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This study aims to investigate existing evidence for the effectiveness of psychological treatments and/or antidepressant medication as a treatment for those diagnosed with moderate levels of depression.
A PRISMA systematic review of articles using electronic research databases (2000–2014) was conducted to identify studies investigating the effectiveness of psychotherapy and/or medication as a treatment for people with moderate levels of depression. Search terms included moderate depression, psychotherapy and/or medication, depressive disorders, antidepressants, psychotherapy, mental health services, and randomized-controlled trial (RCT). The included studies were then assessed, extracted, and synthesised.
A total of 14 studies met the inclusion criteria (11 RCTs and three additional studies) for this review. The findings of the systematic review indicate that there is limited evidence available specific to the treatment of moderate depression and that this research seems to suggest that psychotherapy or combined treatment has a beneficial effect.
Given that depression is one of the biggest challenges the world faces at present, further research is required to examine the effectiveness of treatment for different levels of depression severity.
The medial part of the nucleus of Edinger–Westphal (EWM) in birds mediates light-regulated adaptive increases in choroidal blood flow (ChBF). We sought to characterize the effect of loss of EWM-mediated ChBF regulation on photoreceptor health in pigeons housed in either moderate intensity diurnal or constant light (CL). Photoreceptor abundance following complete EWM destruction was compared to that following a lesion in the pupil control circuit (as a control for spread of EWM lesions to the nearby pupil-controlling lateral EW) or following no EW damage. Birds were housed post-lesion in a 12 h 400 lux light/12 h dark light cycle for up to 16.5 months, or in constant 400 lux light for up to 3 weeks. Paraformaldehyde–glutaraldehyde fixed eyes were embedded in plastic, sectioned, slide-mounted, and stained with toluidine blue/azure II. Blinded analysis of photoreceptor outer segment abundance was performed, with outer segment types distinguished by oil droplet tint and laminar position. Brains were examined histologically to assess lesion accuracy. Disruption of pupil control had no adverse effect on photoreceptor outer segment abundance in either diurnal light or CL, but EWM destruction led to 50–60% loss of blue/violet cone outer segments in both light conditions, and a 42% loss of principal cone outer segments in CL. The findings indicate that adaptive regulation of ChBF by the EWM circuit plays a role in maintaining photoreceptor health and mitigates the harmful effect of light on photoreceptors, especially short wavelength-sensitive cone photoreceptors.
Depression is one of the most prevalent mental illnesses worldwide and a leading cause of disability, especially in the setting of treatment resistance. In recent years, repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising alternative strategy for treatment-resistant depression and its clinical efficacy has been investigated intensively across the world. However, the underlying neurobiological mechanisms of the antidepressant effect of rTMS are still not fully understood. This review aims to systematically synthesize the literature on the neurobiological mechanisms of treatment response to rTMS in patients with depression. Medline (1996–2014), Embase (1980–2014) and PsycINFO (1806–2014) were searched under set terms. Three authors reviewed each article and came to consensus on the inclusion and exclusion criteria. All eligible studies were reviewed, duplicates were removed, and data were extracted individually. Of 1647 articles identified, 66 studies met both inclusion and exclusion criteria. rTMS affects various biological factors that can be measured by current biological techniques. Although a number of studies have explored the neurobiological mechanisms of rTMS, a large variety of rTMS protocols and parameters limits the ability to synthesize these findings into a coherent understanding. However, a convergence of findings suggest that rTMS exerts its therapeutic effects by altering levels of various neurochemicals, electrophysiology as well as blood flow and activity in the brain in a frequency-dependent manner. More research is needed to delineate the neurobiological mechanisms of the antidepressant effect of rTMS. The incorporation of biological assessments into future rTMS clinical trials will help in this regard.
The aim of this study is to examine the risk and protective factors associated with anxiety and depression in a representative sample of Irish adolescents.
