Beam steering by liquid crystal elastomer fibres.

The problem of utilizing a laser beam as an information vehicle and dividing it into different channels is an open problem in the telecommunication field. The switching of a signal into different ports has been demonstrated, to date, by employing complex devices and mechanisms such as the electro optic effect, microelectromechanical system (MEMS) mirrors, or liquid crystal-based spatial light modulators (SLMs). We present here a simple device, namely a mirror held by a liquid crystal elastomer (LCE) fibre, as an optically and remotely driven beam steerer. In fact, a considered signal (laser beam) can be addressed in every in-plane direction by controlling the fibre and mirror rotation, i.e., the deflected probe beam angle. Such movement is possible due to the preparation of LCE fibres able to rotate and contract under a selective light stimulus. By adjusting the irradiation stimulus power, elastic fibres are able to rotate with a specific angle, performing more than one complete revolution around their axis. The described movement is perfectly reversible as soon as the stimulus is removed.

[Working effectively towards rehabilitation goals: long-term outcome of a randomised controlled trial of the Boston psychiatric rehabilitation approach]. / Effectiever werken aan rehabilitatiedoelen: langetermijnuitkomsten van een gerandomiseerde studie naar individuele rehabilitatiebenadering.

BACKGROUND: In the Netherlands the Boston psychiatric rehabilitation approach (bpr) is one of the most widely implemented rehabilitation methods. So far, little research has been done on the efficacy of this approach. AIM: To investigate the effect of bpr on the attainment of personal rehabilitation goals, social functioning and empowerment and on care requirements and quality of life in persons with severe mental illness (smi) in the Netherlands. METHOD: In a multicentre randomised controlled trial (rct: CLINICAL TRIAL REGISTRATION NUMBER: isrctn73683215) patients with smi were randomly assigned to bpr (n = 80) or 'care as usual' (cau; n = 76). The primary outcome was the attainment of the rehabilitation goal as formulated by the patient. The secondary outcomes were a change in the work situation and in the degree of independent living, in care requirements (Camberwell Assessment of Needs), in empowerment (Personal Empowerment Scale) and in the quality of life (who-qol). The effects were tested at 12 and 24 months. RESULTS: The degree of goal attainment was substantially higher in bpr at both 12 months (adjusted risk difference: 16%; 95%ci, 2 to 31; nnt = 7) and 24 months (adjusted risk difference: 21%, 95%ci, 4% to 38%; nnt = 5). The approach was also more effective in the area of societal participation (bpr: 21% adjusted increase, cau: 0% adjusted increase; nnt = 5), but not in the other secondary outcome measures. CONCLUSION: The results suggest that bpr is effective in supporting patients with smi to reach self-formulated rehabilitation goals and in enhancing their societal participation.

[Functional remission of people with serious mental illness (SMI): psychometric properties of a new ROM-instrument]. / Functionele remissie bij mensen met een ernstige psychiatrische aandoening; psychometrische eigenschappen van een nieuw ROM-instrument.

BACKGROUND: Instruments are used for routine outcome monitoring of patients with severe mental illness in order to measure psychiatric symptoms, care needs and quality of life. By adding an instrument for measuring functional remission a more complete picture can be given of the complaints, the symptoms and general functioning, which can give direction to providing care for patients with severe mental illness. AIM: To describe the development and testing of a new instrument of functional remission (FR) among people with a psychotic disorder or another serious mental disorder (SMI) as an addition to the symptomatic remission (SR), according to international criteria. METHOD: The FR-assessment involves assessment by a mental health professional who conducts a semi-structured interview with the patient and his or her family and/or uses patient files relating to the three areas of functioning: daily living and self-care; work, study and housekeeping; and social contacts. These areas are rated on a three-point scale of 0: independent; 1: partially independent; 2: dependent. The assessment covers a period of six months, in accordance with the measurement of symptomatic remission and should be part of regular routine outcome monitoring (ROM) procedures. The FR-instrument was used in 2012 with 840 patients from eight Dutch mental care institutions and included a one-year follow-up among 523 patients (response 62%). RESULTS: The results showed that the instrument is relatively easily to complete. It was also relevant for clinical practice, although further research is needed because of the raters' low response. Intra- and inter-rater reliability, discriminating and convergent validity, and sensitivity to change were rated sufficient to good. CONCLUSION: If the FR-instrument becomes part of regular ROM-procedures and is used as a measure of societal participation, it could be a useful addition to current measures of symptomatic remission.

