ECT augmentation was found to be an effective treatment for patients with schizophrenia resistant to clozapine. In a randomized controlled trial, 50% of patients receiving ECT plus clozapine met response criteria, compared to 0% receiving clozapine alone. Patients receiving ECT augmentation also had greater reductions in psychotic symptoms over time. In a crossover phase, 47.4% of previous non-responders met criteria with ECT. No significant cognitive effects were observed. While preliminary, ECT augmentation shows promise as a safe and effective strategy for treating clozapine-resistant schizophrenia. Larger and longer studies are still needed.
This document summarizes a clinical trial that compared the acceptability of escitalopram versus duloxetine in patients with depression who did not respond to initial antidepressants. The trial found that escitalopram was non-inferior and had a significantly lower discontinuation rate than duloxetine at 8 weeks. By 52 weeks, discontinuation rates were no longer significantly different. No significant differences in efficacy or adverse events were found between the drugs. The results suggest that acceptability may be driven more by patient preference than clinical factors alone.
The STAR*D trial was a large, multi-center study that examined the effectiveness of different treatment options for patients with unipolar depression who did not achieve remission with an initial antidepressant. Over 4,000 outpatients were treated across four levels of sequentially increasing treatment intensity. The study found that after two treatment steps, around 67% of patients achieved remission, but relapse rates were high. Patients with more severe and chronic illness required more treatment steps to achieve remission. While the study provided important real-world data on treating depression, it had some limitations like lack of placebo groups and small sample sizes in later levels.
This study conducted a prospective population-based cohort study and systematic review/meta-analysis to evaluate the risk of stroke in patients with asymptomatic carotid stenosis receiving medical therapy alone. The cohort study included patients found to have asymptomatic carotid stenosis between 2002-2017 who received contemporary medical management including antiplatelet/statin therapy and blood pressure control. The primary outcome was ipsilateral ischemic stroke. A systematic review/meta-analysis of previous studies on this topic was also performed to determine stroke risks with medical therapy alone and evaluate if routine carotid intervention is still warranted.
This review analyzed data from 39 randomized controlled trials assessing the effectiveness of topical NSAIDs for chronic musculoskeletal pain. The review found that over 6-12 weeks, topical diclofenac and ketoprofen were more effective than placebo at reducing pain, with 60% of participants experiencing much reduced pain. Specifically, the number needed to treat was 9.8 for diclofenac and 6.9 for ketoprofen. However, placebo also reduced pain significantly in about 50% of participants. The benefits of the topical NSAIDs over placebo were small. Shorter term studies had limitations and placebo response was high.
This document discusses treatment resistant schizophrenia, including definitions of response, remission, and resistance. It describes assessments that should be conducted before labeling a patient's schizophrenia as drug resistant, including evaluating for pseudo-resistance, co-occurring conditions, organic causes, antipsychotic side effects, and medication nonadherence. Management strategies discussed include optimizing antipsychotic drugs and doses, considering clozapine as the gold standard, and various augmentation strategies if clozapine fails such as with other antipsychotics, mood stabilizers, antidepressants, or other agents targeting glutamatergic transmission.
Ketamine in Treatment Resistant DepressionElisa Brietzke
1. Dr. Elisa Brietzke gave a presentation on intravenous ketamine as an evidence-based approach for treating depression. She discussed ketamine's mechanisms of action, pharmacokinetics, effectiveness for treating unipolar and bipolar depression based on meta-analyses and clinical studies, common side effects and their management, protocols for administration, and comparisons to esketamine.
2. Ketamine has rapid antidepressant effects within 24 hours when administered intravenously, but its effects only last 3-7 days without maintenance treatment. Repeated infusions over several weeks can provide more sustained benefits. Ketamine is generally well-tolerated but can increase blood pressure and heart rate.
3. While ket
This randomized, double-blind, placebo-controlled study evaluated the efficacy and safety of rituximab for relapsing-remitting multiple sclerosis. 104 patients were randomized to receive either rituximab or placebo intravenous infusions. The primary outcome was the number of gadolinium-enhancing lesions on MRI scans from weeks 12-24. Patients receiving rituximab had significantly fewer lesions compared to placebo, indicating rituximab reduces disease activity in multiple sclerosis. Rituximab also decreased relapse rates and reduced lesion volumes on MRI. The most common adverse events were mild to moderate infusion reactions. This study provides evidence that B cell depletion with rituximab is effective and relatively safe for rel
Brexpiprazole is a new atypical antipsychotic approved for the treatment of schizophrenia and as an adjunctive therapy for major depressive disorder. A randomized controlled trial found brexpiprazole 4 mg to be effective for acute schizophrenia based on improvement in PANSS scores compared to placebo. Brexpiprazole was generally well-tolerated with mild to moderate adverse effects. While it shows potential, the study had limitations such as no active comparator and excluded certain patient populations. More research is still needed to determine brexpiprazole's efficacy and safety compared to other antipsychotics.
