Eficacia de la estimulación magnética transcraneal en la disminución de severidad en el trastorno depresivo mayor en monoterapia y coadyuvante comparado con tratamientos farmacológicos. Revisión sistemática y meta-análisis

Resumen Introducción Una posible opción de tratamiento para el manejo del trastorno depresivo mayor (TDM) es la estimulación magnética transcraneal (EMT) que ha mostrado propiedades antidepresivas superiores al placebo con un buen perfil de seguridad. El objetivo del presente trabajo es determinar la reducción en la severidad del TDM y la proporción de eventos adversos (EA) en pacientes con TDM refractario y no refractario, posterior al uso de EMT administrada en monoterapia o tratamiento coadyuvante comparado con terapia farmacológica. Metodología Se planteó una pregunta PICOT de la cual se realizó una búsqueda sistemática de estudios clínicos en las bases de datos Medline, EMBASE y Cochrane. Dos investigadores en forma independiente realizaron la selección de artículos, evaluación de calidad con la herramienta de la colaboración Cochrane y extracción de datos. Se extrajeron datos de eficacia como tasa de respuesta, porcentaje de remisión, calidad de vida, diminución sintomática del trastorno depresivo mayor en la escala de Hamilton y capacidad funcional. Igualmente, proporción de pacientes con EA. Se realizó un meta-análisis de estas variables teniendo en cuenta la heterogeneidad. Resultados La presente revisión sistemática incluyó 26 estudios clínicos aleatorizados de baja calidad metodológica mostrando que la EMT presentó una eficacia superior cuando es usada como coadyuvante a las terapias con que venían siendo tratados los pacientes con TDM refractario y no refractario en los desenlaces de tasa de respuesta y porcentaje de remisión. En el caso de intervenciones farmacológicas específicas, la EMT presento eficacia similar, tanto en terapia coadyuvante como en monoterapia comparado con las intervenciones farmacológicas. En cuanto a seguridad, la EMT presenta un buen perfil de seguridad debido a que en todos los escenarios estudiados los EA fueron no serios y baja frecuencia Conclusiones La evidencia disponible sugiere que la EMT mostró ser efectivo y seguro para el manejo del TDM refractario y no refractario. Sin embargo, la evidencia es débil por lo tanto se necesita mayor investigación clínica que soporte su uso.

Double-blind comparison of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia

The purpose of this study was to compare the efficacy and tolerability of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia. This was an 8-week, multicentre, randomized, double-blind, parallel-group comparison of venlafaxine and amitriptyline. Outpatients with DSM-IV major depression, a minimum score of 20 on the 21-item Hamilton Depression Rating Scale (HAM-D), and depressive symptoms for at least 1 month were eligible. Patients were randomly assigned to venlafaxine or amitriptyline, both drugs titrated to a maximum of 150 mg/day until study day 15. The primary efficacy variables were the final on-therapy scores on the HAM-D, Montgomery-Asberg Depression Rating Scale and Clinical Global Impression severity scales. Data were evaluated on an intent-to-treat basis using the LOCF method. One hundred and 16 patients were randomized, and 115 were evaluated for efficacy. Both drugs showed efficacy in the treatment of depression with or without melancholia. No significant differences were noted between treatments for any efficacy parameter. However, significantly (p < 0.05) more patients in the amitriptyline group had at least one adverse event. These results should support the efficacy and tolerability of venlafaxine in comparison with amitriptyline for treating major depression with or without melancholia.

Sertralina no tratamento de pacientes com depressão maior leve e moderada: Estudo multicêntrico brasileiro

Introduction: To evaluate the efficacy, safety, and tolerability of sertraline for the treatment of Brazilian patients with mild to moderate major depression. Patients and methods: Patients were 18 years old or older treated on an out-patient basis. Previous medications were stopped for a 2-week washout period. Afterwards, patients received sertraline, initial dose of 50 mg/day up to the 4 th week. The dose could then be increased up to 200 mg/day according to the efficacy and tolerability. Therapeutic efficacy was evaluated with the Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton scale for depression (HAM-D), and Clinical Global Impression (CGI). Results: 51 patients (42 women) were evaluated regarding efficacy and safety. Treatment with sertraline significantly decreased scores of MADRS, HAM-D e ICGfrom 15.7 ± 6.1; 12.2 ± 3.9 e 3.5 ± 0.6 to 6.2 ± 6.5; 5.4 ± 4.7 e 2.3 ± 1.0 (P < 0.0001), respectively. Sertraline was well tolerated. Gastro-intestinal upset (N=14; 24.6%), headache (N=7; 12.3%), sleep alterations (H-7; 12.3%), dizziness (N-4; 7.0%), and anorexia (N=4; 7.0%) were the most common adverse events. Six patients discontinued the treatment due to adverse events. Conclusion: Sertraline is efficient and presents a favorable safety and tolerability profile for the treatment of Brazilian patients with mild to moderate major depression. © Copyright Moreira Jr. Editora.

