Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.20
S. Ting, Celeste Chen, Hui-hua Li, S. Hameed, A. Ng, E. Tan, K. Ng, N. Kandiah
Background Early-onset dementia (EOD) is characterized by distinct clinical profiles and prognosis when compared to late-onset dementia (LOD). As the second most common neurodegenerative form of dementia, little is known about the clinical profile of early-onset Dementia with Lewy Bodies (DLB). A current challenge for clinicians when managing patients with DLB is the suboptimal diagnosis rate which will affect treatment efficacy and outcome. To address this knowledge gap, by hypothesizing early-onset DLB will have a distinct profile when compared to Alzheimer’s disease (AD), we accessed and reviewed data of patients with pathological confirmed DLB from National Alzheimer’s Coordinating Center (NACC) database. Methods Patients with first visit that fulfill criteria for dementia of AD or DLB were analyzed. Early onset age was defined as less than 65 years old. Variables included in the analyses include baseline demographics, cognitive, behavioral, motor symptoms, neuropsychological battery scores and clinician diagnosis. Comparisons were made between early-onset AD (EOAD) versus early-onset DLB (EODLB), and early versus late-onset DLB. Results This study included 363 patients with EOAD, 32 EODLB and 147 late-onset DLB. Patients with EODLB were more likely to present with psychosis, apathy, REM sleep behavioral disorder, and motor symptoms. While EOAD patients were more likely to present with cognitive symptoms as first recognized and predominant presentation and perform worse in memory assessment. Motor as first recognized presentation, slowness, visual hallucination, caregiver reporting of agitation and apathy were the significant predictors to differentiate the two. Late-onset DLB patients were less depressed and more impaired in memory and executive function related scores than EODLB. Significant number of EODLB patients were misdiagnosed as EOAD (46.9%, p Conclusions EODLB is characterized by motor and neuropsychiatric symptoms while neuropsychological tests appear less reliable to differentiate EODLB from EOAD. Given that misdiagnosis of DLB remain significantly high, we propose a more careful and comprehensive clinical approach may improve the diagnosis rate. Acknowledgement The NACC database is funded by NIA/NIH Grant U01 AG016976. NACC data are contributed by these NIA funded ADCs: P30 AG019610 (PI Eric Reiman, MD), P30 AG013846 (PI Neil Kowall, MD), P50 AG008702 (PI Scott Small, MD), P50 AG025688 (PI Allan Levey, MD, PhD), P50 AG047266 (PI Todd Golde, MD, PhD), P30 AG010133 (PI Andrew Saykin, PsyD), P50 AG005146 (PI Marilyn Albert, PhD), P50 AG005134 (PI Bradley Hyman, MD, PhD), P50 AG016574 (PI Ronald Petersen, MD, PhD), P50 AG005138 (PI Mary Sano, PhD), P30 AG008051 (PI Steven Ferris, PhD), P30 AG013854 (PI M. Marsel Mesulam, MD), P30 AG008017 (PI Jeffrey Kaye, MD), P30 AG010161 (PI David Bennett, MD), P50 AG047366 (PI Victor Henderson, MD, MS), P30 AG010129 (PI Charles DeCarli, MD), P50 AG016573 (PI Frank LaFerla, PhD), P50 AG016570 (PI
背景与迟发性痴呆(LOD)相比，早发性痴呆(EOD)具有不同的临床特征和预后。作为第二种最常见的神经退行性痴呆形式，早发性路易体痴呆(DLB)的临床特征知之甚少。临床医生在管理DLB患者时面临的一个挑战是诊断率不理想，这将影响治疗效果和结果。为了解决这一知识差距，通过假设早发性DLB与阿尔茨海默病(AD)相比具有不同的特征，我们从国家阿尔茨海默病协调中心(NACC)数据库中获取并回顾了病理证实的DLB患者的数据。方法对首次就诊符合AD或DLB痴呆标准的患者进行分析。早发年龄定义为小于65岁。分析中包含的变量包括基线人口统计学、认知、行为、运动症状、神经心理电池评分和临床医生诊断。比较早发性AD (EOAD)与早发性DLB (EODLB)，以及早发性DLB与晚发性DLB。结果本研究纳入363例EOAD患者，32例EODLB患者，147例迟发性DLB患者。EODLB患者更容易出现精神病、冷漠、快速眼动睡眠行为障碍和运动症状。而EOAD患者更有可能以认知症状作为第一识别和主要表现，在记忆评估中表现较差。运动作为第一识别的表现，缓慢，视觉幻觉，护理者报告的躁动和冷漠是区分两者的重要预测因素。迟发性DLB患者抑郁程度较低，记忆和执行功能相关评分受损程度较EODLB患者高。结论EODLB以运动和神经精神症状为特征，而神经心理测试对EODLB与EOAD的鉴别不可靠。鉴于DLB的误诊率仍然很高，我们建议更仔细和全面的临床方法可以提高诊断率。NACC数据库由NIA/NIH Grant U01 AG016976资助。NACC数据由以下NIA资助的adc提供:e AG019610 (Eric ReimanπMD), e AG013846 (Neil KowallπMD), P50 AG008702 (Scott小πMD), P50 AG025688(π艾伦·利维,医学博士),P50 AG047266(π托德Golde,医学博士),e AG010133 (Andrew Saykinπ大多数),P50 AG005146(π玛丽莲·艾伯特博士),P50 AG005134(π布拉德利·海曼(医学博士),P50 AG016574(π罗纳德·彼得森(医学博士),P50 AG005138(π玛丽佐野博士),e AG008051(πSteven Ferris博士),e AG013854(πm . Marsel Mesulam, MD), e AG008017(πJeffrey Kaye博士),P30 AG010161 (PI David Bennett，医学博士)，P50 AG047366 (PI Victor Henderson，医学博士)，P30 AG010129 (PI Charles DeCarli，医学博士)，P50 AG016573 (PI Frank LaFerla，博士)，P50 AG016570 (PI Marie-Francoise Chesselet，医学博士)，P50 AG005131 (PI Douglas Galasko，医学博士)，P50 AG023501 (PI Bruce Miller，医学博士)，P30 AG035982 (PI Russell Swerdlow，医学博士)，P30 AG028383 (PI John Trojanowski，医学博士)，P30 AG005133 (PI Oscar Lopez，医学博士)，P50 AG005142 (PI Helena Chui，医学博士)，P30 AG012300 (PI Roger Rosenberg, MD)， P50 AG005136 (PI Thomas montin, MD, PhD)， P50 AG033514 (PI Sanjay Asthana, MD, FRCP)， P50 AG005681 (PI John Morris, MD)，和P50 AG047270 (PI Stephen Strittmatter, MD, PhD)。本研究由新加坡健康基金会资助(NRS 15/001)、新加坡国家医学研究所中心资助(NCG CS02)和新加坡国家医学研究委员会(NMRC/IRG/015)资助。
