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Cognitive impairment is considered a core feature of major depressive disorder (MDD) and research into psychological treatments aiming to address cognitive impairment are gaining momentum. Compared with the well-established research base of cognitive treatment trials in schizophrenia, including meta-analyses, mood disorder research is much more preliminary.
To focus on identifying the important factors to consider in developing larger-scale psychological treatment trials targeting cognitive impairment in mood disorders. Trial design recommendations have been published for cognitive treatment trials in bipolar disorder.
An in-depth discussion of methodological considerations in the development of cognitive treatment trials for MDD.
Methodological considerations include: screening for, and defining, cognitive impairment; mood state when cognitive intervention begins; medication monitoring during cognitive interventions; use of concomitant therapy; level of therapist involvement; duration and dose of treatment; choice of specific cognitive training exercises; home practice; improving adherence; appropriate comparison therapies in clinical trials; and choice of primary outcomes.
As well as guidance for clinical trial development, this review may be helpful for clinicians wanting to provide cognitive interventions for individuals with MDD.
Electroconvulsive therapy (ECT) is recommended in treatment guidelines as an efficacious therapy for treatment-resistant depression. However, it has been associated with loss of autobiographical memory and short-term reduction in new learning.
To provide clinically useful guidelines to aid clinicians in informing patients regarding the cognitive side-effects of ECT and in monitoring these during a course of ECT, using complex data.
A Committee of clinical and academic experts from Australia and New Zealand met to the discuss the key issues pertaining to ECT and cognitive side-effects. Evidence regarding cognitive side-effects was reviewed, as was the limited evidence regarding how to monitor them. Both issues were supplemented by the clinical experience of the authors.
Meta-analyses suggest that new learning is impaired immediately following ECT but that group mean scores return at least to baseline by 14 days after ECT. Other cognitive functions are generally unaffected. However, the finding of a mean score that is not reduced from baseline cannot be taken to indicate that impairment, particularly of new learning, cannot occur in individuals, particularly those who are at greater risk. Therefore, monitoring is still important. Evidence suggests that ECT does cause deficits in autobiographical memory. The evidence for schedules of testing to monitor cognitive side-effects is currently limited. We therefore make practical recommendations based on clinical experience.
Despite modern ECT techniques, cognitive side-effects remain an important issue, although their nature and degree remains to be clarified fully. In these circumstances it is useful for clinicians to have guidance regarding what to tell patients and how to monitor these side-effects clinically.
Memory impairment is an important side-effect of electroconvulsive therapy (ECT). However, predicting which patients are at increased risk of developing this is difficult. The study by Sigström et al compares patients’ experience of memory difficulties before and after ECT and suggests that patients with negative expectations of ECT's memory effects are more likely to have subjective memory worsening post-ECT. This intriguing finding suggests that clinicians may be able to modify the risk of patients developing subjective memory difficulties post-ECT by providing appropriate information and addressing concerns prior to treatment, during the informed consent process.
Optimal stroke care requires access to resources such as neuroimaging, acute revascularization, rehabilitation, and stroke prevention services, which may not be available in rural areas. We aimed to determine geographic access to stroke care for residents of rural communities in the province of Ontario, Canada.
We used the Ontario Road Network File database linked with the 2016 Ontario Acute Stroke Care Resource Inventory to estimate the proportion of people in rural communities, defined as those with a population size <10,000, who were within 30, 60, and 240 minutes of travel time by car from stroke care services, including brain imaging, thrombolysis treatment centers, stroke units, stroke prevention clinics, inpatient rehabilitation facilities, and endovascular treatment centers.
Of the 1,496,262 people residing in rural communities, the majority resided within 60 minutes of driving time to a center with computed tomography (85%), thrombolysis (81%), a stroke unit (68%), a stroke prevention clinic (74%), or inpatient rehabilitation (77.0%), but a much lower proportion (32%) were within 60 minutes of driving time to a center capable of providing endovascular thrombectomy (EVT).
