scholarly journals Compliance to completion of sodium valproate annual risk acknowledgement form among women of child-bearing age prescribed sodium valproate in the intellectual disability (ID) services of an NHS trust

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S97-S97
Author(s):  
Victor Ohize ◽  
Deval Bagalkote
Keyword(s):  
Sodium Valproate ◽  
Developmental Disorders ◽  
Significant Risk ◽  
Annual Review ◽  
Challenging Behaviour ◽  
Environmental Interventions ◽  
Child Bearing ◽  
Mood Stabilization ◽  
Variable Compliance ◽  
Annual Risk

AimsTo determine the proportion of women of child-bearing age prescribed SV who have the SV ARF filled.BackgroundIn 2018, the Medicines and Healthcare products Regulatory Agency (MHRA) gave guidance regarding Sodium Valproate (SV) prescription. It acknowledged the significant risk of birth defects and developmental disorders in women of child-bearing age prescribed SV.Consequently, the MHRA recommendation is that SV must not be used in females of child-bearing age unless: conditions of pregnancy prevention programme are met; other treatments are ineffective or not tolerated; and evidence of discussion of risks with patient or carer and annual review of the risks are documented. The evidences of the above criteria are expected to be documented in an Annual Risk Acknowledgement Form (ARF).MethodRetrospective study involving systematic search of Trust database to identify women with ID, aged 16–50 years prescribed SV from 2018 to 2019.Result18 of 28 patients had ARF filled, a 64% compliance.The main indications for SV prescription were epilepsy; challenging behaviour; and mood stabilization.The distribution showed neurology and psychiatrist led prescription initiation equally distributed at 50%.The ARF compliance was higher in the neurology group (93%) compared to 36% in psychiatrist group.A review across the 5 ID teams (A,B,C,D and E) of the trust shows variable compliance to ARF compliance (17%,81%,100%,60%,0% respectively) with teams having higher proportion of neurology led SV prescription initiation also having higher proportion of ARF completion compliance (0%,55%,80%,80%,0% respectively).ConclusionConclusion / RecommendationARF compliance is below standard at 64%.Despite the SV prescription being equally distributed between neurology led and psychiatry led, patients whose prescription of SV is neurology led (prescription indication as epilepsy) had better ARF compliance outcome (93%) compared with patients whose prescription is psychiatry led (prescription indication as challenging behaviour or mood stabilization) with 36% ARF compliance.Organizational difference with dedicated epilepsy nurse in the ID service means patients with epilepsy had reviews of medication and compliance to MHRA guidance in completing the ARF.There is need to increase doctors’ awareness to review ARF status during patients’ appointment. Information Technology design to flag up out of date ARF may be helpful.The review of ARF may also flag up consideration of other alternatives: behavioural, psychological, functional and environmental interventions as well as alternative medications like Risperidone for challenging behaviours and other mood stabilizing options. This will minimize SV prescription, which is the original goal of the MHRA guidance.

Early Childhood Obesity: A Developmental Perspective

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Megan H. Pesch ◽  
Julie C. Lumeng
Keyword(s):  
Risk Factors ◽  
Early Childhood ◽  
Childhood Obesity ◽  
Eating Behaviors ◽  
Developmental Psychology ◽  
Significant Risk ◽  
Annual Review ◽  
Publication Date ◽  
Special Focus ◽  
Developmental Context

Childhood obesity is a multifactorial disease, shaped by child, familial, and societal influences; prevention efforts must begin early in childhood. Viewing the problem of childhood obesity through a developmental lens is critical to understanding the nuances of a child's interactions with food and their environment across the span of growth and development. Risk factors for childhood obesity begin prior to birth, compounding across the life course. Some significant risk factors are unmodifiable (e.g., genetics) while others are theoretically modifiable. Social inequities, however, hinder many families from easily making modifications to a range of risk factors. The objective of this review is to provide background and an overview of the literature on childhood obesity in early childhood (birth to 5 years of age) in a developmental context. Special focus is placed on unique developmental considerations, child eating behaviors, and parental feeding behaviors in infancy, toddlerhood, and preschool ages. Expected final online publication date for the Annual Review of Developmental Psychology, Volume 3 is December 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

scholarly journals Identification and Analysis of Children Developmental Dysphasia Factors in Karawang

2019 ◽  
Vol 09 (01) ◽  
pp. e24-e28
Author(s):  
Hadi Sudarjat ◽  
Mally Sholih ◽  
Ahsanal Kasasiah
Keyword(s):  
Multivariate Regression ◽  
Developmental Disorders ◽  
Significant Risk ◽  
Data Retrieval ◽  
Febrile Seizures ◽  
Survey Method ◽  
Control Group ◽  
Case Group ◽  
Cross Sectional ◽  
Language Difficulties

