CYP2D6 and CYP2C19 genotyping in psychiatry:bridging the gap between practice and lab

CYP2D6 and CYP2C19 are liver enzymes that play an important role in the breakdown of psychopharmaceuticals. The number of active alleles in the DNA determines how quickly these enzymes work and is translated into a phenotype. This phenotype can vary greatly per person and per ethnicity. There is a relationship between the speed of the enzyme and the occurrence of medication side effects. This study has mapped the prevalence of the different phenotypes worldwide. It has also been investigated whether there are fewer side effects in patients taking antipsychotics if you adjust the dosage of medication to the phenotype

Neuropsychiatric symptoms in patients with dementia in primary care: a study protocol

BACKGROUND: Neuropsychiatric symptoms (NPS) frequently occur in patients with dementia. To date, prospective studies on the course of NPS have been conducted in patients with dementia in clinical centers or psychiatric services. The primary goal of this study is to investigate the course of NPS in patients with dementia and caregiver distress in primary care. We also aim to detect determinants of both the course of NPS in patients with dementia and informal caregiver distress in primary care. METHODS/DESIGN: This is a prospective observational study on the course of NPS in patients with dementia in primary care. Thirty-seven general practitioners (GPs) in 18 general practices were selected based on their interest in participating in this study. We will retrieve electronic medical files of patients with dementia from these general practices. Patients and caregivers will be followed for 18 months during the period January 2012 to December 2013. Patient characteristics will be collected at baseline. Time to death or institutionalization will be measured. Co-morbidity will be assessed using the Charlson index. Psychotropic drug use and primary and secondary outcome measures will be measured at 3 assessments, baseline, 9 and 18 months. The primary outcome measures are the Neuropsychiatric Inventory score for patients with dementia and the Sense of Competence score for informal caregivers. In addition to descriptive analyses frequency parameters will be computed. Univariate analysis will be performed to identify determinants of the course of NPS and informal caregiver distress. All determinants will then be tested in a multivariate regression analysis to determine their unique contribution to the course of NPS and caregiver distress. DISCUSSION: The results of this study will provide data on the course of NPS, which is clinically important for prognosis. The data will help GPs and other professionals in planning follow-up visits and in the timing for offering psycho-education, psychosocial interventions and the provision of care. In addition, these data will enlarge health professionals’ awareness of NPS in their patients with dementia

Natural course of neuropsychiatric symptoms in nursing home patients with mental-physical multimorbidity in the first eight months after admission

Objective: Aging societies will bring an increase in the number of long-term care patients with mental-physical multimorbidity (MPM). This paper aimed to describe the natural course of neuropsychiatric symptoms (NPS) in patients with MPM in the first 8 months after admission to a geronto-psychiatric nursing home (GP-NH) unit. Methods: Longitudinal cohort study among 63 patients with MPM no dementia living in 17 GP-NH units across the Netherlands. Data collection consisted of chart review, semi-structured interviews, and brief neuropsychological testing, among which our primary outcome measure the Neuropsychiatric Inventory (NPI). Descriptive and bivariate analyses were conducted. Results: Our study showed a significant increase of the NPI total score (from 25.3 to 29.3, p = 0.045), and the total scores of a NPI hyperactivity cluster (from 9.7 to 11.8, p = 0.039), and a NPI mood/apathy cluster (from 7.7 to 10.1, p = 0.008). Just over 95% had any clinically relevant symptom at baseline and/or six months later, of which irritability was the most prevalent and persistent symptom and the symptom with the highest incidence. Hyperactivity was the most prevalent and persistent symptom cluster. Also, depression had a high persistence. Conclusions: Our results indicate the omnipresence of NPS of which most were found to be persistent. Therefore, we recommend to explore opportunities to reduce NPS in NH patients with MPM, such as creating a therapeutic milieu, educating the staff, and evaluating patient's psychotropic drug use

Reduced morbidity by using LigaSure compared to conventional inguinofemoral lymphadenectomy in vulvar cancer patients:A randomized controlled trial

