Narrative enhancement and cognitive therapy (NECT) to improve social functioning in people with serious mental illness: study protocol for a stepped-wedge cluster randomized controlled trial.

BACKGROUND: Self-stigma is highly prevalent in serious mental illness (SMI) and is associated with poorer clinical and functional outcomes. Narrative enhancement and cognitive therapy (NECT) is a group-based intervention combining psychoeducation, cognitive restructuring and story-telling exercises to reduce self-stigma and its impact on recovery-related outcomes. Despite evidence of its effectiveness on self-stigma in schizophrenia-related disorders, it is unclear whether NECT can impact social functioning. METHODS: This is a 12-centre stepped-wedge cluster randomized controlled trial of NECT effectiveness on social functioning in SMI, compared to treatment as usual. One hundred and twenty participants diagnosed with schizophrenia, bipolar disorder or borderline personality disorder will be recruited across the 12 sites. The 12 centres participating to the study will be randomized into two groups: one group (group 1) receiving the intervention at the beginning of the study (T0) and one group (group 2) being a control group for the first 6 months and receiving the intervention after (T1). Outcomes will be compared in both groups at T0 and T1, and 6-month and 12-month outcomes for groups 1 and 2 will be measured without a control group at T2 (to evaluate the stability of the effects over time). Evaluations will be conducted by assessors blind to treatment allocation. The primary outcome is personal and social performance compared across randomization groups. Secondary outcomes include self-stigma, self-esteem, wellbeing, quality of life, illness severity, depressive symptoms and personal recovery. DISCUSSION: NECT is a promising intervention for reducing self-stigma and improving recovery-related outcomes in SMI. If shown to be effective in this trial, it is likely that NECT will be implemented in psychiatric rehabilitation services with subsequent implications for routine clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov NCT03972735 . Trial registration date 31 May 2019.

Student Self-Efficacy, Classroom Engagement, and Academic Achievement: Comparing Three Theoretical Frameworks.

Student self-efficacy, behavioral engagement, and emotional engagement are key factors for academic achievement. Research has yet to identify the developmental cascades linking these four constructs. Three theoretical frameworks, i.e., Self-Efficacy Theory, the Self-System Model of Motivational Development, and Expectancy-Value Theory, suggest different nexus. Following 671 students (51.8% girls) from their 4th to 6th grade, this study aims to assess competing hypotheses from these three frameworks in math. Three cross-lag models were tested to test each theoretical framework. A fourth and final model was tested to include the significant paths from the previous models. Mediation paths were also tested. Results mainly support assumptions from Self-Efficacy Theory, that is student self-efficacy and academic achievement are mutually associated from 4th to 6th grades. Some of the propositions of Expectancy-Value Theory were also supported. Self-efficacy was associated with later emotional engagement and academic achievement. However, emotional engagement in 5th grade was negatively associated with achievement in 6th grade and was not associated with behavioral engagement. Assumptions from the Self-System Model were not supported by the data. Testing the fourth model revealed an unexpected developmental cascade: 5th-grade self-efficacy mediated the association between 4th-grade achievement and 6th-grade emotional engagement. This last finding may have great implications for young adolescents as emotional engagement is an indicator of student well-being and intrinsic value of learning. Implications for theory validation and intervention targets for adolescents are discussed.

[Mathematical learning disability: A multiple origin? Examples of Turner and Fragile X syndromes]. / Troubles en mathématiques : une origine multiple ? L'exemple des syndromes de Turner et de l'X Fragile.

Problems in mathematics are a frequent major complaint in neuropediatric departments, for which there are two explanatory theoretical models: the hypothesis of a genetic and modular origin (with a number sense deficit) and a multidetermined origin. The purpose of this paper is to review the mathematical difficulties described in Turner syndrome and Fragile X syndrome, because a specific mathematical disorder is usually reported in these populations, supporting the existence of a number sense. Analysis of the literature reveals highly variable cognitive phenotypes in these populations, especially regarding mathematical abilities. Performance heterogeneity might be related to different factors such as the abilities needed to perform the task, the variability of definitions, the different tests used in the studies and the heterogeneity of the syndromes themselves. A number sense deficit is usually described in these syndromes, but variable cognitive impairments are also observed. The idea of a modular functioning is then debated and we argue for the necessity of a global cognitive evaluation approach.

