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Improvement in symptoms of depression is typically delayed with antidepressant treatment. Pipamperone (PIP) at low doses acts as a highly selective 5HT2A/D4 receptor antagonist. The purpose of this study was to investigate whether the addition of PIP to the SSRI citalopram (CIT) would increase the rate of resolution of depressive symptoms.
This was an 8-week, double-blind, parallel-group, single-dummy study in patients with MDD who received either CIT 40 mg daily or PIP 5 mg bid plus CIT 40 mg daily (PIPCIT).
The mean total MADRS score (±SD) of the 165 patients (81% women; mean age, 40 y) was 32.6±5.5. More CIT than PIPCIT patients discontinued treatment in the first 4 weeks [15 (18%) vs 3 (4%); P=0.003]. Reductions in mean total MADRS scores were significantly (ITT LOCF) larger in patients receiving PIPCIT after 1 week [-6.42±6.18 vs -3.99±5.15; P=0.007] and 4 weeks [-15.06±8.48 vs - 12.11±8.30; P=0.025] compared with those receiving CIT alone. Significant differences in favor of PIPCIT were observed in MADRS items “reduced sleep,” “reduced appetite,” “concentration difficulties,” and “pessimistic thoughts.” Mean CGI-I scores were also improved after 1 week of PIPCIT [3.09±0.85 vs. 3.47±0.72; P=0.002]. There were no significant differences observed at 8 weeks. No additional, clinically significant adverse events were noted in the PIPCIT group.
A low dose of PIP added to CIT provided superior antidepressant effects and less discontinuations compared with CIT alone during the first 4 weeks of treatment, and especially in the first week, at apparently no tolerability/safety cost.
Prior studies have demonstrated an inter-relationship between the diagnosis of diabetes, obesity and depression. Our data has demonstrated that baseline body mass index (BMI) was not predictive for clinical outcomes (remission at six months).
Our hypothesis was that obesity (BMI ≥30) and the diagnosis of diabetes in depressed primary patients would have no effect on depression remission rates six months after diagnosis.
This study was retrospective analysis of 1, 894 primary care patients diagnosed with Major Depressive Disorder or Dysthymia with a PHQ-9 score of 10 or greater.
▪ Outcome variable was clinical remission (PHQ-9 < 5) at six months.
▪ Logistic regression modeling included the demographic variables of age, gender, marital status, the clinical variables of BMI, baseline PHQ-9 score, diagnosis of diabetes (yes/no) and clinical diagnosis (recurrent or first episode of depression, or dysthymia).
Odds ratio for clinical remission (PHQ-9<5) at six months in depressed primary care patients, by variable (N=1,894).
Controlling for age, gender, marital status, race, clinical diagnosis and clinical site with logistic regression modeling.
▪ Baseline obesity was not an independent predictor for depression outcome at six months.
▪ Diagnosis of diabetes was not an independent predictor for depression outcome at six months.
This data suggests that obesity and diabetes were not associated with worsening clinical outcomes in depression management.
With one in ten young people being affected by ill mental health and stigma regularly cited as a factor affecting access to early intervention services, focussing resources on school based stigma reduction strategies seems prudent. ‘Headucate’, a student society, designed a 50 minute workshop which aims to increase mental health literacy and decrease stigma.
Repeated, cross sectional surveys were carried out at three time points; 1) immediately before (n=77), 2) Immediately after (n=81) and 3) three months post workshop (n=73). The surveys were paper based versions of the Reported Intended Behaviours Score (RIBS) and Mental Health Knowledge Scale (MAKS) utilising a social distance scale.
Four year 10 classed (pupils aged 14-15) were recruited. Post hoc t-tests were carried out when one-way ANOVAS were significant.
Disorder knowledge (from MAKS) and intended contact (from RIBS) significantly increased between time points one and two (p<0.01 and <0.004 respectively) but then decreased.
Analysis of the question pertaining to knowing where to access help showed a statistically significant increase (p<0.001) between time points one and two and then a decrease at time three, albeit to a higher value than at time point one (3.45 compared to 3.13, P=0.088).
Headucate workshops offer a low resource option which is well accepted by students. Like other school based stigma reduction strategies, a dramatic increase was seen between immediately before and after indicating that the workshop resonates with the pupils, but there was little sustained change in attitudes.
Against a backdrop of poor mental health education in UK schools a group of students from Norwich Medical School have formed a student society called ‘Headucate’ in order to create, deliver and evaluate an educational intervention for adolescents, initially to be delivered in Norfolk schools.
