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Ratheesh A, Hett D, Ramain J, Wong E, Berk L, Conus P, Fristad MA, Goldstein T, Hillegers M, Jauhar S, Kessing LV, Miklowitz DJ, Murray G, Scott J, Tohen M, Yatham LN, Young AH, Berk M, Marwaha S. A systematic review of interventions in the early course of bipolar disorder I or II: a report of the International Society for Bipolar Disorders Taskforce on early intervention. Int J Bipolar Disord 2023; 11:1. [PMID: 36595095 PMCID: PMC9810772 DOI: 10.1186/s40345-022-00275-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/14/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Given the likelihood of progressive illness in bipolar disorder (BD), it is important to understand the benefits and risks of interventions administered early in illness course. We conducted a systematic review of the effectiveness of interventions in the early course of BD I or II. METHODS We completed a systematic search on MEDLINE, PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL and Google Scholar from 1/1/1979 till 14/9/2022. We included controlled trials examining intervention effects on symptomatic, course, functional and tolerability outcomes of patients in the 'early course' of BD I or II. We classified patients to be in early course if they (a) were seeking help for the first time for a manic episode, (b) had a lifetime history of up to 3 manic episodes, or (c) had up to 6 lifetime mood episodes. Evidence quality was assessed using the GRADE approach. RESULTS From 4135 unique publications we included 25 reports representing 2212 participants in 16 randomized studies, and 17,714 participants from nine non-randomized studies. Available evidence suggested that in early illness course, lithium use was associated with lower recurrence risk compared with other mood stabilizers. Mood stabilizers were also associated with better global functioning, compared with the use of antipsychotics in the medium term. While summative findings regarding psychological therapies were limited by heterogeneity, family-focused and cognitive-behavioral interventions were associated with reduced recurrence risk or improved symptomatic outcomes. There was some evidence that the same pharmacological interventions were more efficacious in preventing recurrences when utilized in earlier rather than later illness course. CONCLUSIONS AND RECOMMENDATIONS While there are promising initial findings, there is a need for more adequately powered trials to examine the efficacy and tolerability of interventions in youth and adults in early illness course. Specifically, there is a compelling need to compare the relative benefits of lithium with other pharmacological agents in preventing recurrences. In addition to symptomatic outcomes, there should be a greater focus on functional impact and tolerability. Effective pharmacological and psychological interventions should be offered to those in early course of BD, balancing potential risks using shared decision-making approaches.
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Affiliation(s)
- A. Ratheesh
- grid.488501.00000 0004 8032 6923Orygen, 35 Poplar Road, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - D. Hett
- grid.6572.60000 0004 1936 7486Institute for Mental Health, University of Birmingham, Birmingham, UK ,Birmingham and Solihull Mental Health NHS Trust, Birmingham, UK
| | - J. Ramain
- grid.8515.90000 0001 0423 4662TIPP Program, Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - E. Wong
- grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - L. Berk
- grid.414257.10000 0004 0540 0062IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - P. Conus
- grid.8515.90000 0001 0423 4662TIPP Program, Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - M. A. Fristad
- grid.261331.40000 0001 2285 7943Nationwide Children’s Hospital, The Ohio State University, Columbus, USA
| | - T. Goldstein
- grid.21925.3d0000 0004 1936 9000Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA
| | - M. Hillegers
- grid.5645.2000000040459992XDepartment of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - S. Jauhar
- grid.13097.3c0000 0001 2322 6764Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.415717.10000 0001 2324 5535South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX UK
| | - L. V. Kessing
- grid.475435.4Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - D. J. Miklowitz
- grid.19006.3e0000 0000 9632 6718Semel Institute for Neuroscience and Human Behavior, Los Angeles School of Medicine, University of California, Los Angeles, USA
| | - G. Murray
- grid.1027.40000 0004 0409 2862Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - J. Scott
- grid.1006.70000 0001 0462 7212Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - M. Tohen
- grid.266832.b0000 0001 2188 8502Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM USA
| | - L. N. Yatham
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - A. H. Young
- grid.13097.3c0000 0001 2322 6764Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.415717.10000 0001 2324 5535South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX UK
| | - M. Berk
- grid.414257.10000 0004 0540 0062IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - S. Marwaha
- grid.6572.60000 0004 1936 7486Institute for Mental Health, University of Birmingham, Birmingham, UK ,Birmingham and Solihull Mental Health NHS Trust, Birmingham, UK
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Meechan CF, Laws KR, Young AH, McLoughlin DM, Jauhar S. ECT is evidence-based - a commentary on depression: why drugs and electricity are not the answer. Psychol Med 2022; 52:1416-1418. [PMID: 35674232 DOI: 10.1017/s003329172200085x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- C F Meechan
- Woodland View Hospital, Irvine, Ayrshire & Arran, UK
| | - K R Laws
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - A H Young
- Psychological Medicine, Centre for Affective Disorders, IoPPN, King's College, London, UK
| | - D M McLoughlin
- Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland
| | - S Jauhar
- Psychological Medicine, Centre for Affective Disorders, IoPPN, King's College, London, UK
