Optimizing mental health services in LMICs requires legislation, policies and plans that are enabling of the above strategies and actions. Studies demonstrating the cost-effectiveness of integrated stepped packages of care embracing a task-shifting approach, and best practices for strengthening mental health literacy and collaborative arrangements with community caregivers and other sectors, can assist this process. Specialist mental health training programmes in LMICs also need to be responsive to the changing demands on service providers, incorporating a public health approach and equipping specialists for diversification of their roles within the task shifting model.

The stigma associated with substance use in South Africa is high and not necessarily dependent on the drug of choice. However, a range of factors, including gender of the substance user, and ethnicity of the rater, may impact on stigma. Interventions designed to strengthen mental health literacy and gender-focused anti-stigma campaigns may have the potential to increase treatment seeking behaviour.

This post-hoc analysis evaluated resilience as a predictor of treatment response in patients with posttraumatic stress disorder (PTSD). Data were pooled from two randomized, double-blind studies conducted with adult outpatients treated with flexible doses of venlafaxine extended release (ER) 37.5 to 300 mg/day or placebo. The 17-item Clinician-Administered Posttraumatic Stress Disorder Scale (CAPS-SX(17)) was the primary outcome measure. Baseline Connor-Davidson Resilience Scale (CD-RISC) scores for the 25-, 10-, and 2-item versions were used to predict changes in PTSD symptom severity at week 12 and symptomatic remission (CAPS-SX(17) ≤ 20). Analyses were conducted for the overall population and separately for the individual treatment groups. In total, pretreatment resilience predicted a positive treatment response. For the overall population, all versions of the CD-RISC predicted CAPS-SX(17) change scores and remission after controlling for variables such as treatment group and baseline symptom severity. For venlafaxine ER-treated patients, all versions of the CD-RISC were predictive of remission, but only the 10-item version was predictive of CAPS-SX(17) change score. Our results suggest that higher pretreatment resilience is generally associated with a positive treatment response. Future research may be warranted to explore the relationship between response to active treatment and the spectrum of resiliency.

Abstract Background Anxiety disorders are a potentially disabling group of disorders which are prevalent in childhood and adolescence. The recognition of the early onset of anxiety disorders, and their successful treatment with medication in adults, has led to the growing interest in using medication for paediatric anxiety disorders. Objectives To assess the efficacy and tolerability of medication for treating paediatric anxiety disorders. Search strategy We searched the Cochrane Depression, Anxiety & Neurosis Group specialised register (CCDANCTR‐Studies), MEDLINE (via PubMed 1966 to August 2008), EMBASE (1966 to August 2008), and PsycINFO (1972 to August 2008). Various electronic registers were searched for unpublished studies. Reference lists of retrieved articles were searched for additional studies. Selection criteria All randomised controlled trials (RCTs) of pharmacotherapy in childhood/adolescent anxiety disorders. Data collection and analysis Two raters independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary statistics were stratified by medication class, and by medication agent for the selective serotonin reuptake inhibitors (SSRIs). Dichotomous and continuous measures were calculated using a random effects model, heterogeneity was assessed, and subgroup/sensitivity analyses were undertaken. Main results 22 short‐term (<= 16 weeks) RCTs were included in the analysis (2519 participants). The majority of the trials assessed the efficacy of the SSRIs (N = 15). Medication and placebo response occurred in 58.1% and 31.5% of patients, respectively (Number of studies (N) = 14, Number needed to treat (NNT) = 4). Medication was more effective than placebo in reducing overall symptom severity in OCD in a post‐hoc comparison (N = 7, Weighted Mean Difference (WMD) = ‐4.45, 95%CI = ‐5.94, ‐2.97, n = 765). Medication was less well tolerated than placebo overall, though the absolute proportion of participants who withdrew due to drug‐related adverse events was low (4.9%). Authors' conclusions Medication treatments can be effective in paediatric anxiety disorders, acting to reduce core symptoms, and should be considered as part of the treatment of these disorders. The greatest number of trials showing efficacy to date have assessed the SSRIs in treating paediatric OCD. There is no clear evidence to show that any particular class of medication is more effective or better tolerated than any other. As quantitative data was only available for the SSRIs and venlafaxine the routine use of benzodiazepines cannot be recommended, especially given concerns of dependency and treatment ‐related emergent adverse events associated with this class of drugs. Future RCTs could help identify potential clinical moderators of treatment efficacy. Studies of the long‐term efficacy of medication treatment, optimal dosage, as well as direct comparisons of pharmacotherapy and psychotherapy are also warranted. Plain Language Summary A systematic review and meta‐analysis of randomised controlled trials of medication in treating anxiety disorders in children and adolescents Anxiety disorders are a potentially disabling group of disorders which frequently occur in childhood and adolescence. Increasing recognition of the early onset of anxiety disorders and of the effectiveness of medication in treating adult anxiety disorders has contributed to a growing interest in the use of medication in treating paediatric patients. This systematic review of randomised controlled trials (RCTs) of pharmacotherapy of anxiety disorders in children and adolescents identified 22 short‐term (<= 16 weeks) randomised controlled trials which were eligible for inclusion (2519 participants). Treatment response was significantly greater after treatment with medication (58.1%) than with placebo (31.5%) in 14 trials. Medication was more effective than placebo in reducing overall symptom severity across all of the anxiety disorders (number of studies (N) = 9). The greatest number of trials were for obsessive compulsive disorder (OCD), for which treatment efficacy in reducing symptom severity was also observed . The greatest number of trials showing efficacy to date have used the selective serotonin reuptake inhibitors (SSRIs). No controlled evidence could be found for the effectiveness of benzodiazepines, despite their continued prescription for paediatric anxiety disorders. Medication was less well tolerated than placebo, as indicated by the significant proportion of children and adolescents who dropped out due to adverse effects during the short term trials. Furthermore, while few incidences of suicidal behaviour/ideation in the included trials were attributed to study medication, it is important to be aware of the need for careful monitoring after initiation of SSRIs in treating this population. In conclusion, medication should be considered as part of the treatment of paediatric anxiety disorders over the short‐term. Additional research into the optimal dose and duration of medication treatment, as well as the effects of age on the efficacy and tolerability of medication is warranted.

Among the well-nourished elderly, low vitamin B(12) status is associated with cognitive deficit, particularly in those with the ApoE ε4 allele or with depression.

The study results provide further evidence for OCD-related white matter abnormalities in the ALIC and cingulum, consistent with a cortico striatal model of OCD.

In this paper we apply lightly-supervised training to a hierarchical phrase-based statistical machine translation system. We employ bitexts that have been built by automatically translating large amounts of monolingual data as additional parallel training corpora. We explore different ways of using this additional data to improve our system. Our results show that integrating a second translation model with only non-hierarchical phrases extracted from the automatically generated bitexts is a reasonable approach. The translation performance matches the result we achieve with a joint extraction on all training bitexts while the system is kept smaller due to a considerably lower overall number of phrases. 1

In adolescents, a trend for association between TB incidence and psychosocial and behavioural variables was not statistically significant. Given the trend, research with larger samples, and more comprehensive assessment of the relationship between stressors and TB, is warranted.

Our findings suggest that whereas the premorbid height of female adolescent AN patients is normal, linear growth retardation is a prominent feature of their illness. Weight restoration is associated with catch-up growth, but complete catch-up is often not achieved.