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Less than 40% of depressed older adults treated with an antidepressant achieve remission. Incomplete response to treatment is common. Current augmentation strategies have limited efficacy, and many have side effects that restrict their utilization in older adults. We conducted the first open pilot trial of minocycline augmentation in older adults who had failed to achieve remission after adequate psychopharmacologic treatment. Subjects older than 55 years of age with major depression and failure to achieve substantial improvement of depressive symptoms after at least 6 weeks of antidepressant treatment were given augmentation with minocycline 100 mg twice daily over an 8-week period. At the end of 8 weeks of augmentation with minocycline, 31% (4/13) patients achieved remission. Remitters had higher baseline ratings of hopelessness and apathy. Minocycline was well tolerated with no reported adverse events or discontinuation due to intolerance. Larger placebo-controlled studies are needed to evaluate the effects of minocycline augmentation in older adults who had failed to achieve remission after adequate treatment with antidepressants.
The aim of postgraduate psychiatric training is to prepare psychiatrists to practice independently. The quality of care provided will depend on the training they received. Pregnancy and childbirth (usually called the perinatal period) are a high-risk period for many women with psychiatric problems. An illness episode at that time can have a devastating effect on women and the whole family, including the child's development.
Objectives
To understand how perinatal mental health training is organized within Europe and how it fits in the training curricula.
Methods
The European Federation of Psychiatric Trainees conducts an annual survey of all member country organizations. We have asked respondents if they received training in perinatal psychiatry, whether that was optional or mandatory and what was its duration. Where training in perinatal psychiatry was not available we asked if they felt it should be.
Results
Data will be presented from the 35 countries that responded in the 2016 survey. Six countries reported that training in perinatal mental health is available. But it is mandatory in only one, with the others offering a mix of theoretical and practical optional training. Of the 29 countries that do not offer perinatal psychiatry training, the majority reported it should be offered and mandatory.
Conclusion
There is a gap in the expectations of psychiatrists treating women in pregnancy and after birth, and a widespread lack of training for them to be able to do so effectively.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
There is a shortage of psychiatrists worldwide. Within Europe, psychiatric trainees can move between countries, which increases the problem in some countries and alleviates it in others. However, little is known about the reasons psychiatric trainees move to another country.
Methods:
Survey of psychiatric trainees in 33 European countries, exploring how frequently psychiatric trainees have migrated or want to migrate, their reasons to stay and leave the country, and the countries where they come from and where they move to. A 61-item self-report questionnaire was developed, covering questions about their demographics, experiences of short-term mobility (from 3 months up to 1 year), experiences of long-term migration (of more than 1 year) and their attitudes towards migration.
Results:
A total of 2281 psychiatric trainees in Europe participated in the survey, of which 72.0% have ‘ever’ considered to move to a different country in their future, 53.5% were considering it ‘now’, at the time of the survey, and 13.3% had already moved country. For these immigrant trainees, academic was the main reason they gave to move from their country of origin. For all trainees, the overall main reason for which they would leave was financial (34.4%), especially in those with lower (<500€) incomes (58.1%), whereas in those with higher (>2500€) incomes, personal reasons were paramount (44.5%).
Conclusions:
A high number of psychiatric trainees considered moving to another country, and their motivation largely reflects the substantial salary differences. These findings suggest tackling financial conditions and academic opportunities.
Executive processes consist of at least two sets of functions: one concerned with cognitive control and the other with reward-related decision making. Abnormal performance in both sets occurs in late-life depression. This study tested the hypothesis that only abnormal performance in cognitive control tasks predicts poor outcomes of late-life depression treated with escitalopram.
Method.
We studied older subjects with major depression (N = 53) and non-depressed subjects (N = 30). Executive functions were tested with the Iowa Gambling Test (IGT), Stroop Color-Word Test, Tower of London (ToL), and Dementia Rating Scale – Initiation/Perseveration domain (DRS-IP). After a 2-week placebo washout, depressed subjects received escitalopram (target daily dose: 20 mg) for 12 weeks.
Results.
There were no significant differences between depressed and non-depressed subjects on executive function tests. Hierarchical cluster analysis of depressed subjects identified a Cognitive Control cluster (abnormal Stroop, ToL, DRS-IP), a Reward-Related cluster (IGT), and an Executively Unimpaired cluster. Decline in depression was greater in the Executively Unimpaired (t = −2.09, df = 331, p = 0.0375) and the Reward-Related (t = −2.33, df = 331, p = 0.0202) clusters than the Cognitive Control cluster. The Executively Unimpaired cluster (t = 2.17, df = 331, p = 0.03) and the Reward-Related cluster (t = 2.03, df = 331, p = 0.0433) had a higher probability of remission than the Cognitive Control cluster.
