Institute for Community Living

Major Depressive Disorder is a common and disabling psychiatric illness whose pharmacological treatment options have historically been characterized by relatively low response rates. "Treatment-resistant depression" has emerged to describe patients whose depressive symptoms fail to respond to multiple courses of oral antidepressant medications. In 2019, the FDA approved intranasal esketamine as augmentation to an oral antidepressant in patients with treatment-resistant depression (TRD). While intranasal esketamine's efficacy was demonstrated in Janssen pharmaceutical's drug development program, publications on its real-world use have shown varying degrees of effectiveness. We aim to assess intranasal esketamine's effectiveness in a real-world clinical setting in Hartford, Connecticut, and are among the first to do so in an American sample using the Montgomery-Asberg Depression Rating Scale (MADRS), the same outcome measure used in the clinical trials where efficacy was established. In this analysis, a sample of 50 patients were enrolled in an intranasal esketamine treatment program at the Institute of Living (IOL) in Hartford, Connecticut. Information for these patients was obtained through retrospective analysis of the electronic health record. Descriptive statistics were used to analyze symptom severity and outcomes, using the Montgomery-Asberg Depression Rating Scale (MADRS) score at baseline and over 16 weeks of treatment. Assessment showed that moderate to severe baseline symptoms of depression were reduced to the mild range after 4 weeks and this effect was sustained over 16 weeks of treatment. Adverse effects were transient and generally mild (dissociation and sedation being the most common), with no safety events, and very few discontinuations related to tolerability. Results of this analysis demonstrate real-world effectiveness of intranasal esketamine as augmentation therapy in treatment resistant depression. The medication was well tolerated, with no safety events, misuse or dependence. While results demonstrating the efficacy of intranasal esketamine in patients with TRD were observed in the clinical trial studies, this analysis shows intranasal esketamine treatment to be safe and effective in a real-world clinical setting.

Purpose: The primary purpose of the prevention survey (TPS) is to monitor and enhance preventive health policies across various sectors in Flanders and Brussels, including schools, enterprises, local governments, childcare facilities, and healthcare institutions. This project is innovative in its comprehensive approach, utilising a triennial survey to gather data on a wide range of preventive health measures, not just focused on physical activity and sedentary behaviour, but also on nutrition, mental wellbeing, dental health, fall prevention, smoking, alcohol and drug use. Project or Policy Description. Development: TPS was developed by Flanders Institute of Healthy Living (NGO) in collaboration with key partners. This project is both research and practice-based, designed to evaluate and enhance preventive health policies across various settings. This was funded by the Flemish Department of Health. Implementation: The implementation involves distributing an online detailed questionnaire to various organisations to evaluate their preventive health policies on multiple themes. The data collection is carried out every three years to track progress and identify areas for improvement. Evaluation: The collected data are analysed to provide insights into the effectiveness of current health policies and practices. Within each health theme, the set of questions is based on several criteria for a qualitative preventive health policy. These quality criteria summarise the initiatives, measures, and facilities that constitute a qualitative preventive policy for the respective theme. The results are shared with: (1) participating organisations to help them enhance their preventive health strategies, and (2) partners in the preventive health sector and stakeholders to give them insights and inspiration for future interventions. Dissemination: The findings from TPS are disseminated through public reports and workshops. The results are also used to inform regional health policies and support the scaling up of successful interventions. Conclusions: TPS contributes significantly to the field of preventive health by providing valuable data that informs policymaking and practice. The project’s comprehensive approach and regular data collection offer critical insights for improving health promotion strategies and addressing health disparities across various sectors.

Herbicides are a vital tool to reducing weed competition during the establishment phase of revegetation plantings. However, there is limited information on herbicide tolerances of native species, hindering the ability to develop effective weed-management plans. In a pilot study, tolerances of five New Zealand native species (Coprosma propinqua, Griselinia littoralis, Hoheria angustifolia, Prumnopitys taxifolia, and Cyperus ustulatus) were tested against the herbicides clopyralid, haloxyfop-P-methyl, triclopyr, glufosinate-ammonium and glyphosate at label rates, and to a dilute glyphosate treatment used to simulate drift from spraying around native plants. Treatments were sprayed directly onto plants, with survival and growth over four months compared to a control group. Clopyralid caused significant damage to H. angustifolia and G. littoralis, but increased growth in Cyperus ustulatus. Haloxyfop-P-methyl did not damage any species. While glyphosate and glufosinate-ammonium at label rates caused significant mortality, a low dose of glyphosate did not damage any species except Coprosma propinqua. Triclopyr also caused significant mortality or damage even in non-dicotyledonous plants, possibly due to small plant sizes. These results identify broader than expected susceptibility to triclopyr and clopyralid, suggesting additional caution with these herbicides may be required. The findings from this study also indicate that spraying glyphosate carefully around these species is unlikely to cause harm, except to Coprosma propinqua.

