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Helbrow J, Graby J, Lewis G, Cox S, Nicholas O, Radhakrishna G, Crosby T, Gwynne S. Dose Escalation in Esophageal Cancer: Comparing Pre-Accrual and On-Trial Target Volume Delineation in the UK SCOPE2 Trial. Int J Radiat Oncol Biol Phys 2023; 117:e301-e302. [PMID: 37785101 DOI: 10.1016/j.ijrobp.2023.06.2318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The ongoing UK SCOPE2 trial evaluates radiotherapy (RT) dose escalation and PET-guided systemic therapy in esophageal cancer, and has an accompanying RT trials quality assurance (RTTQA) program, evolved through the preceding SCOPE trials. We compare pre-accrual with on-trial individual case review (ICR) target volume delineation (TVD). MATERIALS/METHODS Prior to recruitment, centers were required to undertake TVD exercises using 3D/4D DICOM datasets with relevant clinical details and a RT planning guidance document (RPGD) provided. Contours were then compared against the RTTQA team-defined gold standard. Exceptions were those who had satisfied QA requirements for a previous esophageal RT trial (NeoSCOPE). For ICRs, prospective reviews (prior RT start, PRs) were undertaken for each center's first submission, plus high-dose cases submitted pending formal safety review. Additional PRs were undertaken at the RTTQA team's discretion. Timely retrospective reviews (within 2 weeks of RT start, TRR) were also undertaken for a random 10% sample. TVDs were assessed for compliance using predefined criteria and the RPGD. Resubmission was requested at reviewer's discretion, usually due to unacceptable variation (UV) from protocol. Clarification was sought before contour approval/resubmission request if appropriate. Review outcomes were then evaluated. PTV6000 was new to SCOPE2, along with a greater emphasis on use of 4DCT than in prior SCOPE trials. RESULTS A total of 85 pre-accrual cases from 33 UK centers were reviewed, of which 20 (24%) were resubmissions, and 50 (59%) were accepted. 99 TVD UVs were observed in 49 cases, most commonly in CTVB (42/99, 42%), which included editing for normal structures and elective lymph node regions, followed by ITV (4D cases only, 14/52, 27%) and PTV6000 (13/99, 13%). 121 ICRs from 31 UK centers were available for review. 87 (72%) were PRs and 34 (28%) TRRs. 43 (36%) completed the relevant SCOPE2 exercise. 19 (16%) were resubmissions, and 82 (68%) were accepted. 72 UVs were observed in 45 ICRs; again, most commonly in CTVB (34/72, 48%), PTV6000 (high dose arm only, 11/46, 24%) and ITV (4D only, 5/26, 19%). Of the 45 cases where a UV was recorded, 16 (36%) had completed the relevant SCOPE2 pre-accrual. Comparing area of UV on SCOPE2 pre-accrual cases and ICRs, 3 (19%) contours contained the same (2 = CTVB, 1 = PTV6000), 5 (31%) contained different and 8 (50%) had no UVs at pre-accrual. The rate of UV was significantly lower for ICR than for pre-accrual submissions (0.60 and 1.16 respectively, p = 0.001). CONCLUSION Significantly fewer UVs in ICR compared with pre-accrual supports a robust, educational RTTQA program through national collaboration and evolving trial series. CTVB, along with newer volumes of ITV and PTV6000, were recurring UV domains and should inform RPGD development and RTTQA for ongoing recruitment and future trials.
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Affiliation(s)
- J Helbrow
- South West Wales Cancer Centre, Swansea, United Kingdom
| | - J Graby
- University of Bath, Bath, United Kingdom
| | - G Lewis
- Velindre Cancer Centre, Cardiff, United Kingdom
| | - S Cox
- Velindre Cancer Centre, Cardiff, United Kingdom
| | - O Nicholas
- South West Wales Cancer Centre, Swansea, United Kingdom; Swansea University, Swansea, United Kingdom
| | | | - T Crosby
- Velindre Cancer Centre, Cardiff, United Kingdom
| | - S Gwynne
- South West Wales Cancer Centre, Swansea, United Kingdom; Swansea University, Swansea, United Kingdom
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Vitikainen EIK, Meniri M, Marshall HH, Thompson FJ, Businge R, Mwanguhya F, Kyabulima S, Mwesige K, Ahabonya S, Sanderson JL, Kalema-Zikusoka G, Hoffman JI, Wells D, Lewis G, Walker SL, Nichols HJ, Blount JD, Cant MA. The social formation of fitness: lifetime consequences of prenatal nutrition and postnatal care in a wild mammal population. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220309. [PMID: 37381858 PMCID: PMC10291432 DOI: 10.1098/rstb.2022.0309] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/19/2023] [Indexed: 06/30/2023] Open
Abstract
Research in medicine and evolutionary biology suggests that the sequencing of parental investment has a crucial impact on offspring life history and health. Here, we take advantage of the synchronous birth system of wild banded mongooses to test experimentally the lifetime consequences to offspring of receiving extra investment prenatally versus postnatally. We provided extra food to half of the breeding females in each group during pregnancy, leaving the other half as matched controls. This manipulation resulted in two categories of experimental offspring in synchronously born litters: (i) 'prenatal boost' offspring whose mothers had been fed during pregnancy, and (ii) 'postnatal boost' offspring whose mothers were not fed during pregnancy but who received extra alloparental care in the postnatal period. Prenatal boost offspring lived substantially longer as adults, but postnatal boost offspring had higher lifetime reproductive success (LRS) and higher glucocorticoid levels across the lifespan. Both types of experimental offspring had higher LRS than offspring from unmanipulated litters. We found no difference between the two experimental categories of offspring in adult weight, age at first reproduction, oxidative stress or telomere lengths. These findings are rare experimental evidence that prenatal and postnatal investments have distinct effects in moulding individual life history and fitness in wild mammals. This article is part of the theme issue 'Evolutionary ecology of inequality'.
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Affiliation(s)
- E. I. K. Vitikainen
- Centre for Ecology and Conservation, University of Exeter, Penryn, Cornwall, TR10 9FE, UK
- Organismal and Evolutionary Biology, University of Helsinki, Helsinki, PO Box 65, 00014 Finland
| | - M. Meniri
- Centre for Ecology and Conservation, University of Exeter, Penryn, Cornwall, TR10 9FE, UK
| | - H. H. Marshall
- Centre for Ecology and Conservation, University of Exeter, Penryn, Cornwall, TR10 9FE, UK
- Centre for Research in Ecology, Evolution and Behaviour, University of Roehampton, Roehampton Lane, London SW15 5PJ, UK
| | - F. J. Thompson
- Centre for Ecology and Conservation, University of Exeter, Penryn, Cornwall, TR10 9FE, UK
| | - R. Businge
- Banded Mongoose Research Project, Queen Elizabeth National Park, PO Box 66 Lake Katwe, Kasese District, Uganda
| | - F. Mwanguhya
- Banded Mongoose Research Project, Queen Elizabeth National Park, PO Box 66 Lake Katwe, Kasese District, Uganda
| | - S. Kyabulima
- Banded Mongoose Research Project, Queen Elizabeth National Park, PO Box 66 Lake Katwe, Kasese District, Uganda
| | - K. Mwesige
- Banded Mongoose Research Project, Queen Elizabeth National Park, PO Box 66 Lake Katwe, Kasese District, Uganda
| | - S. Ahabonya
- Banded Mongoose Research Project, Queen Elizabeth National Park, PO Box 66 Lake Katwe, Kasese District, Uganda
| | - J. L. Sanderson
- Centre for Ecology and Conservation, University of Exeter, Penryn, Cornwall, TR10 9FE, UK
| | - G. Kalema-Zikusoka
- Conservation Through Public Health, PO Box 75298, Uringi Crescent Rd, Entebbe, Uganda
| | - J. I. Hoffman
- Department of Behavioural Ecology, University of Bielefeld, Bielefeld, Konsequenz 45, 33619, Germany
| | - D. Wells
- Department of Behavioural Ecology, University of Bielefeld, Bielefeld, Konsequenz 45, 33619, Germany
| | - G. Lewis
- Department of Biosciences, Wallace Building, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - S. L. Walker
- Chester Zoo Endocrine Laboratory, Endocrinology, Science Centre, Caughall Road, Upton-by-Chester, Chester, CH2 1LH, UK
| | - H. J. Nichols
- Department of Biosciences, Wallace Building, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - J. D. Blount
- Centre for Ecology and Conservation, University of Exeter, Penryn, Cornwall, TR10 9FE, UK
| | - M. A. Cant
- Centre for Ecology and Conservation, University of Exeter, Penryn, Cornwall, TR10 9FE, UK
- Banded Mongoose Research Project, Queen Elizabeth National Park, PO Box 66 Lake Katwe, Kasese District, Uganda
- German Primate Center, University of Goettingen, Kellnerweg 4, 37077 Göttingen, Germany
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Kandola A, Solmi F, Ajnakina O, Ingram E, Iob E, Lee S, Steptoe A, Wright T, Lewis G. The role of loneliness in the association between chronic physical illness and depressive symptoms among older adults: A prospective cohort study. J Affect Disord 2023; 334:220-226. [PMID: 37086792 PMCID: PMC10618404 DOI: 10.1016/j.jad.2023.04.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/10/2023] [Accepted: 04/16/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Chronic physical illness increases the risk of subsequent depressive symptoms, but we know little about the mechanisms underlying this association that interventions can target. We investigated whether loneliness might explain associations between chronic illness and subsequent depressive symptoms. METHODS We used English Longitudinal Study of Ageing data, a prospective cohort of adults over 50. Our exposure was chronic illnesses (wave two) including arthritis, cancer, diabetes, cardiovascular disease, stroke, and chronic obstructive pulmonary disease. Loneliness scores were a mediator on the short University of California, Los Angeles Loneliness Scale at wave three. Depressive symptom scores (outcome) were measured using the Centre for Epidemiologic Studies Depression Scale (wave four). We examined associations of chronic physical illness with loneliness and depressive symptoms in univariable and multivariable regression models. RESULTS Fully-adjusted models included 2436 participants with the depression outcome and 2052 participants with the loneliness outcome. Chronic physical illness was associated with 21 % (incident rate ratio = 1.21, 95%CI = 1.03-1.42) higher depression scores at follow-up. We found no evidence of an association between chronic physical illness and loneliness and therefore did not proceed to analyses of mediation. LIMITATIONS More prevalent chronic illnesses could have driven our results, such as cardiovascular disease. CONCLUSIONS Chronic physical illnesses increase the risk of depressive symptoms in older adults. However, we did not find any that chronic physical illnesses were associated with an increased risk of subsequent loneliness. Therefore, interventions targeting loneliness to reduce depression in older adults with chronic physical illness may be insufficient.
