Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.

T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).

PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).

PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.

Catatonia has many potential underlying causes, but in some patients, no clear etiology is identified, sparking growing interest in its genetic basis. We aimed to provide the first comprehensive synthesis of genetic abnormalities in catatonia.

In this systematic review (PROSPERO CRD42023455118) we searched MEDLINE All, Embase Classic + Embase, PsycINFO, and AMED up to August 15, 2023, for studies on genetic testing and catatonia phenotyping in all age groups. Catatonia was diagnosed using specified diagnostic criteria or description of clinical features. Risk of bias was assessed using the Joanna Briggs Institute quality assessment tools. Results were summarized with a narrative synthesis.

We included 99 studies involving 8600 individuals. Sex was reported for 6080 individuals, of whom 3208 (52.8%) were male. Mean age at onset of catatonia was 28.8 years (SD 16.3). The median duration of the index catatonic episode was 180 days (IQR 38 to 668). Stupor and mutism were the most frequently reported symptoms. Forty-seven genetic conditions were reported in catatonia, including Phelan-McDermid syndrome (n = 80), 22q11.2 deletion syndrome (n = 23), and Down’s syndrome (n = 19). Study quality was good in 29 studies, moderate in 53, and poor in 17. The major focus of association studies has centered on periodic catatonia; despite identifying candidate genes at both 22q13 and 15q15, none have been replicated.

Catatonia can manifest in a wide range of genetic syndromes, suggesting a shared vulnerability across diverse genetic and developmental disorders. We did not identify a unique phenomenology or treatment response profile in genetic associations of catatonia.

Neuropsychiatry training in the UK currently lacks a formal scheme or qualification, and its demand and availability have not been systematically explored. We conducted the largest UK-wide survey of psychiatry trainees to examine their experiences in neuropsychiatry training.

In total, 185 trainees from all UK training regions completed the survey. Although 43.6% expressed interest in a neuropsychiatry career, only 10% felt they would gain sufficient experience by the end of training. Insufficient access to clinical rotations was the most common barrier, with significantly better access in London compared with other regions. Most respondents were in favour of additional neurology training (83%) and a formal accreditation in neuropsychiatry (90%).

Strong trainee interest in neuropsychiatry contrasts with the limited training opportunities currently available nationally. Our survey highlights the need for increased neuropsychiatry training opportunities, development of a formalised training programme and a clinical accreditation pathway for neuropsychiatry in the UK.

An alternative to an “all or none” approach to contact precautions for patients with MRSA carriage may be a “risk-tailored” approach – using gloves and gowns only for certain high-risk activities, locations, or roles.

We distributed a discrete choice experiment to healthcare personnel (HCPs) in three cities. Respondents were presented with eight choice sets, each consisting of two hypothetical policy options for glove and gown use to prevent MRSA transmission. In each comparison, respondents selected their preferred option. Using mixed logit modeling we calculated utility derived from each policy component, probability of uptake for the most favored policies, and heterogeneity in preferences based on HCP role.

In total, 326 HCPs completed the survey. 237 (54%) respondents reported wearing gloves and gowns ‘all the time’ when required. Respondents’ preferred policy with the highest utility score was to use gloves and gown for all HCPs roles (utility, 0.17; 95% CI, 0.12 to 0.23), in high-risk settings (utility, 0.12; 95% CI 0.07–0.18), when touching the patient (utility, 0.11; 95% CI 0.06–0.17). Sixty-three percent (95% CI 60–66) would support a risk-tailored approach over an approach where contact precautions are used by all HCPs in all settings and for all activities. Support varied by HCP role (p < 0.02), with the strongest probability of support from physicians and advanced practice providers (77%, 95% CI 72%–82%) and the least support from environmental services personnel (45%, 95% CI 37%–53%).

This discrete choice survey demonstrates that most HCPs prefer a risk-tailored approach to contact precautions when caring for patients with MRSA.

Levetiracetam (LEV) is an antiseizure medication (ASM) used as a second line after benzodiazepines for status epilepticus treatment. Current literature lacks direct head-to-head comparisons between different LEV loading dose strategies, leading to uncertainty about superior dosing methods and thus clinical practice variations.

A retrospective cohort study was designed to compare efficacy and safety of low (<30 mg/kg) versus high (≥30 mg/kg) weight-based LEV loading doses in adults with benzodiazepine-refractory status epilepticus (BRSE). The primary outcome of this study was termination of BRSE. No requirement for additional ASM after LEV was a surrogate for BRSE termination. Secondary endpoints included endotracheal intubation, intensive care unit (ICU) admission, 30-day all-cause mortality and adverse drug reactions. Statistical analysis included discrete and inferential statistics, including logistic regression and win-ratio analysis, to control for potential confounding variables.

