EXPRESS: Differences in outcomes following an intensive upper-limb rehabilitation programme for patients with common CNS-acting drug prescriptions

Difficulty using the upper-limb is a major barrier to independence for many patients post-stroke or brain injury. High dose rehabilitation can result in clinically significant improvements in function even years after the incident, however there is still high variability in patient responsiveness to such interventions that cannot be explained by age, sex or time since stroke. This retrospective study investigated whether patients prescribed certain classes of CNS-acting drugs - GABA agonists, antiepileptics and antidepressants-differed in their outcomes on the 3 week intensive Queen Square Upper-Limb (QSUL) programme. For 277 stroke or brain injury patients (167 male, median age 52 years (IQR 21), median time since incident 20 months (IQR 26)) upper-limb impairment and activity was assessed at admission to the programme and at 6 months post-discharge, using the upper limb component of the Fugl-Meyer (FM), Action Research Arm Test (ARAT), and Chedoke Arm and Hand Activity Inventory (CAHAI). Drug prescriptions were obtained from primary care physicians at referral. Specification curve analysis (SCA) was used to protect against selective reporting results and add robustness to the conclusions of this retrospective study. Patients with GABA agonist prescriptions had significantly worse upper-limb scores at admission but no evidence for a significant difference in programme-induced improvements was found. Additionally, no evidence of significant differences in patients with or without antiepileptic drug prescriptions on either admission to, or improvement on, the programme was found in this study. Whereas, though no evidence was found for differences in admission scores, patients with antidepressant prescriptions experienced reduced improvement in upper-limb function, even when accounting for anxiety and depression scores. These results demonstrate that, when prescribed typically, there was no evidence that patients prescribed GABA agonists performed worse on this high-intensity rehabilitation programme. Patients prescribed antidepressants, however, performed poorer than expected on the QSUL rehabilitation programme. While the reasons for these differences are unclear, identifying these patients prior to admission may allow for better accommodation of differences in their rehabilitation needs.

The influence of common, CNS-acting, drug prescriptions on outcomes from an intensive upper-limb rehabilitation program

Difficulty using the upper-limb is a major barrier to independence for many patients post-stroke or brain injury. High dose rehabilitation can result in clinically significant improvements in function even years after the incident, however there is still high variability in patient responsiveness to such interventions that cannot be explained by age, sex or time since stroke.This retrospective study investigated whether prescription of certain CNS-acting drug classes-GABA agonists, antiepileptics and antidepressants-influenced outcomes on the 3 week intensive Queen Square Upper-Limb (QSUL) programme.For 277 stroke or brain injury patients upper-limb impairment and activity was assessed at admission to the programme and at 6 months post-discharge, using the upper limb component of the Fugl-Meyer (FM), Action Research Arm Test (ARAT), and Chedoke Arm and Hand Activity Inventory (CAHAI). Drug prescriptions were obtained from primary care physicians at referral. Specification curve analysis (SCA) was used to protect against selective reporting results and add robustness to the conclusions of this retrospective study.GABA agonist prescription had a significant negative effect on upper-limb scores at admission but did not impact programme-induced improvements. There were no effects of antiepileptic drug prescriptions on either admission scores, or improvement during the programme. Antidepressant prescriptions did not impact admission scores but resulted in reduced improvement in upper-limb function, even when accounting for anxiety and depression scores.These results demonstrate that, when prescribed appropriately, GABA agonists do not impair patient’s ability to benefit from rehabilitation programmes. Patients prescribed antidepressants, however, performed poorer than expected on the QSUL rehabilitation programme. While the reasons for this effect are unclear, identifying these patients prior to admission may allow for better accommodation of differences in their rehabilitation needs.

Clinical structure of psychoses, associated with use of modern synthetic psychoactive substances

Psychoses associated with use of modern synthetic psychoactive substances (PAS) have significant differences in clinical features for making accurate diagnosis. These features play important role in correct diagnosis of psychoses, associated with synthetic cannabis (spice), synthetic stimulants (bath salts), and synthetic GABA-agonists (butyrates) still badly investigated. Theaimof this study was to reveal main symptoms and syndromes of psychoses associated with modern synthetic PAS. Methods: clinical and psychopathological, laboratory, statistical. Results. We examined 154patients with psychoses associated with modern synthetic PAS: 53users of synthetic cannabinoids (spices), 54users of synthetic psychostimulants (cathinones, metcathinones, bath salts), and 47users of synthetic GABA-agonists (butyrolactone). Conclusion. Differences in psychotic symptoms in different groups are described.

Effect of di(2-ethylhexyl) phthalate on the neuroendocrine regulation of reproduction in adult male rats and its relationship to anxiogenic behavior: Participation of GABAergic system

The endocrine disruptor di-(2-ethylhexyl) phthalate (DEHP) is used in a variety of consumer products made with polyvinyl chloride and also in the manufacture of medical devices. DEHP disrupts reproductive tract development in an antiandrogenic manner and also may induce neurobehavioral changes. The aim of this study was to investigate the effects of chronic postnatal exposure to DEHP (30 mg/kg body weight/day, orally from birth to day 60) on the neuroendocrine regulation of the gonadal axis and its impact on the anxiety-like behavior in adult male rats, as well as the probable participation of the GABAergic system in these effects. DEHP produced a significant increase in plasmatic luteinizing hormone and follicle stimulating hormone, as well as significant testosterone decrease, accompanied with a decrease in hypothalamic gamma-aminobutyric acid (GABA) concentration. On the other hand, DEHP increased the anxiety-like behavior in the elevated plus maze test, evidenced by a significant decrease in the percentages of time spent in the open arms and the frequency in the open arm entries and a significant increase in the percentage of time spent in closed arms. Neuroendocrine and behavioral effects were reversed by GABA agonists, muscimol (2 mg/kg i.p. ) and baclofen (10 mg/kg i.p.). In conclusion, chronic DEHP postnatal exposure induced a disruption in the neuroendocrine regulation of the testicular axis in young adult male rats, and this effect was correlated with an anxiety-like behavior. Since GABA agonists reversed these effects, the results suggest that GABA could participate in the modulation of reproductive and behavioral DEHP effects.