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Affiliation(s)
- A Kandola
- MRC Unit of Lifelong Health and Ageing, University College London, London, UK; Institute of Mental Health, University College London, London, UK.
| | - F Solmi
- Division of Psychiatry, University College London, London, UK
| | - O Ajnakina
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, University of London, London, UK; Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - E Ingram
- Department of Applied Health Research, Institute of Epidemiology and Health Care, University College London, London, UK
| | - E Iob
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - S Lee
- Division of Psychiatry, University College London, London, UK
| | - A Steptoe
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - T Wright
- Division of Psychiatry, University College London, London, UK
| | - G Lewis
- Division of Psychiatry, University College London, London, UK
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Lange J, Waldman G, Scalzo R, Lewis G, Tsao L, Clark J. Characterization of CD3-Guided Anti-Thymocyte Globulin Dose Minimization for Renal Sparing Induction after Heart Transplant. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Li S, Funamoto M, Osho A, Paneitz D, Singh R, Lewis G, D'Alessandro D. Rejection Outcomes in Donation after Cardiac Death (DCD) Heart Transplants. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Neal T, Drezek K, Ramsay A, D'Alessandro D, Lewis G, Coglianese E. Effect of UNOS 2018 Heart Transplant Policy Change on LVAD Patients Undergoing Heart Transplantation in an Academic Medical Center. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Ton V, Kahlon T, Drezek K, Soydara C, Rupert L, Camuso J, Milley K, Logan T, Dempsey A, Coglianese E, Mastoris I, Osho A, Michel E, D'Alessandro D, Lewis G. Distinct Pressure-Flow Phenotypes During Exercise in Patients Supported with Left Ventricular Assist Devices (lvad). J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Rupert L, Campain J, D'Alessandro D, Lewis G. Characterization of Donor-Derived Cell-Free DNA Results in Cardiac Donation after Brain Death vs. Donation after Cardiac Death. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Drezek K, Ramsay A, Neal T, Lewis G, D'Alessandro D, Coglianese E. The New Heart Allocation System Change and DCD Heart Availability: Effects on Durable VAD Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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10
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Buckman JEJ, Cohen ZD, O'Driscoll C, Fried EI, Saunders R, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Watkins E, Eley T, Peel AJ, Rayner C, Kessler D, Wiles N, Lewis G, Pilling S. Predicting prognosis for adults with depression using individual symptom data: a comparison of modelling approaches. Psychol Med 2023; 53:408-418. [PMID: 33952358 PMCID: PMC9899563 DOI: 10.1017/s0033291721001616] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/08/2021] [Accepted: 04/12/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study aimed to develop, validate and compare the performance of models predicting post-treatment outcomes for depressed adults based on pre-treatment data. METHODS Individual patient data from all six eligible randomised controlled trials were used to develop (k = 3, n = 1722) and test (k = 3, n = 918) nine models. Predictors included depressive and anxiety symptoms, social support, life events and alcohol use. Weighted sum scores were developed using coefficient weights derived from network centrality statistics (models 1-3) and factor loadings from a confirmatory factor analysis (model 4). Unweighted sum score models were tested using elastic net regularised (ENR) and ordinary least squares (OLS) regression (models 5 and 6). Individual items were then included in ENR and OLS (models 7 and 8). All models were compared to one another and to a null model (mean post-baseline Beck Depression Inventory Second Edition (BDI-II) score in the training data: model 9). Primary outcome: BDI-II scores at 3-4 months. RESULTS Models 1-7 all outperformed the null model and model 8. Model performance was very similar across models 1-6, meaning that differential weights applied to the baseline sum scores had little impact. CONCLUSIONS Any of the modelling techniques (models 1-7) could be used to inform prognostic predictions for depressed adults with differences in the proportions of patients reaching remission based on the predicted severity of depressive symptoms post-treatment. However, the majority of variance in prognosis remained unexplained. It may be necessary to include a broader range of biopsychosocial variables to better adjudicate between competing models, and to derive models with greater clinical utility for treatment-seeking adults with depression.
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Affiliation(s)
- J. E. J. Buckman
- Research Department of Clinical, Educational & Health Psychology, Centre for Outcomes Research and Effectiveness (CORE), University College London, 1-19 Torrington Place, London, UK
- iCope – Camden & Islington Psychological Therapies Services – Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Z. D. Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - C. O'Driscoll
- Research Department of Clinical, Educational & Health Psychology, Centre for Outcomes Research and Effectiveness (CORE), University College London, 1-19 Torrington Place, London, UK
| | - E. I. Fried
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - R. Saunders
- Research Department of Clinical, Educational & Health Psychology, Centre for Outcomes Research and Effectiveness (CORE), University College London, 1-19 Torrington Place, London, UK
| | - G. Ambler
- Statistical Science, University College London, 1-19 Torrington Place, London, UK
| | - R. J. DeRubeis
- Department of Psychology, School of Arts and Sciences, 425 S. University Avenue, Philadelphia PA, USA
| | - S. Gilbody
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, UK
| | - S. D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - T. Kendrick
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - E. Watkins
- Department of Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Perry Road, Exeter, UK
| | - T.C. Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A. J. Peel
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - C. Rayner
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - D. Kessler
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - N. Wiles
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, UK
| | - G. Lewis
- Division of Psychiatry, University College London, Maple House, London, UK
| | - S. Pilling
- Research Department of Clinical, Educational & Health Psychology, Centre for Outcomes Research and Effectiveness (CORE), University College London, 1-19 Torrington Place, London, UK
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
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Schrag A, Carroll C, Duncan G, Molloy S, Grover L, Hunter R, Brown R, Freemantle N, Whipps J, Serfaty MA, Lewis G. Antidepressants Trial in Parkinson's Disease (ADepT-PD): protocol for a randomised placebo-controlled trial on the effectiveness of escitalopram and nortriptyline on depressive symptoms in Parkinson's disease. BMC Neurol 2022; 22:474. [PMID: 36510237 PMCID: PMC9743717 DOI: 10.1186/s12883-022-02988-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Depressive symptoms are common in patients with Parkinson's disease and depression is a significant predictor of functional impairment, reduced quality of life and general well-being in Parkinson's disease. Despite the high prevalence of depression, evidence on the effectiveness and tolerability of antidepressants in this population is limited. The primary aim of this trial is to establish the clinical and cost effectiveness of escitalopram and nortriptyline for the treatment of depression in Parkinson's disease. METHODS This is a multi-centre, double-blind, randomised placebo-controlled trial in 408 people with Parkinson's disease with subsyndromal depression, major depressive disorder or persistent depressive disorder and a Beck Depression Inventory-II (BDI-II) score of 14 or above. Participants will be randomised into one of three groups, receiving either escitalopram, nortriptyline or placebo for 12 months. Trial participation is face-to-face, hybrid or remote. The primary outcome measure is the BDI-II score following 8 weeks of treatment. Secondary outcomes will be collected at baseline, 8, 26 and 52 weeks and following withdrawal, including severity of anxiety and depression scores as well as Parkinson's disease motor severity, and ratings of non-motor symptoms, cognitive function, health-related quality of life, levodopa-equivalence dose, changes in medication, overall clinical effectiveness, capability, health and social care resource use, carer health-related quality of life, adverse effects and number of dropouts. DISCUSSION This trial aims to determine the effectiveness of escitalopram and nortriptyline for reducing depressive symptoms in Parkinson's disease over 8 weeks, to provide information on the effect of these medications on anxiety and other non-motor symptoms in PD and on impact on patients and caregivers, and to examine their effect on change in motor severity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03652870 Date of registration - 29th August 2018.
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Affiliation(s)
- A Schrag
- grid.83440.3b0000000121901201Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK ,grid.437485.90000 0001 0439 3380Department of Neurology, Royal Free London NHS Foundation Trust, London, UK
| | - C Carroll
- grid.11201.330000 0001 2219 0747Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - G Duncan
- grid.39489.3f0000 0001 0388 0742NHS Lothian, Edinburgh, UK
| | - S Molloy
- grid.417895.60000 0001 0693 2181Department of Neurosciences, Imperial College Healthcare NHS Trust, London, UK
| | - L Grover
- grid.83440.3b0000000121901201Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - R Hunter
- grid.83440.3b0000000121901201Research Department of Primary Care and Population Health, University College London, London, UK
| | - R Brown
- grid.13097.3c0000 0001 2322 6764Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
| | - N Freemantle
- grid.83440.3b0000000121901201Comprehensive Clinical Trials Unit, University College London, London, UK
| | - J Whipps
- PPI Representative, Plymouth, UK
| | - M. A Serfaty
- grid.83440.3b0000000121901201Division of Psychiatry, UCL, London, UK ,Priory Hospital North London, London, UK
| | - G Lewis
- grid.83440.3b0000000121901201Division of Psychiatry, UCL, London, UK
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Kandola A, Lewis G, Osborn DPJ, Stubbs B, Hayes JF. Device-measured sedentary behaviour and anxiety symptoms during adolescence: a 6-year prospective cohort study. Psychol Med 2022; 52:2962-2971. [PMID: 33336634 PMCID: PMC9693656 DOI: 10.1017/s0033291720004948] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/22/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sedentary behaviour is potentially a modifiable risk factor for anxiety disorders, a major source of global disability that typically starts during adolescence. This is the first prospective study of associations between repeated, device-based measures of sedentary behaviour and anxiety symptoms in adolescents. METHODS A UK cohort with 4257 adolescents aged 12 at baseline (56% female). Main exposures were sedentary behaviour and physical activity measured using accelerometers for 7-days at ages 12, 14, and 16. Primary outcome was anxiety symptom scores at age 18 from a Clinical Interview Schedule-Revised. We used adjusted negative binomial regression and iso-temporal substitution methods to analyse the data. RESULTS We found a positive association between sedentary behaviour at ages 12, 14, and 16, with anxiety symptoms at age 18, independent of total physical activity volume. Theoretically replacing an hour of daily sedentary behaviour for light activity at ages 12, 14, and 16, was associated with lower anxiety symptoms by age 18 by 15.9% (95% CI 8.7-22.4), 12.1% (95% CI 3.4-20.1), and 14.7% (95% CI 4-24.2), respectively. Whereas, theoretically replacing an hour of sedentary behaviour with moderate-to-vigorous physical activity was not associated with differences in anxiety symptoms. These results were robust to a series of sensitivity analyses. CONCLUSION Sedentary behaviour is a possible risk factor for increasing anxiety symptoms during adolescence, independent of total physical activity volume. Instead of focusing on moderate-to-vigorous activity, replacing daily sedentary behaviour with light activity during adolescence could be a more suitable method of reducing future anxiety symptoms.
