scholarly journals Does the 5-HT1A rs6295 polymorphism influence the safety and efficacy of citalopram therapy in the oldest old?

2018 ◽  
Vol 9 (7) ◽  
pp. 355-366 ◽  
Author(s):  
Greg Scutt ◽  
Andrew Overall ◽  
Railton Scott ◽  
Bhavik Patel ◽  
Lamia Hachoumi ◽  
...  
Keyword(s):  
Older People ◽  
Bayesian Analysis ◽  
Oldest Old ◽  
Receptor Gene ◽  
Depression Score ◽  
Geriatric Depression ◽  
Single Nucleotide ◽  
Antidepressant Efficacy ◽  
Highest Density Interval ◽  
New Diagnosis

Major depressive disorder (MDD) in older people is a relatively common, yet hard to treat problem. In this study, we aimed to establish if a single nucleotide polymorphism in the 5-HT1A receptor gene (rs6295) determines antidepressant response in patients aged > 80 years (the oldest old) with MDD. Nineteen patients aged at least 80 years with a new diagnosis of MDD were monitored for response to citalopram 20 mg daily over 4 weeks and genotyped for the rs6295 allele. Both a frequentist and Bayesian analysis was performed on the data. Bayesian analysis answered the clinically relevant question: ‘What is the probability that an older patient would enter remission after commencing selective serotonin reuptake inhibitor (SSRI) treatment, conditional on their rs6295 genotype?’ Individuals with a CC (cytosine–cytosine) genotype showed a significant improvement in their Geriatric Depression Score ( p = 0.020) and cognition ( p = 0.035) compared with other genotypes. From a Bayesian perspective, we updated reports of antidepressant efficacy in older people with our data and calculated that the 4-week relative risk of entering remission, given a CC genotype, is 1.9 [95% highest-density interval (HDI) 0.7–3.5], compared with 0.52 (95% HDI 0.1–1.0) for the CG (cytosine–guanine) genotype. The sample size of n = 19 is too small to draw any firm conclusions, however, the data suggest a trend indicative of a relationship between the rs6295 genotype and response to citalopram in older patients, which requires further investigation.

Prioritization and management of calls from older people to GP out-of-hours services

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Suzanne Smith ◽  
Lucia Carragher
Keyword(s):  
Older People ◽  
Service Provision ◽  
Emergency Services ◽  
Oldest Old ◽  
Community Dwelling ◽  
Third Party ◽  
Older Person ◽  
Out Of Hours ◽  
Accident And Emergency ◽  
Community Dwelling Older People

Abstract Background Urgent out-of-hours medical care is necessary to ensure people can remain living at home into older age. However, older people experience multiple barriers to using out-of-hours services including poor awareness about the general practitioner (GP) out-of-hours (GPOOH) service and how to access it. In particular, older people are reluctant users of GPOOH services because they expect either their symptoms will not be taken seriously or they will simply be referred to hospital accident and emergency services. The aim of this study was to examine if this expectation was borne out in the manner of GPOOH service provision. Objective The objective was to establish the urgency categorization and management of calls to GPOOH , for community dwelling older people in Ireland. Methods An 8-week sample of 770 calls, for people over 65 years, to a GPOOH service in Ireland, was analysed using Excel and Nvivo software. Results Urgency categorization of older people shows 40% of calls categorized as urgent. Recognition of the severity of symptoms, prompting calls to the GPOOH service, is also reflected in a quarter of callers receiving a home visit by the GP and referral of a third of calls to emergency services. The findings also show widespread reliance on another person to negotiate the GPOOH system, with a third party making 70% of calls on behalf of the older person seeking care. Conclusion Older people are in urgent need of medical services when they contact GPOOH service, which plays an effective and patient-centred gatekeeping role, particularly directing the oldest old to the appropriate level of care outside GP office hours. The promotion of GPOOH services should be enhanced to ensure older people understand their role in supporting community living.

scholarly journals Task-Modulated Brain Activity Predicts Antidepressant Responses of Prefrontal Repetitive Transcranial Magnetic Stimulation: A Randomized Sham-Control Study

2021 ◽  
Vol 5 ◽  
pp. 247054702110068
Author(s):  
Cheng-Ta Li ◽  
Chih-Ming Cheng ◽  
Chi-Hung Juan ◽  
Yi-Chun Tsai ◽  
Mu-Hong Chen ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Antidepressant Treatment ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Brain Activity ◽  
Characteristic Curve ◽  
Depression Score ◽  
Double Blind ◽  
Antidepressant Efficacy ◽  
Group B