AbstractSome children fail to develop language skills for obvious reasons. The inability is usually seen due to difficulties in producing and understanding spoken language, lack of intelligence, or other developmental disorders. This usually causes difficulties in reading and writing; in many cases, language difficulties continue until adolescence. This research was conducted from May to June 2018 at Dewi Sri Karawang Hospital and in the Karawang community. This study aims to determine the correlation between factors such as family history, child's gender, febrile seizures, exposure to TV/gadget, and mother's occupation, with children developmental dysphasia in Karawang. This study uses an analytical survey method with a cross-sectional approach. Data retrieval was performed by interviewing parents of pediatric patients diagnosed with dysphasia as the case group and parents of children in the Karawang area as the control group. The data obtained were processed using the multivariate regression statistical method. The results showed that heat seizures, excessive multimedia exposure (more than 1 hour per day), and identified hereditary causes were significant risk factors for dysphasia in children aged 1 to 6 years in Karawang, with p-values less than 0.05.

Valproate used during pregnancy: What should be done?

2017 ◽  
Vol 41 (S1) ◽  
pp. S419-S419 ◽  
Author(s):  
J.N. Beezhold ◽  
D. Fagard ◽  
C. Harabajiu
Keyword(s):  
Literature Review ◽  
Sodium Valproate ◽  
Developmental Disorders ◽  
Treatment Guidelines ◽  
Clinical Excellence ◽  
First Trimester ◽  
Childbearing Age ◽  
Developmental Issues ◽  
Key Population ◽  
Competing Interest

BackgroundSodium valproate can cause serious developmental disorders in unborn babies if taken while pregnant, especially in the first trimester.AimTo review recent literature and advice or treatment for women who have or are using valproate whilst pregnant.DesignLiterature review.MethodsLiterature review using Pubmed with search terms: ‘bipolar’; ‘pregnant’; ‘valproate’ and following up references.ResultsThere are several small methodologically flawed studies that attempt to address this question and will be reprised. Three key population register studies found high rates of malformations. A retrospective study of longer-term outcomes found high rates of developmental issues. There are several relevant treatment guidelines, including from the National Institute for Health and Clinical Excellence (NICE). There is a 40% risk of developmental disorder, a 10% risk of congenital malformations and a 3% risk of IQ deterioration.ConclusionsAvoid valproate in women of childbearing age if at all possible, and consider effective contraception if used. If already pregnant then consider, with involvement from the patient, stopping or minimizing the dose of sodium valproate. Assess the risks and benefits of using sodium valproate during pregnancy versus stopping the treatment for the first trimester as symptoms of the disorder may return. Seek advice from a perinatal psychiatrist. Add 5 mg of folic acid daily for the remainder of the pregnancy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Do lamotrigine and levetiracetam solve the problem of using sodium valproate in women with epilepsy?

2012 ◽  
Vol 5 (1) ◽  
pp. 6-13
Author(s):  
John J Craig
Keyword(s):  
Adverse Effects ◽  
Antiepileptic Drug ◽  
Sodium Valproate ◽  
Broad Spectrum ◽  
Current Information ◽  
Drug Of Choice ◽  
Child Bearing ◽  
Seizure Syndrome

Women with epilepsy, especially those of child-bearing age, are faced with difficult choices when it comes to choosing the most suitable antiepileptic drug (AED). This is particularly so for those with idiopathic generalized epilepsies, or those for whom seizure syndrome is not immediately apparent, where sodium valproate is still considered the drug of choice. While with treatment most might expect to become seizure free, without any adverse effects, other considerations for women mean that valproate is usually initially avoided, with other AEDs such as lamotrigine or levetiracetam being chosen in preference. Based on current information, this article attempts to provide an overview on whether or not the availability of these and other broad-spectrum AEDs have solved the difficulties of using valproate in women of child-bearing age.

scholarly journals Kinetics of Enzymatic Mercury Methylation at Nanomolar Concentrations Catalyzed by HgcAB

2019 ◽  
Vol 85 (13) ◽  
Author(s):  
Swapneeta S. Date ◽  
Jerry M. Parks ◽  
Katherine W. Rush ◽  
Judy D. Wall ◽  
Stephen W. Ragsdale ◽  
...  
Keyword(s):  
Developmental Disorders ◽  
Anaerobic Bacteria ◽  
Significant Risk ◽  
Health Concern ◽  
Global Public Health ◽  
Microbial Conversion ◽  
Experimental Conditions ◽  
Cell Lysates ◽  
Kinetics Of