Síntomas depresivos y trastorno motor en pacientes con enfermedad de Parkinson

Introduction. Complex relations between brain and psychopathology have attracted the interest of researchers, aiming to clarify the neurobiological mechanisms of depression in Parkinson's disease, obviously in addiction to mental features. Aims. The association of motor impairment and decline of personal autonomy with severity of depressive symptoms was the hypothesis of the present study. Aiming to check this hypothesis, the objective of this study consisted in investigating relationships between the severity of depressive symptoms and motor characteristics of Parkinson's disease. Patients and methods. Thirty patients (53 to 80 year-old) with medical diagnosis of idiopathic Parkinson's disease in initial clinic stages were studied. The Unified Parkinson's Disease Rating Scale, Hoehn-Yahr Scale, and Schwab & England Scale were used to assess the clinic signs and symptoms. The depressive symptoms were identified by complete anamnesis, examination of mental condition, and the Hamilton Rating Scale for Depression and the Anxiety and Depression Scale. Statistical analysis was performed by Pearson's correlation and multiple regression analysis. Results. A significant correlation of severity of depression symptoms with disease stage (p < 0.02), with motor signs (p < 0.008), and with functional performance (p < 0.007) was found. Conclusion. There was significant association between motor impairment and severity of depressive symptoms, and between depression and early disease onset or prolonged duration of Parkinson's disease. © 2007, Revista de Neurología.

Drug dependence, mental impairment and education

This study aimed to evaluate the mental conditions of cocaine-dependent individuals and school commitment/attachment. We evaluated 50 patients referred to the psychiatry emergency room due to mental disorders from chemical dependence. After clinical diagnosis, clinical interview, Hospital Anxiety and Depression Scale, Hamilton Scale for Depression and Brief Psychiatric Rating Scale were applied. The Spearman and Mann-Whitney nonparametric tests, as well as the t-Student test were utilized for statistical analysis.. The accepted significance value was 0.05. All subjects had used cocaine or crack and other substances. Only 13 (26%) did not drop out of school (group 1). Regarding the other 37 (74%), irregular class attendance , successive failures and definitive school drop out rates (group 2) were verified. These subjects presented an early substance use when compared with those which did not drop out of school (p=0.0001). Patients with an early substance use presented higher school dropout rates than those with a later initiation to substance use. Psychopathological phenomena were frequent in both groups.

Measuring motor activity in major depression: the association between the Hamilton Depression Rating Scale and actigraphy

Despite the use of actigraphy in depression research, the association of depression ratings and quantitative motor activity remains controversial. In addition, the impact of recurring episodes on motor activity is uncertain. In 76 medicated inpatients with major depression (27 with a first episode, 49 with recurrent episodes), continuous wrist actigraphy for 24h and scores on the Hamilton Depression Rating Scale (HAMD) were obtained. In addition, 10 subjects of the sample wore the actigraph over a period of 5 days, in order to assess the reliability of a 1-day measurement. Activity levels were stable over 5 consecutive days. Actigraphic parameters did not differ between patients with a first or a recurrent episode, and quantitative motor activity failed to correlate with the HAMD total score. However, of the motor-related single items of the HAMD, the item activities was associated with motor activity parameters, while the items agitation and retardation were not. Actigraphy is consistent with clinical observation for the item activities. Expert raters may not correctly rate the motor aspects of retardation and agitation in major depression.

Development of a global inundation map at high spatial resolution from topographic downscaling of coarse-scale remote sensing data

Large-scale estimates of the area of terrestrial surface waters have greatly improved over time, in particular through the development of multi-satellite methodologies, but the generally coarse spatial resolution (tens of kms) of global observations is still inadequate for many ecological applications. The goal of this study is to introduce a new, globally applicable downscaling method and to demonstrate its applicability to derive fine resolution results from coarse global inundation estimates. The downscaling procedure predicts the location of surface water cover with an inundation probability map that was generated by bagged derision trees using globally available topographic and hydrographic information from the SRTM-derived HydroSHEDS database and trained on the wetland extent of the GLC2000 global land cover map. We applied the downscaling technique to the Global Inundation Extent from Multi-Satellites (GIEMS) dataset to produce a new high-resolution inundation map at a pixel size of 15 arc-seconds, termed GIEMS-D15. GIEMS-D15 represents three states of land surface inundation extents: mean annual minimum (total area, 6.5 x 10(6) km(2)), mean annual maximum (12.1 x 10(6) km(2)), and long-term maximum (173 x 10(6) km(2)); the latter depicts the largest surface water area of any global map to date. While the accuracy of GIEMS-D15 reflects distribution errors introduced by the downscaling process as well as errors from the original satellite estimates, overall accuracy is good yet spatially variable. A comparison against regional wetland cover maps generated by independent observations shows that the results adequately represent large floodplains and wetlands. GIEMS-D15 offers a higher resolution delineation of inundated areas than previously available for the assessment of global freshwater resources and the study of large floodplain and wetland ecosystems. The technique of applying inundation probabilities also allows for coupling with coarse-scale hydro-climatological model simulations. (C) 2014 Elsevier Inc All rights reserved.