The Lupus Research Alliance formed the Lupus Accelerating Breakthroughs Consortium (Lupus ABC) in 2023 as a public-private partnership with investigators, pharmaceutical companies, the Food and Drug Administration, National Institutes of Health, patient-focused non-profits and professional societies with the goals of developing initiatives to accelerate lupus drug development in a precompetitive setting, and ensuring that perspectives of people with lived experience of lupus are included into the drug development process. Patient-reported outcome (PRO) measures are a top area of focus for the Lupus ABC. To support future work in the area of PROs, a public meeting was held on 16–17 October 2024 with the objectives of (1) assessing the current state of PROs used in lupus clinical trials, (2) developing a roadmap to advance the use of PROs in lupus clinical trials and (3) identifying and setting priorities for efforts to be pursued by a Lupus ABC PRO Working Group. After a series of presentations, small groups addressed what PRO domains to measure, the questionnaire burden for trial participants, how PROs should be selected for trials and what efforts are needed to advance use of PROs in lupus clinical trials.Meeting participants concluded that although PROs are being collected in most lupus clinical trials, they may be underused as primary or secondary/exploratory endpoints. A strong desire to change the focus in trials from disease activity and signs to include PROs, as a way of highlighting patients’ voices, was noted. The group concluded that the specific steps needed are to identify PRO measures appropriate for the target populations of interest, incorporate PROs into endpoints for regulatory decision-making, ensure PRO data are publicly available and accessible to researchers and involve people living with lupus in selection of PRO domains, measures and trial design. For these actions, collaborations among industry, researchers, regulators, payors and patients are needed.

ABSTRACTAimThis study aimed to evaluate associations in bipolar disorder (BD) across multimodal measures of white matter microstructure (using diffusion tensor imaging; DTI), cognitive, behavioral, and brain electrophysiological measures (using electroencephalography; EEG).MethodsSubjects were recruited through the Psychosis and Affective Research Domains and Intermediate Phenotypes Consortium (n = 45 bipolar with psychosis, n = 40 bipolar without psychosis, n = 66 healthy subjects). DTI data were used to quantify the white matter variables, fractional anisotropy (FA) and radial diffusivity (RD). The Brief Assessment of Cognition in Schizophrenia (BACS), Stop Signal Task (SST), pro‐ and anti‐saccades, auditory event‐related potentials (ERPs), and intrinsic brain activity were used as estimates of brain function.ResultsThe combined BD group differed from healthy controls, but no differences between BD with and without psychosis were observed. BD‐related white matter abnormalities were seen across multiple tracts: right cingulum–cingulate gyrus, bilateral anterior thalamic radiation, bilateral superior longitudinal fasciculus, right inferior longitudinal fasciculus, and forceps major. Results also showed modestly compromised cognitive performance and elevated intrinsic EEG activity associated with BD.ConclusionsFurther analysis indicated worse white matter integrity related to higher intrinsic EEG and modestly higher ERPs. These multimodal analyses are likely to aid in creating future informative diagnostic, etiological, and treatment targets for BD.

Psychiatry lags in adopting etiological approaches to diagnosis, prognosis, and outcome prediction compared to the rest of medicine. Etiological factors such as childhood trauma (CHT), substance use (SU), and socioeconomic status (SES) significantly affect psychotic disorder symptoms. This study applied an agnostic clustering approach to identify exposome clusters "Exposotypes (ETs)" and examine their relationship with clinical, cognitive, and functional outcomes. Using data from individuals with psychotic disorders (n=1,350), and controls (n=623), we assessed the relationship between the exposotypes and outcomes. Four exposotypes were identified: ET1 characterized by high CHT and SU; ET2, high CHT; ET3, high SU; ET4, low exposure. Compared to ET4, ET1 demonstrated higher positive and general symptoms, anxiety, depression, impulsivity, and mania; ET2 had higher anxiety, depression, and impulsivity; ET3 had better cognitive and functional outcomes with lower negative symptoms. Intracranial volume was largest in ET3, and smallest in ET2. No group differences in schizophrenia polygenic risk scores were found. The age of onset was 5 years earlier in ET1 than in ET4. These findings provide insight into the complex etiological interplay between trauma, and SU, as well as their unique effects on clinical symptoms, cognition, neurobiology, genetic risk, and functioning.

Immune dysregulation and chronic inflammation have been hypothesized as potential pathways in metabolic syndrome and schizophrenia. Anti-inflammatory diets have the potential not only to treat metabolic syndrome but also to reduce the symptom burden in schizophrenia. The aim of this systematic review was to investigate the role of anti-inflammatory diets and vitamin supplementation in the management of metabolic syndrome and in symptom remission in people with schizophrenia. This systematic review included research articles from PubMed, EMBASE, Scopus, PsycINFO, and the Cochrane Central Register for Controlled Trials. The primary outcomes were markers of metabolic syndrome and symptoms of psychosis. Our search identified 2,124 potential studies, of which 1,559 were screened based on the title and abstract, resulting in 81 full-text articles assessed for eligibility. A total of 17 studies were included, which demonstrated mixed findings on the impacts of anti-inflammatory diet interventions on metabolic markers and symptom remission in schizophrenia. Prebiotic, probiotic, and fish oil supplementation showed improvements in metabolic markers. Fish oil and vitamin D supplementation demonstrated symptom remission in some trials. It is important to consider that people with schizophrenia may experience common external barriers that hinder adherence to dietary interventions. These findings underscore the need for larger trials with standardized dietary protocols and consistent metabolic and symptom outcome measures in order to better understand the potential role of anti-inflammatory interventions in this population. https://www.crd.york.ac.uk/prospero/, identifier CRD42024511596.