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Estimation of RMR using prediction equations is the basis for calculating energy requirements. In the present study, RMR was predicted by Harris–Benedict, Schofield, Henry, Mifflin–St Jeor and Owen equations and measured by indirect calorimetry in 125 healthy adult women of varying BMI (17–44 kg/m2). Agreement between methods was assessed by Bland–Altman analyses and each equation was assessed for accuracy by calculating the percentage of individuals predicted within ± 10 % of measured RMR. Slopes and intercepts of bias as a function of average RMR (mean of predicted and measured RMR) were calculated by regression analyses. Predictors of equation bias were investigated using univariate and multivariate linear regression. At group level, bias (the difference between predicted and measured RMR) was not different from zero only for Mifflin–St Jeor (0 (sd 153) kcal/d (0 (sd 640) kJ/d)) and Henry (8 (sd 163) kcal/d (33 (sd 682) kJ/d)) equations. Mifflin–St Jeor and Henry equations were most accurate at the individual level and predicted RMR within 10 % of measured RMR in 71 and 66 % of participants, respectively. For all equations, limits of agreement were wide, slopes of bias were negative, and intercepts of bias were positive and significantly (P < 0⋅05) different from zero. Increasing age, height and BMI were associated with underestimation of RMR, but collectively these variables explained only 15 % of the variance in estimation bias. Overall accuracy of equations for prediction of RMR is low at the individual level, particularly in women with low and high RMR. The Mifflin–St Jeor equation was the most accurate for this dataset, but prediction errors were still observed in about one-third of participants.
Background – Ecstasy is a recreational drug with an anecdotal reputation for safety. However, reports of adverse effects and fatalities have increased in the medical and popular press.
Method – Literature search and review.
Results – Acute Ecstasy toxicity does not appear to be due to overdose and cannot be solely attributed to the nature of the usual ambient environment. Adverse effects include hyperthermia, seizures, cardiac arrhythmias, hepatotoxicity, hyponatraemia and many psychiatric disorders. Ecstasy causes serotonergic neurotoxicity in the brains of animals at doses close to those used by humans, but its long-term effect on the human brain is unknown.
Conclusion – Ecstasy toxicity should be considered in the differential diagnosis of a variety of medical and psychiatric conditions. Given its popularity, both the acute and the potential long-term effects are a cause for concern.
The advent of genome wide association studies have resulted in the identification of a number of novel genetic loci for schizophrenia and related disorders. Understanding the functional impact of these variants on brain structure and function is crucial to understand their role in disease pathology. We presents data based on our genetic and neuropsychological assessment of almost 700 patients and healthy participants for a number of these variants and replication of our findings in independent samples of almost 1500 cases and controls. Specifically, we will use this data to suggest that the risk associated with some genetics variants (e.g. NOS1) is being mediated by an influence on variation in intelligence and other cognitive phenotypes, while other risk variants (e.g. ZNF804A) delineate illness subtypes in which cognitive deficits are a less prominent feature.
Brain-derived neurotrophic factor (BDNF) gene variants may potentially influence behaviour. In order to test this hypothesis, we investigated the relationship between BDNF Val66Met polymorphism and aggressive behaviour in a population of schizophrenic patients. Our results showed that increased number of BDNF Met alleles was associated with increased aggressive behaviour.
Post hoc analysis of occupational attainment and performance on a standard neurocognitive battery suggests that performance on letter-number sequencing is strongly associated with work attainment. Letter-number sequencing may warrant further investigation as a clinically useful tool to inform decisions around vocational rehabilitation.
Water intoxication is a rare condition characterised by overconsumption of water. It can occur in athletes engaging in endurance sports, users of MDMA (Ecstasy) and in patients receiving total parenteral nutrition. This case outlines water intoxication in a patient with psychogenic polydipsia. When the kidney’s capacity to compensate for exaggerated water intake is exceeded, hypotonic hyperhydration results. Consequences can involve headaches, behavioural changes, muscular weakness, twitching, vomiting, confusion, irritability, drowsiness and seizures. Cerebral oedema can lead to brain damage and eventual death. In this case, psychogenic polydipsia led to significant hyponatraemia, cerebral oedema and tonic-clonic seizures. Differential diagnoses for hyponatraemia include SIADH, diabetes insipidus, hyperthyroidism and excess cortisol. Extreme water consumption, as in the case outlined, is also implicated. Psychogenic polydipsia is a disorder that can lead to significant morbidity and mortality and occurs in 6% to 20% of psychiatric patients. Although psychogenic polydipsia is relatively common in this population, only one fifth to one third of polydipsic patients will experience symptomatic hyponatraemia. A number of psychiatric disorders have been linked with psychogenic polydipsia. The most commonly reported is chronic schizophrenia, but it may also occur in anorexia nervosa, psychotic depression and bipolar psychosis. The aetiology of psychogenic polydipsia is uncertain, but postulated hypotheses are explored. Psychogenic polydipsia occurs in up 20% of psychiatric patients and this case serves to remind us to be cognisant of water overconsumption.