Background: Inguinofemoral lymphadenectomy (IFL) is part of the surgical treatment of different malignancies of the genital tract and/or the lower limb including vulvar carcinoma, penile carcinoma and melanoma. IFL is associated with morbidity in up to 85% of the patients. The aims of this MAMBO-IC study (Morbidity And Measurement of the Body) are to study the feasibility of using LigaSure for IFL and to assess the differences in the incidence of short-term complications using LigaSure versus conventional IFL randomized within each individual patient. Methods: In this multicenter randomized controlled trial (RCT), women diagnosed with squamous cell carcinoma of the vulva with an indication for bilateral IFL were included. It was randomly assigned for which groin the LigaSure was used; the other groin was treated with conventional IFL (sharp/diathermia). We estimated the incidence of >= 1 complication(s) per groin using logistic regression and compared this between the two surgical methods, adjusting for possible confounders. Results: We included 40 groins of 20 patients. The estimated incidence of >= 1 complication(s) was 29% after LigaSure versus 70% after conventional IFL (risk difference 41% (95% CI 19-62), p <0.001). Patients' reported restriction of daily living activities and maximum pain score were equal for both treatment methods. There were no differences in the surgeon reported workload scores. Conclusions: This RCT shows that LigaSure for IFL is feasible and associated with significantly less short-term surgical complications compared to conventional IFL. Further studies with a larger sample size are needed to validate our findings. ISRCTN15057626

Guest editorial

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Golden gravitational lensing systems from the Sloan Lens ACS Survey. II. SDSS J1430+4105: A precise inner total mass profile from lensing alone

We study the SLACS strong lensing system SDSSJ1430+4105 at z=0.285. The lensed source (z=0.575) of this system has a complex morphology with several subcomponents. Its subcomponents span a radial range from 4 to 10kpc in the lens plane. Therefore we can constrain the slope of the total projected mass profile around the Einstein radius (R_E) from lensing alone. We measure a density profile that is slightly but not significantly shallower than isothermal at R_E. We decompose the mass of the lensing galaxy into a de Vaucouleurs (deV) component to trace the stars and an additional dark component. The spread of multiple image components over a large radial range also allows us to determine the amplitude of the deV and dark matter components separately. We get a mass to light ratio of M_deV/L_B~5.5\pm1.5M/L_sun,B and a dark matter fraction within R_E of ~20 to 40%. Modelling the star formation history assuming composite stellar populations at solar metallicity to the galaxy's photometry yields a mass to light ratio of M_star,salp/L_B~4.0_{-1.3}^{+0.6}M/L_sun,B and M_star,chab/L_B~2.3_{-0.8}^{+0.3}M/L_sun,B for Salpeter and Chabrier IMFs, respectively. Hence, the mass to light ratio derived from lensing is more Salpeter-like, in agreement with results for massive Coma galaxies and other nearby massive early type galaxies. We examine the consequences of the galaxy group in which the lensing galaxy is embedded, showing that it has little influence on the mass to light ratio obtained for the deV component of the lensing galaxy. Finally, we decompose the projected, azimuthally averaged 2D density distribution of the deV and dark matter component of the lensing signal into spherically averaged 3D density profiles. We can show that the 3D dark and luminous matter density within R_E~0.6R_eff of this SLACS galaxy is similar to the values of Coma galaxies with the same velocity dispersions.Comment: 24 pages, 21 figures, 11 tables, accepted for publication by MNRA

Well-being, multidisciplinary work and a skillful team:essential elements of successful treatment in severe challenging behavior in dementia

Objective: Conceptualize successful treatment of persons with dementia and severe challenging behavior as perceived by professionals. Methods: In this concept mapping study 82 experts in dementia care participated. The study followed two phases of data collection: (1) an online brainstorm where participants completed the focus prompt: ‘I consider the treatment of people with severe challenging behavior in dementia successful if.’; (2) individual sorting and rating of the collected statements followed by data analysis using multidimensional scaling and hierarchical cluster analysis, resulting in a concept map. Results: Three clusters were identified, the first addressing treatment outcomes and the latter two addressing treatment processes, each divided into sub-clusters: (1) well-being, comprising well-being of the person with dementia and all people directly involved; (2) multidisciplinary analysis and treatment, comprising multidisciplinary analysis, process conditions, reduction in psychotropic drugs, and person-centered treatment; and (3) attitudes and skills of those involved, comprising consistent approach by the team, understanding behavior, knowing how to respond to behavior, and open attitudes. Conclusions: Successful treatment in people with dementia and severe challenging behavior focuses on well-being of all people involved wherein attention to treatment processes including process conditions is essential to achieve this.</p