Neuropsychiatric symptoms are related to disease progression and cognitive decline over time in cerebral small vessel disease (SVD) but their significance is poorly understood in covert SVD. We investigated neuropsychiatric symptoms and their relationships between cognitive and functional abilities in subjects with varying degrees of white matter hyperintensities (WMH), but without clinical diagnosis of stroke, dementia or significant disability.

The Helsinki Small Vessel Disease Study consisted of 152 subjects, who underwent brain magnetic resonance imaging (MRI) and comprehensive neuropsychological evaluation of global cognition, processing speed, executive functions, and memory. Neuropsychiatric symptoms were evaluated with the Neuropsychiatric Inventory Questionnaire (NPI-Q, n = 134) and functional abilities with the Amsterdam Instrumental Activities of Daily Living questionnaire (A-IADL, n = 132), both filled in by a close informant.

NPI-Q total score correlated significantly with WMH volume (r s = 0.20, p = 0.019) and inversely with A-IADL score (r s = −0.41, p < 0.001). In total, 38% of the subjects had one or more informant-evaluated neuropsychiatric symptom. Linear regressions adjusted for age, sex, and education revealed no direct associations between neuropsychiatric symptoms and cognitive performance. However, there were significant synergistic interactions between neuropsychiatric symptoms and WMH volume on cognitive outcomes. Neuropsychiatric symptoms were also associated with A-IADL score irrespective of WMH volume.

Neuropsychiatric symptoms are associated with an accelerated relationship between WMH and cognitive impairment. Furthermore, the presence of neuropsychiatric symptoms is related to worse functional abilities. Neuropsychiatric symptoms should be routinely assessed in covert SVD as they are related to worse cognitive and functional outcomes.

In the First-HD pivotal trial, the maximum deutetrabenazine dose evaluated to treat chorea associated with Huntington’s disease (HD chorea) was 48 mg/d, which is the approved maximum dose for this population. In ARC-HD, an open-label extension study evaluating the long-term efficacy and safety of deutetrabenazine to treat HD chorea, dosage ranged from 6 mg/d to 72 mg/d, with doses ≥12 mg/d administered twice daily. Doses in ARC-HD were increased by 6 mg/d per week in a response-driven manner based on efficacy and tolerability until 48 mg/d (Week 8). At the investigator’s discretion, further increases were permitted by 12 mg/d per week to a maximum of 72 mg/d. This post-hoc analysis evaluates the safety and tolerability of deutetrabenazine >48 mg/d compared to ≤48 mg/d to treat HD chorea in ARC-HD.

Patient counts and safety assessments were attributed to patients when they received a dose of either ≤48 mg/d or >48 mg/d. For 9 selected adverse events (AEs), we compared AE rates adjusted for duration of drug exposure (as number of AEs/year) at ≤48 mg/d or >48 mg/d. The AE rates were determined after titration when participants were on stable doses of deutetrabenazine.

All 113 patients were exposed to doses ≤48 mg/d (177.1 patient-years) and 49 patients were ever exposed to doses >48 mg/d (74.1 patient-years). In patients taking deutetrabenazine >48 mg/d compared to ≤48 mg/d after the titration period, there were no apparent differences in exposure-adjusted AE rates.

Based on clinical experience, some patients with HD may benefit from doses higher than 48 mg/d to adequately control chorea. These doses were tolerated without apparent increase in the exposure-adjusted rates of selected AEs after titration. This analysis does not address the occurrence of other AEs or whether adequate efficacy was achieved at lower doses, factors that may have influenced dose increases.

Teva Pharmaceutical Industries Ltd., Petach Tikva, Israel

Chorea is a prominent motor dysfunction in Huntington’s disease (HD). Deutetrabenazine, a vesicular monoamine transporter 2 (VMAT2) inhibitor, is FDA-approved for the treatment of chorea in HD. In the pivotal, 12-week First-HD trial, deutetrabenazine treatment reduced the Unified Huntington’s Disease Rating Scale (UHDRS) total maximal chorea (TMC) score versus placebo. ARC-HD, an open-label extension study, evaluated long-term safety and efficacy of deutetrabenazine dosed in a response-driven manner for treatment of HD chorea.