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Affiliation(s)
- A. Kandola
- Division of Psychiatry, University College London, London, UK
| | - G. Lewis
- Division of Psychiatry, University College London, London, UK
| | - D. P. J. Osborn
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - B. Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Physiotherapy Department, South London, and Maudsley National Health Services Foundation Trust, London, UK
| | - J. F. Hayes
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Lewis G, Bodinger LR, Harte FM. Characterization of ethanol-induced casein micelle dissociation using a continuous protein monitoring unit. J Dairy Sci 2022; 105:7266-7275. [PMID: 35931485 DOI: 10.3168/jds.2021-21522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 05/02/2022] [Indexed: 11/19/2022]
Abstract
The effect of ethanol on milk has been shown to be temperature-dependent, with higher ethanol concentrations and temperatures reversibly dissociating casein micelles. This work looked to expand on this knowledge, while also demonstrating the efficiency and precision of a custom-made continuous monitoring unit that combines solutions at defined concentrations and temperatures while measuring various parameters (i.e., absorbance, fluorescence, pressure). Caseins were found to self-associate at moderate ethanol concentrations (i.e., 12-36% vol/vol ethanol); however, they dissociated and remained in the serum at higher ethanol concentrations (≥48% vol/vol) and temperatures (24 and 34°C). Although serum casein content was found to be positively correlated with protein hydrophobicity, the addition of ethanol only increased protein hydrophobicity when the sample was held at high temperatures (34-64°C). Overall, the greatest dissociation of casein micelles was found between 40 and 60% (vol/vol) ethanol concentration at elevated temperatures (≥34°C). At these ethanol concentrations and temperatures, skim milk absorbance was minimized, serum casein content (including β-casein content) was maximized, and protein hydrophobicity reached a relative maximum.
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Affiliation(s)
- G Lewis
- Department of Animal and Food Science, University of Wisconsin-River Falls, River Falls 54022
| | - L R Bodinger
- Department of Food Science, The Pennsylvania State University, University Park 16802
| | - F M Harte
- Department of Food Science, The Pennsylvania State University, University Park 16802.
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Delvi A, Blake L, Lapraik A, Lewis G. An Evaluation of Mental Health Professionals’ Confidence in Performing Perinatal Assessments & The Need for the Development of an Assessment Tool. Eur Psychiatry 2022. [PMCID: PMC9568242 DOI: 10.1192/j.eurpsy.2022.2204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Clinicians often do not have experience assessing perinatal patients unless they work as part of a perinatal team. Informal feedback points to a lack of confidence in performing perinatal assessments. Objectives The aim of the project was to assess clinicians’ confidence in performing perinatal assessments in outpatient and inpatient settings including the Emergency Department. Additionally, we wanted to assess whether access to a perinatal assessment tool was beneficial. We hypothesise that clinicians lack confidence in performing perinatal assessments and would benefit from using a perinatal assessment tool. Methods We designed a survey of 10 questions assessing the above. The survey was sent out to psychiatric trainees and nurses at South London & Maudsley NHS Foundation Trust. The participant’s confidence in completing perinatal assessments in various settings was assessed using a 5 point Likert scale. Results 52 responses were received. 50% of participants felt not so confident in performing perinatal assessments in the outpatient setting. 40.38%(n=21) of participants felt not so confident in exploring the mother and foetal relationship. 71.15% (n=37) of participants felt that they would benefit from additional teaching with 48.1% of participants citing that they would benefit from access to an assessment tool. Conclusions As predicted, the results of the survey show that clinicians lack confidence in performing perinatal assessments. Therefore, we have commenced work on modifying the existing Stafford Interview. This is a structured interview that explores the obstetric and psycho-social background and psychiatric complications of pregnancy. The survey is due to be replicated in other project locations to allow transcultural comparison. Disclosure No significant relationships.
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Lewis G, Coupland JN, Harte FM. Characterization of high-pressure jet-induced fat-protein complexation. J Dairy Sci 2021; 105:2119-2131. [PMID: 34955253 DOI: 10.3168/jds.2021-21251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/12/2021] [Indexed: 11/19/2022]
Abstract
High-pressure jet (HPJ) processing of various dairy systems has been shown to disrupt fat droplets and casein micelles and cause a strong association between fat and casein proteins. The present work seeks to better describe this association between fat and casein using a model milk formulated from confectionary coating fat (3.6% wt/wt), micellar casein (3.4% wt/wt), and water (93% wt/wt), which was then pasteurized, homogenized, and then either HPJ-treated (400 MPa) or not (non-HPJ-treated, control). Upon ultracentrifugation, fat in the non-HPJ-treated model milk creamed due to its low density. In the HPJ-treated model milk, fat precipitated with protein into a thick bottom layer upon ultracentrifugation, reflecting a strong association between protein and fat. Differential scanning calorimetry (DSC) and time-domain nuclear magnetic resonance of the non-HPJ-treated model milk revealed fat in 2 physical states: (1) fat that is physically similar to the bulk fat and (2) fat that was in smaller droplets (i.e., homogenized) and crystallized at a lower temperature than the bulk fat. In contrast, DSC of HPJ-treated model milks supported the presence of fat in 3 states: (1) fat that is physically similar to the bulk fat, (2) fat in small droplets that required substantial supercooling beyond the non-HPJ-treated model milk to crystallize, and (3) fat in such small domains that it crystallizes in a less stable polymorphic form than the non-HPJ-treated model milk (or does not crystallize at all). The state of fat within the HPJ-treated model milk changed minimally with acidification, indicating that the association is not dependent on the charge on the casein. Cryogenic transmission electron microscopy (Cryo-TEM) of the non-HPJ-treated model milk revealed uniform casein micelles, which likely adsorbed to the surface of fat globules post-homogenization. In contrast, Cryo-TEM of the HPJ-treated model milk revealed a porous protein aggregate that likely had dispersed fat throughout. Together, these results suggest that HPJ treatment causes fat to be entrapped by casein proteins in very small domains.
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Affiliation(s)
- G Lewis
- Department of Food Science, The Pennsylvania State University, University Park 16802
| | - J N Coupland
- Department of Food Science, The Pennsylvania State University, University Park 16802
| | - F M Harte
- Department of Food Science, The Pennsylvania State University, University Park 16802.
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Nichols HJ, Fuchs B, Paijmans AJ, Lewis G, Bonin CA, Goebel ME, Hoffman JI. Where are the beachmasters? Unexpectedly weak polygyny among southern elephant seals on a South Shetland Island. J Zool (1987) 2021. [DOI: 10.1111/jzo.12936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H. J. Nichols
- Department of Biosciences Swansea University Swansea UK
- Department of Animal Behaviour University of Bielefeld Bielefeld Germany
| | - B. Fuchs
- Department of Animal Behaviour University of Bielefeld Bielefeld Germany
| | - A. J. Paijmans
- Department of Animal Behaviour University of Bielefeld Bielefeld Germany
| | - G. Lewis
- Department of Biosciences Swansea University Swansea UK
| | - C. A. Bonin
- Department of Marine and Environmental Sciences Hampton University Hampton USA
| | - M. E. Goebel
- Institute of Marine Sciences University of California Santa Cruz Santa Cruz CA USA
| | - J. I. Hoffman
- Department of Animal Behaviour University of Bielefeld Bielefeld Germany
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Abstract
Background Police officers are frequently exposed to distressing and dangerous situations, increasing their risk of posttraumatic stress disorder (PTSD) and complex PTSD (C-PTSD). Research examining C-PTSD in police officers is sparse, particularly examination of the occupational risk factors for trauma symptoms. Aims This study aimed to examine the prevalence and risk factors for PTSD and C-PTSD in UK police officers. Methods A cross-sectional study was conducted using psychological health surveillance data from the UK National Police Wellbeing Service. Police officers were either from high-risk areas of work or had been referred for screening by occupational health practitioners regarding psychological distress. The primary outcome for this study was a positive screening of either PTSD or C-PTSD, measured using the International Trauma Questionnaire. A range of occupational, clinical and lifestyle factors was examined to establish their role as potential risk factors for PTSD and C-PTSD. Results In total, 2444 UK police officers were included, with 89% from high-risk areas of work. A prevalence of 3% for PTSD and 2% for C-PTSD was found in police officers from high-risk areas of work. Higher work stress and lower manager support were found to increase the odds of C-PTSD but not PTSD. Higher personal trauma history increased the risk for PTSD and C-PTSD equally. Conclusions Work-related occupational factors increased the odds of PTSD and C-PTSD in police officers, which could be important risk factors for trauma symptoms within police officers. Efforts should be made to improve the working environment of police officers to help improve their psychological well-being.
