Katie Lennon

Employees need to spend at least 2 hours of the work day on their feet, an international group of experts advised.

The group based this recommendation on studies showing possible links between illness and large amounts of time sitting. Among the findings of such research is that, in the United Kingdom, sedentary behavior occupies over 70% of the total waking hours of people with a high risk of chronic disease. Another data point used to reach the recommendation was that those with office jobs sit for 65%-75% of their time at work.

“In observational research, daily hours spent being sedentary (sitting), independent of levels of exercise or physical activity, are positively correlated with the risk of diabetes and cardiovascular disease, some cancers and premature mortality,” according to John P. Buckley of University Centre Shrewsbury and the University of Chester, England, and his colleagues. “For example, comprehensive reviews of the data found that compared with those who sit the least, those who sit the most have over twice the risk of developing type 2 diabetes and cardiovascular disease, and a 13% and 17% increased risk of cancer incidence and mortality, respectively.”

To potentially reduce the ill effects of prolonged sitting, the group of experts suggested that those with predominantly desk-based jobs adopt the following practices:

• Initially progress towards accumulating at least 2 hours a day of standing and performing light activity – such as walking – during work, and later increase the amount of time on foot to 4 hours a day (prorated to part-time hours).

• Take breaks from both seated- and standing-based work. Thus, sit-stand adjustable desk stations are highly recommended.

• Avoid prolonged static standing postures.

• If adding more standing to the work day causes pain that does not subside after altering posture, walking, or resting, then seek medical advice.

Such guidelines are justified even though longer-term intervention studies that assess standing and light activity in office environments are needed, according to the researchers.

Read the full report in the British Journal of Sports Medicine (2015 June 1 [doi:10.1136/bjsports-2015-094618]).

[email protected]

Employees need to spend at least 2 hours of the work day on their feet, an international group of experts advised.

The group based this recommendation on studies showing possible links between illness and large amounts of time sitting. Among the findings of such research is that, in the United Kingdom, sedentary behavior occupies over 70% of the total waking hours of people with a high risk of chronic disease. Another data point used to reach the recommendation was that those with office jobs sit for 65%-75% of their time at work.

“In observational research, daily hours spent being sedentary (sitting), independent of levels of exercise or physical activity, are positively correlated with the risk of diabetes and cardiovascular disease, some cancers and premature mortality,” according to John P. Buckley of University Centre Shrewsbury and the University of Chester, England, and his colleagues. “For example, comprehensive reviews of the data found that compared with those who sit the least, those who sit the most have over twice the risk of developing type 2 diabetes and cardiovascular disease, and a 13% and 17% increased risk of cancer incidence and mortality, respectively.”

To potentially reduce the ill effects of prolonged sitting, the group of experts suggested that those with predominantly desk-based jobs adopt the following practices:

• Initially progress towards accumulating at least 2 hours a day of standing and performing light activity – such as walking – during work, and later increase the amount of time on foot to 4 hours a day (prorated to part-time hours).

• Take breaks from both seated- and standing-based work. Thus, sit-stand adjustable desk stations are highly recommended.

• Avoid prolonged static standing postures.

• If adding more standing to the work day causes pain that does not subside after altering posture, walking, or resting, then seek medical advice.

Such guidelines are justified even though longer-term intervention studies that assess standing and light activity in office environments are needed, according to the researchers.

Read the full report in the British Journal of Sports Medicine (2015 June 1 [doi:10.1136/bjsports-2015-094618]).

[email protected]

Employees need to spend at least 2 hours of the work day on their feet, an international group of experts advised.

The group based this recommendation on studies showing possible links between illness and large amounts of time sitting. Among the findings of such research is that, in the United Kingdom, sedentary behavior occupies over 70% of the total waking hours of people with a high risk of chronic disease. Another data point used to reach the recommendation was that those with office jobs sit for 65%-75% of their time at work.

