Maintaining social capital in offenders with schizophrenia spectrum disorder-An explorative analysis of influential factors.

The importance of "social capital" in offender rehabilitation has been well established: Stable family and community relationships offer practical assistance in the resettlement process after being released from custody and can serve as motivation for building a new sense of self off the criminal past, thus reducing the risk of re-offending. This also applies to offenders with severe mental disorders. The aim of this study was to identify factors that promote or hinder the establishment or maintenance of social relationships upon release from a court-ordered inpatient treatment using a modern statistical method-machine learning (ML)-on a dataset of 369 offenders with schizophrenia spectrum disorder (SSD). With an AUC of 0.73, support vector machines (SVM) outperformed all the other ML algorithms. The following factors were identified as most important for the outcome in respect of a successful re-integration into society: Social integration and living situation prior to the hospitalization, a low risk of re-offending at time of discharge from the institution, insight in the wrongfulness of the offense as well as into the underlying psychiatric illness and need for treatment, addressing future perspectives in psychotherapy, the improvement of antisocial behavior during treatment as well as a detention period of less than 1 year emerged as the most predictive out of over 500 variables in distinguishing patients who had a social network after discharge from those who did not. Surprisingly, neither severity and type of offense nor severity of the psychiatric illness proved to affect whether the patient had social contacts upon discharge or not. The fact that the majority of determinants which promote the maintenance of social contacts can be influenced by therapeutic interventions emphasizes the importance of the rehabilitative approach in forensic-psychiatric therapy.

Impact of compulsory admission on treatment and outcome: A propensity score matched analysis.

BACKGROUND: Despite multiple ethical issues and little evidence of their efficacy, compulsory admission and treatment are still common psychiatric practice. Therefore, we aimed to assess potential differences in treatment and outcome between voluntarily and compulsorily admitted patients. METHODS: We extracted clinical data from inpatients treated in an academic hospital in Zurich, Switzerland between January 1, 2013 and December 31, 2019. Observation time started upon the first admission and ended after a one-year follow-up after the last discharge. Several sociodemographic and clinical characteristics, including Health of the Nation Outcome Scales (HoNOS) scores, were retrospectively obtained. We then identified risk factors of compulsory admission using logistic regression in order to perform a widely balanced propensity score matching. Altogether, we compared 4,570 compulsorily and 4,570 voluntarily admitted propensity score-matched patients. Multiple differences between these groups concerning received treatment, coercive measures, clinical parameters, and service use outcomes were detected. RESULTS: Upon discharge, compulsorily admitted patients reached a similar HoNOS sum score in a significantly shorter duration of treatment. They were more often admitted for crisis interventions, were prescribed less pharmacologic treatment, and received fewer therapies. During the follow-up, voluntarily admitted patients were readmitted more often, while the time to readmission did not differ. CONCLUSIONS: Under narrowly set circumstances, compulsory admissions might be helpful to avert and relieve exacerbations of severe psychiatric disorders.

Treatment effect variability in brain stimulation across psychiatric disorders: A meta-analysis of variance.

Noninvasive brain stimulation methods such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are promising add-on treatments for a number of psychiatric conditions. Yet, some of the initial excitement is wearing off. Randomized controlled trials (RCT) have found inconsistent results. This inconsistency is suspected to be the consequence of variation in treatment effects and solvable by identifying responders in RCTs and individualizing treatment. However, is there enough evidence from RCTs that patients respond differently to treatment? This question can be addressed by comparing the variability in the active stimulation group with the variability in the sham group. We searched MEDLINE/PubMed and included all double-blinded, sham-controlled RCTs and crossover trials that used TMS or tDCS in adults with a unipolar or bipolar depression, bipolar disorder, schizophrenia spectrum disorder, or obsessive compulsive disorder. In accordance with the PRISMA guidelines to ensure data quality and validity, we extracted a measure of variability of the primary outcome. A total of 130 studies with 5748 patients were considered in the analysis. We calculated variance-weighted variability ratios for each comparison of active stimulation vs sham and entered them into a random-effects model. We hypothesized that treatment effect variability in TMS or tDCS would be reflected by increased variability after active compared with sham stimulation, or in other words, a variability ratio greater than one. Across diagnoses, we found only a minimal increase in variability after active stimulation compared with sham that did not reach statistical significance (variability ratio = 1.03; 95% CI, 0.97, 1.08, P = 0.358). In conclusion, this study found little evidence for treatment effect variability in brain stimulation, suggesting that the need for personalized or stratified medicine is still an open question.

Operative Results and Perioperative Morbidity After Intensified Neoadjuvant Chemotherapy with FLOT for Gastroesophageal Adenocarcinoma Impact of Intensified Neoadjuvant Treatment.