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Affiliation(s)
- C Steel
- Division of Psychiatry, University College London, London, UK
| | | | - G Lewis
- Division of Psychiatry, University College London, London, UK
| | - J Billings
- Division of Psychiatry, University College London, London, UK
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18
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Buckman JEJ, Saunders R, Stott J, Arundell LL, O'Driscoll C, Davies MR, Eley TC, Hollon SD, Kendrick T, Ambler G, Cohen ZD, Watkins E, Gilbody S, Wiles N, Kessler D, Richards D, Brabyn S, Littlewood E, DeRubeis RJ, Lewis G, Pilling S. Role of age, gender and marital status in prognosis for adults with depression: An individual patient data meta-analysis. Epidemiol Psychiatr Sci 2021; 30:e42. [PMID: 34085616 PMCID: PMC7610920 DOI: 10.1017/s2045796021000342] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/04/2021] [Accepted: 05/09/2021] [Indexed: 11/21/2022] Open
Abstract
AIMS To determine whether age, gender and marital status are associated with prognosis for adults with depression who sought treatment in primary care. METHODS Medline, Embase, PsycINFO and Cochrane Central were searched from inception to 1st December 2020 for randomised controlled trials (RCTs) of adults seeking treatment for depression from their general practitioners, that used the Revised Clinical Interview Schedule so that there was uniformity in the measurement of clinical prognostic factors, and that reported on age, gender and marital status. Individual participant data were gathered from all nine eligible RCTs (N = 4864). Two-stage random-effects meta-analyses were conducted to ascertain the independent association between: (i) age, (ii) gender and (iii) marital status, and depressive symptoms at 3-4, 6-8, and 9-12 months post-baseline and remission at 3-4 months. Risk of bias was evaluated using QUIPS and quality was assessed using GRADE. PROSPERO registration: CRD42019129512. Pre-registered protocol https://osf.io/e5zup/. RESULTS There was no evidence of an association between age and prognosis before or after adjusting for depressive 'disorder characteristics' that are associated with prognosis (symptom severity, durations of depression and anxiety, comorbid panic disorderand a history of antidepressant treatment). Difference in mean depressive symptom score at 3-4 months post-baseline per-5-year increase in age = 0(95% CI: -0.02 to 0.02). There was no evidence for a difference in prognoses for men and women at 3-4 months or 9-12 months post-baseline, but men had worse prognoses at 6-8 months (percentage difference in depressive symptoms for men compared to women: 15.08% (95% CI: 4.82 to 26.35)). However, this was largely driven by a single study that contributed data at 6-8 months and not the other time points. Further, there was little evidence for an association after adjusting for depressive 'disorder characteristics' and employment status (12.23% (-1.69 to 28.12)). Participants that were either single (percentage difference in depressive symptoms for single participants: 9.25% (95% CI: 2.78 to 16.13) or no longer married (8.02% (95% CI: 1.31 to 15.18)) had worse prognoses than those that were married, even after adjusting for depressive 'disorder characteristics' and all available confounders. CONCLUSION Clinicians and researchers will continue to routinely record age and gender, but despite their importance for incidence and prevalence of depression, they appear to offer little information regarding prognosis. Patients that are single or no longer married may be expected to have slightly worse prognoses than those that are married. Ensuring this is recorded routinely alongside depressive 'disorder characteristics' in clinic may be important.
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Affiliation(s)
- J. E. J. Buckman
- Research Department of Clinical, Educational & Health Psychology, Centre for Outcomes Research and Effectiveness (CORE), University College London, 1-19 Torrington Place, LondonWC1E 7HB, UK
- iCope – Camden & Islington NHS Foundation Trust, St Pancras Hospital, LondonNW1 0PE, UK
| | - R. Saunders
- Research Department of Clinical, Educational & Health Psychology, Centre for Outcomes Research and Effectiveness (CORE), University College London, 1-19 Torrington Place, LondonWC1E 7HB, UK
| | - J. Stott
- Research Department of Clinical, Educational & Health Psychology, Centre for Outcomes Research and Effectiveness (CORE), University College London, 1-19 Torrington Place, LondonWC1E 7HB, UK
| | - L.-L. Arundell
- Research Department of Clinical, Educational & Health Psychology, Centre for Outcomes Research and Effectiveness (CORE), University College London, 1-19 Torrington Place, LondonWC1E 7HB, UK
| | - C. O'Driscoll
- Research Department of Clinical, Educational & Health Psychology, Centre for Outcomes Research and Effectiveness (CORE), University College London, 1-19 Torrington Place, LondonWC1E 7HB, UK
| | - M. R. Davies
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, LondonSE5 8AF, UK
| | - T. C. Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, LondonSE5 8AF, UK
| | - S. D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN37240, USA
| | - T. Kendrick
- Faculty of Medicine, Primary Care, Population Sciences and Medical Education, University of Southampton, SouthamptonSO16 5ST, UK
| | - G. Ambler
- Statistical Science, University College London, LondonWC1E 7HB, UK
| | - Z. D. Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - E. Watkins
- Department of Psychology, University of Exeter, ExeterEX4 4QG, UK
| | - S. Gilbody
- Department of Health Sciences, University of York, YorkYO10 5DD, UK
| | - N. Wiles
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, BristolBS8 2BN, UK
| | - D. Kessler
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - D. Richards
- Institute of Health Research, University of Exeter College of Medicine and Health, ExeterEX1 2LU, UK
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063Bergen, Norway
| | - S. Brabyn
- Department of Health Sciences, University of York, YorkYO10 5DD, UK
| | - E. Littlewood
- Department of Health Sciences, University of York, YorkYO10 5DD, UK
| | - R. J. DeRubeis
- Department of Psychology, School of Arts and Sciences, 425 S. University Avenue, PhiladelphiaPA, 19104-60185, USA
| | - G. Lewis
- Division of Psychiatry, University College London, LondonW1T 7NF, UK
| | - S. Pilling
- Research Department of Clinical, Educational & Health Psychology, Centre for Outcomes Research and Effectiveness (CORE), University College London, 1-19 Torrington Place, LondonWC1E 7HB, UK
- Camden & Islington NHS Foundation Trust, 4 St Pancras Way, LondonNW1 0PE, UK
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O'Driscoll C, Buckman JEJ, Fried EI, Saunders R, Cohen ZD, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Kessler D, Lewis G, Watkins E, Wiles N, Pilling S. The importance of transdiagnostic symptom level assessment to understanding prognosis for depressed adults: analysis of data from six randomised control trials. BMC Med 2021; 19:109. [PMID: 33952286 PMCID: PMC8101158 DOI: 10.1186/s12916-021-01971-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/23/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Depression is commonly perceived as a single underlying disease with a number of potential treatment options. However, patients with major depression differ dramatically in their symptom presentation and comorbidities, e.g. with anxiety disorders. There are also large variations in treatment outcomes and associations of some anxiety comorbidities with poorer prognoses, but limited understanding as to why, and little information to inform the clinical management of depression. There is a need to improve our understanding of depression, incorporating anxiety comorbidity, and consider the association of a wide range of symptoms with treatment outcomes. METHOD Individual patient data from six RCTs of depressed patients (total n = 2858) were used to estimate the differential impact symptoms have on outcomes at three post intervention time points using individual items and sum scores. Symptom networks (graphical Gaussian model) were estimated to explore the functional relations among symptoms of depression and anxiety and compare networks for treatment remitters and those with persistent symptoms to identify potential prognostic indicators. RESULTS Item-level prediction performed similarly to sum scores when predicting outcomes at 3 to 4 months and 6 to 8 months, but outperformed sum scores for 9 to 12 months. Pessimism emerged as the most important predictive symptom (relative to all other symptoms), across these time points. In the network structure at study entry, symptoms clustered into physical symptoms, cognitive symptoms, and anxiety symptoms. Sadness, pessimism, and indecision acted as bridges between communities, with sadness and failure/worthlessness being the most central (i.e. interconnected) symptoms. Connectivity of networks at study entry did not differ for future remitters vs. those with persistent symptoms. CONCLUSION The relative importance of specific symptoms in association with outcomes and the interactions within the network highlight the value of transdiagnostic assessment and formulation of symptoms to both treatment and prognosis. We discuss the potential for complementary statistical approaches to improve our understanding of psychopathology.
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Affiliation(s)
- C O'Driscoll
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK. ciaran.o'
| | - J E J Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
- iCope - Camden & Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, NW1 0PE, UK.
| | - E I Fried
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - R Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Z D Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - G Ambler
- Statistical Science, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - R J DeRubeis
- School of Arts and Sciences, Department of Psychology, 425 S. University Avenue, Philadelphia, PA, 19104-60185, USA
| | - S Gilbody
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - S D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - T Kendrick
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
| | - D Kessler
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - G Lewis
- Division of Psychiatry, University College London, Maple House, London, W1T 7NF, UK
| | - E Watkins
- Department of Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Perry Road, Exeter, EX4 4QG, UK
| | - N Wiles
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, UK
| | - S Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
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20
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Rogers JP, Chesney E, Oliver D, Begum N, Saini A, Wang S, McGuire P, Fusar-Poli P, Lewis G, David AS. Suicide, self-harm and thoughts of suicide or self-harm in infectious disease epidemics: a systematic review and meta-analysis. Epidemiol Psychiatr Sci 2021; 30:e32. [PMID: 33902775 PMCID: PMC7610720 DOI: 10.1017/s2045796021000214] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 12/22/2022] Open
Abstract
AIMS Suicide accounts for 2.2% of all years of life lost worldwide. We aimed to establish whether infectious epidemics are associated with any changes in the incidence of suicide or the period prevalence of self-harm, or thoughts of suicide or self-harm, with a secondary objective of establishing the frequency of these outcomes. METHODS In this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO and AMED were searched from inception to 9 September 2020. Studies of infectious epidemics reporting outcomes of (a) death by suicide, (b) self-harm or (c) thoughts of suicide or self-harm were identified. A random-effects model meta-analysis for the period prevalence of thoughts of suicide or self-harm was conducted. RESULTS In total, 1354 studies were screened with 57 meeting eligibility criteria, of which 7 described death by suicide, 9 by self-harm, and 45 thoughts of suicide or self-harm. The observation period ranged from 1910 to 2020 and included epidemics of Spanish Flu, severe acute respiratory syndrome, human monkeypox, Ebola virus disease and coronavirus disease 2019 (COVID-19). Regarding death by suicide, data with a clear longitudinal comparison group were available for only two epidemics: SARS in Hong Kong, finding an increase in suicides among the elderly, and COVID-19 in Japan, finding no change in suicides among children and adolescents. In terms of self-harm, five studies examined emergency department attendances in epidemic and non-epidemic periods, of which four found no difference and one showed a reduction during the epidemic. In studies of thoughts of suicide or self-harm, one large survey showed a substantial increase in period prevalence compared to non-epidemic periods, but smaller studies showed no difference. As a secondary objective, a meta-analysis of thoughts of suicide and self-harm found that the pooled prevalence was 8.0% overall (95% confidence interval (CI) 5.2-12.0%; 14 820 of 99 238 cases in 24 studies) over a time period of between seven days and six months. The quality assessment found 42 studies were of high quality, nine of moderate quality and six of high quality. CONCLUSIONS There is little robust evidence on the association of infectious epidemics with suicide, self-harm and thoughts of suicide or self-harm. There was an increase in suicides among the elderly in Hong Kong during SARS and no change in suicides among young people in Japan during COVID-19, but it is unclear how far these findings may be generalised. The development of up-to-date self-harm and suicide statistics to monitor the effect of the current pandemic is an urgent priority.
