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Bipolar depression remains difficult to treat, and people often experience ongoing residual symptoms, decreased functioning and impaired quality of life. Adjunctive therapies targeting novel pathways can provide wider treatment options and improve clinical outcomes. Garcinia mangostana Linn. (mangosteen) pericarp has serotonogenic, antioxidant anti-inflammatory and neurogenic properties of relevance to the mechanisms of bipolar depression.
Aims
The current 28-week randomised, multisite, double-blind, placebo-controlled trial investigated mangosteen pericarp extract as an adjunct to treatment-as-usual for treatment of bipolar depression.
Method
This trial was prospectively registered on the Australia New Zealand Clinical Trials Registry (no. ACTRN12616000028404). Participants aged 18 years and older with a diagnosis of bipolar I or II and with at least moderate depressive symptoms were eligible for the study. A total of 1016 participants were initially approached or volunteered for the study, of whom 712 did not progress to screening, with an additional 152 screened out. Seventy participants were randomly allocated to mangosteen and 82 to a placebo control. Fifty participants in the mangosteen and 64 participants in the placebo condition completed the treatment period and were analysed.
Results
Results indicated limited support for the primary hypothesis of superior depression symptom reduction following 24 weeks of treatment. Although overall changes in depressive symptoms did not substantially differ between conditions over the course of the trial, we observed significantly greater improvements for the mangosteen condition at 24 weeks, compared with baseline, for mood symptoms, clinical impressions of bipolar severity and social functioning compared with controls. These differences were attenuated at week 28 post-discontinuation assessment.
Conclusions
Adjunctive mangosteen pericarp treatment appeared to have limited efficacy in mood and functional symptoms associated with bipolar disorder, but not with manic symptoms or quality of life, suggesting a novel therapeutic approach that should be verified by replication.
We propose a new method for identifying active galactic nuclei (AGN) in low mass ($\mathrm{M}_*\leq10^{10}\mathrm{M}_\odot$) galaxies. This method relies on spectral energy distribution (SED) fitting to identify galaxies whose radio flux density has an excess over that expected from star formation alone. Combining data in the Galaxy and Mass Assembly (GAMA) G23 region from GAMA, Evolutionary Map of the Universe (EMU) early science observations, and Wide-field Infrared Survey Explorer (WISE), we compare this technique with a selection of different AGN diagnostics to explore the similarities and differences in AGN classification. We find that diagnostics based on optical and near-infrared criteria (the standard BPT diagram, the WISE colour criterion, and the mass-excitation, or MEx diagram) tend to favour detection of AGN in high mass, high luminosity systems, while the “ProSpect” SED fitting tool can identify AGN efficiently in low mass systems. We investigate an explanation for this result in the context of proportionally lower mass black holes in lower mass galaxies compared to higher mass galaxies and differing proportions of emission from AGN and star formation dominating the light at optical and infrared wavelengths as a function of galaxy stellar mass. We conclude that SED-derived AGN classification is an efficient approach to identify low mass hosts with low radio luminosity AGN.
Liberal modernity and its associated individualism have created conditions in which a case for an established Church appears to contradict all the principles of social diversity. But the characteristic mechanisms of liberal modernity for managing difference – the ballot and the market – have proved inadequate to prevent social divisions from deepening, as the national argument about Brexit demonstrates. Despite the Church of England's lack of a confident narrative of establishment and the tendency to evaluate establishment on pragmatic grounds, this article proposes that a robust theological defence of establishment can be made in terms of both Anglican ecclesiology and a theology of power and authority in which the highest sources of authority are those with the least power. Whether the Church of England is able to regain confidence in such a theology of establishment and rise to the challenge of generating a unifying national narrative of identity post-Brexit, is left as an open question.
As duchess of Brittany [1491-1514] and twice queen of France [1491-98; 1498-1514], Anne de Bretagne set a benchmark by which to measure the status of female authority in Europe at the dawn of the Renaissance. Although at times a traditional political pawn, when men who ruled her life were involved in reshaping European alliances, Anne was directly or indirectly involved with the principal political and religious European leaders of her time and helped define the cultural landscape of her era. Taking a variety of cross-disciplinary perspectives, these ten essays by art historians, literary specialists, historians, and political scientists contribute to the ongoing discussion of Anne de Bretagne and seek to prompt further investigations into her cultural and political impact. At the same time, they offer insight of a broader nature into related areas of intellectual interest - patronage, the history of the book, the power and definition of queenship and the interpretation of politico-cultural documents and court spectacles - thereby confirming the extensive nature of Anne's legacy.
CYNTHIA J. BROWN is Professor of French at the University of California, Santa Barbara.
A series of editorials in this Journal have argued that psychiatry is in the midst of a crisis. The various solutions proposed would all involve a strengthening of psychiatry's identity as essentially ‘applied neuroscience’. Although not discounting the importance of the brain sciences and psychopharmacology, we argue that psychiatry needs to move beyond the dominance of the current, technological paradigm. This would be more in keeping with the evidence about how positive outcomes are achieved and could also serve to foster more meaningful collaboration with the growing service user movement.
Elizabeth A. R. Brown provides below a list of Anne's children, based on Patrick Van Kerrebrouck, Les Valois (pp. 157–9, 166–7).
With Charles VIII (30 June 1470–7 April 1498)
Charles-Orland, dauphin of Viennois (10 Oct. 1492–16 Dec. 1495), buried at Saint-Martin of Tours.
Unnamed (Aug. 1493), buried at Notre-Dame of Cléry.
Unnamed (March 1495).
Charles, dauphin of Viennois (8 Sept. 1496–2 Oct. 1496), buried at Saint-Martin of Tours.
François, dauphin of Viennois (1497), buried at Saint-Martin of Tours.
Anne (20 March 1498), buried at Saint-Martin of Tours.
With Louis XII (27 June 1462–1 Jan. 1515)
Claude, duchess of Brittany, countess of Blois (13 Oct. 1499–20 July 1524), married 18 May 1514 to François, duke of Valois and Milan, count of Angoulême, the future François Ier (12 Sept. 1494–31 March 1547), crowned queen of France 10 May 1517, buried at Saint-Denis.
Unnamed (21 Jan. 1503), perhaps buried at Blois.
Renée, duchess of Chartres, countess of Gisors (25 Oct. 1510–12 June 1575), married 10 Feb. 1528 to Hercule of Este, duke of Ferrara (4 April 1508–3 Oct. 1560); buried at Montargis.