Clonidine for post-traumatic stress disorder: a systematic review of the current evidence

Background: Clonidine is a centrally acting anti-adrenergic agent that may have applications in post-traumatic stress disorder (PTSD), particularly for sleep.Objective: In this systematic review, we aimed to summarize the effect of clonidine on sleep quality and duration, nightmares, and PTSD symptom severity in adults with PTSD.Method: PubMed (Medline), Embase, PsycINFO, CINAHL, and clinicaltrials.gov were searched up to April 2023. Studies on clonidine use in adult PTSD patients reporting data on the effect on sleep, nightmares, and PTSD symptoms were included. A narrative summary and a meta-analysis of the study findings are presented.Results: Ten reports, accounting for N = 569 patients with PTSD (145 on clonidine and 436 controls), were included in the final selection. There were four case reports, four observational studies, one non-blind clinical trial, and one crossover randomized controlled trial (RCT). Median clonidine dose was 0.15 mg/day (range: 0.1-0.5 mg/day). Median follow-up time was 31 days (range: 3 days to 19 months). The quality of the evidence was rated from very low to low. There was marked between-study heterogeneity and low power in the individual studies, but many reported improved sleep quality, nightmare reduction, and improvement of PTSD symptoms for patients treated with clonidine. Meta-analysis was only possible for two studies reporting the effect of clonidine on nightmares, and showed no difference from the comparator (i.e. prazosin or terazosin) (odds ratio: 1.16; 95% confidence interval: 0.66 to 2.05), potentially pointing towards non-inferiority between these medications.Conclusions: Future research, such as well-powered RCTs, is needed to identify the efficacy in the lower dose range and the most suitable treatment group, and to obtain good evidence on the effects of clonidine in the treatment of sleep disorders related to PTSD.Post-traumatic stress disorder (PTSD) is associated with hyperarousal and sleep disorders, reflecting adrenergic nervous system involvement.The use of anti-adrenergic drugs to target the sympathetic activation in PTSD is rational. However, previous reports on prazosin, a peripherally acting agent, yielded weak evidence.Clonidine, a central adrenergic antagonist, shows promise in improving sleep, nightmares, and PTSD symptoms, but further research is needed because the quality of the current evidence is low.Antecedentes: La clonidina es un agente antiadren & eacute;rgico de acci & oacute;n central que podr & iacute;a tener aplicaciones en el trastorno de estr & eacute;s postraum & aacute;tico (TEPT), particularmente para el sue & ntilde;o.Objetivo: En esta revisi & oacute;n sistem & aacute;tica el objetivo fue resumir el efecto de la clonidina sobre la calidad y duraci & oacute;n del sue & ntilde;o, las pesadillas y la gravedad de los s & iacute;ntomas de TEPT en adultos con TEPT.M & eacute;todo: Se realizaron b & uacute;squedas en PubMed (Medline), Embase, PsycINFO, CINAHL y Clinicaltrials.gov hasta abril de 2023. Se incluyeron estudios sobre el uso de clonidina en pacientes adultos con TEPT informando datos sobre el efecto en el sue & ntilde;o, pesadillas y s & iacute;ntomas de TEPT. Se presenta un resumen narrativo y un metan & aacute;lisis de los hallazgos del estudio.Resultados: En la selecci & oacute;n final se incluyeron diez comunicaciones, que representaban N = 569 pacientes con TEPT (145 con clonidina y 436 controles). Hubo 4 informes de casos, 4 estudios observacionales, 1 ensayo cl & iacute;nico no ciego y 1 ensayo cl & iacute;nico aleatorizado (ECA) cruzado. La dosis mediana de clonidina fue de 0,15 mg/d & iacute;a (rango: 0,1-0,5 mg/d & iacute;a). La mediana del tiempo de seguimiento fue de 31 d & iacute;as (entre 3 d & iacute;as y 19 meses). La calidad de la evidencia se calific & oacute; de muy baja a baja. Hubo una marcada heterogeneidad entre los estudios y un poder estad & iacute;stico bajo en los estudios individuales, pero muchos informaron una mejor calidad del sue & ntilde;o, una reducci & oacute;n de las pesadillas y una mejor & iacute;a de los s & iacute;ntomas de TEPT en los pacientes tratados con clonidina. El metan & aacute;lisis solo fue posible para dos estudios que informaron el efecto de la clonidina sobre las pesadillas y no mostr & oacute; diferencias con el comparador (es decir, prazosina o terazosina) (OR: 1,16; IC del 95 %: 0,66; 2,05), potencialmente apuntando hacia una no inferioridad entre estos medicamentos.Conclusiones: Se necesitan investigaciones futuras, como ECA de suficiente poder, para identificar la eficacia en el rango de dosis m & aacute;s bajo, el grupo de tratamiento m & aacute;s adecuado y obtener buena evidencia de los efectos de la clonidina para el tratamiento de los trastornos del sue & ntilde;o relacionados con el TEPT