Antipsychotic polypharmacy is defined as the co-prescription of more than one antipsychotic for a single patient. The practice has been criticised because of a lack of convincing evidence for its effectiveness and safety. It is associated with increased hospitalisation rates, more adverse effects, elevated cost, pharmacokinetic interactions, reduced adherence and increased mortality.
This study aimed to identify patients attending a community psychiatric service who are currently prescribed more than one antipsychotic. It aimed to examine their diagnoses, comorbid physical illnesses and other medications. Patterns of co-prescription were also considered.
A computerised database was utilised to identify all patients prescribed any antipsychotic.
98 patients who were prescribed antipsychotics were identified. Of these, 22 (22%) were prescribed two antipsychotics. No pattern of a preferred combination of antipsychotics was identified. 15 of those prescribed more than one antipsychotic (68%) were prescribed two second generation drugs, with the remainder on a combination of a first and second generation antipsychotic.
Antipsychotic polypharmacy rates (22%) were in line with the European average (23%). Antipsychotic polypharmacy should be a last resort after evidence-based treatments have tried and failed. It is recommended that it is considered only after a minimum of two trials of single antipsychotics at adequate doses and durations; after at least one trial of depot antipsychotic; and following at least one trial of Clozapine, with consideration given to ECT. Focused interventions rather than passive dissemination of guidelines are more likely to reduce antipsychotic polypharmacy rates.
Depression and anxiety disorders show a high comorbidity based on common pathophysiological mechanisms. Childhood environmental and life stressors are leading factors in both disorders and result in stable changes of genetic expression mediated by epigenetics, which has been found to impact in the transcription of genes, influence neurogenesis, neuroplasticity and neuronal connectivity.
To provide an overview about functional neuroimaging genetics in MDD and anxiety disorders.
Functional MRI, epigenetic and genetic information was obtained in a cohort of patients with MDD with high and low levels of anxiety and healthy controls. Associations between methylation of SLC6A4, genetic variants and brain function and connectivity was analysed.
Higher methylation of SLC6A4 gene was associated with higher BOLD response during emotion processing and lower BOLD response during higher order cognitive processes. Specific asociation with anxiety and depression are further analysed.
Our study provides further support to the hypothesis that particular DNA methylation states that are associated with brain function during emotion processing are detectable in the periphery. The influence of anxiety or depression on this association is discussed.
Recent literature suggests that over 70% of cases of antibody-mediated encephalitis present to psychiatry services with features of psychosis predominantly.
To investigate the seroprevalence of N-Methyl-D-Aspartate receptor antibodies (NMDAr-Ab) in patients with first episode psychosis (FEP)
Following ethical approval, all cases meeting entry criteria were invited to participate. Participants were interviewed with SCID to obtain a DSM diagnosis. NMDAr-Ab were identified in serum by cell based assay using co-transfected Human Embryonic Kidney (HEK)cells. Positive cases were reviewed by clinical neurology. Decision to treat with immunotherapy was made on a case by case basis.
85/115 (72%) of patients with FEP entered the study. 49 (58%) participants were male, mean age (SD) 37 (15.7) years. 42 (52%) were outpatients at the time of assessment. Four cases (5%) were serum NMDAr-Ab positive. 3 of these cases were male, age 48 (16.3) years. All four were admitted as inpatients with normal brain MRI imaging. One case (female, 55) was confirmed as NMDAr-Ab encephalitis based on case presentation, EEG demonstrating bilateral cerebral dysfunction and NMDAr-Ab in CSF. Immunotherapy treatment lead to clinical improvement. In remaining cases, EEG was normal and CSF negative. All 3 of these cases showed clinical improvement following psychiatric treatment as usual.
Our findings support the current estimates as to NMDAr-Ab prevalence in FEP. Increased awareness has lead to rapid treatment of florid cases of NMDAr-Ab encephalitis in our service. Additional seropositive cases are being followed with neuro-cognitive testing for any evidence of decline.
Autism spectrum disorder (ASD) is a pervasive developmental disorder characterized by impairments in social and communicative abilities, along with the presence of ritualistic and/or repetitive behaviors. One of the under-researched areas in the ASD literature is the large gender difference in the diagnosis rates. On average, the male to female ratio stands at 4.3:1, increasing to 9:1 in the absence of comorbid intellectual impairment. It has been evidenced that compared to boys, ASD is diagnosed later in cognitively able girls, despite there being no difference in the number of visits to a health-care professional during the diagnostic process and the age at which parents first express concern. The suboptimal identification of the disorder in cognitively able girls causes a large magnitude of gender discrepancy. These statistics may not be accurate since females may camouflage their difficulties and may be undetected due to their ability to disguise their symptoms better than males. The other hypothesis of under diagnosing ASD in girls is how we quantify and diagnose it. It is based on a male-centric presentation, which does not accurately reflect the disorder in girls. Altogether, these differences may make it more challenging for medical professionals and clinicians to identify potential early signs of the disorder in girls. Hence, there is a need to develop programs to mentor girls and women on the autism spectrum in schools, colleges and industry. And there should be an insistence on inclusion of females on the autism spectrum in pharmacological research and other research projects.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Patients with major mental illness are recognised to be at risk of premature death for a multitude of reasons. Those with schizophrenia and bipolar disorder are at highest risk.