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Affiliation(s)
- J. P. Rogers
- Division of Psychiatry, University College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - E. Chesney
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychosis Studies, King's College London, London, UK
| | - D. Oliver
- Department of Psychosis Studies, King's College London, London, UK
| | - N. Begum
- GKT School of Medical Education, King's College London, London, UK
| | - A. Saini
- Medical School, University College London, London, UK
| | - S. Wang
- Department of Psychology, King's College London, London, UK
| | - P. McGuire
- Department of Psychosis Studies, King's College London, London, UK
| | - P. Fusar-Poli
- Department of Psychosis Studies, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - G. Lewis
- Division of Psychiatry, University College London, London, UK
| | - A. S. David
- UCL Institute of Mental Health, University College London, London, UK
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21
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Lewis G, Thame M, Howitt C, Hambleton I, Serjeant GR. Pregnancy outcome in homozygous sickle cell disease: observations from the Jamaican Birth Cohort. BJOG 2021; 128:1703-1710. [PMID: 33683802 DOI: 10.1111/1471-0528.16696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To document pregnancy outcome in homozygous sickle cell (SS) disease and in age-matched controls with a normal haemoglobin genotype followed from birth for up to 45 years. METHODS A total of 100 000 consecutive non-operative deliveries screened for sickle cell disease at the main Government maternity hospital in Kingston, Jamaica between 1973 and 1981 detected 311 (149 female) babies with SS disease who were matched by age and gender with 250 (129 female) controls with an AA haemoglobin phenotype. These individuals have been followed from birth with prospective assessment of menarche and detailed documentation of all pregnancies. RESULTS There were 177 pregnancies in 71 SS patients and 226 pregnancies in 74 AA controls. Mothers with SS disease had more spontaneous abortions (adjusted relative risk [aRR] 3.2, 95% CI 1.6-6.1), fewer live births (aRR 0.7, 95% CI 0.6-0.9) and their offspring were more likely to have a gestational age <37 weeks (aRR 2.1, 95% CI 1.1-3.7) and low birthweight <2.5 kg (aRR 3.0, 95% CI 1.6-5.3). They were more prone to acute chest syndrome (aRR 13.7, 95% CI 4.1-45.5), urinary tract infection (aRR 12.8, 95% CI 1.3-125.9), pre-eclampsia/eclampsia (aRR 3.1, 95% CI 1.1-8.8), retained placenta (aRR 10.1, 95% CI 1.1-90.3), sepsis (Fisher's Exact test 0.04) and pregnancy-related deaths (Fisher's Exact test 0.02). Four of five deaths were attributable to acute chest syndrome. There was no genotypic difference in pregnancy-induced hypertension or postpartum haemorrhage. CONCLUSION Pregnancy in SS disease carries risks for both mother and child. The variable characteristics of pregnancy-related deaths complicate their prevention. TWEETABLE ABSTRACT Pregnancy in SS disease compared with controls showed increased abortions and stillbirths, fewer live births and maternal deaths in 7% patients.
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Affiliation(s)
- G Lewis
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica
| | - M Thame
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica
| | - C Howitt
- Sir George Alleyne Chronic Disease Research Centre, The University of the West Indies, Cave Hill, Bridgetown, Barbados
| | - I Hambleton
- Sir George Alleyne Chronic Disease Research Centre, The University of the West Indies, Cave Hill, Bridgetown, Barbados
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Subbe CP, Holland M, Lewis G, Soong J, Varia R, Price V, Gebrill A, Sullivan P. Quality: What does it mean in Acute Medicine and how do we measure it? Acute Med 2021; 20:125-130. [PMID: 34190739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Acute Medicine is a specialty that is not defined by a single organ system and sits at the interface between primary and secondary care. In order to document improvements in the quality of care delivered a system of metrics is required. A number of frameworks for measurements exist to quantify quality of care at the level of patients, teams and organisations, such as measures of population health, patient satisfaction and cost per patient. Measures can capture whether care is safe, effective, patient-centred, timely, efficient and equitable. Measurement in Acute Medicine is challenged by the often-transient nature of the contact between Acute Medicine clinicians and patients, the lack of diagnostic labels, a low degree of standardisation and difficulties in capturing the patient experience in the context. In a time of increasing ecological and financial constraints, reflecting about the most appropriate metrics to document the impact of Acute Medicine is required.
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Affiliation(s)
- C P Subbe
- Consultant Acute Medicine, Senior Clinical Lecturer, Bangor University, Bangor
| | - M Holland
- Visiting Professor & Clinical Lecturer, Bolton University
| | - G Lewis
- Consultant Acute Medicine and Nephrology, Antrim Area Hospital, Northern Ireland
| | - Jty Soong
- Consultant Physician, Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore
| | - R Varia
- Clinical Director & Consultant Acute Medicine, St Helens & Knowsley Hospitals NHS Trust. Trust Fluid & AKI Lead
| | - V Price
- Consultant Acute Medicine, Royal Liverpool Hospital, Liverpool
| | - A Gebrill
- Consultant Acute Medicine, Salford Royal Hospital, Salford
| | - P Sullivan
- Consultant Acute Medicine, St Richard's Hospital, Chichester
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23
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Nicholas O, Lewis G, Thomas B, Smyth M, Spezi E, Gwynne S. PD-0422: Evaluating inter-observer variation in oesophageal target volume delineation. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00444-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Skapinakis P, Lewis G, Davies S, Brugha T, Prince M, Singleton N. Panic disorder and subthreshold panic in the UK general population: Epidemiology, comorbidity and functional limitation. Eur Psychiatry 2020; 26:354-62. [DOI: 10.1016/j.eurpsy.2010.06.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 06/14/2010] [Accepted: 06/23/2010] [Indexed: 10/19/2022] Open
Abstract
AbstractObjectiveThe epidemiology of panic disorder has not been investigated in the past in the UK using a nationally representative sample of the population. The aim of the present paper was to examine the epidemiology, comorbidity and functional impairment of subthreshold panic and panic disorder with or without agoraphobia.MethodWe used data from the 2000 Office for National Statistics Psychiatric Morbidity survey (N = 8580). Panic disorder and agoraphobia were assessed with the Revised Clinical Interview Schedule (CIS-R).ResultThe prevalence of panic disorder with or without agoraphobia was 1.70% (95% confidence interval: 1.41–2.03%). Subthreshold panic was more common. Economic inactivity was consistently associated with all syndromes. The comorbidity pattern of the panic syndromes and the associated functional impairment show that panic-related conditions are important public health problems, even in subthreshold status.ConclusionsThe findings show that efforts to reduce the disability associated with psychiatric disorders should include detection and management of panic disorder.
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Waldman G, Gift T, Turvey K, Ho J, Shah R, Thomas S, Carlson W, Ton V, Ibrahim N, Rogers C, Nayor M, Spahillari A, Coglianese E, D'Alessandro D, Lewis G. Optimal Dosing of Enoxaparin to Achieve Therapeutic Anticoagulation in Heart Transplant Recipients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Bachmann MO, Lewis G, John WG, Turner J, Dhatariya K, Clark A, Pascale M, Sampson M. Determinants of diagnostic discordance for non-diabetic hyperglycaemia and Type 2 diabetes using paired glycated haemoglobin measurements in a large English primary care population: cross-sectional study. Diabet Med 2019; 36:1478-1486. [PMID: 31420897 DOI: 10.1111/dme.14111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2019] [Indexed: 12/25/2022]
Abstract
AIM To investigate factors influencing diagnostic discordance for non-diabetic hyperglycaemia and Type 2 diabetes. METHODS Some 10 000 adults at increased risk of diabetes were screened with HbA1c and fasting plasma glucose (FPG). The 2208 participants with initial HbA1c ≥ 42 mmol/mol (≥ 6.0%) or FPG ≥ 6.1 mmol/l were retested after a median 40 days. We compared the first and second HbA1c results, and consequent diagnoses of non-diabetic hyperglycaemia and Type 2 diabetes, and investigated predictors of discordant diagnoses. RESULTS Of 1463 participants with non-diabetic hyperglycaemia and 394 with Type 2 diabetes on first testing, 28.4% and 21.1% respectively had discordant diagnoses on repeated testing. Initial diagnosis of non-diabetic hyperglycaemia and/or impaired fasting glucose according to both HbA1c and FPG criteria, or to FPG only, made reclassification as Type 2 diabetes more likely than initial classification according to HbA1c alone. Initial diagnosis of Type 2 diabetes according to both HbA1c and FPG criteria made reclassification much less likely than initial classification according to HbA1c alone. Age, and anthropometric and biological measurements independently but inconsistently predicted discordant diagnoses and changes in HbA1c . CONCLUSIONS Diagnosis of non-diabetic hyperglycaemia or Type 2 diabetes with a single measurement of HbA1c in a screening programme for entry to diabetes prevention trials is unreliable. Diagnosis of non-diabetic hyperglycaemia and Type 2 diabetes should be confirmed by repeat testing. FPG results could help prioritise retesting. These findings do not apply to people classified as normal on a single test, who were not retested.
