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The aim of this study was to examine the long-term efficacy and safety of a monotherapy with quetiapine or sodium valproate (VPA) in patients with rapid cycling bipolar disorder.
This open-label trial was conducted at three German centers. A sample of 38 remitted or partly remitted bipolar patients with rapid cycling (quetiapine n = 22; VPA n = 16) were treated with quetiapine or VPA (flexible-dose design) up to 12 months. Analyses were based on the ITT-LOCF principle.
41 % of the patients with quetiapine and 50 % with VPA completed the trial. According to the Clinical Global Impression Scale responder rates tended to be higher for quetiapine than for VPA: i.e. 43 % vs. 25 % (depression), 48 % vs. 36 % (mania), and 43 % vs. 19 % (improvement in both mania and depression). There were no differences found between the treatment groups evaluating the HRSD, MADRS and YMRS. In contrast, Life Chart Method data showed that patients being treated with quetiapine had significantly less depressive days than patients on VPA whilst they did not differ in the number of days with manic symptoms. The incidence of adverse events, especially of orthostatic dysregulation and sedation was higher in the quetiapine group.
Quetiapine may be more effective than VPA regarding depressive symptoms and as effective as VPA in the treatment of manic symptoms in the long-term treatment of rapid cycling bipolar disorder. The side effect profile of quetiapine tends to be less favorable than the one of VPA.
Attention Deficit Hyperactivity Disorder (ADHD) is a serious risk factor for co-occurring psychiatric disorders and negative psychosocial consequences in adulthood. Given this background, there is great need for an effective treatment of adult ADHD patients.
Therefore, our research group has conducted a first controlled randomized multicenter study on the evaluation of disorder-tailored DBT-based group program in adult ADHD compared to a psychophar-macological treatment.
Between 2007 and 2010, in a four-arm-design 433 patients were randomized to a manualized dialectical behavioural therapy (DBT) based group program plus methylphenidate or placebo or clinical management plus methylphenidate or placebo with weekly sessions in the first twelve weeks and monthly sessions thereafter. Therapists are graduated psychologists or physicians. Treatment integrity is established by independent supervision. Primary endpoint (ADHD symptoms measured by the Conners Adult ADHD Rating Scale) is rated by interviewers blind to the treatment allocation (Current Controlled Trials ISRCTN54096201). The trial is funded by the German Federal Ministry of Research and Education (01GV0606) and is part of the German network for the treatment of ADHD in children and adults (ADHD-NET). In the lecture the first data of our interim analysis are presented (baseline data, results of treatment compliance and adherence).
Internet-based self-help for social phobia with minimal therapist support via email have shown efficacy in several controlled trials by independent research teams. The role and necessity of therapist guidance is, however, still largely unclear. The present study compared the benefits of a 10-week web-based unguided self-help treatment for social phobia with the same intervention complemented with minimal, although weekly, therapist support via email. Further, a third treatment arm was included, in which the level of support was flexibly stepped up, from no support to email or telephone contact, on demand of the participants. Eighty-one individuals meeting diagnostic criteria for social phobia were randomly assigned to one of the three conditions. Results showed significant symptom reductions in all three treatment groups with large effect sizes for primary social phobia measures (Cohen's d = 1.47) and for secondary outcome measures (d = 1.16). No substantial and significant between-groups effects were found on any of the measures (Cohen's d = .00−.36). Moreover, no difference between the three conditions was found regarding diagnosis-free status, clinically significant change, dropout rates, or adherence measures such as sessions or exercises completed.
