Pharmacological treatment approaches to difficult-to-treat depression

In the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial of almost 3000 patients with depression in the United States, 50% responded to the initial trial of a selective serotonin reuptake inhibitor antidepressant, but only a third achieved remission (nil or minimal depressive symptoms). The final remission rate, even after four potential treatment steps, was only 70%. This finding reflects the reality of clinical practice and highlights the need to employ the best available evidence in the management of people with complex depression. Before adopting a pharmacological strategy for a patient with difficult-to-treat depression, general clinical issues (such as missed psychiatric diagnoses, unresolved psychological issues and treatment non-adherence) should be considered. While there is no strong evidence for the order of implementing evidence-based pharmacological strategies for difficult-to-treat depression, we recommend: i) increase antidepressant dose; ii) switch to different antidepressant; iii) augment with a non-antidepressant agent; and iv) combine antidepressants. Sometimes it may be more appropriate to consider augmentation before switching antidepressants. The use of psychological interventions or other physical treatments such as electroconvulsive therapy should be considered at each step in management

Psychosocial, physical and cognitive perspectives on the adolescent dancer

This is the final version. Available from IGI Global via the DOI in this recordAdolescence is a critical period that is heightened for dancers, whether participating recreationally or vocationally. Changes are situated within a highly complex setting and are influenced by many factors, including the dance training environment, personal feelings about changes, and perceptions of changes by significant others. The way in which sub-cultures (such as ballet) construct adolescence is likely to impact upon experiences of, and engagement in, dance, as well as development. The dance context, however, has received little attention in relation to development and maturation from a psychosocial perspective. While the facets of talent that predict engagement or dropout of young dancers have been discussed, little research within dance has viewed the adolescent from a truly developmental perspective. This chapter will explore how contemporary cultural constructions of adolescence apply to the dance context, outline the developmental ‘tasks’ of adolescence, and discuss how young dancers navigate these tasks, drawing on psychosocial perspectives

The miswired brain: making connections from neurodevelopment to psychopathology

Developmental neurobiologists have made great progress in elucidating the molecular mechanisms underlying nervous system development. There has been less focus, however, on the consequences when these processes go wrong. As the evidence increases that mutations in neurodevelopmental genes are associated with major psychiatric disorders, defining these consequences assumes paramount importance in elucidating pathogenic mechanisms

On-time maturation in female adolescent ballet dancers: Learning from lived experiences

This is the final version. Available on open access from SAGE Publications via the DOI in this recordThis study employed semi-structured interviews and Interpretative Phenomenological Analysis to explore experiences of on-time maturation in nine adolescent ballet dancers from across three vocational ballet schools in the United Kingdom. Two themes were identified as central to their experiences: ‘A right and a wrong way to grow’, and fitting in and moving forward. Instead of perceiving themselves as ‘average’ and experiencing a relatively easy pubertal transition, on-time dancers described unique challenges associated with a fluctuation between fitting in and not fitting in within their social context. The implications of on-time maturation in this context are complex and do not appear to follow the same trajectory as early maturing ballet dancers nor on-time non-dancers

Of grit and grace: negotiating puberty, surviving, and succeeding in professional ballet

This is the author accepted manuscript. The final version is available from Human Kinetics via the DOI in this recordExperiences of puberty and how individuals adapt to puberty may be integral to success in ballet; however, there is a paucity of current research in this area. This study explores the lived experiences of nine professional ballet dancers to capture the journey of negotiating puberty in a ballet context. An interpretative phenomenological analysis approach was employed with semistructured interviews utilized to gather rich, descriptive accounts from nine professional ballet dancers from the United Kingdom and United States. Lived experiences were characterized by conflict and struggle, coming to terms with physical changes and possessing grit and grace in order to successfully negotiate puberty, and to succeed and survive in professional ballet. Accepting physical and esthetic strengths and weaknesses and learning how to adapt or how to compensate for weaknesses was described as pivotal. Factors such as social support, the timing and extent of pubertal changes, dance teacher behaviors, and the ballet training context influenced the extent to which dancers experienced conflict and struggle and how easily they were able to come to terms with their adult physique. Further research is needed to explore the implications of maturing and developing within the context of ballet training and to develop strategies to better facilitate healthy development in ballet

The role of community champions in place-based early years support: how can we successfully share knowledge and build parent confidence?

