Major depressive disorder and nutritional medicine : a review of monotherapies and adjuvant treatments

A literature review was conducted to examine the evidence for nutritional interventions in depression. It revealed a number of significant conclusions. Interestingly, more positive clinical trials were found to support adjuvant, rather than monotherapeutic, use of nutrients to treat depression. Much evidence exists in the area of adjuvant application of folic acid, S-adenosyl-methionine, omega-3, and L-tryptophan with antidepressants. Current evidence does not support omega-3 as an effective monotherapy to treat depression. However, this may be due, at least in part, to olive oil being used as the control intervention, some studies using docosahexaenoic acid alone or a higher docosahexaenoic acid to eicosapentaenoic acid ratio, and significant heterogeneity regarding depressive populations. Nevertheless, adjunctive prescription of omega-3 with antidepressants, or in people with dietary deficiency, may be beneficial. Inositol lacks evidence as an effective antidepressant and cannot be currently recommended. Evidence on the use of L-trytophan for depression is inconclusive and additional studies utilizing a more robust methodology are required.

Expressed emotion as predictor of relapse in patients with comorbid psychoses and substance use disorder

Objective: Expressed emotion (EE) and substance use disorder predict relapse in psychosis, but there is little research on EE in comorbid samples. The current study addressed this issue. Method: Sixty inpatients with a DSM-IV psychosis and substance use disorder were recruited and underwent diagnostic and substance use assessment. Key relatives were administered the Camberwell Family Interview. Results: Patients were assessed on the initial symptoms and recent substance use, and 58 completed the assessment over the following 9 months. High EE was observed in 62% of households. Expressed emotion was the strongest predictor of relapse during follow up and its predictive effect remained in participants with early psychosis. A multivariate prediction of a shorter time to relapse entered EE, substance use during follow up Q1 and (surprisingly) an absence of childhood attention deficit hyperactivity disorder. Conclusions: Since high EE is a common and important risk factor for people with comorbid psychosis and substance misuse, approaches to address it should be considered by treating clinicians.

Current evidence on integrated treatment for serious mental disorder and substance misuse

Substance misuse in people with serious mental disorders is common and has a wideranging negative impact. The multiplicity of problems suggests that this comorbidity is better conceptualized as a type of complex disorder than by ‘dual diagnosis’. Problems with sequential and parallel treatments have led to the development of integrated approaches, with one practitioner or team addressing both the substance use and mental disorder. These treatments are typically characterized by motivation enhancement, minimizing treatment-related stress, emphasizing harm reduction as well as abstinence, and assertive outreach. A review of published randomized trials demonstrates that superior effects to controls are rarely consistent across treatment foci and over time. While motivational interventions assist engagement, more intervention is usually required for integrated treatment programs to improve long-term outcomes more than control conditions. More intensive case management does not consistently improve impact, but extended cognitive-behavioral therapies have promise. Suggestions for maximizing treatment effects and improving research evidence are provided.

Eye-movements and visual imagery : a working memory approach to the treatment of post-traumatic stress disorder

It has been claimed that the symptoms of post-traumatic stress disorder (PTSD) can be ameliorated by eye-movement desensitization-reprocessing therapy (EMD-R), a procedure that involves the individual making saccadic eye-movements while imagining the traumatic event. We hypothesized that these eye-movements reduce the vividness of distressing images by disrupting the function of the visuospatial sketchpad (VSSP) of working memory, and that by doing so they reduce the intensity of the emotion associated with the image. This hypothesis was tested by asking non-PTSD participants to form images of neutral and negative pictures under dual task conditions. Their images were less vivid with concurrent eye-movements and with a concurrent spatial tapping task that did not involve eye-movements. In the first three experiments, these secondary tasks did not consistently affect participants' emotional responses to the images. However, Expt 4 used personal recollections as stimuli for the imagery task, and demonstrated a significant reduction in emotional response under the same dual task conditions. These results suggest that, if EMD-R works, it does so by reducing the vividness and emotiveness of traumatic images via the VSSP of working memory. Other visuospatial tasks may also be of therapeutic value.

Reducing the risk of posttraumatic stress disorder in children following natural disasters

A significant number of children suffer long term psychological disturbance following exposure to a natural disaster. Evidence suggests that a dose-response relationship exists, so that children and adolescents who experience the most intense or extensive exposure to the risk factors for PTSD are likely to develop the most serious and persistent symptoms. Risk factors include gender, age, personality, extent of exposure to the natural disaster, amount of damage to property and infrastructure, witnessing injury or death of others or perceiving a threat to their own life. Knowing these factors enables various strategies to be put in place to decrease the risk of psychological disturbance following the aftermath of traumatic events. Re-establishing a sense of safety, security and normality is important in the aftermath of a natural disaster, and promoting social connectedness, positive family functioning, and effective coping mechanisms can make children more resilient in the face of catastrophic events. This paper examines the risk and protective factors associated with the development of post traumatic stress disorder (PTSD), and considers how schools can use this knowledge to contribute to the recovery effort, and reduce the prevalence of PTSD amongst pupils in the wake of a natural disaster.