{"title":"20 Clinical characteristics of pathological confirmed early onset dementia with lewy bodies","authors":"S. Ting, Celeste Chen, Hui-hua Li, S. Hameed, A. Ng, E. Tan, K. Ng, N. Kandiah","doi":"10.1136/JNNP-2019-BNPA.20","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.20","url":null,"abstract":"Background Early-onset dementia (EOD) is characterized by distinct clinical profiles and prognosis when compared to late-onset dementia (LOD). As the second most common neurodegenerative form of dementia, little is known about the clinical profile of early-onset Dementia with Lewy Bodies (DLB). A current challenge for clinicians when managing patients with DLB is the suboptimal diagnosis rate which will affect treatment efficacy and outcome. To address this knowledge gap, by hypothesizing early-onset DLB will have a distinct profile when compared to Alzheimer’s disease (AD), we accessed and reviewed data of patients with pathological confirmed DLB from National Alzheimer’s Coordinating Center (NACC) database. Methods Patients with first visit that fulfill criteria for dementia of AD or DLB were analyzed. Early onset age was defined as less than 65 years old. Variables included in the analyses include baseline demographics, cognitive, behavioral, motor symptoms, neuropsychological battery scores and clinician diagnosis. Comparisons were made between early-onset AD (EOAD) versus early-onset DLB (EODLB), and early versus late-onset DLB. Results This study included 363 patients with EOAD, 32 EODLB and 147 late-onset DLB. Patients with EODLB were more likely to present with psychosis, apathy, REM sleep behavioral disorder, and motor symptoms. While EOAD patients were more likely to present with cognitive symptoms as first recognized and predominant presentation and perform worse in memory assessment. Motor as first recognized presentation, slowness, visual hallucination, caregiver reporting of agitation and apathy were the significant predictors to differentiate the two. Late-onset DLB patients were less depressed and more impaired in memory and executive function related scores than EODLB. Significant number of EODLB patients were misdiagnosed as EOAD (46.9%, p Conclusions EODLB is characterized by motor and neuropsychiatric symptoms while neuropsychological tests appear less reliable to differentiate EODLB from EOAD. Given that misdiagnosis of DLB remain significantly high, we propose a more careful and comprehensive clinical approach may improve the diagnosis rate. Acknowledgement The NACC database is funded by NIA/NIH Grant U01 AG016976. NACC data are contributed by these NIA funded ADCs: P30 AG019610 (PI Eric Reiman, MD), P30 AG013846 (PI Neil Kowall, MD), P50 AG008702 (PI Scott Small, MD), P50 AG025688 (PI Allan Levey, MD, PhD), P50 AG047266 (PI Todd Golde, MD, PhD), P30 AG010133 (PI Andrew Saykin, PsyD), P50 AG005146 (PI Marilyn Albert, PhD), P50 AG005134 (PI Bradley Hyman, MD, PhD), P50 AG016574 (PI Ronald Petersen, MD, PhD), P50 AG005138 (PI Mary Sano, PhD), P30 AG008051 (PI Steven Ferris, PhD), P30 AG013854 (PI M. Marsel Mesulam, MD), P30 AG008017 (PI Jeffrey Kaye, MD), P30 AG010161 (PI David Bennett, MD), P50 AG047366 (PI Victor Henderson, MD, MS), P30 AG010129 (PI Charles DeCarli, MD), P50 AG016573 (PI Frank LaFerla, PhD), P50 AG016570 (PI","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125226671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.40
Lori Black
A 51 year old man with bipolar affective disorder and an extensive forensic history was admitted informally to the forensic low secure inpatient unit for alcohol detoxification and to establish more effective long-term community management. 3 weeks into the admission his presentation abruptly changed. He would have prolonged periods of unresponsiveness, lasting hours to days, where he would lie in bed or stand rigidly with no vocal response to commands or questions. These were interspersed by periods where he would become agitated, pacing the wards, urinating and defecating in public spaces. This could last several hours and required rapid tranquilisation regularly. On examination in his stupor, he was seen to be lying in bed with his eyes closed, opening them a fraction to voice. He was sometimes able to follow simple commands but this was slow and inconsistent. He was unable to communicate through head movements or blinking and stared with a fixed expression. There was waxy flexibility of his limbs and arching on the back at regular intervals. Power was normal with flexor plantars. There were no ictal signs (i.e. no nystagmus/gaze deviation/twitching/dystonia). When agitated he was seen to have echopraxia. He consistently had hyperhydrosis and tachycardia. Bloods showed an elevated T4 (22.7) with a suppressed TSH ( It was felt that the patient had developed catatonia secondary to thyrotoxicosis due to his underlying neuropsychiatric susceptibility. He was treated effectively with high dose lorazepam as per the Maudsley Guidelines along with olanzapine (20 mg) and sodium valproate, which was used as an alternative to lithium. The thyrotoxicosis was effectively treated with carbimazole and the patient made a good recovery. Hyperthyroidism is a rare but recognised cause of psychosis and multiple case reports have demonstrated an association between thyrotoxicosis and catatonic states. In this case report, it is probable that the patient’s underlying bipolar affective disorder made him more susceptible to developing neuropsychiatric features as a consequence of his thyrotoxicosis. However, this is particularly pertinent given that lithium, the most evidence-based treatment for bipolar affective disorder, has potential to disrupt thyroid function.
