Development & validation of the BSI-9: A brief screening tool for the SAD Triad

Introduction

The Brief Symptom Inventory (BSI-53) was originally developed as a shorter alternative to the Symptom Checklist-90R, which captures a breath of psychopathology. Subsequently, the BSI-53 was further streamlined to an 18-item scale assessing psychological distress in terms of somatization (S), anxiety (A), and depression (D) – also known as the “SAD Triad”. The BSI-18 has been shown to have good validity in the German general population.

Objectives

The objective of the present study was to further improve the ease of use of the BSI as a clinical screening tool by developing a reliable and valid 9-item version of the BSI-18.

Methods

A representative sample of the German general population (N=2,516) was surveyed for demographic information and completed a variety of questionnaires, including the BSI-18. Confirmatory factor analyses, item-level statistics, and correlations were used to select three rather heterogeneous items for each subscale and confirm the model fit.

Results

The proposed 3-factor model of the BSI-9, corresponding to the SAD triad, demonstrated a good model fit. The internal consistency (Cronbach’s alpha) was .87 for the total scale, .72 for the somatisation scale, .79 for the depression scale, and .68 for the anxiety scale. Each of the subscales were significantly related to the Patient Health Questionnaire-4 and Hopkins Symptoms Checklist-25 in the hypothesized direction.

Conclusions

The BSI-9 provides researchers and clinicians with a brief, effective, and valid tool to screen for anxiety, depression, and somatization, thus preventing potential overload for research participants and flagging patients who might need further clinical assessment.

Increasing sensitivity in the measurement of heart rate variability: the method of non-stationary RR time-frequency analysis

A novel method of the time-frequency analysis of non-stationary heart rate variability (HRV) is developed which introduces the fragmentary spectrum as a measure that brings together the frequency content, timing and duration of HRV segments. The fragmentary spectrum is calculated by the similar basis function algorithm. This numerical tool of the time to frequency and frequency to time Fourier transformations accepts both uniform and non-uniform sampling intervals, and is applicable to signal segments of arbitrary length. Once the fragmentary spectrum is calculated, the inverse transform recovers the original signal and reveals accuracy of spectral estimates. Numerical experiments show that discontinuities at the boundaries of the succession of inter-beat intervals can cause unacceptable distortions of the spectral estimates. We have developed a measure that we call the "RR deltagram" as a form of the HRV data that minimises spectral errors. The analysis of the experimental HRV data from real-life and controlled breathing conditions suggests transient oscillatory components as functionally meaningful elements of highly complex and irregular patterns of HRV.

New directions for patient-centred care in scleroderma: the Scleroderma Patient-centred Intervention Network (SPIN)

Systemic sclerosis (SSc), or scleroderma, is a chronic multisystem autoimmune disorder characterised by thickening and fibrosis of the skin and by the involvement of internal organs such as the lungs, kidneys, gastrointestinal tract, and heart. Because there is no cure, feasibly-implemented and easily accessible evidence-based interventions to improve health-related quality of life (HRQoL) are needed. Due to a lack of evidence, however, specific recommendations have not been made regarding non-pharmacological interventions (e.g. behavioural/psychological, educational, physical/occupational therapy) to improve HRQoL in SSc. The Scleroderma Patient-centred Intervention Network (SPIN) was recently organised to address this gap. SPIN is comprised of patient representatives, clinicians, and researchers from Canada, the USA, and Europe. The goal of SPIN, as described in this article, is to develop, test, and disseminate a set of accessible interventions designed to complement standard care in order to improve HRQoL outcomes in SSc.

Effect of cycloheximide on protein biosynthesis in rat liver

1. The liver ribosomes of rats given cycloheximide by intraperitoneal injection incorporate less amino acid into protein than ribosomes from control rat liver when they are incubated in vitro with excess of Sephadex-treated cell sap. The effect is rapid, marked and persistent. 2. Cell sap from liver of cycloheximide-treated animals is inhibitory but the inhibition can be relieved almost entirely by treating the cell sap with Sephadex. No damage has been done to the cell-sap factors: it is suggested that the dissolved cycloheximide in the cell sap causes the inhibition. 3. Cycloheximide added in vitro inhibits amino acid incorporation into protein in the presence or absence of polyuridylic acid. The inhibition is lessened by addition of excess of cell sap but is not abolished. 4. The differences between these results and those obtained with mouse liver (Trakatellis, Montjar & Axelrod, 1965) might arise because of species differences in sensitivity to the drug.