ABSTRACTMethylmercury (MeHg) is a potent bioaccumulative neurotoxin that is produced by certain anaerobic bacteria and archaea. Mercury (Hg) methylation has been linked to the gene pairhgcAB, which encodes a membrane-associated corrinoid protein and a ferredoxin. Although microbial Hg methylation has been characterizedin vivo, the cellular biochemistry and the specific roles of the gene products HgcA and HgcB in Hg methylation are not well understood. Here, we report the kinetics of Hg methylation in cell lysates ofDesulfovibrio desulfuricansND132 at nanomolar Hg concentrations. The enzymatic Hg methylation mediated by HgcAB is highly oxygen sensitive, irreversible, and follows Michaelis-Menten kinetics, with an apparentKmof 3.2 nM andVmaxof 19.7 fmol · min−1· mg−1total protein for the substrate Hg(II). Although the abundance of HgcAB in the cell lysates is extremely low, Hg(II) was quantitatively converted to MeHg at subnanomolar substrate concentrations. Interestingly, increasing thiol/Hg(II) ratios did not impact Hg methylation rates, which suggests that HgcAB-mediated Hg methylation effectively competes with cellular thiols for Hg(II), consistent with the low apparentKm. Supplementation of 5-methyltetrahydrofolate or pyruvate did not enhance MeHg production, while both ATP and a nonhydrolyzable ATP analog decreased Hg methylation rates in cell lysates under the experimental conditions. These studies provide insights into the biomolecular processes associated with Hg methylation in anaerobic bacteria.IMPORTANCEThe concentration of Hg in the biosphere has increased dramatically over the last century as a result of industrial activities. The microbial conversion of inorganic Hg to MeHg is a global public health concern due to bioaccumulation and biomagnification of MeHg in food webs. Exposure to neurotoxic MeHg through the consumption of fish represents a significant risk to human health and can result in neuropathies and developmental disorders. Anaerobic microbial communities in sediments and periphyton biofilms have been identified as sources of MeHg in aquatic systems, but the associated biomolecular mechanisms are not fully understood. In the present study, we investigate the biochemical mechanisms and kinetics of MeHg formation by HgcAB in sulfate-reducing bacteria. These findings advance our understanding of microbial MeHg production and may help inform strategies to limit the formation of MeHg in the environment.

Sodium Valproate use among pregnant women and women-of child-bearing potential in Western Cape, South Africa

2018 ◽  
Vol 80 ◽  
pp. 149
Author(s):  
Ushma Mehta ◽  
Mariette Smith ◽  
Emma Kalk ◽  
Annoesjka Swart ◽  
Renier Coetzee ◽  
...  
Keyword(s):  
South Africa ◽  
Pregnant Women ◽  
Sodium Valproate ◽  
Western Cape ◽  
Child Bearing

Challenging Behaviour in People with Intellectual Disabilities: The Assessment and Intervention Team

2016 ◽  
Vol 33 (S1) ◽  
pp. S475-S475
Author(s):  
K. Courtenay ◽  
S. Jaydeokar
Keyword(s):  
Intellectual Disabilities ◽  
Developmental Disorders ◽  
Models Of Care ◽  
Community Services ◽  
Challenging Behaviour ◽  
Community Based ◽  
People With Intellectual Disabilities ◽  
Competing Interest ◽  
Intervention Team ◽  
Age Range

ObjectivesPeople with intellectual disabilities (ID) present with behaviours that challenge community services. Community models of care as alternatives to hospital care exist but are often vary in their function. Certain strategies have been developed to manage challenging behaviour in people with ID. Data from a three-year period on a community-based service for people with ID and challenging behaviour that uses an objective, multi-disciplinary approach is presented.MethodsA case note survey of adults with ID under the care of the Assessment and Intervention Team (AIT), a challenging behaviour service in the London Borough of Haringey.ResultsOver the three-year period, 65 adults were managed by AIT. Forty-four were male and 21 were female. The age range was 21–64 years of age. The level of ID was mild ID 61%, moderate 39%. Diagnoses included psychotic disorder (25%); mood disorder (20%); developmental disorder (40%); dementia (10%); challenging behaviour (45%). Six people (11%) were admitted to hospital during their time with AIT. The length of care under AIT ranged from four to fourteen months.ConclusionsAIT managed effectively people with ID living in the community who presented with complex problems putting their placement at risk. The rate of hospital admission was reduced in this period compared with the previous three years. The length of stay in in-patient services was reduced. The most common reasons for the behaviours included mental illness and ‘challenging behaviour’. People with developmental disorders were a large proportion. Community alternatives are effective with positive benefits to the person.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Valproate Prescribing in Women of Childbearing Age: An Audit of Clinical Practice

