Compassionate use of esketamine intranasal in patients with severe major depressive disorder resistant to the treatment.

BACKGROUND: Treatment-resistant depression (TRD) is defined as the failure of at least two antidepressants in adequate doses and timing during a major depressive episode. Esketamine intranasal (ESK-IN) has been approved by the Food and Drug Administration and the European Medicines Agency for the treatment of TRD in combination with other antidepressants. AIMS: To assess the effectiveness and tolerability of a sample of TRD patients who received treatment with ESK-IN as part of the compassionate use program. METHODS: A retrospective, observational study was carried out on patients with a diagnosis of TRD enrolled in the early access program of ESK-IN in nine centers. Effectiveness was assessed with the Montgomery-Asberg depression rating scale (MADRS) at four time points: baseline, 28, 90, and 180 days of treatment. RESULTS: The sample included 71 patients (70% women) with a mean baseline MADRS score of 38.27 ± 5.9 and total or partial work disability rates of 85%. ESK-IN treatment was associated with a statistically and clinically significant reduction in the severity of depressive symptoms at all time points assessed. The presence of side effects was common but the majority were mild in severity and resolved after the observation period. Those patients who received psychotherapy in combination with ESK-IN showed a significantly lower MADRS score at 90 and 180 days than those patients who did not undergo psychotherapy. CONCLUSION: ESK-IN has proven to be effective and safe in a clinical sample of patients with severe TRD. To optimize clinical outcomes, the pharmacological treatment for TRD should always be integrated into a comprehensive therapeutic plan that encompasses strategies such as psychotherapy, social support, and family interventions.

Validation of the synthetic model for the imaging heavy ion beam probe at the ASDEX Upgrade tokamak (invited).

Recent experiments at the ASDEX Upgrade tokamak have provided the first ever measurements from the imaging heavy-ion beam probe. In this work, we show that the developed simulation framework can reproduce qualitatively the measurement's observed shape and position. Quantitatively, we demonstrate that the model reproduces, within the experimental uncertainties, the observed signal levels. A detailed explanation of the synthetic model is presented, along with the calibration of the optical setup that reproduces the measurements.

Simulation of a scintillator-based fast ion loss detector for steady-state operation in Wendelstein 7-X (invited).

A quantitative theoretical framework has been created to model neutral beam injection and fast ion losses in the Wendelstein 7-X (W7-X) stellarator, including a novel method to develop synthetic diagnostics for fast ion loss detectors (FILDs) of many types, such as scintillating and Faraday Cup FILDs. This is the first time that this has been done in stellarator geometry with this level of fidelity, providing a way for fast ion losses to be predicted more precisely in future stellarator experiments and in W7-X. Simulations of the signal seen by a Faraday Cup FILD have been completed for multiple W7-X plasmas and show close agreement with the measured signals. This method is now applied to an actively water-cooled, scintillator-based FILD, which is currently in development to measure the fast ion loss distribution in W7-X in greater detail. The design makes use of a double slit to measure energy-and-pitch-angle-resolved losses of both co-going and counter-going fast ions. The diagnostic, which can be inserted to different radial positions, has been designed to withstand steady-state heat fluxes of up to 120 kW/m2 along with additional transient heat loads of 100 kW/m2 lasting for up to 20 s at a time. Simulations of W7-X standard magnetic configuration show up to 8 × 1013 (s-1 cm-2) ion fluxes onto the sensor from each neutral beam source and no signal from the counter-going slit. These simulations will help inform experimental proposals for future W7-X campaigns after installation of this diagnostic.

Cognitive reserve moderates the relationship between childhood maltreatment, objective and subjective cognition, and psychosocial functioning in individuals with first-episode psychosis.