To create an educational intervention that:
Is the length of a standard lesson
Is age appropriate and acceptable
Contains appropriate signposting
Contains content that challenges common myths and replaces them with knowledge
Contains content that encourages empathy and understanding towards those with mental illnesses
Is easily delivered in the same way each time so that its effectiveness can be evaluated
To create an intervention effective at tackling stigma and empowering adolescents to recognise signs of poor mental health and access services appropriately.
Lesson plan created after consultation with psychiatrists, a psychologist, a GP, a university outreach professional, a teacher and secondary school age children, then trialled and revised.
Interactive workshop produced with 5 sections.
1) Myth vs Fact activity that dispels prevalent myths
2) Scenario based activity to demonstrate that mental health is a spectrum
3) An interactive presentation covering the most common mental illnesses and their symptoms
4) An activity focusing on talking to those with mental illnesses, furthering the scenario from the previous activity
5) A question and answer session. Every student leaves with a leaflet containing appropriate signposting.
We have created an educational intervention ready to be delivered and evaluated.
Prior studies have demonstrated an inter-relationship between the diagnosis of diabetes, obesity and depression. Our prior studies have shown that the diagnosis of diabetes or baseline body mass index (BMI) did not impact six month depression remission rates.
Our hypothesis was that level of control of diabetes (hemoglobulin A1c < 8.0%) in depressed diabetic patients would have no effect on depression remission rates six months after diagnosis.
This study was retrospective analysis of 451 diabetic primary care patients diagnosed with Major Depressive Disorder or Dysthymia with a PHQ-9 score of 10 or greater.
▪ Outcome variable was clinical remission (PHQ-9 < 5) at six months.
▪ Logistic regression modeling included the demographic variables of age, gender, marital status, the clinical variables of BMI, baseline PHQ-9 score, hemoglobin A1c level (at date of diagnosis of depression) and clinical diagnosis (recurrent or first episode of depression, or dysthymia).
78.5% (354) of depressed diabetics were in good control of diabetes (hemoglobin A1c< 8%) at enrollment. Obesity (BMI≥ 30) at baseline was not different between the controlled and uncontrolled diabetic patients at baseline (approximately 70%), p=0.36.
Odds ratio for clinical remission (PHQ-9<5) at six months in diabetic primary care patients, by variable (N=451).
Controlling for age, gender, marital status, race, clinical diagnosis and clinical site.
▪ Baseline control of diabetes was not an independent predictor for depression outcome at six months.
This data suggests that poor diabetic control was not associated worsening clinical outcomes in depression management.
Mental health education is not compulsory in the UK therefore adolescents have very varied experiences despite half of people with mental health illnesses reporting having experienced symptoms by 14 years old. University students are ideal for delivering a relaxed, educational intervention aimed at this age group, providing an opportunity to for them to learn necessary tools for recognising signs of poor mental health and tackle associated stigma.
To expand Headucate's membership, including other disciplines within the University of East Anglia (UEA) and provide core training enabling members to deliver a school-based educational intervention
Recruitment of members has been a multifaceted approach utilising social media sites such as Facebook and the Headucate website, and oncampus events and ‘awareness campaigns’ including several successful evening talks and lectures.
Three training sessions, which include ‘Introduction to Mental Health’, ‘Workshop run-through’ and ‘Child Protection’, have been developed for all members wishing to partake in the delivery of workshops.
We have recruited approximately 300 members since summer 2012; 70 fully paid members in 2012/13 academic year and currently 45 paid members for 2013/14.
A total of 18 members are fully trained and ready to deliver workshops within schools and 17 other members have just one training session remaining.
We are looking forward to delivering our first workshops in October and building on a successful first year. We are confident we can provide workshops for approximately 600 children per year.
The symptoms of many mental illnesses often begin during high school. Interventions to improve mental health awareness amongst adolescents may lead to improved outcomes. in the UK unfortunately many schools do not fulfil this need and mental health education is not a compulsory part of the curriculum.
To develop and measure the effectiveness of and educational intervention designed to raise awareness and empower adolescents to recognise signs of poor mental health and access services appropriately.
Evaluate the effectiveness of the intervention through baseline and follow up surveys.
Students at Norwich Medical School collaborated with teachers, psychiatrists and general practitioners to design an educational intervention that aims to tackle stigma and raise awareness of mental health conditions among 13-14 year olds in the hope that they can access services when needed, support those around them and look after their mental health. To evaluate effectiveness of the intervention, a knowledge, attitudes and practices survey that utilises a social distance scale that has been adapted for this age group and will be used to gather baseline and follow up data after six months.
We have developed a one-hour educational intervention delivered by medical students, that uses a variety of teaching techniques to raise awareness of mental health issues. We will start implementation in January 2013 so will have baseline effectiveness results shortly after.