This document summarizes a clinical trial that compared the acceptability of escitalopram versus duloxetine in patients with depression who did not respond to initial antidepressants. The trial found that escitalopram was non-inferior and had a significantly lower discontinuation rate than duloxetine at 8 weeks. By 52 weeks, discontinuation rates were no longer significantly different. No significant differences in efficacy or adverse events were found between the drugs. The results suggest that acceptability may be driven more by patient preference than clinical factors alone.
The STAR*D trial was a large, multi-center study that examined the effectiveness of different treatment options for patients with unipolar depression who did not achieve remission with an initial antidepressant. Over 4,000 outpatients were treated across four levels of sequentially increasing treatment intensity. The study found that after two treatment steps, around 67% of patients achieved remission, but relapse rates were high. Patients with more severe and chronic illness required more treatment steps to achieve remission. While the study provided important real-world data on treating depression, it had some limitations like lack of placebo groups and small sample sizes in later levels.
This study conducted a prospective population-based cohort study and systematic review/meta-analysis to evaluate the risk of stroke in patients with asymptomatic carotid stenosis receiving medical therapy alone. The cohort study included patients found to have asymptomatic carotid stenosis between 2002-2017 who received contemporary medical management including antiplatelet/statin therapy and blood pressure control. The primary outcome was ipsilateral ischemic stroke. A systematic review/meta-analysis of previous studies on this topic was also performed to determine stroke risks with medical therapy alone and evaluate if routine carotid intervention is still warranted.
This review analyzed data from 39 randomized controlled trials assessing the effectiveness of topical NSAIDs for chronic musculoskeletal pain. The review found that over 6-12 weeks, topical diclofenac and ketoprofen were more effective than placebo at reducing pain, with 60% of participants experiencing much reduced pain. Specifically, the number needed to treat was 9.8 for diclofenac and 6.9 for ketoprofen. However, placebo also reduced pain significantly in about 50% of participants. The benefits of the topical NSAIDs over placebo were small. Shorter term studies had limitations and placebo response was high.
This document discusses treatment resistant schizophrenia, including definitions of response, remission, and resistance. It describes assessments that should be conducted before labeling a patient's schizophrenia as drug resistant, including evaluating for pseudo-resistance, co-occurring conditions, organic causes, antipsychotic side effects, and medication nonadherence. Management strategies discussed include optimizing antipsychotic drugs and doses, considering clozapine as the gold standard, and various augmentation strategies if clozapine fails such as with other antipsychotics, mood stabilizers, antidepressants, or other agents targeting glutamatergic transmission.
Ketamine in Treatment Resistant DepressionElisa Brietzke
1. Dr. Elisa Brietzke gave a presentation on intravenous ketamine as an evidence-based approach for treating depression. She discussed ketamine's mechanisms of action, pharmacokinetics, effectiveness for treating unipolar and bipolar depression based on meta-analyses and clinical studies, common side effects and their management, protocols for administration, and comparisons to esketamine.
2. Ketamine has rapid antidepressant effects within 24 hours when administered intravenously, but its effects only last 3-7 days without maintenance treatment. Repeated infusions over several weeks can provide more sustained benefits. Ketamine is generally well-tolerated but can increase blood pressure and heart rate.
3. While ket
This randomized, double-blind, placebo-controlled study evaluated the efficacy and safety of rituximab for relapsing-remitting multiple sclerosis. 104 patients were randomized to receive either rituximab or placebo intravenous infusions. The primary outcome was the number of gadolinium-enhancing lesions on MRI scans from weeks 12-24. Patients receiving rituximab had significantly fewer lesions compared to placebo, indicating rituximab reduces disease activity in multiple sclerosis. Rituximab also decreased relapse rates and reduced lesion volumes on MRI. The most common adverse events were mild to moderate infusion reactions. This study provides evidence that B cell depletion with rituximab is effective and relatively safe for rel
Brexpiprazole is a new atypical antipsychotic approved for the treatment of schizophrenia and as an adjunctive therapy for major depressive disorder. A randomized controlled trial found brexpiprazole 4 mg to be effective for acute schizophrenia based on improvement in PANSS scores compared to placebo. Brexpiprazole was generally well-tolerated with mild to moderate adverse effects. While it shows potential, the study had limitations such as no active comparator and excluded certain patient populations. More research is still needed to determine brexpiprazole's efficacy and safety compared to other antipsychotics.