OBJECTIVE: This study aimed to assess the relationship between childhood maltreatment (CM), objective and subjective cognition, and psychosocial functioning in adults with first-episode psychosis (FEP) by examining the moderating role of cognitive reserve (CR). A secondary objective was to explore whether unique CM subtypes (physical and/or emotional abuse, sexual abuse, physical and/or emotional neglect) were driving this relationship. METHOD: Sixty-six individuals with FEP (Mage = 27.3, SD = 7.2 years, 47% male) completed a comprehensive neuropsychological test battery, the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA), the Functioning Assessment Short Test (FAST), the Childhood Trauma Questionnaire (CTQ), and the Cognitive Reserve Assessment Scale in Health (CRASH). Linear regression analyses were conducted to evaluate the interaction effect of CR between CM and cognitive and psychosocial variables, controlling for age, sex, and social desirability (CTQ-denial-minimization). RESULTS: In adults with FEP overall CM interacted with CR to predict COBRA-subjective cognitive complaints, but not neurocognitive or psychosocial functioning. Sexual abuse and physical neglect interacted with CR to predict verbal memory. Most of the CM subtypes interacted with CR to predict FAST-leisure time, whereas only emotional neglect interacted with CR to predict FAST-interpersonal relationships. Overall, greater CR was related to better functioning. CONCLUSIONS: The current results indicate that associations between specific CM subtypes, subjective and objective cognition, and psychosocial domains are moderated through CR with greater functioning. Early interventions focused on CR seeking to improve cognitive and psychosocial outcomes, with emphasis on improving subjective cognitive functions would be beneficial for individuals with FEP and CM. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

First measurements of an imaging heavy ion beam probe at the ASDEX Upgrade tokamak.

The imaging heavy ion beam probe (i-HIBP) diagnostic has been successfully commissioned at ASDEX Upgrade. The i-HIBP injects a primary neutral beam into the plasma, where it is ionized, leading to a fan of secondary (charged) beams. These are deflected by the magnetic field of the tokamak and collected by a scintillator detector, generating a strike-line light pattern that encodes information on the density, electrostatic potential, and magnetic field of the plasma edge. The first measurements have been made, demonstrating the proof-of-principle of this diagnostic technique. A primary beam of 85/87Rb has been used with energies ranging between 60 and 72 keV and extracted currents up to 1.5 mA. The first signals have been obtained in experiments covering a wide range of parameter spaces, with plasma currents (Ip) between 0.2 and 0.8 MA and on-axis toroidal magnetic field (Bt) between 1.9 and 2.7 T. Low densities appear to be critical for the performance of the diagnostic, as signals are typically observed only when the line integrated density is below 2.0-3.0 × 1019 m-2 in the central interferometer chord, depending on the plasma shape. The strike line moves as expected when Ip is ramped, indicating that current measurements are possible. Additionally, clear dynamics in the intensity of the strike line are often observed, which might be linked to changes in the edge profile structure. However, the signal-to-background ratio of the signals is hampered by stray light, and the image guide degradation is due to neutron irradiation. Finally, simulations have been carried out to investigate the sensitivity of the expected signals to plasma density and temperature. The results are in qualitative agreement with the experimental observations, suggesting that the diagnostic is almost insensitive to fluctuations in the temperature profile, while the signal level is highly determined by the density profile due to the beam attenuation.

[Autism spectrum disorder: the impact of an online training strategy on the knowledge of the healthcare staff of a tertiary care hospital]. / Trastorno del espectro autista: impacto de una estrategia de formación en línea en los conocimientos del personal sanitario de un hospital de tercer nivel.

INTRODUCTION: Autism spectrum disorder (ASD) often presents related medical disorders that require specialised healthcare. Professionals in the health sector therefore face difficulties that require specific training in the healthcare needs of this population. AIM: The aim of this study is to quantify paediatric healthcare professionals' knowledge about ASD and to assess the impact of online training. SUBJECTS AND METHODS: It is a quasi-experimental, longitudinal, prospective before-and-after study; study subjects: health professionals; independent variable: online training in ASD; dependent variable: knowledge about ASD. An online training course was held for paediatric professionals to address the core characteristics of diagnosis, as well as the needs they present in the hospital context and the adaptations it is recommended that should be carried out. Fifty-eight healthcare professionals took part. RESULTS: An increase in knowledge about ASD was observed at the end of the intervention (from 73.9% to 85% according to the ASD background knowledge questionnaire), which showed that more than 90% of the participants had the highest level of knowledge about ASD. CONCLUSIONS: Online training courses are a useful and effective way to increase knowledge about ASD and the adaptations that are recommended in the hospital setting. More training in ASD should be made available in these settings.