“In observational research, daily hours spent being sedentary (sitting), independent of levels of exercise or physical activity, are positively correlated with the risk of diabetes and cardiovascular disease, some cancers and premature mortality,” according to John P. Buckley of University Centre Shrewsbury and the University of Chester, England, and his colleagues. “For example, comprehensive reviews of the data found that compared with those who sit the least, those who sit the most have over twice the risk of developing type 2 diabetes and cardiovascular disease, and a 13% and 17% increased risk of cancer incidence and mortality, respectively.”

To potentially reduce the ill effects of prolonged sitting, the group of experts suggested that those with predominantly desk-based jobs adopt the following practices:

• Initially progress towards accumulating at least 2 hours a day of standing and performing light activity – such as walking – during work, and later increase the amount of time on foot to 4 hours a day (prorated to part-time hours).

• Take breaks from both seated- and standing-based work. Thus, sit-stand adjustable desk stations are highly recommended.

• Avoid prolonged static standing postures.

• If adding more standing to the work day causes pain that does not subside after altering posture, walking, or resting, then seek medical advice.

Such guidelines are justified even though longer-term intervention studies that assess standing and light activity in office environments are needed, according to the researchers.

Read the full report in the British Journal of Sports Medicine (2015 June 1 [doi:10.1136/bjsports-2015-094618]).

[email protected]

A psychiatrist in the United Kingdom is calling for the reclassification of psychedelic drugs to facilitate more research on their potential for treatment of psychiatric disorders.

In an opinion piece published in the BMJ, Dr. James J.H. Rucker asks that the U.K. Advisory Council on the Misuse of Drugs and the 2016 U.N. General Assembly Special Session on Drugs recommend that psychedelics be assigned the less stringent classification of schedule 2 compounds.

Among Dr. Rucker’s arguments in favor of this change is that there is little evidence showing that the use of these drugs is habit forming or harmful in controlled settings. He pointed out that various studies conducted prior to 1967 found that psychedelics served as “psychotherapeutic catalysts of mentally beneficial change in many psychiatric disorders, problems of personality development, recidivistic behavior, and existential anxiety.”

Studies had been demonstrating the positive outcomes of psychedelic drug use until a legal change to their classification brought research on them to halt after 1967, he said. At that time, psychedelics became classified as schedule 1 drugs under the U.K. Misuse of Drugs Act 1971 and 1971 United Nations Convention on Psychotropic Substances. Assigning these drugs such a classification “denoted psychedelic drugs as having no accepted medical use and the greatest potential for harm, despite the existence of research evidence to the contrary,” wrote Dr. Rucker of the Institute of Psychiatry, Psychology, and Neuroscience at King’s College in London.

Another criticism made by Dr. Rucker is that the drugs’ classification has made using them in clinical studies “almost impossible throughout the Western world,” because of the “financial and bureaucratic obstacles” it imposes.

“[T]he cost of clinical research using psychedelics is 5-10 times that of research into less restricted (but more harmful) drugs such as heroin – with no prospect that the benefits can be translated into wider medical practice,” he explained.

Outside of the United Kingdom, recent studies showed that these drugs were effective at treating anxiety associated with advanced cancer, obsessive-compulsive disorder, tobacco addiction, alcohol addiction, and cluster headaches, Dr. Rucker noted.

Read the full opinion piece in the BMJ.

[email protected]

A psychiatrist in the United Kingdom is calling for the reclassification of psychedelic drugs to facilitate more research on their potential for treatment of psychiatric disorders.

In an opinion piece published in the BMJ, Dr. James J.H. Rucker asks that the U.K. Advisory Council on the Misuse of Drugs and the 2016 U.N. General Assembly Special Session on Drugs recommend that psychedelics be assigned the less stringent classification of schedule 2 compounds.

Among Dr. Rucker’s arguments in favor of this change is that there is little evidence showing that the use of these drugs is habit forming or harmful in controlled settings. He pointed out that various studies conducted prior to 1967 found that psychedelics served as “psychotherapeutic catalysts of mentally beneficial change in many psychiatric disorders, problems of personality development, recidivistic behavior, and existential anxiety.”

