The effects of centralised and specialised intervention in the early course of severe unipolar depressive disorder: a randomised clinical trial

Background

Little is known on whether centralised and specialised combined pharmacological and psychological intervention in the early phase of severe unipolar depression improve prognosis. The aim of the present study was to assess the benefits and harms of centralised and specialised secondary care intervention in the early course of severe unipolar depression.

Methods

A randomised multicentre trial with central randomisation and blinding in relation to the primary outcome comparing a centralised and specialised outpatient intervention program with standard decentralised psychiatric treatment. The interventions were offered at discharge from first, second, or third hospitalisation due to a single depressive episode or recurrent depressive disorder. The primary outcome was time to readmission to psychiatric hospital. The data on re-hospitalisation was obtained from the Danish Psychiatric Central Register. The secondary and tertiary outcomes were severity of depressive symptoms according to the Major Depression Inventory, adherence to medical treatment, and satisfaction with treatment according to the total score on the Verona Service Satisfaction Scale-Affective Disorder (VSSS-A). These outcomes were assessed using questionnaires one year after discharge from hospital.

Results

A total of 268 patients with unipolar depression were included. There was no significant difference in the time to readmission (unadjusted hazard ratio 0.89, 95% confidence interval 0.60 to 1.32; log rank: χ² = 0.3, d.f. = 1, p = 0.6); severity of depressive symptoms (mood disorder clinic: median 21.6, quartiles 9.7–31.2 versus standard treatment: median 20.2, quartiles 10.0–29.8; p = 0.7); or the prevalence of patients in antidepressant treatment (73.9% versus 80.0%, p = 0.2). Centralised and specialised secondary care intervention resulted in significantly higher satisfaction with treatment (131 (SD 31.8) versus 107 (SD 25.6); p<0.001).

Conclusions

Centralised and specialised secondary care intervention in the early course of severe unipolar depression resulted in no significant effects on time to rehospitalisation, severity of symptoms, or use of antidepressants, but increased patient satisfaction.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00253071","term_id":"NCT00253071"}}NCT00253071     

Effects of 1-MCP on the vase life and ethylene response of cut flowers

Pretreatment for 6 h with low concentrations of 1-MCP (1-Methylcyclopropene, formerly designated as SIS-X), a cyclic ethylene analog, inhibits the normal wilting response of cut carnations exposed continuously to 0.4 l·l^–1 ethylene. The response to 1-MCP was a function of treatment concentration and time. Treatment with 1-MCP was as effective in inhibiting ethylene effects as treatment with the anionic silver thiosulfate complex (STS), the standard commercial treatment. Other ethylene-sensitive cut flowers responded similarly to carnations. In the presence of 1 l·l^–1 ethylene, the vase life of 1-MCP-treated flowers was up to 4 times that of the controls.Abbreviations 1-MCP 1-Methylcyclopropene - STS silver thiosulfate     

Effects of 1-MCP on the vase life and ethylene response of cut flowers

Pretreatment for 6 h with low concentrations of 1-MCP (1-Methylcyclopropene, formerly designated as SIS-X), a cyclic ethylene analog, inhibits the normal wilting response of cut carnations exposed continuously to 0.4 μl·l^?1 ethylene. The response to 1-MCP was a function of treatment concentration and time. Treatment with 1-MCP was as effective in inhibiting ethylene effects as treatment with the anionic silver thiosulfate complex (STS), the standard commercial treatment. Other ethylene-sensitive cut flowers responded similarly to carnations. In the presence of 1 μl·l^?1 ethylene, the vase life of 1-MCP-treated flowers was up to 4 times that of the controls.     

Effect of 1-methylcyclopropene and methylenecyclopropane on ethylene binding and ethylene action on cut carnations

1-Methylcyclopropene (1-MCP), formerly designated as Sis-X, has been shown to be an effective inhibitor of ethylene responses in carnation flowers in either the light or the dark. The binding appears to be to the receptor and to be permanent. A 6 h treatment at 2.5 nl l^–1 is sufficient to protect against ethylene, and 0.5 nl l^–1 is sufficient if exposure is for 24 h. As carnation flowers age, a little higher concentration appears to be needed. Most of the natural increase in ethylene production during senescence is prevented by treatment with 1-MCP. A closely related compound, methylenecyclopropane shows ethylene activity. A tritium labelled 1-MCP (60 mCi mmol^–1) has been prepared. A higher specific activity is needed for more critical studies.     

Involvement of ABA in postharvest life of miniature potted roses

Exogenous application of ABA (abscisic acid) to intact miniature potted rose plants (Rosa hybrida L.) resulted in deterioration of postharvest quality of two cultivars. Spraying with ABA increased leaf drop and accelerated flower senescence in Vanilla and Bronze, while bud drop was only induced in Bronze. Application of ABA to detached rose flowers accelerated their senescence, indicating that the observed senescence promoting effect was not a secondary response resulting from ABA-induced leaf senescence and abscission. ABA-treatment increased ethylene production in Bronze flowers, while no ethylene production was measured in flowers of Vanilla, or in the leaves of both cultivars. Pre-treatment with 1-MCP (1-methylcyclopropene) delayed ABA promoted flower senescence in Bronze, suggesting that the effect of ABA is at least partly mediated by ethylene. The senescence promoting effect of ABA on leaf drop and flower life of Vanilla flowers was not counteracted by 1-MCP pre-treatment. The cultivar Vanilla had a low ABA level at all flower stages, while ABA content of the Bronze petals was high in buds, lower in open flowers, and increased during flower senescence. An increased ABA content after ethylene treatment in Vanilla suggests that ethylene, natural or exogenous, can increase ABA levels of flowers.     

