Frequently asked questions on epilepsy, pregnancy and lactation: a EURAP-NL report.

PURPOSE: To describe the questions addressed by participants and physicians to the International Registry of Antiepileptic Drugs and Pregnancy centre in The Netherlands (EURAP-NL). METHODS: All incoming questions during the study period were systematically inventoried. Characteristics of the inquirer, antiepileptic drugs (AEDs) indicated, question topic, indication for which AEDs were (to be) prescribed, and timing of the question relative to pregnancy were evaluated. RESULTS: Healthcare professionals posed the majority of questions. Lamotrigine, levetiracetam, valproate and carbamazepine were the drugs most frequently referred to. Common reasons to contact EURAP-NL were congenital malformation risks associated with specific AEDs, requests for information updates when available guidelines were considered lacking, and concerns regarding breastfeeding while using AEDs. CONCLUSIONS: There is an evident demand for additional information regarding AEDs and pregnancy. Pregnancy registries like EURAP can be a useful tool to identify information deficits and may serve as an information source for the development of guidelines to facilitate common practice among healthcare professionals

Pre-treatment cortisol awakening response predicts symptom reduction in posttraumatic stress disorder after treatment

Dysfunction of the HPA-axis has frequently been found in the aftermath of trauma exposure with or without PTSD. Decreasing HPA-axis reactivity to different stress cues has been reported during PTSD treatment. The cortisol awakening response (CARi) is a well-validated, standardized measure of HPA-axis reactivity which can be easily acquired in the clinical setting. Whether CARi changes over time in traumatized individuals are specific to PTSD treatment is unknown. Furthermore, a possible role for the baseline CARi in predicting symptom reduction after treatment in PTSD has not been examined before. To answer these questions, a cohort study was conducted in which the awakening cortisol was measured in both PTSD (N=41) and non-PTSD (N=25) combat-exposed male subjects. Measurements took place at inclusion and 6-8 months after inclusion for both the PTSD and the non-PTSD group. During the 6-8 months interval, PTSD patients received trauma-focused focused psychotherapy, whereas non-PTSD patients received no treatment. We found a decrease in the CARi over time in both groups, suggesting it was not specific to PTSD or the effect of treatment. Therefore, caution is warranted when attributing diminished HPA-axis reactivity over time to effects of PTSD treatment. Second, CARi prior to treatment predicted PTSD symptom reduction (CAPS score change) after treatment, and accounted for 10% of the variance, even when adjusted for changes in depressive symptoms and medication use during the study period. A putative role emerges for CARi as a predictive biomarker of symptom reduction in male individuals with combat-related PTSD

Vantage sensitivity: a framework for individual differences in response to psychological intervention

Purpose People differ significantly in their response to psychological intervention, with some benefitting more from treatment than others. According to the recently proposed theoretical framework of vantage sensitivity, some of this variability may be due to individual differences in environmental sensitivity, the inherent ability to register, and process external stimuli. In this paper, we apply the vantage sensitivity framework to the field of psychiatry and clinical psychology, proposing that some people are more responsive to the positive effects of psychological intervention due to heightened sensitivity. Methods After presenting theoretical frameworks related to environmental sensitivity, we review a selection of recent studies reporting individual differences in the positive response to psychological intervention. Results A growing number of studies report that some people benefit more from psychological intervention than others as a function of genetic, physiological, and psychological characteristics. These studies support the vantage sensitivity proposition that treatment response is influenced by factors associated with heightened sensitivity to environmental influences. More recently, studies have also shown that sensitivity can be measured with a short questionnaire which appears to predict the response to psychological intervention. Conclusions Vantage sensitivity is a framework with significant relevance for our understanding of widely observed heterogeneity in treatment response. It suggests that variability in response to treatment is partly influenced by people’s differing capacity for environmental sensitivity, which can be measured with a short questionnaire. Application of the vantage sensitivity framework to psychiatry and clinical psychology may improve our knowledge regarding when, how, and for whom interventions work