{"title":"40 A multi-speciality conundrum: neuropsychiatric sequelae of thyrotoxicosis","authors":"Lori Black","doi":"10.1136/JNNP-2019-BNPA.40","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.40","url":null,"abstract":"A 51 year old man with bipolar affective disorder and an extensive forensic history was admitted informally to the forensic low secure inpatient unit for alcohol detoxification and to establish more effective long-term community management. 3 weeks into the admission his presentation abruptly changed. He would have prolonged periods of unresponsiveness, lasting hours to days, where he would lie in bed or stand rigidly with no vocal response to commands or questions. These were interspersed by periods where he would become agitated, pacing the wards, urinating and defecating in public spaces. This could last several hours and required rapid tranquilisation regularly. On examination in his stupor, he was seen to be lying in bed with his eyes closed, opening them a fraction to voice. He was sometimes able to follow simple commands but this was slow and inconsistent. He was unable to communicate through head movements or blinking and stared with a fixed expression. There was waxy flexibility of his limbs and arching on the back at regular intervals. Power was normal with flexor plantars. There were no ictal signs (i.e. no nystagmus/gaze deviation/twitching/dystonia). When agitated he was seen to have echopraxia. He consistently had hyperhydrosis and tachycardia. Bloods showed an elevated T4 (22.7) with a suppressed TSH ( It was felt that the patient had developed catatonia secondary to thyrotoxicosis due to his underlying neuropsychiatric susceptibility. He was treated effectively with high dose lorazepam as per the Maudsley Guidelines along with olanzapine (20 mg) and sodium valproate, which was used as an alternative to lithium. The thyrotoxicosis was effectively treated with carbimazole and the patient made a good recovery. Hyperthyroidism is a rare but recognised cause of psychosis and multiple case reports have demonstrated an association between thyrotoxicosis and catatonic states. In this case report, it is probable that the patient’s underlying bipolar affective disorder made him more susceptible to developing neuropsychiatric features as a consequence of his thyrotoxicosis. However, this is particularly pertinent given that lithium, the most evidence-based treatment for bipolar affective disorder, has potential to disrupt thyroid function.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"171 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117295859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.51
K. O'driscoll, Tayler Sulse, Emily M. Huston, P. Byrne, J. Hoblyn
Objectives/Aims Case studies of all current Inpatients with Korsakoff’s Syndrome in a 114 bed Psychiatric Hospital. Methods Audit and review of 114 individuals residing in a long stay Psychiatric Hospital during 2018. Medical records and Pharmacy Data base were reviewed to identify co-morbidities and medication exposure. Results Thirteen individuals were identified with the formal diagnosis of Korsakoff’s syndrome. Five were female with and age range from 51 years to 84 years. Eight were male with an age range from 55 to 84 years. Conclusions Careful consideration must continue to minimize polypharmacy. KS patients have complex comorbid health conditions. Careful consideration of potential interactions, disabling side effects, potential adverse reactions and collaboration with a Pharmacist is invaluable. References Kopelman M.D., Thomson, A.D., Guerrini, I., Marshall, E.J. The Korsakoff Syndrome: Clinical Aspects, Psychology and Treatment. Alcohol & Alcoholism 2009;44(2):148–154. Johnson, J.M., and Fox, V. Beyond Thiamine: Treatment for Cognitive Impairment in Korsakoff’s Syndrome. Psychosomatics 2018;59(4):311–317.
{"title":"51 Korsakoff’s psychosis: is polypharmacy a concern?","authors":"K. O'driscoll, Tayler Sulse, Emily M. Huston, P. Byrne, J. Hoblyn","doi":"10.1136/JNNP-2019-BNPA.51","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.51","url":null,"abstract":"Objectives/Aims Case studies of all current Inpatients with Korsakoff’s Syndrome in a 114 bed Psychiatric Hospital. Methods Audit and review of 114 individuals residing in a long stay Psychiatric Hospital during 2018. Medical records and Pharmacy Data base were reviewed to identify co-morbidities and medication exposure. Results Thirteen individuals were identified with the formal diagnosis of Korsakoff’s syndrome. Five were female with and age range from 51 years to 84 years. Eight were male with an age range from 55 to 84 years. Conclusions Careful consideration must continue to minimize polypharmacy. KS patients have complex comorbid health conditions. Careful consideration of potential interactions, disabling side effects, potential adverse reactions and collaboration with a Pharmacist is invaluable. References Kopelman M.D., Thomson, A.D., Guerrini, I., Marshall, E.J. The Korsakoff Syndrome: Clinical Aspects, Psychology and Treatment. Alcohol & Alcoholism 2009;44(2):148–154. Johnson, J.M., and Fox, V. Beyond Thiamine: Treatment for Cognitive Impairment in Korsakoff’s Syndrome. Psychosomatics 2018;59(4):311–317.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126159343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.45
Corretge Maria, Chun Ho-Yan Yvonne, Roscoe Mhairi, Carson Alan
Background/Aims Functional neurological disorder (FND) may be present amongst elderly people in hospital. FND could hinder patients’ rehabilitation progress and impact negatively on discharge outcomes. Little data exist for FND in the elderly. We aimed to report the incidence of FND, clinical presentations, co-morbidities, and impact of FND on discharge in elderly patients receiving inpatient rehabilitation. Methods In our retrospective case series, a consultant geriatrician reviewed electronic case notes of consecutive discharges from a 28-bed geriatric rehabilitation unit at St John’s Hospital, which serves all patients requiring inpatient rehabilitation in West Lothian—a mixed rural and urban area with a population of 1 80 000 and high levels of deprivation. Data collected: demographics, suspected/definite diagnosis of FND and its presentation, significant co-morbidities and impact on discharge. Results We reviewed case notes of 100 patients discharged consecutively from 30/3/2018 to 30/10/2018 (age range 41–101, mean 79, SD 11; 55% men). 20% received a diagnosis of suspected or definite FND. FND diagnosis was made by a geriatrician (17%) or a neurologist (3%). Clinical description of FND cases and their co-morbidities will be presented in a summary table. Of the 20 FND cases (mean age 77, SD 14), 9/20 (45%) were men. FND impacted on discharges in 13/20 (8/20 had delayed discharge, 5/20 had increased care needs, 7/20 had no impact on discharge). Conclusion Key finding FND was common amongst elderly patients receiving inpatient rehabilitation. FND presentations were varied. Patients with FND also had chronic conditions common in the elderly e.g. Parkinson’s disease, stroke, dementia, anxiety or depression. Weakness and strength of our study Assessor bias might be introduced as diagnosis was made by a geriatrician with an interest in neuropsychiatry. Our data are likely generalisable to the geriatric rehabilitation population as sample was obtained from the only unit that served the entire population of West Lothian. Implications for future research and practice FND presents a unique challenge in the geriatric population. Geriatricians are not accustomed to assessing and managing FND, sometimes dismissing symptoms as ‘behavioural’. This can lead to symptoms remaining unexplained and untreated. Specialist neurology or neuropsychiatry services are not always available. The identification of FND and its effective treatment during rehabilitation could have potential impact on hospital length of stay and associated cost. Further research in FND in the elderly is needed. Better education would raise awareness of FND amongst geriatricians and thus its identification in clinical practice.
