Lisdexamfetamine dimesylate (LDX) is a long-acting prodrug stimulant for treatment of attention-deficit/hyperactivity disorder (ADHD).

Review efficacy and safety data from two double-blind, randomized trials (SPD489-325 and SPD489-326) in patients with ADHD aged 6–17 years.

In SPD489-325, patients received placebo or optimized doses of LDX or the reference treatment, osmotic-release oral system methylphenidate (OROS-MPH) for ≤7 weeks. The primary efficacy measure was ADHD Rating Scale IV (ADHD-RS-IV) total score. Statistical comparison of LDX versus OROS-MPH was not pre-specified. In SPD489-326, a ≥26-week open-label LDX period preceded a 6-week, placebo-controlled, randomized-withdrawal period (RWP). The primary endpoint was treatment failure (50% increase in ADHD-RS-IV total score and ≥2-point increase in Clinical Global Impressions-Severity score from RWP baseline). Efficacy was assessed in the full analysis sets.

In SPD489-325 (N=317), placebo-adjusted least-squares-mean changes in ADHD-RS-IV total score from baseline to endpoint were: LDX, –18.6 (95% confidence interval [CI]: –21.5, –15.7; p<0.001; effect size 1.80) and OROS MPH, –13.0 (–15.9, –10.2; p<0.001; 1.26). In SPD489-326 (N=262, open-label period; N=153, RWP), 15.8% and 67.5% of patients receiving LDX and placebo, respectively, met treatment failure criteria at RWP endpoint (differen –51.7%; 95% CI: –65.0%, –38.5%; p<0.001). The most common treatment-emergent adverse events in LDX-treated patients were decreased appetite, headache and decreased weight.

Short-term LDX treatment improved symptoms of ADHD in children and adolescents. Continued LDX treatment was associated with maintenance of efficacy compared with placebo. The safety profile of LDX was generally consistent with that of stimulant therapy.

Although pharmacological treatment is indicated by international guidelines not to be considered the first choice intervention for the management of problem behavior in Intellectual Developmental Disorders (IDD), around 60% of prescriptions are still for this purpose, while reliability with psychiatric diagnosis is often uncertain. Antipsychotics represent the most frequently prescribed class, followed by mood stabilisers, benzodiazepines, and antidepressants.

Several empirical studies support the use of these compounds, although some other publications are more sceptical of the quality of the evidence to date. Special attention is given to their side-effects on cognitive skills.

In the last years clinicians have shown increasing interest for Very New Generation Antipsychotics (VNGA) having a better tolerability profile, like aripiprazole, asenapine, quetiapine, ziprasidone, and paliperidone.

The purpose of this paper is to provide an overview on the use of VNGA in adults with IDD.

Systematic mapping of the literature. Systematic mapping varies from a systematic review in the breadth of the topic area and questions, and the limits of data extracted.

Evidence on these compounds is lacking, but clinical experiences and the few trials conducted in the last years allow to make some distinctions within the group.

Current psychopharmacology tends to evaluate the usefulness of pharmacological treatments in terms of effectiveness rather than in terms of efficacy on target symptoms and safety. This new measure, which focus on prevention of discontinuation seems to be strictly related to patient's perception of treatment adequacy and usefulness to their own life overall.

Studies have reported high rates of schizophrenia and other psychoses in the Black Caribbean population in the UK, between two and 14 times higher than for the White population (Sharpley et al., 2001; Cantor-Graae & Selten, 2005; Fearon et al. 2006). We sought to clarify whether social adversity may contribute to the higher risk of psychosis in the Black Caribbean population.

To address this question we used preliminary data from the ongoing EU-GEI study of first episode psychosis being conducted in London, UK. Socio-demographic information and data on social adversity were collected from 227 cases presenting with a first episode of psychosis to the South London & Maudsley National Health Service (NHS) Foundation Trust and from 199 controls representative of the local population. Logistic regression and odds ratios were calculated using Stata 11.