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Jauhar S, Fortea L, Solanes A, Albajes-Eizagirre A, McKenna PJ, Radua J. Brain activations associated with anticipation and delivery of monetary reward: A systematic review and meta-analysis of fMRI studies. PLoS One 2021; 16:e0255292. [PMID: 34351957 PMCID: PMC8341642 DOI: 10.1371/journal.pone.0255292] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 07/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND While multiple studies have examined the brain functional correlates of reward, meta-analyses have either focused on studies using the monetary incentive delay (MID) task, or have adopted a broad strategy, combining data from studies using both monetary and non-monetary reward, as probed using a wide range of tasks. OBJECTIVE To meta-analyze fMRI studies that used monetary reward and in which there was a definable cue-reward contingency. Studies were limited to those using monetary reward in order to avoid potential heterogeneity from use of other rewards, especially social rewards. Studies using gambling or delay discounting tasks were excluded on the grounds that reward anticipation is not easily quantifiable. STUDY ELIGIBILITY English-language fMRI studies (i) that reported fMRI findings on healthy adults; (ii) that used monetary reward; and (iii) in which a cue that was predictive of reward was compared to a no win (or lesser win) condition. Only voxel-based studies were included; those where brain coverage was incomplete were excluded. DATA SOURCES Ovid, Medline and PsycInfo, from 2000 to 2020, plus checking of review articles and meta-analyses. DATA SYNTHESIS Data were pooled using Seed-based d Mapping with Permutation of Subject Images (SDM-PSI). Heterogeneity among studies was examined using the I2 statistic. Publication bias was examined using funnel plots and statistical examination of asymmetries. Moderator variables including whether the task was pre-learnt, sex distribution, amount of money won and width of smoothing kernel were examined. RESULTS Pooled data from 45 studies of reward anticipation revealed activations in the ventral striatum, the middle cingulate cortex/supplementary motor area and the insula. Pooled data from 28 studies of reward delivery again revealed ventral striatal activation, plus cortical activations in the anterior and posterior cingulate cortex. There was relatively little evidence of publication bias. Among moderating variables, only whether the task was pre-learnt exerted an influence. CONCLUSIONS According to this meta-analysis monetary reward anticipation and delivery both activate the ventral but not the dorsal striatum, and are associated with different patterns of cortical activation.
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Affiliation(s)
- S. Jauhar
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - L. Fortea
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - A. Solanes
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- FIDMAG, Germanes Hospitalàries Research foundation, Barcelona, Spain
- Antonomous University of Barcelona, Barcelona, Spain
| | - A. Albajes-Eizagirre
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- FIDMAG, Germanes Hospitalàries Research foundation, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - P. J. McKenna
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - J. Radua
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- FIDMAG, Germanes Hospitalàries Research foundation, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Jauhar S, Lai S, Bonoldi I, Salazar de Pablo G, di Forti M, Alameda L, Donocik J, Iacoponi E, Spencer T, Haege B, McLaughlan D, Taylor D, Young AH, Thornicroft G, Gaughran F, MacCabe JH, Murray RM, McGuire P, Fusar-Poli P. Early intervention in psychosis during the COVID-19 pandemic: Maudsley recommendations. Eur Neuropsychopharmacol 2021; 47:130-135. [PMID: 33642195 PMCID: PMC8640608 DOI: 10.1016/j.euroneuro.2021.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 12/12/2022]
Affiliation(s)
- S Jauhar
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; COAST service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - S Lai
- COAST service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - I Bonoldi
- TREAT service, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom
| | - G Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - M di Forti
- LEO service, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - L Alameda
- LEO service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - J Donocik
- LEIS service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - E Iacoponi
- LEO service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - T Spencer
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; OASIS service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - B Haege
- STEP service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - D McLaughlan
- LEO Ward, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - D Taylor
- Pharmacy and Pathology, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - A H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - G Thornicroft
- LEO service, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - F Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; National Psychosis Unit, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - J H MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom; National Psychosis Unit, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - R M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom
| | - P McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom
| | - P Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; OASIS service, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
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Riese F, Guloksuz S, Roventa C, Fair J, Haravuori H, Rolko T, Flynn D, Giacco D, Banjac V, Jovanovic N, Bayat N, Palumbo C, Rusaka M, Kilic O, Augėnaitė J, Nawka A, Zenger M, Kekin I, Wuyts P, Barrett E, Bausch-Becker N, Mikaliūnas J, del Valle E, Feffer K, Lomax G, Marques J, Jauhar S. Pharmaceutical industry interactions of psychiatric trainees from 20 European countries. Eur Psychiatry 2020; 30:284-90. [DOI: 10.1016/j.eurpsy.2014.09.417] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/15/2014] [Accepted: 09/21/2014] [Indexed: 11/30/2022] Open
Abstract
AbstractBackground:Interactions between the pharmaceutical industry (PI) and psychiatrists have been under scrutiny recently, though there is little empirical evidence on the nature of the relationship and its intensity at psychiatry trainee level. We therefore studied the level of PI interactions and the underlying beliefs and attitudes in a large sample of European psychiatric trainees.Methods:One thousand four hundred and forty-four psychiatric trainees in 20 European countries were assessed cross-sectionally, with a 62-item questionnaire.Results:The total number of PI interactions in the preceding two months varied between countries, with least interactions in The Netherlands (M (Mean) = 0.92, SD = 1.44, range = 0–12) and most in Portugal (M = 19.06, SD = 17.44, range = 0–100). Trainees were more likely to believe that PI interactions have no impact on their own prescribing behaviour than that of other physicians (M = 3.30, SD = 1.26 vs. M = 2.39, SD = 1.06 on a 5-point Likert scale: 1 “completely disagree” to 5 “completely agree”). Assigning an educational role to the pharmaceutical industry was associated with more interactions and higher gift value (IRR (incidence rate ratio) = 1.21, 95%CI = 1.12–1.30 and OR = 1.18, 95%CI = 1.02–1.37).Conclusions:There are frequent interactions between European psychiatric trainees and the PI, with significant variation between countries. We identified several factors affecting this interaction, including attribution of an educational role to the PI. Creating alternative educational opportunities and specific training dedicated to PI interactions may therefore help to reduce the impact of the PI on psychiatric training.
