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17 results

  • Reduced cortical cerebral blood flow in antipsychotic-free first-episode psychosis and relationship to treatment response

  • Pierluigi Selvaggi, Sameer Jauhar, Vasileia Kotoula, Fiona Pepper, Mattia Veronese, Barbara Santangelo, Fernando Zelaya, Federico E. Turkheimer, Mitul A. Mehta, Oliver D. Howes
  • Journal:
    Psychological Medicine / Volume 53 / Issue 11 / August 2023
    Published online by Cambridge University Press:
    25 August 2022, pp. 5235-5245
    Print publication:
    August 2023
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  • Background

    Altered cerebral blood flow (CBF) has been found in people at risk for psychosis, with first-episode psychosis (FEP) and with chronic schizophrenia (SCZ). Studies using arterial spin labelling (ASL) have shown reduction of cortical CBF and increased subcortical CBF in SCZ. Previous studies have investigated CBF using ASL in FEP, reporting increased CBF in striatum and reduced CBF in frontal cortex. However, as these people were taking antipsychotics, it is unclear whether these changes are related to the disorder or antipsychotic treatment and how they relate to treatment response.

    Methods

    We examined CBF in FEP free from antipsychotic medication (N = 21), compared to healthy controls (N = 22). Both absolute and relative-to-global CBF were assessed. We also investigated the association between baseline CBF and treatment response in a partially nested follow-up study (N = 14).

    Results

    There was significantly lower absolute CBF in frontal cortex (Cohen's d = 0.84, p = 0.009) and no differences in striatum or hippocampus. Whole brain voxel-wise analysis revealed widespread cortical reductions in absolute CBF in large cortical clusters that encompassed occipital, parietal and frontal cortices (Threshold-Free Cluster Enhancement (TFCE)-corrected <0.05). No differences were found in relative-to-global CBF in the selected region of interests and in voxel-wise analysis. Relative-to-global frontal CBF was correlated with percentage change in total Positive and Negative Syndrome Scale after antipsychotic treatment (r = 0.67, p = 0.008).

    Conclusions

    These results show lower cortical absolute perfusion in FEP prior to starting antipsychotic treatment and suggest relative-to-global frontal CBF as assessed with magnetic resonance imaging could potentially serve as a biomarker for antipsychotic response.

  • Real-world clinical and cost-effectiveness of community clozapine initiation: mirror cohort study

  • Emma Butler, Toby Pillinger, Kirsten Brown, Faith Borgan, Alice Bowen, Katherine Beck, Enrico D'Ambrosio, Lisa Donaldson, Sameer Jauhar, Stephen Kaar, Tiago Reis Marques, Robert A. McCutcheon, Maria Rogdaki, Fiona Gaughran, James MacCabe, Rosalind Ramsay, David Taylor, Paul McCrone, Alice Egerton, Oliver D. Howes
  • Journal:
    The British Journal of Psychiatry / Volume 221 / Issue 6 / December 2022
    Published online by Cambridge University Press:
    19 April 2022, pp. 740-747
    Print publication:
    December 2022
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  • Background

    Clozapine is the only drug licensed for treatment-resistant schizophrenia (TRS) but the real-world clinical and cost-effectiveness of community initiation of clozapine is unclear.

    Aims

    The aim was to assess the feasibility and cost-effectiveness of community initiation of clozapine.

    Method

    This was a naturalistic study of community patients recommended for clozapine treatment.

