A REVIEW OF THE ADVERSE SIDE EFFECTS ASSOCIATED WITH ANTIPSYCHOTICS AS RELATED TO THEIR EFFICACY

Since the introduction of antipsychotic medication for the treatment of psychosis, a wide range of different types of antipsychotic drugs have been developed while their side effects have become evident. The side effects of both the typical and atypical generation of antipsychotics have important consequences for the quality of life of recipients, stigma experienced and also the level of care of patients. It is well acknowledged that the side effects of antipsychotics reduce compliance with the medication. In this review the data for an association between typical and atypical antipsychotics and the main side effects that are wellsupported in the literature was explored: weight gain and associated metabolic effects; extrapyramidal symptoms and tardive dyskinesia; prolactin elevation and associated sexual effects; QTc elongation; and a group of miscellaneous side effects. It has been demonstrated that the production of adverse effects following the use of antipsychotic medication differs widely both between atypical and typical drugs but also within these subgroups. Considering the wide range of antipsychotics available amongst both groups and the differing effects they have on patients in terms of side effects, there is reason to believe that a more personalised approach to antipsychotic treatment should be considered. Additionally, screening for risk factors, screening for the appearance of side effects, as well as good communication with patients about the side effects and other options available are important tasks for clinicians in order to optimise concordance with medication

Correction: Meta-Analysis of the Relationship between Multiple Sclerosis and Migraine.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.PMCID: PMC3613438PMCID: PMC3613438PMCID: PMC3613438PMCID: PMC3613438[This corrects the article on p. e45295 in vol. 7.]

AUDIT OF THE PREVALENCE OF ANXIETY IN BIPOLAR DISORDER – A COMORBIDITY THAT REQUIRES ATTENTION AND ACTION

Bipolar affective disorder (BPD) frequently occurs with co-morbid mental health problems. This study shows that that the prevalence of co-morbid BPD and anxiety symptoms is especially high. This is important because for a person affected by both BPD and anxiety there is a negative impact on the symptoms, treatment response and recovery. A clinician faces particular treatment challenges when managing these co-morbid conditions due to a limited evidence base for effective interventions. The frequent occurrence of anxiety symptoms and BPD together has informed theories of the shared aetiology of these conditions

Hydrogel nanoparticle encapsulated plasmid as a suitable gene delivery system

To facilitate the delivery of genetic material, the use of appropriate carriers such as polymers is necessary. Nanoparticles comprising of chitosan-alginate polymers were formed through pregel preparation method. Chi/Alg nanoparticles had a mean Z-Average diameter of 161.8 nm and mean zeta 29.3 mV, respectively. The ability of plasmid-complex in preventing DNA migration showed Chi/Alg nanoparticles have great capacity to maintain plasmid. The efficiency of nanoparticles for transfection of pEGFP-N1 plasmid in the cultured HEK 293 cells was measured by flow cytometry. Cell viability assays indicated that nanoparticles had no toxic effect on HEK 293 cells after 4 or 24 h. Our suitable candidate for gene delivery would be alg/chi nanoparticles.Для облегчения доставки генетического материала необходимо использование подходящих носителей, таких как полимеры. Наночастицы, состоящие из хитозан-альгинатных полимеров, были получены методом подготовки прегеля. Chi/Alg наночастицы имели средний диаметр 161.8 нм (Z-Average) и средний zeta-потенциал 29.3 mV. Отсутствие миграции ДНК во время электрофореза комплексов плазмиды с наночастицами показало, что Chi/Alg наночастицы могут удерживать плазмидную ДНК внутри комплекса. Эффективность наночастиц для трансфекции плазмиды pEGFP-N1 в культивируемые клетки HEK 293 была измерена с помощью жидкостной цитометрии. Тесты на жизнеспособ-ность клеток показали, что наночастицы не имели токсичного эффекта на клетки HEK 293 через 4 ч или 24 ч. Наночастицы Alg/Chi являются подходящим кандидатом для доставки генов