RECIPE COMPLETION USING MACHINE LEARNING TECHNIQUES.

Completing a recipe is a non-trivial task, as the success of ingredient combinations depends on a multitude of factors such as taste, smell, texture, etc. The aim of our work is to build a model that adds one or more ingredients to a given number of ingredients. The idea is based on leftover ingredients in a fridge. A person could list the available ingredients in his or her fridge and the model would suggest some additional ingredients to create a full recipe.

[The use of psychodiagnostic tests in forensic psychiatric reports within the framework of internment. An exploratory study of records on internees in the judicial district of Ghent]. / Gebruik van testinstrumenten in psychiatrische deskundigenverslagen bij internering; een exploratief dossieronderzoek in het gerechtelijk arrondissement Gent.

BACKGROUND: In Belgium there is now a new law on the detention of mentally disordered offenders. The main problems with psychiatric reports compiled by experts concern the indistrict legal framework and the lack of financial resources; both of these factors may affect the quality of the reports. Earlier studies have shown that only a few standardised tests are used to substantiate the conclusions reached in the reports. AIM: To examine to what extent forensic psychiatrists use diagnostic tools to substantiate the conclusions in their reports. METHOD: We based our study on a sample consisting of 84 records of recent cases dealt with by the Committee for the Protection of Society (CPS) of the judicial district of Ghent. RESULTS: We found that diagnostic tools were used in 63% of the cases studied. CONCLUSION: In spite of the difficult circumstances in which a forensic psychiatrist has to work, test instruments were used regularly in diagnostics. Moreover, most of the test instruments used were considered acceptable according to the scientific literature. The study has shown the need for a clear-cut legal framework involving criteria that forensic psychiatrists must meet when conducting their research. Inspiration for these criteria is to be found in the Netherlands where psychiatrists are already working with a specific format for forensic psychiatric reports.

Crisis intervention models in the French-speaking countries.

The article presents the crisis intervention model devised by Andreoli (Geneva) which is currently being developed in most crisis units and emergency services in the French-speaking countries of Europe. Two clinical examples are presented: the Short Therapy Centre (Geneva, Switzerland) and the crisis unit of the Saint-Luc Clinic (Brussels, Belgium). The following aspects of these approaches are discussed: (a) the need for crisis intervention rather than a simple answer to emergency, (b) the need for crisis intervention in all acute psychiatric disorders and not only in psychosocial problems, (c) the need to integrate psychiatric hospitalization into a coherent mental health policy, (d) the need for well-trained and round-the-clock teams, (e) the need for continuity of care.

Emergencies and somatization.

The article presents the clinical profile of 72 patients with somatization seen by a psychiatric team at the request of somaticians in a emergency service in St Luc hospital (Brussels-Belgium). These include 37.5% of mood disorders, 11% of psychotic disorders and 20% of serious anxiety disorders. The psychiatric antecedents of these patients are very poor. Only the combined intervention of the somatician and the psychiatrist can improve the compliance and the level of psychiatric care which is very low.

[Functional somatic complaints in the emergency service and 4 year outcome]. / Plaintes somatiques fonctionnelles dans un service des urgences et leur devenir à 4 ans.

The article presents the clinical profile of 72 somatizations taking in charge by a psychiatric team in a emergency room. They represent mood disorders (37.5%), psychotic disorders (11%) and anxiety disorders (20%). The psychiatric antecedents are very poor. Their outcome after 4 years is good on the health sickness rating scale of Luborsky in 35% and very bad in 25%, particularly for symptomatic score. After their taking in charge in the emergency room, these patients go not much in psychiatric hospitals and in psychiatric consultations. This observation gives to this first intervention in the emergency room a very important rule.