Patients who completed First-HD (Rollover) and patients who converted overnight from a stable dose of tetrabenazine (Switch) were included. Safety was assessed over the entire treatment period; exposure-adjusted incidence rates (EAIRs; adverse events [AEs] per person-year) were calculated. A stable, post-titration time point of 8 weeks was chosen for efficacy analyses.

Of 119 patients enrolled (Rollover, n=82; Switch, n=37), 100 (84%) completed ≥1 year of treatment (mean [SD] follow-up, 119 [48] weeks). End of study EAIRs for patients in the Rollover and Switch cohorts, respectively, were: any AE, 2.6 and 4.3; serious AEs, 0.13 and 0.14; AEs leading to dose suspension, 0.05 and 0.04. Overall, 68% and 73% of patients in Rollover and Switch, respectively, experienced a study drug–related AE. Most common AEs possibly related to study drug were somnolence (17% Rollover; 27% Switch), depression (23%; 19%), anxiety (9%; 11%), insomnia (10%; 8%), and akathisia (9%; 14%). Rates of AEs of interest include suicidality (9%; 3%) and parkinsonism (6%; 11%). In both cohorts, mean UHDRS TMC score and total motor score (TMS) decreased from baseline to Week 8; mean (SD) change in TMC score (units) was –4.4 (3.1) and –2.1 (3.3) and change in TMS was –7.1 (7.3) and –2.4 (8.7) in Rollover and Switch, respectively. While receiving stable dosing from Week 8 to 132 (or end of treatment), patients showed minimal change in TMC score (0.9 [5.0]), but TMS increased compared to Week 8 (9.0 [11.3]). Upon drug withdrawal, there were no remarkable AEs and TMC scores increased 4.4 (3.7) units compared to end of treatment.

The type and severity of AEs observed in long-term deutetrabenazine exposure are consistent with the previous study. Efficacy in reducing chorea persisted over time. There was no unexpected worsening of HD or chorea associated with HD upon deutetrabenazine withdrawal.

Teva Pharmaceutical Industries Ltd., Petach Tikva, Israel

Depression is projected to be the primary cause of disability worldwide by 2030. Our aim was to test the feasibility of a supportive text messaging mobile health intervention in improving treatment outcomes in depressed patients.

We performed a single-rater-blinded randomised trial involving 73 patients with Major Depressive Disorder. Patients in the intervention group (n = 35) received twice-daily supportive text messages for 3 months while those in the control group (n = 38) received a single text message every fortnight thanking them for participating in the study.

After adjusting for baseline BDI scores, a significant difference remained in the three month mean BDI scores between the intervention and control groups: (20.8 (SD = 11.7) vs. 24.9 (SD = 11.5), F (1, 60) = 4.83, P = 0.03, ηp2 = 0.07). The mean difference in the BDI scores change was significant with an effect size (Cohen's d) of 0.67. Furthermore, after adjusting for baseline scores, a significant difference remained in the three month mean self-rated VAS scores (EQ-5D-5L scale) between the intervention and control groups, 65.7 (SD = 15.3) vs. 57.4 (SD = 22.9), F (1, 60) = 4.16, P = 0.05, ηp2 = 0.065. The mean difference in change mean self-rated VAS scores was also statistically significant with an effect size (Cohen's d) of 0.51.

Our findings suggest that supportive text messages are a potentially useful psychological intervention for depression, especially in underserved populations. Further studies are needed to explore the implications of our findings in larger clinical samples.

Epidemiological studies of emergency room (ER) psychiatric settings can help monitor unmet needs and improve the quality of care.

To characterize the patients presenting to emergency department with psychiatric complaints in a medium sized health centre in oil sands region of the Northernalberta.

information on a data assessment tool designed to capture all relevant demographic and clinical characteristics of psychiatric patients in the ER was compiled as part of a clinical audit process.

Overall, 477 patients were assessed by the psychiatric team over the 12 month period, comprising 230 (48.2%) males and 247 (51.8%) females. There was a fairly balanced distribution by age, ethnic background, and relationship status between the male and female patients. The majority of patients with a history of self-harm or childhood sexual abuse were female while male patients were significantly more likely to report medication non-compliance.a higher proportion of the female patients had depressive disorders and personality disorders while a higher proportion of male patients had anxiety disorders, bipolar and related disorders, schizophrenia spectrum disorders, and substance-related disorders.approximately half of all the patients had an impaired clinical insight. Majority of the patients had a G aF score of 70 or less. Nearly one in five patients were admitted for inpatient treatment with a significantly higher proportion of male patients being admitted involuntarily.