This is the final version. Available on open access from SAGE Publications via the DOI in this recor

How do patients, politicians, physiotherapists and other health professionals view physiotherapy research in Switzerland? : a qualitative study

Since 2002, the professional education for Swiss physiotherapists has been upgraded to a tertiary educational level. With this change, the need for research related to professional practice has become more salient. The elaboration of research priorities is seen as a possible way to determine the profession's needs, to help coordinate research collaborations and to address expectations regarding physiotherapy. There is still limited evidence about stakeholders' views with regard to physiotherapy research. The objective of this study was to investigate key stakeholders' opinions about research in physiotherapy in Switzerland

e-Consent in UK academic-led clinical trials: current practice, challenges and the need for more evidence

BACKGROUND: During the COVID-19 pandemic, in-person healthcare visits were reduced. Consequently, trial teams needed to consider implementing remote methods for conducting clinical trials, including e-Consent. Although some clinical trials may have implemented e-Consent prior to the pandemic, anecdotes of uptake for this method increased within academic-led trials. When the increased use of this process emerged, representatives from several large academic clinical trial groups within the UK collaborated to discuss ways in which trialists can learn from one another when implementing e-Consent. METHODS: A survey of UKCRC-registered Clinical Trials Units (CTUs) was undertaken in April–June 2021 to understand the implementation of and their views on the use of e-Consent and experiences from the perspectives of systems programmers and quality assurance staff on the use of e-Consent. CTUs not using e-Consent were asked to provide any reasons/barriers (including no suitable trials) and any plans for implementing it in the future. Two events for trialists and patient and public involvement (PPI) representatives were then held to disseminate findings, foster discussion, share experiences and aid in the identification of areas that the academic CTU community felt required more research. RESULTS: Thirty-four (64%) of 53 CTUs responded to the survey, with good geographical representation across the UK. Twenty-one (62%) of the responding CTUs had implemented e-Consent in at least one of their trials, across different types of trials, including CTIMPs (Clinical Trial of Investigational Medicinal Product), ATIMPs (Advanced Therapy Medicinal Products) and non-CTIMPs. One hundred ninety-seven participants attended the two workshops for wide-ranging discussions. CONCLUSION: e-Consent is increasingly used in academic-led trials, yet uncertainties remain amongst trialists, patients and members of the public. Uncertainties include a lack of formal, practical guidance and a lack of evidence to demonstrate optimal or appropriate methods to use. We strongly encourage trialists to continue to share their own experiences of the implementation of e-Consent

Dissociable effects of 5-HT2C receptor antagonism and genetic inactivation on perseverance and learned non-reward in an egocentric spatial reversal task

Cognitive flexibility can be assessed in reversal learning tests, which are sensitive to modulation of 5-HT2C receptor (5-HT2CR) function. Successful performance in these tests depends on at least two dissociable cognitive mechanisms which may separately dissipate associations of previous positive and negative valence. The first is opposed by perseverance and the second by learned non-reward. The current experiments explored the effect of reducing function of the 5-HT2CR on the cognitive mechanisms underlying egocentric reversal learning in the mouse. Experiment 1 used the 5-HT2CR antagonist SB242084 (0.5 mg/kg) in a between-groups serial design and Experiment 2 used 5-HT2CR KO mice in a repeated measures design. Animals initially learned to discriminate between two egocentric turning directions, only one of which was food rewarded (denoted CS+, CS−), in a T- or Y-maze configuration. This was followed by three conditions; (1) Full reversal, where contingencies reversed; (2) Perseverance, where the previous CS+ became CS− and the previous CS− was replaced by a novel CS+; (3) Learned non-reward, where the previous CS− became CS+ and the previous CS+ was replaced by a novel CS-. SB242084 reduced perseverance, observed as a decrease in trials and incorrect responses to criterion, but increased learned non-reward, observed as an increase in trials to criterion. In contrast, 5-HT2CR KO mice showed increased perseverance. 5-HT2CR KO mice also showed retarded egocentric discrimination learning. Neither manipulation of 5-HT2CR function affected performance in the full reversal test. These results are unlikely to be accounted for by increased novelty attraction, as SB242084 failed to affect performance in an unrewarded novelty task. In conclusion, acute 5-HT2CR antagonism and constitutive loss of the 5-HT2CR have opposing effects on perseverance in egocentric reversal learning in mice. It is likely that this difference reflects the broader impact of 5HT2CR loss on the development and maintenance of cognitive function

The antisaccade task as an index of sustained goal activation in working memory: modulation by nicotine

The antisaccade task provides a laboratory analogue of situations in which execution of the correct behavioural response requires the suppression of a more prepotent or habitual response. Errors (failures to inhibit a reflexive prosaccade towards a sudden onset target) are significantly increased in patients with damage to the dorsolateral prefrontal cortex and patients with schizophrenia. Recent models of antisaccade performance suggest that errors are more likely to occur when the intention to initiate an antisaccade is insufficiently activated within working memory. Nicotine has been shown to enhance specific working memory processes in healthy adults. MATERIALS AND METHODS: We explored the effect of nicotine on antisaccade performance in a large sample (N = 44) of young adult smokers. Minimally abstinent participants attended two test sessions and were asked to smoke one of their own cigarettes between baseline and retest during one session only. RESULTS AND CONCLUSION: Nicotine reduced antisaccade errors and correct antisaccade latencies if delivered before optimum performance levels are achieved, suggesting that nicotine supports the activation of intentions in working memory during task performance. The implications of this research for current theoretical accounts of antisaccade performance, and for interpreting the increased rate of antisaccade errors found in some psychiatric patient groups are discussed