Editorial: what is new in the treatment of gliomas?

PURPOSE OF REVIEW: In this editorial, we seek to critically analyse currently available options for the treatment of gliomas in order to provide guidance for evidence-based therapeutic decisions. RECENT FINDINGS: Several recently reported trials in gliomas have investigated ways of optimizing traditional treatments (i.e. radiotherapy and cytotoxic chemotherapy), as well as novel approaches such as molecularly targeted therapy. SUMMARY: Chemotherapy with temozolomide concomitant with radiotherapy remains a standard of care for glioblastoma, but current efforts are concentrated on confirming phase II results of protracted temozolomide schedules. The role of chemotherapy for grade III and II gliomas lacks phase III evidence but several trials are ongoing. Such trials are stratified by (or designed separately according to) chromosomes 1p/19q codeletion status, and such genetic analysis will thus be essential for therapeutic decisions in the future. The single positive results with targeted therapy remain to date the high response rates with bevacizumab and irinotecan in a phase II trial for recurrent malignant gliomas. Several questions regarding survival benefits and toxicity remain, however. Results of randomized trials of bevacizumab-based combinations are eagerly awaited, and if positive, they will point to antiangiogenesis strategies as the most promising current investigation venue in gliomas.     

‘Who is in the castle?’ One man’s use of the Frankenstein story in art therapy

This article stems from my art therapy research MA and focuses on the themes of Frankenstein, the therapeutic use of story, the usefulness of story making and collaboration within one man’s art therapy treatment. It explores the story of Frankenstein and the themes embedded in the story investigating how they might help someone trying to make sense of their own experiences of a frightening if familiar world. The themes include issues of life, death and relationships for someone with a learning disability and links to art psychotherapeutic work are indicated. The pseudonym ‘Ben’ is used to protect the client’s identity.     

Chemotherapy during clozapine treatment. Increased risk of agranulocytosis?

In a 37-year-old female, a combined treatment consisting of chemotherapy and radiation was considered for cervical cancer. However, she was using clozapine for the treatment of schizophrenia. As both clozapine and chemotherapy can induce decrease of white blood cell counts, we had to decide if clozapine and chemotherapy could be safely co-prescribed. Hypotheses concerning the mechanisms underlying clozapine-induced decrease of white blood cell counts and case reports on combining chemotherapy and clozapine are discussed. After cessation of clozapine the psychosis recurred despite treatment with risperidone. The decision was made to administer radiotherapy only and to reinstate the treatment with clozapine. The radiotherapy treatment went according to plan and the psychosis receded.     

Economic factors in of patients’ nonadherence to antidepressant treatment

Purpose

Patients’ nonadherence to antidepressant treatment hampers cost and efficacy of depression-specific treatment. However, previous studies have failed to find consistent findings in economic effect on nonadherence and also failed to reach consensus in how to measure nonadherence to treatment. The study attempts to investigate income effect on nonadherence to selective serotonin reuptake inhibitors (SSRIs) treatment with clear definitions of nonadherence: self discontinuation of SSRIs (nonpersistence) and under-dose of SSRIs (noncompliance).

Methods

The study extracted data from the National Comorbidity Survey-Replication (NCS-R). The study sample (n?=?280) includes adults between the ages of 18 and 64 who were diagnosed with Diagnostic Statistics Manual IV Major Depressive Episode (MDE) at some point during their lifetime and medicated with SSRIs in the past 12?months.

Results

Just above poverty level of family income and no health insurance increased the risk of medication nonpersistence in SSRIs treatment. The study findings confirmed that African Americans were at higher risk of medication noncompliance than Whites (odds ratio, 4.53) and MDE comorbidity was positively associated with medication noncompliance (odds ratio, 4.25).

Conclusions

Low income level, combined with health insurance status, and race/ethnicity, predict nonadherence to antidepressant treatment. The study findings would help physicians and hospitals developing interventional strategies and programs to increase patients’ adherence rates in antidepressant treatment.     

Pramipexole versus sertraline in the treatment of depression in Parkinson’s disease

In addition to treating the motor symptoms of Parkinson's disease, the dopamine agonist pramipexole has shown an antidepressant effect. The trials, however, included patients with motor complications, raising the question of whether the antidepressant benefit represented only a treatment-related motor improvement. To address this issue, we have conducted a 14-week randomized trial comparing pramipexole with an established antidepressant in patients without motor complications. At seven Italian centers, 67 Parkinsonian outpatients with major depression but no history of motor fluctuations and/or dyskinesia received open-label pramipexole (at 1.5 to 4.5 mg/day) or sertraline (at 50 mg/day). In both groups, the Hamilton Depression Rating Scale (HAM-D) score decreased throughout 12 weeks of treatment, but in the pramipexole group the proportion of patients who recovered, as defined by a final HAM-D score 相似文献   

Should ‘typical’, first-generation antipsychotics no longer be generally used in the treatment of schizophrenia?

European Archives of Psychiatry and Clinical Neuroscience -