TITLE: Trastorno del espectro autista: impacto de una estrategia de formación en línea en los conocimientos del personal sanitario de un hospital de tercer nivel.Introducción. El trastorno del espectro autista (TEA) frecuentemente presenta trastornos médicos relacionados que requieren una atención sanitaria especializada. En este sentido, los profesionales del ámbito sanitario se enfrentan a dificultades que precisan una formación específica en las necesidades sanitarias que presenta esta población. Objetivo. Cuantificar los conocimientos sobre el TEA de los profesionales sanitarios del área pediátrica y valorar el impacto de una formación en línea. Sujetos y métodos. Estudio cuasi experimental del antes y después, longitudinal y prospectivo; sujetos a estudio: profesionales sanitarios; variable independiente: formación en línea en TEA; variable dependiente: conocimiento sobre el TEA. Se llevó a cabo una formación en línea para profesionales del área de pediatría en la que se abordaron las características nucleares del diagnóstico, así como las necesidades que presentan en el contexto hospitalario y las adaptaciones que se recomiendan llevar a cabo. Participaron 58 profesionales sanitarios. Resultados. Se observó un aumento en el conocimiento sobre el TEA al finalizar la intervención (del 73,9 al 85% según el cuestionario de conocimientos previos del TEA), que mostró que más del 90% de los participantes tenía el grado máximo de conocimiento sobre el TEA. Conclusiones. Las formaciones en línea son un método para ampliar conocimiento útil y eficaz para aumentar el conocimiento sobre el TEA y las adaptaciones que se recomiendan en el ámbito hospitalario. Se recomienda aumentar la disponibilidad de formación sobre TEA en estos entornos.

Long-term efficacy of a new 6-session cognitive behavioral therapy for adults with attention-deficit/hyperactivity disorder: A randomized, controlled clinical trial.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that affects about 2.8 % of the adult population. Cognitive behavioral therapy (CBT) has been demonstrated to be the most effective psychological intervention for ADHD. The aim of this study was to explore the efficacy of a new 6-session CBT program in comparison with a 12-session CBT program for adults with ADHD at short- and long-term. METHODS: 81 adults with ADHD (58 % males; mean age = 41.27±9.26 years old) were randomly assigned to each treatment condition (6- or 12-session CBT). Validated instruments were used to assess ADHD symptoms, comorbidities (anxiety and depression), and functional impairments at post treatment, and at 3- and 6-month follow-up. RESULTS: A significant improvement in ADHD severity, comorbidities (anxiety and depression) and functional impairments were found in both CBT programs after treatment. Furthermore, this improvement was also reported at 3- and 6-month follow-up. CONCLUSION: The current study highlights that a 6-session CBT program is as effective as a 12-session CBT program for ADHD improvement at post treatment and follow-up. The newly developed 6-session CBT program can be used to treat a larger number of patients, reducing the financial cost.

Attention-deficit/hyperactivity disorder is associated with increased risk of cardiovascular diseases: A systematic review and meta-analysis.

Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with other psychiatric and physical diseases. However, available evidence on associations between ADHD and cardiovascular diseases (CVDs) is mixed. To systematically review, quantitatively synthesize, and appraise available evidence on the link between ADHD with CVDs, we searched relevant articles in PubMed, Embase, PsycINFO, and Web of Science from inception to May 1, 2022. Study quality was assessed by using the Newcastle-Ottawa Scale, and random-effects model meta-analyses were performed. A total of 18,391,169 (ADHD: n = 421,224) individuals from 11 studies were included in our systematic review and 8,196,648 (ADHD = 332,619) individuals from five studies were included in the main meta-analysis of adjusted estimates. Pooled estimates showed that ADHD was significantly associated with an increased risk of CVDs in analyses based on adjusted effect size (odds ratio (OR) = 1.96; 95% confidence interval (CI) = 1.19-2.23, Q = 140.74, P Q < 0.001, I 2 = 97.2%). When restricted among adults, the heterogeneity declined to null (OR = 1.73; 95% CI = 1.14-2.62, Q = 6.28, P Q = 0.10, I 2 = 6.28%), suggesting age might be the main source of heterogeneity. In subgroup analyses, we found increased risk of CVDs associated with ADHD across age groups, type of CVDs, and data sources. This systematic review and meta-analyses indicate that ADHD is associated with increased risk for CVDs, but further studies with various study designs are warranted to advance the understanding of the underlying mechanisms for the observed association between ADHD and CVDs. Additional research is also needed to resolve the role of ADHD medications which remains unclear due to the limited number of primary studies exploring this issue.