Post-transplant diabetes mellitus in children following renal transplantation

PTDM plays a role in chronic allograft nephropathy and decreases graft and patient survival. Considering the serious outcome of chronic hyperglycemia, the importance of early recognition and the few data in children, in this retrospective analysis we studied the characteristics and risk factors of PTDM in 45 pediatric renal transplant recipients receiving Tac or CyA-based immunosuppression. Fasting blood sampling and OGTT were performed. PTDM has been developed in six patients (13%), while seven children (16%) had IGT, with the overall incidence of a glucose metabolic disorder of 29% in pediatric renal transplants. Patients in the PTDM + IGT group were younger and had higher systolic blood pressure and serum triglyceride level than children with normal glucose tolerance. Multivariate analysis identified Tac treatment, Tac trough level, steroid pulse therapy and family history of diabetes to be associated with the onset of PTDM. In pediatric renal transplants, OGTT and frequent assessment of blood glucose levels might be essential not only in the post-transplant management, but also prior to transplantation, particularly with family history of diabetes. Careful monitoring and modified protocols help to minimize the side effects of Tac and corticosteroids.

Liveliness

OBJECTIVE

The objective of this study is to explore the significance of the experience of liveliness in psychotherapeutic interactions and its relevance to the practice of psychotherapy.

METHOD

Stern's notion of 'vitality affects' and Emde's concept of a 'primary affective core' are employed in developing a concept of liveliness, or an enlivening-deadening axis of experience. A critique of Freud's 'principles of mental functioning' is made in the light of this concept. Clinical examples are provided as illustrations of the relevance of considering the 'sense of liveliness', and its sustainability, in psychotherapy.

RESULTS AND CONCLUSIONS

A sense of liveliness relates closely to activity within a system of interpersonal resonance with non-linear characteristics. The experience of, and responses to, vitality affects may be an important basis of a sense of liveliness. Sudden shifts towards experiences of deadness are a matter for concern in psychotherapy. This sphere of experience, although occurring largely outside verbal awareness, may constitute a distinct type of mental process. Three types of mental activity or process are postulated: (i) emergent, pre-representational activity characterised by the sense of liveliness; (ii) Play-related thought or activity typically experienced as enlivening; and (iii) work-related or adaptational thought or activity.

(You gotta have) faith

OBJECTIVE

The modern scientific tendency to disavow the relevance of faith is questioned, particularly in relation to psychiatric practice. An experience-near approach to psychiatric practice, inclusive of human values such as faith, is highlighted.

METHOD

Drawing upon the philosophical work of Jaspers and the developmental psychology of Stern, a model is built up of the flow of lived experience that relies to a large extent on what can be 'taken on faith' rather than 'known about'. An argument is presented that from this standpoint of 'lived reality', the separation of fact and value inherent in modern scientific thought is not valid.

CONCLUSIONS

It is found that lived experience is infused with faith in three senses: that of faith-in-oneself, that of faith-in-the-other; and that of transcendent faith. Each of these is shown to be relevant to praxis in psychiatry. Failure to include faith in psychiatric thinking may lead to a distancing of the discipline from the level of everyday experience.

Organization of sleep-waking states in conjoined twin neonates

Developmentally normal twins, joined from the mid-sternum to the umbilicus in a face-to-face position, were observed in 90-minute sessions twice daily from postnatal days 12 to 16. Sleep-waking states were coded in 10-second epochs. Within-twin data were analyzed for bout lengths, interbout intervals, transition probabilities and 60-minute autocorrelation patterns. Between-twin data were studied for simultaneous occurrences of sleep-waking states and 60-minute cross-correlation patterns. Epochs per bout and interbout intervals for quiet and active sleep, active sleep epochs with rapid eye movements (REMs) and quiet and active waking states showed little difference between the twins over the study days. Probabilities of transition between quiet and active sleep and active wakefulness also showed the same patterns for each twin. However, the organization of temporal states differed markedly. Simultaneous occurrences of the same states were at or barely above chance levels, autocorrelation patterns of all states except epochs with REMs were not the same and cross-correlations indicated little influence of one twin's current state on the subsequent probability of that state's occurrence in the other twin. Thus, neither shared environment, identical genotype nor shared stimulation from co-twin motor activity appeared to synchronize the temporal organization of behavioral states in these twins. We concluded that the overall distributions of neonatal sleep-waking states seem to be determined primarily by age, whereas the temporal organization of states expresses the neonate's individuality.

Differential inhibition of mammalian ribonucleic acid polymerases by an exotoxin from Bacillus thuringiensis. The direct observation of nucleoplasmic ribonucleic acid polymerase activity in intact nuclei

The effects of the exotoxin from Bacillus thuringiensis on DNA-dependent RNA polymerases from rat liver were examined. The exotoxin inhibits all RNA polymerase activity at both low and high ionic strength in intact nuclei, and soluble enzymes are similarly affected. This inhibition is relieved by ATP. Dephosphorylated exotoxin did not inhibit the soluble enzymes. Nucleolar and nucleoplasmic RNA polymerases respond to different concentration ranges of exotoxin, and the compound can be used in intact nuclei to isolate the nucleoplasmic activity.