Somatic symptoms and anxiety symptoms are often disregarded in the detection of depression in primary care. The present investigation examined to what extent somatic and anxiety symptoms recorded with the Composite International Diagnostic Interview—Primary Health Care Version (CIDI—PHC) can improve the detection of depression as compared to the General Health Questionnaire—12-item version alone. Data from the World Health Organization study on Psychological Problems in General Health Care were used. The study sample consisted of primary care attenders from 15 centres from all over the world who underwent a psychiatric examination with the CIDI—PHC. Medically unexplained somatic symptoms (back pain, feelings of heaviness/lightness in parts of the body, periods of bodily weakness, seizures/convulsions, permanent tiredness, exhaustion after a minimum of effort) and—to a smaller extent—diverse anxiety symptoms (e.g. feelings of anxiousness/nervousness, feelings of tension, difficulties relaxing) significantly contributed to the detection of depression in a logistic regression analysis. The results confirm the observation that in primary care somatic symptoms play an important role in the manifestation of depressive disorders. The items investigated herein could prove beneficial for future depression screening instruments to improve the detection of depressive disorders in primary care.
Today, internet-based technologies are used in all phases of psychosocial services. Current psychotherapeutic applications focus on the implementation of traditional approaches in the Internet. For instance, self-help material is posted onto the net, therapies are conducted via email, and groups meet in virtual chatrooms. However, recent advancements in web-based technologies are providing even greater opportunities for psychotherapy on the Internet. Today, many different aspects of psychotherapy on the Internet can be provided on a single integrated Web platform.
Recently, we have created an Internet platform that offers various aspects of a cognitive behavioral approach to social phobia. This includes an interactive self-help guide, contact with therapists, a continuous monitoring and feedback of patient response, as well as collaborative elements, offering patients the opportunity to share their experiences with other patients. The aim of this presentation is to provide insight into the concrete application of such a platform. Experiences, pitfalls and opportunities are discussed along with the primary results of a controlled study.
Les AVP sont le principal pourvoyeur d’ESPT (Kupchik et al., 2007), dont la prévalence fluctue de 6 à 45 % entre les études (Heron-Delaney et al., 2013). En l’absence de repérage clinique, l’ESPT peut se chroniciser (Kessler et al., 1995). Les outils actuels permettent son diagnostic (Jackson et al., 2011), mais pas de dépister précocement les sujets à risque de développer un ESPT post-AVP en aigu (8 semaines) comme en chronique (6 mois) ou en tardif (1 an). Nous présentons une étude longitudinale réalisée sur 274 patients répartis sur 6 centres de traumatologie ayant pour objectif principal de valider un outil infirmier de dépistage précoce d’ESPT après un AVP (DEPITAC). Dix questions ont été soumises à tout patient hospitalisé dans les 15 jours après un AVP, ainsi qu’une PDI et un MINI DSM-IV. La PCL-S (cut-off à 44) a permis le diagnostic à 8 semaines, 6 mois et 1 an. L’analyse statistique a été réalisée avec le logiciel SAS Institute 9.4. Le score total DEPITAC était significativement associé au diagnostic d’ESPT à 1 an (OR : 1,43 ; IC95 % : 1,14–1,79) avec un pouvoir discriminant de 0,64 (IC95 % : 0,56–0,72). DEPITAC était corrélé à l’échelle PDI (p < 0,0001) avec un faible coefficient de corrélation (r = 0,32) montrant une faible redondance. Seules 3 questions après analyses bivariées s’avèrent significatives : « présence d’autres blessés ou décédés lors de l’AVP », « présence d’une dissociation post-AVP » et « s’être vu mourir lors de l’AVP » avec un pouvoir discriminant de 0,65 (IC95 % : 0,57–0,73). Aucun effet centre n’a été mis en évidence (p = 0,90). Nos résultats semblent montrer qu’à l’aide de seulement 3 questions de dépistage, les équipes infirmières pourraient repérer les patients à risque de développer un ESPT aigu ou tardif, leur permettant ainsi d’alerter précocement les équipes psychiatriques de liaison ou de pschotraumatologie.
Research into mechanisms of interaction between growth and inhibitory proteins of the CNS and behavioral expressions of healthy and disordered brain is one of the contemporary topics. A knockdown model with decreased expression of Nogo-A protein in neurons was developed on the genetic background of Sprague-Dawley wildtypes. Disruption of this inhibitory factor was hypothesized to result in behavioral abnormalities, which were studied both in young, middle age (6 months) and aged (12 months) rats.