There are sex-specific differences in many of the demographic and clinical measures collected in our ER psychiatric sample.

The authors have not supplied their declaration of competing interest.

There is only a limited body of literature which has examined the factors which can predict the presence of substance use disorders (SUD) in psychiatric patients seeking emergency room (ER) treatment.

To examine the factors that can predict the likelihood that a patient presenting to the emergency room and referred to the liaison psychiatric team will suffer from a SUD.

Nineteen independent demographic and clinical factors from data assessment tools for 477 patients assessed by the liaison psychiatric team in the ER over 12 months were compiled and analysed using univariate analyses and logistic regression in SPSS (version 20).

The 12-month prevalence rate of all SUDs in our clinical sample was 24.7%. Patients who presented to the ER with a chief alcohol and/or drug related complaint (withdrawal or intoxication) were 142 times more likely to fulfill the diagnostic criteria for SUD compared to those who presented with non-SUD related complaints. Male patients or patients with forensic history were both three times more likely to suffer from SUD than female patients or patients with no forensic history, respectively.

There is a high prevalence of SUDs among psychiatric patients assessed in the ER. In addition to targeting patients who present to the ER with an alcohol or drug withdrawal/intoxication for brief psycho-educational interventions and referrals to addiction treatment services, patients with forensic history and male patients should be targeted for SUD screening.

The authors have not supplied their declaration of competing interest.

To complement the oversubscribed counselling services in Alberta, the Text4Mood program which delivers daily supportive text messages to subscribers was launched on the 18th of January, 2016. This report presents an evaluation of self-reports of the impact of the program on the mental wellbeing of subscribers.

An online link to a survey questionnaire was created by an expert group and delivered via text messages to mobile phones of all 4111 active subscribers of the Text4Mood program as of April 11, 2016.

Overall, 894 subscribers answered the survey (overall response rate 21.7%). The response rate for individual questions varied and is reported alongside the results. Most respondents were female (83%, n = 668), Caucasian (83%, n = 679), and diagnosed with a psychiatric disorder (38%, n = 307), including Depression (25.4%, n = 227) and Anxiety (20%, n = 177). Overall, 52% (n = 461) signed up for Text4Mood to help elevate their mood and 24.5% (n = 219) signed up to help them worry less. Most respondents felt the text messages made them more hopeful about managing issues in their lives (81.7%, n = 588), feel in charge of managing depression and anxiety (76.7%, n = 552), and feel connected to a support system (75.2%, n = 542). The majority of respondents felt Text4Mood improved their overall mental well-being (83.1%, n = 598).

Supportive text messages are a feasible and acceptable way of delivering adjunctive psychological interventions. Given that text messages are affordable, readily available, and can be delivered to thousands of people simultaneously, they present an opportunity to help close the psychological treatment gap for mental health patients.

The authors have not supplied their declaration of competing interest.

To conduct a three-arm partial randomised controlled trail to evaluate the effectiveness of expedited regular supportive psychotherapy and assertive case management for patients presenting with suicidal ideation or self-harm to the emergency department (ED).

we expect expedited regular supportive psychotherapy plus assertive case management will reduce the suicidality and/or suicidal behaviour in patients by at least 20% at 4 weeks compared to patients receiving only assertive case management or routine care and these differences will be sustained at 6 months.

This will be a longitudinal, prospective, three-arm controlled single-rater-blinded partial randomized clinical trial with a recruitment period of 12 months and an observation period of 6 months for each participant. Patients in the intervention group will receive regular face-to-face or over the phone brief supportive psychotherapy during weekdays following presentation to the ED with suicidal ideation or self-harm until patients are actively enrolled in regular community mental health services with active case management by the therapist. Patients in the control and the assertive outreach arms will each receive the usual follow-up services offered routinely to regular patients and assertive outreach patients respectively who present to the ED with suicidal ideation or self-harm.

Recruitment will commence in February 2016 and we expect the results of the study to be available by September 2017.

If our hypothesis is proved correct, our intervention will be a new model for caring for patients with self-harm and suicidal ideation and is expected to reduce suicide rates.

The authors have not supplied their declaration of competing interest.