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Harini Atturu ◽  
Adedeji Odelola
Keyword(s):  
Multidisciplinary Approach ◽  
Annual Review ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Off Label ◽  
Prenatal Counselling ◽  
Trust Level ◽  
Child Bearing ◽  
Prescribing Practice ◽  
Childbearing Women

Background. Evidence is accruing regarding the risks of valproate exposure in women of childbearing age. Recommendations have recently been made for a higher standard of prenatal counselling and prescribing practice in respect of valproate use in this patient group. Aim and Method. A reaudit was carried out to review the standard of clinical discussion around teratogenic risk and pregnancy planning offered to women of child-bearing age prescribed valproate. Case notes and prescription charts of women 45 years old or less were examined and compared with the results of a previous audit in 2005. Results. The use of valproate was increased overall by 64% and there was an 18% increase in off-label valproate use. The rate of clinical discussion carried out during commencement declined from 70% to 35% and at annual review from 50% to 22%. There was less clinical discussion in outpatients and in older patients. More than 40% of doctors surveyed were not confident about giving information to women. Clinical Implication. There is a need for a multidisciplinary approach and action at Healthcare Trust level, to increase awareness and reduce risks associated with valproate prescribing in childbearing women.

‘Conceivably Neglected’ – Are prescribers sufficiently aware of the risks of prescribing sodium valproate to women with mental illness?

2019 ◽  
Vol 27 (2) ◽  
pp. 125-128 ◽  
Author(s):  
Charana Perera ◽  
Sue Patterson ◽  
George Bruxner
Keyword(s):  
Sodium Valproate ◽  
Chart Review ◽  
Descriptive Analysis ◽  
Public Mental Health ◽  
Retrospective Chart Review ◽  
Prescribing Practices ◽  
Bipolar Mood Disorder ◽  
Public Mental Health Service ◽  
Child Bearing ◽  
Robust Evidence

Objectives: To describe prescription of sodium valproate (SV) for bipolar mood disorder to potentially child-bearing women within one public mental health service and describe risks of fetal exposure, and safe prescribing practices among psychiatrists. Methods: A 24-month retrospective chart review with descriptive analysis; narrative review of literature and guidelines. Results: Review of 383 charts demonstrated prescription of valproate to 20% of 98 women aged 15–45, with little evidence of advice regarding risk and contraception. Robust evidence of teratogenic and neurodevelopmental risk underpins increased regulation, and recommendations that valproate not be prescribed to this cohort. Conclusions: The significant risks associated with SV oblige all prescribers to proactively access authoritative guidelines such as those published by the Centre of Perinatal Excellence.

scholarly journals Prevalence of ADHD symptoms and their association with learning-related skills in Grade 1 children in South Africa

2020 ◽  
pp. 1-7
Author(s):  
Monique de Milander ◽  
Robert Schall ◽  
Elizna de Bruin ◽  
Melissa Smuts-Craft
Keyword(s):  
South Africa ◽  
Attention Deficit ◽  
Developmental Disorders ◽  
Rating Scale ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Symptom Clusters ◽  
Adhd Symptoms ◽  
Normal Behaviour ◽  
Attention Deficit Hyperactivity Disorders

Attention Deficit / Hyperactivity Disorders (ADHD) are developmental disorders in children with 3 symptom clusters, namely hyperactivity, attention deficit and impulsivity, and a combination. We investigated the prevalence of the 3 symptom clusters and their association with learning-related skills among children aged 6 to 7 years in Bloemfontein, Free State province, South Africa. The Aptitude Test for School Beginners (ASB) was applied to determine learning-related skills, and the Strength and Weaknesses of ADHD Symptoms Normal Behaviour rating scale (SWAN) was used to determine ADHD symptoms. Data on SWAN scores were available for 390 children, while data on both the SWAN and ASB were available for 345 children (189 girls and 156 boys) with a mean age of 6 years and 8 months. The prevalence of ADHD symptoms was as follows: 74.6% of the children did not fulfil the criteria for ADD/ADHD, 7.7% presented with the combined subtype, 6.7% presented with hyperactivity and impulsiveness, and 11.0% with inattentiveness. The presence of ADHD symptoms had a significant effect p = < 0.05 on reasoning, numerical abilities, gestalt, coordination and memory. We conclude that ADHD symptoms are a significant risk factor for 5 of the 8 learning-related skills in children, namely numerical skills, memory, reasoning, gestalt and coordination.

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