    Results

    Of 158 patients recommended for clozapine treatment, 88 (56%) patients agreed to clozapine initiation and, of these, 58 (66%) were successfully established on clozapine. The success rate for community initiation was 65.4%; which was not significantly different from that for in-patient initiation (58.82%, χ2(1,88) = 0.47, P = 0.49). Following clozapine initiation, there was a significant reduction in median out-patient visits over 1 year (from 24.00 (interquartile range (IQR) = 14.00–41.00) to 13.00 visits (IQR = 5.00–24.00), P < 0.001), and 2 years (from 47.50 visits (IQR = 24.75–71.00) to 22.00 (IQR = 11.00–42.00), P < 0.001), and a 74.71% decrease in psychiatric hospital bed days (z = −2.50, P = 0.01). Service-use costs decreased (1 year: –£963/patient (P < 0.001); 2 years: –£1598.10/patient (P < 0.001). Subanalyses for community-only initiation also showed significant cost reductions (1 year: –£827.40/patient (P < 0.001); 2 year: –£1668.50/patient (P < 0.001) relative to costs prior to starting clozapine. Relative to before initiation, symptom severity was improved in patients taking clozapine at discharge (median Positive and Negative Syndrome Scale total score: initial visit: 80 (IQR = 71.00–104.00); discharge visit 50.5 (IQR = 44.75–75.00), P < 0.001) and at 2 year follow-up (Health of Nation Outcome Scales total score median initial visit: 13.00 (IQR = 9.00–15.00); 2 year follow-up: 8.00 (IQR = 3.00–13.00), P = 0.023).

    Conclusions

    These findings indicate that community initiation of clozapine is feasible and is associated with significant reductions in costs, service use and symptom severity.

  • Electroconvulsive therapy for depression: 80 years of progress

  • George Kirov, Sameer Jauhar, Pascal Sienaert, Charles H. Kellner, Declan M. McLoughlin
  • Journal:
    The British Journal of Psychiatry / Volume 219 / Issue 5 / November 2021
    Published online by Cambridge University Press:
    18 March 2021, pp. 594-597
    Print publication:
    November 2021
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  • Electroconvulsive therapy is the most effective treatment for severe, psychotic or treatment-resistant depression. However, its effectiveness continues to be questioned, both in mainstream media and narratives within the scientific literature. In this analysis, we use an evidence-based approach to demonstrate the efficacy and safety of modern electroconvulsive therapy.

  • Chapter 18 - Molecular Imaging of Dopamine and Antipsychotics in Bipolar Disorder

  • from Section 5 - Therapeutic Applications of Neuroimaging in Mood Disorders
  • Edited by Sudhakar Selvaraj, Paolo Brambilla, Università degli Studi di Milano, Jair C. Soares
  • Book:
    Mood Disorders
    Published online:
    12 January 2021
    Print publication:
    07 January 2021, pp 236-247

  • Summary

    There is a curious disparity between the body of literature linking the dopamine system to schizophrenia/psychosis and bipolar disorder. This is surprising, given the similarities between the tenets of the dopamine hypothesis and schizophrenia and some states observed in bipolar disorder.

    In this chapter, the author will present the evidence for a link between changes in the dopamine system and facets of bipolar disorder, the use of antipsychotics in bipolar disorder, and the possible integration of this knowledge in studying antipsychotic response and the dopamine system in bipolar disorder.

  • Ideology over evidence?

  • Sameer Jauhar, Allan H. Young
  • Journal:
    BJPsych Bulletin / Volume 42 / Issue 3 / June 2018
    Published online by Cambridge University Press:
    15 May 2018, pp. 130-131
    Print publication:
    June 2018
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  • Alcohol and cognitive impairment

  • Sameer Jauhar, E. Jane Marshall, Iain D. Smith
  • Journal:
    Advances in Psychiatric Treatment / Volume 20 / Issue 5 / September 2014
    Published online by Cambridge University Press:
    02 January 2018, pp. 304-313
    Print publication:
    September 2014
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  • The relationship between alcohol use and cognitive impairment has been notoriously difficult to disentangle. We present what is known about cognitive impairment associated with alcohol use/misuse, covering the spectrum from mild and subtle cognitive change through to severe alcohol-related brain damage, including Wernicke-Korsakoff syndrome. We highlight aids to the diagnosis and management of these conditions, and emphasise the benefits of prompt treatment on outcome. We also review progress in understanding their neurobiology. Suggestions for possible service configuration based on both our clinical practice and national guidelines are given.