Conclusions.
Dysfunction of cognitive control functions, but not reward-related decision making, may influence the decline of symptoms and the probability of remission of late-life depression treated with escitalopram. If replicated, simple to administer cognitive control tests may be used to select depressed older patients at risk for poor outcomes to selective serotonin reuptake inhibitors who may require structured psychotherapy.
The latest collection of the most up-to-date research on matters of medieval military history contains a remarkable geographical range, extending from Spain and Britain to the southern steppe lands, by way of Scandinavia, Byzantium, and the Crusader States. At one end of the timescale is a study of population in the later Roman Empire and at the other the Hundred Years War, touching on every century in between. Topics include the hardware of war, the social origins of soldiers, considerations of individual battles, and words for weapons in Old Norse literature. Contributors: Bernard S. Bachrach, Gary Baker, Michael Ehrlich, Nicholas A. Gribit, Nicolaos S. Kanellopoulos,Mollie M. Madden, Kenneth J. McMullen, Craig M. Nakashian, Mamuka Tsurtsumia, Andrew L.J. Villalon.
One of the most impressive military feats of the fourteenth century was the activity of the Great Catalan Company in the eastern Mediterranean area. Initially a band of mercenaries in the service of Frederick of Sicily (1295–1337) and then of the Byzantine Emperor Andronikos II Palaiologos (1282–1328), they turned into an autonomous fighting force against the Byzantines and settled permanently in the duchy of Athens. Their main strength and one of the principal reasons for their success lay in their military skills. They defeated the Turks in a series of battles; defeated the Byzantines at the battle of Apros; and took both the life and the duchy of the duke of Athens, Gautier I de Brienne (1308–1311) in the battle of Kephissos. This last battle is much acclaimed and well documented as it is deemed one of the first conflicts of the fourteenth century where an army of knights was defeated by a force on foot. Was Kephissos, however, the first time in the Company's turbulent history that the Catalans fought on foot and prevailed against a force of horsemen? A fresh analysis of the battle of Apros demonstrates that in all probability in 1305 a Byzantine force of horsemen was defeated by the Catalan foot soldiers. Thus, the objective of this paper is the examination of the Catalan art of war that culminated in the battle of Apros, which can be considered a most accurate foreshadowing of Kephissos.
Chronic obstructive pulmonary disease (COPD) is often complicated by depression and exemplifies the challenge in managing chronic illnesses that require active patient participation in care. In a clinical trial (NCT00151372), we compared a novel personalised intervention for depression and COPD (PID-C) targeting treatment adherence with treatment as usual (TAU). In 138 patients with major depression and severe COPD, PID-C led to a higher remission rate and a greater reduction in depressive symptoms and in dyspnoea-related disability than TAU over 28 weeks and 6 months after the last session. If replicated, PID-C may serve as a care model for patients with both depression and medical illnesses with a deteriorating course.
A study of the ideal magnetohydrodynamic linear eigenvalue spectrum for free-boundary modes in the Z-pinch is presented. The application of a variational method to estimate eigenvalues is described and limitations imposed by the nature of the spectrum are discussed. An analytic expression for the long-wavelength m = 0 growth rate is derived
In 1254, following the death of the emperor John III Vatatzes (1222–54), his successor, his son Theodore II Laskaris (1254–58), had to confront a Bulgarian penetration into Thrace and Macedonia. These areas had been recently restored to Byzantine rule and King Michael Asen (1246–56) of Bulgaria anticipated that Vatatzes' death was an opportunity to regain control over them. The Bulgarians were able to seize many towns and strongholds because they had inadequate garrisons. To maintain the prestige of his empire, Laskaris needed to expel the Bulgarians. The main Byzantine historian of this confrontation is George Akropolites whose work is reproduced with the addition of interesting details by Theodore Skoutariotes. Nikephoros Gregoras mentions the war briefly without adding any more information and George Pachymeres does not mention it at all. Fortunately, we have enough information to understand the campaigns. The outcome of the war confirmed that the Nicaean Empire was, in a military as well as an ideological and political sense, the heir to the pre–1204 Byzantine Empire. As for the new emperor, we would suggest that he was not only a theologian and philosopher, but also a capable, although sometimes an overkeen and impetuous, general.
Course of the War
In this section, we are looking into the course of events of this war, as recorded by the two Byzantine historians. The Bulgarians had profited from the weakness of the town garrisons which lacked enough supplies and war machines to stand siege. Moreover, the inhabitants of these towns were not at all faithful to the emperor. This is why the Nicaean garrisons did not resist and came to terms with the invaders. The emperor held a war council when the news of extensive Bulgarian penetration broke.
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