Tavistock Adult Depression Study (TADS): a randomised controlled trial of psychoanalytic psychotherapy for treatment-resistant/treatment-refractory forms of depression

ABSTRACT: BACKGROUND: Long-term forms of depression represent a significant mental health problem for which there is a lack of effective evidence-based treatment. This study aims to produce findings about the effectiveness of psychoanalytic psychotherapy in patients with treatment-resistant/treatment-refractory depression and to deepen the understanding of this complex form of depression. METHODS: INDEX GROUP: Patients with treatment resistant/treatment refractory depression. DEFINITION & INCLUSION CRITERIA: Current major depressive disorder, 2 years history of depression, a minimum of two failed treatment attempts, [greater than or equal to]14 on the HRSD or [greater than or equal to]21 on the BDI, plus complex personality and/or psycho-social difficulties. EXCLUSION CRITERIA: Moderate or severe learning disability, psychotic illness, bipolar disorder, substance dependency or receipt of test intervention in the previous two years. DESIGN: Pragmatic, randomised controlled trial with qualitative and clinical components. TEST INTERVENTION: 18 months of weekly psychoanalytic psychotherapy, manualised and fidelity-assessed using the Psychotherapy Process Q-Sort. CONTROL CONDITION: Treatment as usual, managed by the referring practitioner. RECRUITMENT: GP referrals from primary care. RCT MAIN OUTCOME: HRSD (with [less than or equal to]14 as remission). SECONDARY OUTCOMES: depression severity (BDI-II), degree of co-morbid disorders Axis-I and Axis-II (SCID-I and SCID-II-PQ), quality of life and functioning (GAF, CORE, Q-les-Q), object relations (PROQ2a), Cost-effectiveness analysis (CSRI and GP medical records). FOLLOW-UP: 2 years. Plus: a). Qualitative study of participants' and therapists' problem formulation, experience of treatment and of participation in trial. (b) Narrative data from semi-structured pre/post psychodynamic interviews to produce prototypes of responders and non-responders. (c) Clinical case-studies of sub-types of TRD and of change. DISCUSSION: TRD needs complex, long-term intervention and extended research follow-up for the proper evaluation of treatment outcome. This pushes at the limits of the design of randomised therapeutic trials,. We discuss some of the consequent problems and suggest how they may be mitigated. Trial registration Current Controlled Trials ISRCTN40586372

Effect of equal channel angular pressing die angle on corrosion behavior of bulk nanostructured metal

Equal channel angular pressing technique was used to process bulk nanostructured commercial pure titanium Cp2(Ti Cp2) and aluminium alloy 6061(Al6061). The samples were processed at two different die channel angles of 120 º and 126 º. Hardness test shows that the hardness for Al6061, using channel angle 120° ECAP-ed, has increase 15.55% while using channel angle 126° the increase was 14.89% compared to non-ECAP-ed sample. Hardness test for Ti Cp2 ,using channel angle 120° ECAP-ed has increase 32.89% while using channel angle 126° the increase was 27.05%. The hardness for this both materials have shown that Ti Cp2 has higher hardness compared to Al6061 since the highest increment is 5.84% for 120°ECAP-ed than 126°ECAP-ed for Ti Cp2 samples. The corrosion behavior of the ECAP-ed Al6061 was investigated in 3.5% sodium chloride (NaCl) solution relative to seawater concentration while Ti Cp2 was investigated in phosphate buffered saline (PBS) solution. Corrosion resistance on 120° ECAP-ed for both Al6061 and Ti Cp2 have shown improved corrosion behavior indicated by the least value of corrosion current density when compared to non-ECAP . By using channel angle 120°, Al6061 have shown the lowest corrosion current density (Icorr) value of 1.61E-7 while Ti Cp2 has also shown lowest Icorr value of 1.19E-08. This means ECAP-ed using 120° is the most noble sample with lowest corrosion value, when applied with current, among all samples