Predictors of successful discontinuation of antipsychotics and antidepressants

Background To offer support for patients who decide to discontinue antipsychotic and antidepressant medication, identifying which potentially modifiable factors correlate with discontinuation success is crucial. Here, we analyzed the predictive value of the professional support received, circumstances prior to discontinuation, a strategy of discontinuation, and use of functional and non-functional coping strategies during discontinuation on self-reported discontinuation success and on objective discontinuation. Methods Patients who had attempted discontinuing antipsychotics (AP) and/or antidepressants (AD) during the past 5 years (n = 316) completed an online survey including questions on subjective and objective discontinuation success, sociodemographic, clinical and medication-related factors, and scales to assess the putative predictors. Results A regression model with all significant predictors explained 20–30% of the variance in discontinuation success for AD and 30–40% for AP. After controlling for baseline sociodemographic, clinical and medication-related factors, the most consistent predictor of subjective discontinuation success was self-care behavior, in particular mindfulness, relaxation and making use of supportive relationships. Other predictors depended on the type of medication: For AD, good alliance with the prescribing physician predicted higher subjective success whereas gradual tapering per se was associated with lower subjective success and a lower chance of full discontinuation. In those tapering off AP, leaving time to adjust between dose reductions was associated with higher subjective success and fewer negative effects. Conclusions The findings can inform evidence-based clinical guidelines and interventions aiming to support patients during discontinuation. Further studies powered to take interactions between variables into account are needed to improve the prediction of successful discontinuation.

Colpocleisis as an obliterative surgery for pelvic organ prolapse: is it still a viable option in the twenty-first century? Narrative review

Introduction and hypothesis The aims were to review the literature from the last two decades and analyze treatment efficacy and findings of the studies on colpocleisis. Methods A systematic search was conducted within the MEDLINE/PubMed and ClinicalTrials.gov databases, using the following keywords: pelvic organ prolapse (POP), colpocleisis, obliterative, and LeFort. All English full-text prospective and retrospective observational and interventional studies were included. Anatomical and subjective success, surgical techniques, concomitant procedures, complication rates, anesthesia methods, and decision regret were analyzed. Results A total of 237 papers were identified and 49 met the inclusion criteria. Mean patient age was 69.0 ± 8.0 to 84 ± 3.1. Over 90.2% of patients undergoing colpocleisis were diagnosed with POP stage ≥ 3. The follow-up ranged from 30 days to a median of 5 years. Anatomical success, defined as POP-Q stage ≤ 1 and no prolapse beyond the hymen, was achieved in 62.5 to 100% and 87.5 to 100% of all patients respectively. Subjective success ranged from 88% to 100%. Regret over the loss of coital ability ranged from 0% in many studies to 12.9%, general decision regret from 0% to 13.8%. After concomitant midurethral sling surgery, 86.8% to 94% of all patients were continent, with a 0–14% sling revision rate due to urinary retention. Urinary tract infection was the most common postoperative complication (4.3 to 9% confirmed with urine culture, 34.7% based on symptom definition). Bowel (0 to 2.7%) and urinary tract (0 to 9.1%) injuries were the consequences of concomitant procedures. The mortality rates were up to 1.3%. Conclusions Colpocleisis is a heterogeneous procedure, characterized by high subjective and objective success, low coital ability regret, and a low risk of complications.

THE CONDITIONALITY OF THE EMOTIONAL INTELLIGENCE INFLUENCE ON ADAPTABILITY, PSYCHOLOGICAL WELL-BEING AND SUBJECTIVE SUCCESS (DURING THE PANDEMIC)