Background Prolonged intermittent theta-burst stimulation (piTBS) and repetitive transcranial magnetic stimulation (rTMS) are effective antidepressant interventions for major depressive disorder (MDD). Cognition-modulated frontal theta (frontalθ) activity had been identified to predict the antidepressant response to 10-Hz left prefrontal rTMS. However, whether this marker also predicts that of piTBS needs further investigation. Methods The present double-blind randomized trial recruited 105 patients with MDD who showed no response to at least one adequate antidepressant treatment in the current episode. The recruited patients were randomly assigned to one of three groups: group A received piTBS monotherapy; group B received rTMS monotherapy; and group C received sham stimulation. Before a 2-week acute treatment period, electroencephalopgraphy (EEG) and cognition-modulated frontal theta changes (Δfrontalθ) were measured. Depression scores were evaluated at baseline, 1 week, and 2 weeks after the initiation of treatment. Results The Δfrontalθ at baseline was significantly correlated with depression score changes at week 1 (r = −0.383, p = 0.025) and at week 2 for rTMS group (r = −0.419, p = 0.014), but not for the piTBS and sham groups. The area under the receiver operating characteristic curve for Δfrontalθ was 0.800 for the rTMS group (p = 0.003) and was 0.549 for the piTBS group (p = 0.619). Conclusion The predictive value of higher baseline Δfrontalθ for antidepressant efficacy for rTMS not only replicates previous results but also implies that the antidepressant responses to rTMS could be predicted reliably at baseline and both piTBS and rTMS could be effective through different neurobiological mechanisms.

scholarly journals DEPRESSION IN OLDER ADULTS- A STUDY ON PATIENTS VISITING A TERTIARY CARE CENTER IN NORTH INDIA

2019 ◽  
Vol 3 (5) ◽  
Author(s):  
Indrajeet Singh Gambhir ◽  
Amit Raj Sharma ◽  
Sankha Shubhra Chakrabarti ◽  
Upinder Kaur ◽  
Bindu Prakash
Keyword(s):  
Logistic Regression ◽  
Marital Status ◽  
Short Form ◽  
Care Center ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Depression Score ◽  
North India ◽  
Geriatric Depression ◽  
Depression Prevalence

Background: Depression is the commonest psychiatric disorder in the elderly. We attempted to analyze the prevalence and correlates of depression in the north Indian elderly. Methods: An observational study was carried out taking cases from patients attending the geriatric clinic for the first time. Depression was diagnosed by the Geriatric Depression Score short form (≥5). Various epidemiological parameters were assessed in 504 subjects (M = 304, F = 200; mean age = 66.47±13.71 years). Results: Depression prevalence was 45%. A significant correlation was found between depression prevalence and gender (F>M, p=0.011), level of education (p=0.002), marital status (p<0.001) and insomnia (p<0.001) on univariate analysis. On binomial logistic regression analysis, marital status (widowed > married, p=0.008) and insomnia (present > absent, p<0.001) showed significant correlation with depression prevalence.    Conclusion: Our study highlights certain epidemiological aspects of depression in the aged Indian population presenting to the tertiary hospital. Spousal loss and insomnia are documented as possible depression risks but longitudinal studies are needed to confirm the same. Keywords: Geriatrics, Depression, Epidemiology, Geriatric Depression Score, Prevalence, Logistic Regression

Characterisation of the melanocortin-1 receptor gene in alpaca and identification of possible markers associated with phenotypic variations in colour

2009 ◽  
Vol 49 (8) ◽  
pp. 675 ◽  
Author(s):  
N. L. Feeley ◽  
K. A. Munyard
Keyword(s):  
Mus Musculus ◽  
Bos Taurus ◽  
Receptor Gene ◽  
Nucleotide Polymorphisms ◽  
Wild Type ◽  
Single Nucleotide ◽  
Melanocortin 1 Receptor ◽  
Mc1r Gene ◽  
Pcr Products ◽  
Phenotypic Variations

The aim of this study was to determine if any correlation exists between melanocortin-1 receptor (MC1R) polymorphisms and skin and fibre colour in alpacas. Primers capable of amplifying the entire alpaca MC1R gene were designed from a comparative alignment of Bos taurus and Mus musculus MC1R gene sequences. The complete MC1R gene of 41 alpacas exhibiting a range of fibre colours, and which were sourced from farms across Australia, was sequenced from PCR products. Twenty-one single nucleotide polymorphisms were identified within MC1R. Two of these polymorphisms (A82G and C901T) have the potential to reduce eumelanin production by disrupting the activity of MC1R. No agreement was observed between fibre colour alone and MC1R genotype in the 41 animals in this study. However, when the animals were assigned to groups based on the presence or absence of eumelanin in their fibre and skin, only animals that had at least one allele with the A82/C901 combination expressed eumelanin. We propose that A82/C901 is the wild-type dominant ‘E’ MC1R allele, while alpacas with either G82/T901 or G82/Y901 are homozygous for the recessive ‘e’ MC1R allele and are therefore unable to produce eumelanin.