The influence of plant growth regulators and storage on root induction and growth in <Emphasis Type="Italic">Pelargonium zonale</Emphasis> cuttings

The effects of post harvest application of ethylene, abscisic acid (ABA), indole-3-butyric acid (IBA) treatments or dark storage on root induction and continued growth of regenerated roots in Pelargonium cuttings were investigated using hydroponics in the greenhouse. Ethylene markedly increased rooting percentage in ‘Greco’ and ‘Surfing’, reduced the number of roots per cutting in ‘Surfing’ and had no effect on the total root lengths in the two cultivars. Ethylene treatment reduced fresh root mass in ‘Surfing’, increased dry root mass and reduced root water content in both cultivars. ABA (50 μM) enhanced rooting percentage in ‘Greco’, reduced the number of roots per cutting, reduced total root lengths and fresh root mass in both cultivars. ABA increased dry root mass and reduced root water content in ‘Surfing’ but this effect was not apparent in ‘Greco’. Storing cuttings in the dark for 4 days had no effect on rooting percentage and number of roots per cutting in ‘Greco’ and ‘Surfing’. However, dark storage reduced total root lengths in ‘Surfing’ and reduced fresh root mass in ‘Greco’. Dark storage had no effect on dry root mass and water content in both cultivars. Applying 4 μl l⁻¹ IBA in the rooting solution induced maximum (100%) root induction in ‘Surfing’. However, IBA reduced the number of roots per cutting in ‘Greco’, reduced total root lengths and fresh root mass in the two cultivars. IBA treatment profoundly increased and reduced dry root mass and root water content, respectively, in ‘Greco’ and ‘Surfing’. The enhanced root induction observed after IBA and ABA applications could be ascribed to their influence on ethylene biosynthesis, since ethylene treatment increased rooting percentage in both cultivars. However, high ABA (100 μM) and IBA (12 μl l⁻¹) levels or dark storage reduced the ability of induced roots to continue growth. We attribute our results to plant stress-response mechanism and ethylene appears to play an important role in the process of root initiation and root growth in Pelargonium cuttings.     

Transformation of<Emphasis Type="Italic"> Kalanchoe blossfeldiana</Emphasis> with <Emphasis Type="Italic">rol-</Emphasis>genes is useful in molecular breeding towards compact growth

Dwarf genotypes of the economically important flowering potted plant Kalanchoe blossfeldiana were developed by molecular breeding. Root inducing (Ri)-lines were regenerated by applying CPPU to the hairy roots, which were produced by inoculating leaf explants with a wild-type Agrobacterium rhizogenes strain ATCC15834. Amplification by polymerase chain reaction (PCR) and Southern blot analysis confirmed the presence of T-DNA in the Ri-lines. Six Ri-lines were characterised in a greenhouse trial revealing that several morphological traits changed with respect to ornamental value such as plant height, number of lateral shoots, leaf size, leaf number, flower size and number of flowers. The Ri-lines differed in their degree of Ri-phenotype, and the internodes of the Ri-lines were clearly shorter, giving a compact growth habit compared to control plants. Time to anthesis was the same in Ri-line 331 as in control plants and delayed by only 3 days in Ri-line 306 as compared to control plants. A compact plant without delayed flowering can be assumed to be valuable for further breeding.     

Inhibition of ethylene responses by 1-Methylcyclopropene and 3-Methylcyclopropene

3-Methylcyclopropene (3-MCP) binds to the ethylene receptor and blocks it for several days, but concentrationswise is less effective than 1-methylcyclopropene (1-MCP). In diverse ethylene-responsive systems, including ripening of mature-green bananas (Musa sapientum L.), inhibition of growth in etiolated pea (Pisum sativum L.) seedlings, abscission of orange (Citrus sinensis L.) leaf explants and mung bean (Vigna radiata L.) leaves, and wilting of campanula (Campanula carpatica) and kalanchoe (Kalanchoë blossfeldiana) florets, full inhibition of the ethylene response required higher concentrations of 3-MCP. Depending on the experimental system, the effective concentration of 3-MCP was from 5 to 10 times higher than that required for 1-MCP.     

In vitro propagation of <Emphasis Type="Italic">Hippeastrum</Emphasis> × <Emphasis Type="Italic">chmielii</Emphasis> Chm. – influence of flurprimidol and the culture in solid or liquid medium and in temporary immersion systems

At Weyerhaeuser Company, somatic embryo production in liquid medium and manufactured seed delivery has been developed to reduce labor costs and increase efficiency of mass clonal propagation. We have scaled-up embryonal suspensor masses (ESM) of Douglas-fir in 1-l liquid medium flasks. Over 10,000 somatic embryos have been produced from a single flask. We have cryostored ESM of over 700 genotypes in liquid nitrogen. Somatic embryos of Douglas-fir have also been produced from liquid medium in a bioreactor. Different types of bioreactors are required for embryo multiplication and for cotyledonary embryo development. Over 250,000 Douglas-fir somatic seedlings from a large number of genotypes have been produced for clonal field tests.