67% (n=150) of cases, compared with 25% (n=49) of controls, reported two or more markers of social adversity at admission. Compared with White British, Black Caribbean patients were 3.7 times more likely to experience adversity (i.e., being unemployed, living alone and being single) in adulthood (OR 3.7; 95%CI 1.2-10.7 p≤ 0.001). Interestingly, the same pattern was not evident for the other ethnic minority groups (Asian, Black African, Non British White and other minority).

These initial findings suggest that social adversity may be contributing to the high rates of psychosis observed in the Black Caribbean population in the UK.

Determine if the use of new technology (The Internet-Videogames-Mobile Phones-TV) by adolescents, could share the same pattern, even adiction, as seen in eating disorders-ED, and externalizing disorders.

New technology provides a better quality of life. The problem is their addictive potential for adolescents, and about all, in young people with impulse control disorders, such as eating disorders (bulimia Nervosa, obesity, binge disorder, pica, e.g) and externalizing disorders (attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, e.g) in the Institute of Trastorns Alimentaris-ITA, and our program ITA-Conduct.

This is a descriptive-comparative study, with diagnosis, according to our protocol(DSM-IV/CIE-10), and the application of four individual instruments: BIS.11 (Barratt-Impulsiveness-Scale),DENA(Screening Questionnaire of New-Addiction),IAT (Internet-Addiction-Test), and PVP (Problem-Video-Game-Playing). The population was divided into two groups:Eating Disorders(n=12) and Externalizing Disorders(n=14), within the ages of 12 to 17 years old, at our Argentona and Barcelona Centers, in treatment inpatient.

There is not significative differences in the Impulsivity(cognitive, motor and unplanned)among ED and externalizing-disorders. The unplanned impulsivity is associated with higher scoring in trials to Internet Addiction and Video-Game-Play. The mobil-phone use is higher in ED.

The use and potential abuse of new technology is similar in adolescents hospitalized for Eating Disooders and pathologies related to Externalizing Disorders, providing a problematic area: channeling symptoms without a proper approach of its implications.

Disruption within the working memory (WM) network is an integral feature of schizophrenia. The WM network, and the dorsolateral prefrontal cortex (DLPFC) in particular, undergo significant remodeling in late adolescence. Our aim was to determine whether DLPFC activation and functional connectivity related to WM are differentially affected over time in patients with early-onset schizophrenia (EOS) and healthy individuals.

The study sample included 45 youths; 25 EOS patients and 20 matched healthy individuals. They were scanned with 1.5T scanner whilst performing the WM task N-back at two time-points 3 years apart. Within-group effects in WM and the interaction between time and diagnosis were tested. Psychophysiological interaction analysis was used to examine DLPFC connectivity at baseline and follow-up.

EOS patients showed reduced activation compared to healthy adolescents at baseline in the left DLPFC, bilateral ACC and right frontal operculum and at follow-up, in the right frontopolar and the left DLPFC. In healthy controls the DLPFC showed increased positive connections compared to EOS patients with the ACC, the inferior parietal lobule and the middle occipital gyrus at baseline and with the superior temporal gyrus and the intraparietal lobule at follow-up as well as increased within connectivity at both time-points. Prefrontal connectivity increased with time in both healthy individuals and EOS patients. However, the loss of prefrontal connectivity associated with EOS was not eliminated at the follow-up.

EOS is associated with sustained deficits in prefrontal connectivity. The normal trajectory of prefrontal connectivity changes may be disrupted in EOS.

Antipsychotic-induced weight gain (AIWG) is a major drawback in the treatment of schizophrenic patients with second-generation antipsychotics (SGAs). Pharmacogenetic studies have established several polymorphisms in genes of different pathways contributing to the development of weight gain in schizophrenic patients. However interactions of genetic polymorphisms and clinical predictors have not been studied extensively enough to reliable predict weight gain before initiating antipsychotic treatment.