{"title":"45 Functional neurological disorder in geriatric rehabilitation: incidence, clinical presentations, and impact on discharge","authors":"Corretge Maria, Chun Ho-Yan Yvonne, Roscoe Mhairi, Carson Alan","doi":"10.1136/JNNP-2019-BNPA.45","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.45","url":null,"abstract":"Background/Aims Functional neurological disorder (FND) may be present amongst elderly people in hospital. FND could hinder patients’ rehabilitation progress and impact negatively on discharge outcomes. Little data exist for FND in the elderly. We aimed to report the incidence of FND, clinical presentations, co-morbidities, and impact of FND on discharge in elderly patients receiving inpatient rehabilitation. Methods In our retrospective case series, a consultant geriatrician reviewed electronic case notes of consecutive discharges from a 28-bed geriatric rehabilitation unit at St John’s Hospital, which serves all patients requiring inpatient rehabilitation in West Lothian—a mixed rural and urban area with a population of 1 80 000 and high levels of deprivation. Data collected: demographics, suspected/definite diagnosis of FND and its presentation, significant co-morbidities and impact on discharge. Results We reviewed case notes of 100 patients discharged consecutively from 30/3/2018 to 30/10/2018 (age range 41–101, mean 79, SD 11; 55% men). 20% received a diagnosis of suspected or definite FND. FND diagnosis was made by a geriatrician (17%) or a neurologist (3%). Clinical description of FND cases and their co-morbidities will be presented in a summary table. Of the 20 FND cases (mean age 77, SD 14), 9/20 (45%) were men. FND impacted on discharges in 13/20 (8/20 had delayed discharge, 5/20 had increased care needs, 7/20 had no impact on discharge). Conclusion Key finding FND was common amongst elderly patients receiving inpatient rehabilitation. FND presentations were varied. Patients with FND also had chronic conditions common in the elderly e.g. Parkinson’s disease, stroke, dementia, anxiety or depression. Weakness and strength of our study Assessor bias might be introduced as diagnosis was made by a geriatrician with an interest in neuropsychiatry. Our data are likely generalisable to the geriatric rehabilitation population as sample was obtained from the only unit that served the entire population of West Lothian. Implications for future research and practice FND presents a unique challenge in the geriatric population. Geriatricians are not accustomed to assessing and managing FND, sometimes dismissing symptoms as ‘behavioural’. This can lead to symptoms remaining unexplained and untreated. Specialist neurology or neuropsychiatry services are not always available. The identification of FND and its effective treatment during rehabilitation could have potential impact on hospital length of stay and associated cost. Further research in FND in the elderly is needed. Better education would raise awareness of FND amongst geriatricians and thus its identification in clinical practice.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"387 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132374035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.41
J. Hoblyn, Tayler Sulse, Emily M. Huston, Melanie Ryberg, P. Byrne, K. O'driscoll
Objectives/aims To explore the burden of neurocognitive impairments in a cohort of Individuals with Korsakoff’s psychosis requiring current long stay psychiatric care. To consider additional therapeutic interventions to target the health care burden potentially created by these comorbidities. Methods As part of a comprehensive systematic review of Korsakoff’s Psychosis, an audit was performed of 114 Individuals currently requiring long-term care in an approved psychiatric facility during the year of 2018. Medical and psychiatric diagnoses as well as pharmacological histories were examined. Alcoholic and non-alcoholic aetiologies were considered, the latter may be underdiagnosed (Nikolakaros et al, 2018). Results Thirteen individuals were identified with a formal diagnosis of Korsakoff’s syndrome (KS) and all continue to require structured Inpatient care due to their levels of neurocognitive impairment and psychiatric presentations. Episodic memory is severely affected, as is the learning of new semantic memories. Patients with Korsakoff’s psychosis are capable of new learning in a calm, structured environment with cued new information (Kopelman et al, 2009). Conclusions Individuals with Korsakoff’s psychosis may have comorbid psychiatric symptoms including mood, anxiety, aggression or psychotic disorders that command therapeutic interventions. Specific memory targeting intervention may not prioritized. Potential therapeutic interventions include Errorless learning (EL) which target levels of competence and independence (Rensen et al, 2017). EL is reported to improve symptoms of psychosis, aggression, apathy or mood disorders. Behavioural Interventions include environmental adaptations and cognitive remediation, which may be combined with pharmacological approaches such as donepezil or memantine to target cognition (Johnson and Fox, 2018). However, these approaches are not identical to those required by Alzheimer’s disease or other dementing disorders. Epidemiological and genomic studies could be preformed to identify those particularly at risk of developing this potentially life-altering condition. References Nikolakaros, G., Kurki, T., Paju, J., Papageorgiou, S.G., Vataja, R., llonen, T. Korsakoff Syndrome in Non-alcoholic Psychiatric Patients Variable Cognitive Presentation and Impaired Frontotemporal Connectivity. Frontiers in Psychiatry 2018;9(204). Kopelman M.D., Thomson, A.D., Guerrini, I., Marshall, E.J. The Korsakoff Syndrome: Clinical Aspects, Psychology and Treatment. Alcohol & Alcoholism 2009;44(2):148–154. Rensen, Y, Egger, J, Westhoff, J., Walvoort, S., Kessels, R. (2017) The effect of errorless learning on quality of life in patients with Korsakoff’s syndrome. Neuropsychiatric Disease and Treatment 2017;13:2867–2873. Johnson, J.M., and Fox, V. Beyond Thiamine: Treatment for Cognitive Impairment in Korsakoff’s Syndrome. Psychosomatics 2018;59(4):311–317.