The purpose of this study was to examine the relationship between self-reported symptoms from antihypertensive medications and medication adherence. Data were collected from 28 individuals taking antihypertensive medications who completed questionnaires on symptoms experienced in the past 3 months. Symptom scores were developed based on the frequency of symptoms reported and correlated with two measures of medication adherence calculated from pharmacy refill records and reminder caps. Non-significant negative correlations were found for calcium channel blockers and beta blockers, suggesting increased symptoms related to decreased adherence. Non-significant positive correlations were found for ACE-inhibitors, ARBs, and thiazide diuretics, suggesting increased symptoms related to increased adherence. The study did not find a clear relationship
The effect of second-generation antipsychotics on hippocampal volume in first...kkapil85
This study compared changes in hippocampal volume over one year in patients experiencing their first episode of psychosis (FEP) taking different second-generation antipsychotics. Specifically, it compared patients taking aripiprazole to those taking risperidone/paliperidone, olanzapine, or who refused antipsychotics. MRI scans were conducted at baseline and one year for 62 FEP patients and 44 healthy controls. Results showed no significant differences between groups in demographic factors. As expected, those who refused antipsychotics spent the least amount of time on medication and had the lowest adherence rates. Statistical analyses were conducted to examine changes in hippocampal volume and symptoms between the groups over time.
Sytematic treatment enhancement program for bipolar disorder(step bd) (1)Dr Wasim
The STEP-BD study was a large, long-term outpatient study that evaluated treatments for bipolar disorder. Over 7 years it enrolled 4,361 participants ages 15 and older from 22 sites to evaluate which treatments were most effective for episodes of depression and mania and for preventing recurrence. The study assessed mood stabilizers, antidepressants, antipsychotics, and psychosocial interventions. It found that certain medications were not more effective than placebo for acute depression. Intensive psychosocial therapies improved relationship and life satisfaction compared to a brief control intervention. The study provided important longitudinal data on the course and comorbidities of bipolar disorder.
The MTA study compared four treatment approaches for ADHD in children ages 7-9: medication management alone, behavioral treatment alone, a combination of the two, and routine community care. It found that medication management alone and the combination treatment were both superior to behavioral treatment alone or routine community care in treating the symptoms of ADHD. The study helped show that medication and behavioral treatments can both effectively treat ADHD in children.
Slides from Lunch and Learn Lectures by Stephen Grcevich, MD, sponsored by Stark County MHAR Board, August 2023.
Videos may be found here:
https://vimeo.com/853034484
https://vimeo.com/856856675
https://vimeo.com/863669380
WS3_Marsden_Filling in the Gaps edited.pdfssuser3372de
Recent clinical investigations have helped fill some gaps in understanding the effects of Viscum album therapy in cancer patients.
1) Quality trials show Viscum album improves quality of life and reduces side effects of conventional cancer treatments.
2) Some data suggests it may improve overall survival for certain cancer types, though evidence is still inconsistent.
3) Emerging studies of high-dose intravenous, intrapleural, and intravesicular Viscum album show potential for disease response, though more research is still needed. Future studies should further evaluate local and intravenous applications as well as non-aqueous Viscum album extracts.
Dr. Michael H. Bloch - Simposio Internacional 'La enfermedad de la duda: el TOC'Fundación Ramón Areces
El 14 de noviembre de 2013, la Fundación Ramón Areces organizó y acogió en su sede un Simposio Internacional sobre 'La enfermedad de la duda: el TOC'. El Trastorno Obsesivo-Compulsivo (TOC) es un problema de salud pública, poco conocido, que afecta a un porcentaje de la población en torno a un 1-2% y que la Organización Mundial de la Salud ha situado entre las diez entidades que producen más discapacidad.
John Kane - Treatment-Resistant Schizophrenia: New Guidelines on Diagnosis an...wef
Presentation made at the live webinar hosted by the Schizophrenia Research Forum on the 21st of February, 2017 - http://www.schizophreniaforum.org/forums/treatment-resistant-schizophrenia-new-guidelines-diagnosis-and-terminology
Levels of evidence and design of clinical trailSanika Kulkarni
Evidence based medicine involves integrating clinical expertise with the best available external evidence from systematic research. Clinical trials generate safety and efficacy data on treatments and are conducted in multiple phases. Randomized controlled trials are considered the gold standard for clinical research as they minimize bias through randomization and use of control groups. Statistical considerations like sample size, endpoints, and interim analyses are important for clinical trial design.