International best practice recommends monitoring of blood tests, physical parameters such as weight, BMI, waist circumference and blood pressure, and side effects of patients prescribed antipsychotic medication. A clinic was established to target these interventions.
This initiative aimed to improve the physical health monitoring of patients prescribed depot antipsychotic medication in a catchment area of approximately 36,000 in Ireland.
A twice-yearly, multidisciplinary monitoring clinic was established. A protocol was drawn up, following a literature review and inspection of current international guidelines, and a proforma assisted as an aide-mémoire. A self-report questionnaire, the Glasgow Antipsychotic Side Effect Scale, was used to enquire about side effects.
Evaluation took place in descriptive form with audit used to examine outcomes. Full blood test monitoring improved from 9% of patients to 61% in one year, with 78% of patients having had at least one blood test recorded. Prior to the clinic's establishment, only one patient had had any physical parameters recorded, but this improved to 96% recorded after the clinics were run. Side effect documentation also improved.
The clinic was well-received and led to improved teamwork. Future recommendations include organising the clinic so as to include simultaneous blood testing. A similar project is being planned to target all patients attending who are prescribed antipsychotic medication.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Diet modifies the risk of colorectal cancer (CRC), and inconclusive evidence suggests that yogurt may protect against CRC. We analysed the data collected from two separate colonoscopy-based case–control studies. The Tennessee Colorectal Polyp Study (TCPS) and Johns Hopkins Biofilm Study included 5446 and 1061 participants, respectively, diagnosed with hyperplastic polyp (HP), sessile serrated polyp, adenomatous polyp (AP) or without any polyps. Multinomial logistic regression models were used to derive OR and 95 % CI to evaluate comparisons between cases and polyp-free controls and case–case comparisons between different polyp types. We evaluated the association between frequency of yogurt intake and probiotic use with the diagnosis of colorectal polyps. In the TCPS, daily yogurt intake v. no/rare intake was associated with decreased odds of HP (OR 0·54; 95 % CI 0·31, 0·95) and weekly yogurt intake was associated with decreased odds of AP among women (OR 0·73; 95 % CI 0·55, 0·98). In the Biofilm Study, both weekly yogurt intake and probiotic use were associated with a non-significant reduction in odds of overall AP (OR 0·75; 95 % CI 0·54, 1·04) and (OR 0·72; 95 % CI 0·49, 1·06) in comparison with no use, respectively. In summary, yogurt intake may be associated with decreased odds of HP and AP and probiotic use may be associated with decreased odds of AP. Further prospective studies are needed to verify these associations.
Evidence from observational studies indicates that seaweed consumption may reduce the risk of non-communicable diseases such as cardiovascular disease, type two diabetes, and obesity. Accumulating evidence from in vitro and animal studies suggest seaweed have antihyperlipidemic, anti-inflammatory and antioxidant properties which may in part be attributed to the high content of soluble dietary fibre in seaweeds. The viscosity of seaweed fibres is suggested to mediate antihyperlipdiemic effects via the alteration of lipid/bile acid absorption kinetics to decrease low-density lipoprotein cholesterol (LDL). Thus, there is a need to evaluate the efficacy of seaweed derived dietary fibre in the management of dyslipidemia. Therefore, the aim of this study was to determine the effect of a fibre rich extract from Palmaria palmata on the lipid profile as well as markers of inflammation and oxidative stress in healthy adults. A total of 60 healthy participants (30 male and 30 female) aged 20 to 58 years, were assigned to consume the Palmaria palmata fibre extract (5g/day), Synergy-1 and the placebo (maltodextrin) for a duration of 4 weeks with a minimum 4 week washout between each treatment in a double blind, randomised crossover study conducted over 5 months. Fasting concentrations of cholesterol, triglycerides and high-density lipoprotein cholesterol (HDL) were analysed and low-density lipoprotein cholesterol (LDL) and LDL: HDL ratio was calculated. C-reactive protein (CRP) and Ferric Reducing Ability of Plasma (FRAP) were analysed as markers of inflammation and oxidative stress, respectively. Supplementation for 4 weeks with Palmaria palmata resulted in favourable changes to lipid profiles with a reduced LDL:HDL ratio; however intention-to-treat univariate ANCOVA identified no significant difference between the treatment groups over time on any of the lipid profile markers. A non-significant increase in CRP and triglyceride concentration along with lower FRAP was also observed with Palmaria palmata supplementation. Evidence from this study suggests that Palmaria palmata may have effects on lipid metabolism and appears to mobilise triglycerides. More research is needed in individuals with dyslipidaemia to fully elucidate these effects.