A genome-wide genomic score added to standard recommended stratification tools does not improve the identification of patients with very low bone mineral density

The role of integrating genomic scores (GSs) needs to be assessed. Adding a GS to recommended stratification tools does not improve the prediction of very low bone mineral density. However, we noticed that the GS performed equally or above individual risk factors in discrimination.

PURPOSE

We aimed to investigate whether adding a genomic score (GS) to recommended stratification tools improves the discrimination of participants with very low bone mineral density (BMD).

METHODS

BMD was measured in three thoracic vertebrae using CT. All participants provided information on standard osteoporosis risk factors. GSs and FRAX scores were calculated. Participants were grouped according to mean BMD into very low (<80 mg/cm3), low (80-120 mg/cm3), and normal (>120 mg/cm3) and according to the Bone Health and Osteoporosis Foundation recommendations for BMD testing into an "indication for BMD testing" and "no indication for BMD testing" group. Different models were assessed using the area under the receiver operating characteristics curves (AUC) and reclassification analyses.

RESULTS

In the total cohort (n=1421), the AUC for the GS was 0.57 (95% CI 0.52-0.61) corresponding to AUCs for osteoporosis risk factors. In participants without indication for BMD testing, the AUC was 0.60 (95% CI 0.52-0.69) above or equal to AUCs for osteoporosis risk factors. Adding the GS to a clinical risk factor (CRF) model resulted in AUCs not statistically significant from the CRF model. Using probability cutoff values of 6, 12, and 24%, we found no improved reclassification or risk discrimination using the CRF-GS model compared to the CRF model.

CONCLUSION

Our results suggest adding a GS to a CRF model does not improve prediction. However, we noticed that the GS performed equally or above individual risk factors in discrimination. Clinical risk factors combined showed superior discrimination to individual risk factors and the GS, underlining the value of combined CRFs in routine clinics as a stratification tool.

Mental Health Act Commission and the code of practice

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Personal questionnaire changes and their correlates in a psychotherapeutic group

Personal questionnaires were constructed for seven members of a psychotherapy group. Self-reported changes during group sessions and over a period of up to 10 months' treatment were analysed. There was no general pattern of 'improvement' either during sessions or in the longer term. There was evidence suggestive of an inverse relationship between changes during sessions and over the period of the study. Some clinically meaningful relationships were discerned between the present data and repertory grid and verbal behaviour measures on the same group members reported in a previous paper. Theoretical and methodological implications are discussed.

Some correlates of repertory grid measures used to study a psychotherapeutic group

Repertory grid data provided monthly by the members of a psychotherapeutic group were related to measures of verbal behaviour during group sessions in ways which were both statistically significant and psychologically meaningful. There was evidence that the group members re-enacted earlier patterns of family relationship in their mutual interaction. For individual patient members of the group, speaking, being spoken to, and introducing several kinds of topic into the group discussion had significant associations with grid variables implicating self-esteem and patterns of identification with parents; but the correlation patterns varied between patients.

Outpatient maintenance of chronic schizophrenic patients with long-acting fluphenazine: double-blind placebo trial. Report to the Medical Research Council Committee on Clinical Trials in Psychiatry

A double-blind placebo trial of fluphenazine decanoate, a long-acting phenothiazine, was carried out to determine its value in maintenance therapy of chronic schizophrenic outpatients already established on the drug for a minimum period of eight weeks. In low doses it was significantly more effective than placebo in preventing relapse and admission to hospital. Relapse was accompanied by a resurgence of specifically schizophrenic symptoms and by an increase in abnormalities described by the relatives. There was no difference between the experimental and control groups in the treatment required for depression. The group on active medication required more treatment for Parkinsonism, but this difference did not reach statistical significance.In the context of a well-run special clinic for outpatient follow-up of chronic schizophrenic patients these results confirm the usefulness of long-acting fluphenazine. By inference, the benefit of this treatment highlights the need for adequate community services to deal with the residual chronic disabilities which are characteristic of these patients.