Data used in this study were drawn from a subset of the My World Survey (MWS). The MWS-Second Level (MWS-SL) subset consists of a randomised sample of 72 schools, with a final sample of 6085 students. Outcome measures were depression and anxiety. Risk and protective factors included measures within the socio-demographic, psychosocial and risk-taking domains.
One in three adolescents experienced elevated levels of depression and anxiety. Age, gender, maternal education, family composition, parental mental health as well as the experience of racism and bereavement were associated with elevated distress. Psychosocial factors associated with depression and anxiety included optimism, personal competence, life-satisfaction, self-esteem, anger, body dissatisfaction, family competence, maternal and paternal criticism, experiencing the break-up of a romantic relationship, school and peer connectedness as well as the availability of one good adult. Finally, engaging in substance misuse was found to increase the likelihood of anxiety and depression.
Since factors protecting and putting adolescents at risk of anxiety and depression exist at every level of the adolescent’s ecological system, the study supports a community-based approach to youth mental health.
Anxiety disorders are associated with abnormalities in amygdala function and prefrontal cortex–amygdala connectivity. The majority of functional magnetic resonance imaging studies have examined mean group differences in amygdala activation or connectivity in children and adolescents with anxiety disorders relative to controls, but emerging evidence suggests that abnormalities in amygdala function are dependent on the timing of the task and may vary across the course of a scanning session. The goal of the present study was to extend our knowledge of the dynamics of amygdala dysfunction by examining whether changes in amygdala activation and connectivity over scanning differ in pediatric anxiety disorder patients relative to typically developing controls during an emotion processing task. Examining changes in activation over time allows for a comparison of how brain function differs during initial exposure to novel stimuli versus more prolonged exposure. Participants included 34 anxiety disorder patients and 19 controls 7 to 19 years old. Participants performed an emotional face-matching task during functional magnetic resonance imaging scanning, and the task was divided into thirds in order to examine change in activation over time. Results demonstrated that patients exhibited an abnormal pattern of amygdala activation characterized by an initially heightened amygdala response relative to controls at the beginning of scanning, followed by significant decreases in activation over time. In addition, controls evidenced greater context-modulated prefrontal cortex–amygdala connectivity during the beginning of scanning relative to patients. These results indicate that differences in emotion processing between the groups vary from initial exposure to novel stimuli relative to more prolonged exposure. Implications are discussed regarding how this pattern of neural activation may relate to altered early-occurring or anticipatory emotion-regulation strategies and maladaptive later-occurring strategies in children and adolescents with anxiety disorders.
We describe two cases of infant botulism due to Clostridium butyricum producing botulinum type E neurotoxin (BoNT/E) and a previously unreported environmental source. The infants presented at age 11 days with poor feeding and lethargy, hypotonia, dilated pupils and absent reflexes. Faecal samples were positive for C. butyricum BoNT/E. The infants recovered after treatment including botulism immune globulin intravenous (BIG-IV). C. butyricum BoNT/E was isolated from water from tanks housing pet ‘yellow-bellied’ terrapins (Trachemys scripta scripta): in case A the terrapins were in the infant's home; in case B a relative fed the terrapin prior to holding and feeding the infant when both visited another relative. C. butyricum isolates from the infants and the respective terrapin tank waters were indistinguishable by molecular typing. Review of a case of C. butyricum BoNT/E botulism in the UK found that there was a pet terrapin where the infant was living. It is concluded that the C. butyricum-producing BoNT type E in these cases of infant botulism most likely originated from pet terrapins. These findings reinforce public health advice that reptiles, including terrapins, are not suitable pets for children aged <5 years, and highlight the importance of hand washing after handling these pets.
Delirium is a common neuropsychiatric syndrome with considerable heterogeneity in clinical profile. Identification of clinical subtypes can allow for more targeted clinical and research efforts. We sought to develop a brief method for clinical subtyping in clinical and research settings.
