal of facilitating the SDM process. Consistent with the principles of consumer-defined recovery, we also suggest a strategy for engaging consumers in SDM dialogue based on "where the consumers are at". Providers are advised to be cognizant of their medically driven perspective and attempt to work with the consumers in the perspective of the consumers' own recovery goals.

Executive function in first-episode schizophrenia: a three-year prospective study of the Hayling Sentence Completion Test.

In recent decade, deficits in the mechanism of Supervisory Attentional System (SAS) have become increasingly influential in explaining the nature of dysexecutive syndrome experienced by schizophrenic patients. The SAS model is characterized by having a detailed sub-classification of specific executive function components, among which semantic inhibition has been investigated using the Hayling Sentence Completion Test (HSCT). Several studies thus far have indicated that schizophrenic patients show impairment in HSCT performance. However, HSCT data concerning first-episode patients is still scarce. Besides, as previous HSCT studies were all cross-sectional in nature, they were not able to assess changes in HSCT performance over time. In order to address the paucity of knowledge about the longitudinal trajectories and correlates of semantic inhibition deficits in early schizophrenia, this paper reports a three-year prospective study of HSCT performance in medication-naïve, first-episode patients with schizophrenia-spectrum disorders. HSCT performance was assessed in 34 patients at four times over a period of three years, while the 34 healthy controls were assessed once. We found that medication-naïve patients demonstrated impairment in the inhibition condition in HSCT as compared to controls, but not in the initiation condition. Such HSCT impairment gradually improved in the three years following the first psychotic episode; however, HSCT performance did not predict improvement in negative or positive symptoms over the three-year period. The present findings suggest that semantic inhibition impairment is a specific deficit in schizophrenia that may require early intervention efforts, with the goal of facilitating more successful verbal communication and thereby better interpersonal functioning.

Clinical and cognitive correlates of insight in first-episode schizophrenia.

This study aims to explore the relationship between clinical symptoms and cognitive functions with different insight dimensions in patients with first-episode schizophrenia. Seventy-nine patients were assessed following six months of treatment. Insight was assessed using the abridged version of Scale of Unawareness of Mental Disorder (SUMD). Symptoms were assessed using Positive and Negative Syndrome Scale (PANSS). Cognitive functions were assessed using the Modified Wisconsin Card Sorting Test (MWCST), semantic verbal fluency and the letter-number sequencing (LNS) test from the Wechsler Adult Intelligence Scale (WAIS). Positive, negative and disorganized symptoms were found to be correlated with overall insight and all three general insight dimensions. Only perseverative errors and categories completed of MWCST were correlated with overall insight. Perseverative errors and non-perseverative errors of MWCST were correlated with the awareness of medication effects; perseverative errors of MWCST were also correlated with the awareness of social consequence of the illness. These support the link between poor insight and impaired executive function particularly measured by MWCST. The specific correlation of cognitive functions and different dimensions of insight suggests different underlying mechanism within each dimension of insight. The combined model of symptomatology and cognitive function explained 20.6% to 36.4% of the variance in the lack of insight within the different dimensions. The modest combined relationship of clinical and cognitive function with insight suggests that the exploration of other models in relationship to different insight dimensions is important.

Theory of mind and paranoia in schizophrenia: a game theoretical investigation framework.

INTRODUCTION. Ample evidence already shows that theory of mind (ToM) is impaired in people with schizophrenia. Our aim was to critically review this literature. METHOD. We completed a selected review of the research literature on ToM in schizophrenia. RESULTS. Gaps in ToM research were identified. A specific relationship between impaired ToM and paranoid delusions, although intuitively reasonable from a theoretical basis, has only been demonstrated in a few studies. Psychometric properties of ToM tasks employed in these studies may be a confounding factor in drawing conclusions about the relationship. Because most ToM measures have focused on the third-person perspective, participants are not actively interacting. The tasks fail to capture the cognitive demands faced by individuals in real-life situations, and, in effect, are not a direct measure of ToM. CONCLUSIONS. Potential research areas are discussed. Since game theoretical paradigms require the direct involvement of the first person and situate the participant's interpersonal reasoning within an interactive context, they provide more ecologically valid experimental platforms than conventional questionnaire measures to assess ToM in schizophrenia research.

Perceptions of relapse risks following first-episode psychosis and attitudes towards maintenance medication: a comparison between nursing and social work professionals.

AIM: Existing clinical guidelines have not yet identified an optimal duration of maintenance antipsychotic drug treatment for stable, remitted first-episode psychosis patients. This study compares the perception of relapse risk and attitudes towards maintenance medication among professionals in nursing and social work fields who have direct clinical experience with first-episode psychosis patients. We explore a perception model that identifies the decision-making factors in the clinical dilemma between relapse and maintenance. METHODS: A specially designed survey addressing perceptions of relapse risk and optimal duration of maintenance treatment was conducted among 63 experienced health-care professionals (30 nurses and 33 social workers) in the field of early psychosis in Hong Kong. RESULTS: Two clinically relevant themes were identified that affected professionals' judgment on the optimal duration of maintenance treatment in stable, remitted first-episode psychosis patients: (i) the remission period; and (ii) professionals' perceptions of relapse risk involved in medication discontinuation. The remission period was a significant predictor of the perceived relapse risk. Compared with social workers, mental health nurses perceived a higher relapse risk for patients before Bonferroni adjustment. CONCLUSIONS: The three key clinical components discussed--remission period, perceived relapse risk and perceived optimal duration of maintenance treatment--are interconnected, collectively influencing health-care professionals' attitudes towards relapse and maintenance for patients. Our study identified differences between the perceptions of nursing and social work professionals, indicating a need for communication and discussion among professional groups in order to arrive at a coherent, efficacious team consensus.

Executive function in first-episode schizophrenia: a three-year longitudinal study of an ecologically valid test.

Executive function impairment is a key cognitive deficit in schizophrenia. However, traditional neuropsychological tests of executive function may not be sensitive enough to capture the everyday dysexecutive problems experienced by patients. Additionally, existing literature has been inconsistent about longitudinal changes of executive functions in schizophrenia. The present study focuses on examining the longitudinal change of executive functions in schizophrenia using the Modified Six Elements Test (MSET) that was developed based on the Supervisory Attentional System model and shown to be sensitive to everyday dysexecutive problems. In the present study, MSET performance was assessed in 31 medication-naïve first-episode schizophrenic patients at four times over a period of three years, while the 31 normal controls were assessed once. Patients demonstrated impairment in MSET as compared to controls. Importantly, the MSET impairment persisted from the medication-naïve state to clinical stabilization and the three years following the first psychotic episode though patients improved in a conventional executive test (Modified Wisconsin Card Sorting Test). Performance was not related to intelligence, educational level, symptom changes, age-of-onset, or duration of untreated psychosis. Better MSET performance at medication-naïve state predicted improvement in negative and positive symptoms over the three-year period. These findings may suggest that MSET impairment is a primary deficit in schizophrenia that occurs early in the course of the illness and remains stable irrespective of clinical state for at least three years following the first episode of schizophrenia.