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Affiliation(s)
- S Jauhar
- Department of Psychological Medicine,Institute of Psychiatry, Psychology and Neuroscience,London,UK
| | - K R Laws
- School of Life and Medical Sciences, University of Hertfordshire,Hatfield,UK
| | - P J McKenna
- FIDMAG Research Foundation, Barcelona and CIBERSAM,Spain
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Jauhar S, Krishnadas R, Nour MM, Cunningham-Owens D, Johnstone EC, Lawrie SM. Is there a symptomatic distinction between the affective psychoses and schizophrenia? A machine learning approach. Schizophr Res 2018; 202:241-247. [PMID: 30054176 DOI: 10.1016/j.schres.2018.06.070] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 04/21/2018] [Accepted: 06/30/2018] [Indexed: 10/28/2022]
Abstract
Dubiety exists over whether clinical symptoms of schizophrenia can be distinguished from affective psychosis, the assumption being that absence of a "point of rarity" indicates lack of nosological distinction, based on prior group-level analyses. Advanced machine learning techniques, using unsupervised (hierarchical clustering) and supervised (regularized logistic regression algorithm and nested-cross-validation) were applied to a dataset of 202 patients with functional psychosis (schizophrenia n = 120, affective psychosis, n = 82). Patients were initially assessed with the Present State Examination (PSE), and followed up 2.5 years later, when DSM III diagnoses were applied (independent of initial PSE). Based on PSE syndromes, unsupervised learning discriminated depressive (approximately unbiased probability, AUP = 0.92) and mania/psychosis (AUP = 0.94) clusters. The mania/psychosis cluster further split into two groups - a mania (AUP = 0.84) and a psychosis cluster (AUP = 0.88). Supervised machine learning classified schizophrenia or affective psychosis with 83.66% (95% CI = 77.83% to 88.48%) accuracy. Area under the ROC curve (AUROC) was 89.14%. True positive rate for schizophrenia was 88.24% (95%CI = 81.05-93.42%) and affective psychosis 77.11% (95%CI = 66.58-85.62). Classification accuracy and AUROC remained high when PSE syndromes corresponding to affective symptoms (those that corresponded to the depressive and mania clusters) were removed. PSE syndromes, based on clinical symptoms, therefore discriminated between schizophrenia and affective psychosis, suggesting validity to these diagnostic constructs.
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Affiliation(s)
- S Jauhar
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom.
| | - R Krishnadas
- Sackler Institute for Psychobiological Research, Glasgow Clinical Research Facility, Queen Elizabeth University Hospital, Glasgow, G51 4TF, United Kingdom.
| | - M M Nour
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Denmark Hill, London SE5 8AF, United Kingdom.
| | - D Cunningham-Owens
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF, United Kingdom.
| | - E C Johnstone
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF, United Kingdom.
| | - S M Lawrie
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF, United Kingdom.
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McCutcheon R, Beck K, D'Ambrosio E, Donocik J, Gobjila C, Jauhar S, Kaar S, Pillinger T, Reis Marques T, Rogdaki M, Howes OD. Antipsychotic plasma levels in the assessment of poor treatment response in schizophrenia. Acta Psychiatr Scand 2018; 137:39-46. [PMID: 29072776 PMCID: PMC5734612 DOI: 10.1111/acps.12825] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Treatment resistance is a challenge for the management of schizophrenia. It is not always clear whether inadequate response is secondary to medication ineffectiveness, as opposed to medication underexposure due to non-adherence or pharmacokinetic factors. We investigated the prevalence of subtherapeutic antipsychotic plasma levels in patients identified as treatment-resistant by their treating clinician. METHOD Between January 2012 and April 2017, antipsychotic plasma levels were measured in 99 individuals provisionally diagnosed with treatment-resistant schizophrenia by their treating clinicians, but not prescribed clozapine. Patients were followed up to determine whether they were subsequently admitted to hospital. RESULTS Thirty-five per cent of plasma levels were subtherapeutic, and of these, 34% were undetectable. Black ethnicity (P = 0.006) and lower dose (P < 0.001) were significantly associated with subtherapeutic/undetectable plasma levels. Individuals with subtherapeutic/undetectable levels were significantly more likely to be admitted to hospital (P = 0.02). CONCLUSION A significant proportion of patients considered treatment-resistant have subtherapeutic antipsychotic plasma levels, and this is associated with subsequent admission. The presence of subtherapeutic plasma levels may suggest a need to address adherence or pharmacokinetic factors as opposed to commencing clozapine treatment. While antipsychotic levels are not recommended for the routine adjustment of dosing, they may assist with the assessment of potential treatment resistance in schizophrenia.