{"title":"41 Korsakoff’s syndrome: neurocognitive domains impairments and potential therapeutic interventions","authors":"J. Hoblyn, Tayler Sulse, Emily M. Huston, Melanie Ryberg, P. Byrne, K. O'driscoll","doi":"10.1136/JNNP-2019-BNPA.41","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.41","url":null,"abstract":"Objectives/aims To explore the burden of neurocognitive impairments in a cohort of Individuals with Korsakoff’s psychosis requiring current long stay psychiatric care. To consider additional therapeutic interventions to target the health care burden potentially created by these comorbidities. Methods As part of a comprehensive systematic review of Korsakoff’s Psychosis, an audit was performed of 114 Individuals currently requiring long-term care in an approved psychiatric facility during the year of 2018. Medical and psychiatric diagnoses as well as pharmacological histories were examined. Alcoholic and non-alcoholic aetiologies were considered, the latter may be underdiagnosed (Nikolakaros et al, 2018). Results Thirteen individuals were identified with a formal diagnosis of Korsakoff’s syndrome (KS) and all continue to require structured Inpatient care due to their levels of neurocognitive impairment and psychiatric presentations. Episodic memory is severely affected, as is the learning of new semantic memories. Patients with Korsakoff’s psychosis are capable of new learning in a calm, structured environment with cued new information (Kopelman et al, 2009). Conclusions Individuals with Korsakoff’s psychosis may have comorbid psychiatric symptoms including mood, anxiety, aggression or psychotic disorders that command therapeutic interventions. Specific memory targeting intervention may not prioritized. Potential therapeutic interventions include Errorless learning (EL) which target levels of competence and independence (Rensen et al, 2017). EL is reported to improve symptoms of psychosis, aggression, apathy or mood disorders. Behavioural Interventions include environmental adaptations and cognitive remediation, which may be combined with pharmacological approaches such as donepezil or memantine to target cognition (Johnson and Fox, 2018). However, these approaches are not identical to those required by Alzheimer’s disease or other dementing disorders. Epidemiological and genomic studies could be preformed to identify those particularly at risk of developing this potentially life-altering condition. References Nikolakaros, G., Kurki, T., Paju, J., Papageorgiou, S.G., Vataja, R., llonen, T. Korsakoff Syndrome in Non-alcoholic Psychiatric Patients Variable Cognitive Presentation and Impaired Frontotemporal Connectivity. Frontiers in Psychiatry 2018;9(204). Kopelman M.D., Thomson, A.D., Guerrini, I., Marshall, E.J. The Korsakoff Syndrome: Clinical Aspects, Psychology and Treatment. Alcohol & Alcoholism 2009;44(2):148–154. Rensen, Y, Egger, J, Westhoff, J., Walvoort, S., Kessels, R. (2017) The effect of errorless learning on quality of life in patients with Korsakoff’s syndrome. Neuropsychiatric Disease and Treatment 2017;13:2867–2873. Johnson, J.M., and Fox, V. Beyond Thiamine: Treatment for Cognitive Impairment in Korsakoff’s Syndrome. Psychosomatics 2018;59(4):311–317.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131953842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.49
S. Ahmed, N. Drummond, C. Butler
Objective Lack of awareness or underestimation of cognitive deficits is a common feature in several neurodegenerative disorders, including Alzheimer’s Disease (AD). Little is known about the profile of insight loss in atypical clinical variants of AD, such as posterior cortical atrophy (PCA). Insight loss is typically associated with negative outcomes for patients and their carers. Characterising the profile in PCA may therefore have important implications for management. Methods Seventeen PCA patients and 21 healthy controls estimated their ability in five cognitive domains: visuospatial skills, visual imagery, attention, verbal memory and language, before undertaking objective neuropsychological testing in these domains. An index of insight was obtained by calculating a discrepancy score between estimated and objective memory scores. Results A repeated measures ANOVA using group (healthy controls and PCA) and insight domain (visuospatial, visual imagery, attention, verbal memory and language) revealed a significant interaction of group by domain (p Conclusions Loss of insight affects the core visuospatial deficits which define PCA more than other cognitive domains. The findings of this study are the first to investigate loss of insight in PCA.