Treatment resistant schizophrenia is defined as lack of satisfactory improvement despite trials of two antipsychotics for adequate duration and dose. Around 20-30% of schizophrenia patients are considered treatment resistant. Clozapine is currently the treatment of choice for such patients, though combination and augmentation strategies with other agents have limited evidence. Definitive treatment guidelines recommend establishing treatment resistance before trials of clozapine or other strategies for treatment resistant schizophrenia.
Eeesentials of Reading Biomedical Research Papers 2021 version.pptxMingdergLai
The document outlines two main types of biomedical research papers - studies where all experiments are designed in advance, and studies where the results of one experiment determine the next. It discusses two types of reading for research papers - skim reading to understand the key questions and conclusions, and close reading which requires a more critical analysis of the data and methods. For any type of reading, the key is to understand what is already known on the topic and what new information the paper provides.
Psychosis High Risk State and Schizophrenia ProdromeBrian Levins
This document provides an overview of psychosis, the clinical high risk state for psychosis, and potential therapeutics in the prodromal phase of psychosis. It defines psychosis and differentiates types. It reviews the symptoms and diagnostic criteria for schizophrenia and related disorders. It then discusses the clinical high risk state, potential outcomes, and characteristics. Finally, it discusses the importance of early intervention and reviews five studies on the use of antipsychotic medications during the prodromal phase.
Major depression is a common mental disorder in the United States, affecting around 15.7 million adults annually. Up to 50% of patients treated with a single antidepressant do not achieve full remission. The STAR*D study evaluated treatment strategies for patients with treatment-resistant depression, defined as lack of response to at least two antidepressant trials. STAR*D involved four levels of treatment including medication changes or augmentations. The cumulative remission rate after four treatment steps was 67%, with higher remission rates occurring earlier in treatment. STAR*D provides guidance for treating treatment-resistant depression, with the goal of achieving remission through persistent, adequately dosed interventions.
This study evaluated men with Peyronie's disease who received collagenase clostridium histolyticum (CCH) or placebo in two large clinical trials. The percentage of "composite responders" - defined as those with ≥20% improvement in penile curvature and symptom bother - was significantly higher in the CCH group compared to placebo at both 24 and 52 weeks. When the definition was changed to require a ≥2 point improvement in symptom bother, the percentage of composite responders remained significantly higher in the CCH group, supporting the efficacy of CCH treatment for both physical and psychosexual aspects of Peyronie's disease.
Acetyl-L-carnitine supplementation was evaluated in two randomized controlled trials involving over 1,200 patients with diabetic neuropathy. The studies found that 500-1000 mg doses taken three times daily resulted in:
1) Increased myelinated nerve fiber numbers and regenerating clusters on nerve biopsy.
2) Improved vibration sensation in fingers and toes.
3) Greater benefits seen in subgroups under age 55, BMI under 30, type 2 diabetes, and HbA1c under 8.5%.
While results suggest acetyl-L-carnitine may provide symptomatic relief for diabetic neuropathy, limitations included short trial duration and lack of data on important outcomes like long-term nerve regeneration. The assistant recommended
The study compared the efficacy and safety of low-dose and high-dose oral colchicine regimens for treating acute gout flares in 575 patients. It found that both low-dose (1.2mg then 0.6mg in 1hr) and high-dose (1.2mg then 0.6mg every 6hrs) regimens were more effective than placebo in reducing pain within 24 hours. However, high-dose treatment caused more diarrhea and other adverse effects. The results provide evidence that lower doses of colchicine can effectively treat acute gout flares while causing fewer side effects.
This document summarizes research on using quetiapine as an augmentation strategy for treatment-resistant depression. Six studies are reviewed that examine adding quetiapine to ongoing antidepressant treatment. The studies generally found quetiapine augmentation led to greater improvement in depression symptoms compared to placebo, especially when starting at dosages of 150-300 mg/day. The most common side effects were dry mouth, drowsiness, and weight gain. Overall, the research suggests quetiapine may be a valid option for improving outcomes for patients with treatment-resistant depression.
- The study aimed to assess the safety and efficacy of 20-Hz repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex as an adjunct treatment for negative symptoms in schizophrenia.
- 30 patients were randomly assigned to real or sham rTMS treatment groups. Real rTMS significantly reduced negative symptoms after 5 and 20 sessions based on SANS and PANSS scores, while sham rTMS only reduced symptoms after 5 sessions.