Most rural Ontario residents have appropriate geographic access to stroke services, with the exception of EVT. This information may be useful for jurisdictions seeking to optimize the regional organization of stroke care services.
The term ‘mood stabiliser’ is ill-defined and lacks clinical utility. We propose a framework to evaluate medications and effectively communicate their mood stabilising properties – their acute and prophylactic efficacy across the domains of mania and depression. The standardised framework provides a common definition to facilitate research and clinical practice.
Declaration of interest
The Treatment Algorithm Group (TAG) was supported logistically by Servier who provided financial assistance with travel and accommodation for those TAG members travelling interstate or overseas to attend the meeting in Sydney (held on 18 November 2017). None of the committee were paid to participate in this project and Servier have not had any input into the content, format or outputs from this project.
Connectedness is a central dimension of personal recovery from severe mental illness (SMI). Research reports that people with SMI have lower social capital and poorer-quality social networks compared to the general population.
To identify personal well-being network (PWN) types and explore additional insights from mapping connections to places and activities alongside social ties.
We carried out 150 interviews with individuals with SMI and mapped social ties, places and activities and their impact on well-being. PWN types were developed using social network analysis and hierarchical k-means clustering of this data.
Three PWN types were identified: formal and sparse; family and stable; and diverse and active. Well-being and social capital varied within and among types. Place and activity data indicated important contextual differences within social connections that were not found by mapping social networks alone.
Place locations and meaningful activities are important aspects of people's social worlds. Mapped alongside social networks, PWNs have important implications for person-centred recovery approaches through providing a broader understanding of individual's lives and resources.
Transient Ischaemic Attack (TIA) is a neurologic event with symptom resolution within 24 hours. Early specialist assessment of TIA reduces risk of stroke and death. National United Kingdom (UK) guidelines recommend patients with TIA are seen in specialist clinics within 24 hours (high risk) or seven days (low risk).
We aimed to develop a complex intervention for patients with low risk TIA presenting to the emergency ambulance service. The intervention is being tested in the TIER feasibility trial, in line with Medical Research Council (MRC) guidance on staged development and evaluation of complex interventions.
We conducted three interrelated activities to produce the TIER intervention:
•Survey of UK Ambulance Services (n = 13) to gather information about TIA pathways already in use
•Scoping review of literature describing prehospital care of patients with TIA
•Synthesis of data and definition of intervention by specialist panel of: paramedics; Emergency Department (ED) and stroke consultants; service users; ambulance service managers.
The panel used results to define the TIER intervention, to include:
1.Protocol for paramedics to assess patients presenting with TIA and identify and refer low risk patients for prompt (< 7day) specialist review at TIA clinic
2.Patient Group Directive and information pack to allow paramedic administration of aspirin to patients left at home with referral to TIA clinic
3.Referral process via ambulance control room
4.Training package for paramedics
5.Agreement with TIA clinic service provider including rapid review of referred patients
We followed MRC guidance to develop a clinical intervention for assessment and referral of low risk TIA patients attended by emergency ambulance paramedic. We are testing feasibility of implementing and evaluating this intervention in the TIER feasibility trial which may lead to fully powered multicentre randomized controlled trial (RCT) if predefined progression criteria are met.
Studies using acute tryptophan depletion (ATD) to examine the effects of a rapid reduction in serotonin function have shown a reduction in global cognitive status during ATD in Alzheimer's disease (AD) and Parkinson's disease (PD). Based on the severe cholinergic loss evident in dementia with Lewy bodies (DLB) and Parkinson's disease and dementia (PDD), we predicted that a reduction of global cognitive status during ATD would be greater in these conditions than in AD.
Patients having DLB or PDD underwent ATD in a double-blind, placebo-controlled, randomized, counterbalanced, crossover design.
While the study intended to test 20 patients, the protocol was poorly tolerated and terminated after six patients attempted, but only four patients – three with DLB and one with PDD – completed the protocol. The Modified Mini-Mental State Examination (3MSE) score was reduced in all three DLB patients and unchanged in the PDD and dementia patient during ATD compared with placebo.
