The music of war: Seven World War 1 composers and their experience of combat.

The effect of World War 1 military service on composers has been neglected in comparison with poets and artists. This article describes the wartime service of Arthur Bliss, Ralph Vaughan Williams, Ivor Gurney, EJ Moeran, Gordon Jacob, Patrick Hadley, and Maurice Ravel. The relationship between experiences of combat and the psychological health of these men is examined, with consideration being given to predisposition and possible causative influences of military service on their later careers, examined from individual and societal perspectives.

Ralph Albert Blakelock (1847-1919): Psychiatric hospitalization and the abduction of an American landscape artist.

Ralph Blakelock was a leading American landscape painter. Much of his life was lived in obscurity and destitution. He developed late onset paranoid schizophrenia, resulting in prolonged hospitalization. During his time in hospital, demand for Blakelock's works grew, but he was unable to enjoy any of this success. Instead, the artist fell prey to unscrupulous and unlikely exploitation by a self-appointed guardian, aided and abetted by Blakelock's psychiatrists, which broke his spirit and may well have hastened his demise.

The Wesselhoefts: A medical dynasty from the age of Goethe to the era of nuclear medicine.

For six generations, members of the Wesselhoeft family have practiced medicine in Germany, Denmark, Switzerland, Canada and/or the USA. In the early decades of the 19th century, two Wesselhoeft brothers left Europe to eventually settle in New England, where they and their progeny gave rise to a regional medical dynasty. The Wesselhoeft doctors became well-known practitioners of homeopathy, hydropathy, conventional medicine and surgery, in academic and general clinical settings. An additional connection was established to the literary worlds of Germany and the USA, either through friendships or as personal physicians.

Escitalopram in specific phobia: results of a placebo-controlled pilot trial.

OBJECTIVE: To assess the efficacy and safety of escitalopram in treating specific phobia. METHOD: The study was performed in an academic medical center. Adults meeting DSM-IV criteria for specific phobia were randomly assigned to 12 weeks of double-blind treatment with escitalopram or placebo. Efficacy measures included the Main Phobia Scale (MPS), the Marks Fear Questionnaire (FQ) and the Clinical Global Impressions of Improvement (CGI-I) scale. Data were collected between September 2002 and September 2004. RESULTS: Of 13 subjects enrolled, 12 returned for at least one post-randomization visit and were included in the intent to treat sample. Response rates on the various subscales of the MPS and the FQ ranged from 20 to 80% for escitalopram, compared to 0-43% with placebo. Rates of response using the CGI-I scale were 60% for escitalopram and 29% for placebo, with a strong between treatment effect in favor of the drug at week 12 (effect-size = 1.13). Using the last observation carried forward, no statistically significant treatment differences were found. The drug was well tolerated. CONCLUSION: Treatment response was consistently greater for escitalopram than for placebo, with strong effects observed in favor of the drug. However, treatment differences on the primary outcome measures were not significant in this under-powered pilot study. Escitalopram may hold promise as a treatment for specific phobia and larger randomized controlled trials are needed.

Post-traumatic stress disorder: an evaluation of existing pharmacotherapies and new strategies.

Post-traumatic stress disorder (PTSD) is often a chronic and disabling anxiety disorder that develops after exposure to a traumatic event. Researchers have demonstrated efficacy for both pharmacologic and psychosocial interventions in the treatment of PTSD. First-line pharmacotherapeutic options are the selective serotonin re-uptake inhibitors and serotonin noradrenaline re-uptake inhibitors. Older antidepressant agents, such as the tricyclic antidepressants and the monoamine oxidase inhibitor, phenelzine, have also proven efficacy in PTSD among more established agents. However, concerns for side effects have limited frequent use of these. Existing pharmacologic agents produce meaningful results and bear the advantage of treating depression and other co-morbid disorders, yet still fall short of being ideal due to limited response and remission rates and tolerability issues. The need for improving pharmacotherapy of PTSD remains compelling and directions for further research are discussed.

Effect of Hypericum perforatum (St John's wort) in major depressive disorder: a randomized controlled trial.

CONTEXT: Extracts of Hypericum perforatum (St John's wort) are widely used for the treatment of depression of varying severity. Their efficacy in major depressive disorder, however, has not been conclusively demonstrated. OBJECTIVE: To test the efficacy and safety of a well-characterized H perforatum extract (LI-160) in major depressive disorder. DESIGN AND SETTING: Double-blind, randomized, placebo-controlled trial conducted in 12 academic and community psychiatric research clinics in the United States. PARTICIPANTS: Adult outpatients (n = 340) recruited between December 1998 and June 2000 with major depression and a baseline total score on the Hamilton Depression Scale (HAM-D) of at least 20. INTERVENTIONS: Patients were randomly assigned to receive H perforatum, placebo, or sertraline (as an active comparator) for 8 weeks. Based on clinical response, the daily dose of H perforatum could range from 900 to 1500 mg and that of sertraline from 50 to 100 mg. Responders at week 8 could continue blinded treatment for another 18 weeks. MAIN OUTCOME MEASURES: Change in the HAM-D total score from baseline to 8 weeks; rates of full response, determined by the HAM-D and Clinical Global Impressions (CGI) scores. RESULTS: On the 2 primary outcome measures, neither sertraline nor H perforatum was significantly different from placebo. The random regression parameter estimate for mean (SE) change in HAM-D total score from baseline to week 8 (with a greater decline indicating more improvement) was -9.20 (0.67) (95% confidence interval [CI], -10.51 to -7.89) for placebo vs -8.68 (0.68) (95% CI, -10.01 to -7.35) for H perforatum (P =.59) and -10.53 (0.72) (95% CI, -11.94 to -9.12) for sertraline (P =.18). Full response occurred in 31.9% of the placebo-treated patients vs 23.9% of the H perforatum-treated patients (P =.21) and 24.8% of sertraline-treated patients (P =.26). Sertraline was better than placebo on the CGI improvement scale (P =.02), which was a secondary measure in this study. Adverse-effect profiles for H perforatum and sertraline differed relative to placebo. CONCLUSION: This study fails to support the efficacy of H perforatum in moderately severe major depression. The result may be due to low assay sensitivity of the trial, but the complete absence of trends suggestive of efficacy for H perforatum is noteworthy.