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Affiliation(s)
- R. McCutcheon
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - K. Beck
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
| | - E. D'Ambrosio
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - J. Donocik
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - C. Gobjila
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - S. Jauhar
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - S. Kaar
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - T. Pillinger
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - T. Reis Marques
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - M. Rogdaki
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - O. D. Howes
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- MRC London Institute of Medical SciencesHammersmith HospitalLondonUK
- Faculty of MedicineInstitute of Clinical SciencesImperial College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
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Bhavsar V, Jauhar S, Murray RM, Hotopf M, Hatch SL, McNeill A, Boydell J, MacCabe JH. Tobacco smoking is associated with psychotic experiences in the general population of South London. Psychol Med 2018; 48:123-131. [PMID: 28655360 DOI: 10.1017/s0033291717001556] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The association between cigarette smoking and psychosis remains unexplained, but could relate to causal effects in both directions, confounding by socioeconomic factors, such as ethnicity, or use of other substances, including cannabis. Few studies have evaluated the association between cigarettes and psychotic experiences (PEs) in diverse, inner-city populations, or relationships with number of cigarettes consumed. METHODS We assessed associations and dose-response relationships between cigarette smoking and PEs in a cross-sectional survey of household residents (n = 1680) in South East London, using logistic regression to adjust for cannabis use, other illicit substances, and socioeconomic factors, including ethnicity. RESULTS We found association between any PEs and daily cigarette smoking, which remained following adjustment for age, gender, ethnicity, cannabis and use of illicit stimulant drugs (fully adjusted odds ratio 1.47, 95% confidence interval 1.01-2.15). Fully adjusted estimates for the association, and with number of PEs, increased with number of cigarettes smoked daily, implying a dose-response effect (p = 0.001 and <0.001, respectively). Odds of reporting any PEs in ex-smokers were similar to never-smokers. CONCLUSIONS In this diverse epidemiological sample, association between smoking and PEs was not explained by confounders such as cannabis or illicit drugs. Daily cigarette consumption showed a dose-response relationship with the odds of reporting PEs, and of reporting a greater number of PEs. There was no difference in odds of reporting PEs between ex-smokers and never-smokers, raising the possibility that the increase in PEs associated with smoking may be reversible.
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Affiliation(s)
- V Bhavsar
- Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London
| | - S Jauhar
- Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London
| | - R M Murray
- Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London
| | - M Hotopf
- Department of Psychological Medicine,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London
| | - S L Hatch
- Department of Psychological Medicine,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London
| | - A McNeill
- National Addictions Centre, Institute of Psychiatry, Psychology and Neuroscience and UK Centre for Tobacco and Alcohol Studies, King's College London,London
| | - J Boydell
- Cornwall Partnership Foundation NHS Trust,Cornwall
| | - J H MacCabe
- Department of Psychosis Studies,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London
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Jauhar S, Veronese M, Rogdaki M, Bloomfield M, Natesan S, Turkheimer F, Kapur S, Howes OD. Regulation of dopaminergic function: an [ 18F]-DOPA PET apomorphine challenge study in humans. Transl Psychiatry 2017; 7:e1027. [PMID: 28170002 PMCID: PMC5438020 DOI: 10.1038/tp.2016.270] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/25/2016] [Accepted: 08/02/2016] [Indexed: 02/08/2023] Open
Abstract
Dopaminergic function has a key role in normal brain function, dopaminergic dysfunction being implicated in numerous neuropsychiatric disorders. Animal studies show that dopaminergic stimulation regulates dopaminergic function, but it is not known whether this exists in humans. In the first study (study 1), we measured dopamine synthesis capacity (indexed as Kicer) to identify the relationship between baseline and change in Kicer under resting conditions for comparison with effects of dopaminergic stimulation. In the second study (study 2), we used a within-subjects design to test effects of dopaminergic stimulation on dopamine synthesis capacity. In study 1, eight volunteers received two 18F-DOPA scans on separate days, both at rest. In study 2, 12 healthy male volunteers received two 18F-DOPA positron emission tomographic (PET) scans after treatment with either the dopamine partial agonist apomorphine (0.03 or 0.005 mg kg-1) or placebo. In study 1, no significant correlation was found between baseline and change in dopamine synthesis capacity between scans (r=-0.57, n=8, P=0.17, two-tailed). In study 2, a significant negative correlation was found between baseline dopamine synthesis capacity and percentage change in dopamine synthesis capacity after apomorphine challenge (r=-0.71, n=12, P=0.01, two-tailed). This correlation was significantly different (P<0.01) from the correlation between baseline and change in dopamine synthesis capacity under unstimulated conditions. One-way repeated-measures analysis of variance showed a significant group (study 1/study 2) × time interaction (F(1,18)=11.5, P=0.003). Our findings suggest that regulation of dopamine synthesis capacity by apomorphine depends on baseline dopamine function, consistent with dopamine stimulation stabilizing dopaminergic function. Loss of this autoregulation may contribute to dopaminergic dysfunction in brain disorders such as schizophrenia, substance dependence, and Parkinson's disease.
