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Self-compassion constitutes a positive way of relating towards the self that enables emotional regulation and reduces emotional distress. This research first explored differences among a sample of persons with social anxiety disorder (SAD) and groups of high socially anxious (HSA) and low socially anxious (LSA) students on self-compassion, emotion regulation, and social anxiety. We then investigated emotional regulation as a mediator of the prediction of social anxiety by self-compassion and the influence of depressed mood on those relationships.Study 1 compared a SAD group to matched groups of HSA and LSA students. Study 2 utilized the total sample (n = 330 students and n = 33 SAD) to test mediation. Self-compassion and emotion regulation were predictors of social anxiety and depression a covariate.In Study 1, the SAD group did not differ from the HSA group on most aspects of self-compassion and emotional regulation but was higher on depression. Both were lower on most measures and higher on depression than the LSA group. In Study 2, higher self-compassion predicted lower social interaction anxiety, and emotional regulation strategies mediated this effect, regardless of depression. However, for social performance anxiety, controlling for depression removed mediation. Refraining from uncompassionate responses was directly connected to social anxiety, whereas compassionate responses influenced social anxiety via emotional regulation.Results affirm the ameliorative role of self-compassion on social anxiety and emotion regulation strategies as mechanisms of that influence. However, self-compassion's influence was affected by depression and type of social anxiety. Also, refraining from uncompassionate self-responding appears to be of prime importance in predicting social anxiety, whereas compassionate self-responding influences social anxiety via emotion regulation.

Sf6 is a bacterial virus that infects the human pathogen Shigella flexneri. Here, we describe the cryo–electron microscopy structure of the Sf6 tail machine before DNA ejection, which we determined at a 2.7-angstrom resolution. We built de novo structures of all tail components and resolved four symmetry-mismatched interfaces. Unexpectedly, we found that the tail exists in two conformations, rotated by ~6° with respect to the capsid. The two tail conformers are identical in structure but differ solely in how the portal and head-to-tail adaptor carboxyl termini bond with the capsid at the fivefold vertex, similar to a diamond held over a five-pronged ring in two nonidentical states. Thus, in the mature Sf6 tail, the portal structure does not morph locally to accommodate the symmetry mismatch but exists in two energetic minima rotated by a discrete angle. We propose that the design principles of the Sf6 tail are conserved across P22-like Podoviridae.

Background Dynamic optical coherence tomography (D-OCT) has recently been introduced in dermatology. In contrast to 'Standard' OCT imaging, which exclusively relies on the morphological analysis of the tissue, D-OCT allows the in vivo visualization of blood flow. Preliminary D-OCT data showed differences in the vascularization of nevus to melanoma transition, suggesting that this technology may help to differentiate between benign and malignant lesions. Objective Several factors may influence the quality of D-OCT imaging. Therefore, standard operating procedures as well as a common terminology are required for better validation and comparison of the images. Methods Here, we present practical guidelines for optimal image acquisition and a proposed terminology on vascular patterns observed by D-OCT. Results Dynamic OCT allows the morphologic distinction of different vascular shapes (e.g. dots, blobs, curves, lines), their distribution and organization within skin lesions. Conclusion D-OCT adds functional information on skin microvasculature and the vascular networks within lesions.

While child sexual abuse is a problem worldwide, the risk factors for the perpetration of child sexual abuse within Fiji are unique in their relation to the traditional and communal nature of Fijian society. In this article, culturally relevant dynamic risk factors found within contemporary Fijian society are identified and understood alongside static factors contributing to abuse. Although there have been recent changes to sexual offence legislation and traditional criminal justice system responses to victims of sexual abuse, state-sanctioned responses continue to maintain victimising practices. Equally, the relative rural isolation means many Indigenous Fijian (iTaukei) communities continue to use customary restorative justice practices that may marginalise the rehabilitation of victims and offenders for the communities' benefit. However, a culturally specific amalgamation of traditional criminal justice and customary restorative responses may help to create more holistic protection for survivors of child sexual abuse in Fiji. Language: en