Dealing with Post-GFC stress disorder : Bwembya Chikolwa quoted by Christine Retschlag for Property Australia magazine 4th March 2010

Has the GFC really changed the thinking of the property industry? Or are investment managers suffering from post-GFC stress disorder fated to repeat the mistakes of the past? Christine Retschlag reports on the mindset of the market.

FPGA implementation of dual-microphone delay-and-sum beamforming for in-car speech enhancement and recognition

In an automotive environment, the performance of a speech recognition system is affected by environmental noise if the speech signal is acquired directly from a microphone. Speech enhancement techniques are therefore necessary to improve the speech recognition performance. In this paper, a field-programmable gate array (FPGA) implementation of dual-microphone delay-and-sum beamforming (DASB) for speech enhancement is presented. As the first step towards a cost-effective solution, the implementation described in this paper uses a relatively high-end FPGA device to facilitate the verification of various design strategies and parameters. Experimental results show that the proposed design can produce output waveforms close to those generated by a theoretical (floating-point) model with modest usage of FPGA resources. Speech recognition experiments are also conducted on enhanced in-car speech waveforms produced by the FPGA in order to compare recognition performance with the floating-point representation running on a PC.

Impact of cognitive load and frustration on drivers’ speech [Abstract]

Secondary tasks such as cell phone calls or interaction with automated speech dialog systems (SDSs) increase the driver’s cognitive load as well as the probability of driving errors. This study analyzes speech production variations due to cognitive load and emotional state of drivers in real driving conditions. Speech samples were acquired from 24 female and 17 male subjects (approximately 8.5 h of data) while talking to a co-driver and communicating with two automated call centers, with emotional states (neutral, negative) and the number of necessary SDS query repetitions also labeled. A consistent shift in a number of speech production parameters (pitch, first format center frequency, spectral center of gravity, spectral energy spread, and duration of voiced segments) was observed when comparing SDS interaction against co-driver interaction; further increases were observed when considering negative emotion segments and the number of requested SDS query repetitions. A mel frequency cepstral coefficient based Gaussian mixture classifier trained on 10 male and 10 female sessions provided 91% accuracy in the open test set task of distinguishing co-driver interactions from SDS interactions, suggesting—together with the acoustic analysis—that it is possible to monitor the level of driver distraction directly from their speech.

Simulated cataracts and their effect on speech intelligibility

Purpose: The classic study of Sumby and Pollack (1954, JASA, 26(2), 212-215) demonstrated that visual information aided speech intelligibility under noisy auditory conditions. Their work showed that visual information is especially useful under low signal-to-noise conditions where the auditory signal leaves greater margins for improvement. We investigated whether simulated cataracts interfered with the ability of participants to use visual cues to help disambiguate the auditory signal in the presence of auditory noise. Methods: Participants in the study were screened to ensure normal visual acuity (mean of 20/20) and normal hearing (auditory threshold ≤ 20 dB HL). Speech intelligibility was tested under an auditory only condition and two visual conditions: normal vision and simulated cataracts. The light scattering effects of cataracts were imitated using cataract-simulating filters. Participants wore blacked-out glasses in the auditory only condition and lens-free frames in the normal auditory-visual condition. Individual sentences were spoken by a live speaker in the presence of prerecorded four-person background babble set to a speech-to-noise ratio (SNR) of -16 dB. The SNR was determined in a preliminary experiment to support 50% correct identification of sentence under the auditory only conditions. The speaker was trained to match the rate, intensity and inflections of a prerecorded audio track of everyday speech sentences. The speaker was blind to the visual conditions of the participant to control for bias.Participants’ speech intelligibility was measured by comparing the accuracy of their written account of what they believed the speaker to have said to the actual spoken sentence. Results: Relative to the normal vision condition, speech intelligibility was significantly poorer when participants wore simulated catarcts. Conclusions: The results suggest that cataracts may interfere with the acquisition of visual cues to speech perception.

Contrasting scenarios : embracing speech recognition

The purpose of this chapter is to describe the use of caricatured contrasting scenarios (Bødker, 2000) and how they can be used to consider potential designs for disruptive technologies. The disruptive technology in this case is Automatic Speech Recognition (ASR) software in workplace settings. The particular workplace is the Magistrates Court of the Australian Capital Territory.----- Caricatured contrasting scenarios are ideally suited to exploring how ASR might be implemented in a particular setting because they allow potential implementations to be “sketched” quickly and with little effort. This sketching of potential interactions and the emphasis of both positive and negative outcomes allows the benefits and pitfalls of design decisions to become apparent.----- A brief description of the Court is given, describing the reasons for choosing the Court for this case study. The work of the Court is framed as taking place in two modes: Front of house, where the courtroom itself is, and backstage, where documents are processed and the business of the court is recorded and encoded into various systems.----- Caricatured contrasting scenarios describing the introduction of ASR to the front of house are presented and then analysed. These scenarios show that the introduction of ASR to the court would be highly problematic.----- The final section describes how ASR could be re-imagined in order to make it useful for the court. A final scenario is presented that describes how this re-imagined ASR could be integrated into both the front of house and backstage of the court in a way that could strengthen both processes.