- Real rTMS was more effective than sham rTMS at reducing negative symptoms and general illness severity after 20 sessions based on differences in SANS and CGI-S scores. No significant differences were found for positive symptoms or depression
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
The purpose of this study was to examine the relationship between self-reported symptoms from antihypertensive medications and medication adherence. Data were collected from 28 individuals taking antihypertensive medications who completed questionnaires on symptoms experienced in the past 3 months. Symptom scores were developed based on the frequency of symptoms reported and correlated with two measures of medication adherence calculated from pharmacy refill records and reminder caps. Non-significant negative correlations were found for calcium channel blockers and beta blockers, suggesting increased symptoms related to decreased adherence. Non-significant positive correlations were found for ACE-inhibitors, ARBs, and thiazide diuretics, suggesting increased symptoms related to increased adherence. The study did not find a clear relationship
The effect of second-generation antipsychotics on hippocampal volume in first...kkapil85
This study compared changes in hippocampal volume over one year in patients experiencing their first episode of psychosis (FEP) taking different second-generation antipsychotics. Specifically, it compared patients taking aripiprazole to those taking risperidone/paliperidone, olanzapine, or who refused antipsychotics. MRI scans were conducted at baseline and one year for 62 FEP patients and 44 healthy controls. Results showed no significant differences between groups in demographic factors. As expected, those who refused antipsychotics spent the least amount of time on medication and had the lowest adherence rates. Statistical analyses were conducted to examine changes in hippocampal volume and symptoms between the groups over time.
Sytematic treatment enhancement program for bipolar disorder(step bd) (1)Dr Wasim
The STEP-BD study was a large, long-term outpatient study that evaluated treatments for bipolar disorder. Over 7 years it enrolled 4,361 participants ages 15 and older from 22 sites to evaluate which treatments were most effective for episodes of depression and mania and for preventing recurrence. The study assessed mood stabilizers, antidepressants, antipsychotics, and psychosocial interventions. It found that certain medications were not more effective than placebo for acute depression. Intensive psychosocial therapies improved relationship and life satisfaction compared to a brief control intervention. The study provided important longitudinal data on the course and comorbidities of bipolar disorder.
The MTA study compared four treatment approaches for ADHD in children ages 7-9: medication management alone, behavioral treatment alone, a combination of the two, and routine community care. It found that medication management alone and the combination treatment were both superior to behavioral treatment alone or routine community care in treating the symptoms of ADHD. The study helped show that medication and behavioral treatments can both effectively treat ADHD in children.
Slides from Lunch and Learn Lectures by Stephen Grcevich, MD, sponsored by Stark County MHAR Board, August 2023.
Videos may be found here:
https://vimeo.com/853034484
https://vimeo.com/856856675
https://vimeo.com/863669380
WS3_Marsden_Filling in the Gaps edited.pdfssuser3372de
Recent clinical investigations have helped fill some gaps in understanding the effects of Viscum album therapy in cancer patients.
1) Quality trials show Viscum album improves quality of life and reduces side effects of conventional cancer treatments.
2) Some data suggests it may improve overall survival for certain cancer types, though evidence is still inconsistent.
3) Emerging studies of high-dose intravenous, intrapleural, and intravesicular Viscum album show potential for disease response, though more research is still needed. Future studies should further evaluate local and intravenous applications as well as non-aqueous Viscum album extracts.
Dr. Michael H. Bloch - Simposio Internacional 'La enfermedad de la duda: el TOC'Fundación Ramón Areces
El 14 de noviembre de 2013, la Fundación Ramón Areces organizó y acogió en su sede un Simposio Internacional sobre 'La enfermedad de la duda: el TOC'. El Trastorno Obsesivo-Compulsivo (TOC) es un problema de salud pública, poco conocido, que afecta a un porcentaje de la población en torno a un 1-2% y que la Organización Mundial de la Salud ha situado entre las diez entidades que producen más discapacidad.
John Kane - Treatment-Resistant Schizophrenia: New Guidelines on Diagnosis an...wef
Presentation made at the live webinar hosted by the Schizophrenia Research Forum on the 21st of February, 2017 - http://www.schizophreniaforum.org/forums/treatment-resistant-schizophrenia-new-guidelines-diagnosis-and-terminology
Levels of evidence and design of clinical trailSanika Kulkarni
Evidence based medicine involves integrating clinical expertise with the best available external evidence from systematic research. Clinical trials generate safety and efficacy data on treatments and are conducted in multiple phases. Randomized controlled trials are considered the gold standard for clinical research as they minimize bias through randomization and use of control groups. Statistical considerations like sample size, endpoints, and interim analyses are important for clinical trial design.