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Affiliation(s)
- S Jauhar
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - M Veronese
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - M Rogdaki
- MRC London Institute of Medical Sciences, London, UK
| | - M Bloomfield
- MRC London Institute of Medical Sciences, London, UK
| | - S Natesan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - F Turkheimer
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - S Kapur
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - O D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK,MRC London Institute of Medical Sciences, London, UK,Institute of Clinical Sciences, Department of Medicine, Imperial College London, London, UK,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College, Box 67, Camberwell, London SE5 8AF, UK. E-mail:
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McKenna PJ, Laws KR, Jauhar S. Selective reporting of results in guidelines. Br J Psychiatry 2015; 207:560-1. [PMID: 26628697 DOI: 10.1192/bjp.207.6.560a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- P J McKenna
- P. J. McKenna, Germanes Hospitalàries Research Foundation and CIBERSAM, Spain. ; K. R. Laws, School of Life and Medical Sciences, University of Hertfordshire, UK; S. Jauhar, Department of Psychosis Studies, Institute of Psychiatry, London, UK
| | - K R Laws
- P. J. McKenna, Germanes Hospitalàries Research Foundation and CIBERSAM, Spain. ; K. R. Laws, School of Life and Medical Sciences, University of Hertfordshire, UK; S. Jauhar, Department of Psychosis Studies, Institute of Psychiatry, London, UK
| | - S Jauhar
- P. J. McKenna, Germanes Hospitalàries Research Foundation and CIBERSAM, Spain. ; K. R. Laws, School of Life and Medical Sciences, University of Hertfordshire, UK; S. Jauhar, Department of Psychosis Studies, Institute of Psychiatry, London, UK
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McKenna PJ, Laws KR, Jauhar S. Authors' reply. Br J Psychiatry 2015; 207:269-70. [PMID: 26329567 DOI: 10.1192/bjp.207.3.269a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- P J McKenna
- P. J. McKenna, MB ChB, FIDMAG Germanes Hospitalàries Research Foundation and CIBERSAM, Spain. ; K. R. Laws, PhD, School of Life and Medical Sciences, University of Hertfordshire, UK; S. Jauhar, MB, ChB, BSc (Hons), Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - K R Laws
- P. J. McKenna, MB ChB, FIDMAG Germanes Hospitalàries Research Foundation and CIBERSAM, Spain. ; K. R. Laws, PhD, School of Life and Medical Sciences, University of Hertfordshire, UK; S. Jauhar, MB, ChB, BSc (Hons), Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - S Jauhar
- P. J. McKenna, MB ChB, FIDMAG Germanes Hospitalàries Research Foundation and CIBERSAM, Spain. ; K. R. Laws, PhD, School of Life and Medical Sciences, University of Hertfordshire, UK; S. Jauhar, MB, ChB, BSc (Hons), Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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McKenna PJ, Radua J, Laws KR, Jauhar S. Authors' reply. Br J Psychiatry 2014; 205:160-1. [PMID: 25252325 DOI: 10.1192/bjp.205.2.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- P J McKenna
- P. J. McKenna, MB ChB, J. Radua, MD, PhD, FIDMAG Germanes Hospitalàries Research Foundation and CIBERSAM, Spain. ; K. R. Laws, PhD, School of Life and Medical Sciences, University of Hertfordshire, UK; S. Jauhar, MB, ChB, BSc (Hons), Department of Psychosis Studies, Institute of Psychiatry, London, UK
| | - J Radua
- P. J. McKenna, MB ChB, J. Radua, MD, PhD, FIDMAG Germanes Hospitalàries Research Foundation and CIBERSAM, Spain. ; K. R. Laws, PhD, School of Life and Medical Sciences, University of Hertfordshire, UK; S. Jauhar, MB, ChB, BSc (Hons), Department of Psychosis Studies, Institute of Psychiatry, London, UK
| | - K R Laws
- P. J. McKenna, MB ChB, J. Radua, MD, PhD, FIDMAG Germanes Hospitalàries Research Foundation and CIBERSAM, Spain. ; K. R. Laws, PhD, School of Life and Medical Sciences, University of Hertfordshire, UK; S. Jauhar, MB, ChB, BSc (Hons), Department of Psychosis Studies, Institute of Psychiatry, London, UK
| | - S Jauhar
- P. J. McKenna, MB ChB, J. Radua, MD, PhD, FIDMAG Germanes Hospitalàries Research Foundation and CIBERSAM, Spain. ; K. R. Laws, PhD, School of Life and Medical Sciences, University of Hertfordshire, UK; S. Jauhar, MB, ChB, BSc (Hons), Department of Psychosis Studies, Institute of Psychiatry, London, UK
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Affiliation(s)
- P J McKenna
- P. J. McKenna, FIDMAG Germanes Hospitalàries Research Foundation, Barcelona and CIBERSAM, Spain. ; J. Radua, FIDMAG Germanes Hospitalàries Research Foundation, Barcelona and CIBERSAM, Spain; S. Jauhar, Department of Psychosis Studies, Institute of Psychiatry, London, UK; K. R. Laws, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - J Radua
- P. J. McKenna, FIDMAG Germanes Hospitalàries Research Foundation, Barcelona and CIBERSAM, Spain. ; J. Radua, FIDMAG Germanes Hospitalàries Research Foundation, Barcelona and CIBERSAM, Spain; S. Jauhar, Department of Psychosis Studies, Institute of Psychiatry, London, UK; K. R. Laws, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - S Jauhar
