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STUDY OBJECTIVE Evaluate the impact of orofacial tardive dyskinesia (TD) symptoms on the professional and social lives of patients with TD. BACKGROUND TD, a movement disorder affecting the face and extremities, may arise in patients taking antipsychotics. The impact of social stigma on the professional and social lives of patients with orofacial manifestations of TD has not been thoroughly examined. METHODS This study is an experimental, randomized digital survey of a general population sample. Three component surveys were developed, corresponding to employment, dating, and friendship domains. For each domain, participants were randomized 11 into either a test group (who viewed a video of a scripted interview with a standardized patient actor depicting TD movements) or a control group (who viewed the same actors but without TD movements), and asked about their impressions of the video subject. Actor simulations were validated by physicians familiar with TD and rehearsed to simulate a total Abnormal Involuntarhan in the control group (P less then 0.001). CONCLUSIONS Actors simulating orofacial TD movements were perceived to be statistically significantly less likely to move forward in a job interview, be considered as a potential romantic partner, or be a new friend. This is the first study to quantify the stigma faced by people with TD in a variety of professional and social situations. FUNDING ACKNOWLEDGEMENTS This study was funded by Teva Pharmaceuticals, Petach Tikva, Israel.OBJECTIVES According to Nemeth et al. (2011), pediatric mania is difficult to distinguish from childhood hyperactivity. Both share 3 common symptoms distractibility, motoric hyperactivity, and talkativeness (Biederman, 2000). Oftentimes, children are referred from their pediatrician due to a lack of appropriate response to stimulant medication. Pediatricians have learned that merely raising the dose or changing the stimulant does not work. A thorough neuropsychological evaluation often reveals Bipolar Mania. They may have comorbid Bipolar Disorder and ADHD. This poster paper will examine measures that can assist in this important differential diagnosis as well as offer treatment options, including medication management. METHODS This case study includes three pediatric patients diagnosed with Childhood Bipolar Disorder and ADHD. A comprehensive psychoeducational assessment was conducted for each of the patients, which resulted in this comorbid diagnosis. RESULTS One of the most helpful measures was the TOVA. Wr rate of suicide.STUDY OBJECTIVE SPN-812 (extended-release viloxazine) is a structurally distinct, bicyclic, Serotonin Norepinephrine Modulating Agent (SNMA) in development as a treatment for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. This Phase 3, randomized, double-blind study (P303) evaluated the efficacy and safety of once-daily SPN-812 at doses of 200 and 400 mg compared to placebo in children ages 6-11yrs with ADHD. METHOD Inclusion criteria required subjects have a confirmed Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) ADHD diagnosis, ADHD-Rating Scale-5 (ADHD-RS-5) score ≥28, Clinical Global Impression-Severity score ≥4, and be free of ADHD medication ≥1 week before randomization. Subjects were enrolled at 31 study sites in the United States. Subjects (N=313) were randomized 111 to placebo200 mg SPN-812400 mg SPN-812. Treatment included up to 3 weeks of titration and 5 weeks of maintenance (intent-to-treat population N=301; placebo=97, 200 mg=107, 400 mg=IRS-P total average score (p=0.0651, p=0.1680; respectively). The most common (≥5%) treatment-related AEs were somnolence, decreased appetite, fatigue, headache, and upper abdominal pain. CONCLUSIONS In this study, SPN-812 met the primary objective for both the 200 and 400 mg doses and the key secondary objective (CGI-I) for both the 200 and 400 mg doses with statistical significance. A second key secondary objective (Conners 3-PS) for the 200 mg dose was also met. AE-related dropouts were ≤5%, indicating SPN-812 treatment was well tolerated.This study is an encore of a poster presentation at the 2019 Annual Meeting of the American Academy of Child and Adolescent Psychiatry (AACAP). FUNDING ACKNOWLEDGEMENTS This research was funded by Supernus Pharmaceuticals, Inc., Rockville, MD.OBJECTIVES The current study explores the feasibility of more effectively managing BPD symptoms/traits with a unique medication protocol consisting of two medications; an anticonvulsant (oxcarbazepine) and a dopaminergic (amantadine HCl), without use of an antipsychotic medication. METHODS Subjects were 147 females, ages 13-16, with the diagnosis of BPD treated with the described medication protocol in a residential facility. Positive outcome was described as achievement and maintenance of greater than 50% improvement from baseline admission state of functioning for 1 year. They were discharged when stable and having achieved greater than 50% improvement from baseline. Outpatient prescribers were requested to be compliant with the treatment protocol. However, some were non-compliant, substituting antipsychotic medication instead. Care givers were surveyed at 6 months and 1 year to determine whether their child was maintaining greater than 50% improvement. RESULTS The percent maintaining greater than 50% improvement was calculated for those whose caregivers reported continuation of the medications as prescribed, versus those whose prescribers changed the medications to the Community Standard. Of those compliant with the medication protocol, 61 of 86 (71%) maintained >50% improvement. Of those moved to the Community Standard approach, 19 of 61 (31%) maintained >50% improvement. see more