Genetic architecture of ADHD and overlap with other psychiatric disorders and cognition-related phenotypes.

Attention-deficit/hyperactivity disorder (ADHD) co-occurs with many other psychiatric disorders and traits. In this review, we summarize and interpret the existing literature on the genetic architecture of these comorbidities based on hypothesis-generating approaches. Quantitative genetic studies indicate that genetic factors play a substantial role in the observed co-occurrence of ADHD with many different disorders and traits. Molecular genetic correlations derived from genome-wide association studies and results of studies based on polygenic risk scores confirm the general pattern but provide effect estimates that are smaller than those from twin studies. The identification of the specific genetic variants and biological pathways underlying co-occurrence using genome-wide approaches is still in its infancy. The first analyses of causal inference using genetic data support causal relationships between ADHD and comorbid disorders, although bidirectional effects identified in some instances point to complex relationships. While several issues in the methodology and inferences from the results are still to be overcome, this review shows that the co-occurrence of ADHD with many psychiatric disorders and traits is genetically interpretable.

Corrigendum: Influence of clinical and neurocognitive factors in psychosocial functioning after a first episode non-affective psychosis: differences between males and females.

[This corrects the article DOI: 10.3389/fpsyt.2022.982583.].

Virtual self-conversation using motivational interviewing techniques to promote healthy eating and physical activity: A usability study.

Introduction: We aim to examine the usability of a Virtual Reality (VR) platform, called ConVRSelf, which has been designed to address the needs of People Living With Obesity (PLWO). Methods: Fourteen participants with a desire to eat healthier and exercise more (6 normal weight and 8 PLWO; Mean age = 41.86, SD = 13.89) were assigned to the experimental group (EG) or the control group (CG). EG participants, after being trained on motivational interviewing skills, engaged in a virtual self-conversation using embodiment and body swapping techniques, which aimed to normalize and resolve their ambivalence to change lifestyle habits. CG participants, embodied in their virtual bodies, participated in a pre-established discourse with a virtual counselor giving them psychoeducational advice about how to change lifestyle habits. A mixed-methods design was used, involving a semi-structured interview and self-report questionnaires, including readiness to change habits (Readiness Rulers), body ownership (Body Ownership Questionnaire, BOQ), and system usability (System Evaluation Questionnaire, SEQ). Thematic content analysis was carried out for qualitative data while statistical data analysis was carried out using SPSS 20.0. Results: Participants from both groups showed high readiness to change lifestyle (Readiness Rulers) before engaging with the virtual experiences, which was maintained at the same level after the interventions and their scores on the SEQ and BOQ were satisfactory. Regarding qualitative information obtained from the interviews, almost all participants found the VR experience to be novel, interesting, and enjoyable. A higher acceptability was observed among PLWO from the EG than normal weight participants from the same group, a promising finding for the ConVRSelf platform, which had been specifically designed to address the needs of PLWO. Conclusion: The ConVRSelf system is well-accepted by participants and is ready to be tested with PLWO in a clinical setting.

The Conners Continuous Performance Test CPT3™: Is it a reliable marker to predict neurocognitive dysfunction in Myalgic encephalomyelitis/chronic fatigue syndrome?

Introduction: The main objective is to delimit the cognitive dysfunction associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in adult patients by applying the Continuous Performance Test (CPT3™). Additionally, provide empirical evidence on the usefulness of this computerized neuropsychological test to assess ME/CFS. Method: The final sample (n = 225; 158 Patients/67 Healthy controls) were recruited in a Central Sensitization Syndromes (CSS) specialized unit in a tertiary hospital. All participants were administered this neuropsychological test. Results: There were significant differences between ME/CFS and healthy controls in all the main measures of CPT3™. Mainly, patients had a worse indicator of inattentiveness, sustained attention, vigilance, impulsivity, slow reaction time, and more atypical T-scores, which is associated with a likelihood of having a disorder characterized by attention deficits, such as Attention Deficit Hyperactivity Disorder (ADHD). In addition, relevant correlations were obtained between the CPT3™ variables in the patient's group. The most discriminative indicators of ME/CFS patients were Variability and Hit Reaction Time, both measures of response speed. Conclusion: The CPT3™ is a helpful tool to discriminate neurocognitive impairments from attention and response speed in ME/CFS patients, and it could be used as a marker of ME/CFS severity for diagnosing or monitoring this disease.

