Anti-glutamic acid decarboxylase antibody screening in first-episode psychosis.

OBJECTIVE: The Royal Australian and New Zealand College of Psychiatrists recommends screening for a range of antibodies in first-episode psychosis, including anti-glutamic acid decarboxylase antibodies. Glutamic acid decarboxylase antibody-associated encephalitis occurs with high antibody titres and may cause cognitive dysfunction, seizures and psychiatric symptoms. However, glutamic acid decarboxylase antibodies are more frequently found in lower titre in association with other autoimmune disorders (such as diabetes mellitus type 1) and in healthy individuals. The utility of testing unselected populations of consumers with psychosis is unclear. The psychiatric manifestations of this disorder are also poorly described. METHODS: First, systematic review of cohort and case-control studies that tested for IgG glutamic acid decarboxylase antibodies in psychiatric populations was conducted. Random-effects meta-analysis of odds ratio for antibody positivity in cases with psychosis and controls assessed prevalence. Second, literature review of all published cases and case series of glutamic acid decarboxylase antibody-associated limbic encephalitis was assessed for frequency and description of psychotic symptoms. RESULTS: There were 17 studies, in which 2754 individuals with psychotic disorders were tested for glutamic acid decarboxylase IgG antibodies. Thirty-one consumers with psychosis (0.7%) had positive glutamic acid decarboxylase antibodies compared to 24 controls (1.0%), all at low titre and not fulfilling diagnostic criteria for autoimmune encephalitis. Meta-analysis found no significant difference in rates of glutamic acid decarboxylase antibody positivity (odds ratio = 1.8, 95% confidence interval: [0.90, 3.63]). Literature review found 321 cases of glutamic acid decarboxylase antibody-associated limbic encephalitis, with psychosis in 15 (4.3%) cases. Clinical screening would have identified all cases that presented to psychiatric services. CONCLUSION: Glutamic acid decarboxylase antibodies were uncommon in consumers with psychosis, with no significant difference in prevalence from controls and no cases of encephalitis identified. In cases with established glutamic acid decarboxylase antibody-associated limbic encephalitis, psychotic symptoms were uncommon and identifiable by clinical assessment. Targeted antibody testing guidelines should be further considered.

Working towards success in the Royal Australian and New Zealand College of Psychiatrists Modified Essay Question Exam.

OBJECTIVE: To describe an approach to support Royal Australian and New Zealand College of Psychiatrists (RANZCP) trainees achieve success in the Modified Essay Question (MEQ) examination. METHOD: Synthesis of the opinion of the authorship encompassing a range of relevant stakeholders, supported by a qualitative content analysis of published examination feedback from the RANZCP Committee for Examinations. RESULTS: In approaching the MEQs, candidates are encouraged to (1) read the scenario and questions carefully, (2) answer questions broadly and with justification, (3) manage time effectively, (4) undertake deliberate practice in preparation, and (5) 'check your own pulse' (i.e. limit the detrimental impact of anxiety on performance). CONCLUSION: Preparing for the MEQ examination through deliberate practice will help candidates become competent psychiatrists. The ability to critically think in clinical practice, a key focus of this assessment, is an essential skill all psychiatrists need to develop and maintain.

'Stranger than Fiction': a description of an online essay examination preparation club for Queensland trainees.

OBJECTIVE: To describe an online essay-style examination preparation group. METHODS: The process of the establishment - including recruitment, rules and characteristics - of 'Stranger than Fiction' is outlined. RESULTS: Over the 10-week period, 66 essays were submitted, and 40 essays were marked. Sixteen out of 30 registered candidates submitted at least one essay, and 11 out of 17 registered markers marked at least one essay. CONCLUSION: 'Stranger than Fiction' is a novel approach to create a supportive environment where trainees are given opportunities to practise critical essay questions.

A flagellum-specific chaperone facilitates assembly of the core type III export apparatus of the bacterial flagellum.

Many bacteria move using a complex, self-assembling nanomachine, the bacterial flagellum. Biosynthesis of the flagellum depends on a flagellar-specific type III secretion system (T3SS), a protein export machine homologous to the export machinery of the virulence-associated injectisome. Six cytoplasmic (FliH/I/J/G/M/N) and seven integral-membrane proteins (FlhA/B FliF/O/P/Q/R) form the flagellar basal body and are involved in the transport of flagellar building blocks across the inner membrane in a proton motive force-dependent manner. However, how the large, multi-component transmembrane export gate complex assembles in a coordinated manner remains enigmatic. Specific for most flagellar T3SSs is the presence of FliO, a small bitopic membrane protein with a large cytoplasmic domain. The function of FliO is unknown, but homologs of FliO are found in >80% of all flagellated bacteria. Here, we demonstrate that FliO protects FliP from proteolytic degradation and promotes the formation of a stable FliP-FliR complex required for the assembly of a functional core export apparatus. We further reveal the subcellular localization of FliO by super-resolution microscopy and show that FliO is not part of the assembled flagellar basal body. In summary, our results suggest that FliO functions as a novel, flagellar T3SS-specific chaperone, which facilitates quality control and productive assembly of the core T3SS export machinery.