Childhood abuse and neglect in relation to the presence and persistence of psychotic and depressive symptomatology.

BACKGROUND: The association between childhood trauma and psychotic and depressive symptomatology is well established. However, less is known about the specificity and course of these symptoms in relation to childhood trauma. METHOD: In a large sample (n = 2765) of patients with psychosis (n = 1119), their siblings (n = 1057) and controls (n = 589), multivariate (mixed-effects) regression analyses with multiple outcomes were performed to examine the association between childhood trauma and psychotic and depressive symptomatology over a 3-year period. RESULTS: A dose-response relationship was found between childhood trauma and psychosis. Abuse was more strongly associated with positive symptoms than with negative symptoms whereas the strength of the associations between neglect and positive and negative symptoms was comparable. In patients, similar associations between childhood trauma and psychotic or depressive symptoms were found, and in siblings and controls, stronger associations were found between trauma and depressive symptomatology. Childhood trauma was not related to a differential course of symptoms over a 3-year time period. CONCLUSIONS: In congruence with earlier work, our findings suggest that childhood trauma, and abuse in particular, is associated with (subthreshold) psychosis. However, childhood trauma does not seem to be associated with a differential course of symptoms, nor does it uniquely heighten the chance of developing (subthreshold) psychotic symptomatology. Our results indicate that trauma may instead contribute to a shared vulnerability for psychotic and depressive symptoms.

Beam focalization in reflection from flat dielectric subwavelength gratings.

We experimentally demonstrate the recently predicted effect of near-field focusing for light beams from flat dielectric subwavelength gratings (SWGs). This SWGs were designed for visible light 532 nm and fabricated by direct laser writing in a negative photoresist, with the refractive index n=1.5 and the period d=314 nm. The laterally invariant gratings can focus light beams without any optical axis to achieve the transversal invariance. We show that focal distances can be obtained up to 13 µm at normal reflection for TE polarization.

Factors contributing to the duration of untreated psychosis.

BACKGROUND: Shortening the duration of untreated psychosis (DUP) - with the aim of improving the prognosis of psychotic disorders - requires an understanding of the causes of treatment delay. Current findings concerning several candidate risk factors of a longer DUP are inconsistent. Our aim was to identify factors contributing to DUP in a large sample that represents the treated prevalence of non-affective psychotic disorders. METHOD: Patients with a non-affective psychotic disorder were recruited from mental health care institutes from 2004 to 2008. Of the 1120 patients enrolled, 852 could be included in the present analysis. Examined candidate factors were gender, educational level, migration status, premorbid adjustment and age at onset of the psychotic disorder. DUP was divided into five ordinal categories: less than one month, one month to three months, three months to six months, six months to twelve months and twelve months and over. An ordinal logistic regression analysis was used to identify the risk factors of a longer DUP. RESULTS: Median DUP was less than one month (IQR 2). The factors migration status (p=0.028), age at onset of the psychotic disorder (p=0.003) and gender (p=0.034) were significantly associated with DUP in our analysis. CONCLUSION: First generation immigrant patients, patients with an early onset of their psychotic disorder and male patients seem at risk of a longer DUP. These findings can assist in designing specific interventions to shorten treatment delay.

Insight change in psychosis: relationship with neurocognition, social cognition, clinical symptoms and phase of illness.

OBJECTIVE: Impaired insight is an important and prevalent symptom of psychosis. It remains unclear whether cognitive disturbances hamper improvements in insight. We investigated the neurocognitive, social cognitive, and clinical correlates of changes in insight. METHOD: One hundred and fifty-four patients with a psychotic disorder were assessed at baseline (T0 ) and after three years (T3 ) with the Birchwood Insight Scale, the Positive And Negative Syndrome Scale, measures of neurocognition and social cognition. Linear regression analyses were conducted to examine to what extend neurocognition, social cognition, clinical symptoms and phase of illness could uniquely predict insight change. Subsequently, changes in these factors were related to insight change. RESULTS: Better neurocognitive performance and fewer clinical symptoms at baseline explained insight improvements. The additional effect of clinical symptoms over and above the contribution of neurocognition was significant. Together, these factors explained 10% of the variance. Social cognition and phase of illness could not predict insight change. Changes in clinical symptoms, but not changes in neurocognitive performance were associated with insight change. CONCLUSION: Neurocognitive abilities may predict, in part, the development of insight in psychosis.

