Bedford Hospital Bedford

Bedfordshire, United Kingdom

Bedford Hospital Bedford

Bedfordshire, United Kingdom

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Poo S.X.W.,University of Cambridge | Poo S.X.W.,Cambridge College | Agius M.,University of Essex | Agius M.,University of Cambridge | Agius M.,Bedford Hospital Bedford
Psychiatria Danubina | Year: 2014

Background: The introduction of atypical antipsychotics in the management of adult bipolar disorder has been increasingly adopted in clinical setting. While new studies continue to emerge, NICE has recently updated the guidelines on the assessment and management of bipolar disorder. Aim: To review the efficacy and tolerability profiles of atypical antipsychotics used to treat adult bipolar disorder in clinical practice, in relation to the latest NICE guidelines. Methods: The recent NICE guidelines (CG185), published in September 2014 was analysed to identify second generation antipsychotics (SGA) for the various presentations of bipolar disorder in adults. A qualitative literature search was conducted to review the evidence to support these changes, and identify randomized controlled trials on off-label and newer SGAs. Results and conclusions: With respect to atypical antipsychotics, NICE guidelines introduced olanzapine and fluoxetine combination therapy as first line treatment for moderate to severe bipolar depression; and improved clarity on the treatment of mania, hypomania and rapid cycling bipolar disorder. Evidence from our literature search favour these changes; and recognized other atypical antipsychotics such as aripiprazole, asenapine, lurasidone, ziprasidone and clozapine which could be of potential clinical benefit. © Medicinska naklada - Zagreb, Croatia


Yi K.,University of Cambridge | Yi K.,Cambridge College | Austin J.,University of Cambridge | Austin J.,Cambridge College | And 6 more authors.
Psychiatria Danubina | Year: 2014

OCD is a condition seen often in Community Mental Health Teams in England. It is treated with medication and psychology. We wanted to assess what co-morbidities were present in our OCD patients, with which medications they were being treated, and whether patients had received psychological treatment. On assessment It is clear that a very large number of the OCD patients in our cohort are complex patients who have not responded to first line treatment, such as SSRIs or basic psychology, and who suffer from co-morbidities. Treatment of these patients, while oriented towards the achievement of recovery, is also relatively complex and long term. © Medicinska naklada - Zagreb, Croatia


Agius M.,University of Cambridge | Agius M.,Cambridge College | Agius M.,University of Essex | Agius M.,Bedford Hospital Bedford | And 3 more authors.
Psychiatria Danubina | Year: 2014

We review the evidence that Bipolar Disorder with Comorbid Anxiety, Rapid Cycling Bipolar Disorder, Mixed Affective states, are all related to each other and to Dopamine Transmission in Bipolar Disorder. All these states are related to the presence of particular polymorphisms of the genes of the D2 andD3 receptors. All these states increase the risk of suicidality. Substance and alcohol abuse comorbid with bipolar disorder increases the risk of both Rapid Cycling and Suicidality.We present a model which demonstrates these relationships. © Medicinska naklada - Zagreb, Croatia


Christy J.,University of Cambridge | Burnside D.,University of Cambridge | Agius M.,University of Cambridge | Agius M.,University of Essex | Agius M.,Bedford Hospital Bedford
Psychiatria Danubina | Year: 2014

Antipsychotic drugs are commonly combined in psychiatric practice in an attempt to treat schizophrenia. Such practice is widespread, despite the lack of explicit endorsement by many of the main regulatory bodies. There are varying rationales behind combining these potent drugs-either to augment the effect of a drug whose action alone is inadequate for patients with treatment resistant schizophrenia (TRS), or to improve the side effects seen due to treatment. Augmentations are most frequently observed with clozapine, a drug reserved for use when other antipsychotic medications have failed. Several drugs have been chosen as adjuvants, including aripiprazole, sulpiride, amisulpiride and risperidone. A small number of RCTs (randomized controlled trials) have been performed but, despite this data and numerous case reports showing positive changes in symptomatology, Cochrane reviews of available studies have been unable to definitively confirm the efficacy of these combinations, frequently citing the need for larger, longer term, prospective studies.Evidence for benefits of combination therapy on side effects is also inadequate. Some RCTs and case series have shown they can positively alter side effects due to drugs such as clozapine, e.g. metabolic side effects. However, despite many of the combinations being relatively well tolerated, there is some evidence they can cause adverse effects of their own. More evidence is essential as, on the current data alone, it is not possible to make a firm recommendation on the efficacy and safety of antipsychotic combinations. In addition it is vital that the importance of a fair trial of monotherapy at adequate dosages is reinforced to clinicians, so that patients are not put onto these relatively unknown treatment strategies unnecessarily. © Medicinska naklada - Zagreb, Croatia


Agius M.,Cambridge College | Agius M.,University of Essex | Agius M.,University of Cambridge | Agius M.,Bedford Hospital Bedford | Aquilina F.F.,Materials Dei Hospital
Psychiatria Danubina | Year: 2014

This article aims at addressing the implications of defining 'comorbidity' within the field of psychiatry. We have looked at the standard definition of comorbidity and then discussed whether this definition can be applied to comorbidities in psychiatry. While comorbidities in physical illness are clearly the coexistence of two independent illnesses, Comorbidities in Mental illness are the result of the polygenic nature of mental illnesses, especially in psychotic illness whether schizophrenia or bipolar disorder. As a consequence, often the comorbidities of psychiatric illness are caused by two conditions which have in common the presence of particular single nucleotide polymorphisms (snps), which regulate the metabolism of neurotransmitters or the presence of neurotrophic factors . Thus inevitably, many such comorbidities are inextricably linked. We discuss the consequences of this form of comorbidity for the description, classification, and risk profile of mental illness. © Medicinska naklada - Zagreb, Croatia


Butler S.,Foundation Programme East Anglian Deanery | Agius M.,Bedford Hospital Bedford | Agius M.,University of Cambridge | Holt C.,Foundation Programme East Anglian Deanery | And 2 more authors.
Psychiatria Danubina | Year: 2010

Background: Whilst it is important that we treat patients with depression in primary care if possible there are many patients with depression who will need the more expert support provided in secondary care. Aims and Methods: An Anonymised Database held by the Bedford East Community Mental Health Team was studied to assess what factors were related to the use of Augmentation Strategies to treat resistant depression. Results: Of the total 282 patients 109 (38.7%) were on augmentation therapy. In the F32 and F33 group just over a third of the patients (35.8% and 37.1%) were on augmentation therapy and in the F41.2 group over a half of patients (56.7%) were on augmentation therapy. Discussion: There does seem to be a relationship between the number of risk factors a patient has and the likelihood that they are on augmentation. Particularly strong factors are another psychiatric diagnosis and 'other suicide risk factors '. Conclusion: Generally the patients coming to secondary care with more of the specified risk factors are more likely to need augmentation. © Medicinska naklada.


Mark A.,Cambridge College | Mark A.,Bedford Hospital Bedford
Psychiatria Danubina | Year: 2014

The consultation has been described as the most important part of Medicine. The Doctor-Patient Relationship is considered to depend on the trust of the patient in the doctor. This paper seeks to explore fundamental requirements of the consultation by exploring empathy, integrity, and the understanding of the human self, using concepts taken from Neuroscience, Group Analysis, Philosophy and Theology. It then introduces a plan for a study aimed at assessing the impact of a specific form of teaching consultation on the patient. © Medicinska naklada - Zagreb, Croatia

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