Active Control of Alfvén Eigenmodes by Externally Applied 3D Magnetic Perturbations.

The suppression and excitation of Alfvén eigenmodes have been experimentally obtained, for the first time, by means of externally applied 3D perturbative fields with different spatial spectra in a tokamak plasma. The applied perturbation causes an internal fast-ion redistribution that modifies the phase-space gradients responsible for driving the modes, determining, ultimately their existence. Hybrid kinetic-magnetohydrodynamic simulations reveal an edge resonant transport layer activated by the 3D perturbative field as the responsible mechanism for the fast-ion redistribution. The results presented here may help to control fast-ion driven Alfvénic instabilities in future burning plasmas with a significant fusion born alpha particle population.

Identifying pathways between psychiatric symptoms and psychosocial functioning in the general population.

The present study aims to identify pathways between psychiatric network symptoms and psychosocial functioning and their associated variables among functioning clusters in the general population. A cross-sectional web-based survey was administered in a total of 3,023 individuals in Brazil. The functioning clusters were derived by a previous study identifying three different groups based on the online Functioning Assessment Short Test. Networking analysis was fitted with all items of the Patient-Reported Outcomes Measurement Information System for depression and for anxiety (PROMIS) using the mixed graphical model. A decision tree model was used to identify the demographic and clinical characteristics of good and low functioning. A total of 926 (30.63%) subjects showed good functioning, 1,436 (47.50%) participants intermediate functioning, and 661 (21.86%) individuals low functioning. Anxiety and uneasy symptoms were the most important nodes for good and intermediate clusters but anxiety, feeling of failure, and depression were the most relevant symptoms for low functioning. The decision tree model was applied to identify variables capable to discriminate individuals with good and low functioning. The algorithm achieved balanced accuracy 0.75, sensitivity 0.87, specificity 0.63, positive predictive value 0.63 negative predictive value 0.87 (p<0.001), and an area under the curve of 0.83 (95%CI:0.79-0.86, p<0.01). Our results show that individuals who present psychological distress are more likely to experience poor functional status, suggesting that this subgroup should receive a more comprehensive psychiatric assessment and mental health care.

Assessment and accumulation of microplastics in sewage sludge at wastewater treatment plants located in Cádiz, Spain.

Sludge from Wastewater treatment plants (WWTPs) have been determined as a sink of microplastics (MP) removed from wastewater. The aim of this research work has been to evaluate the presence of these pollutants in the sludge of seven WWTPs (five urban and two industrial), located in southern Spain. Samples were collected in the primary, secondary and digested sludge matrixes, MPs were extracted following wet peroxide oxidation and the removal of cellulose, finally the samples were analyzed according to their abundance, size (from 100 µm to 5 mm), shape, colour, and polymer type. Subsequently, the data obtained on the WWTPs were compared, the main difference among the WWTPs and different sample points showed high heterogeneity in terms of abundance of microplastics, due to the differences in the sludge loaded, the processes and the type of sludge. The results from this study established that the most abundant shape was fibers; regarding the size, 100-355 µm fraction was the most abundant, showing that the amount of MPs increased when the size decreased. Regarding the type of polymers, 23 were identified by ATR-FTIR. Further, Acrylate, PE, EAA and PP were the most abundant found polymers. The presence of MPs in the digested sludge varied from 0.02 ± 0.006 MP g DW-1 to 57.18 ± 20.69 MP g DW-1 in the WWTP 6 (food industry) and WWTP 3 (urban city over 212,000 inhabitants), respectively; higher abundance of MPs found in the primary sludge in respect to secondary sludge; in concordance with the removal from wastewater line reported in other studies. The results obtained showed that MPs were widely present in sludge, becoming a sink of these pollutants, estimating that among 8.05 · 104 and 1.77 · 109 MPs · day-1 were loaded to sludge; therefore, these facilities act as a significant source of MPs into agriculture when sludge is used as soil amendment.

ADHD Remote Technology study of cardiometabolic risk factors and medication adherence (ART-CARMA): a multi-centre prospective cohort study protocol.