Background: Since their introduction, second-generation antipsychotics (SGAs) have become the drugs of choice for the treatment of schizophrenia. However, recent findings have questioned the benefits of SGAs over first-generation antipsychotics (FGAs). Objective: This post hoc analysis sought to compare the utility of the SGA aripiprazole with the FGA haloperidol in patients with early-phase schizophrenia (ES) or chronic schizophrenia (CS). Method: Data were pooled from two identical 52-week, randomized, active comparator trials (31-98-217 and 31-98-304) of aripiprazole 20-30 mg/day versus haloperidol 7-10 mg/day. Patients in the efficacy sample were classified as having ES if they were ≤40 years of age with a duration of illness ≤5 years. All other patients were classified as having CS. Health-state utilities were derived from the Positive and Negative Syndrome Scale and adverse events, using the last observation carried forward method. Results: Of 1294 patients in the efficacy sample, 362 met criteria for ES (aripiprazole, n - 239; haloperidol, n - 123) and 932 met criteria for CS (aripiprazole, n - 622; haloperidol, n - 310). Baseline patient characteristics were similar between treatment arms. At week 52, patients treated with aripiprazole in the total and ES populations had significantly greater total utility than those treated with haloperidol, although there were no statistically significant differences in total utility for the CS population at week 52. For the total population, patients treated with aripiprazole had significantly higher quality-adjusted life days (QALDs)/year than haloperidol recipients (+6.48 QALDs/year, p - 0.02). Significantly higher QALDs/year were also seen for aripiprazole-treated patients with ES (+10.65 QALDs/year, p - 0.04) but not for patients with CS (+4.92 QALDs/year, p - 0.14), compared with haloperidol-treated patients. Conclusions: Aripiprazole demonstrates greater utility than haloperidol over 52 weeks of treatment. This difference was driven by superiority of aripiprazole over haloperidol in patients with ES, which was not observed in patients with CS.

Background: Individuals with mental illness are at a higher risk of medical mortality than the general population, primarily due to an increased risk of cardiovascular disease. There are a number of modifiable metabolic risk factors associated with some atypical antipsychotics that warrant careful monitoring and treatment in both psychiatric and primary care practice if the risk of cardiovascular disease is to be effectively reduced. Data Sources: Previous guidelines have focused on awareness of metabolic risk factors in psychiatry, yet few articles have appeared in the primary care–focused journals. We present pragmatic guidelines that focus on monitoring metabolic abnormalities in primary care based on established guidelines, including joint recommendations of the American Diabetes Association, the American Psychiatric Association, the American Association of Clinical Endocrinologists, and the North American Association for the Study of Obesity, and the Mount Sinai conference. Data Synthesis: All patients receiving atypical antipsychotic agents associated with metabolic adverse events should be routinely monitored for weight gain and abnormalities in blood glucose and lipid levels. Effective communication and collaboration between mental health and primary care services and better access to primary care screening and treatment for individuals with mental health problems are needed. Conclusion: There is a clear need for awareness among primary care physicians, particularly as metabolic effects of atypical antipsychotics such as blood pressure and glucose and lipid levels are possibly best monitored in a primary care setting.

Optical coherence tomography (OCT) represents a non-invasive imaging technology, which may be applied to the diagnosis of non-melanoma skin cancer and which has recently been shown to improve the diagnostic accuracy of basal cell carcinoma. Technical developments of OCT continue to expand the applicability of OCT for different neoplastic and inflammatory skin diseases. Of these, dynamic OCT (D-OCT) based on speckle variance OCT is of special interest as it allows the in vivo evaluation of blood vessels and their distribution within specific lesions, providing additional functional information and consequently greater density of data. In an effort to assess the potential of D-OCT for future scientific and clinical studies, we have therefore reviewed the literature and preliminary unpublished data on the visualization of the microvasculature using D-OCT. Information on D-OCT in skin cancers including melanoma, as well as in a variety of other skin diseases, is presented in an atlas. Possible diagnostic features are suggested, although these require additional validation.

In the primate cerebral cortex, morphologically and functionally diverse classes of local circuit neurons containing the inhibitory neurotransmitter γ-aminobutyric acid (GABA) differentially regulate the activity of pyramidal cells, the principal type of excitatory output neurons. In schizophrenia, GABA neurotransmission in the prefrontal cortex (PFC) appears to be disturbed but whether specific populations of GABA neurons are affected is not known. The chandelier class of GABA neurons are of particular interest because their axon terminals, which form distinctive arrays termed “cartridges,” provide inhibitory input exclusively to the axon initial segment of pyramidal cells. Thus, chandelier cells are positioned to powerfully regulate the excitatory output of pyramidal neurons and, consequently, to substantially affect the patterns of neuronal activity within the PFC. In this study, an antibody directed against the GABA membrane transporter GAT-1 was used to label GABA axon terminals in postmortem human brains. The relative density of GAT-1-immunoreactive axon cartridges furnished by chandelier neurons was decreased by 40% in the PFC of schizophrenic subjects compared with matched groups of normal control and nonschizophrenic psychiatric subjects. In contrast, markers of the axon terminals of other populations of GABA neurons were not altered in the schizophrenic subjects. Furthermore, the density of GAT-1-immunoreactive axon cartridges was not altered in psychiatric subjects who had been treated with antipsychotic medications. The changes in GAT-1-immunoreactive axon cartridges of chandelier neurons in schizophrenia are likely to reflect altered information processing within the PFC and in its output connections to other brain regions and could contribute to the cognitive impairments seen in this disorder.

