There was widespread reporting in the media this week about a study looking at antipsychotic use in nursing homes in people with dementia.
Research in Mood Disorders
Placebo response in paediatric antidepressant trials was found to correlate with the number of sites involved in the study as well as the severity of the depression. The authors found an increasing placebo response (which is similar to a finding reported in an article on dementia research last year) and concluded that this could be due to milder cases of depression being included, increasing numbers of study sites in trials and non-publication of negative studies (STT4).
Research in Child and Adolescent Psychiatry
A prospective cohort study of 1037 children followed into adulthood found that lower IQ was a predictor for depression and anxiety in adulthood, whilst higher IQ was a predictor for adult mania. The authors recommend that this information is utilised in service development (STT4). In a study which looked at MRI scans of three groups – children with ADHD treated with psychostimulants, children with ADHD not treated with psychostimulants and age matched controls – the hypothesis being tested was that psychostimulants would interfere with cortical development using cortical thickness as a marker. The findings showed however that the children with ADHD not treated with psychostimulants were characterised by a thinner cortex than the other two groups while the psychostimulant treated group did not differ from the controls contrary to the null hypothesis (STT4). In an fMRI study of four groups – boys with ADHD, boys with ADHD with hyperactive-inattentive subtype, boys with conduct disorder and age matched controls – there was found in the conduct disorder subgroup to be reduced activation during a sustained attention task, in the insular cortex, hippocampus and anterior cingulate cortex and cerebellum whilst in the ADHD group there was found to be reduced activation in the ventrolateral prefrontal cortex and increased activation in the cerebellum (STT4). In another fMRI study there was found to be reduced Amygdala activation in response to presentation of fearful faces in boys with conduct problems and callous-unemotional traits (STT4).
Research in Dementia
There has been widespread reporting in the UK media about a study investigating the use of antipsychotics in people with dementia which shows increased mortality relative to those taking placebo. The dementia antipsychotic withdrawal trial (DART-AD) was a 12-week placebo-controlled trial in which patients in nursing homes were continued on one of five antipsychotics (thioridazine (which has since been withdrawn from general use), chlorpromazine, haloperidol, trifluoperazine and risperidone) or switched to oral placebo. 165 people were included in the trial, evenly divided between the two groups and survival in the groups were found to be 70% v 77% at 12 months (antipsychotic v placebo), 46% v 71% at 24 months (antipsychotics v placebo) and 30% v 59% at 36 months (antipsychotics v placebo). Important question here however include the indication for the antipsychotic and the choice of antipsychotics for inclusion (STT2).
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