Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

The British Association for Psychopharmacology developed an evidence-based consensus guideline on the management of catatonia. A group of international experts from a wide range of disciplines was assembled. Evidence was gathered from existing systematic reviews and the primary literature. Recommendations were made on the basis of this evidence and were graded in terms of their strength. The guideline initially covers the diagnosis, aetiology, clinical features and descriptive epidemiology of catatonia. Clinical assessments, including history, physical examination and investigations are then considered. Treatment with benzodiazepines, electroconvulsive therapy and other pharmacological and neuromodulatory therapies is covered. Special regard is given to periodic catatonia, malignant catatonia, neuroleptic malignant syndrome and antipsychotic-induced catatonia. There is attention to the needs of particular groups, namely children and adolescents, older adults, women in the perinatal period, people with autism spectrum disorder and those with certain medical conditions. Clinical trials were uncommon, and the recommendations in this guideline are mainly informed by small observational studies, case series and case reports, which highlights the need for randomised controlled trials and prospective cohort studies in this area

Nest Making and Oxytocin Comparably Promote Wound Healing in Isolation Reared Rats

Background: Environmental enrichment (EE) fosters attachment behavior through its effect on brain oxytocin levels in the hippocampus and other brain regions, which in turn modulate the hypothalamic-pituitary axis (HPA). Social isolation and other stressors negatively impact physical healing through their effect on the HPA. Therefore, we reasoned that: 1) provision of a rat EE (nest building with Nestlets®) would improve wound healing in rats undergoing stress due to isolation rearing and 2) that oxytocin would have a similar beneficial effect on wound healing. Methodology/Principal Findings: In the first two experiments, we provided isolation reared rats with either EE or oxytocin and compared their wound healing to group reared rats and isolation reared rats that did not receive Nestlets or oxytocin. In the third experiment, we examined the effect of Nestlets on open field locomotion and immediate early gene (IEG) expression. We found that isolation reared rats treated with Nestlets a) healed significantly better than without Nestlets, 2) healed at a similar rate to rats treated with oxytocin, 3) had decreased hyperactivity in the open field test, and 4) had normalized IEG expression in brain hippocampus. Conclusions/Significance: This study shows that when an EE strategy or oxytocin is given to isolation reared rats, the peripheral stress response, as measured by burn injury healing, is decreased. The findings indicate an association between the effect of nest making on wound healing and administration of the pro-bonding hormone oxytocin. Further elucidation of this animal model should lead to improved understanding of how EE strategies can ameliorate poor wound healing and other symptoms that result from isolation stress

The predictive validity of a Brain Care Score for dementia and stroke: data from the UK Biobank cohort

IntroductionThe 21-point Brain Care Score (BCS) was developed through a modified Delphi process in partnership with practitioners and patients to promote behavior changes and lifestyle choices in order to sustainably reduce the risk of dementia and stroke. We aimed to assess the associations of the BCS with risk of incident dementia and stroke.MethodsThe BCS was derived from the United Kingdom Biobank (UKB) baseline evaluation for participants aged 40–69 years, recruited between 2006–2010. Associations of BCS and risk of subsequent incident dementia and stroke were estimated using Cox proportional hazard regressions, adjusted for sex assigned at birth and stratified by age groups at baseline.ResultsThe BCS (median: 12; IQR:11–14) was derived for 398,990 UKB participants (mean age: 57; females: 54%). There were 5,354 incident cases of dementia and 7,259 incident cases of stroke recorded during a median follow-up of 12.5 years. A five-point higher BCS at baseline was associated with a 59% (95%CI: 40-72%) lower risk of dementia among participants aged <50. Among those aged 50–59, the figure was 32% (95%CI: 20-42%) and 8% (95%CI: 2-14%) for those aged >59 years. A five-point higher BCS was associated with a 48% (95%CI: 39-56%) lower risk of stroke among participants aged <50, 52% (95%CI, 47-56%) among those aged 50–59, and 33% (95%CI, 29-37%) among those aged >59.DiscussionThe BCS has clinically relevant and statistically significant associations with risk of dementia and stroke in approximately 0.4 million UK people. Future research includes investigating the feasibility, adaptability and implementation of the BCS for patients and providers worldwide

Entrez Gene ID Numbers and Primer Sequences of Genes Used for Quantitative Polymerase Chain Reaction Experiments

<p>Entrez Gene ID Numbers and Primer Sequences of Genes Used for Quantitative Polymerase Chain Reaction Experiments</p

Degree of impaired burn healing rats in each condition.

<p>For each rat, the number of pixels comprising the width of the maximum gap of unhealed tissue was normalized to the width of its back. The average normalized pixels of unhealed tissue were significantly greater for the isolation-reared rats (middle column) compared with both the group-reared rats (first column) and the isolation reared rats treated with Nestlets (third column). Average±S.E.M., *p<.05, ** <i>P</i><0.01.</p

Effect of Nestlet treatment on open field test behavior.

<p>Ambulatory time was significantly lower for isolation reared rats treated with Nestlets (column 4) compared to untreated isolation reared rats (column 3) and not different from group reared rats (column 1) or group reared rats treated with Nestlets (column 2). Average±SEM.,*<i>P</i><0.05, ** <i>P</i><0.01, ***<i>P</i><0.001.</p

Example of healing in rats in the different conditions examined

<p>(A). 92% of group reared rats healed well (n = 12, column 1, 2B, and top row 2C), 12% of isolation reared rats healed well (n = 8, middle column 2B, and middle row 2C), and 64% of isolation reared rats treated with Nestlets healed well (n = 11 see third column 2B, and bottom row 2C).* <i>P</i><0.05, ** <i>P</i><0.01, *** <i>P</i><0.001.</p

Time series analysis of Nest Building and Oxytocin effect on wound healing.

<p>Panel A shows an example of wound healing over six weeks from weaning (PN20 to PN62) in the four conditions examined. Panel B shows that group reared rats had significantly better healing compared to isolation reared rats by 21 days post burn injury, while Nestlet and oxytocin treated rats showed similar healing to group reared rats by 28 days post burn injury. The difference between Nestlet treated, oxytocin treated, and group reared rats compared to isolation reared rats continued until 42 days post burn injury. Average±S.E.M., *p<.05, ** p<0.01, ***p<0.001.</p

Nestlet “treatment” of isolation reared rats.

<p>Twice weekly cages are changed and replaced with a new Nestlet (A), the Nestlet is shredded by the rat prior to forming the nest (B), and then the rat spends time resting in the formed nest (C).</p