A multi-site database, including motor symptom assessments conducted in 487 patients from palliative care, adult and old age consultation-liaison psychiatry services was used to document motor activity disturbances as per the Delirium Motor Checklist (DMC). Latent class analysis (LCA) was used to identify the class structure underpinning DMC data and also items for a brief subtyping scale. The concordance of the abbreviated scale was then compared with the original Delirium Motor Subtype Scale (DMSS) in 375 patients having delirium as per the American Psychiatric Association's Diagnostic and Statistical Manual (4th edition) criteria.
Latent class analysis identified four classes that corresponded closely with the four recognized motor subtypes of delirium. Further, LCA of items (n = 15) that loaded >60% to the model identified four features that reliably identified the classes/subtypes, and these were combined as a brief motor subtyping scale (DMSS-4). There was good concordance for subtype attribution between the original DMSS and the DMSS-4 (κ = 0.63).
The DMSS-4 allows for rapid assessment of clinical subtypes in delirium and has high concordance with the longer and well-validated DMSS. More consistent clinical subtyping in delirium can facilitate better delirium management and more focused research effort.
This study examined whether processing of emotional words impairs cognitive performance in acutely ill patients with pediatric bipolar disorder (PBD), with or without comorbid attention-deficit hyperactivity disorder (ADHD), relative to healthy controls (HC). Forty youths with PBD without ADHD, 20 youths with PBD and ADHD, and 29 HC (mean age = 12.97 ± 3.13) performed a Synonym Matching task, where they decided which of two probe words was the synonym of a target word. The three words presented on each trial all had the same emotional valence, which could be negative, positive, or neutral. Relative to HC both PBD groups exhibited worse accuracy for emotional words relative to neutral ones. This effect was greater with negative words and observed regardless of whether PBD patients had comorbid ADHD. In the PBD group without ADHD, manic symptoms correlated negatively with accuracy for negative words, and positively with reaction time (RT) for all word types. Our findings suggest a greater disruptive effect of emotional valence in both PBD groups relative to HC, reflecting the adverse effect of altered emotion processing on cognitive function in PBD. Future studies including an ADHD group will help clarify how ADHD symptoms may affect emotional interference independently of PBD. (JINS, 2013, 19, 1–12)
In modern technology more and more attention is given to epitaxial superlattices. III/V, and more recently Si/Ge superlattices are widely studied because of their applications in integrated optoelectronics. Since the physical properties are strongly dependent on structural characteristics, it is evident that accurate characterization methods are required in order to improve their quality and obtain optimal behavior. X-ray high resolution diffraction is extensively and successfully used to this purpose. In general diffracted intensity is measured close to strong substrate reflections where satellite peaks from superlattice take place. If the crystalline quality, mainly concerning thickness layer uniformity and interface abruptness is good, several orders of diffraction from the superlattice are visible, and fitting based on kinematical or dynamical diffraction can provide information about many structural parameters of the superlattice. However from diffracted intensity the information about the phase of the structure factor is lost. It is well known that the X-ray Standing Wave (XSW) technique can provide direct information about the phase . In this paper we present measurements and calculations relative to the extension of the XSW method to the study of MBE-grown Si/Ge superlattices. The novelty consists in using the superlattice satellite peaks close to a strong reflection from the substrate to form the standing wave field which in turn excites the atoms whose fluorescence is measured. These satellite peaks correspond to high-order diffraction for the superlattice periodicity.
Strained layer Si/Si0.79Ge0.21 superlattices consisting of 16 alternating 19.0 nm Si0.79Ge0.21 / 18.5 nm Si layers have been amorphized by Si ion irradiation, then implanted with H ions to nominal atomic concentrations of 1%, 0.1% and 0.05% within the amorphized region. Subsequent solid phase epitaxy (SPE) at a regrowth temperature of 575°C was monitored in situ by time resolved reflectivity (TRR) measurements, while changes in the H distribution were measured by elastic recoil detection analysis (ERDA). Analysis was supplemented by Rutherford backscattering spectrometry (RBS), x-ray double crystal diffraction and reflectivity (DCD/XRF) and transmission electron microscopy (TEM). TRR data reveals a decrease in the initial SPE rate in the Si substrate from 4.9 Å/sec (no H) to 2Å/sec for 1% H concentration as well as a rate decrease as the interface enters the Si/SiGe layers. TRR also indicates an increased roughness in the crystal/amorphous interface with increasing H concentration. ERDA reveals that a significant fraction of the implanted H is stable in the amorphous region for the anneal times (10-30 min) at 575°C, while in the regrown lattice the H concentration has dropped below 20 ppm, near the detection limit of the ERDA. DCD shows almost no strain in the regrown structures. TEM and RBS channeling techniques reveal degradation in the crystal quality of epitaxially regrown structures and a large concentration of strain relieving defects originating near the second deepest of eight SiGe layers in all regrown structures. XRF indicates decreasing sharpness of the regrown Si/SiGe interfaces with increasing H concentration.