Exploiting breakdown of the similarity relation for diffuse light transport: simultaneous retrieval of scattering anisotropy and diffusion constant.

As manifested in the similarity relation of diffuse light transport, it is difficult to assess single scattering characteristics from multiply scattered light. We take advantage of the limited validity of the diffusion approximation of light transport and demonstrate, experimentally and numerically, that even deep into the multiple scattering regime, time-resolved detection of transmitted light allows simultaneous assessment of both single scattering anisotropy and scattering mean free path, and therefore also macroscopic parameters like the diffusion constant and the transport mean free path. This is achieved via careful assessment of early light and matching against Monte Carlo simulations of radiative transfer.

Risk assessment and shared care planning in out-patient forensic psychiatry: cluster randomised controlled trial.

BACKGROUND: Forensic psychiatry aims to reduce recidivism and makes use of risk assessment tools to achieve this goal. Various studies have reported on the predictive qualities of these instruments, but it remains unclear whether their use is associated with actual prevention of recidivism in clinical care. AIMS: To test whether an intervention combining risk assessment and shared care planning is associated with a reduction in violent and criminal behaviour. METHOD: A cluster randomised controlled trial (Netherlands Trial Register number NTR1042) was conducted in three out-patient forensic psychiatric clinics. The intervention comprised risk assessment with the Short Term Assessment of Risk and Treatability (START) and a shared care planning protocol formulated according to shared decision-making principles. The control group received usual care. The outcome consisted of the proportion of clients with violent or criminal incidents at follow-up. RESULTS: In total 58 case managers and 632 of their clients were included. In the intervention group (n = 310), 65% received the intervention at least once. Findings showed a general treatment effect (22% of clients with an incident at baseline v. 15% at follow-up, P<0.01) but no significant difference between the two treatment conditions (odds ratio (OR) = 1.46, 95% CI 0.89-2.44, P = 0.15). CONCLUSIONS: Although risk assessment is common practice in forensic psychiatry, our results indicate that the primary goal of preventing recidivism was not reached through risk assessment embedded in shared decision-making.

Mapping local charge recombination heterogeneity by multidimensional nanospectroscopic imaging.

As materials functionality becomes more dependent on local physical and electronic properties, the importance of optically probing matter with true nanoscale spatial resolution has increased. In this work, we mapped the influence of local trap states within individual nanowires on carrier recombination with deeply subwavelength resolution. This is achieved using multidimensional nanospectroscopic imaging based on a nano-optical device. Placed at the end of a scan probe, the device delivers optimal near-field properties, including highly efficient far-field to near-field coupling, ultralarge field enhancement, nearly background-free imaging, independence from sample requirements, and broadband operation. We performed ~40-nanometer-resolution hyperspectral imaging of indium phosphide nanowires via excitation and collection through the probes, revealing optoelectronic structure along individual nanowires that is not accessible with other methods.

Age at onset of non-affective psychosis in relation to cannabis use, other drug use and gender.

BACKGROUND: Cannabis use is associated with an earlier age at onset of psychotic illness. The aim of the present study was to examine whether this association is confounded by gender or other substance use in a large cohort of patients with a non-affective psychotic disorder. METHOD: In 785 patients with a non-affective psychotic disorder, regression analysis was used to investigate the independent effects of gender, cannabis use and other drug use on age at onset of first psychosis. RESULTS: Age at onset was 1.8 years earlier in cannabis users compared to non-users, controlling for gender and other possible confounders. Use of other drugs did not have an additional effect on age at onset when cannabis use was taken into account. In 63.5% of cannabis-using patients, age at most intense cannabis use preceded the age at onset of first psychosis. In males, the mean age at onset was 1.3 years lower than in females, controlling for cannabis use and other confounders. CONCLUSIONS: Cannabis use and gender are independently associated with an earlier onset of psychotic illness. Our findings also suggest that cannabis use may precipitate psychosis. More research is needed to clarify the neurobiological factors that make people vulnerable to this precipitating effect of cannabis.

The effects of guided discontinuation of antipsychotics on neurocognition in first onset psychosis.