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Affiliation(s)
- M O Bachmann
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - G Lewis
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - W G John
- Department of Clinical Biochemistry, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
| | - J Turner
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
| | - K Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
| | - A Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - M Pascale
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
| | - M Sampson
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
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Irish M, Solmi F, Mars B, King M, Lewis G, Pearson RM, Pitman A, Rowe S, Srinivasan R, Lewis G. Depression and self-harm from adolescence to young adulthood in sexual minorities compared with heterosexuals in the UK: a population-based cohort study. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There are few population-based cohort studies of the emergence, development, and persistence of mental health problems in sexual minorities compared with heterosexuals. We compared trajectories of depressive symptoms in sexual-minority adolescents and heterosexual adolescents from when they were aged 10 to 21 years, and examined self-harm at ages 16 and 21 years.
Methods
The study included 4828 adolescents born between April 1, 1991, and Dec 31, 1992, from the Avon Longitudinal Study of Parents and Children birth cohort (Bristol, UK) who reported their sexual orientation when aged 16 years. Depressive symptoms were assessed with the short Mood and Feelings Questionnaire at seven timepoints between ages 10 and 21 years. A self-harm questionnaire was completed at ages 16 and 21 years. Analyses were linear multilevel models with growth curves (depressive symptoms), logistic multilevel models (self-harm in the previous year at ages 16 and 21 years), and multinomial regression (lifetime self-harm with and without suicidal intent at age 21 years).
Findings
At age 10, depressive symptoms were higher in sexual minorities than in heterosexuals and increased with age to a larger extent. Depressive symptoms increased at each timepoint by 0·31 points in hetereosexuals, and by 0·49 points in sexual minorities. Sexual-minority adolescents were more likely than heterosexual adolescents to report self-harm in the previous year at ages 16 and 21 years, with no evidence that this estimate decreased with age. At aged 21, sexual minorities were more likely to report lifetime self-harm (ie, on at least one previous occasion) with suicidal intent than heterosexuals.
Interpretation
Mental health disparities between heterosexuals and sexual minorities are present early in adolescence and increase throughout the school years, persisting to young adulthood. Prevention of these mental health problems and early intervention must be a priority.
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Affiliation(s)
- M Irish
- Department of Psychological Medicine, King’s College London, London, UK
| | - F Solmi
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - B Mars
- Population Health Sciences, University of Bristol, Bristol, UK
| | - M King
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - G Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - R M Pearson
- Population Health Sciences, University of Bristol, Bristol, UK
| | - A Pitman
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - S Rowe
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - R Srinivasan
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - G Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
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Zuhour R, Messer J, Haque W, Lewis G, Wong A, Schefler A, Bernicker E, Chevez-Barrios P, Quan M, Farach A, Butler E, Teh B. Trends in Eye Plaque Brachytherapy for the Treatment of Choroidal Melanoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hui TP, Kandola A, Shen L, Lewis G, Osborn DPJ, Geddes JR, Hayes JF. A systematic review and meta-analysis of clinical predictors of lithium response in bipolar disorder. Acta Psychiatr Scand 2019; 140:94-115. [PMID: 31218667 PMCID: PMC6772083 DOI: 10.1111/acps.13062] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine clinical predictors of lithium response in bipolar disorder. METHODS Systematic review of studies examining clinical predictors of lithium response was conducted. Meta-analyses were performed when ≥2 studies examined the same potential predictor. RESULTS A total of 71 studies, including over 12 000 patients, identified six predictors of good response: mania-depression-interval sequence [odds ratio (OR): 4.27; 95% CI: 2.61, 6.97; P < 0.001], absence of rapid cycling (OR for rapid cycling: 0.30; 95% CI: 0.17, 0.53; P < 0.001), absence of psychotic symptoms (OR for psychotic symptoms: 0.52; 95% CI: 0.34, 0.79; P = 0.002), family history of bipolar disorder (OR: 1.61; 95% CI: 1.03, 2.52; P = 0.036), shorter prelithium illness duration [standardised mean difference (SMD): -0.26; 95% CI: -0.41, -0.12; P < 0.001] and later age of onset (SMD: 0.17; 95% CI: 0.02, 0.36; P = 0.029). Additionally, higher body mass index was associated with poor response in two studies (SMD: -0.61; 95% CI: -0.90, -0.32; P < 0.001). There was weak evidence for number of episodes prior to lithium treatment (SMD: -0.42; 95% CI: -0.84, -0.01; P = 0.046), number of hospitalisations before lithium (SMD: -0.40; 95% CI: -0.81, 0.01; P = 0.055) and family history of lithium response (OR: 10.28; 95% CI: 0.66, 161.26; P = 0.097). CONCLUSIONS The relative importance of these clinical characteristics should be interpreted with caution because of potential biases and confounding.
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Affiliation(s)
| | | | - L. Shen
- Division of PsychiatryUCLLondonUK
| | - G. Lewis
- Division of PsychiatryUCLLondonUK
| | | | - J. R. Geddes
- Department of PsychiatryUniversity of OxfordOxfordUK
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Lewis G, Melo T, Mercer M, Kaur H, Kings R. 35IS YOUR PATIENT MORE CONFUSED THAN NORMAL? A COMPLETE AUDIT CYCLE ON THE DIAGNOSIS AND MANAGEMENT OF DELIRIUM AT WATFORD GENERAL HOSPITAL. Age Ageing 2019. [DOI: 10.1093/ageing/afz055.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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31
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Lewis G, Haque W, Butler E, Teh B. Survival Outcomes and Patterns of Management for Anal Adenocarcinoma: An Analysis of the National Cancer Data Base. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Aworinde J, Werbeloff N, Lewis G, Livingston G, Sommerlad A. 70SEVERITY OF DEMENTIA AT DEATH: COHORT STUDY USING ROUTINELY COLLECTED SECONDARY CARE DATA. Age Ageing 2018. [DOI: 10.1093/ageing/afy118.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J Aworinde
- University College London, Faculty of Brain Sciences, Division of Psychiatry
| | - N Werbeloff
- University College London, Faculty of Brain Sciences, Division of Psychiatry
- Camden and Islington NHS Foundation Trust
| | - G Lewis
- University College London, Faculty of Brain Sciences, Division of Psychiatry
| | - G Livingston
- University College London, Faculty of Brain Sciences, Division of Psychiatry
- Camden and Islington NHS Foundation Trust
| | - A Sommerlad
- University College London, Faculty of Brain Sciences, Division of Psychiatry
- Camden and Islington NHS Foundation Trust
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Fudim M, Kelly JG, Jones A, Coles A, McNulty SJ, Redfield M, Lewis G, Hernandez AF, Felker GM. P884Can biomarkers be used to predict cardiopulmonary exercise test performance in patients with chronic heart failure? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Fudim
- Duke Clinical Research Institute, Cardiology, Durham, United States of America
| | - J G Kelly
- Duke Clinical Research Institute, Cardiology, Durham, United States of America
| | - A Jones
- Duke Clinical Research Institute, Cardiology, Durham, United States of America
| | - A Coles
- Duke Clinical Research Institute, Cardiology, Durham, United States of America
| | - S J McNulty
- Duke Clinical Research Institute, Cardiology, Durham, United States of America
| | - M Redfield
- Mayo Clinic, Rochester, United States of America
| | - G Lewis
- Massachusetts General Hospital, Boston, United States of America
| | - A F Hernandez
- Duke Clinical Research Institute, Cardiology, Durham, United States of America
| | - G M Felker
- Duke Clinical Research Institute, Cardiology, Durham, United States of America
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Khandaker GM, Stochl J, Zammit S, Goodyer I, Lewis G, Jones PB. Childhood inflammatory markers and intelligence as predictors of subsequent persistent depressive symptoms: a longitudinal cohort study. Psychol Med 2018; 48:1514-1522. [PMID: 29140226 PMCID: PMC6088526 DOI: 10.1017/s0033291717003038] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND To identify developmental sub-groups of depressive symptoms during the second decade of life, a critical period of brain development, using data from a prospective birth cohort. To test whether childhood intelligence and inflammatory markers are associated with subsequent persistent depressive symptoms. METHODS IQ, a proxy for neurodevelopment, was measured at age 8 years. Interleukin 6 (IL-6) and C-reactive protein, typical inflammatory markers, were measured at age 9 years. Depressive symptoms were measured six times between 10 and 19 years using the short mood and feelings questionnaire (SMFQ), which were coded as binary variable and then used in latent class analysis to identify developmental sub-groups of depressive symptoms. RESULTS Longitudinal SMFQ data from 9156 participants yielded three distinct population sub-groups of depressive symptoms: no symptoms (81.2%); adolescent-onset symptoms (13.2%); persistent symptoms (5.6%). Lower IQ and higher IL-6 levels in childhood were independently associated with subsequent persistent depressive symptoms in a linear, dose-response fashion, but not with adolescent-onset symptoms. Compared with the group with no symptoms the adjusted odds ratio for persistent depressive symptoms per s.d. increase in IQ was 0.80 (95% CI, 0.68-0.95); that for IL-6 was 1.20 (95% CI, 1.03-1.39). Evidence for an association with IL-6 remained after controlling for initial severity of depressive symptoms at 10 years. There was no evidence that IL-6 moderated or mediated the IQ-persistent depressive symptom relationship. CONCLUSIONS The results indicate potentially important roles for two distinct biological processes, neurodevelopment and inflammation, in the aetiology of persistent depressive symptoms in young people.