[The role of the psychiatric nurse in an emergency service]. / La place de l'infirmière psychiatrique dans un service des urgences.

Since september 1989, 3 psychiatric nurses have been working with the crisis and psychiatric emergencies unit of the emergency service of Saint-Luc Hospital in Brussels (Belgium). In this paper, the authors examine the specific functions of psychiatric nurses in the taking in charge of psychiatric emergencies and functional somatic complaints, as well as their role in relation with the nursing team as a whole.

[Outcome of 89 psychiatric emergencies managed by 3 mental health centers in an emergency service]. / Devenir de la prise en charge par 3 centres de santé mentale de 89 urgences psychiatriques à partir d'un service des urgences.

This paper deals with the assessment after 2 years of the outcome of 89 psychiatric emergencies taking in charge in Saint-Luc hospital's (Brussels) emergency room, by 3 community mental health services. After the triangulation of the demand, in the emergency room, 91% of the patients go to the community mental health service. In 92.5% of cases, the crisis intervention is carried out by the same therapists they met in the emergency room with the collaboration of other members of the outpatient team. Crisis interventions are brief (less than 3 months) in 50% of cases, less than 1 years in 11.5% of cases and lead in 35% of cases to long-term in charge (more than 2 years: psychiatric and social follow-up).

[Psychiatric commitment and current legislation of 26 June 1990 relative to mentally ill persons]. / Collocation et nouvelle loi du 26 juin 1990 relative à la protection de la personne des malades mentaux.

A study on the psychiatric confinements in the Walloon region in the year 1984 allows to define the patient's psychopathology and the context of the requests. The new law of the 26 June 1990 relating to the protection of the mentally ill person will probably be used mostly in such situations. Its conditions of implementation, positive aspects and the difficulties it could create are detailed.

Bioactive glass particulate material as a filler for bone lesions.

Calcium-phosphate ceramic particulates are often used as filler material for enhanced repair of dental bone defects. Although evidence of bone ingrowth in the scaffold of these particles has been described, it is not observed consistently. Fibrous tissue often encapsulates these particles, which can subsequently become dispersed into the surrounding tissues or even exfoliated. The aim of the present study was to evaluate bioactive glass granules (Biogran) as a filler for osseous lesions, and to compare them with two commercially available Hydroxylapatite (HA) granules. The particulates were implanted in the jaws of five beagle dogs, resected and evaluated after 1, 2, 3, 6 and 12 months of implantation. Histological analysis revealed an improvement in repair of all the lesions. A massive osteoconductive bone growth was seen near the walls of the bony cavities, but in greater amounts around the bioactive glass granules than around the HA materials. On top of this massive growth a trabecular bone growth was observed in the centre of the bony cavities. These trabeculae were associated with the glass particles, which exhibited osteophilic properties, while fibrous tissue separated the bone tissue from the HA particles. The centres of many of the particles are excavated, and are subsequently filled by newly formed bone tissue. This internally formed bone tissue is not necessarily connected to the surrounding bone tissue, and functions as a nucleation site for further bone repair. For the mesenchymal cells within the eroded glass particles this inner environment acts as a stimulus to differentiate into osteoblasts and to start their osteogenetic potential. This phenomenon was not observed around the HA materials. If the latter were surrounded by fibrous tissue, disintegration of the surface by giant cells was observed.

[Crisis intervention, a response to the changing of psychiatric practice and the needs of the patient]. / L'intervention de crise, une réponse au changement de la pratique psychiatrique et de la demande du patient.

Traditional nosographic models are changing in psychiatry and becoming more polymorphic they can no longer be reduced to psychosis. The patient's demand has become paroxystic, more somatized. Pathological "acting" is frequent and calls upon the family and the life context of the patient, the latter demanding an immediate answer to his request for help. Crisis intervention appears as a new approach that allows both taking into account and benefiting from these changes in the clinic and the patient's demand. The example of a crisis team within the emergency service of a general hospital in Brussels is given in this paper.