The article studies the importance of emotional intelligence in various social situations. It emphasizes that a person’s behaviour is determined both by personal traits and a social situation. The foreign experience in studying the influence of social situations on emotional intelligence manifestations and its components is analysed. The foreign view takes into account, in fact, not the characteristics of the social situation experienced by a person, but the characteristics (context) of the social environment. The article presents also national scientists’ views on this issue, according to which a social situation and its role is considered via "emotionogenicity" of the situation for the individual, and also the question appears on classification of social situations. Manifestations of emotional intelligence and its components should be studied theoretically and empirically in the context of a person’s emotional experience and "physical living" in difficult life circumstances. The author defines the qualitative indicators of emotional intelligence and its components that can become certain markers of the psychological quality of difficult situation experiencing. A person’s psychological well-being, adaptability and subjective success can be such qualitative indicators revealing understanding by a person of experienced difficult life circumstances. Namely, these psychological indicators indicate the quality of the situation experiencing and the role of the emotional intelligence components in adaptability, ensured psychological well-being and a sense of subjective success. The empirical analysis of the proposed indicators give an understanding of whether a person is fully psychologically and qualitatively living the circumstances and what the role of emotional intelligence is. The theoretical model of emotional intelligence influence on the psychological indicators of a person’s life quality, depending on a social situation, is presented. The model demonstrates the influence of emotional intelligence and its components on adaptability, psychological well-being and subjective success depending on social situations, and vice versa. This model should be applied for the empirical study on the mutual influence of emotional intelligence on the above indicators; its novelty and importance for understanding of the social context is emphasizes. The constructed regression models are examined to determine connections and assert that the feelings of psychological well-being, adaptability and subjective success in a difficult situation are determined by the corresponding components of emotional intelligence, in particular, during the pandemic. In such difficult life situation as the pandemic, emotional intelligence ensures adaptability, psychological well-being and subjective success. The constructed regression models indicate that emotional intelligence components influence differently on particular characteristics during the pandemic, in particular, adaptability is ensured indirectly by controlling emotions and developed interpersonal emotional intelligence; psychological well-being depends on such emotional intelligence components as understanding one’s emotions, empathizing with unhappiness, and control over expressions; the feeling of subjective success during the pandemic is mediated by understanding of one’s own emotions and empathizing with unhappiness. In such difficult life situation as the pandemic, the components ensuring both psychological well-being and subjective success are the understanding of one’s own emotions and empathy for unhappiness, which indicates the importance of a contact with one’s own emotions and collective inclusion into the difficult situation. And the resulting regression model for adaptability includes completely different components of emotional intelligence, namely, emotional management and interpersonal emotional intelligence, which shows the focus on interpersonal interaction.

Objective Method for Determining the Importance of Unprecedented Restlessness as a Rice Crisis Indicator at the National Level

In this study, we use restlessness as an input for a rice crisis indicator, since restlessness rather than rice price provides a comparable year-to year context. We outline the significant increase in the use of unprecedented restlessness (UR) as an indicator for rice crises. The UR approach involves a precedence analysis, in contrast with the existing approach, the price shock analysis. We test UR as a new indicator for rice crises at the national level, which can be applied in Asia and other countries around the world where rice is the staple food. Strong indicators point out the effectiveness of strategic government programs and are able to assess solutions and detect rice crises, while weak indicators are only reliable in detecting whether or not there has been a crisis. UR is tested across 43 countries using two new statistics: success probability (SP) and constraint probability (CP). As a consequence of SP and CP calculations, a large number of IMR control charts for UR analysis are constructed to provide evidence that UR is a strong indicator. The optimum validity measurement result is achieved with SP = 8/26 = 0.31 and CP = 8/14 = 0.57. This means that the UR detects and is followed by only 31% of riot events. Since the value of SP is less than 0.6, we can conclude that the UR indicator is not considered valid as an indicator of rice crises at the national level. The values of CP and SP are determined subjectively as equal to 0.6. This is the main cause of the emergence of new problems in the calibration of UR as an indicator of rice crises. The subjective success criteria trigger a question regarding why the value is 0.6, for which there is no scientific justification. Based on this background, we continue to objectively establish success criteria for UR validity. After conducting a risk analysis involving a crisis recovery cost (CRC) to crisis anticipation cost (CAC) ratio, it is found that the probability of the CRC-to-CAC ratio having values greater than 7 is 0.76, which means the CRC-to-CAC ratio tends to be higher than 7. Objectively, it is concluded that UR, which has been defined as rice crisis indicator at the national level, is an important indicator.

