Background:Findings of substantial remaining morbidity in treated major depressive disorder (MDD) led us to review controlled trials of treatments aimed at preventing early relapses or later recurrences in adults diagnosed with MDD to summarize available data and to guide further research.Methods:Reports (n = 97) were identified through systematic, computerized literature searching up to February 2015. Treatment versus control outcomes were summarized by random-effects meta-analyses.Results:In 45 reports of 72 trials (n = 14 450 subjects) lasting 33.4 weeks, antidepressants were more effective than placebos in preventing relapses (response rates [RR] = 1.90, confidence interval [CI]: 1.73–2.08; NNT = 4.4; p < 0.0001). In 35 reports of 37 trials (n = 7253) lasting 27.0 months, antidepressants were effective in preventing recurrences (RR = 2.03, CI 1.80–2.28; NNT = 3.8; p < 0.0001), with minor differences among drug types. In 17 reports of 22 trials (n = 1 969) lasting 23.7 months, psychosocial interventions yielded inconsistent or inconclusive results.Conclusions:Despite evidence of the efficacy of drug treatment compared to placebos or other controls, the findings further underscore the substantial, unresolved morbidity in treated MDD patients and strongly encourage further evaluations of specific, improved individual and combination therapies (pharmacological and psychological) conducted over longer times, as well as identifying clinical predictors of positive or unfavorable responses and of intolerability of long-term treatments in MDD.

Volume deficits of the hippocampus in schizophrenia have been consistently reported. However, the hippocampus is anatomically heterogeneous; it remains unclear whether certain portions of the hippocampus are affected more than others in schizophrenia. In this study, we aimed to determine whether volume deficits in schizophrenia are confined to specific subfields of the hippocampus and to measure the subfield volume trajectories over the course of the illness. MRI scans were obtained from Dataset 1: 155 patients with schizophrenia (mean duration of illness of 7 years) and 79 healthy controls, and Dataset 2: an independent cohort of 46 schizophrenia patients (mean duration of illness of 18 years) and 46 healthy controls. In addition, follow-up scans were collected for a subset of Dataset 1. A novel, automated method based on an atlas constructed from ultra-high resolution, post-mortem hippocampal tissue was used to label 7 hippocampal subfields. Significant cross-sectional volume deficits in the CA1, but not of the other subfields, were found in the schizophrenia patients of Dataset 1. However, diffuse cross-sectional volume deficits across all subfields were found in the more chronic and ill schizophrenia patients of Dataset 2. Consistent with this pattern, the longitudinal analysis of Dataset 1 revealed progressive illness-related volume loss (~ 2 to 6% per year) that extended beyond CA1 to all of the other subfields. This decline in volume correlated with symptomatic worsening. Overall, these findings provide converging evidence for early atrophy of CA1 in schizophrenia, with extension to other hippocampal subfields and accompanying clinical sequelae over time.

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Delineating the normal development of brain white matter (WM) over the human lifespan is crucial to improved understanding of underlying WM pathology in neuropsychiatric and neurological conditions. We review the extant literature concerning diffusion tensor imaging studies of brain WM development in healthy individuals available until October 2012, summarise trends of normal development of human brain WM and suggest possible future research directions. Temporally, brain WM maturation follows a curvilinear pattern with an increase in fractional anisotropy (FA) from newborn to adolescence, decelerating in adulthood till a plateau around mid-adulthood, and a more rapid decrease of FA from old age onwards. Spatially, brain WM tracts develop from central to peripheral regions, with evidence of anterior-to-posterior maturation in commissural and projection fibres. The corpus callosum and fornix develop first and decline earlier, whilst fronto-temporal WM tracts like cingulum and uncinate fasciculus have protracted maturation and decline later. Prefrontal WM is most vulnerable with greater age-related FA reduction compared with posterior WM. Future large scale studies adopting longitudinal design will better clarify human brain WM changes over time.

Background: In order to improve the quality of courses in simulation, it is necessary to get to know the educational environment. The objective of this study was to adapt the DREEM scale and to present a new questionnaire called QuESST, that allows to de ne medical simulation environment as a speci c type of educational environment. Methods: The DREEM scale was translated and adapted into Polish conditions. A new tool-QuESST questionnaire was developed to complete the data with medical simulation environment aspects. Reliability, t-test, Component Analysis as well as correlation between the two methods were assessed in a sample of medical science students (N=312). Results: Statistical analysis presented a good reliability of the Polish translation of the DREEM scale (Cronbach's Alpha = 0,95). The t-test for the DREEM questionnaire was stable and reliable relevant (t=-,584, p=,562). Signi cant strong correlation was reported with the DREEM and QuESST tool (r=0,559, p£ 0.001). Also, moderate and high correlations were found with the overall result of QuESST and the results of individual DREEM subscales. Conclusions: The QuESST scale may be considered helpful in determining the medical simulation environment conditions and can be used to supplement the DREEM scale to create an effective educational environment with medical simulation.

Morphological abnormalities in the corpus callosum may increase with illness progression.

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Discontinuation of antidepressant treatment for major depressive episodes at times less than 6 months was associated with rising risks after randomization to continuation with placebo. This relationship requires critical consideration in both clinical management of depressed patients and the design and interpretation of treatment discontinuation trials.