Bipolar disorder is a chronic condition characterized by the recurrence of episodes of manic, hypomanic, depressive, and mixed states.1 The lifetime prevalence of bipolar disorder has been estimated to be 1%, although recent evidence suggests that the prevalence may be as high as 5% when applying broader definitions that encompass the entire bipolar spectrum.2,3 Worldwide, bipolar disorder is the sixth leading cause of medical disability among patients aged 15 to 44 years.1 The annual cost of bipolar disorder in the United States in 1991 was estimated to be $45 billion, $7 billion of which was direct costs and $38 billion was indirect costs, including lost productivity of patients and caregivers.1 Lost productivity alone may account for up to $14.1 billion among employed patients.3 Current pharmacologic interventions for bipolar disorder include lithium, anticonvulsant agents, and second-generation antipsychotic medications.4,5 As in many chronic disease states with intermittent symptoms, medication nonadherence is a common occurrence in bipolar disorder5 and is associated with poorer outcomes.6–10 One survey found that 34% of respondents with bipolar disorder reported missing at least 1 dose of psychotropic medication in a 10-day period.11 Studies of veterans with bipolar disorder found even higher rates of nonadherence at approximately 45.9% among those taking lithium or anticonvulsant agents12 and 48.1% among those taking antipsychotic medications.13 Nonadherent patients with bipolar disorder are at a greater risk of suicide,6,7 experience shorter duration between episodes, and are more likely to relapse,8,9 resulting in higher total medical expenditures and higher outpatient mental health care costs.10 Multiple sociodemographic factors have been associated with nonadherence in bipolar disorder, including gender,14 age,11 race,14,15 and education level.15 In addition, clinical factors such as alcohol dependence,11,14 comorbid affective disorders,11 manic episodes,14 and severity of depressive episodes15 are associated with poorer adherence. However, because medication nonadherence is a behavioral symptom related to specific decisions made by patients, patient-centered experiences should also be considered. Patient satisfaction with medication is a significant predictor of better adherence,14,15 whereas side effects such as cognitive impairment,15 extrapyramidal symptoms, sedation, sexual dysfunction, and weight gain are associated with poorer adherence.15,16 Clinical Points ♦ Nonadherence is common among patients with bipolar disorder. ♦ Several risk factors for nonadherence have been identified, including low medication satisfaction, a high number of medications, and psychic side effects. ♦ By assessing tolerability and side effects, physicians may help to assist patients to improve adherence and health outcomes. To date, research on medication nonadherence in bipolar disorder has been limited to narrow subpopulations such as veterans or patients recently discharged from the hospital. The primary objective of this survey study was to identify and describe drivers of medication adherence in a large, national sample of outpatients with bipolar disorder.

We have studied the response of erosive or ulcerative esophagitis to treatment with omeprazole and its subsequent relapse on cessation of therapy in 196 patients. In the first phase of the study omeprazole (20 or 40 mg daily) was compared with placebo in 64 patients. After 4 wk there was endoscopic healing in 81% (25 of 31) of omeprazole-treated patients and in only 6% (2 of 32) of placebo-treated patients. Endoscopic healing of esophagitis was accompanied by symptom relief and histologic healing of ulceration. In the second (dose finding) phase a further 132 patients were randomized to omeprazole (20 or 40 mg daily) and endoscopic healing was assessed. In patients with the mildest grade of ulcerative esophagitis (grade 2), healing occurred at 4 wk in 87% receiving 20 mg and in 97% receiving 40 mg. In patients with grade 3 esophagitis, 67% (20 mg) and 88% (40 mg) were healed. Less than half the patients with grade 4 esophagitis (Barrett's ulcers or confluent ulceration) healed with either 20 mg (48%) or 40 mg (44%). Regression analysis in the 164 omeprazole-treated patients showed no evidence that healing was influenced by factors other than severity of esophagitis at entry and omeprazole dose. In phase 3 of the study the rate of endoscopic relapse was determined in 107 endoscopically healed patients after stopping omeprazole. Erosive or ulcerative esophagitis recurred in 88 of 107 (82%) by 6 mo. Neither initial dose, grade of esophagitis, nor smoking was shown to influence relapse rate. Omeprazole is a highly effective treatment for peptic esophagitis. The 40-mg/day dosage produces endoscopic healing slightly more quickly than the 20-mg/day dosage, and the initial endoscopic gradings are of prognostic value. Relapse occurs rapidly when treatment is stopped.