We analyzed several single-nucleotide polymorphisms (SNPs) of candidate genes (e.g. APOA, GHRL, SNAP-25, LDLR, LPL, INSIG2, Resistin, 5HTR2C, MC4R) and clinical predictors (e.g. age gender, BMI at baseline, number of episodes, pretreatment, PANSS-scores) in a sample of 259 (n=138 for regression analyses) schizophrenic patients participating in different monotherapeutic trials of atypical antipsychotics (risperidone, olanzapine, quetiapine, amisulpride, aripiprazole) with up to six weeks of treatment. We used Univariate tests, regression analysis and Classification and Regression-Tree (CART)-analysis to determine relevant clinical and genetic predictors and their interactions.

We found younger age, male gender and weight at baseline as strongest clinical predictors. APOA variants and the Resistin -420 C/G rs1862513 polymorphism were associated with weight gain in the overall patient sample. Heterocygotic GC-allele carriers (n=53) gained less weight (1 kg) compared to 2,2 kg in homocygotic G-allele carriers (n=76) (p<0.0075). We found several interactions of the clinical predictors and genetic variants or type of used SGAs in linear regression models. Use of quetiapine and olanzapine and PANSS total scores showed significant interactions over the time. APOA polymorphisms showed a tendency towards significance in linear regression models (p=0.09). The Resistin -420 C/G rs1862513 polymorphism showed significant interaction in patients treated with risperidone (p<0.0001) and amisulpride (p=0.0006) in a model adjusted for all clinical predictors. CART-analyses support to some extend the relevance of the Resistin polymorphism.

In this sample we found a polymorphism in the Resistin gene (-420 C/G rs1862513) to potentially contribute to AIWG. CART-analysis shows interactions of several clinical predictors and this polymorphism. Our approach of combining clinical and genetic predictors may help to identify subgroups of patients a priori of SGA treatment in order to reduce development of severe weight gain. Further investigations on larger samples are necessary to confirm our results.

Improvements in study designs, in statistical methods and the use of ’real world’ data as well as better safety monitoring helped in better defining efficacy, effectiveness and safety of drugs. New formulations of available drugs have been developed. Better information on efficacy, effectiveness and safety and larger variety of formulations help to improve the selection of the right drug for different patient groups and for individual patients.

The aims of this study are to examine 1/. How different formulations of antipsychotic drugs may impact on treatment? 2/. How recent comparative analyses of treatment efficacy/effectiveness and safety may help clinicians and patients in making better selection from the available pool of antipsychotic drugs?

Selected review of the literature on antipsychotic treatment. Variables: all-cause treatment discontinuation and patients’ preference.

Small but robust, in some cases significant differences exist between the efficacy/effectiveness of antipsychotics and their different formulations (1,2). Patients may prefer one formulation over the other and a high proportion of patients prefer to continue taking their prescribed drug, rather than switching to another one (3).

Clinically relevant differences exist between antipsychotic drugs and between different formulations of the same drug. Treatment patterns may influence treatment efficacy.

Longer duration of untreated bipolar disorder (DUB) can lead to a prolonged exposure to inflammatory and neurodegenerative processes, that are believed to underlie etiopathogenesis of bipolar affective disorder (BAD), and thus cause a more severe course of illness as well as difficulties in the maintenance of remission.

The aim was to determine the relationship between DUB and socio-demographic characteristics, along with clinical characteristics related to the course of illness, applied psychopharmacotherapy and the ability to maintain an adequate remission over 24 months period following hospital treatment.

The study used retrospective design and included patients with BAD (n = 127), hospitalized between 2006 and 2010. We acquired data on socio-demographic and clinical characteristics, previous treatment and the information on posthospital period between 0 and 24 months.

The average DUB was 130.59 ± 108.44 months. Patients with longer DUB presented with higher number of mood episodes of BAP, higher number of inpatient treatments, and required a significantly higher dose of lithium in the remission period. Female patients and those with metabolic syndrome more frequently failed to maintain remission for more than 24 months.

Interventions for monitoring of DUB, its diminishing duration, early detection and recognition, and timely treatment, would be useful for fewer relapses and therefore a better course and outcome of BAP. Furthermore, the results of the study strongly imply that a systematic, longitudinal monitoring of the course of illness and potential inflammatory, endocrine and metabolic markers that underlie its systemic nature is recommended.