Treatment resistant schizophrenia is defined as lack of satisfactory improvement despite trials of two antipsychotics for adequate duration and dose. Around 20-30% of schizophrenia patients are considered treatment resistant. Clozapine is currently the treatment of choice for such patients, though combination and augmentation strategies with other agents have limited evidence. Definitive treatment guidelines recommend establishing treatment resistance before trials of clozapine or other strategies for treatment resistant schizophrenia.
Eeesentials of Reading Biomedical Research Papers 2021 version.pptxMingdergLai
The document outlines two main types of biomedical research papers - studies where all experiments are designed in advance, and studies where the results of one experiment determine the next. It discusses two types of reading for research papers - skim reading to understand the key questions and conclusions, and close reading which requires a more critical analysis of the data and methods. For any type of reading, the key is to understand what is already known on the topic and what new information the paper provides.
Psychosis High Risk State and Schizophrenia ProdromeBrian Levins
This document provides an overview of psychosis, the clinical high risk state for psychosis, and potential therapeutics in the prodromal phase of psychosis. It defines psychosis and differentiates types. It reviews the symptoms and diagnostic criteria for schizophrenia and related disorders. It then discusses the clinical high risk state, potential outcomes, and characteristics. Finally, it discusses the importance of early intervention and reviews five studies on the use of antipsychotic medications during the prodromal phase.
Major depression is a common mental disorder in the United States, affecting around 15.7 million adults annually. Up to 50% of patients treated with a single antidepressant do not achieve full remission. The STAR*D study evaluated treatment strategies for patients with treatment-resistant depression, defined as lack of response to at least two antidepressant trials. STAR*D involved four levels of treatment including medication changes or augmentations. The cumulative remission rate after four treatment steps was 67%, with higher remission rates occurring earlier in treatment. STAR*D provides guidance for treating treatment-resistant depression, with the goal of achieving remission through persistent, adequately dosed interventions.
This study evaluated men with Peyronie's disease who received collagenase clostridium histolyticum (CCH) or placebo in two large clinical trials. The percentage of "composite responders" - defined as those with ≥20% improvement in penile curvature and symptom bother - was significantly higher in the CCH group compared to placebo at both 24 and 52 weeks. When the definition was changed to require a ≥2 point improvement in symptom bother, the percentage of composite responders remained significantly higher in the CCH group, supporting the efficacy of CCH treatment for both physical and psychosexual aspects of Peyronie's disease.
Acetyl-L-carnitine supplementation was evaluated in two randomized controlled trials involving over 1,200 patients with diabetic neuropathy. The studies found that 500-1000 mg doses taken three times daily resulted in:
1) Increased myelinated nerve fiber numbers and regenerating clusters on nerve biopsy.
2) Improved vibration sensation in fingers and toes.
3) Greater benefits seen in subgroups under age 55, BMI under 30, type 2 diabetes, and HbA1c under 8.5%.
While results suggest acetyl-L-carnitine may provide symptomatic relief for diabetic neuropathy, limitations included short trial duration and lack of data on important outcomes like long-term nerve regeneration. The assistant recommended
The study compared the efficacy and safety of low-dose and high-dose oral colchicine regimens for treating acute gout flares in 575 patients. It found that both low-dose (1.2mg then 0.6mg in 1hr) and high-dose (1.2mg then 0.6mg every 6hrs) regimens were more effective than placebo in reducing pain within 24 hours. However, high-dose treatment caused more diarrhea and other adverse effects. The results provide evidence that lower doses of colchicine can effectively treat acute gout flares while causing fewer side effects.
This document summarizes research on using quetiapine as an augmentation strategy for treatment-resistant depression. Six studies are reviewed that examine adding quetiapine to ongoing antidepressant treatment. The studies generally found quetiapine augmentation led to greater improvement in depression symptoms compared to placebo, especially when starting at dosages of 150-300 mg/day. The most common side effects were dry mouth, drowsiness, and weight gain. Overall, the research suggests quetiapine may be a valid option for improving outcomes for patients with treatment-resistant depression.
- The study aimed to assess the safety and efficacy of 20-Hz repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex as an adjunct treatment for negative symptoms in schizophrenia.
- 30 patients were randomly assigned to real or sham rTMS treatment groups. Real rTMS significantly reduced negative symptoms after 5 and 20 sessions based on SANS and PANSS scores, while sham rTMS only reduced symptoms after 5 sessions.