BACKGROUND: Emerging evidence points at substantial comorbidity between adult attention deficit hyperactivity disorder (ADHD) and cardiometabolic diseases, but our understanding of the comorbidity and how to manage cardiometabolic disease in adults with ADHD is limited. The ADHD Remote Technology study of cardiometabolic risk factors and medication adherence (ART-CARMA) project uses remote measurement technology to obtain real-world data from daily life to assess the extent to which ADHD medication treatment and physical activity, individually and jointly, may influence cardiometabolic risks in adults with ADHD. Our second main aim is to obtain valuable real-world data on adherence to pharmacological treatment and its predictors and correlates during daily life from adults with ADHD. METHODS: ART-CARMA is a multi-site prospective cohort study within the EU-funded collaboration 'TIMESPAN' (Management of chronic cardiometabolic disease and treatment discontinuity in adult ADHD patients) that will recruit 300 adults from adult ADHD waiting lists. The participants will be monitored remotely over a period of 12 months that starts from pre-treatment initiation. Passive monitoring, which involves the participants wearing a wrist-worn device (EmbracePlus) and downloading the RADAR-base Passive App and the Empatica Care App on their smartphone, provides ongoing data collection on a wide range of variables, such as physical activity, sleep, pulse rate (PR) and pulse rate variability (PRV), systolic peaks, electrodermal activity (EDA), oxygen saturation (SpO2), peripheral temperature, smartphone usage including social connectivity, and the environment (e.g. ambient noise, light levels, relative location). By combining data across these variables measured, processes such as physical activity, sleep, autonomic arousal, and indicators of cardiovascular health can be captured. Active remote monitoring involves the participant completing tasks using a smartphone app (such as completing clinical questionnaires or speech tasks), measuring their blood pressure and weight, or using a PC/laptop (cognitive tasks). The ART system is built on the RADAR-base mobile-health platform. DISCUSSION: The long-term goal is to use these data to improve the management of cardiometabolic disease in adults with ADHD, and to improve ADHD medication treatment adherence and the personalisation of treatment.

A comparison of medically serious suicide attempters admitted to intensive care units versus other medically serious suicide attempters.

BACKGROUND: Medically serious suicide attempts (MSSA) represent a subgroup of clinically heterogeneous suicidal behaviours very close to deaths by suicide. A simple definition of an MSSA is a suicide attempt with life-threatening consequences, regardless of the severity of the attempter's mental disorder. Few studies have specifically analysed the heterogeneity of MSSA. Therefore, the aim of this study is to describe the profile of individuals who made a highly severe MSSA and to compare those admitted to Intensive Care Units (ICU) - including Burn Units- with other MSSA admitted to other medical and surgical units. METHODS: The study sample consisted of 168 patients consecutively admitted to non-psychiatric wards from two public hospitals in Barcelona after an MSSA during a 3-year period. In order to select more severe MSSA, the minimum hospital stay was expanded from Beautrais' definition of ≥ 24 h to ≥ 48 h. Mean hospital stay was 23.68 (SD = 41.14) days. Patients needing ICU treatment (n = 99) were compared to other MSSArs (n = 69) that were admitted to other medical and surgical units, not requiring intensive care treatment, with an initial bivariant analysis followed by a logistic regression analysis using conditional entrance. RESULTS: Medically serious suicide attempters (MSSArs) spent more time hospitalized, more frequently reported recent stressful life events, were more likely to have at least one prior suicide attempt (SA) and their current attempt was more frequently non-planned, compared to the profile of MSSArs reported in previous studies. The most frequent method was medication overdose (67.3%) and jumping from heights (23.2%). Among those who chose more than one method (37.6%), the most frequent combination was medication overdose and drug use. Affective disorders and personality disorders were the most frequent diagnoses. Higher educational level, history of previous mental disorders and prior lifetime suicide attempts were significantly more frequent among those admitted to ICU compared to other MSSArs. Patients needing admission to ICU less frequently used self-poisoning and cuts. CONCLUSIONS: MSSA needing ICU admission can be regarded clinically as similar to attempts resulting in suicide. More research on this type of highly severe suicide behaviour is needed due to its serious implications both from a clinical and public health perspective.

Influence of clinical and neurocognitive factors in psychosocial functioning after a first episode non-affective psychosis: Differences between males and females.

