Early-Onset Bipolar Spectrum Disorders: Diagnostic Issues

Since the mid 1990s, early-onset bipolar spectrum disorders (BPSDs) have received increased attention in both the popular press and scholarly press. Rates of diagnosis of BPSD in children and adolescents have increased in inpatient, outpatient, and primary care settings. BPSDs remain difficult to diagnose, particularly in youth. The current diagnostic system makes few modifications to accommodate children and adolescents. Researchers in this area have developed specific BPSD definitions that affect the generalizability of their findings to all youth with BPSD. Despite knowledge gains from the research, BPSDs are still difficult to diagnose because clinicians must: (1) consider the impact of the child’s developmental level on symptom presentation (e.g., normative behavior prevalence, environmental limitations on youth behavior, pubertal status, irritability, symptom duration); (2) weigh associated impairment and course of illness (e.g., neurocognitive functioning, failing to meet full DSM criteria, future impairment); and (3) make decisions about appropriate assessment (differentiating BPSD from medical illnesses, medications, drug use, or other psychiatric diagnoses that might better account for symptoms; comorbid disorders; informant characteristics and assessment measures to use). Research findings concerning these challenges and relevant recommendations are offered. Areas for further research to guide clinicians’ assessment of children with early-onset BPSD are highlighted

Stability of Satellite Planes in M31 II: Effects of the Dark Subhalo Population

The planar arrangement of nearly half the satellite galaxies of M31 has been a source of mystery and speculation since it was discovered. With a growing number of other host galaxies showing these satellite galaxy planes, their stability and longevity have become central to the debate on whether the presence of satellite planes are a natural consequence of prevailing cosmological models, or represent a challenge. Given the dependence of their stability on host halo shape, we look into how a galaxy plane's dark matter environment influences its longevity. An increased number of dark matter subhalos results in increased interactions that hasten the deterioration of an already-formed plane of satellite galaxies in spherical dark halos. The role of total dark matter mass fraction held in subhalos in dispersing a plane of galaxies present non trivial effects on plane longevity as well. But any misalignments of plane inclines to major axes of flattened dark matter halos lead to their lifetimes being reduced to < 3 Gyrs. Distributing > 40% of total dark mass in subhalos in the overall dark matter distribution results in a plane of satellite galaxies that is prone to change through the 5 Gyr integration time period.Comment: 11 pages, 9 figures, accepted to MNRAS September 22 201

Mrs. H. Fristad to Mr. Meredith (15 October 1962)

https://egrove.olemiss.edu/mercorr_pro/2173/thumbnail.jp

An evidence map of psychosocial interventions for the earliest stages of bipolar disorder.

Depression, schizophrenia, and bipolar disorder are three of the four most burdensome problems in people aged under 25 years. In psychosis and depression, psychological interventions are effective, low-risk, and high-benefit approaches for patients at high risk of first-episode or early-onset disorders. We review the use of psychological interventions for early-stage bipolar disorder in patients aged 15-25 years. Because previous systematic reviews had struggled to identify information about this emerging sphere of research, we used evidence mapping to help us identify the extent, distribution, and methodological quality of evidence because the gold standard approaches were only slightly informative or appropriate. This strategy identified 29 studies in three target groups: ten studies in populations at high risk for bipolar disorder, five studies in patients with a first episode, and 14 studies in patients with early-onset bipolar disorder. Of the 20 completed studies, eight studies were randomised trials, but only two had sample sizes of more than 100 individuals. The main interventions used were family, cognitive behavioural, and interpersonal therapies. Only behavioural family therapies were tested across all of our three target groups. Although the available interventions were well adapted to the level of maturity and social environment of young people, few interventions target specific developmental psychological or physiological processes (eg, ruminative response style or delayed sleep phase), or offer detailed strategies for the management of substance use or physical health

Mesenchymal stem cells induce endothelial cell quiescence and promote capillary formation