- Real rTMS was more effective than sham rTMS at reducing negative symptoms and general illness severity after 20 sessions based on differences in SANS and CGI-S scores. No significant differences were found for positive symptoms or depression
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. Electroconvulsive Therapy Augmentation in
Clozapine-Resistant Schizophrenia: A
Prospective, Randomized Study
Georgios Petrides, Chitra Malur, Raphael Braga, Samuel Bailine, Nina Schooler, Anil
Malhotra, John Kane, Sohag Sanghani, Terry Goldberg, Majnu John, Alan Mendelowitz
Am J Psychiatry. 2014 Aug 26. doi: 10.1176/appi.ajp.2014.13060787. [Epub ahead of
print]
2. American Journal of Psychiatry
• Editor: Robert Freedman, M.D
• Published every month
• Impact factor of 14.721 (Journal Citation reports,
2012)
• Ranking is third among 135 journals in the
category "Psychiatry“ according to “scimago
journal report 2013
3. DEFINING TREATMENT RESISTANT
SCHIZOPHRENIA
• Kane’s criteria, 1988
• 1. treatment with different classes of anti-psychotics at equal doses of
1000mg/day of chlorpromazine for at least 3 periods of 6 weeks in the last 5 years
without significant clinical improvement
• 2. reduction of at least 20% on the BPRS scale, score>35 points on the BPRS scale
after treatment, CGI score>3 after treatment with 60mg/day of haloperidol for 6
weeks
• 3. BPRS score >45, score >2 on BPRS items of conceptual disorganizaton, unusual
thoughts, hallucinatory behaviour and mistrust, CGI >4
4. • Kane’s modified criteria. ( Fabre et al, 1992, Kane et al 1993, Barnes et al,
1996)
• 1. treatment with different classes of anti-psychotics at equal doses of
400-600 mg/day of chlorpromazine for at least 2 periods of 6 weeks in the
last 5 years without significant clinical improvement
• 2. reduction of at least 20% on the BPRS scale, score>35 points on the
BPRS scale after treatment, CGI score>3 after treatment with 60mg/day of
haloperidol for 6 weeks
• 3. BPRS score >45, score >2 on BPRS items of conceptual disorganizaton,
unusual thoughts, hallucinatory behaviour and mistrust, CGI >4
•
5. Introduction
• 30% of schizophrenics respond poorly to standard anti-
psychotic treatment.
• Clozapine is the only medication shown to be effective
• But in 45-70% of these patients, even Clozapine is shown to
be resistant
6. Available options for Clozapine
resistant Patients
• Meta analysis of Randomized placebo controlled studies has
not been clearly able to show any substantial benefit of
augmentation with anti- psychotics
7. ECT as an augmentation strategy
Kupchik et al, 2000 in their meta analysis found that 67% of these
treatment resistant patients benefitted with combination of
Clozapine and ECT
Kho et al, 2004 found combination of Clozapine plus ECT to be
efficacious but had only 11 resistant patients.
Havaki-Kontaxaki et al, 2006 in a review article concluded that
preliminary evidence exists for safety and short term efficiacy of
this combination.
Masoudzadeh and Khalilian, 2007 comparing groups of these resistant
patients on Clozaoine alone, ECT alone and Combination of
Clozapine and ECT found that the combination group fared
significantly better.
8. Aims and Objectives
• To study ECT as an effective augmentation strategy for
Clozapine resistant patients with Schizophrenia
9. METHOD
• Place of study- Zucker Hillside hospital of the north shore – LJI
health system.
• Only inpatients from the hospital were included in the study.
• Duration of study- 8 weeks of treatment trial followed by 8
weeks of cross over trial.
Study Design
• Randomized controlled trial with non blinded treatment and
blinded assessments with a crossover trial for non responders
10. Definitions used for resistance
• Anti psychotic resistance – history of at least 2 failed trials of
400 mg of chlorpromazine equivalents for at least 4 weeks.