{"title":"49 Loss of insight for cognitive symptoms in posterior cortical atrophy","authors":"S. Ahmed, N. Drummond, C. Butler","doi":"10.1136/JNNP-2019-BNPA.49","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.49","url":null,"abstract":"Objective Lack of awareness or underestimation of cognitive deficits is a common feature in several neurodegenerative disorders, including Alzheimer’s Disease (AD). Little is known about the profile of insight loss in atypical clinical variants of AD, such as posterior cortical atrophy (PCA). Insight loss is typically associated with negative outcomes for patients and their carers. Characterising the profile in PCA may therefore have important implications for management. Methods Seventeen PCA patients and 21 healthy controls estimated their ability in five cognitive domains: visuospatial skills, visual imagery, attention, verbal memory and language, before undertaking objective neuropsychological testing in these domains. An index of insight was obtained by calculating a discrepancy score between estimated and objective memory scores. Results A repeated measures ANOVA using group (healthy controls and PCA) and insight domain (visuospatial, visual imagery, attention, verbal memory and language) revealed a significant interaction of group by domain (p Conclusions Loss of insight affects the core visuospatial deficits which define PCA more than other cognitive domains. The findings of this study are the first to investigate loss of insight in PCA.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123186151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1136/jnnp-2019-bnpa.39
J. Lisshammar, Graham Blackman, B. Carter, R. Zafar, R. Stewart, M. Pritchard, T. Pollak, J. Rogers, A. Cullen, P. McGuire, A. David, J. MacCabe
Objectives The pathoetiology of Schizophrenia remains elusive, however, a growing body of literature suggests immune dysfunction may contribute. Clozapine, an atypical antipsychotic, has superior efficacy in treatment-resistant Schizophrenia compared to other antipsychotics – however underlying mechanisms remain unknown. Clozapine has recognised immunomodulatory effects, responsible for potentially fatal haematological side-effects - such as agranulocytosis. Whether Clozapine’s immunomodulatory properties contribute toward its unique efficacy in treatment-resistant schizophrenia has not been systematically explored. Methods A retrospective cohort study design was employed to examine the relationship between white cell, neutrophil, and platelet temporal trajectories and Clozapine response in treatment-resistant schizophrenia. Eligible patients were initiated on Clozapine for the first time and continued treatment for at least twelve weeks between 2007 and 2014 within the South London and Maudsley NHS Foundation Trust, and underwent weekly haematological monitoring. Retrospective clinical ratings were performed at baseline and three months following initiation, based upon patients’ electronic clinical notes accessed through the Maudsley BRC Clinical Records Interactive Search system. Treatment response was defined as ‘much’ or ‘very much’ improved on the Clinical Global Impression – Improvement subscale. Serial cell counts were extracted from a Clozapine haematological monitoring database. Results Of 188 included patients, 114 (61%) responded to treatment. Response did not significantly vary by ethnicity or age. Mean interval between haematological assessments was 6.9 (SD 2.0) days. General linear models revealed a significant increase from baseline for all cell lines in the second treatment week (p=0.001) which persisted for three weeks (p=0.001). Group based trajectory modelling indicated that 15% of patients showed a temporary increase in white cell and neutrophil trajectories. Logistic regression revealed that treatment response was not associated with a ‘spike’ in cell count. However, females were 2.08 times more likely to respond to treatment (95% CI [1.09, 4.08], p=0.017) and 2.67 times more likely to exhibit a ‘spike’ in cell counts following Clozapine initiation (95% CI [1.14, 6.24], p=0.023). Conclusions This is the first study to examine whether Clozapine’s immunomodulatory properties contribute towards its unique efficacy. We found that clozapine was associated with an early ‘spike’ in all cell lines. Further analysis revealed a relatively small portion of patients were responsible for this transient increase. Increased cell counts did not predict Clozapine response at three months, but gender was implicated as a potential moderator variable.
精神分裂症的病理机制仍然难以捉摸，然而，越来越多的文献表明免疫功能障碍可能起作用。氯氮平是一种非典型抗精神病药物，与其他抗精神病药物相比，它在治疗难治性精神分裂症方面具有优越的疗效，但其潜在机制尚不清楚。氯氮平具有公认的免疫调节作用，可能导致致命的血液学副作用——如粒细胞缺乏症。氯氮平的免疫调节特性是否有助于其在治疗难治性精神分裂症中的独特疗效尚未得到系统的探讨。方法采用回顾性队列研究设计，探讨难治性精神分裂症患者白细胞、中性粒细胞和血小板时间轨迹与氯氮平反应的关系。符合条件的患者在2007年至2014年期间首次开始使用氯氮平，并在南伦敦和莫兹利NHS基金会信托基金内持续治疗至少12周，并进行每周血液学监测。基于患者通过Maudsley BRC临床记录交互式搜索系统访问的电子临床记录，在基线和开始后三个月进行回顾性临床评分。在临床总体印象-改善量表上，治疗反应被定义为“多”或“非常多”的改善。从氯氮平血液学监测数据库中提取连续细胞计数。结果188例患者中，114例(61%)对治疗有效。不同种族和年龄的反应没有显著差异。血液学评估的平均间隔时间为6.9天(SD 2.0)。一般线性模型显示所有细胞系在第二个治疗周较基线显著增加(p=0.001)，并持续三周(p=0.001)。基于组的轨迹模型显示，15%的患者表现出白细胞和中性粒细胞轨迹的暂时增加。逻辑回归显示，治疗反应与细胞计数的“峰值”无关。然而，女性对治疗的反应是男性的2.08倍(95% CI [1.09, 4.08]， p=0.017)，在氯氮平开始治疗后出现细胞计数“峰值”的可能性是女性的2.67倍(95% CI [1.14, 6.24]， p=0.023)。这是首次研究氯氮平的免疫调节特性是否有助于其独特的疗效。我们发现氯氮平与所有细胞系的早期“尖峰”有关。进一步的分析显示，相对一小部分患者造成了这种短暂的增加。细胞计数增加不能预测三个月时氯氮平的反应，但性别是一个潜在的调节变量。
{"title":"39 The immunomodulatory effect of clozapine in patients with treatment resistant schizophrenia: a retrospective cohort study","authors":"J. Lisshammar, Graham Blackman, B. Carter, R. Zafar, R. Stewart, M. Pritchard, T. Pollak, J. Rogers, A. Cullen, P. McGuire, A. David, J. MacCabe","doi":"10.1136/jnnp-2019-bnpa.39","DOIUrl":"https://doi.org/10.1136/jnnp-2019-bnpa.39","url":null,"abstract":"Objectives The pathoetiology of Schizophrenia remains elusive, however, a growing body of literature suggests immune dysfunction may contribute. Clozapine, an atypical antipsychotic, has superior efficacy in treatment-resistant Schizophrenia compared to other antipsychotics – however underlying mechanisms remain unknown. Clozapine has recognised immunomodulatory effects, responsible for potentially fatal haematological side-effects - such as agranulocytosis. Whether Clozapine’s immunomodulatory properties contribute toward its unique efficacy in treatment-resistant schizophrenia has not been systematically explored. Methods A retrospective cohort study design was employed to examine the relationship between white cell, neutrophil, and platelet temporal trajectories and Clozapine response in treatment-resistant schizophrenia. Eligible patients were initiated on Clozapine for the first time and continued treatment for at least twelve weeks between 2007 and 2014 within the South London and Maudsley NHS Foundation Trust, and underwent weekly haematological monitoring. Retrospective clinical ratings were