The Dark Side of High-Fliers: The Dark Triad, High-Flier Traits, Engagement, and Subjective Success

The aim of this study was to understand the relationship between bright-side, High Potential and dark-side Dark Triad traits, as well as work engagement on judgements of perceived success. In all, 290 working adults completed questionnaires assessing their High Potential Personality Traits (HPTI), their dark-triad traits, job engagement and self-rated success at work. The data showed that the three dark-triad traits (Narcissism, Psychopathy, Machiavellianism) were systematically and significantly correlated with High Potential traits Adjustment/neuroticism, Tolerance of Ambiguity and Conscientiousness. Three HPTI traits, namely curiosity, Conscientiousness, and courage, were systematically positively correlated with all three engagement measures. Narcissism was strongly related to all measures of engagement. Those with higher scores Adjustment, Courage, and Narcissism and of the male sex, rated their success highest. Job engagement mediated between high-flier and dark-side traits and success ratings. Implications and limitations are discussed.

Middle ear barotrauma in diving

Introduction: Middle ear barotrauma (MEBt) is the most common medical complication in diving, posing a serious risk to dive safety. Given this prevalence and the continuing growth of the diving industry, a comprehensive overview of the condition is warranted. Methods: This was a survey study. An anonymous, electronic questionnaire was distributed to 7,060 recipients: professional divers of the Finnish Border Guard, the Finnish Rescue Services, and the Finnish Heritage agency; and recreational divers registered as members of the Finnish Divers’ Association reachable by e-mail (roughly two-thirds of all members and recreational divers in Finland). Primary outcomes were self-reported prevalence, clinical characteristics, and health effects of MEBt while diving. Secondary outcomes were adjusted odds ratios (OR) for frequency of MEBt with respect to possible risk factors. Results: A total of 1,881 respondents participated in the study (response rate 27%). In total, 81% of the respondents had experienced MEBt while diving. Of those affected, 38% had used medications and 1% had undergone otorhinolaryngology-related surgical procedures due to MEBt. Factors most associated with MEBt were poor subjective success in Valsalva (‘occasionally’ versus ‘always’ successful: OR 11.56; 95% CI 7.24–18.47) and Toynbee (‘occasionally’ versus ‘always’ successful: OR 3.51; 95% CI 1.95–6.30) manoeuvres. Conclusions: MEBt is common in both recreational and professional divers, having affected 81% of the respondents. The main possible risk factors include poor success in pressure equalisation manoeuvres.

The Prospective Association of Personality Traits and Successful Aging

We used data ( N = 928) from ORANJ BOWL, a six-wave panel of adults (aged 50–74 at baseline) to address the association between personality and successful aging at two points in time, 8 years apart. Regressions examined the associations between Wave 2 neuroticism, extraversion, openness, agreeableness, and conscientiousness and Wave 3 subjective success, functional ability, pain, and chronic conditions. Models tested personality traits independently and then simultaneously, with interactions. Confirmatory analyses used Waves 5/6 data. All traits but openness were individually associated with successful aging at both time points. When testing traits simultaneously, only neuroticism and extraversion were consistently associated with subjective success, with an interaction at Waves 2/3. Neuroticism (Waves 2/3) and conscientiousness (Waves 5/6) were associated with functional ability. Neuroticism was associated with pain (Waves 2/3). Personality was not associated with chronic conditions. These analyses set up future work examining relationships between change in personality and change in successful aging.