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Affiliation(s)
- G. M. Khandaker
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - J. Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Kinanthropology, Charles University, Prague, Czech Republic
| | - S. Zammit
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - I. Goodyer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - G. Lewis
- Division of Psychiatry, University College London, London, UK
| | - P. B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Zha H, Jeffs A, Dong Y, Lewis G. Potential virulence factors of bacteria associated with tail fan necrosis in the spiny lobster, Jasus edwardsii. J Fish Dis 2018; 41:817-828. [PMID: 29473647 DOI: 10.1111/jfd.12791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 06/08/2023]
Abstract
Tail fan necrosis (TFN) is a common condition found in commercially exploited spiny lobsters that greatly diminishes their commercial value. Bacteria possessing proteolytic, chitinolytic and lipolytic capabilities were associated with TFN in spiny lobsters, Jasus edwardsii. In this study, 69 bacterial isolates exhibiting all the three enzymatic capabilities from the haemolymph and tail fans of J. edwardsii with and without TFN were further characterized and compared, including morphology, biofilm formation, antimicrobial activity, antimicrobial resistance, and production of siderophores, melanin and ammonia. The genomic patterns of the most common Vibrio crassostreae isolates were also compared between TFN-affected and unaffected lobsters. Biofilm formation was stronger in bacterial isolates from both haemolymph and tail fans of TFN-affected lobsters compared to those from the unaffected lobsters, while melanin production and siderophore production were stronger in the isolates from tail fans of lobsters with TFN. By contrast, the other characteristics of isolates were similar in lobsters with and without TFN. The Vib. crassostreae isolates from the affected lobsters had similar genomic patterns. Overall, the results indicate that in addition to proteolytic, chitinolytic and lipolytic activities, the bacteria associated with TFN commonly have enhanced activity of important virulence factors, including biofilm formation, melanin production and siderophore production.
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Affiliation(s)
- H Zha
- School of Biological Sciences, University of Auckland, Auckland, New Zealand
- Institute of Marine Science, University of Auckland, Auckland, New Zealand
| | - A Jeffs
- School of Biological Sciences, University of Auckland, Auckland, New Zealand
- Institute of Marine Science, University of Auckland, Auckland, New Zealand
| | - Y Dong
- School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - G Lewis
- School of Biological Sciences, University of Auckland, Auckland, New Zealand
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Hollander AC, Kirkbride JB, Pitman A, Lundberg M, Lewis G, Magnusson C, Dalman C. Are refugees at increased risk of suicide compared with non-refugee migrants and the host population. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- AC Hollander
- Institutionen för Folkhälsovetenskap, Karolinska Institutet, Stockholm, Sweden
| | - JB Kirkbride
- Division of Psychiatry, University College London, London, UK
| | - A Pitman
- Division of Psychiatry, University College London, London, UK
| | - M Lundberg
- Institutionen för Folkhälsovetenskap, Karolinska Institutet, Stockholm, Sweden
| | - G Lewis
- Division of Psychiatry, University College London, London, UK
| | - C Magnusson
- Institutionen för Folkhälsovetenskap, Karolinska Institutet, Stockholm, Sweden
| | - C Dalman
- Institutionen för Folkhälsovetenskap, Karolinska Institutet, Stockholm, Sweden
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Lewis G, Agrusa J, Teh B, Gramatges M, Kothari V, Allen C, Paulino A. Radiation Pneumonitis in Pediatric Hodgkin Lymphoma Patients receiving Radiotherapy to the Chest. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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O'Gorman A, Suvitaival T, Ahonen L, Cannon M, Zammit S, Lewis G, Roche HM, Mattila I, Hyotylainen T, Oresic M, Brennan L, Cotter DR. Identification of a plasma signature of psychotic disorder in children and adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Transl Psychiatry 2017; 7:e1240. [PMID: 28949339 PMCID: PMC5639252 DOI: 10.1038/tp.2017.211] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 08/02/2017] [Accepted: 08/17/2017] [Indexed: 11/14/2022] Open
Abstract
The identification of an early biomarker of psychotic disorder is important as early treatment is associated with improved patient outcome. Metabolomic and lipidomic approaches in combination with multivariate statistical analysis were applied to identify plasma alterations in children (age 11) (38 cases vs 67 controls) and adolescents (age 18) (36 cases vs 117 controls) preceeding or coincident with the development of psychotic disorder (PD) at age 18 in the Avon Longitudinal Study of Parents and Children (ALSPAC). Overall, 179 lipids were identified at age 11, with 32 found to be significantly altered between the control and PD groups. Following correction for multiple comparisons, 8 of these lipids remained significant (lysophosphatidlycholines (LPCs) LPC(18:1), LPC(18:2), LPC(20:3); phosphatidlycholines (PCs) PC(32:2; PC(34:2), PC(36:4), PC(0-34-3) and sphingomyelin (SM) SM(d18:1/24:0)), all of which were elevated in the PD group. At age 18, 23 lipids were significantly different between the control and PD groups, although none remained significant following correction for multiple comparisons. In conclusion, the findings indicate that the lipidome is altered in the blood during childhood, long before the development of psychotic disorder. LPCs in particular are elevated in those who develop PD, indicating inflammatory abnormalities and altered phospholipid metabolism. These findings were not found at age 18, suggesting there may be ongoing alterations in the pathophysiological processes from prodrome to onset of PD.
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Affiliation(s)
- A O'Gorman
- Department of Psychiatry, Royal College of Surgeons in Ireland (RCSI), Beaumont Hospital, Dublin, Ireland,Institute of Food and Health, UCD School of Agriculture and Food Science, University College Dublin (UCD), Belfield, Dublin, Ireland
| | | | - L Ahonen
- Steno Diabetes Center, Gentofte, Denmark
| | - M Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland (RCSI), Beaumont Hospital, Dublin, Ireland
| | - S Zammit
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK,Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - G Lewis
- Division of Psychiatry, University College London, London, UK
| | - H M Roche
- Nutrigenomics Research Group, UCD Conway Institute/UCD Institute of Food & Health, School of Public Health, Physiotherapy & Sports Science, University College Dublin (UCD), Belfield, Dublin, Ireland
| | - I Mattila
- Steno Diabetes Center, Gentofte, Denmark
| | - T Hyotylainen
- Steno Diabetes Center, Gentofte, Denmark,Department of Chemistry, Örebro University, Örebro, Sweden
| | - M Oresic
- Steno Diabetes Center, Gentofte, Denmark,Turku Centre for Biotechnology, University of Turku and Åbo Akademi University, Turku, Finland,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - L Brennan
- Institute of Food and Health, UCD School of Agriculture and Food Science, University College Dublin (UCD), Belfield, Dublin, Ireland,Institute of Food and Health, UCD School of Agriculture and Food Science, University College Dublin (UCD), Belfield, Dublin 4, Ireland. E-mail:
| | - D R Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland (RCSI), Beaumont Hospital, Dublin, Ireland,Department of Psychiatry, Royal College of Surgeons in Ireland (RCSI), Beaumont Hospital, Dublin 9, Ireland. E-mail:
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Lagan J, Naish J, Clark D, Foden P, Caldwell J, Trafford A, Critchley W, Fildes J, Reid A, Lewis G, Sarma J, Schmitt M, Miller C. P3358In vivo evidence of chronic myocardial inflammation in ischaemic cardiomyopathy using USPIO enhanced cardiovascular magnetic resonance. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Solmi F, Hayes JF, Lewis G, Kirkbride JB. Curiosity killed the cat: no evidence of an association between cat ownership and psychotic symptoms at ages 13 and 18 years in a UK general population cohort. Psychol Med 2017; 47:1659-1667. [PMID: 28222824 PMCID: PMC5939988 DOI: 10.1017/s0033291717000125] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Congenital or early life infection with Toxoplasma gondii has been implicated in schizophrenia aetiology. Childhood cat ownership has been hypothesized as an intermediary marker of T. gondii infection and, by proxy, as a risk factor for later psychosis. Evidence supporting this hypothesis is, however, limited. METHOD We used birth cohort data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to investigate whether cat ownership in pregnancy and childhood (ages 4 and 10 years) was associated with psychotic experiences (PEs) in early (age 13, N = 6705) and late (age 18, N = 4676) adolescence, rated from semi-structured interviews. We used logistic regression to examine associations between cat ownership and PEs, adjusting for several sociodemographic and socioeconomic factors, household characteristics and dog ownership. Missing data were handled via multiple imputation. RESULTS Cat ownership during pregnancy was not associated with PEs at age 13 years [adjusted odds ratio (OR) 1.15, 95% confidence interval (CI) 0.97-1.35] or 18 years (OR 1.08, 95% CI 0.86-1.35). Initial univariable evidence that cat ownership at ages 4 and 10 years was associated with PEs at age 13 years did not persist after multivariable adjustment (4 years: OR 1.18, 95% CI 0.94-1.48; 10 years: OR 1.12, 95% CI 0.92-1.36). There was no evidence that childhood cat ownership was associated with PEs at age 18 years. CONCLUSIONS While pregnant women should continue to avoid handling soiled cat litter, given possible T. gondii exposure, our study strongly indicates that cat ownership in pregnancy or early childhood does not confer an increased risk of later adolescent PEs.
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Affiliation(s)
- F. Solmi
- Division of Psychiatry, University College
London, London, UK
| | - J. F. Hayes
- Division of Psychiatry, University College
London, London, UK
| | - G. Lewis
- Division of Psychiatry, University College
London, London, UK
| | - J. B. Kirkbride
- Division of Psychiatry, University College
London, London, UK
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Lewis G, Kounali D, Button KS, Duffy L, Wiles NJ, Munafò MR, Harmer CJ, Lewis G. Variation in the recall of socially rewarding information and depressive symptom severity: a prospective cohort study. Acta Psychiatr Scand 2017; 135:489-498. [PMID: 28374430 PMCID: PMC5763395 DOI: 10.1111/acps.12729] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To test the association between recall for socially rewarding (positive) and/or socially critical (negative) information and depressive symptoms. METHOD Cohort study of people who had visited UK primary care in the past year reporting depressive symptoms (N = 558, 69% female). Positive and negative recall was assessed at three time-points, 2 weeks apart, using a computerised task. Depressive symptoms were assessed at four time-points using the Beck Depression Inventory (BDI). Analyses were conducted using multilevel models. RESULTS Concurrently we found evidence that, for every increase in two positive words recalled, depressive symptoms reduced by 0.6 (95% CI -1.0 to -0.2) BDI points. This association was not affected by adjustment for confounders. There was no evidence of an association between negative recall and depressive symptoms (-0.1, 95% CI -0.5 to 0.3). Longitudinally, we found more evidence that positive recall was associated with reduced depressive symptoms than vice versa. CONCLUSION People with more severe depressive symptoms recall less positive information, even if their recall of negative information is unaltered. Clinicians could put more emphasis on encouraging patients to recall positive, socially rewarding information, rather than trying to change negative interpretations of events that have already occurred.