performed at baseline and three months following initiation, based upon patients’ electronic clinical notes accessed through the Maudsley BRC Clinical Records Interactive Search system. Treatment response was defined as ‘much’ or ‘very much’ improved on the Clinical Global Impression – Improvement subscale. Serial cell counts were extracted from a Clozapine haematological monitoring database. Results Of 188 included patients, 114 (61%) responded to treatment. Response did not significantly vary by ethnicity or age. Mean interval between haematological assessments was 6.9 (SD 2.0) days. General linear models revealed a significant increase from baseline for all cell lines in the second treatment week (p=0.001) which persisted for three weeks (p=0.001). Group based trajectory modelling indicated that 15% of patients showed a temporary increase in white cell and neutrophil trajectories. Logistic regression revealed that treatment response was not associated with a ‘spike’ in cell count. However, females were 2.08 times more likely to respond to treatment (95% CI [1.09, 4.08], p=0.017) and 2.67 times more likely to exhibit a ‘spike’ in cell counts following Clozapine initiation (95% CI [1.14, 6.24], p=0.023). Conclusions This is the first study to examine whether Clozapine’s immunomodulatory properties contribute towards its unique efficacy. We found that clozapine was associated with an early ‘spike’ in all cell lines. Further analysis revealed a relatively small portion of patients were responsible for this transient increase. Increased cell counts did not predict Clozapine response at three months, but gender was implicated as a potential moderator variable.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125261620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.22
Idura N. Hisham, J. Stern, H. Simmons
Aim To examine whether Attention Deficit Hyperactive Disorder (ADHD), a common comorbid disorder in Tourette’s Syndrome (TS) patients, is often missed by physicians referring to a Tic Disorder Clinic. Method Referral letters and first clinic attendance reports for 119 new patients aged between 4–17 that attended a national tic disorder clinic between 2015–2017 were analysed to see how many new diagnoses of ADHD were made at first consultation that were not included in the referral letters. Other variables that were noted for each patient included age, sex, if referrer had a suspicion of ADHD (rather than established or firm diagnosis), medication for ADHD and the main treatment target decided at the tic disorder clinic. Results Out of 119 patients 13 (11%) already had a diagnosis of ADHD, which is in line with the prevalence of comorbid ADHD in the general population but not with the known increased prevalence in patients with TS (up to 80% in some studies). The assessment at the Tic Disorder Clinic found 46 cases of ADHD (38%). Referrals were from pediatricians (51%), general practitioners (35%) and from mental health services (10%). Conclusions As the prevalence of comorbid ADHD is high in Tourette’s patients and this can sometimes be obscured by the presentation of the tic disorder, referrers should have a low threshold for suspecting and managing ADHD in cases where specialist input for tics is awaited. It is likely that CAMHS referrals were under-represented in the sample and it may be expected that prior ADHD diagnoses would be more likely from that source.
{"title":"22 Missed diagnosis of ADHD in children referred to a tic disorder clinic","authors":"Idura N. Hisham, J. Stern, H. Simmons","doi":"10.1136/JNNP-2019-BNPA.22","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.22","url":null,"abstract":"Aim To examine whether Attention Deficit Hyperactive Disorder (ADHD), a common comorbid disorder in Tourette’s Syndrome (TS) patients, is often missed by physicians referring to a Tic Disorder Clinic. Method Referral letters and first clinic attendance reports for 119 new patients aged between 4–17 that attended a national tic disorder clinic between 2015–2017 were analysed to see how many new diagnoses of ADHD were made at first consultation that were not included in the referral letters. Other variables that were noted for each patient included age, sex, if referrer had a suspicion of ADHD (rather than established or firm diagnosis), medication for ADHD and the main treatment target decided at the tic disorder clinic. Results Out of 119 patients 13 (11%) already had a diagnosis of ADHD, which is in line with the prevalence of comorbid ADHD in the general population but not with the known increased prevalence in patients with TS (up to 80% in some studies). The assessment at the Tic Disorder Clinic found 46 cases of ADHD (38%). Referrals were from pediatricians (51%), general practitioners (35%) and from mental health services (10%). Conclusions As the prevalence of comorbid ADHD is high in Tourette’s patients and this can sometimes be obscured by the presentation of the tic disorder, referrers should have a low threshold for suspecting and managing ADHD in cases where specialist input for tics is awaited. It is likely that CAMHS referrals were under-represented in the sample and it may be expected that prior ADHD diagnoses would be more likely from that source.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131383515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.26
Leigh Townsend, Daniel Johnson, A. David, S. Askey‐Jones, Richard J. Brown, D. Okai
Aims/Objectives Impulse control behaviors (ICBs) affect 15%–35% of Parkinson’s Disease patients. There is evidence of increased carer strain due to these behaviours; however, little is known about clinical variables mediating this effect. This study aims to investigate the factors predictive of carer burden within a cohort of Parkinson’s Disease patients with ICBs. Identification of such factors may allow for targeted therapeutic intervention. Method Data was collected from 45 patients with clinically significant ICBs and their carers including levodopa equivalent daily dosage, assessments of motor and neuropsychiatric symptoms, cognitive function and ICBs. Carer burden was assessed using the Zarit Burden Interview (ZBI). Univariate analyses were performed using Spearman’s Rank Correlation Coefficient. A backward model was used to remove variables to create a final multivariate model using ZBI score as the dependent variable. Results Univariate analysis identified significant correlations between ZBI and total NPI (rs=0.50, p Conclusions This is the largest study to date, looking at associations between carer burden and ICBs. Our findings indicate low mood, poor motivation, social disinhibition and neuropsychiatric symptom burden to be significant factors in carer burden. We also observe that carers reporting poorer health had increased carer strain. Further work should explore methods of physical and psychosocial support and coping strategies for carers.