Animals were tested in a battery of Carousel maze variants with various demands for segregation of spatial information and flexibility; animals avoided an unmarked sector of either stable or rotating arena; moreover the sector could be defined in room- or arena-frame. A shortened Carousel maze battery and Morris water maze (MWM) including one- trial matching-to-place and reversal configurations was used.
Nogo-A-deficient rats were impaired in the final phases of the Carousel maze battery but their spatial working memory tested in the MWM was intact. Middle-aged and aged groups were differently affected in the battery, but deficits in young animals were observed not to be worsened with ageing. Concept of multidirectional age-related alterations in this animal model is further supported by biochemical brain changes.
Nogo-A-deficient rats may serve as an extremely useful model of neurodevelopmental deficit, which may manifest by behavioral changes accessible to phenotyping and in-depth analysis. Relevance of this approach for animal models of neuropsychiatric models will be discussed.
To measure fatty acid composition, particularly whole-blood PUFA content, in acutely malnourished children and identify associations with markers of nutritional and health status.
PUFA were assessed in dried blood spots obtained from a cross-sectional study. Nutritional and health status were assessed by anthropometry, haemoglobinopathies, inflammation and blood counts.
The study was conducted with 174 children aged 0·5–18 years with acute malnutrition.
Among total fatty acids (FA), the relative percentage of total PUFA was 20 % FA, with 14 % of the children having very low PUFA (mead acid (MA):arachidonic acid (AA) >0·02, n-6 docosapentaenoic acid:DHA >0·2 and total n-6:n-3 PUFA >10·5). Wasting was not associated with any PUFA. Stunting and low height were consistently positively associated with total PUFA and positively with n-6 PUFA. Height was positively associated with n-3 long-chain PUFA (LCPUFA). The presence of haemoglobinopathies or inflammation was positively associated with MA:AA, but not total PUFA. Elevated blood platelet counts were positively correlated with linoleic acid and appeared to be influenced by anaemia (P = 0·010) and inflammation (P = 0·002). Monocyte counts were high during inflammation (P = 0·052) and correlated positively with n-6 LCPUFA and n-3 LCPUFA.
Children with acute malnutrition or stunting had low PUFA, while elevated platelets and monocytes were associated with high PUFA. In acutely malnourished children, inflammation could lead to elevated blood cell counts resulting in increased whole-blood PUFA which does not reflect dietary intake or nutritional status.
The study aimed at assessing stunting, wasting and breast-feeding as correlates of body composition in Cambodian children. As part of a nutrition trial (ISRCTN19918531), fat mass (FM) and fat-free mass (FFM) were measured using 2H dilution at 6 and 15 months of age. Of 419 infants enrolled, 98 % were breastfed, 15 % stunted and 4 % wasted at 6 months. At 15 months, 78 % were breastfed, 24 % stunted and 11 % wasted. Those not breastfed had lower FMI at 6 months but not at 15 months. Stunted children had lower FM at 6 months and lower FFM at 6 and 15 months compared with children with length-for-age z ≥0. Stunting was not associated with height-adjusted indexes fat mass index (FMI) or fat-free mass index (FFMI). Wasted children had lower FM, FFM, FMI and FFMI at 6 and 15 months compared with children with weight-for-length z (WLZ) ≥0. Generally, FFM and FFMI deficits increased with age, whereas FM and FMI deficits decreased, reflecting interactions between age and WLZ. For example, the FFM deficits were –0·99 (95 % CI –1·26, –0·72) kg at 6 months and –1·44 (95 % CI –1·69; –1·19) kg at 15 months (interaction, P<0·05), while the FMI deficits were –2·12 (95 % CI –2·53, –1·72) kg/m2 at 6 months and –1·32 (95 % CI –1·77, –0·87) kg/m2 at 15 months (interaction, P<0·05). This indicates that undernourished children preserve body fat at the detriment of fat-free tissue, which may have long-term consequences for health and working capacity.