Headucate has the potential to fill an important gap in effectively raising awareness of mental health issues in schools.
Perfectionism is a transdiagnostic risk factor across psychopathology. The Clinical Perfectionism Questionnaire (CPQ) was developed to assess change in order to provide clinical utility, but currently the psychometric properties of the CPQ with adolescents is unknown.
To assess the factor structure and construct validity of the CPQ in female adolescents.
The CPQ was administered to 267 females aged 14–19 years of age. Confirmatory factor analysis (CFA) was used to examine the validity of the two-factor model and a second-order factor model. Pearson correlations were used to evaluate the relationships between the CPQ and a wide range of measures of perfectionism, psychopathology and personality traits.
The study demonstrated internal consistency, construct validity and incremental validity of the CPQ in a sample of female adolescents. The CFA in the present study confirmed the two-factor model of the CPQ with Factor 1 relating to perfectionistic strivings and Factor 2 representing perfectionistic concerns. The second-order two factor model indicated no deterioration in fit.
The two-factor model of the CPQ fits with the theoretical definition of clinical perfectionism where the over-dependence of self-worth on achievement and concern over mistakes are key elements. The CPQ is suitable for use with female adolescents in future research that seeks to better understand the role of perfectionism in the range of mental illnesses that impact youth.
The Mediterranean diet offers a range of health benefits. However, previous studies indicate that the restricted consumption of red meat in the diet may affect long-term sustainability in non-Mediterranean countries. A 24-week randomised controlled parallel cross-over design compared a Mediterranean diet supplemented with 2–3 serves per week of fresh, lean pork (MedPork) with a low-fat control diet (LF). Thirty-three participants at risk of CVD followed each intervention for 8 weeks, with an 8-week washout period separating interventions. The primary outcome was home-measured systolic blood pressure. Secondary outcomes included diastolic blood pressure, fasting lipids, glucose, insulin, C-reactive protein (CRP), body composition and dietary adherence. During the MedPork intervention, participants achieved high adherence to dietary guidelines. Compared with the MedPork intervention, the LF intervention led to greater reductions in weight (Δ = −0·65; 95 % CI −0·04, −1·25 kg, P = 0·04), BMI (Δ = −0·25; 95 % CI −0·03, −0·47 kg/m2, P = 0·01) and waist circumference (Δ = −1·40; 95 % CI −0·45, −2·34 cm, P < 0·01). No significant differences were observed for blood pressure, lipids, glucose, insulin or CRP. These findings indicate that Australians are capable of adhering to a Mediterranean diet with 2–3 weekly serves of fresh, lean pork. Larger intervention studies are now required to demonstrate clinical efficacy of the diet in populations with elevated blood pressure.
The propagation of wave disturbances in water of varying depth bounded above by ice sheets is discussed, accounting for gravity, compressibility and elasticity effects. Considering the more realistic scenario of elastic ice sheets reveals a continuous spectrum of acoustic–gravity modes that propagate even below the cutoff frequency of the rigid surface solution where surface (gravity) waves cannot exist. The balance between gravitational forces and oscillations in the ice sheet defines a new dimensionless quantity
. When the ice sheet is relatively thin and the prescribed frequency is relatively low (
), the free-surface bottom-pressure solution is retrieved in full. However, thicker ice sheets or propagation of relatively higher frequency modes (
) alter the solution fundamentally, which is reflected in an amplified asymmetric signature and different characteristics of the eigenvalues, such that the bottom pressure is amplified when acoustic–gravity waves are transmitted to shallower waters. To analyse these scenarios, an analytical solution and a depth-integrated equation are derived for the cases of constant and varying depths, respectively. Together, these are capable of modelling realistic ocean geometries and an inhomogeneous distribution of ice sheets.
There is a lack of evidence pointing to the efficacy of any specific psychotherapy for adults with anorexia nervosa (AN). The aim of this study was to compare three psychological treatments for AN: Specialist Supportive Clinical Management, Maudsley Model Anorexia Nervosa Treatment for Adults and Enhanced Cognitive Behavioural Therapy.
A multi-centre randomised controlled trial was conducted with outcomes assessed at pre-, mid- and post-treatment, and 6- and 12-month follow-up by researchers blind to treatment allocation. All analyses were intention-to-treat. One hundred and twenty individuals meeting diagnostic criteria for AN were recruited from outpatient treatment settings in three Australian cities and offered 25–40 sessions over a 10-month period. Primary outcomes were body mass index (BMI) and eating disorder psychopathology. Secondary outcomes included depression, anxiety, stress and psychosocial impairment.