Introduction: Rapid establishment of functional blood vessels is a prerequisite for successful tissue engineering. During vascular development, endothelial cells (ECs) and perivascular cells assemble into a complex regulating proliferation of ECs, vessel diameter and production of extracellular matrix proteins. The aim of this study was to evaluate the ability of mesenchymal stem cells (MSCs) to establish an endothelial-perivascular complex in tissue-engineered constructs comprising ECs and MSCs. Methods: Primary human ECs and MSCs were seeded onto poly(L-lactide-co-1,5-dioxepan-2-one) (poly(LLA-co-DXO)) scaffolds and grown in dynamic culture before subcutaneous implantation in immunocompromised mice for 1 and 3 weeks. Cellular activity, angiogenic stimulation and vascular assembly in cell/scaffold constructs seeded with ECs or ECs/MSCs in a 5:1 ratio was monitored with real-time RT-PCR, ELISA and immunohistochemical microscopy analysis. Results: A quiescent phenotype of ECs was generated, by adding MSCs to the culture system. Decreased proliferation of ECs, in addition to up-regulation of selected markers for vascular maturation was demonstrated. Baseline expression of VEGFa was higher for MSCs compared with EC (P <0.001), with subsequent up-regulated VEGFa-expression for EC/MSC constructs before (P <0.05) and after implantation (P <0.01). Furthermore, an inflammatory response with CD11b + cells was generated from implantation of human cells. At the end of the 3 week experimental period, a higher vascular density was shown for both cellular constructs compared with empty control scaffolds (P <0.01), with the highest density of capillaries being generated in constructs comprising both ECs and MSCs. Conclusions: Induction of a quiescent phenotype of ECs associated with vascular maturation can be achieved by co-seeding with MSCs. Hence, MSCs can be appropriate perivascular cells for tissue-engineered constructs

Improving Clinical Prediction of Bipolar Spectrum Disorders in Youth.

This report evaluates whether classification tree algorithms (CTA) may improve the identification of individuals at risk for bipolar spectrum disorders (BPSD). Analyses used the Longitudinal Assessment of Manic Symptoms (LAMS) cohort (629 youth, 148 with BPSD and 481 without BPSD). Parent ratings of mania symptoms, stressful life events, parenting stress, and parental history of mania were included as risk factors. Comparable overall accuracy was observed for CTA (75.4%) relative to logistic regression (77.6%). However, CTA showed increased sensitivity (0.28 vs. 0.18) at the expense of slightly decreased specificity and positive predictive power. The advantage of CTA algorithms for clinical decision making is demonstrated by the combinations of predictors most useful for altering the probability of BPSD. The 24% sample probability of BPSD was substantially decreased in youth with low screening and baseline parent ratings of mania, negative parental history of mania, and low levels of stressful life events (2%). High screening plus high baseline parent-rated mania nearly doubled the BPSD probability (46%). Future work will benefit from examining additional, powerful predictors, such as alternative data sources (e.g., clinician ratings, neurocognitive test data); these may increase the clinical utility of CTA models further

Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Background The mental health of children and young people (CYP) is a major UK public health concern. Recent policy reviews have identified that service provision for CYP with mental health needs is not as effective, responsive, accessible or child-centred as it could be. Following on from a previous National Institute for Health Research (NIHR) study into self-care support for CYP with long-term physical health needs, this study explored self-care support’s potential in CYP’s mental health. Objectives To identify and evaluate the types of mental health self-care support used by, and available to, CYP and their parents, and to establish how such support interfaces with statutory and non-statutory service provision. Design Two inter-related systematic literature reviews (an effectiveness review with meta-analysis and a perceptions review), together with a service mapping exercise and case study. Setting Global (systematic reviews); England and Wales (mapping exercise and case study). Participants (case study) Fifty-two individuals (17 CYP, 16 family members and 19 staff) were interviewed across six sites. Main outcome measures (meta-analysis) A measure of CYP’s mental health symptomatology. Data sources (literature reviews) MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, All Evidence-Based Medicine (EBM) Reviews, Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC). Review methods Titles and abstracts of papers were screened for relevance then grouped into studies. Two independent reviewers extracted data from studies meeting the inclusion criteria. A descriptive analysis and meta-analysis were conducted for the effectiveness review; descriptive analyses were conducted for the perceptions review. These analyses were integrated to elicit a mixed-methods review. Results Sixty-five of 71 included studies were meta-analysable. These 65 studies elicited 71 comparisons which, when meta-analysed, suggested that self-care support interventions were effective at 6-month [standardised mean difference (SMD) = −0.20; 95% confidence interval (CI) −0.28 to −0.11] and 12-month (SMD = −0.12; 95% CI −0.17 to −0.06) follow-ups. However, judged against Cochrane criteria, the studies were mostly low quality. Key elements of self-care support identified in the perceptions review were the acquisition of knowledge and skills, peer support and the relationship with the self-care support agent; CYP also had different perceptions from adults about what is important in self-care support. The mapping exercise identified 27 providers of 33 self-care support services. According to the case study data, effective self-care support services are predicated on flexibility; straightforward access; non-judgemental, welcoming organisations and staff; the provision of time and attention; opportunities to learn and practise skills relevant to self-care; and systems of peer support. Conclusions Mental health self-care support interventions for CYP are modestly effective in the short to medium term. Self-care support can be conceptualised as a process which has overlap with ‘recovery’. CYP and their families want choice and flexibility in the provision of such interventions and a continued relationship with services after the nominal therapy period. Those delivering self-care support need to have specific child-centred attributes. Future work Future work should focus on under-represented conditions (e.g. psychosis, eating disorders, self-harm); the role of technology, leadership and readiness in self-care support; satisfaction in self-care support; the conceptualisation of self-care support in CYP’s mental health; and efficacy and cost-effectiveness