Background: Deficits in psychosocial functioning are present in the early stages of psychosis. Several factors, such as premorbid adjustment, neurocognitive performance, and cognitive reserve (CR), potentially influence functionality. Sex differences are observed in individuals with psychosis in multiple domains. Nonetheless, few studies have explored the predictive factors of poor functioning according to sex in first-episode psychosis (FEP). This study aimed to explore sex differences, examine changes, and identify predictors of functioning according to sex after onset. Materials and methods: The initial sample comprised 588 individuals. However, only adults with non-affective FEP (n = 247, 161 males and 86 females) and healthy controls (n = 224, 142 males and 82 females) were included. A comprehensive assessment including functional, neuropsychological, and clinical scales was performed at baseline and at 2-year follow-up. A linear regression model was used to determine the predictors of functioning at 2-year follow-up. Results: FEP improved their functionality at follow-up (67.4% of both males and females). In males, longer duration of untreated psychosis (ß = 0.328, p = 0.003) and worse premorbid adjustment (ß = 0.256, p = 0.023) were associated with impaired functioning at 2-year follow-up, while in females processing speed (ß = 0.403, p = 0.003), executive function (ß = 0.299, p = 0.020) and CR (ß = -0.307, p = 0.012) were significantly associated with functioning. Conclusion: Our data indicate that predictors of functioning at 2-year follow-up in the FEP group differ according to sex. Therefore, treatment and preventative efforts may be adjusted taking sex into account. Males may benefit from functional remediation at early stages. Conversely, in females, early interventions centered on CR enhancement and cognitive rehabilitation may be recommended.

Conceptual study for velocity space resolved thermal ion loss detection in tokamaks.

A new concept for velocity space thermal ion loss detection is presented. This diagnostic provides pitch angle resolved measurements that are unfeasible with current diagnostics. It uses the same detection principle as the Fast-Ion Loss Detector with a scintillator as the active component and includes a double slit configuration to measure simultaneously the escaping counter- and co-current ions. Simulations show a gyroradius range between 0.15 and 1.00 cm with a resolution below 0.15 cm (for a gyroradius of 1 cm) and a pitch angle range between 30° and 150° with a resolution below 8° for both counter- and co-current ions. The formation of a sheath in front of the detector and its associated electric field may impact the detection principle. Preliminary simulations with a homogeneous electric field show a decrease in the measurable velocity space range, whereas the gyroradius and pitch angle resolution barely change. The strike map is sensitive to the sheath electric field.

The clinical course of comorbid substance use disorder and attention deficit/hyperactivity disorder: protocol and clinical characteristics of the INCAS study.

BACKGROUND: Substance use disorders (SUD) often co-occur with attention deficit hyperactivity disorder (ADHD). Although the short-term effects of some specific interventions have been investigated in randomized clinical trials, little is known about the long-term clinical course of treatment-seeking SUD patients with comorbid ADHD. AIMS: This paper presents the protocol and baseline clinical characteristics of the International Naturalistic Cohort Study of ADHD and SUD (INCAS) designed and conducted by the International Collaboration on ADHD and Substance Abuse (ICASA) foundation. The overall aim of INCAS is to investigate the treatment modalities provided to treatment-seeking SUD patients with comorbid ADHD, and to describe the clinical course and identify predictors for treatment outcomes. This ongoing study employs a multicentre observational prospective cohort design. Treatment-seeking adult SUD patients with comorbid ADHD are recruited, at 12 study sites in nine different countries. During the follow-up period of nine months, data is collected through patient files, interviews, and self-rating scales, targeting a broad range of cognitive and clinical symptom domains, at baseline, four weeks, three months and nine months. RESULTS: A clinically representative sample of 578 patients (137 females, 441 males) was enrolled during the recruitment period (June 2017-May 2021). At baseline, the sample had a mean age (SD) of 36.7 years (11.0); 47.5% were inpatients and 52.5% outpatients; The most prevalent SUDs were with alcohol 54.2%, stimulants 43.6%, cannabis 33.1%, and opioids 14.5%. Patients reported previous treatments for SUD in 71.1% and for ADHD in 56.9%. Other comorbid mental disorders were present in 61.4% of the sample: major depression 31.5%, post-traumatic stress disorder 12.1%, borderline personality disorder 10.2%. CONCLUSIONS: The first baseline results of this international cohort study speak to its feasibility. Data show that many SUD patients with comorbid ADHD had never received treatment for their ADHD prior to enrolment in the study. Future reports on this study will identify the course and potential predictors for successful pharmaceutical and psychological treatment outcomes. TRIAL REGISTRATION: ISRCTN15998989 20/12/2019.