Increased Belief Instability in Psychotic Disorders Predicts Treatment Response to Metacognitive Training.

BACKGROUND AND HYPOTHESIS: In a complex world, gathering information and adjusting our beliefs about the world is of paramount importance. The literature suggests that patients with psychotic disorders display a tendency to draw early conclusions based on limited evidence, referred to as the jumping-to-conclusions bias, but few studies have examined the computational mechanisms underlying this and related belief-updating biases. Here, we employ a computational approach to understand the relationship between jumping-to-conclusions, psychotic disorders, and delusions. STUDY DESIGN: We modeled probabilistic reasoning of 261 patients with psychotic disorders and 56 healthy controls during an information sampling task-the fish task-with the Hierarchical Gaussian Filter. Subsequently, we examined the clinical utility of this computational approach by testing whether computational parameters, obtained from fitting the model to each individual's behavior, could predict treatment response to Metacognitive Training using machine learning. STUDY RESULTS: We observed differences in probabilistic reasoning between patients with psychotic disorders and healthy controls, participants with and without jumping-to-conclusions bias, but not between patients with low and high current delusions. The computational analysis suggested that belief instability was increased in patients with psychotic disorders. Jumping-to-conclusions was associated with both increased belief instability and greater prior uncertainty. Lastly, belief instability predicted treatment response to Metacognitive Training at the individual level. CONCLUSIONS: Our results point towards increased belief instability as a key computational mechanism underlying probabilistic reasoning in psychotic disorders. We provide a proof-of-concept that this computational approach may be useful to help identify suitable treatments for individual patients with psychotic disorders.

[The course of early neurological rehabilitation in a patient with severe posterior reversible encephalopathy syndrome]. / Verlauf der neurologischen Frührehabilitation bei einem Patienten mit ausgeprägtem Posteriorem Reversiblem Enzephalopathiesyndrom.

Posterior reversible encephalopathy syndrome (PRES) is widely held to be a benign and potentially reversible disease. However, severe cases have been described in the literature. Data on the long-term outcome of these severe cases are scarce. Furthermore, there are no data focusing on potential benefits of neurological early rehabilitation in these patients. Here we present the clinical picture, neuroimaging features, rehabilitative course and long-term outcome of a patient with severe PRES who underwent early neurological rehabilitation.

Spatiotemporal dependency of age-related changes in brain signal variability.

Recent theoretical and empirical work has focused on the variability of network dynamics in maturation. Such variability seems to reflect the spontaneous formation and dissolution of different functional networks. We sought to extend these observations into healthy aging. Two different data sets, one EEG (total n = 48, ages 18-72) and one magnetoencephalography (n = 31, ages 20-75) were analyzed for such spatiotemporal dependency using multiscale entropy (MSE) from regional brain sources. In both data sets, the changes in MSE were timescale dependent, with higher entropy at fine scales and lower at more coarse scales with greater age. The signals were parsed further into local entropy, related to information processed within a regional source, and distributed entropy (information shared between two sources, i.e., functional connectivity). Local entropy increased for most regions, whereas the dominant change in distributed entropy was age-related reductions across hemispheres. These data further the understanding of changes in brain signal variability across the lifespan, suggesting an inverted U-shaped curve, but with an important qualifier. Unlike earlier in maturation, where the changes are more widespread, changes in adulthood show strong spatiotemporal dependence.

Dorsal pancreas agenesis and ductal adenocarcinoma: surgical implications of an extremely rare association.

It is presented the case of a 44-year-old woman with ductal adenocarcinoma of the pancreatic head with associated dorsal pancreas agenesis. In this case, curative intent surgery implies removal of the whole pancreas with its consequences--parental insulin requirement and exocrine pancreatic insufficiency. A review of the literature on the previously reported cases was performed.

Phage typing, an accessible and useful method in the epidemiological surveillance of diphtheria.

Within the framework of the measures for diphtheria prevention and control, phage typing of isolates is useful for epidemiological investigations in a disease focus and in general population. The identification of asymptomatic carriers of toxigenic C.diphtheriae and its eradication decrease the transmission rate of the disease. The study of the circulating phage types (6058) enabled us to demonstrate the frequency and distribution of the different phage types, toxigenic and nontoxigenic in Romania. With the current knowledge of the circulating phage types it can be concluded that imported cases of diphtheria have not occurred so far. The Romanian phage typing schemes are able to type isolates from overseas, sometimes through phage adaptation methods. Our phage typing schemes are also able to demonstrate any modifications in the phage sensitivity patterns of diphtheria.

Experimental study on estimating the immunogenic potency of diphtheria and/or tetanus toxoids in monovaccines and associated vaccines.

The results obtained using the "classical" active immunoprotection tests on guinea pigs, biometrically interpreted by the regression analysis in "PROBIT" systems revealed that the biopreparations of the Cantacuzino Institute meet the validity conditions related to the parallelism of the "slopes" enabling the calculation of ED50 and of the relative potencies against the reference preparations. The results also showed that the relative potencies of the biopreparations tested by the two methodologies were very close. The geometrical means and the geometrical standard deviations of the titrers obtained in mice pointed to the similarity of the values following inoculation of the Cantacuzino Institute preparations on the one hand and of the international reference preparation on the other.

[Immunotherapy with autovaccines in urinary tract infections caused by gram-negative bacteria]. / Imunoterapia cu autovaccinuri în infectiile urinare cu germeni gramnegativi.

The efficiency of immunotherapy with autovaccines was determined in 162 patients with urinary infections produced by Gramnegative bacteria. In each case quantitative urocultures were performed, with examination of the urinary sediment, and blood samples taken before and after treatment with autovaccines in order to determine the agglutination and hemagglutination titer with autovaccines in order to determine the agglutination and hemagglutination titer with regard to the incriminated germs. The latter were identified by their enzymatic and serologic characters and their sensitivity to chemotherapeutical agents. Autovaccines were prepared (2, 3 or even 4 series), repeating the tests after administration of the vaccines. Following immunotherapy, 87 patients (53.7%) presented repeated negative urocultures, 11 presented alternate positive and negative cultures, and 64 remained positive in spite of the treatment applied. There was an increase in hemagglutination titers in the patients with negative urocultures following autovaccination. To conclude it is assumed that the efficiency of immunotherapy with autovaccines depends upon their administration at the onset of infection after the patient has benefitted by the chemotherapeutical treatment. In the cases in which germs belonging to different taxonomic groups are repeatedly isolated in urocultures, it is recommended to prepare a polyvalent autovaccine to be applied in 2-3 series.