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The CdTe photoluminescence spectra of CdTe/CdS/ZnO heterojunctions annealed in the presence of CdCl2 have been analyzed in the 4.7-100K temperature range. The analysis has been performed for laser excitation power between 0.01 mW and 30 mW. The analysis showed that the photoluminescence spectrum in the 1.1-1.6 eV region consists of a defect band (1.437 eV) having complex structure and revealing well contoured LO phonon replicas and bound exciton annihilation in the 1.587-1.593 eV region. The band analysis has been carried out by deconvoluting the spectra. It has been shown that the defect band consists of two elementary bands and their phonon replica. An “unusual” temperature dependence of the defect band has been found.
Depression is a common and costly comorbidity in dementia. There are very few data on the cost-effectiveness of antidepressants for depression in dementia and their effects on carer outcomes.
To evaluate the cost-effectiveness of sertraline and mirtazapine compared with placebo for depression in dementia.
A pragmatic, multicentre, randomised placebo-controlled trial with a parallel cost-effectiveness analysis (trial registration: ISRCTN88882979 and EudraCT 2006-000105-38). The primary cost-effectiveness analysis compared differences in treatment costs for patients receiving sertraline, mirtazapine or placebo with differences in effectiveness measured by the primary outcome, total Cornell Scale for Depression in Dementia (CSDD) score, over two time periods: 0–13 weeks and 0–39 weeks. The secondary evaluation was a cost-utility analysis using quality-adjusted life years (QALYs) computed from the Euro-Qual (EQ-5D) and societal weights over those same periods.
There were 339 participants randomised and 326 with costs data (111 placebo, 107 sertraline, 108 mirtazapine). For the primary outcome, decrease in depression, mirtazapine and sertraline were not cost-effective compared with placebo. However, examining secondary outcomes, the time spent by unpaid carers caring for participants in the mirtazapine group was almost half that for patients receiving placebo (6.74 v. 12.27 hours per week) or sertraline (6.74 v. 12.32 hours per week). Informal care costs over 39 weeks were £1510 and £1522 less for the mirtazapine group compared with placebo and sertraline respectively.
In terms of reducing depression, mirtazapine and sertraline were not cost-effective for treating depression in dementia. However, mirtazapine does appear likely to have been cost-effective if costing includes the impact on unpaid carers and with quality of life included in the outcome. Unpaid (family) carer costs were lower with mirtazapine than sertraline or placebo. This may have been mediated via the putative ability of mirtazapine to ameliorate sleep disturbances and anxiety. Given the priority and the potential value of supporting family carers of people with dementia, further research is warranted to investigate the potential of mirtazapine to help with behavioural and psychological symptoms in dementia and in supporting carers.
The use of antipsychotics for the treatment of behavioural and psychological symptoms of dementia (BPSD) is controversial. Antipsychotics cause harm and evidence-based guidelines advise against their use. We argue that antipsychotics may be justified using a palliative model: by reducing severe distress in those whose life expectancy is short.
Helen Lester, General Practitioner and Professor of Primary Care, School of Community Based Medicine University of Manchester,
Harry Allen, Consultant in Old-Age Psychiatry, Manchester Mental Health and Social Care Trust,
Simon Cocksedge, General Practitioner and Lecturer in General Practice, University of Manchester,
Joy Ratcliffe, Consultant in Old-Age Psychiatry, Manchester Mental Health and Social Care Trust,
Steve Iliffe, General Practitioner and Professor of Primary Care, Royal Free and University College, Medical School, London,
Cornelius Katona Dean, Consultant and Senior Lecturer in Psychiatry, Kent Institute of Medicine and Health Sciences, University of Kent,
Dr Chris Fox, Consultant and Senior Lecturer in Psychiatry Kent, Institute of Medicine and Health Sciences, University of Kent
In the next three case commentaries we asked our contributors to comment on more complicated cases where input from both primary and secondary health care and social care would be necessary.
Depression with psychotic features
Mrs Paulette B is an African-Caribbean lady who came over to the UK 50 years ago with her husband. She raised six children who have all done very well and all except one live in different parts of the UK. When her husband died, Mrs PB threw herself into her work with the local church, helping run a group for young women and teaching in the Sunday School. For the last three months she has been off her food, unable to concentrate, less interested in things and reluctant to go to church, fearing that she will bring some calamity onto the congregation.
In the last two weeks, she has been aware of a man's voice warning her to stay at home and to avoid answering the telephone as her thoughts will be recorded. Initially she thought this might be her husband's voice but has now become convinced that it is the voice of the vicar and so when he called on her last week, she spoke to him through the door. She told him she knew that she had committed ‘the unforgivable sin’.
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