Scale structure, age and growth in the freshwater carp, Labeo calbasu (Pisces/Cyprinidae) from Harike wetland, India

Age structure and growth profile based on the scale studies of 468 specimens ranging from 17-62 cm total length of Labeo calbasu (Hamilton) from Harike wetland (30°13'N, 75°12'E), Punjab, India have been described, the present study showed better growth in terms of two important growth parameters namely index of species average size and population weight-growth intensity. Two distinct phases in its life history have been described that indicates the optimum exploitation of this species from this water body. Harvestable size is found to be fish of 34 cm total length. The detailed structural elaboration of scale (normal, regenerated, lateral line) has also been done using scanning electron microscopy (SEM).

Méthodes rapides et efficaces pour la résolution numérique d'équations de type Hamilton-Jacobi avec application à la simulation de feux de forêt

Cette thèse est divisée en trois chapitres. Le premier explique comment utiliser la méthode «level-set» de manière rigoureuse pour faire la simulation de feux de forêt en utilisant comme modèle physique pour la propagation le modèle de l'ellipse de Richards. Le second présente un nouveau schéma semi-implicite avec une preuve de convergence pour la solution d'une équation de type Hamilton-Jacobi anisotrope. L'avantage principal de cette méthode est qu'elle permet de réutiliser des solutions à des problèmes «proches» pour accélérer le calcul. Une autre application de ce schéma est l'homogénéisation. Le troisième chapitre montre comment utiliser les méthodes numériques des deux premiers chapitres pour étudier l'influence de variations à petites échelles dans la vitesse du vent sur la propagation d'un feu de forêt à l'aide de la théorie de l'homogénéisation.

Regional-scale models for relating land cover to basin surface-water quality using remotely sensed data in a GIS

Plant-based management systems implementing deep-rooted, perennial vegetation have been identified as important in mitigating the spread of secondary dryland salinity due to its capacity to influence water table depth. The Glenelg Hopkins catchment is a highly modified watershed in the southwest region of Victoria, where dryland salinity management has been identified as a priority. Empirical relationships between the proportion of native vegetation and in-stream salinity were examined in the Glenelg Hopkins catchment using a linear regression approach. Whilst investigations of these relationships are not unique, this is the first comprehensive attempt to establish a link between land use and in-stream salinity in the study area. The results indicate that higher percentage land cover with native vegetation was negatively correlated with elevated in-stream salinity. This inverse correlation was consistent across the 3 years examined (1980, 1995, and 2002). Recognising the potential for erroneously inferring causal relationships, the methodology outlined here was both a time and cost-effective tool to inform management strategies at a regional scale, particularly in areas where processes may be operating at scales not easily addressed with on-site studies.

The bipolar depression rating scale (BDRS) : its development, validation and utility

Objectives: Unipolar and bipolar depression differ neurobiologically and in clinical presentation. Existing depression rating instruments, used in bipolar depression, fail to capture the necessary phenomenological nuances, as they are based on and skewed towards the characteristics of unipolar depression. Both clinically and in research there is a growing need for a new observer-rated scale that is specifically designed to assess bipolar depression.

Methods: An instrument reflecting the characteristics of bipolar depression was drafted by the authors, and administered to 122 participants aged 18–65 (44 males and 78 females) with a diagnosis of DSM-IV bipolar disorder, who were currently experiencing symptoms of depression. The Bipolar Depression Rating Scale (BDRS) was administered together with the Hamilton Depression Rating Scale (HAM-D), Montgomery Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS).

Results: The BDRS has strong internal consistency (Cronbach's alpha = 0.917), and robust correlation coefficients with the MADRS (r = 0.906) and HAM-D (r = 0.744), and the mixed subscale correlated with the YMRS (r = 0.757). Exploratory factor analysis showed a three-factor solution gave the best account of the data. These factors corresponded to depression (somatic), depression (psychological) and mixed symptom clusters.

Conclusions: This study provides evidence for the validity of the BDRS for the measurement of depression in bipolar disorder. These results suggest good internal validity, provisional evidence of inter-rater reliability and strong correlations with other depression rating scales.