BACKGROUND: Perioperative treatment is the standard of care in Western Europe for locally advanced gastric cancer (GC) and adenocarcinoma of the gastroesophageal junction (GEJ). Intensified neoadjuvant treatment within the NeoFLOT trial proved to be safe and effective. Yet, the influence of such intensification with 6 cycles of FLOT in the neoadjuvant setting has not been analyzed regarding its possible impact on perioperative results. MATERIALS AND METHODS: A total of 537 patients were enrolled in this study; of whom, 132 had followed a standard neoadjuvant protocol (CTx), 356 had not received any neoadjuvant treatment (NoCTx), and 49 patients had undergone an intensified chemotherapy within the NeoFLOT trial (IntCTx) with 6 cycles of FLOT (5-FU, leucovorin, oxaliplatin, docetaxel) every 2 weeks. RESULTS: Our results reveal no significant difference in perioperative morbidity or mortality with regard to the neoadjuvant treatment. Postoperative bleeding and hematoma occurred less frequently in the IntCTx group compared to the NoCTx and the CTx groups (2.0% vs. 5.33% vs. 5.1%). Postoperative lymph fistulas were slightly more frequent in the IntCTx group (4.1% vs. 0.3% vs. 1.6%). Patients treated within the NeoFLOT trial had a higher risk for blood transfusions (OR 5.5; 95%-KI, 2.49-12.19), whereas patients without neoadjuvant therapy had the longest ICU stay (mean 8.3 vs. CTx 4.5 vs. IntCTx 6.7 days). CONCLUSION: The results of the current study indicate that also an intensification of neoadjuvant chemotherapy with 6 preoperative cycles of FLOT does not significantly increase perioperative complications. Thus, prolonged neoadjuvant chemotherapy with FLOT is safe for patients with locally advanced GC or GEJ tumors.

Differential contribution of pyramidal cells and interneurons to activity-dependent gene transcription changes.

The type of neuronal activity determines the outcome of gene expression. Hence, the characterization of underlying mechanisms in transcriptome alterations may serve as a biomarker and provide new intervention methods for the treatment of pathologic conditions. Parrish et al. (Parrish RR, Codadu NK, Racca C, Trevelyan AJ. J Neurophysiol 120: 2358-2367, 2018) show that the changes in interneuronal gene transcription are correlated with the type of the activated neuronal population and that the initiation route of Ras/ERK MAPK pathway determines the polarity of the gene expression.

Chronic Psychosocial Stress in Mice Is Associated With Increased Acid Sphingomyelinase Activity in Liver and Serum and With Hepatic C16:0-Ceramide Accumulation.

Chronic psychosocial stress adversely affects human morbidity and is a risk factor for inflammatory disorders, liver diseases, obesity, metabolic syndrome, and major depressive disorder (MDD). In recent studies, we found an association of MDD with an increase of acid sphingomyelinase (ASM) activity. Thus, we asked whether chronic psychosocial stress as a detrimental factor contributing to the emergence of MDD would also affect ASM activity and sphingolipid (SL) metabolism. To induce chronic psychosocial stress in male mice we employed the chronic subordinate colony housing (CSC) paradigm and compared them to non-stressed single housed control (SHC) mice. We determined Asm activity in liver and serum, hepatic SL concentrations as well as hepatic mRNA expression of genes involved in SL metabolism. We found that hepatic Asm activity was increased by 28% (P = 0.006) and secretory Asm activity by 47% (P = 0.002) in stressed mice. C16:0-Cer was increased by 40% (P = 0.008). Gene expression analysis further revealed an increased expression of tumor necrosis factor (TNF)-α (P = 0.009) and of several genes involved in SL metabolism (Cers5, P = 0.028; Cers6, P = 0.045; Gba, P = 0.049; Gba2, P = 0.030; Ormdl2, P = 0.034; Smpdl3B; P = 0.013). Our data thus provides first evidence that chronic psychosocial stress, at least in mice, induces alterations in SL metabolism, which in turn might be involved in mediating the adverse health effects of chronic psychosocial stress and peripheral changes occurring in mood disorders.

[Life Story Work in Foster Care - Results from an Expert Survey in Germany and Great Britain]. / Biografiearbeit im Pflegekinderwesen ­ Ergebnisse einer Expertenbefragung in Deutschland und Großbritannien.

Life Story Work in Foster Care - Results from an Expert Survey in Germany and Great Britain This article presents the results of an exploratory study on the current practice of life story work in the German foster care system. As life story work with foster and adopted children has a long tradition in the UK, both German and British experts were interviewed. The comparative analysis showed that life story work in the German foster care system is characterized by a rather heterogeneous practice and is considerably less established than in Great Britain. From the point of view of the German experts surveyed, several improvements make sense, such as the introduction of quality standards for life story work and mandated training for pedagogical professionals in the foster care sector. The interviews conducted with the British experts provide valuable ideas for practical applications in Germany.

Ion mobility spectrometry for microbial volatile organic compounds: a new identification tool for human pathogenic bacteria.

Presently, 2 to 4 days elapse between sampling at infection suspicion and result of microbial diagnostics. This delay for the identification of pathogens causes quite often a late and/or inappropriate initiation of therapy for patients suffering from infections. Bad outcome and high hospitalization costs are the consequences of these currently existing limited pathogen identification possibilities. For this reason, we aimed to apply the innovative method multi-capillary column-ion mobility spectrometry (MCC-IMS) for a fast identification of human pathogenic bacteria by determination of their characteristic volatile metabolomes. We determined volatile organic compound (VOC) patterns in headspace of 15 human pathogenic bacteria, which were grown for 24 h on Columbia blood agar plates. Besides MCC-IMS determination, we also used thermal desorption-gas chromatography-mass spectrometry measurements to confirm and evaluate obtained MCC-IMS data and if possible to assign volatile compounds to unknown MCC-IMS signals. Up to 21 specific signals have been determined by MCC-IMS for Proteus mirabilis possessing the most VOCs of all investigated strains. Of particular importance is the result that all investigated strains showed different VOC patterns by MCC-IMS using positive and negative ion mode for every single strain. Thus, the discrimination of investigated bacteria is possible by detection of their volatile organic compounds in the chosen experimental setup with the fast and cost-effective method MCC-IMS. In a hospital routine, this method could enable the identification of pathogens already after 24 h with the consequence that a specific therapy could be initiated significantly earlier.