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Predicting Treatment Response to Antidepressant Medication Using Early Changes in Emotional Processing

15 November 2018

Comparative economic evaluation of quetiapine plus lamotrigine combination versus quetiapine monotherapy (and folic acid versus placebo) in patients with bipolar depression (CEQUEL).

15 November 2018

OBJECTIVES: Although not licensed for acute bipolar depression, lamotrigine has evidence for efficacy in trials and its use is recommended in guidelines. So far there had been no prospective health economic evaluation of its use. METHODS: Cost-utility analysis of the CEQUEL trial comparing quetiapine plus lamotrigine versus quetiapine monotherapy (and folic acid versus placebo in an add-on factorial design) for patients with bipolar depression (n=201) from the health and social care perspective. Differences in costs together with quality-adjusted life years (QALYs) between the groups were assessed over 52 weeks using a regression-based approach. RESULTS: Health-related quality of life improved substantially for all randomization groups during follow-up with no significant difference in QALYs between any of the comparisons (mean adjusted QALY difference: lamotrigine vs. placebo -0·001 (95% CI: -0·05 to 0·05), folic acid vs. placebo 0·002 (95% CI: -0·05 to 0·05)). While medication costs in the lamotrigine group were higher than in the placebo group (£647, p<0·001), mental health community/outpatient costs were significantly lower (-£670, p<0·001). Mean total costs were similar in the groups (-£180, p=0·913). CONCLUSIONS: Lamotrigine improved clinical ratings in bipolar depression compared with placebo. This differential effect was not detected using the EQ-5D-3L. The additional cost of lamotrigine was balanced by significant savings in some other medical costs which made its use cost neutral to the health service. Compared to placebo, folic acid produced neither clinical nor significant health economic benefits. The study supports the use of lamotrigine in combination with other drugs to treat bipolar depression. This article is protected by copyright. All rights reserved.

Sleep disturbance and intrusive memories after presenting to the emergency department following a traumatic motor vehicle accident: an exploratory analysis.

6 February 2019

Background: Sleep disturbances are common after traumatic events and have been hypothesized to be a risk factor in the development of psychopathology such as that associated with posttraumatic stress disorder (PTSD). Objective: To assess the association between intrusive memories, a core clinical feature of PTSD, and self-reported sleep disturbance shortly after experiencing or witnessing a motor vehicle accident, and whether a brief behavioural intervention (trauma reminder cue and Tetris gameplay) reduced sleep disturbance post-trauma. Method: The exploratory analyses included 71 participants (mean age 39.66, standard deviation 16.32; 37 women, 52.1%) enrolled in a previously published proof-of-concept randomized controlled trial. Participants were recruited from the emergency department after experiencing or witnessing a traumatic motor vehicle accident. Intrusive memories were assessed with a daily paper-and-pen diary for one week post-trauma, and sleep disturbances with three questions from the Impact of Event Scale-Revised assessing problems initiating sleep, problems maintaining sleep and dreams about the event at one week and one month post-trauma. Missing data were imputed 15 times. Results: The total number of intrusive memories during the first week post-trauma suggested weak to moderate pooled intercorrelations with problems initiating and maintaining sleep. An ordinal regression using imputed data suggested that the intervention had no effect on sleep disturbances, while completers only analyses suggested an improvement in problems maintaining sleep at one week. Conclusions: This exploratory study suggested that experiencing early intrusive memories is related to sleep disturbances. Sleep disturbance might be a particularly important construct to assess in studies involving intrusive memories post-trauma.

Deep brain stimulation: current challenges and future directions.

21 February 2019

The clinical use of deep brain stimulation (DBS) is among the most important advances in the clinical neurosciences in the past two decades. As a surgical tool, DBS can directly measure pathological brain activity and can deliver adjustable stimulation for therapeutic effect in neurological and psychiatric disorders correlated with dysfunctional circuitry. The development of DBS has opened new opportunities to access and interrogate malfunctioning brain circuits and to test the therapeutic potential of regulating the output of these circuits in a broad range of disorders. Despite the success and rapid adoption of DBS, crucial questions remain, including which brain areas should be targeted and in which patients. This Review considers how DBS has facilitated advances in our understanding of how circuit malfunction can lead to brain disorders and outlines the key unmet challenges and future directions in the DBS field. Determining the next steps in DBS science will help to define the future role of this technology in the development of novel therapeutics for the most challenging disorders affecting the human brain.

Metastable brain waves

6 February 2019

Decoding Movement States in Stepping Cycles Based on Subthalamic LFPs in Parkinsonian Patients

19 February 2019

The role of registration in functional magnetic resonance imaging

6 February 2019

© 2001 by CRC Press LLC. Functional magnetic resonance imaging, or fMRI, is a noninvasive imaging technique used to investigate physiological function. It is most commonly used to study brain function by measuring blood oxygenation level, although other organs (e.g., kidneys) and other quantities (e.g., perfusion) can be studied. This chapter concentrates on using fMRI for blood oxygenation-related imaging of the brain, as image registration has become an indispensible part of the analysis of these data for research and clinical purposes.

The Oxford study of Calcium channel Antagonism, Cognition, Mood instability and Sleep (OxCaMS): study protocol for a randomised controlled, experimental medicine study

15 February 2019

Discovery of key whole-brain transitions and dynamics during human wakefulness and non-REM sleep

15 February 2019

Neuromelanin-MRI in REM sleep behaviour disorder predicts dopaminergic dysfunction and clinical risk of Parkinson's disease

15 February 2019