Medication adherence in community-dwelling older people exposed to chronic polypharmacy

2021 ◽  
pp. jech-2020-214238
Author(s):  
Carlotta Franchi ◽  
Ilaria Ardoino ◽  
Monica Ludergnani ◽  
Gjiliola Cukay ◽  
Luca Merlino ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Older People ◽  
Oldest Old ◽  
Medication Possession Ratio ◽  
Community Dwelling ◽  
Administrative Database ◽  
Lombardy Region ◽  
Drug Classes ◽  
Community Dwelling Older People ◽  
Lower Adherence

BackgroundTo evaluate medication adherence and associated factors of seven of the most common drug classes prescribed to community-dwelling older people.MethodsThis is a retrospective cohort study on medication adherence in community-dwelling older people (65–94 years old) on chronic polypharmacy and recorded from 2013 to 2015 in the administrative database of the Lombardy region (Northern Italy). Adherence was assessed for diabetic drugs, antithrombotic agents, drugs acting on the renin–angiotensin system, statins, bisphosphonates, antidepressants and drugs for obstructive airway diseases by calculating the medication possession ratio (MPR). Patients were then divided in fully (MPR ≥80%), partially (40%≤MPR<80%) and poorly adherent (10%<MPR<40%).ResultsAmong 140 537 patients included in the study, only 19.3% was fully adherent to all the therapies considered. Almost 40% of them were poorly adherent to at least one drug class, becoming 50% when patients exposed to four or more drug classes were considered. In adjusted regression model, being women (OR=1.14, 95% CI 1.13 to 1.16) and aged ≥80 years old (OR=1.22, 95% CI 1.20 to 1.24) were associated with an overall lower adherence. Instead, the participation to an experimental healthcare programme was associated with higher adherence (OR=0.92, 95% CI 0.87 to 0.96). Furthermore, being coprescribed with ≥10 drugs was associated with lower adherence to all the drug classes, with different effects (ORs from 0.42 to 0.73).ConclusionThis study overall shows a low medication adherence in community-dwelling older people on chronic polypharmacy, especially in women and oldest old. The implementation and promotion of healthcare programmes for these patients could help improve overall adherence to chronic drug therapies.

Histamine H3 receptor gene variants associated with drug abuse in patients with cocaine use disorder

2020 ◽  
Vol 34 (11) ◽  
pp. 1326-1330
Author(s):  
Iñigo Pallardo-Fernández ◽  
José Ramón Muñoz-Rodríguez ◽  
Carmen González-Martín ◽  
Luis F Alguacil
Keyword(s):  
Drug Abuse ◽  
Single Nucleotide Polymorphisms ◽  
Receptor Gene ◽  
Gene Variants ◽  
Nucleotide Polymorphisms ◽  
Single Nucleotide ◽  
Histamine H3 Receptor ◽  
Cocaine Use ◽  
H3 Receptor ◽  
Histamine H3

Background: Preclinical work revealed significant interactions between ligands of the histamine H3 receptor and different drugs of abuse. In the case of psychostimulants, the results reported are somewhat controversial and human data are still scarce, despite the fact that an inverse agonist of the H3 receptor (pitolisant) has reached the market after approval for the treatment of narcolepsy. Aims: We have studied associations between histamine H3 receptor gene variants and cocaine use disorder to increase the knowledge of the possible involvement of histamine H3 receptor in drug abuse. Methods: Seven single nucleotide polymorphisms of the histamine H3 receptor gene were genotyped by using a multiplexing assay in 248 samples of subjects with cocaine use disorder and 500 randomized samples of subjects representative of the Spanish population. Results: The study of the epidemiological information associated to the samples revealed that subjects with cocaine use disorder broadly abused alcohol, tobacco and cannabinoids. Two single nucleotide polymorphisms (rs3787430 and rs74627870) were found significantly associated with the occurrence of addiction and one more (rs13042865) was specifically related to the severity of cocaine dependence within drug abusers. Conclusions: The associations found in this study further extend the hypothesis that histamine H3 receptor function could be relevant in drug abuse in general and cocaine addiction in particular.

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