This reduction in global cognitive function and the poor tolerability may fit with the hypothesis that people with dementia with Lewy bodies have sensitivity to the effects of reduced serotonin function.
Microalgal blooms are a natural part of the seasonal cycle of photosynthetic organisms in marine ecosystems. They are key components of the structure and dynamics of the oceans and thus sustain the benefits that humans obtain from these aquatic environments. However, some microalgal blooms can cause harm to humans and other organisms. These harmful algal blooms (HABs) have direct impacts on human health and negative influences on human wellbeing, mainly through their consequences to coastal ecosystem services (fisheries, tourism and recreation) and other marine organisms and environments. HABs are natural phenomena, but these events can be favoured by anthropogenic pressures in coastal areas. Global warming and associated changes in the oceans could affect HAB occurrences and toxicity as well, although forecasting the possible trends is still speculative and requires intensive multidisciplinary research. At the beginning of the 21st century, with expanding human populations, particularly in coastal and developing countries, mitigating HABs impacts on human health and wellbeing is becoming a more pressing public health need. The available tools to address this global challenge include maintaining intensive, multidisciplinary and collaborative scientific research, and strengthening the coordination with stakeholders, policymakers and the general public. Here we provide an overview of different aspects of the HABs phenomena, an important element of the intrinsic links between oceans and human health and wellbeing.
With the large improvement in effective area of Astro-H's micro-calorimeter soft X-ray spectrometer (SXS) over grating spectrometers, high-resolution X-ray spectroscopy with good signal to noise will become more commonly available, also for faint and extended sources. This will result in a range of spectral lines being resolved for the first time in celestial sources, especially in the Fe region. However, a large number of X-ray line energies in the atomic databases are known to a lesser accuracy than that expected for Astro-H/SXS, or have no known uncertainty at all. To benchmark the available calculations, we have therefore started to measure reference energies of K-shell transition in L-shell ions for astrophysically relevant elements in the range 11≤ Z ≤ 28 (Na to Ni), using the Lawrence Livermore National Laboratory's EBIT-I electron beam ion trap coupled with the NASA/GSFC EBIT calorimeter spectrometer (ECS). The ECS has a resolution of ~5 e V, i.e., similar to Astro-H/SXS and Chandra/HETG. A comparison to crystal spectra of lower charge states of sulfur with ~0.6 e V resolution shows that the analysis of spectra taken at ECS resolution allows to determine the transition energies of the strongest components.
Impaired neuropsychological function and differences in facial emotion
processing are features of major depression. Some aspects of these
functions may change during treatment and may be useful in assessing
treatment response, even at an early stage of treatment.
To examine early and later changes in neuropsychological functioning and
facial emotion processing as potential markers of treatment response in
In total, 68 newly admitted in-patients with a primary diagnosis of major
depression and 50 healthy controls completed an assessment, including
mood ratings, neuropsychological measures and facial emotion processing
measures at three time points (baseline, 10–14 days and 6 weeks).
Pervasive neuropsychological impairment was evident at baseline in
patients with depression compared with healthy controls. During 6 weeks
of treatment, only simple reaction time, verbal working memory and the
recognition of angry facial expressions showed differential change in
those whose depression responded to treatment compared with treatment
non-responders in the depression group. None of the measures showed a
significant difference between treatment responders and non-responders at
Despite significant impairment in neuropsychological functioning in the
depression group, most measures failed to differentiate between treatment
responders and non-responders at 10–14 days or at 6 weeks. Simple
reaction time, verbal working memory and recognition of angry facial
expressions may be useful in assessing response in severe depression but
probably not at an early stage.
Facial emotion processing was examined in patients with severe depression (n = 68) and a healthy control group (n = 50), using the Facial Expression Recognition Task. A negative interpretation bias was observed in the depression group: neutral faces were more likely to be interpreted as sad and less likely to be interpreted as happy, compared with controls. The depression group also displayed a specific deficit in the recognition of facial expressions of disgust, compared with controls. This may relate to impaired functioning of frontostriatal structures, particularly the basal ganglia.