    Learning Objectives

    1. • Gain an understanding of the spectrum of clinical presentations found in alcohol-related brain damage.

    2. • Understand that the aetiology of these conditions is complex and not solely due to the neurotoxic effects of alcohol.

    3. • Be better able to plan for the rehabilitation of individuals with established alcohol-related brain damage in your local service area.

  • Authors' reply

  • Rajeev Krishnadas, Sameer Jauhar, Susan Telfer, Somashekara Shivashankar, Robin G. McCreadie
  • Journal:
    The British Journal of Psychiatry / Volume 202 / Issue 1 / January 2013
    Published online by Cambridge University Press:
    02 January 2018, p. 75
    Print publication:
    January 2013
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  • Nicotine dependence and illness severity in schizophrenia

  • Rajeev Krishnadas, Sameer Jauhar, Susan Telfer, Somashekara Shivashankar, Robin G. McCreadie
  • Journal:
    The British Journal of Psychiatry / Volume 201 / Issue 4 / October 2012
    Published online by Cambridge University Press:
    02 January 2018, pp. 306-312
    Print publication:
    October 2012
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  • Background

    Reasons for the increased prevalence of cigarette smoking in schizophrenia are unclear. Studies assessing clinical symptoms have sampled heterogeneous populations, with discrepant findings.

    Aims

    To examine the relationship between clinical features, social adjustment and nicotine dependence in a geographically defined population of people with schizophrenia.

    Method

    Cross-sectional clinical study of 131 people with schizophrenia in Nithsdale, Scotland.

    Results

    Smokers were younger, mostly males and three times more likely to be unemployed. Those with severe nicotine dependence had greater scores on the positive subscale of the Positive and Negative Syndrome Scale (PANSS), and were prescribed higher doses of antipsychotic. Those with mild–moderate dependence had greater scores on the PANSS negative subscale. Greater symptom severity was associated with poorer social adjustment. Psychopathology and social adjustment were similar in quitters and never-smokers.

    Conclusions

    Our findings indicate an association between nicotine dependence, clinical symptoms and social adjustment in schizophrenia. Although causal links cannot be inferred, identifying the relationship between nicotine dependence and psychopathology may have some value in the management of smoking in schizophrenia. Further longitudinal studies are required to explore this relationship.

  • 7 - Bipolar disorder: treatment

  • from I - Disorders
  • Edited by Clare Oakley, Floriana Coccia, Neil Masson, Iain McKinnon, Meinou Simmons
  • Book:
    101 Recipes for Audit in Psychiatry
    Published online:
    02 January 2018
    Print publication:
    01 March 2011, pp 33-34

  • Summary

    Setting

    This audit is of relevance to all psychiatrists in Scotland who are involved in treating patients with bipolar disorder.

    Background

    The guideline on bipolar affective disorder produced by the Scottish Intercollegiate Guidelines Network (SIGN) was last updated in July 2005 and is based on a critical appraisal of primary research evidence. The guideline separately considers treatment for mania, depression, relapse prevention, psychosocial interventions, comorbid substance misuse, reproductive health and suicide prevention.

    Standards

    The SIGN standards used for this audit include the following.

    ᐅ In the acute treatment of mania:

  • ▹ antipsychotics, semisodium valproate or lithium should be used

  • ▹ antidepressant drug treatment should be reduced and discontinued.

    • ᐅ In the acute treatment of depression, an antidepressant with an antimanic drug or lamotrigine should be given.

    ᐅ Intramuscular injection of antipsychotics and/or benzodiazepines should be used in emergencies for rapid tranquillisation.

    ᐅ Evidence-based psychosocial interventions (e.g. cognitive–behavioural therapy, behavioural family therapy) should be available and arranged for a patient when indicated.