[Knowledge about previous psychiatric care: is it a guaranty for therapeutic investment or a curse in psychiatric emergencies]. / Les antécédents de prise en charge: gage d'investissement thérapeutique ou de malédiction pour les urgences psychiatriques.

A sample of 755 psychiatric emergencies taken in charge in the emergency service of the St-Luc Hospital, Brussels, was divided into two groups: patients without psychiatric background (498) and patients having received previous psychiatric care (238). A background of psychiatric follow-up strongly influence the taking on and therapeutic decisions to be made by psychiatrists: its absence protects the patient and is seen as the guaranty of a good investment from the therapist while the existence of previous psychiatric treatment rather leads to hospital in lieu of crisis intervention, even when the crisis mechanisms are not significantly different in both samples.

[Crisis work challenged in emergencies]. / Le travail de la crise à l'épreuve de l'urgence.

This paper present a statistical study on the population of 775 psychiatric emergencies that arrived at the emergency service of Saint-Luc Hospital in Brussels (Belgium), between September 1, 1986 and December 31, 1986. The first request of the patient is medical, whereas his relatives expect that the abnormal and disturbing aspects of the patient's behaviour be taken in charge. From the point of view of diagnosis, two populations are clearly identified: psychiatric disorders (or psychiatry in emergency) and couple or family crisis situations, these representing the most specific aspect of psychiatric emergencies. The model of crisis interaction-intervention developed to address these emergencies is presented.

Interfacial analysis of fiber-reinforced bioactive glass dental root implants.

Bioactive glass can form an effective bond with bone. Essential for this connection are the interfacial reactions which lead to the development of a Si-rich film covered by a CaP-rich film. The presence of these layers can be demonstrated clearly by EDX analysis of fiber-reinforced bioactive glass and bulk bioactive glass implants installed for 4 and 16 months in the partial edentulous jaws of beagle dogs. EDX analysis reveals three types of microchemical interface. The first type develops when the implant is bonded to bone. Here, a smooth transition of the CaP profile can be observed between bioactive glass and the bone, thus providing for a compositional gradient between the implant and the surrounding tissues. The second type is seen when the implant surface is surrounded by fibrous tissue. This causes a discontinuity in the CaP profile. The third type is characterized by a gradual decrease in the Ca and P concentrations across the interface, caused by the presence of Ca and P in the fibrous tissue near the implant surface. This suggests that the interface is dynamic in time and transforms to a functionally better optimized interface. EDX analysis does not reveal any metal fiber ion contamination of the outer glass rim of the implant. When stainless-steel or wrought Co-Cr alloy is exposed to the surrounding fluids, the interfacial osteogenesis is disturbed, possibly by a synergistic effect of glass ions and metal ions. Exposure of titanium does not interfere with this osteogenesis. The bone bonding can also be influenced by surgical trauma. However, with precise implantation techniques, an enhancement of bone growth by osteoconductivity can be measured.

Histological and histomorphometrical analysis of bioactive glass and fibre reinforced bioactive glass dental root implants.

Bioactive glass has the ability to bond with bone, but it cannot be used as a load bearing device due to its limited mechanical properties. By reinforcing bioactive glass with a ductile second phase, a structurally reliable material is obtained. The aim of the present study was to evaluate histologically and morphometrically the interfacial behaviour of submerged composite dental root implants. Therefore, bulk and composite implants were subgingivally installed in the partially edentulous jaws of Beagle dogs and harvested after 4 and 16 months. Histologically, the connection between the implants and bone tissue could be clearly demonstrated. This bone connection is mainly located at the cortical bone level. In the vicinity of the infraalveolar nerve a fibrous tissue contact was found. It is shown that surgical trauma, motion at the glass to tissue interface, and gross ion dissolution from the material adversely affect the interfacial osteogenesis. If these factors are controlled, bone bonding is found over a larger area than the initial area of contact between the implant and bone tissue. This means that bone grows out along the implant surface, starting from the initial contact area. No difference was observed between the interfacial behaviour of bulk bioactive glass and intact fibre reinforced bioactive glass implants.