Of the 106 patients included in this study, 54 (51%) did not require additional ASM after LEV, thereby achieving seizure termination. There was a higher proportion of patients with seizure termination in the higher weight-based dosing group as compared to the lower weight-based group (66% vs 40%, respectively; aOR 3.07; 95% CI: 1.36–7.21). There were lower rates for endotracheal intubation, ICU admission and all-cause mortality in the higher dosing group. Adverse events were comparable between the both groups.

LEV’s high weight-based loading dose strategy (≥30 mg/kg) is more effective in the termination of BRSE as compared to the lower weight-based loading dose strategy (<30 mg/kg).

Anxiety disorders and treatment-resistant major depressive disorder (TRD) are often comorbid. Studies suggest ketamine has anxiolytic and antidepressant properties.

To investigate if subcutaneous racemic ketamine, delivered twice weekly for 4 weeks, reduces anxiety in people with TRD.

The Ketamine for Adult Depression Study was a multisite 4-week randomised, double-blind, active (midazolam)-controlled trial. The study initially used fixed low dose ketamine (0.5 mg/kg, cohort 1), before protocol revision to flexible, response-guided dosing (0.5–0.9 mg/kg, cohort 2). This secondary analysis assessed anxiety using the Hamilton Anxiety (HAM-A) scale (primary measure) and ‘inner tension’ item 3 of the Montgomery–Åsberg Depression Rating Scale (MADRS), at baseline, 4 weeks (end treatment) and 4 weeks after treatment end. Analyses of change in anxiety between ketamine and midazolam groups included all participants who received at least one treatment (n = 174), with a mixed effects repeated measures model used to assess the primary anxiety measure. The trial was registered at www.anzctr.org.au (ACTRN12616001096448).

In cohort 1 (n = 68) the reduction in HAM-A score was not statistically significant: −1.4 (95% CI [−8.6, 3.2], P = 0.37), whereas a significant reduction was seen for cohort 2 (n = 106) of −4.0 (95% CI [−10.6, −1.9], P = 0.0058), favouring ketamine over midazolam. These effects were mediated by total MADRS and were not maintained at 4 weeks after treatment end. MADRS item 3 was also significantly reduced in cohort 2 (P = 0.026) but not cohort 1 (P = 0.96).

Ketamine reduces anxiety in people with TRD when administered subcutaneously in adequate doses.

Recent studies have focussed on detecting white matter abnormalities in subjects who transition to psychosis (UHR-T). Research suggests that fractional anisotropy (FA), may be decreased in UHR-T. However, global and regional findings have been inconsistent. By objectively combining data in a meta-analysis, we have investigated white matter alterations associated with transition, by comparing FA in UHR-T with subjects that do not transition (UHR-NT) and healthy volunteers.

The meta-analysis was registered on PROSPERO (ID: CRD42021265348) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA guidance. A systematic database search of PUBMED and EMBASE identified reports, which were screened by 2 independent researchers (CN and DD) for inclusion, from inception to 20 July 2021. Discrepancies were decided on consensus with a third researcher (KM). Reference lists of eligible studies were also screened. Authors of screened reports were contacted to provide parametric maps. Coordinate-based meta-analysis was conducted using Seed-based d-Mapping software to combine parametric map and coordinate data from reports, using a random-effects model. Quality and risk of bias analysis were conducted using the Newcastle-Ottowa Scale. Heterogeneity and sensitivity analyses were also conducted.

The search strategy identified 889 potential studies, from which 6 met eligibility criteria. A total of 71 UHR-T, 142 UHR-NT and 148 healthy volunteers were included. Weighted-mean decreases in FA were observed in UHR-T compared with: UHR-NT (d = −0.99; p < 0.0001; 95% CI −1.43 to −0.55); and healthy volunteers (d = −0.91; p = 0.04; 95% CI −1.78 to −0.05). The level of heterogeneity for the former was not significant. For UHR-T, regional FA decreases were observed in areas including the left genu of the corpus callosum (Z-score = −1.76, 204 voxels, p < 0.0001) compared with UHR-NT, while FA increases were most observed in the white matter region adjacent to the left postcentral gyrus (Z-score = 1.64, voxels = 16, p < 0.0001). These findings persisted despite sensitivity analyses.

The findings suggest that white matter alterations, specifically in left frontotemporal tracts, are associated with an increased risk of transition to psychosis. The neurobiological implications of these findings, and their contribution to UHR-T prediction efforts, are explored, as are avenues for further research.

Additional Author: Mr Gunnar Gronlid.1