Då reiser du ikkje til REKO-ringen for å kjøpe egg, men for å handle

I Noreg legg ein ned mykje tid på frivillig arbeid. Ein type frivillig arbeid vert utøvd ved REKO-ringane, eit konsept som er i stadig vekst og utbreiing i landet. I eit samfunn som stadig endrast har eg vore oppteken av kva som gjer at nokre organisasjonar utviklar seg og overlever, mens andre dør ut. Eg har hatt ein hypotese om at god leiing har mykje å seie for utviklinga. Det kan då vere avgjerande for organisasjonen kven som leiar og korleis det vert leia. I samband med studiet innan innovasjon og leiing vart eg presentert for REKO-konseptet, og fann det så interessant at eg har følgt utviklinga over tid. Eg ønskte å få djupare kompetanse om fenomenet, og har difor valt å nytte det som case for masteroppgåva mi. I denne studien har eg sett nærmare på motivasjon for leiing REKO-ringen, og kva for effektar innovasjonen har på leiaren. Eg har sett på korleis leiarane årsaksforklarer at dei tok på seg leiarrolla, kva behov leiarrolla er med på å fylle, og kva som ligg i sjølve leiarrolla. Eg har også sett på kva verdiar leiarane meiner er viktige ved REKO-ringane , og kva effektar det får for både leiinga og ringen. Studien er basert på kvalitativ forskingsmetode og eg har gjennomført semi-strukturerte intervju med seks leiarar. Studien er inspirert av Grounded Theory, og med koding og strukturering i fleire nivå, og eg har difor ikkje eit fast rameverk som grunnlag for analyse og drøfting av funn, men fleire sentrale teoriar. Eg har funne verdiar som viktige motivasjonsfaktorar for leiarar av REKO-ringane i området, og andre sentrale motivasjonsfaktorar. Eg har også funne at leiarane har ei noko uklår rolleoppfatning. Dette gjer at ringane vert leia på ulike måtar, og med ulikt resultat. Leiarane er i ulik grad medvitne om si eiga rolle og mulegheita ein har til å påverke. Tittelen på oppgåva «Då reiser ein ikkje til REKO-ringen for å kjøpe egg, men for å handle» er eit sitat til ein av leiarane, og eg meiner det illustrerer kva mulegheit som finns i REKO-konseptet. Nøkkelord: Leiing, verdibasert leiing, leiarrolla, motivasjon, innovasjon, frivillig arbeid, frivillighei

