Search

This study aims to analyze changes in health-related quality of life (HRQoL) and safety in patients with generalized anxiety disorder (GAD) prescribed a homogenous selection of cannabis-based medicinal products (CBMPs). Patients prescribed Adven CBMPs (Curaleaf International, UK) for GAD were identified from the UK Medical Cannabis Registry. Primary outcomes were changes in patient-reported outcome measures (PROMs) from baseline up to 12 months, including GAD-7, Single-Item Sleep Quality Scale (SQS), and EQ-5D-5L. Adverse events were recorded using CTCAE version 4.0. A total of 120 patients were identified for inclusion, of which 38 (31.67%), 52 (43.33%), and 30 (25.00%) were prescribed oils, dried flower, and both formulations of CBMP. Associated improvements in GAD-7, SQS, and EQ-5D-5L at 1, 3, 6, and 12 months were observed compared to baseline ( P  < 0.010). There were 24 (20.00%) patients who reported 442 (368.33%) adverse events, most of which were mild (n = 184, 41.63%) and moderate (n = 197, 44.57%). This study reports an association between initiation of a homogeneous CBMP therapy and improvements in anxiety severity and HRQoL in individuals with GAD. Moreover, therapy was well-tolerated at 12 months follow-up. Further investigation through randomized controlled trials will ultimately be required to determine causation., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Around 2% of the population have intellectual disabilities. Over one-third people with intellectual disabilities (PwID) present with 'challenging behaviour', which nosologically and diagnostically is an abstract concept. Challenging behaviour is influenced by a range of bio-psycho-social factors in a population, which is unable to suitably comprehend and/or communicate concerns. This predisposes to poor health and social outcomes. There is no evidence-based treatments for managing challenging behaviour. Cannabidiol (CBD) and tetrahydrocannabinol (THC) are being trialled for a range of disorders, which are over-represented in PwID and provoke challenging behaviours, such as severe epilepsy, spasticity, post-traumatic stress disorder, social phobia, pain, etc., Methods: This perspective review explores the different conditions, which benefit from medicinal CBD/THC preparations, by analysing recent literature from neurobiological, pre-clinical and clinical studies related to the topic. The evidence is synthesised to build an argument of the therapeutic benefits and challenges of medicinal cannabis to manage severe challenging behaviour in PwID., Results: There is developing evidence of medicinal CBD/THC improving psychiatric and behavioural presentations in general. In particular, there is emergent proof in certain key areas of influence of medicinal CBD/THC positively supporting challenging behaviour, for example in children with neurodevelopmental disorders. However, there are significant challenges in employing such treatments in vulnerable populations such as PwID., Conclusion: Further clinical research for the considered use of medicinal CBD/THC for challenging behaviour management in PwID is needed. Strong co-production with experts with lived experience is needed for further testing to be done in this exciting new area., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: LK works privately half a day a week for Sapphire Clinics https://www.sapphireclinics.com/ which is a medicinal cannabis prescribing private clinic. She also runs a cannabinoid peer group in her Trust. She has contributed to the Volteface-led report for the All-Party Parliamentary Group exploring the need for appropriate and indication-specific prescribing of cannabis medications in the UK. RS has received institutional and research support from LivaNova, UCB, Eisai, Veriton Pharma, Bial, Angelini, UnEEG and Jazz/GW pharma outside the submitted work. No other author has any notable disclosures.

Sleep is vital for our physical and mental health. Studies have shown that there is a high prevalence of sleep disorders and sleep difficulties amongst adults with intellectual disabilities. Despite this, sleep is often overlooked or its disorders are considered to be difficult to treat in adults with intellectual disabilities. There is a significant amount of research and guidance on management of sleep disorders in the general population. However, the evidence base for sleep disorders in adults with intellectual disabilities is limited. In this review paper, we look at the current evidence base for sleep disorders in adults with an intellectual disability, discuss collaborative working between intellectual disabilities psychiatrists and sleep medicine specialists to manage sleep disorders, and provide recommendations for future directions.