This paper quickly reviews the structure of band-edge luminescence in Si/strained Si1−xGex heterostructures, and then focusses on two recent developments -- the origin of “deep” sub-bandgap luminescence which is sometimes observed in structures grown by Molecular Beam Epitaxy (MBE) and the understanding of the temperature dependence of the band-edge luminescence (up to room temperature). Strong evidence will be presented that the origin of the deep luminescence is radiation damage, and that generated defects are segregated or trapped in the SilxGex layers. The modelling of the temperature dependence by twocarrier numerical simulation is presented for the first time. The work and experimental data show convincingly that the strength of the luminescence at high temperature is controlled by recombination at the top silicon surface, which in turn can be controlled by surface passivation. At high pump powers and low temperatures, Auger recombination reduces the lifetime in the Si1−xGex layers, and leads to a luminescence vs. temperature which is flat up to 250 K and which is reduced only by a factor of three at room temperature.
Dislocation-free Si1−xGex epilayers are successfully grown on (100) silicon at 440°C by ultrahigh vacuum electron cyclotron resonance chemical vapor deposition (UHV-ECRCVD). The effects of process parameters on the crystallinity of Si1−xGex epitaxial layers were studied. As the GeH4 flow rate increases and consequently Ge fraction increases above 20%, Si1−xGex epilayers become damaged heavily by ions. When Ge fraction is larger than 20%, process parameters like total pressure need to be adjusted to reduce the ion flux for high quality Sil−xGex. Growth rate of Si1−xGex epitaxial layers increases at 440°C with Ge content in the film. It is presumed that the hydrogen desorption from the surface is the rate-limiting step, however, the enhancement in growth rate is comparatively suppressed and delayed.
The stability of strained quantum wires against the propagation of threading dislocations is considered, using a critical thickness criterion due to Matthews and Blakeslee that is extensively used for strained layers. Given first are results for the critical mismatch at which a buried wire of a given thickness becomes susceptible to degradation. It is found that a wire, once buried, is extremely stable, being able to support, without loss of coherency, around five times the lattice mismatch that can be supported by a buried strained layer of the same thickness. It is concluded that if a strained wire contains dislocations then those dislocations must have been introduced during its growth, when the top surface of the wire is exposed. To investigate this, the results of finite element calculations are presented that give the critical relationship between mismatch and thickness during the growth of a triangular quantum wire being deposited in a -oriented V-groove in a patterned (001) substrate. The results may be approximately expressed through an expression of the same form as that derived by Matthews and Blakeslee for a strained layer, but with modified coefficients obtained via the finite element analysis. Contact is made with the limited experimental evidence available.
Using finite elements we quantitatively calculate the inhomogeneous strain distribution associated with the so called crosshatch pattern. This pattern is a twodimensional, pseudoregular surface undulation that generally arises as an intermediate stage of heteroepitaxial growth of low misfitting semiconductor layers. This stage is characterized by an interplay of elastic and plastic relaxation processes. The calculations yield (i) the elastic strain energy density distribution and corresponding degree of elastic relaxation and (ii) the shear stress distribution in the glide system, in which misfit dislocations form. As a main result shear stresses due to the crosshatch pattern within the substrate are identified that cause misfit dislocations to multiply in the substrate.