Islam, Arab women's entrepreneurship and the construal of success

PurposeThe aim of this paper is to explore how Arab Muslim women entrepreneurs construe success, their identity as successful and the influence of Islam on these construals in the country-specific context of Lebanon.Design/methodology/approachTo achieve our aim, a qualitative interpretative methodology, drawing upon 25 in-depth, semi-structured interviews with Muslim women entrepreneurs was adopted.FindingsEquipped with Islamic feminism, Arab women entrepreneurs experienced Islam as a malleable resource. Islam allowed them to construe success and their identity as successful at the juncture of their lived experiences as business owners, Muslims of good character and standing and Arab females. Ultimately, Islam unfolded as a dynamic religion that supports women's agency in a landscape dominated by deeply entrenched patriarchal societal and cultural norms and gender-based restrictions.Originality/valueFirst, we contribute to research on the effect of Islam on entrepreneurship by demonstrating the influence of Islam on women's identity construction as successful and their construals of success. Second, we contribute to research on how entrepreneurs construe success beyond situating their construals of success in opposing camps of either objective or subjective success. Third, we contribute to research on identity construction and identity work by demonstrating how Muslim women entrepreneurs' identity as successful is construed at the intersection of their personal and social identities.

Objective and subjective outcomes following external dacryocystorhinostomy and inferior tear duct stenting in patients with acquired lacrimal drainage system obstruction

Background: We compared objective and subjective outcomes of dacryocystorhinostomy (DCR) vs. inferior tear duct stenting (stenting) in acquired infrasaccal stenosis.Methods: In this retrospective study 114 eyes of 100 patients who underwent 50 DCRs and 64 stentings between August 2009 and September 2018 were evaluated. Subjective success was quantified by interviewing the patients (complete, some or no improvement) at 10 days, 3 months and 17.2±17.2 months postoperatively. Success was objectified by postoperative clinical examinations at 10 days, 3 months and 9.3±7.8 months postoperatively and clinical scoring. Complete improvement was defined as complete success. Complete and some improvement was considered qualified success. Intra- and postoperative complications were evaluated.Results: At the last time point, DCR (78.0%) had significantly higher complete subjective success rates than stenting (59.4%, p=0.044). Qualified subjective success rates were comparable (DCR 88.0% vs. stenting 76.6%, p=0.147). DCR (76.0%) had significantly higher complete objective success rates than stenting (51.6%, p=0.006) and similar qualified objective success rates (88.0% vs. 75.0%, p=0.097).There were no significant differences between subjective and objective success rates at any time point (p=0.125-1.0). At the last time point, patients with the stent left in place for at least 4 months had significantly higher objective qualified success rates (92.7%) than those who had the stent removed (43.5%, p<0.001; mean removal interval 2.9±1.0 months). The stent-in-place group had comparable complete (obj. p=0.067, subj. p=0.344) and qualified (obj. p=0.506, subj. p=0.556) success rates to DCR at the last time point, while the stent-removal group performed worse (complete: obj. p=0.007, subj. p=0.031; qualified: obj. p=0.002; subj. p<0.001). No major intra- or postoperative complications occurred.Conclusion: DCR lead to high subjective and objective success rates. Stenting can be a minimally invasive alternative to DCR, particularly when the stent remains in place. Subjective and objective evaluation of symptom improvement showed high agreement.

Decoding Nonconscious Thought Representations during Successful Thought Suppression

Controlling our thoughts is central to mental well-being, and its failure is at the crux of a number of mental disorders. Paradoxically, behavioral evidence shows that thought suppression often fails. Despite the broad importance of understanding the mechanisms of thought control, little is known about the fate of neural representations of suppressed thoughts. Using fMRI, we investigated the brain areas involved in controlling visual thoughts and tracked suppressed thought representations using multivoxel pattern analysis. Participants were asked to either visualize a vegetable/fruit or suppress any visual thoughts about those objects. Surprisingly, the content (object identity) of successfully suppressed thoughts was still decodable in visual areas with algorithms trained on imagery. This suggests that visual representations of suppressed thoughts are still present despite reports that they are not. Thought generation was associated with the left hemisphere, and thought suppression was associated with right hemisphere engagement. Furthermore, general linear model analyses showed that subjective success in thought suppression was correlated with engagement of executive areas, whereas thought-suppression failure was associated with engagement of visual and memory-related areas. These results suggest that the content of suppressed thoughts exists hidden from awareness, seemingly without an individual's knowledge, providing a compelling reason why thought suppression is so ineffective. These data inform models of unconscious thought production and could be used to develop new treatment approaches to disorders involving maladaptive thoughts.