We performed a single-centre study to assess the risk of cardiovascular disease (CVD) in psychiatry outpatients with intellectual disability (ID) using the QRISK-3 score. There were 143 patients known to the ID psychiatry clinic enrolled. Of these, 28 (19.6%) had elevated CVD risk - defined as 10-year risk of heart attack or stroke of ≥10%. Of these, 57.1% were not prescribed statin therapy, which - after lifestyle measures - is recommended by National Institute for Health and Care Excellence (NICE) guidelines. The mean QRISK-3 score was 6.31% (95% confidence interval [CI] 4.84 to 7.78), with a relative risk of 3.50 (95%CI 2.34 to 4.67) compared with matched controls. The high CVD risk identified in this study supports routine CVD risk assessment and management in adult outpatients with ID. Appropriate lifestyle measures and statin therapy could help reduce the excess CVD-related morbidity and mortality in ID patients., Competing Interests: Conflicts of interest None declared., (Copyright © 2021 Medinews (Cardiology) Limited.)

Background : Attention-deficit hyperactivity disorder (ADHD) is higher in people with intellectual disability (ID) compared to the general population. Available limited evidence suggests this population has increased psychological problems, diagnostic overshadowing and psychotropic prescribing. This audit Identifies and analyzes real-world characteristics, diagnostic practices, treatment, and management of ADHD in adults with ID. Research Design and Methods: Pooled retrospective case note data for people with ID and ADHD, collected from 30 organizations across the UK, were analyzed. Patients were classified into mild and moderate-profound ID groups. Associated mental health and neurodevelopmental co-morbidity, Demographics, concomitant psychotropics, and mental and behavioral concerns were collected. Group differences were reported using logistic regression models. Results: Of 445 participants, 73% had co-occurring autism spectrum disorder (ASD) and 65% were prescribed ADHD medications. Those on ADHD medication were less likely to be prescribed antipsychotics (p < 0.001) and antidepressants (p < 0.001). Multiple significant differences were found in ADHD medication response between ID groups and those with/without co-morbid ASD but not associated with challenging behavior reduction. Conclusions: High levels of neurodevelopmental and psychiatric comorbidity were found. ID severity and the presence of ASD appear to influence the use of certain psychotropic medications. Appropriate use of ADHD medication appears to reduce psychotropic polypharmacy.

Modern ultrasound-guided prostate brachytherapy is rapidly changing the way localized prostate cancer is managed. With routine use of prostate-specific antigen screening, prostate cancer is being diagnosed in younger men, who are understandably concerned about the morbidity of radical treatments that may significantly decrease their quality of life. Numerous studies of prostate brachytherapy have shown the excellent disease control rates achieved while maintaining low levels of urinary and erectile difficulties. This report examines a modern implant method of brachytherapy; describes patient selection for brachytherapy, alone and in combination with external beam therapy; and presents results from a series of men followed for 12 years.