Treatment was completed by 60% of participants and 52.5% of the total sample completed 12-month follow-up. Completion rates did not differ between treatments. There were no significant differences between treatments on continuous outcomes; all resulted in clinically significant improvements in BMI, eating disorder psychopathology, general psychopathology and psychosocial impairment that were maintained over follow-up. There were no significant differences between treatments with regard to the achievement of a healthy weight (mean = 50%) or remission (mean = 28.3%) at 12-month follow-up.
The findings add to the evidence base for these three psychological treatments for adults with AN, but the results underscore the need for continued efforts to improve outpatient treatments for this disorder.
Past research shows that prices move in response to World Agricultural Supply and Demand Estimates (WASDE) reports immediately prior to and after a report. This research develops trading models based on knowing the next WASDE report in advance. This should help traders evaluate investments to predict information contained within the report and in determining how best to use such forecasts. The price-forecasting models use regressions against the ratios of ending stocks to use. Results show a steady increasing return to trading over the report month. The highest returns are produced by trading during the growing and harvest seasons.
Tiny, pelagic arthropods from the Anisian Luoping Biota exposed in two quarries near Luoping, Yunnan Province, China, represent the numerically most abundant organisms in the assemblage. They form the basis for definition of two, and possibly three, species referred to the order Lophogastrida, family Eucopiidae. Yunnanocopia grandis new genus new species and Y. longicauda n. gen. new species represent the oldest occurrence of mysidaceans in the fossil record. Their anatomy allies them with the Ladinian species Schimperella acanthocercus Taylor, Schram, and Shen, 2001, from Guizhou Province, China, which previously was thought to be the oldest lophogastrid, and with extant species of Eucopiidae. Their appearance in the Anisian represents one additional element of the early faunal radiation within the Luoping Biota following the end-Permian extinction event. Presence of well-preserved oostegites, along with other morphological features, documents a conservative bauplan expressed in Eucopiidae.
The recently implemented Rainfall Index Annual Forage pilot program aims to provide risk coverage for annual forage producers in select states through the use of area rainfall indices as a proxy for yield. This article utilizes unique data from a long-term study of annual ryegrass production with rainfall recorded at the site to determine whether the use of rainfall indices provides adequate coverage for annual forage growers. The rainfall index is highly correlated with actual rainfall. However, it does not provide much yield loss risk protection for our cool-season forage data.
Phyllocarids of the Waukesha Biota were systematically and taphonomically evaluated. Three Ceratiocaris species are present in the biota: C. macroura Collette and Rudkin, 2010; C. papilio Salter in Murchison, 1859; and C. pusilla Matthew, 1889. Specimens range in completeness from nearly complete, including the cephalic to caudal regions, to isolated telsons and furcae. Evidence of Salter’s position is present in only three specimens. Relatively complete specimens are interpreted to represent corpses, rather than molts; whereas specimens including only the pleon and caudal region, or caudal region, and specimens with evidence of Salter’s position likely represent exuviae. Specimens are preserved essentially as compression fossils exhibiting two types of preserved cuticle: brown inner cuticle, which tends to be impressed over the topography of bedding planes on which specimens are preserved, and blue-gray phosphatized cuticle exhibiting sub-millimeter scale relief. Cuticle phosphatization likely occurred during early diagenesis. The presence of characteristic near-shore species and C. pusilla, only known from turbidite facies, interpreted to possibly represent a marine trough, suggests that the Waukesha phyllocarid assemblage might represent a transported assemblage, rather than a biota, or that C. pusilla from the Jones Creek Formation was transported basinward in sediment gravity flows.
We investigated the genetic and environmental contributions to disordered eating (DE) between early and late adolescence in order to determine whether different sources of heritability and environmental risk contributed to these peak times of emergence of eating disorders.
Adolescent female twins from the Australian Twin Registry were interviewed over the telephone with the Eating Disorder Examination (EDE). Data were collected at 12–15 and 16–19 years (wave 1: N = 699, 351 pairs; wave 3: N = 499, 247 pairs). Assessments also involved self-report measures related to negative life events and weight-related peer teasing.
Unstandardized estimates from the bivariate Cholesky decomposition model showed both genetic influences and non-shared environmental influences increased over adolescence, but shared environmental influences decreased. While non-shared environmental sources active at ages 12–15 years continued to contribute at 16–19 years, new sources of both additive genetic and non-shared environmental risk were introduced at ages 16–19 years. Weight-related peer teasing in early-mid adolescence predicted increases of DE in later adolescence, while negative life events did not.