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Affiliation(s)
- G. Lewis
- Division of PsychiatryFaculty of Brain SciencesUniversity College LondonLondonUK
| | - D.‐Z. Kounali
- School of Social and Community MedicineUniversity of BristolBristolUK
| | - K. S. Button
- Department of PsychologyUniversity of BathBathUK
| | - L. Duffy
- Division of PsychiatryFaculty of Brain SciencesUniversity College LondonLondonUK
| | - N. J. Wiles
- Centre for Academic Mental HealthSchool of Social and Community MedicineUniversity of BristolBristolUK
| | - M. R. Munafò
- MRC Integrative Epidemiology Unit and School of Experimental PsychologyUniversity of BristolBristolUK
| | - C. J. Harmer
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - G. Lewis
- Division of PsychiatryFaculty of Brain SciencesUniversity College LondonLondonUK
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Hayes JF, Khandaker GM, Anderson J, Mackay D, Zammit S, Lewis G, Smith DJ, Osborn DPJ. Childhood interleukin-6, C-reactive protein and atopic disorders as risk factors for hypomanic symptoms in young adulthood: a longitudinal birth cohort study. Psychol Med 2017; 47:984-986. [PMID: 28091342 DOI: 10.1017/s0033291716003408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Chan WC, Wong CS, Chen EY, Ng RM, Hung SF, Cheung EF, Sham PC, Chiu HF, Lam M, Chang WC, Lee EH, Chiang TP, Lau JT, van Os J, Lewis G, Bebbington P, Lam LC. Validation of the Chinese Version of the Revised Clinical Interview Schedule: Findings from Hong Kong Mental Morbidity Survey. East Asian Arch Psychiatry 2017; 27:3-10. [PMID: 28387207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study aimed to assess the psychometric properties of the Chinese version of the Revised Clinical Interview Schedule (C-CIS-R), and explore its applicability as a diagnostic instrument for common mental disorders (CMDs) in Hong Kong. Its psychometric properties were evaluated among 140 patients and 161 healthy controls. In comparison to the diagnoses made by the Structured Clinical Interview for the DSM-IV, the C-CIS-R showed good criterion validity in diagnosing CMDs. The correlation of the total score of C-CIS-R with the 12-item General Health Questionnaire and Hospital Anxiety and Depression Scale was satisfactory, indicating favourable convergent validity as well. The inter-rater and test-retest reliability were also satisfactory. Receiver operating characteristic analyses suggested an optimal cut-off point of 11/12 for detecting diagnosable CMDs (sensitivity: 0.69; specificity: 0.93) and 17/18 for identifying a need for treatment (sensitivity: 0.70; specificity: 0.95). In conclusion, C-CIS-R is a valid diagnostic instrument for CMDs in a Chinese community. Its cut-off points for clinically significant symptoms and treatment needs among Chinese are identical to those adopted in the original English version.
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Affiliation(s)
- W C Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - C Sm Wong
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - E Yh Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - R Mk Ng
- Department of Psychiatry, Kowloon Hospital, Hong Kong SAR, China
| | - S F Hung
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong SAR, China
| | - E Fc Cheung
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - P C Sham
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - H Fk Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - M Lam
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - W C Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - E Hm Lee
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - T P Chiang
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - J Tf Lau
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - G Lewis
- Division of Psychiatry, University College London, London, United Kingdom
| | - P Bebbington
- Division of Psychiatry, University College London, London, United Kingdom
| | - L Cw Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
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Chattree A, Barbour JA, Thomas-Gibson S, Bhandari P, Saunders BP, Veitch AM, Anderson J, Rembacken BJ, Loughrey MB, Pullan R, Garrett WV, Lewis G, Dolwani S, Rutter MD. Report of the Association of Coloproctology of Great Britain and Ireland/British Society of Gastroenterology Colorectal Polyp Working Group: the development of a complex colorectal polyp minimum dataset. Colorectal Dis 2017; 19:67-75. [PMID: 27610599 DOI: 10.1111/codi.13504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/04/2016] [Indexed: 02/08/2023]
Abstract
AIM The management of large non-pedunculated colorectal polyps (LNPCPs) is complex, with widespread variation in management and outcome, even amongst experienced clinicians. Variations in the assessment and decision-making processes are likely to be a major factor in this variability. The creation of a standardized minimum dataset to aid decision-making may therefore result in improved clinical management. METHOD An official working group of 13 multidisciplinary specialists was appointed by the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG) to develop a minimum dataset on LNPCPs. The literature review used to structure the ACPGBI/BSG guidelines for the management of LNPCPs was used by a steering subcommittee to identify various parameters pertaining to the decision-making processes in the assessment and management of LNPCPs. A modified Delphi consensus process was then used for voting on proposed parameters over multiple voting rounds with at least 80% agreement defined as consensus. The minimum dataset was used in a pilot process to ensure rigidity and usability. RESULTS A 23-parameter minimum dataset with parameters relating to patient and lesion factors, including six parameters relating to image retrieval, was formulated over four rounds of voting with two pilot processes to test rigidity and usability. CONCLUSION This paper describes the development of the first reported evidence-based and expert consensus minimum dataset for the management of LNPCPs. It is anticipated that this dataset will allow comprehensive and standardized lesion assessment to improve decision-making in the assessment and management of LNPCPs.
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Affiliation(s)
- A Chattree
- Department of Gastroenterology, University Hospital of North Tees, Stockton on Tees, UK.,University School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | - J A Barbour
- Department of Gastroenterology, Queen Elizabeth Hospital, Gateshead, UK
| | | | - P Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - B P Saunders
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK
| | - A M Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - J Anderson
- Department of Gastroenterology, Cheltenham General Hospital, Cheltenham, UK
| | - B J Rembacken
- Department of Gastroenterology, Leeds General Infirmary, Leeds, UK
| | - M B Loughrey
- Department of Histopathology, Royal Victoria Hospital, Belfast, UK
| | - R Pullan
- Department of Colorectal Surgery, Torbay Hospital, Torquay, UK
| | - W V Garrett
- Department of Colorectal Surgery, Medway Maritime Hospital, Gillingham, UK
| | - G Lewis
- Department of Gastroenterology, University Hospital Llandough, Cardiff, UK
| | - S Dolwani
- Department of Gastroenterology, University Hospital Llandough, Cardiff, UK
| | - M D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton on Tees, UK.,University School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
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Hayes JF, Khandaker GM, Anderson J, Mackay D, Zammit S, Lewis G, Smith DJ, Osborn DPJ. Childhood interleukin-6, C-reactive protein and atopic disorders as risk factors for hypomanic symptoms in young adulthood: a longitudinal birth cohort study. Psychol Med 2017; 47:23-33. [PMID: 27476619 PMCID: PMC5197925 DOI: 10.1017/s0033291716001574] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 05/16/2016] [Accepted: 06/15/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND There are no existing longitudinal studies of inflammatory markers and atopic disorders in childhood and risk of hypomanic symptoms in adulthood. This study examined if childhood: (1) serum interleukin-6 (IL-6) and C-reactive protein (CRP); and (2) asthma and/or eczema are associated with features of hypomania in young adulthood. METHOD Participants in the Avon Longitudinal Study of Parents and Children, a prospective general population UK birth cohort, had non-fasting blood samples for IL-6 and CRP measurement at the age of 9 years (n = 4645), and parents answered a question about doctor-diagnosed atopic illness before the age of 10 years (n = 7809). These participants completed the Hypomania Checklist at age 22 years (n = 3361). RESULTS After adjusting for age, sex, ethnicity, socio-economic status, past psychological and behavioural problems, body mass index and maternal postnatal depression, participants in the top third of IL-6 values at 9 years, compared with the bottom third, had an increased risk of hypomanic symptoms by age 22 years [adjusted odds ratio 1.77, 95% confidence interval (CI) 1.10-2.85, p < 0.001]. Higher IL-6 levels in childhood were associated with adult hypomania features in a dose-response fashion. After further adjustment for depression at the age of 18 years this association remained (adjusted odds ratio 1.70, 95% CI 1.03-2.81, p = 0.038). There was no evidence of an association of hypomanic symptoms with CRP levels, asthma or eczema in childhood. CONCLUSIONS Higher levels of systemic inflammatory marker IL-6 in childhood were associated with hypomanic symptoms in young adulthood, suggesting that inflammation may play a role in the pathophysiology of mania. Inflammatory pathways may be suitable targets for the prevention and intervention for bipolar disorder.
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Affiliation(s)
| | - G. M. Khandaker
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - J. Anderson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - D. Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - S. Zammit
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
- Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - G. Lewis
- Division of Psychiatry, UCL, London, UK
| | - D. J. Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Abstract
Seven pigs were poisoned by feeding from 1 to 3 months with Senecio jacobaea (“ragwort”). Clinically, the disease induced was characterised by dyspnœa and fluctuating pyrexia, anatomically by firm, heavy, discoloured, oedematous lungs and histologically by pulmonary oedema, congestion, haemorrhage and alveolar epithelialisation, and by hepatic and renal karyomegaly. Ragwort poisoning in pigs was compared with groundnut poisoning and it was concluded that the two are unlikely to be confused.
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Affiliation(s)
- J.D.J. Harding
- From the Central Veterinary Laboratory, Weybridge, England
| | - G. Lewis
- From the Central Veterinary Laboratory, Weybridge, England
| | - J.T. Done
- From the Central Veterinary Laboratory, Weybridge, England
| | - R. Allcroft
- From the Central Veterinary Laboratory, Weybridge, England
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Rice D, Parker R, Lewis G, McNair P. THU0547 Is Pain Catastrophising Associated with Impaired Conditioned Pain Modulation in People with Chronic Widespread Pain? Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Parker R, Lewis G, Rice D, McNair P. FRI0646-HPR Does Painful Hand Arthritis Influence Motor Cortex Excitability and Motor Skill Learning? Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Tan J, Lewis G, Townend J, Holloway B. 013 Primary care direct access coronary artery calcium (CAC) score – prognosis from a novel service. Heart 2016. [DOI: 10.1136/heartjnl-2016-309680.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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