The participant will get an insight in the challenges of the implementation of new systems in routine clinical practice. He will get an opportunity to learn about the positive impact of operations management in health care. He also will get an idea about the attitude of patients towards new systems.

Anxiety and somatic disorders are frequently comorbid, especially in the presence of depression and/or substance abuse both in children and adults. Chronic illnesses and exposure to pain in early childhood are major risk factors for anxiety disorders in children.

The aims of this study are to estimate the point prevalence of anxiety and somatic disorders and their comorbidity in European adolescents.

Data were drawn from the Saving and Empowering Young Lives in Europe (SEYLE) study, comprising 12,395 adolescents from 11 European countries. Anxiety was measured by the Zung Self-Rating Anxiety Scale (SAS), and the following questions were on physical illnesses: Have you seen a doctor in the last 12 months?, Do you have a physical disability?, Do you suffer from any chronic illness?, Do these discomforts lower your ability or hinder other daily activities?, Overall, how would you describe your state of health these days?

Out of 12395 adolescents more than 80% saw a doctor in the last 12 months, 3% described their state of health poor or very poor, 3% reported of having physical disability and almost 15% reported of suffering from chronic illness. Eight percept of the responders was anxious based on the SAS. Anxiety as measured by SAS total score was significantly associated with describing the state of health as poor or very poor, having physical disability, suffering from chronic illness, reporting that discomforts lower the ability somewhat or certainly.

Patients with psysical illness should be screen for anxiety disorders.

We analyzed data collected from 271 patients with MS according IDF criteria, (aged 30 – 60 years) in Federal Research Program of the Risks of Cardiovascular Diseases. Mild cognitive impairment (MCI) was confirmed by psychodiagnostic interview according to the criteria of ICD-10. All patients passed through: MMSE test, Wechsler memory scale and Category Fluency test. Level of blood glucose and plasma indicators of lipid spectrum were assessed in the blood samples with «Abbott» kits. To assess the results the NCEP criteria were used.

As a result of research 271 subject were divided into 2 groups, group A – with CD and/or MCI (212 subjects) and the group B -without affective disorders (49 subjects). Using the Mann-Whitney test significantly strong connection between high levels of total cholesterol (TC), cholesterol low density lipoprotein (LDL-C), lipoproteins of very low density (VLDL), the GL and MCI in group A were obtained. Optional subjects with sings of PH, MS and MCI had a fairly high level of VLDL and LDL-C in comparison with subjects without MCI.

Our data support the assumption that there is link between MCI and components of MS. Prehypertension, MS, can provoke MCI in middleage subjects.

We analyzed longitudinal course of illness in schizophrenia until age 43 years, and its correlates to antipsychotic medication and cognition.

Northern Finland 1966 Birth Cohort Study has been followed serially since mid-pregnancy. Structural and functional MRI, cognitive, and clinical examinations were performed at ages 34 (73 schizophrenic psychoses, 104 controls) and 43 (63 schizophrenic psychoses, 192 controls); 40 cases and 75 controls participated in both surveys. Psychiatric outcomes have been ascertained through data linkage to a national case registers, hospital charts and clinical evaluations.

Prognosis of schizophrenia is heterogeneous: minority of individuals experience recovery, some achieve remission, but many are on disability pension, and excess mortality (especially suicides) is common. Long duration of untreated psychosis, early age of illness onset and presence of suicidal ideation associated with poorer long-term outcome. Both cases and non-psychotic controls show a small decline in verbal learning and memory, but the difference in decline is not significantly more pronounced in cases. Higher doses of antipsychotics at age 43-years associated to lower education and poorer clinical and functional outcomes, and high cumulative life-time use of antipsychotics associated to decrease of verbal learning and memory in 9-year follow-up.

Based on this naturalistic sample, midlife progression of schizophrenia may follow a variety of different trajectories. Poor clinical course is common but not necessary outcome. Compared to controls, more pronounced cognitive decline was not seen in schizophrenia cases. However, high doses of antipsychotics may relate to a decrease of verbal learning and memory.