OBJECTIVE: To assess the effects of second generation antipsychotics on neurocognitive function in patients with stable remission of first episode psychosis. METHODS: Fifty-three patients with first onset psychosis in the schizophrenia spectrum entered a randomised controlled trial of guided discontinuation (GD) versus maintenance treatment (MT) with second generation antipsychotics. A comprehensive neurocognitive test battery was administered at the time of remission and shortly after dose reduction or discontinuation (GD-group) or at the same time in the MT-group. RESULTS: With the exception of negative symptoms, PANSS scores decreased over time and neurocognition improved significantly on most tests in both groups. The GD-group, however, improved significantly more than the MT-group on three neurocognitive measures in the domain of speed of processing. CONCLUSION: These data suggest that, in first episode patients, dose reduction or discontinuation of second generation antipsychotics after stable remission is achieved, might improve neurocognitive function more than continuing second generation antipsychotics, suggesting a negative role for second generation antipsychotics, specifically in the domain of speed of processing.

A systematic review of instruments to measure depressive symptoms in patients with schizophrenia.

BACKGROUND: Depressive symptoms require accurate recognition and monitoring in clinical practice of patients with schizophrenia. Depression instruments developed for use in depressed patients may not discriminate depressive symptoms from negative psychotic symptoms. OBJECTIVE: We reviewed depression instruments on their reliability and validity in patients with schizophrenia. METHODOLOGY: A systematic literature search was carried out in three electronic databases. Psychometric properties were extracted for those instruments of which reliability, divergent, concurrent and predictive validity were reported in one or more publications. RESULTS: Forty-eight publications described the reliability and validity of six depression instruments in patients with schizophrenia. The only self-report was the Beck Depression Inventory (BDI). The Brief Psychiatric Rating Scale-Depression subscale (BPRS-D), Positive and Negative Syndrome Scale-Depression subscale (PANSS-D), Hamilton Rating Scale for Depression (HAMD), Montgomery Asberg Depression Rating Scale (MADRS) and Calgary Depression Scale for Schizophrenia (CDSS) were clinician rated. All instruments were reliable for the measurement of depressive symptoms in patients with schizophrenia. The CDSS most accurately differentiated depressive symptoms from other symptoms of schizophrenia (divergent validity), correlated well with other depression instruments (concurrent validity), and was least likely to miss cases of depression or misdiagnose depression (predictive validity). CONCLUSIONS: We would recommend to use the CDSS for the measurement of depressive symptoms in research and in daily clinical practice of patients with schizophrenia. A valid self-report instrument is to be developed for the use in clinical practice.

Auditory hallucinations in childhood: associations with adversity and delusional ideation.

BACKGROUND: Previous work suggests that exposure to childhood adversity is associated with the combination of delusions and hallucinations. In the present study, associations between (severity of) auditory vocal hallucinations (AVH) and (i) social adversity [traumatic experiences (TE) and stressful events (SE)] and (ii) delusional ideation were examined. METHOD: A baseline case-control sample of children with and without AVH were re-assessed on AVH after 5 years and interviewed about the experience of social adversity and delusions. RESULTS: A total of 337 children (mean age 13.1 years, S.D.=0.5) were assessed: 40 children continued to hear voices that were present at baseline (24%, persistent group), 15 heard voices only at follow-up (9%, incident group), 130 children no longer reported AVH that were present at baseline (remitted group) and 152 never heard voices (referent group). Both TE and SE were associated with both incident and persistent AVH, as well as with greater AVH severity and delusional ideation at follow-up. In addition, the combination of AVH and delusions displayed a stronger association with TE and SE compared with either AVH or delusions alone. CONCLUSIONS: Early childhood AVH are mostly benign and transitory. However, experience of social adversity is associated with persistence, severity and onset of new AVH closer to puberty, and with delusional ideation.

The course of depressive symptoms and prescribing patterns of antidepressants in schizophrenia in a one-year follow-up study.