- P. J. McKenna, FIDMAG Germanes Hospitalàries Research Foundation, Barcelona and CIBERSAM, Spain. ; J. Radua, FIDMAG Germanes Hospitalàries Research Foundation, Barcelona and CIBERSAM, Spain; S. Jauhar, Department of Psychosis Studies, Institute of Psychiatry, London, UK; K. R. Laws, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - K R Laws
- P. J. McKenna, FIDMAG Germanes Hospitalàries Research Foundation, Barcelona and CIBERSAM, Spain. ; J. Radua, FIDMAG Germanes Hospitalàries Research Foundation, Barcelona and CIBERSAM, Spain; S. Jauhar, Department of Psychosis Studies, Institute of Psychiatry, London, UK; K. R. Laws, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Jauhar S, McKenna PJ, Radua J, Fung E, Salvador R, Laws KR. Cognitive-behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias. Br J Psychiatry 2014; 204:20-9. [PMID: 24385461 DOI: 10.1192/bjp.bp.112.116285] [Citation(s) in RCA: 302] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cognitive-behavioural therapy (CBT) is considered to be effective for the symptoms of schizophrenia. However, this view is based mainly on meta-analysis, whose findings can be influenced by failure to consider sources of bias. AIMS To conduct a systematic review and meta-analysis of the effectiveness of CBT for schizophrenic symptoms that includes an examination of potential sources of bias. METHOD Data were pooled from randomised trials providing end-of-study data on overall, positive and negative symptoms. The moderating effects of randomisation, masking of outcome assessments, incompleteness of outcome data and use of a control intervention were examined. Publication bias was also investigated. RESULTS Pooled effect sizes were -0.33 (95% CI -0.47 to -0.19) in 34 studies of overall symptoms, -0.25 (95% CI -0.37 to -0.13) in 33 studies of positive symptoms and -0.13 (95% CI -0.25 to -0.01) in 34 studies of negative symptoms. Masking significantly moderated effect size in the meta-analyses of overall symptoms (effect sizes -0.62 (95% CI -0.88 to -0.35) v. -0.15 (95% CI -0.27 to -0.03), P = 0.001) and positive symptoms (effect sizes -0.57 (95% CI -0.76 to -0.39) v. -0.08 (95% CI -0.18 to 0.03), P<0.001). Use of a control intervention did not moderate effect size in any of the analyses. There was no consistent evidence of publication bias across different analyses. CONCLUSIONS Cognitive-behavioural therapy has a therapeutic effect on schizophrenic symptoms in the 'small' range. This reduces further when sources of bias, particularly masking, are controlled for.
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Affiliation(s)
- S Jauhar
- S. Jauhar, MB, ChB, BSc(Hons), MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, London, UK; P. J. McKenna, MB, ChB, MRCPsych, J. Radua, MD, PhD, FIDMAG Germanes Hospitalàries Research Foundation, Barcelona and CIBERSAM, Spain; E. Fung, MD, Department of Psychiatry, Faculty of Medicine, University of Calgary, Alberta, Canada; R. Salvador, PhD, FIDMAG Germanes Hospitalàries Research Foundation, Barcelona and CIBERSAM, Spain; K. R. Laws, PhD, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Jaber A, Whitworth JM, Corbett IP, Al-Baqshi B, Jauhar S, Meechan JG. Effect of massage on the efficacy of the mental and incisive nerve block. Anesth Prog 2013; 60:15-20. [PMID: 23506279 DOI: 10.2344/12-00024.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The purpose of this trial was to assess the effect of soft tissue massage on the efficacy of the mental and incisive nerve block (MINB). Thirty-eight volunteers received MINB of 2.2 mL of 2% lidocaine with 1 : 80,000 epinephrine on 2 occasions. At one visit the soft tissue overlying the injection site was massaged for 60 seconds (active treatment). At the other visit the crowns of the mandibular premolar teeth were massaged (control treatment). Order of treatments was randomized. An electronic pulp tester was used to measure pulpal anesthesia in the ipsilateral mandibular first molar, a premolar, and lateral incisor teeth up to 45 minutes following the injection. The efficacy of pulp anesthesia was determined by 2 methods: (a) by quantifying the number of episodes with no response to maximal electronic pulp stimulation after each treatment, and (b) by quantifying the number of volunteers with no response to maximal pulp stimulation (80 reading) on 2 or more consecutive tests, termed anesthetic success. Data were analyzed by McNemar, Mann-Whitney, and paired-samples t tests. Anesthetic success was 52.6% for active and 42.1% for control treatment for lateral incisors, 89.5 and 86.8% respectively for premolars, and 50.0 and 42.1% respectively for first molars (P = .344, 1.0, and .508 respectively). There were no significant differences in the number of episodes of negative response to maximum pulp tester stimulation between active and control massage. A total of 131 episodes were recorded after both active and control massage in lateral incisors (McNemar test, P = 1.0), 329 (active) versus 316 (control) episodes in the premolars (McNemar test, P = .344), and 119 (active) versus 109 (control) episodes respectively for first molars (McNemar test, P = .444). Speed of anesthetic onset and discomfort did not differ between treatments. We concluded that soft tissue massage after MINB does not influence anesthetic efficacy.