How to do it: Vitamin D supplementation

Vitamin D testing and supplementation is of great interest to neurologists and their patients. Recommended nutritional intakes of vitamin D in the UK remain focused on bone health, despite increasing evidence for a role outside this area. Here we discuss how neurologists might approach vitamin D testing and supplementation, focusing on two conditions associated with vitamin D deficiency that have an increased risk of downstream complications resulting from these: multiple sclerosis and epilepsy. We set out a rationale for testing serum 25-hydroxyvitamin D concentrations and discuss our personal practice in terms of supplementation, with evidence where available

Funding source and primary outcome changes in clinical trials registered on ClinicalTrials.gov are associated with the reporting of a statistically significant primary outcome: a cross-sectional study.

BACKGROUND: We and others have shown a significant proportion of interventional trials registered on ClinicalTrials.gov have their primary outcomes altered after the listed study start and completion dates. The objectives of this study were to investigate whether changes made to primary outcomes are associated with the likelihood of reporting a statistically significant primary outcome on ClinicalTrials.gov. METHODS: A cross-sectional analysis of all interventional clinical trials registered on ClinicalTrials.gov as of 20 November 2014 was performed. The main outcome was any change made to the initially listed primary outcome and the time of the change in relation to the trial start and end date. FINDINGS: 13,238 completed interventional trials were registered with ClinicalTrials.gov that also had study results posted on the website. 2555 (19.3%) had one or more statistically significant primary outcomes. Statistical analysis showed that registration year, funding source and primary outcome change after trial completion were associated with reporting a statistically significant primary outcome . CONCLUSIONS:  Funding source and primary outcome change after trial completion are associated with a statistically significant primary outcome report on clinicaltrials.gov

High reprint orders in medical journals and pharmaceutical industry funding: case-control study

Objectives To assess the extent to which funding and study design are associated with high reprint orders

Both cladribine and alemtuzumab may effect MS via B-cell depletion.

OBJECTIVE: To understand the efficacy of cladribine (CLAD) treatment in MS through analysis of lymphocyte subsets collected, but not reported, in the pivotal phase III trials of cladribine and alemtuzumab induction therapies. METHODS: The regulatory submissions of the CLAD Tablets Treating Multiple Sclerosis Orally (CLARITY) (NCT00213135) cladribine and Comparison of Alemtuzumab and Rebif Efficacy in Multiple Sclerosis, study one (CARE-MS I) (NCT00530348) alemtuzumab trials were obtained from the European Medicine Agency through Freedom of Information requests. Data were extracted and statistically analyzed. RESULTS: Either dose of cladribine (3.5 mg/kg; 5.25 mg/kg) tested in CLARITY reduced the annualized relapse rate to 0.16-0.18 over 96 weeks, and both doses were similarly effective in reducing the risk of MRI lesions and disability. Surprisingly, however, T-cell depletion was rather modest. Cladribine 3.5 mg/kg depleted CD4+ cells by 40%-45% and CD8+ cells by 15%-30%, whereas alemtuzumab suppressed CD4+ cells by 70%-95% and CD8+ cells by 47%-55%. However, either dose of cladribine induced 70%-90% CD19+ B-cell depletion, similar to alemtuzumab (90%). CD19+ cells slowly repopulated to 15%-25% of baseline before cladribine redosing. However, alemtuzumab induced hyperrepopulation of CD19+ B cells 6-12 months after infusion, which probably forms the substrate for B-cell autoimmunities associated with alemtuzumab. CONCLUSIONS: Cladribine induced only modest depletion of T cells, which may not be consistent with a marked influence on MS, based on previous CD4+ T-cell depletion studies. The therapeutic drug-response relationship with cladribine is more consistent with lasting B-cell depletion and, coupled with the success seen with monoclonal CD20+ depletion, suggests that B-cell suppression could be the major direct mechanism of action