A decreased aminoacyl-transfer-ribonucleic acid-binding capacity of 40S ribosomal subunits resulting from hypophysectomy of the rat

A technique that permitted the reversible dissociation of rat liver ribosomes was used to study the difference in protein-synthetic activity between liver ribosomes of normal and hypophysectomized rats. Ribosomal subunits of sedimentation coefficients 38S and 58S were produced from ferritin-free ribosomes by treatment with 0.8m-KCl at 30 degrees C. These recombined to give 76S monomers, which were as active as untreated ribosomes in incorporating phenylalanine in the presence of poly(U). Subunits from normal and hypophysectomized rats were recombined in all possible combinations and the ability of the hybrid ribosomes to catalyse polyphenylalanine synthesis was measured. The results show that the defect in ribosomes of hypophysectomized rats lies only in the small ribosomal subunit. The 40S but not the 60S subunit of rat liver ribosomes bound poly(U). The only requirement for the reaction was Mg(2+), the optimum concentration of which was 5mm. No apparent difference was seen between the poly(U)-binding abilities of 40S ribosomal subunits from normal or hypophysectomized rats. Phenylalanyl-tRNA was bound by 40S ribosomal subunits in the presence of poly(U) by either enzymic or non-enzymic reactions. Non-enzymic binding required a Mg(2+) concentration in excess of 5mm and increased linearly with increasing Mg(2+) concentrations up to 20mm. At a Mg(2+) concentration of 5mm, GTP and either a 40-70%-saturated-(NH(4))(2)SO(4) fraction of pH5.2 supernatant or partially purified aminotransferase I was necessary for binding of aminoacyl-tRNA. Hypophysectomy of rats resulted in a decreased binding of aminoacyl-tRNA by 40S ribosomal subunits.

Hormonal control of protein synthesis

Most hormones stimulate protein biosynthesis either of specific proteins, or in specific tissues, or in a more generalized fashion. In general protein anabolic hormones can be shown to stimulate amino acid uptake by tissues; to increase protein biosynthesis by a mechanism independent of the increased uptake of amino acids; to stimulate the labelling of ribonucleic acid (RNA) by tissues again in addition to stimulatory effects on precursor entry ; to stimulate RNA polymerase activity; to enhance the activity of ribosomes assayed in cell-free systems and to alter the patterns of polysomes analysed by sucrose density gradient centrifugation; to stimulate the synthesis of endoplasmic reticulum and of ribosomes and, in some instances, to stimulate deoxyribonucleic acid (DNA) synthesis. In general these effects are seen only after the hormone is injected into a suitable experimental animal or are added to the medium in which a cell culture or a tissue is incubated or with which an organ is perfused. There are a few, well-authenticated cases where hormones stimulate protein synthesis when added to cell-free systems. This fact means that certain difficulties are inherent in work with hormones. It is difficult to ensure that the effect observed after injection is not a secondary effect of the hormone through its influence on some other endocrine gland, or other tissue, or some other metabolic event.

Amino acid requirement for the growth-hormone stimulation of incorporation of precursors into protein and nucleic acids of liver slices

1. Incorporation of [(14)C]leucine into protein in rat liver slices, incubated in vitro, increased as the concentration of unlabelled amino acids in the incubation medium was raised. A plateau of incorporation was reached when the amino acid concentration was 6 times that present in rat plasma. Labelling of RNA by [(3)H]orotic acid was not stimulated by increased amino acid concentration in the incubation medium. 2. When amino acids were absent from the medium, or present at the normal plasma concentrations, no effect of added growth hormone on labelling of protein or RNA by precursor was observed. 3. When amino acids were present in the medium at 6 times the normal plasma concentrations addition of growth hormone stimulated incorporation of the appropriate labelled precursor into protein of liver slices from normal rats by 31%, and into RNA by 22%. A significant effect was seen at a hormone concentration as low as 10ng/ml. 4. Under the same conditions addition of growth hormone also stimulated protein labelling in liver slices from hypophysectomized rats. Tissue from hypophysectomized rats previously treated with growth hormone did not respond to growth hormone in vitro. 5. No effect of the hormone on the rate or extent of uptake of radioactive precursors into acid-soluble pools was found. 6. Cycloheximide completely abolished the hormone-induced increment in labelling of both RNA and protein. 7. It was concluded that, in the presence of an abundant amino acid supply, growth hormone can stimulate the synthesis of protein in rat liver slices by a mechanism that is more sensitive to cycloheximide than is the basal protein synthesis. The stimulation of RNA labelling observed in the presence of growth hormone may be a secondary consequence of the hormonal effect on protein synthesis. 8. The mechanism of action of growth hormone on liver protein synthesis in vitro was concluded to be similar to its mechanism of action in vivo.