Sustainability in Norwegian eldercare

Fakultet for lærarutdanning, kultur og idrettGjennom denne oppgaven har jeg hatt som mål å drøfte hvordan ledere i norsk eldreomsorg opplever eldreomsorgen. Opplever de eldreomsorgen som bærekraftig i møte med «eldrebølgen»? Bærekraftig eldreomsorg har jeg i oppgaven definert som: Eldreomsorg som opprettholder kvaliteten for brukerne og tar hensyn til alle tre bærekraftdimensjonene. Hvordan de tre bærekraftdimensjonene påvirker hverandre og påvirker eldreomsorgen, vil jeg gå nærmere inn på i teori og analysekapitlene. Problemstillingen min har jeg formulert slik: Hvordan bærekrafthensyn påvirker eldreomsorgen og hva som er utfordringene og mulige løsninger, sett i et ledelsesperspektiv. For å analysere disse spørsmålene har jeg gjennomført en kvalitativ studie, der jeg har intervjuet informanter med ledende roller ved norske sykehjem. Jeg har også presentert relevant teori, som jeg har brukt i analysen av datamaterialet. Dette gjelder spesielt teori om bærekraftbegrepet, velferdsteknologi og boformer innenfor eldreomsorg, samt ledelsesteori. Av utfordringer i eldreomsorgen peker informantene mine på at det først og fremst er flere som blir eldre og sykere enn tidligere, en utvikling som både de og andre omtaler som eldrebølgen. En konsekvens av dette er at det er et økt behov for både sykehjemsplasser og personell, noe som innebærer et økt ressursbehov. Når det gjelder løsninger har jeg løftet fram tre punkter som har vært veldig tydelige i datamaterialet. Disse er: Endringer i forhold til hvordan eldre bor; blant annet så blir omsorg pluss løftet frem som en mulig løsning, og private bofellesskap blir omtalt. Noen av informantene ser for seg en mer radikal endring rundt boformene, og tror kanskje at vi må tilbake til generasjonsboliger eller lignende løsninger. Videre blir velferdsteknologi fremhevet som viktig i møte med eldrebølgen. Teknologi kan bidra til å lette på presset, og det kan bidra til at flere kan bo lengre hjemme og være mer uavhengige lengre inn i alderdommen. Likevel blir begrensingene ved teknologi omtalt, og informantene er tydelige på at teknologi alene ikke er nok til å imøtekomme utfordringen. Et tredje punkt som blir fremhevet er økt kompetanse; både blant personale og pårørende. For å få til dette kan økt kursing og bedre utdanning, gjerne med bedre lønnsvilkår, bidra til å totalt sett redusere ressursbehovet. Informantene beskrev gjennom intervjuene også andre forhold som påvirker eldreomsorgen, som vil bli presentert i analysekapitlet. Det foregår en del forandringer innen eldreomsorgen i dag. Staten legger til rette for flere sykepleierstudenter, gjennom blant annet å opprette 500 nye studieplasser ved forskjellige sykepleierlinjer i 2022, og velferdsteknologi er fremhevet som satsingsområde. Likevel opplever 5 informantene mine at det ikke blir gjort nok, og flere uttrykker bekymring for fremtiden, også for sin egen alderdom. De er ikke sikre på om kvaliteten på omsorgen vil være den samme som den er i dag, og tvilsomme til at eldreomsorgen kan bli bærekraftig. Til slutt må det understrekes at for at eldreomsorgen skal kunne regnes som bærekraftig slik som jeg har definert det i denne oppgaven, så er det nødvendig at alle de tre bærekraftdimensjonen - den sosiale, den økonomiske samt klima- og miljødimensjonen - er i harmoni med hverandre, og ivaretatt. Informantene på sin side stiller seg tvilsomme til at det vil være mulig å oppnå bærekraft innen alle dimensjonene, og mener at eldreomsorgen ikke kan bli bærekraftig, i hvert fall ikke om det skjer store forandringer i forhold til hvordan vi tenker om eldreomsorg. Slik det ser ut i dag er de tre dimensjonene ikke i harmoni med hverandre. For eksempel så gjøres det i dag mye for at den sosiale dimensjonen ved bærekraft blir ivaretatt, men samtidig øker kostnader betydelig, noe som står i strid med den økonomiske dimensjonen ved bærekraftbegrepet. Dette betyr indirekte at klima- og miljødimensjonen underprioriteres. For at norsk eldreomsorg skal bli bærekraftig, mener mine informanter at det må gjøres mye mer, og at vi må tenke nytt rundt tematikken eldreomsorg.MGUSA55