{"title":"26 Predictors of carer burden in impulse control disorders in parkinson’s disease","authors":"Leigh Townsend, Daniel Johnson, A. David, S. Askey‐Jones, Richard J. Brown, D. Okai","doi":"10.1136/JNNP-2019-BNPA.26","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.26","url":null,"abstract":"Aims/Objectives Impulse control behaviors (ICBs) affect 15%–35% of Parkinson’s Disease patients. There is evidence of increased carer strain due to these behaviours; however, little is known about clinical variables mediating this effect. This study aims to investigate the factors predictive of carer burden within a cohort of Parkinson’s Disease patients with ICBs. Identification of such factors may allow for targeted therapeutic intervention. Method Data was collected from 45 patients with clinically significant ICBs and their carers including levodopa equivalent daily dosage, assessments of motor and neuropsychiatric symptoms, cognitive function and ICBs. Carer burden was assessed using the Zarit Burden Interview (ZBI). Univariate analyses were performed using Spearman’s Rank Correlation Coefficient. A backward model was used to remove variables to create a final multivariate model using ZBI score as the dependent variable. Results Univariate analysis identified significant correlations between ZBI and total NPI (rs=0.50, p Conclusions This is the largest study to date, looking at associations between carer burden and ICBs. Our findings indicate low mood, poor motivation, social disinhibition and neuropsychiatric symptom burden to be significant factors in carer burden. We also observe that carers reporting poorer health had increased carer strain. Further work should explore methods of physical and psychosocial support and coping strategies for carers.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132297939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.27
Felix May, Stephanie Romiszewski, Ben Norris, Michelle A. Miller, A. Zeman
Objectives/Aims There is growing recognition that sound sleep is a pillar of health, alongside adequate nutrition and exercise. Sleep problems are common and often treatable, improving lives. Twenty years ago, Stores1 revealed the paucity of UK medical school-education on sleep disorders, with a median teaching time of 20 min: we investigate here whether this situation has changed. Methods A cross-sectional survey of 34 medical degree courses in the UK, adapted from Stores’ 1998 questionnaire, including time spent on teaching sleep medicine, sub-topics covered, and forms of assessment. Responses were coded and analysed numerically where possible; free text was analysed thematically. We excluded responses not concerned with general undergraduate education. Results Twenty-five (74%) UK medical schools responded to our survey. The time devoted to teaching sleep medicine during undergraduate training was median 1.5 hours, mode- Only two schools reported a sleep medicine syllabus or dedicated compulsory module (8%), whilst two had optional student-selected sleep medicine modules (8%). Sleep medicine was generally described as being subsumed into other areas, primarily respiratory medicine, sometimes ENT, Psychiatry and Neurology; coverage of subtopics mirrored this pattern. Asked if enough time is allotted for teaching on sleep medicine, 50% said Yes, 38% No, 13% were unsure. Free-text comments made by our respondents had recurring themes: sleep medicine is typically subsumed into teaching by other specialties, consequently course directors are uncertain about the details of provision, obstructive sleep-apnoea is often identified as the key or only relevant sleep disorder, knowledge of sleep disorders is regarded as optional, and there is inertia about the prospect of change. However, a substantial minority of respondents are enthusiastic about making improvements to the sleep education they currently provide, and keen to use additional resources. Examples of good practice exist already, with one school offering an optional 30 hour sleep medicine module annually to 12 students. Conclusions Little has changed since Stores’ previous survey 20 years ago: sleep medicine remains a neglected topic despite agreement on the importance of sleep for general health. Sleep research is the exception rather than the rule. Obstacles to change are akin to those noted by Stores, including the views that ‘sleep is not a core topic’, or the ‘curriculum is too crowded’. However, there is some enthusiasm for improving sleep education. Given its broad importance to health, and the existence of effective therapies, we recommend that medical schools should implement a sleep medicine curriculum. Reference Stores, G. & Crawford, C. Medical student education in sleep and its disorders. J. R. Coll. Physicians Lond. 1998;32:149–153. Declaration of interests Funded by the Royal Devon and Exeter Trust Research Grants Scheme. No competing interests.
目标/目的人们日益认识到，良好的睡眠与充足的营养和锻炼一样，是健康的支柱。睡眠问题很常见，而且通常是可以治疗的，可以改善生活。20年前，Stores1揭示了英国医学院在睡眠障碍方面的教育不足，平均教学时间为20分钟:我们在这里调查这种情况是否已经改变。方法对英国34个医学学位课程的横断面调查，改编自Stores 1998年的问卷，包括教授睡眠医学的时间、涵盖的子主题和评估形式。在可能的情况下，对答复进行编码和数字分析;对自由文本进行了主题分析。我们排除了与普通本科教育无关的回答。25所(74%)英国医学院回应了我们的调查。本科阶段睡眠医学教学时间平均为1.5小时，只有两所学校(8%)报告了睡眠医学教学大纲或专门的必修模块，而两所学校(8%)有学生自选的睡眠医学模块。睡眠医学通常被归入其他领域，主要是呼吸医学，有时是耳鼻喉科，精神病学和神经病学;子主题的覆盖反映了这种模式。当被问及是否有足够的时间用于睡眠医学教学时，50%的人说有，38%的人说没有，13%的人不确定。我们的受访者的自由文本评论有反复出现的主题:睡眠医学通常被纳入其他专业的教学，因此课程主任对提供的细节不确定，阻塞性睡眠呼吸暂停通常被确定为关键或唯一相关的睡眠障碍，睡眠障碍的知识被认为是可选的，并且对改变的前景存在惯性。然而，相当一部分受访者热衷于改进他们目前提供的睡眠教育，并热衷于使用额外的资源。良好实践的例子已经存在，一所学校每年为12名学生提供30小时的可选睡眠医学模块。自20年前Stores的上一次调查以来，情况几乎没有改变:尽管人们一致认为睡眠对整体健康很重要，但睡眠药物仍然是一个被忽视的话题。睡眠研究是例外，而不是规律。改变的障碍与Stores指出的类似，包括“睡眠不是核心话题”或“课程太拥挤”的观点。然而，人们对改善睡眠教育抱有一些热情。鉴于睡眠对健康的广泛重要性，以及有效疗法的存在，我们建议医学院开设睡眠医学课程。参考Stores, G. & Crawford, C.医学生睡眠教育及其障碍。j·r·科尔。中华医学杂志。1998;32:149-153。由皇家德文郡和埃克塞特信托研究资助计划资助的利益声明。没有竞争利益。
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