    ᐅ Where coexisting substance misuse or alcohol problems exist, patients may be usefully managed under the care programme approach (CPA).

    ᐅ In relation to suicide prevention, acute and maintenance treatment with lithium should be optimised (blood lithium level and adjustment of dose to therapeutic level).

    Method

    Data collection

    The case notes of all patients discharged from hospital with a diagnosis of bipolar disorder over a specified period were reviewed. A standardised form was used to collect anonymised data on age, gender, diagnosis, treatment for mania, treatment for depression, medication used in rapid tranquillisation, documented need for psychosocial interventions and their availability, assessment and treatment of drug or alcohol misuse (including use of CPA) and optimisation of lithium treatment.

    Data analysis

    For patients with mania or depression, or those requiring rapid tranquillisation, the percentages were recorded of who were treated pharmacologically in accordance with the guideline. The proportion of patients who were referred for psychosocial interventions was also noted. Account was taken of which psychosocial interventions were available in each locality as this restricted the ability to arrange such interventions. The proportion of case notes which document the presence or otherwise of alcohol/drug misuse was noted along with the percentage of such patients on the CPA.

  • Psychiatric and behavioural manifestations of Huntington's disease

  • Sameer Jauhar, Stuart Ritchie
  • Journal:
    Advances in Psychiatric Treatment / Volume 16 / Issue 3 / May 2010
    Published online by Cambridge University Press:
    02 January 2018, pp. 168-175
    Print publication:
    May 2010
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  • Patients with Huntington's disease can be a challenge to psychiatrists and to psychiatric services. We present a patient whose case history illustrates this and underlines the need for prompt and adequate treatment of psychiatric problems in this population. We discuss the psychiatric and behavioural manifestations of the illness, the treatments available and the role of psychiatric services in providing care for people with Huntington's disease.

  • Integrating research into the career of a psychiatrist in the past, present and future?

  • Sameer Jauhar
  • Journal:
    The Psychiatrist / Volume 34 / Issue 1 / January 2010
    Published online by Cambridge University Press:
    02 January 2018, p. 37
    Print publication:
    January 2010
    • Article
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  • Alcohol-related brain damage: not a silent epidemic

  • Sameer Jauhar, Iain D. Smith
  • Journal:
    The British Journal of Psychiatry / Volume 194 / Issue 3 / March 2009
    Published online by Cambridge University Press:
    02 January 2018, pp. 287-288
    Print publication:
    March 2009
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  • Wake-up call for British psychiatry: responses

  • Sameer Jauhar
  • Journal:
    The British Journal of Psychiatry / Volume 193 / Issue 6 / December 2008
    Published online by Cambridge University Press:
    02 January 2018, p. 516
    Print publication:
    December 2008
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  • Can trainees contribute to recruitment into specialty training?

  • Sameer Jauhar, Martin Bartos, Thomas Hacker, Pavan Srireddy
  • Journal:
    Psychiatric Bulletin / Volume 32 / Issue 12 / December 2008
    Published online by Cambridge University Press:
    02 January 2018, pp. 470-472
    Print publication:
    December 2008
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  • Aims and Methods

    Following the 2007 Modernising Medical Careers process, an online survey of applicants for psychiatry training posts in Scotland was undertaken. Views on short-listing, interview, communication and future recruitment were sought, qualitative and quantitative analyses being employed.

    Results

    Of 200 doctors, 115 responded, representing all regions and grades. Over 75% (n=84) expressed lack of confidence in short-listing. There was no significant difference between responses of successful and unsuccessful candidates (χ2=3.66, d.f.=2, P > 0.05). A total of 45% perceived interviews as invalid (n=55). About two-thirds (66%, n=69) felt communication was poor. Constructive suggestions for 2008 were made.

    Clinical Implications

    Although highlighting inadequacies in the 2007 process, trainees offered valid suggestions for future recruitment into specialty training, information being obtained quickly and efficiently.