BACKGROUND: Antidepressants are frequently prescribed in patients with psychotic disorders, but little is known about their effects in routine clinical practice. The objective was to investigate the prescribing patterns of antidepressants in relation to the course of depressive symptoms in patients with psychotic disorders. METHODS: A cohort of 214 Dutch patients with psychotic disorders received two assessments of somatic and psychiatric health, including a clinician-rated screening for depressive symptoms, as part of annual routine outcome monitoring. RESULTS: Depressive symptoms were prevalent among 43% (93) of the patients. Antidepressants were prescribed for 40% (86) of the patients and the majority 83% (71) continued this therapy after one year. Multivariable analysis showed that patients with more severe psychopathology had a higher risk to develop depressive symptoms the following year (OR [95% CI]=0.953 [0.912-0.995]). For patients with depressive symptoms at baseline, polypharmacy was a potential risk factor to keep having depressive symptoms (OR [95% CI]=1.593 [1.123-2.261]). Antidepressant use was not an independent predictor in both analyses. CONCLUSIONS: Routine outcome monitoring in patients with psychotic disorders revealed a high prevalence of depressive symptoms. Antidepressants were frequently prescribed and continued in routine clinical practice.

Association of treatment delay, migration and urbanicity in psychosis.

BACKGROUND: Several factors may contribute to duration of untreated psychosis (DUP): patient-delay, referral-delay and treatment-delay caused by mental health care services (MHS-delay). In order to find the most effective interventions to reduce DUP, it is important to know what factors in these pathways to care contribute to DUP. AIM: To examine the relationship of the constituents of treatment delay, migration status and urbanicity. METHOD: In first episode psychotic patients (n=182) from rural, urban and highly urbanized areas, DUP, migration status and pathways to care were determined. RESULTS: Mean DUP was 53.6 weeks (median 8.9, SD=116.8). Patient-delay was significantly longer for patients from highly urbanized areas and for first generation immigrants. MHS-delay was longer for patients who were treated already by MHS for other diagnoses. CONCLUSIONS: Specific interventions are needed focusing on patients living in highly urbanized areas and first generation immigrants in order to shorten patient delay. MHS should improve early detection of psychosis in patients already in treatment for other diagnosis.

[Parents with severe mental illness. Epidemiological data]. / Ouders met ernstige psychische aandoeningen; epidemiologische gegevens.

BACKGROUND: It is becoming increasingly clear that people with severe mental illness (SMI) are in need of support with parenting. So far, however, little is known about how many persons fall into this category. AIM: To estimate how many SMI patients aged 18 to 65 are parents with children and how many need help with parenting. METHOD: We based our estimate on epidemiological studies and on official records and data relating to SMI patients for the year 2009. RESULTS: We estimated that 48% of patients with smi had children. The total number of such patients for the year 2009 was 68,000; this figure represents 0.9% of the Dutch population in the 18-64 age-group. CONCLUSION: Health professionals and carers need to be alerted to the fact that almost 50%of the patients with SMI require possibly help in fulfilling their parental role. Potential problems in the parent-child relationship need to be registered in greater details so that more adequate care can be provided both at individual level and national level.

Young's type interference for probing the mode symmetry in photonic structures.

A revisited realization of the Young's double slit experiment is introduced to directly probe the photonic mode symmetry by photoluminescence experiments. We experimentally measure the far field angular emission pattern of quantum dots embedded in photonic molecules. The experimental data well agree with predictions from Young's interference and numerical simulations. Moreover, the vectorial nature of photonic eigenmodes results in a rather complicated parity property for different polarizations, a feature which has no counterpart in quantum mechanics.

[Typical and atypical antipsychotics: Is there a difference in their influence on neurocognition?]. / Typische en atypische antipsychotica bij patiënten met schizofrenie: is er verschil in invloed op neurocognitie?

BACKGROUND: Neurocognitive dysfunction is a core feature of schizophrenia and is related to the functional outcome of the illness. It has been suggested that the so-called atypical antipsychotics may have a more favourable influence on neurocognition than the older, typical antipsychotics and thus also on the functional outcome. AIM: To review the recent scientific literature concerning the effects of antipsychotics on neurocognition. METHOD: The literature was reviewed systematically via the most important databases. RESULTS: Meta-analyses suggest that atypical antipsychotics have moderate, positive effects on neurocognition and in that respect are more beneficial than typical antipsychotics. Recent studies, however, challenge this finding. CONCLUSION: The reported positive, cognitive effects of atypical antipsychotics are slight, particularly compared to the severity of neurocognitive dysfunction found in schizophrenia. In clinical practice there seem to be no convincing reason for attaching much weight to any differential effects that typical or atypical antipsychotics may have on neurocognition.