The ‘patient voice’: patients who experience antidepressant withdrawal symptoms are often dismissed, or misdiagnosed with relapse, or a new medical condition

Background: Stopping antidepressants commonly causes withdrawal symptoms, which can be severe and long-lasting. National Institute for Health and Care Excellence (NICE) guidance has been recently updated to reflect this; however, for many years withdrawal (discontinuation) symptoms were characterised as ‘usually mild and self-limiting over a week’. Consequently, withdrawal symptoms might have been misdiagnosed as relapse of an underlying condition, or new onset of another medical illness, but this has never been studied. Method: This paper outlines the themes emerging from 158 respondents to an open invitation to describe the experience of prescribed psychotropic medication withdrawal for petitions sent to British parliaments. The accounts include polypharmacy (mostly antidepressants and benzodiazepines) but we focus on antidepressants because of the relative lack of awareness about their withdrawal effects compared with benzodiazepines. Mixed method analysis was used, including a ‘lean thinking’ approach to evaluate common failure points. Results: The themes identified include: a lack of information given to patients about the risk of antidepressant withdrawal; doctors failing to recognise the symptoms of withdrawal; doctors being poorly informed about the best method of tapering prescribed medications; patients being diagnosed with relapse of the underlying condition or medical illnesses other than withdrawal; patients seeking advice outside of mainstream healthcare, including from online forums; and significant effects on functioning for those experiencing withdrawal. Discussion: Several points for improvement emerge: the need for updating of guidelines to help prescribers recognise antidepressant withdrawal symptoms and to improve informed consent processes; greater availability of non-pharmacological options for managing distress; greater availability of best practice for tapering medications such as antidepressants; and the vital importance of patient feedback. Although the patients captured in this analysis might represent medication withdrawal experiences that are more severe than average, they highlight the current inadequacy of health care systems to recognise and manage prescribed drug withdrawal, and patient feedback in general

Attractive instability of oppositely charged membranes induced by charge density fluctuations

We predict the conditions under which two oppositely charged membranes show a dynamic, attractive instability. Two layers with unequal charges of opposite sign can repel or be stable when in close proximity. However, dynamic charge density fluctuations can induce an attractive instability and thus facilitate fusion. We predict the dominant instability modes and timescales and show how these are controlled by the relative charge and membrane viscosities. These dynamic instabilities may be the precursors of membrane fusion in systems where artificial vesicles are engulfed by biological cells of opposite charge

Inter- and intra-subject variation of abdominal vs. thoracic respiratory motion using kernel density estimation

In nuclear medicine, there is a significant research focus in developing a new approach in monitoring, tracking and compensating respiratory motion during image acquisition. We address this by attempting to model the respiratory cycle pattern and finding a method that describes the configuration of the anterior surface which then correlates with the internal position/configuration of the internal organ as a foundation for motion compensation. This paper presents novel work in parameterizing external respiratory motion using a method based on the variation of abdominal vs. thoracic surface markers to investigate inter- and intra-subject variation. The dominant mode of variation of the Abdominal and Thoracic surfaces during respiration using Principle Component Analysis (PCA) is studied. This demonstrates that pattern of TS vs AS motion appears temporally at a global level stable. Thus although breathing style is consistent within a given subject, we there observe temporal changes in the amplitude and density of the PDF in intra-subject data

Marker-less tracking for respiratory motion correction in nuclear medicine

This paper present preliminary work in developing a method of using a marker-less tracking system to analyze the natural temporal variations in chest wall configuration during breathing, thus avoiding reliance on a limited number of fiducial markers. This involves using a marker-less video capture of the motion of the abdominal-chest surface and the development of a B-spline model to parameterize this motion. The advantage of the marker-less system that is non-invasive and non-ionizing, thus facilitating high throughput without the need for marker-based patient set-up time

A study of long-term potentiation in transgenic mice over-expressing mutant forms of both amyloid precursor protein and presenilin-1

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.Abstract Synaptic transmission and long-term potentiation (LTP) in the CA1 region of hippocampal slices have been studied during ageing of a double transgenic mouse strain relevant to early-onset familial Alzheimer's disease (AD). This strain, which over-expresses both the 695 amino acid isoform of human amyloid precursor protein (APP) with K670N and M671L mutations and presenilin 1 with the A246E mutation, has accelerated amyloidosis and plaque formation. There was a decrease in synaptic transmission in both wildtype and transgenic mice between 2 and 9 months of age. However, preparing slices from 14 month old animals in kynurenic acid (1 mM) counteracted this age-related deficit. Basal transmission and paired-pulse facilitation was similar between the two groups at all ages (2, 6, 9 and 14 months) tested. Similarly, at all ages LTP, induced either by theta burst stimulation or by multiple tetani, was normal. These data show that a prolonged, substantially elevated level of Aβ are not sufficient to cause deficits in the induction or expression of LTP in the CA1 hippocampal region.Published versio

Scale dependence of the primordial spectrum from combining the three-year WMAP, Galaxy Clustering, Supernovae, and Lyman-alpha forests

We probe the scale dependence of the primordial spectrum in the light of the three-year WMAP (WMAP3) alone and WMAP3 in combination with the other cosmological observations such as galaxy clustering and Type Ia Supernova (SNIa). We pay particular attention to the combination with the Lyman $\alpha$ (Ly$\alpha$) forest. Different from the first-year WMAP (WMAP1), WMAP3's preference on the running of the scalar spectral index on the large scales is now fairly independent of the low CMB multipoles $\ell$. A combination with the galaxy power spectrum from the Sloan Digital Sky Survey (SDSS) prefers a negative running to larger than 2$\sigma$, regardless the presence of low $\ell$ CMB ($2\le \ell \le 23$) or not. On the other hand if we focus on the Power Law $\Lambda$CDM cosmology with only six parameters (matter density $\Omega_m h^2$, baryon density $\Omega_b h^2$, Hubble Constant $H_0$, optical depth $\tau$, the spectral index, $n_s$, and the amplitude, $A_s$, of the scalar perturbation spectrum) when we drop the low $\ell$ CMB contributions WMAP3 is consistent with the Harrison-Zel'dovich-Peebles scale-invariant spectrum ($n_s=1$ and no tensor contributions) at $\sim 1\sigma$. When assuming a simple power law primordial spectral index or a constant running, in case one drops the low $\ell$ contributions ($2\le \ell \le 23$) WMAP3 is consistent with the other observations better, such as the inferred value of $\sigma_8$. We also find, using a spectral shape with a minimal extension of the running spectral index model, LUQAS$+$ CROFT Ly$\alpha$ and SDSS Ly$\alpha$ exhibit somewhat different preference on the spectral shape.Comment: 16 pages, 13 figures Revtex

Minimally Invasive Mitral Valve Surgery III: Training and Robotic-Assisted Approaches.

Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program