Over the past decade, NASA, under a succession of rotary-wing programs, has been moving towards coupling multiple discipline analyses to evaluate rotorcraft conceptual designs. Handling qualities is one of the component analyses to be included in such a future Multidisciplinary Analysis and Optimization framework for conceptual design of Vertical Take-Off and Landing (VTOL) aircraft. Similarly, the future vision for the capability of the Concept Design and Assessment Technology Area of the U.S Army Aviation Development Directorate also includes a handling qualities component. SIMPLI-FLYD is a tool jointly developed by NASA and the U.S. Army to perform modelling and analysis for the assessment of the handling qualities of rotorcraft conceptual designs. Illustrative scenarios of a tiltrotor in forward flight and a single-main rotor helicopter at hover are analysed using a combined process of SIMPLI-FLYD integrated with the conceptual design sizing tool NDARC. The effects of variations of input parameters such as horizontal tail and tail rotor geometry were evaluated in the form of margins to fixed- and rotary-wing handling qualities metrics and the computed vehicle empty weight. The handling qualities Design Margins are shown to vary across the flight envelope due to both changing flight dynamics and control characteristics and changing handling qualities specification requirements. The current SIMPLI-FLYD capability, lessons learned from its use and future developments are discussed.
To assess the impact of the acute-phase response (APR) during inflammation on Fe, Zn and vitamin A biomarkers to allow accurate evaluation of micronutrient status in populations.
Ferritin (FER), soluble transferrin receptor (TfR), retinol-binding protein (RBP), Zn, α1-acid glycoprotein and C-reactive protein concentrations were measured. Correction factors (CF) for each biomarker were calculated as the ratio for groups at different stages of inflammation v. the reference group without inflammation.
Senegalese (n 594) and Cambodian schoolchildren (n 2471); Cambodian women of reproductive age (n 2117).
TfR was higher during the incubation phase (CF=1·17) and lower during early and late convalescence (CF=0·87 and 0·78). FER was higher during all phases (CF=0·83, 0·48 and 0·65, respectively). RBP was higher during incubation (CF=0·88) and lower during early convalescence (CF=1·21). No effect of inflammation on Zn status was found.
Inflammation led to overestimation of Fe status and underestimation of vitamin A status. The response of the biomarker for vitamin A status to inflammation depended on the vitamin A status of the populations. Surprisingly, the assessment of Zn status was hardly affected by inflammation. Different phases of the APR had opposite effects on the assessment of Fe status using TfR. More research is needed to define the correct methods to adjust for inflammation in nutritional studies.
Even though current policy is strongly focused on the crucial first ‘1000 days’, it might be still possible to enhance cognitive function during the pre-adolescent and adolescent years by improving micronutrient status. In Cambodia, nutritional status is poor. Provision of rice fortified with micronutrients through a school meal programme (SMP) could be a cost-effective strategy to help improve health and school performance. The present study aimed to evaluate the effect of three different micronutrient-fortified rice formulations on cognitive function in Cambodian children.
Sixteen Cambodian schools receiving SMP.
The FORISCA-UltraRice®+NutriRice® study was a randomized, double-blind, placebo-controlled trial. Four groups of four schools were randomly allocated to receive normal rice, UltraRice®Original, UltraRice®New or NutriRice®. Within each school, 132 children were randomly selected. Data on cognitive performance (picture completion, block design and Raven’s coloured progressive matrices (RCPM)), anthropometry, parasite infestation and micronutrient status were collected before the intervention and after 6 months.
Cognitive data were available for 1796 children aged 6–16 years.
All cognitive scores improved after 6 months (P<0·001). Block design score improvement was significantly higher in children consuming UltraRice®Original (P=0·03) compared with the other fortified rice groups and placebo. No difference among groups was found on RCPM or picture completion scores. Stunting, parasite infestation and inflammation negatively affected the impact of the intervention.