• Clozapine resistance- history of persistence of psychotic
symptoms after a trial of Clozapine of at least 12 weeks, at a
blood level of >= 350ng per ml
11. Inclusion Criteria
• Diagnosis of Schizophrenia, DSM IV criteria
• Age 18-60 years
• Duration of illness> 2 years
• Resistance of at least 2 anti psychotics(as per above the definition)
• Clozapine resistance(as per the definition)
• A baseline BPRS score of atleast 4 on one of the 4 psychotic items on the
psychotic symptom subscale or a score of 12 on these 4 items combined
• A CGIS rating of at least 4
• Capacity to give informed consent
• For women of child bearing age, a negative pregnancy test and patient
agreement to use a medically accepted form of contraception
12. Exclusion criteria
• Schizoaffective disorder
• Bipolar disorder
• Current affective episode
• ECT within 6 months
• History of epilepsy
• Severe neurological or systemic disorder that could significantly affect
cognition, behaviour or mental status
• Psychoactive substance dependence(other than caffeine or nicotine)
within 1 month prior to entering the study
• A score >18 on the 24 item Hamilton Depression rating scale
• Clinical determination that mood stabilizers that could not be
discontinued were necessary
13. Primary outcome
• Response criterion- improvement >= 40% based on the
psychotic symptom subscale
• A CGI Severity rating of 3 or less
• A CGI Improvement rating of much improved (<=2)
14. Method of study
• Participants were randomly assigned into 2 groups – those
who were to receive Clozapine alone and those who were to
receive Clozapine and ECT
Clozapine Group
• Concurrent use of other antipsychotics allowed if taken at a
stable dose of least 12 weeks before study began.
15. ECT and Clozapine group
• ECT was performed by bilateral placement.
• ECT was administered 3 times per week for the first 4 weeks
and then twice weekly for the next 4 weeks
• Clozapine was continued at the same doses as before the
study began
• Crossover trial
• Participants from the Clozapine group who did not respond to
8 weeks of continued pharmacotherapy received ECT
augmentation with the same schedule of treatment and
ratings as the ECT plus Clozapine group for an additional 8
weeks
16. Assessments and raters
• DSM-IV diagnosis was established using the Structured Clinical
Interview for DSM-IV
• Patients were rated at baseline and weekly.
• The raters were masked to the clinical assignment.
• Scales used-
• BPRS, CGI, HAM-D, the Schedule for Assessment of Negative
Symptoms, and the Treatment Emergent Side Effects Scale
• A focused neuropsychological battery was performed at
baseline and at week 9 to study the cognitive adverse effects
of ECT
17. Statistical analyses
• Histograms, q-q plots and shapiro wilk test – to assess
distribution of continuous variables
• For comparison of data Independent-samples t-test and
Wilcoxon rank sum test was used for continuous variables
Chi square test for categorical variables
Analysis of the longitudinal data was done using the mixed
models approach
18. • consistency intraclass coefficient between rating- 0.892
• Absolute agreement intraclass coefficient- 0.888
• All analyses were adjusted for age
19. Results
Of the 20 participants assigned to ECT plus clozapine, 17
completed the 8-week trial,
In the clozapine group, 16 of the 19 patients completed the 8-
week clozapine phase but all participated in the crossover
phase
Ten of the 20 patients (50%) in the ECT augmentation and none
(0%) of the patients in the clozapine group met the response
criterion defined
20. • Patients randomly assigned to ECT augmentation were found
to have significantly greater reduction in ratings on the BPRS-
psychosis subscale and the CGI-severity scale compared with
patients in the clozapine group over time.
21. Changes in BPRS psychotic subscales and CGI severity rating scales over
time
(red line- ECT plus Clozapine and blue line- ECT alone)
22. • In the crossover phase, 9 of the 19 patients (47.4%) met the
response criteria
Cognitive effects
• Neither group demonstrated a significant change in the global
neurocognitive measures tested from baseline to endpoint.
23. Clozapine dosages and plasma levels
• The mean clozapine dosage for the ECT treatment group at
baseline was 525.0 mg/day (SD=224.3), and the mean dosage
for the clozapine group was 511.1 mg/day (SD=171.0).
• There were no significant differences between groups.
24. Discussion
• The results of this study suggest that ECT is a safe and
effective treatment option for these patients and confirm
findings from smaller uncontrolled studies and from earlier
case reports.
• The response rates of 50% observed in the randomized arm
and 47% in the crossover arm compare favorably to all other
suggested augmentation strategies for clozapine in this
population
• With regard to the cognitive effects of the combined
treatment, there were no unusual effects of ECT
25. Limitations
• No placebo arm( sham ECT not acceptable)
• Small sample size that included only inpatients
• Age difference between the 2 groups
• Duration of the study was short so long term effects could not
be elicited.
• In the statistical analyses of data, only baseline and final
scores were used.
• A treatment group receiving ECT alone was not included in
the study.
26. Conclusions
• The augmentation of clozapine with ECT for the treatment of
clozapine-resistant schizophrenia is a safe and effective
treatment option.
• Further research is required to determine the persistence of
results and the need for maintenance treatment.
27. Study information
• Some authors have received research support from
pharmaceutical companies
• All authors report no financial relationships with commercial
interests
Supported by an RO1 grant from NIMH to Dr. Petrides