Toward Autonomous Guidance and Control: A Robust AI-Based Solution for Low-Thrust Orbit Transfers

The focus of our initial application scenario centers around a low-thrust orbit transfer in Low-Earth Orbit (LEO). This specific use-case has been chosen due to its inherent challenges, including the requirements for robustness and real-time computation. We propose an AI-based solution capable of autonomous and robust on-board G&C. The core of our approach leverages a Deep Neural Network (DNN) trained through Reinforcement Learning (RL) techniques. Our method aims at enhancing a traditional guidance approach by managing environmental perturbations, it processes the on-board navigation coordinates and provides the thrust to be imposed by the propulsion subsystem. Our approach demonstrates effectiveness in performing maneuvers changing semi-major axis (SMA), eccentricity (ECC), and inclination (INC), operating continuously with a control horizon of several days. Robustness is tested by using physical model uncertainties, introducing disturbances in the mission coordinates, and injecting perturbations in subsystems

Longitudinal Analysis of Sympton Expression in Grapevines Affected by Esca

An analysis of symptom expression in esca infected grapevines was performed by focusing on the dynamics of each plant. A parametric statistical model was proposed to evaluate the probability that a plant would show esca symptoms at given values for a relevant set of factors (year, presence of symptoms in the previous year, presence of plants with symptoms in the close neighborhood). The statistical tests of the hypotheses revealed that the considered factors explained a large amount of the observed variability. In particular, the state of plants in the close vicinity is one of those factors. Thus we found evidence that there was an association between plant vicinity and esca symptoms. Future developments of our model will include the factors field column and weather

Clonidine for post-traumatic stress disorder: a systematic review of the current evidence

Background: Clonidine is a centrally acting anti-adrenergic agent that may have applications in post-traumatic stress disorder (PTSD), particularly for sleep.Objective: In this systematic review, we aimed to summarize the effect of clonidine on sleep quality and duration, nightmares, and PTSD symptom severity in adults with PTSD.Method: PubMed (Medline), Embase, PsycINFO, CINAHL, and clinicaltrials.gov were searched up to April 2023. Studies on clonidine use in adult PTSD patients reporting data on the effect on sleep, nightmares, and PTSD symptoms were included. A narrative summary and a meta-analysis of the study findings are presented.Results: Ten reports, accounting for N = 569 patients with PTSD (145 on clonidine and 436 controls), were included in the final selection. There were four case reports, four observational studies, one non-blind clinical trial, and one crossover randomized controlled trial (RCT). Median clonidine dose was 0.15 mg/day (range: 0.1-0.5 mg/day). Median follow-up time was 31 days (range: 3 days to 19 months). The quality of the evidence was rated from very low to low. There was marked between-study heterogeneity and low power in the individual studies, but many reported improved sleep quality, nightmare reduction, and improvement of PTSD symptoms for patients treated with clonidine. Meta-analysis was only possible for two studies reporting the effect of clonidine on nightmares, and showed no difference from the comparator (i.e. prazosin or terazosin) (odds ratio: 1.16; 95% confidence interval: 0.66 to 2.05), potentially pointing towards non-inferiority between these medications.Conclusions: Future research, such as well-powered RCTs, is needed to identify the efficacy in the lower dose range and the most suitable treatment group, and to obtain good evidence on the effects of clonidine in the treatment of sleep disorders related to PTSD

Machine-Learning for Prescription Patterns: Random Forest in the Prediction of Dose and Number of Antipsychotics Prescribed to People with Schizophrenia