Using Chi Square analysis, there was a significant relationship between maintenance of improvement and medication protocol compliance. Chi Square, Fisher's exact test = p less then 0.001. CONCLUSION The results indicate that, for adolescents 1 year post-discharge from residential treatment for BPD, continuation of the above described medication protocol provides significantly higher rates of maintenance of achieved symptom improvement. Further controlled studies are needed. FUNDING None.OBJECTIVES Evaluate comparative bioavailability of single-dose amphetamine extended-release tablet (AMPH ER TAB, Tris Pharma, Inc., Monmouth Junction, NJ) 20 mg, swallowed whole or chewed and amphetamine extended-release oral suspension (AMPH EROS) 2.5 mg/mL; and evaluate whether a PK food effect exists on AMPH ER TAB (contains a 3.21 ratio of d- to l-amphetamine). METHODS Healthy volunteers (18-55 yr) were randomized to 1 dose of AMPH ER TAB 20 mg swallowed (fasted), chewed (fed/fasted), or 20 mg AMPH EROS (fasted).A crossover design was used. Samples were collected each period pre-dose and at time points to 60 h post-dose. D-and l-amphetamine were measured, and PK was calculated (90% CIs of the ratios of the geometric mean plasma levels) for Cmax, AUCt, and AUC0∞. Comparative bioavailability was determined when ratios were within 80 and 125%. Safety was also assessed. RESULTS 32 subjects completed the study. Based on the calculated bioavailability ratios, for AMPH ER TAB swallowed vs. AMPH EROS fasted d-ampIONS Bioavailability of single dose of AMPH ER TAB for both d- and l-amphetamine was comparable, swallowed whole or chewed, to an equivalent 20 mg dose of the reference product AMPH EROS, 2.5 mg/mL fasted, and showed equivalent peak and overall exposure.No food effect was observed for AMPH ER TAB administered chewed. All AEs were mild in severity and AE profiles were similar to other amphetamine formulations used for treatment of ADHD. FUNDING ACKNOWLEDGEMENTS Tris Pharma, Inc.TITLE A Lost Family Secret Masquerading as Schizoaffective Disorder and Traumatic Brain Injury A Atypical, Non-Choreiform Subtype of Huntington's Disease. STUDY OBJECTIVES 1Describe a case of an atypical presentation of Huntington's Disease who presented to our acute inpatient setting with the diagnoses of schizoaffective disorder and traumatic brain injury.2Recognize the importance of identifying medical/neurological disease that may be masked by psychiatric symptoms.3Identify areas for improvement for patient-doctor-caregiver communication. METHOD Direct patient care, chart review, expert consultation and collateral biographical information obtained from multidisciplinary sources. Performed at Albert Einstein Medical Center, Philadelphia, Pennsylvania. RESULTS After re-evaluation of a patient discharged from our care with inconclusive MRI brain imaging, it was discovered with prior genetic testing that his unique presentation was in fact an atypical form of Huntington's Disease with 46 CAG on the IT15 allellness and be allowed to seek out anything that could delay or reverse his illness. Huntington's disease is known by its stereotypical choreiform movements; however, the psychiatric co-manifestations may present in up to 10 percent of HD patients with the atypical form which has less-pronounced movement abnormalities and can be interpreted as a psychiatric illness, while overlooking the underlying neurological pathology. Currently, many of the tests are cost prohibitive and require persistence to obtain genetic testing and detailed radiological imaging, but as medical providers, we are ultimately responsible for helping our patients overcome these barriers to offer them the best and most comprehensive care.This article describes a protocol to be able to utilize medication assisted treatment options for patients dependent on opioids. The first step is using a 15-day Klonopin taper for effect detox of acute opioid withdrawal. Once detoxed, the patient can be started on low dose methadone or low dose Buprenorphine. Titration above 40 mg of Methadone, or 8 mg of buprenorphine will usually not be needed. Buprenorphine is utilized as the mono product, Subutex. Avoiding Suboxone eliminates the risk of reemergence of acute opioid withdrawal symptoms.A description of how to transition to Naltrexone is provided. There are some differences between Methadone and Buprenorphine in the transition to Naltrexone. Once the patient is transitioned to Naltrexone, the stage is set for the patient to be able to get off medication assisted treatment.STUDY OBJECTIVE Akathisia and restlessness are common adverse events associated with atypical antipsychotic use; in severe cases, symptoms may lead to treatment discontinuation. Cariprazine, a dopamine D3/D2 receptor partial agonist with preferential binding to D3 receptors, is approved for the treatment of schizophrenia (1.5-6 mg/d), and manic or mixed (3-6 mg/d) and depressive episodes (1.5-3 mg/d) associated with bipolar I disorder. Pooled post hoc analyses were conducted to characterize the incidence and severity of cariprazine-related akathisia and restlessness in patients who participated in bipolar disorder studies. METHOD All studies were Phase II/III multicenter, randomized, double-blind, placebo-controlled, parallel-group studies in patients with bipolar I disorder who were currently experiencing a manic/mixed (NCT00488618, NCT01058096, NCT01058668) or depressive (NCT01396447, NCT02670538, NCT02670551) mood episode. Patients received flexibly dosed cariprazine 3-12 mg/d (day 1 1.5 mg; day 2 3 mg; subsequent up-titration in 3-mg increments if needed) or placebo in the bipolar mania studies and fixed-dose cariprazine 1.
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