Background: The purported lack of long term modern prostate brachytherapy outcome data continues to lead many physicians to recommend other, more traditional treatments. This concern for long term results has encouraged the authors to supplement their earlier 10-year follow-up of patients receiving brachytherapy; in the process, an additional 77 patients (> 50%) were added to the original cohort, and the follow-up time was increased by 2 years., Methods: Between January 1987 and September 1989, 229 patients with T1-T3 prostate carcinoma underwent transperineal prostate brachytherapy using iodine-125 (I-125). No patient received adjuvant hormone therapy. The median Gleason sum was 5 (range, 2-10). Of these patients, 147 were determined to have a high probability of organ-confined disease and were treated solely with an I-125 implant. The remaining 82 patients were determined to be at increased risk for extracapsular disease and received pelvic external beam radiation in addition to brachytherapy. All patients were followed continuously. Failure was defined as a positive biopsy, radiographic evidence of metastases, or three consecutive rises in prostate specific antigen (PSA) levels as defined by the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus article., Results: Excluding deaths from intercurrent disease, the median follow-up was 122 months (range, 18-144 months). Fourteen patients were excluded from analysis due to insufficient follow-up. Adopting the ASTRO definition of failure resulted in minimal change in survival when compared with the authors' previous study, which used a PSA level > 0.5 ng/mL as the failure point. Observed 10-year disease free survival (DFS) for the entire cohort was 70%. In the brachytherapy only group, the observed 10-year DFS was 66%, whereas those patients treated with the addition of external pelvic radiation achieved a DFS of 79%. None of the patients who were followed for the full 12 years failed between Years 10 and 12. Only 25% of the failures observed occurred > 5 years after treatment, thus confirming the durability of brachytherapy., Conclusions: Prostate brachytherapy provides excellent long term disease control with few late failures reported in the authors' program. The addition of external beam radiation appears to confer survival advantages in selected patients. Using the ASTRO failure criteria for long term follow-up resulted in no significant difference compared with using a PSA failure point of 0.5 ng/mL., (Copyright 2000 American Cancer Society.)

The large population of men who will develop metastatic prostate cancer creates a strong need for good palliative care. For many men, androgen ablation works well; however, when this fails, the quality of a man's life can quickly degrade. Pain from skeletal metastases, neurologic involvement, bleeding, and obstruction can all occur. Radiotherapy has long been the gold standard for palliation of symptomatic disease. However, a new approach using hemibody irradiation (HBI) earlier in the disease course, as well as more effective and tolerable dose and fractionation schemes for local field radiation, are providing excellent amelioration of symptoms and the possibility of living longer and more comfortably to many men with metastatic prostate cancer. The indications and use of therapeutic systemic radioisotopes to help achieve these objectives are also discussed., (Copyright 2000 Wiley-Liss, Inc.)

Prostate brachytherapy is an effective treatment option for clinically organ-confined prostate carcinoma. Observed 5- and 10-year follow-up have documented prostate-specific antigen (PSA) levels that were comparable to published radical prostatectomy series and were better than several published external-beam radiation series. Between January 1987 and June 1988, a total of 152 consecutive patients with Stage T1 to T3 low to high Gleason grade prostate cancer were studied at Northwest Hospital in Seattle, Washington. Patients' median age was 70 years (range, 53 to 92 years). All patients received Iodine-125 prostate brachytherapy with or without a 45 Gy dose of external-beam radiation. The average preoperative PSA, clinical stage, and prostate needle biopsy Gleason sum were 11 ng/ml, T2, and (5), respectively, and were known in all but five patients. PSA follow-up, clinical examination, and biopsy results judged disease-free survival at 5 and 10 postoperative years. Elevation of PSA above 0.5 ng/ml or a positive biopsy or a positive bone scan was considered treatment failure. The authors provide an historical review of prostate brachytherapy in conjunction with up-to-date implant techniques and long-term outcome results., (Copyright 2000 Wiley-Liss, Inc.)

Vaccinia virus secretes a 35 kD protein, vaccinia virus complement control protein (VCP), that inhibits the classical and alternative pathways of complement at several points, indicating that it may be a viral analogue of human complement receptor type 1 (CR1; CD35). Structurally, however, CR1 is composed of 30 short consensus repeats (SCRs), whereas VCP consists entirely of four SCRs. We have begun a structure-function analysis of VCP to define the minimum number of SCRs necessary for function, the functional differences between VCP and CR1, and the potential therapeutic roles for VCP. We addressed these questions by creating and characterizing recombinant soluble and membrane-bound forms of VCP. We have determined that (1) VCP requires all four SCRs to bind C3b, (2) whereas CR1 binds C3b and iC3b, VCP binds C3b but not iC3b, and (3) although normally secreted, if expressed on the membrane of mammalian cells, VCP effectively protects the cells from complement-mediated lysis. Thus, VCP appears to be a compact and unique complement regulatory protein with the ability to inhibit both arms of the complement cascade, but lacking affinity for iC3b. By releasing rather than capturing iC3b-bearing complexes following inactivation of C3b, VCP may 'recycle' its active site locally among infected cells, and thereby enable the virus to evade more efficiently host immune and inflammatory responses. The unique function, compact structure, and capacity of VCP to protect mammalian cells from complement-mediated attack, suggests that it could be used both to better understand the structure-function relationship of complement regulatory proteins, in general, and also to rationally design and develop novel therapeutic agents.