Scale bridging concepts in molecular simulation : coarse-graining and thermodynamic coupling

In dieser Arbeit wurden Simulation von Flüssigkeiten auf molekularer Ebene durchgeführt, wobei unterschiedliche Multi-Skalen Techniken verwendet wurden. Diese erlauben eine effektive Beschreibung der Flüssigkeit, die weniger Rechenzeit im Computer benötigt und somit Phänomene auf längeren Zeit- und Längenskalen beschreiben kann.rnrnEin wesentlicher Aspekt ist dabei ein vereinfachtes (“coarse-grained”) Modell, welches in einem systematischen Verfahren aus Simulationen des detaillierten Modells gewonnen wird. Dabei werden ausgewählte Eigenschaften des detaillierten Modells (z.B. Paar-Korrelationsfunktion, Druck, etc) reproduziert.rnrnEs wurden Algorithmen untersucht, die eine gleichzeitige Kopplung von detaillierten und vereinfachten Modell erlauben (“Adaptive Resolution Scheme”, AdResS). Dabei wird das detaillierte Modell in einem vordefinierten Teilvolumen der Flüssigkeit (z.B. nahe einer Oberfläche) verwendet, während der Rest mithilfe des vereinfachten Modells beschrieben wird.rnrnHierzu wurde eine Methode (“Thermodynamische Kraft”) entwickelt um die Kopplung auch dann zu ermöglichen, wenn die Modelle in verschiedenen thermodynamischen Zuständen befinden. Zudem wurde ein neuartiger Algorithmus der Kopplung beschrieben (H-AdResS) der die Kopplung mittels einer Hamilton-Funktion beschreibt. In diesem Algorithmus ist eine zur Thermodynamischen Kraft analoge Korrektur mit weniger Rechenaufwand möglich.rnrnAls Anwendung dieser grundlegenden Techniken wurden Pfadintegral Molekulardynamik (MD) Simulationen von Wasser untersucht. Mithilfe dieser Methode ist es möglich, quantenmechanische Effekte der Kerne (Delokalisation, Nullpunktsenergie) in die Simulation einzubeziehen. Hierbei wurde zuerst eine Multi-Skalen Technik (“Force-matching”) verwendet um eine effektive Wechselwirkung aus einer detaillierten Simulation auf Basis der Dichtefunktionaltheorie zu extrahieren. Die Pfadintegral MD Simulation verbessert die Beschreibung der intra-molekularen Struktur im Vergleich mit experimentellen Daten. Das Modell eignet sich auch zur gleichzeitigen Kopplung in einer Simulation, wobei ein Wassermolekül (beschrieben durch 48 Punktteilchen im Pfadintegral-MD Modell) mit einem vereinfachten Modell (ein Punktteilchen) gekoppelt wird. Auf diese Weise konnte eine Wasser-Vakuum Grenzfläche simuliert werden, wobei nur die Oberfläche im Pfadintegral Modell und der Rest im vereinfachten Modell beschrieben wird.

Relationship between definitive datum levels and magnetic polarity and revised geomagnetic polarity time-scale at DSDP Hole 72-516F

This paper contains magnetobiostratigraphic correlation charts for each of the four sites occupied during DSDP Leg 72. Microfossil zonal boundaries and magnetic polarity determinations for Sites 515 through 518 are summarized in Figures 1 through 4, respectively. Our discussion focuses on the correlations derived for the Paleogene and late Cretaceous (Coniacian-Maestrichtian) of Site 516, because of the value of this site as a stratigraphic reference section for the South Atlantic.

Evaluations of treatment efficacy of depression from perspective of both patients' symptoms and general sense of mental health and wellbeing: a large scale, multi-centered, longitudinal study in China

Relying on the absence, presence of level of symptomatology may not provide an adequate indication of the effects of treatment for depression, nor sufficient information for the development of treatment plans that meet patients' needs. Using a prospective, multi-centered, and observational design, the present study surveyed a large sample of outpatients with depression in China (n=9855). The 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Remission Evaluation and Mood Inventory Tool (REMIT) were administered at baseline, two weeks later and 4 weeks, to assess patients' self-reported symptoms and general sense of mental health and wellbeing. Of 9855 outpatients, 91.3% were diagnosed as experiencing moderate to severe depression. The patients reported significant improvement over time on both depressive symptoms and general sense after 4-week treatment. The effect sizes of change in general sense were lower than those in symptoms at both two week and four week follow-up. Treatment effects on both general sense and depressive symptomatology were associated with demographic and clinical factors. The findings indicate that a focus on both general sense of mental health and wellbeing in addition to depressive symptomatology will provide clinicians, researchers and patients themselves with a broader perspective of the status of patients.