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Affiliation(s)
- A Jaber
- School of Dental Sciences, Newcastle University, UK
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Riese F, Guloksuz S, Roventa C, Fair J, Haravuori H, Rolko T, Flynn D, Giacco D, Banjac V, Jovanovic N, Bayat N, Palumbo C, Rusaka M, Kilic O, Augėnaitė J, Nawka A, Zenger M, Kekin I, Wuyts P, Barrett E, Bausch-Becker N, Mikaliunas J, del Valle E, Feffer K, Lomax G, Gama Marques J, Jauhar S. 721 – European psychiatric trainees and their interactions with the pharmaceutical industry: results from the efpt-prirs study. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)75941-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Jauhar S, Orchardson R, Banham SW, Livingston E, Sherriff A, Lyons MF. The Kushida Index as a screening tool for obstructive sleep apnoea-hypopnoea syndrome. Br Dent J 2012; 212:E2. [PMID: 22240714 DOI: 10.1038/sj.bdj.2012.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To test the validity of the Kushida Index for screening for sleep apnoea in a West of Scotland adult population. METHODS Specific intra-oral measurements and respiratory polysomnography were carried out on 71 patients in this prospective study. The intra-oral measurements were applied to the Kushida formula to obtain a value for the Kushida Index. This value was compared to the diagnosis obtained using polysomnography in the conventional manner. RESULTS The sensitivity of the Kushida Index in this present study was 68% (95% CI 50-81) and the specificity was 71% (95% CI 52-84). The positive predictive value was 71% and the negative predictive value was 67%. The Mallampati score, Epworth sleepiness score and enlargement of the tongue, soft palate or tonsils were not statistically significantly related to a diagnosis of sleep apnoea (p >0.05). CONCLUSION With the limited sensitivity and specificity of the Kushida Index demonstrated in this study, this test cannot be recommended as a screening tool for sleep apnoea in a West of Scotland population.
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Affiliation(s)
- S Jauhar
- Department of Restorative Dentistry, Glasgow Dental Hospital and School, 378 Sauchiehall Street, Glasgow G2 3JZ.
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Gama Marques J, Andlauer O, Banjac V, Guloksuz S, Jauhar S, Kilic O, Mitkovic M, Nawka A, Palumbo C, Pantovic M, Pinto da Costa M, Riese F. P-852 - Access to information in psychiatric training (ATIIPT) among the delegates to the european federation of psychiatric trainees (EFPT) 2011 forum. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)75019-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Jauhar S, Guloksuz S, Marques J, Nawka A, Roventa C, Psaras R, Andlauer O, Lydall G, De Vriendt N, Mendonca L, Van Zanten J, Dumiterscu I, Nwachukwu I, Riese F. How do european psychiatry trainees prescribe when treating depression, and what influences decision-making? (Survey of the European Federation of Psychiatric Trainees Research Group). Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72953-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
ObjectivesDespite recent recent evidence and subsequent guidelines that have suggested factors such as side-effect profile and cost should be taken into account when prescribing antidepressant medication, relatively little evidence exists on decision-making in clinical practice.Our Pan-European Research Group looked at clinical practice regarding antidepressants amongst Psychiatry trainees, treatments trainees would desire themselves, and factors influencing decision-making.MethodsA semi-structured survey was constructed from recent literature, was piloted, and a homogenous sample size of at least 50 agreed upon from each country, with 50% the minimum response rate. It was distributed via web-link, questioning preference of antidepressant for patients, and factors influencing choice. Trainees were asked for their preference should they develop a moderate to severe depressive episode, and require medication.ResultsTreatment choices are summarised in Table 1. 79% of trainees would prescribe similar antidepressants for themselves as for patients.Factors influencing decision-making mapped onto three main domains: cost, efficacy and side-effect profile (5% other reasons). 86% (n = 548) of those who responded felt efficacy most important, 38% (n = 237) felt side-effect profile most important and 6% (n = 33) considered cost of most importance.ConclusionsSome differences exist in choice of antidepressant for European trainees and their patients, and factors affecting choice conflict with evidence base and guideline suggestions.