Complete deficiency of C1q, the first component of the classical pathway of complement activation, is almost invariably associated with the development of systemic lupus erythematosus. Understanding why complement deficiency results in the specific autoimmune phenotype of SLE may provide valuable clues to the role of complement in the maintenance of immune tolerance. The following review will focus on the characteristics of complement-deficient SLE and the experimental evidence in support of our hypothesis that C1q may critically influence the immune response to self-antigen contained within surface blebs generated by apoptotic cells.

Purpose: To study the dose distributions of high dose rate (HDR) endobronchial implants using the dose nonuniformity ratio (DNR) and three volumetric irradiation indices., Methods and Materials: Multiple implants were configured by allowing a single HDR 192Ir source to step through a length of 6 cm along an endobronchial catheter. Dwell times were computed to deliver a dose of 5 Gy to points 1 cm away from the catheter axis. Five sets of source configurations, each with different dwell position spacings from 0.5 to 3.0 cm, were evaluated. Three-dimensional (3D) dose distributions were then generated for each source configuration. Differential and cumulative dose-volume curves were generated to quantify the degree of target volume coverage, dose nonuniformity within the target volume, and irradiation of tissues outside the target volume. Evaluation of the implants were made using the DNR and three volumetric irradiation indices., Results: The observed isodose distributions were not able to satisfy all the dose constraints. The ability to optimally satisfy the dose constraints depended on the choice of dwell position spacing and the specification of the dose constraint points. The DNR and irradiation indices suggest that small dwell position spacing does not result in a more homogeneous dose distribution for the implant. This study supports the existence of a relationship between the dwell position spacing and the distance from the catheter axis to the reference dose or dose constraint points. Better dose homogeneity for an implant can be obtained if the spacing of the dwell positions are about twice the distance from the catheter axis to the reference dose or dose constraint points.

The effects of extended source-to-surface distance (SSD) on the electron-beam depth dose curves were examined for five electron beam energies ranging from 6 MeV to 20 MeV. The depth dose curves were measured with the water phantom surface set at 100 cm, 110 cm, and 120 cm from the source. Except for the dose in the build-up region, negligible depth dose curve changes due to extended SSD were observed for electron energies less than or equal to 12 MeV. For electron beams greater than 12 MeV, the percent surface dose decreases and, additionally, the depth of maximum dose shifts deeper into the phantom as the SSD increases. Changes in the rapid falloff region of the depth dose curves were apparent only for the higher energy electron beams, in particular 20 MeV. Extended SSD has no observable effect on the tail portion of the depth dose curves. As such, the energies of the electron beams are not changed significantly by increasing the SSD.

This is a retrospective analysis of the management of the neck in 84 patients with squamous cell carcinoma of the oral tongue treated with curative intent between 1968 and 1985. Patients with a clinically negative neck were treated to the neck only if the patient was thought to have a reasonable probability of occult neck metastases. This policy resulted in a 3-year adjusted neck control rate for N0 patients treated with limited (no, bilateral-partial, or ipsilateral) neck therapy of 38% compared with 95% for patients treated with bilateral, whole neck irradiation (p less than .001). None of the relapses in the patients with limited irradiation were in the treatment portal. Attempted salvage with a neck dissection resulted in cure in only 30%. The 3-year adjusted neck control rate for the N1 and N2 patients treated with total neck irradiation and surgery was 75% and 63%, respectively. The location of recurrence in these patients was in the field of irradiation, but contralateral to the side of the neck dissection.