Two-thirds of the heritable influence contributing to DE in late adolescence was unique to this age group. During late adolescence independent sources of genetic risk, as well as environmental influences are likely to be related in part to peer teasing, appear key antecedents in growth of DE.
Large numbers of evacuees arrived in Dallas, Texas, from Hurricanes Katrina and Rita just 3 weeks apart in 2005 and from Hurricanes Gustav and Ike just 3 weeks apart again in 2008. The Dallas community needed to locate, organize, and manage the response to provide shelter and health care with locally available resources. With each successive hurricane, disaster response leaders applied many lessons learned from prior operations to become more efficient and effective in the provision of services. Mental health services proved to be an essential component. From these experiences, a set of operating guidelines for large evacuee shelter mental health services in Dallas was developed, with involvement of key stakeholders. A generic description of the processes and procedures used in Dallas that highlights the important concepts, key considerations, and organizational steps was then created for potential adaptation by other communities. (Disaster Med Public Health Preparedness. 2015;9:423–429)
Helicobacter pylori imparts a considerable burden to public health. Infections are mainly acquired in childhood and can lead to chronic diseases, including gastric ulcers and cancer. The bacterium subsists in water, but the environment's role in transmission remains poorly understood. The nationally representative National Health and Nutrition Examination Survey (NHANES) was examined for environmental risk factors associated with H. pylori seroprevalence. Data from 1999–2000 were examined and weighted to represent the US population. Multivariable logistic regression estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for associations with seropositivity. Self-reported general health condition was inversely associated with seropositivity. Of participants aged <20 years, seropositivity was significantly associated with having a well as the source of home tap water (aOR 1·7, 95% CI 1·1–2·6) and living in a more crowded home (aOR 2·3, 95% CI 1·5–3·7). Of adults aged ⩾20 years, seropositivity was not associated with well water or crowded living conditions, but adults in soil-related occupations had significantly higher odds of seropositivity compared to those in non-soil-related occupations (aOR 1·9, 95% CI 1·2–2·9). Exposures to both well water and occupationally related soil increased the effect size of adults' odds of seropositivity compared to non-exposed adults (aOR 2·7, 95% CI 1·3-5·6). Environmental exposures (well-water usage and occupational contact with soil) play a role in H. pylori transmission. A disproportionate burden of infection is associated with poor health and crowded living conditions, but risks vary by age and race/ethnicity. These findings could help inform interventions to reduce the burden of infections in the United States.
A randomized controlled trial of three school-based programs and a no-intervention control group was conducted to evaluate their efficacy in reducing eating disorder and obesity risk factors.
A total of 1316 grade 7 and 8 girls and boys (mean age = 13.21 years) across three Australian states were randomly allocated to: Media Smart; Life Smart; the Helping, Encouraging, Listening and Protecting Peers (HELPP) initiative; or control (usual school class). Risk factors were measured at baseline, post-program (5 weeks later), and at the 6- and 12-month follow-ups.
Media Smart girls had half the rate of onset of clinically significant concerns about shape and weight than control girls at the 12-month follow-up. Media Smart and HELPP girls reported significantly lower weight and shape concern than Life Smart girls at the 12-month follow-up. Media Smart and control girls scored significantly lower than HELPP girls on eating concerns and perceived pressure at the 6-month follow-up. Media Smart and HELPP boys experienced significant benefit on media internalization compared with control boys and these were sustained at the 12-month follow-up in Media Smart boys. A group × time effect found that Media Smart participants reported more physical activity than control and HELPP participants at the 6-month follow-up, while a main effect for group found Media Smart participants reported less screen time than controls.
Media Smart was the only program to show benefit on both disordered eating and obesity risk factors. Whilst further investigations are indicated, this study suggests that this program is a promising approach to reducing risk factors for both problems.
An extremely weak circularly-polarized signature was recently detected in the spectral lines of the Am star Sirius A. With a prominent positive lobe, the shape of the phase-averaged Stokes V line profile is atypical of stellar Zeeman signatures, casting doubts on its magnetic origin. We report here on ultra-deep spectropolarimetric observations of two more bright Am stars: β Uma and θ Leo. Stokes V line signatures are detected in both objects, with a shape and amplitude similar to the one observed on Sirius A. We demonstrate that the amplitude of the Stokes V line profiles depend on various line parameters (Landé factor, wavelength, depth) as expected from a Zeeman signature, confirming that extremely weak magnetic fields are likely present in a large fraction of Am stars. We suggest that the strong asymmetry of the polarized signatures, systematically observed so far in Am stars and never reported in strongly magnetic Ap stars, bears unique information about the structure and dynamics of the thin surface convective shell of Am stars.