Objective: We aimed to predict antipsychotic prescription patterns for people with schizophrenia using machine learning (ML) algorithms.Methods: In a cross-sectional design, a sample of community mental health service users (SUs; n = 368) with a primary diagnosis of schizophrenia was randomly selected. Socio-demographic and clinical features, including the number, total dose, and route of administration of the antipsychotic treatment were recorded. Information about the number and the length of psychiatric hospitalization was retrieved. Ordinary Least Square (OLS) regression and ML algorithms (i.e., random forest [RF], supported vector machine, K-nearest neighborhood, and Naive Bayes) were used to estimate the predictors of total antipsychotic dosage and prescription of antipsychotic polytherapy (APP).Results: The strongest predictor of the total dose was APP. The number of Community Mental Health Centers (CMHC) contacts was the most important predictor of APP and, with APP omitted, of dosage. Treatment with anticholinergics predicted APP, emphasizing the strong correlation between APP and higher antipsychotic dose. RF performed better than OLS regression and the other ML algorithms in predicting both antipsychotic dose (root square mean error = 0.70, R-2 = 0.31) and APP (area under the receiving operator curve = 0.66, true positive rate = 0.41, and true negative rate = 0.78).Conclusion: APP is associated with the prescription of higher total doses of antipsychotics. Frequent attenders at CMHCs, and SUs recently hospitalized are often treated with APP and higher doses of antipsychotics. Future prospective studies incorporating standardized clinical assessments for both psychopathological severity and treatment efficacy are needed to confirm these findings

TCT-737 MONITORING THE LEARNING CURVE AND QUALITY OF CARE IN TAVI PROCEDURES BY CUSUM ANALYSIS

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Bone Health in Mood Disorders: A Narrative Review about Clinical and Biological Connections

Evidence about bone health in people affected by psychiatric disorders is limited. This narrative review aims to highlight what is known, up to the present time, about clinical connections between bone health and psychiatric disorders, particularly depressive disorders (DD) and bipolar disorders (BD), in terms of common biological pathways. Besides inflammation, we focused on two molecules of growing interest: neuropeptide Y (NPY) and the neuro-hormone melatonin. Also, the role of psychoactive drugs on bone tissue was explored. For the preparation of this narrative review, the scientific literature of the most recent 7 years from PubMed, Springer Nature, Science Direct (Elsevier), Wiley Online, ResearchGate, and Google Scholar databases was analyzed. Reviewed evidence reveals that people diagnosed with BD or DD have an increased risk of both fractures and osteoporosis; NPY reduces bone loss induced by longer periods of depression and "buffers" psychological stress effects on bone health. MLT shows beneficial effects in osteoporosis and bone healing. Lithium, a mood stabilizer, shows potential bone-protective activity, while antipsychotic and antidepressant treatments may increase the risk of bone tissue damage, though further investigation is needed

Post-traumatic stress disorder among LGBTQ people: a systematic review and meta-analysis

Aims: Lesbian, gay, bisexual, transgender and queer people (LGBTQ) are at increased risk of traumatization. This systematic review aimed to summarize data regarding the risk of post-traumatic stress disorder (PTSD) for LGBTQ people and their subgroups. Methods: Medline, Scopus, PsycINFO and EMBASE were searched until September 2022. Studies reporting a comparative estimation of PTSD among LGBTQ population and the general population (i.e., heterosexual/cisgender), without restrictions on participants' age and setting for the enrolment, were identified. Meta-analyses were based on odds ratio (OR and 95% confidence intervals [CI]), estimated through inverse variance models with random effects. Results: The review process led to the selection of 27 studies, involving a total of 31,903 LGBTQ people and 273,842 controls, which were included in the quantitative synthesis. Overall, LGBTQ people showed an increased risk of PTSD (OR: 2.20 [95% CI: 1.85; 2.60]), although there was evidence of marked heterogeneity in the estimate (I2 = 91%). Among LGBTQ subgroups, transgender people showed the highest risk of PTSD (OR: 2.52 [95% CI: 2.22; 2.87]) followed by bisexual people (OR: 2.44 [95% CI: 1.05; 5.66]), although these comparisons are limited by the lack of data for other sexual and gender minorities, such as intersex people. Interestingly, the risk of PTSD for bisexual people was confirmed also considering lesbian and gay as control group (OR: 1.44 [95% CI: 1.07; 1.93]). The quality of the evidence was low. Conclusions: LGBTQ people are at higher risk of PTSD compared with their cisgender/heterosexual peers. This evidence may contribute to the public awareness on LGBTQ mental health needs and suggest supportive strategies as well as preventive interventions (e.g., supportive programs, counselling, and destigmatizing efforts) as parts of a tailored health-care planning aimed to reduce psychiatric morbidity in this at-risk population

Minimally invasive aortic valve replacement with a sutureless valve through a right anterior mini-thoracotomy versus transcatheter aortic valve implantation in high-risk patients

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