Combined with other interventions, using SMP to distribute fortified rice to schoolchildren may be a cost-effective way to increase cognitive performance and thereby improve school performance and educational achievements.
The new agenda: Globalisation and global governance
Heloise Weber, Senior Lecturer in the School of Political Science and International Studies at the University of Queensland,
Mark T. Berger, Professor in the Department of Defense Analysis at the Naval Postgraduate School, Monterey.
This chapter examines the politics of global poverty, inequality and development. The first section provides the background for our analysis of global poverty and inequality. Any meaningful discussion of poverty and inequality necessarily has to be in relation to development – which, as we show, is itself contested in theory and practice (McMichael 2010). The second section provides a basic outline of a relational perspective of global development. The final section focuses on the UN Millennium Development Goals (MDGs) initiative and the 2030 Sustainable Development Goals (SDGs). We conclude with some critical observations about the relationship between development, poverty and inequality.
Global poverty and inequality in development
Concerns about global poverty have been high on the agenda in world politics at least since the start of the new millennium. For example, the MDG initiative was conceived as part of the United Nations Millennium Declaration (2000), and followed by the declaration on the 2030 Sustainable Development Goals (2015). This high-level focus on development and poverty is not surprising, as not only is the worldwide gap between the rich and the poor growing, but there has also been an unprecedented rise in insecurities and vulnerability in the everyday lived experiences of many people, particularly those experiencing poverty. Two highly visible issues can be drawn upon to illustrate the growth of inequality and poverty in global development. These are the growth of slum-dweller and/or squatter communities (see Cattaneo and Martinez 2014), and the rise of food insecurities for many across the globe. For example, in Planet of Slums, Mike Davis (2006) documents the rise and expansion of slum dwellings globally, and draws attention to the rapid increases in precarious living conditions in urban and peri-urban areas. The expansion of slum dwellings occurs in direct relation to development processes, including industralisation and urbanisation. In the case of food insecurities, the rise in the incidence of food riots globally since the 1980s has also been taking place in the midst of high technology-oriented, high massscale production of food for the global market (Patel 2008; Walton and Seddon 1994). Activists, non-governmental organisations (NGOs), policy-makers, politicians and scholars are all engaged in rigorous debates about the scale and character of global poverty and inequality, and have embarked on various campaigns to ‘make poverty history’.
Internet-based cognitive–behavioural treatment (ICBT) for anxiety disorders has shown some promise, but no study has yet examined unguided ICBT in primary care. This randomized controlled trial (RCT) investigated whether a transdiagnostic, unguided ICBT programme for anxiety disorders is effective in primary care settings, after a face-to-face consultation with a physician (MD). We hypothesized that care as usual (CAU) plus unguided ICBT would be superior to CAU in reducing anxiety and related symptoms among patients with social anxiety disorder (SAD), panic disorder with or without agoraphobia (PDA) and/or generalized anxiety disorder (GAD).
Adults (n = 139) with at least one of these anxiety disorders, as reported by their MD and confirmed by a structured diagnostic interview, were randomized. Unguided ICBT was provided by a novel transdiagnostic ICBT programme (‘velibra’). Primary outcomes were generic measures, such as anxiety and depression symptom severity, and diagnostic status at post-treatment (9 weeks). Secondary outcomes included anxiety disorder-specific measures, quality of life, treatment adherence, satisfaction, and general psychiatric symptomatology at follow-up (6 months after randomization).
CAU plus unguided ICBT was more effective than CAU at post-treatment, with small to medium between-group effect sizes on primary (Cohen's d = 0.41–0.47) and secondary (Cohen's d = 0.16–0.61) outcomes. Treatment gains were maintained at follow-up. In the treatment group, 28.2% of those with a SAD diagnosis, 38.3% with a PDA diagnosis, and 44.8% with a GAD diagnosis at pretreatment no longer fulfilled diagnostic criteria at post-treatment.
The unguided ICBT intervention examined is effective for anxiety disorders when delivered in primary care.
Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach.
Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data.
A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29–0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit–risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration.
Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.
Palmer amaranth has greatly disrupted agricultural practices in the United
States with its rapid growth and rapid evolution of herbicide resistance.
This weed species is now suspected in Argentina. To document whether the
suspected plant populations are indeed Palmer amaranth, molecular
comparisons to known standards were conducted. Additionally, these same
plant populations were screened for possible herbicide resistance to several
acetolactate synthase (ALS)-inhibiting herbicides. Sequencing data confirmed
that suspected populations (A2, A3, A4) were indeed Palmer amaranth. Another
population (A1) was tested to determine whether hybridization had occurred
between Palmer amaranth and mucronate amaranth the native amaranth species
of the region. Tests confirmed that no hybridization had occurred and that
A1 was simply a unique phenotype of mucronate amaranth. Each population was
screened for resistance to imazapic, nicosulfuron, and diclosulam. All
Palmer amaranth populations from Argentina were shown to be resistant to at
least one ALS-inhibiting herbicide. The populations were then subjected to
further testing to identify the mutation responsible for the observed ALS
resistance. All mucronate amaranth populations exhibited a mutation
previously documented to confer ALS resistance (S653N). No known
resistance-conferring mutations were found in Palmer amaranth.
Major depressive disorder (MDD) is moderately heritable, however genome-wide association studies (GWAS) for MDD, as well as for related continuous outcomes, have not shown consistent results. Attempts to elucidate the genetic basis of MDD may be hindered by heterogeneity in diagnosis. The Center for Epidemiological Studies Depression (CES-D) scale provides a widely used tool for measuring depressive symptoms clustered in four different domains which can be combined together into a total score but also can be analysed as separate symptom domains.
We performed a meta-analysis of GWAS of the CES-D symptom clusters. We recruited 12 cohorts with the 20- or 10-item CES-D scale (32 528 persons).
One single nucleotide polymorphism (SNP), rs713224, located near the brain-expressed melatonin receptor (MTNR1A) gene, was associated with the somatic complaints domain of depression symptoms, with borderline genome-wide significance (pdiscovery = 3.82 × 10−8). The SNP was analysed in an additional five cohorts comprising the replication sample (6813 persons). However, the association was not consistent among the replication sample (pdiscovery+replication = 1.10 × 10−6) with evidence of heterogeneity.
Despite the effort to harmonize the phenotypes across cohorts and participants, our study is still underpowered to detect consistent association for depression, even by means of symptom classification. On the contrary, the SNP-based heritability and co-heritability estimation results suggest that a very minor part of the variation could be captured by GWAS, explaining the reason of sparse findings.
Palmer amaranth is a troublesome weed in cotton production. Yield losses of
65% have been reported from season-long Palmer amaranth competition with
cotton. To determine whether water is a factor in this system, experiments
were conduced in 2011, 2012, and 2013 in Citra, FL, and in Tifton, GA. In
2011, infrequent rainfall lead to drought stress. The presence of Palmer
amaranth resulted in decreased soil relative water content up to 1 m in
depth. Cotton stomatal conductance (gs) was reduced up to 1.8 m from a Palmer amaranth plant. In 2012
and 2013 higher than average rainfall resulted in excess water throughout
the growing season. In this situation, no differences were found in soil
relative water content or cotton gs as a function of proximity to Palmer amaranth. A positive
linear trend was found in cotton photosynthesis and yield; each parameter
increased as distance from Palmer amaranth increased. Even in these
well-watered conditions, daily water use of Palmer amaranth was considerably
higher than that of cotton, at 1.2 and 0.49 g H20 cm−2
d−1, respectively. Although Palmer amaranth removed more water
from the soil profile, rainfall was adequate to replenish the profile in 2
of the 3 yr of this study. However, yield loss due to Palmer amaranth was
still observed despite no change in gs, indicating other factors, such as competition for light or
response to neighboring plants during development, are driving yield