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Jauhar S. ECP09-04 - The european federation of psychiatric trainees' psychiatric resident - industry relationship survey (efpt-prirs). Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)73512-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
There is no doubt that, in the modern era, psychiatry and the pharmaceutical industry have a relationship, though the nature of this is not universally well defined. Given that psychotropic medication is widely prescribed (ranking 3rd and 4th in US sales in 2007), and the role of the pharmaceutical industry in medical education has come under scrutiny, it is worth noting that the relationship between the industry and psychiatry trainees has not been studied in great depth.Our Pan-European research group, composed exclusively of psychiatry trainees from at least 18 different countries, as part of the European Federation of Psychiatric Trainees (EFPT) has sought to study this in a systematic fashion. I will present preliminary findings of our survey, PRIRS (Psychiatric Residents-Industry Relationship Survey) which is currently taking place.It is also hoped that this will facilitate a discussion amongst those attending the session, on the role of the pharmaceutical industry in psychiatric training, education and in general.
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Hickey B, Jauhar S. Gingival veneers. SADJ 2010; 65:118-120. [PMID: 20496844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- B Hickey
- Glasgow Dental Hospital and School, 378 Sauchiehall Street, Glasgow, Scotland
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Jauhar S, Guloksuz S, Gama Marques J, Bendix M, Lydall G, Andlauer O, Gerber S, Roventa C, Van Zanten J, De Vriendt N, Nawka A, Nwachukw I, Dobrzynska E, Mufic A, Nazaraliev A, Dumitrescu I, Mendonca L, Riese F. P03-343 - Treatment choice in psychiatry? How would European trainees treat psychosis for their patients and themselves, and what influences decision-making? Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70949-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Jauhar S, Lydall G, Riese F, Gama Marques J, Bendix M, Andlauer O, Gerber S, De Vriendt N, Dumitrescu I, Nawka A, Guloksuz S, Mendonca L, Nwachukw I, Psaras R, Roventa C, Giacco D, Mufic A, Dobrzynska E, Nazaraliev A, Van Zanten J. PW01-264 - How would European trainees treat bipolar disorder for their patients and themselves, and what influences decision-making? Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71577-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Jauhar S. P03-342 - The European federation of psychiatric trainees research group; initial findings. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70948-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Riese F, Jauhar S, Guloksuz S, Andlauer O, Lydall G, Gama Marques J, Van Zanten J, Bendix M, Giacco D, Gerber S, Mendonca L, Nawka A, De Vriendt N, Nazaraliev A, Psaras R, Nwachukw I, Roventa C, Atay O, Coccia F, Barry H, Nikitopoulos J, Rusaka M, Kudinova M, Mitkovic M, Ostrovschi N, Sos P, Wuyts P, Rakos I, Volpe U. P02-184 - The European federation of psychiatric trainees’ psychiatric resident - industry relationship survey (EFPT-PRIRS). Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70799-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Leitch J, Jauhar S. A Follow-up Survey of the Teaching of Conscious Sedation in Dental Schools of the United Kingdom and Ireland. Anesth Prog 2006; 53:43-8. [PMID: 16863392 PMCID: PMC1614217 DOI: 10.2344/0003-3006(2006)53[43:afsott]2.0.co;2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Accepted: 03/22/2006] [Indexed: 11/11/2022] Open
Abstract
The purpose of this follow-up study was to assess and compare the quantity and quality of dental undergraduate teaching in conscious sedation with comparisons to a previous study conducted in 1998. Questionnaires were designed to collect information about undergraduate sedation education from teaching staff and final-year dental undergraduates at the 15 dental schools in the United Kingdom and Ireland. Staff responses from 9 schools (60%) and student responses from 11 schools (73%) were received. From the students' responses, the mean (range) number of cases observed in inhalational sedation was 7 (0-17) and the mean (range) number performed in inhalational sedation was 4 (0-8). The mean (range) number of cases observed in intravenous sedation was 9 (2-19), and the mean (range) number performed was 5 (0-8). There has been an increase in didactic teaching. There has been a decrease in the observing of inhalational cases, but an increase in the hands-on performance of this type of sedation. There is an increase in the hands-on teaching of intravenous sedation.
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Affiliation(s)
- J Leitch
- Department of Sedation, Glasgow Dental Hospital and School, UK.
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Kouwenhoven LP, Jauhar S, Orenstein J, McEuen PL, Nagamune Y, Motohisa J, Sakaki H. Observation of photon-assisted tunneling through a quantum dot. Phys Rev Lett 1994; 73:3443-3446. [PMID: 10057382 DOI: 10.1103/physrevlett.73.3443] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Kouwenhoven LP, Jauhar S, McCormick K, Dixon D, McEuen PL, Nazarov YV, Foxon CT. Photon-assisted tunneling through a quantum dot. Phys Rev B Condens Matter 1994; 50:2019-2022. [PMID: 9976406 DOI: 10.1103/physrevb.50.2019] [Citation(s) in RCA: 177] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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