Studies had been demonstrating the positive outcomes of psychedelic drug use until a legal change to their classification brought research on them to halt after 1967, he said. At that time, psychedelics became classified as schedule 1 drugs under the U.K. Misuse of Drugs Act 1971 and 1971 United Nations Convention on Psychotropic Substances. Assigning these drugs such a classification “denoted psychedelic drugs as having no accepted medical use and the greatest potential for harm, despite the existence of research evidence to the contrary,” wrote Dr. Rucker of the Institute of Psychiatry, Psychology, and Neuroscience at King’s College in London.

Another criticism made by Dr. Rucker is that the drugs’ classification has made using them in clinical studies “almost impossible throughout the Western world,” because of the “financial and bureaucratic obstacles” it imposes.

“[T]he cost of clinical research using psychedelics is 5-10 times that of research into less restricted (but more harmful) drugs such as heroin – with no prospect that the benefits can be translated into wider medical practice,” he explained.

Outside of the United Kingdom, recent studies showed that these drugs were effective at treating anxiety associated with advanced cancer, obsessive-compulsive disorder, tobacco addiction, alcohol addiction, and cluster headaches, Dr. Rucker noted.

Read the full opinion piece in the BMJ.

[email protected]

A psychiatrist in the United Kingdom is calling for the reclassification of psychedelic drugs to facilitate more research on their potential for treatment of psychiatric disorders.

In an opinion piece published in the BMJ, Dr. James J.H. Rucker asks that the U.K. Advisory Council on the Misuse of Drugs and the 2016 U.N. General Assembly Special Session on Drugs recommend that psychedelics be assigned the less stringent classification of schedule 2 compounds.

Among Dr. Rucker’s arguments in favor of this change is that there is little evidence showing that the use of these drugs is habit forming or harmful in controlled settings. He pointed out that various studies conducted prior to 1967 found that psychedelics served as “psychotherapeutic catalysts of mentally beneficial change in many psychiatric disorders, problems of personality development, recidivistic behavior, and existential anxiety.”

Studies had been demonstrating the positive outcomes of psychedelic drug use until a legal change to their classification brought research on them to halt after 1967, he said. At that time, psychedelics became classified as schedule 1 drugs under the U.K. Misuse of Drugs Act 1971 and 1971 United Nations Convention on Psychotropic Substances. Assigning these drugs such a classification “denoted psychedelic drugs as having no accepted medical use and the greatest potential for harm, despite the existence of research evidence to the contrary,” wrote Dr. Rucker of the Institute of Psychiatry, Psychology, and Neuroscience at King’s College in London.

Another criticism made by Dr. Rucker is that the drugs’ classification has made using them in clinical studies “almost impossible throughout the Western world,” because of the “financial and bureaucratic obstacles” it imposes.

“[T]he cost of clinical research using psychedelics is 5-10 times that of research into less restricted (but more harmful) drugs such as heroin – with no prospect that the benefits can be translated into wider medical practice,” he explained.

Outside of the United Kingdom, recent studies showed that these drugs were effective at treating anxiety associated with advanced cancer, obsessive-compulsive disorder, tobacco addiction, alcohol addiction, and cluster headaches, Dr. Rucker noted.

Read the full opinion piece in the BMJ.

[email protected]

Higher-than-normal body mass index and inflammation in late adolescence may be associated with colorectal cancer risk, a cohort study of 239,658 Swedish men showed.

The study’s results suggest that body mass index (BMI) and inflammation in early life may be important to the development of colorectal cancer (CRC), said Dr. Elizabeth D. Kantor and her colleagues.

The study’s participants, who were all between the ages of 16 and 20, were drawn from a cohort of men who underwent a compulsory conscription assessment for the Swedish military between 1969 and 1976 – when only men with severe disability or chronic diseases were exempt from serving in the military.

During the assessments, each young man’s height and weight was measured, which the study’s researchers used to calculate BMIs in kg/m² for the sample. The BMIs were categorized in the following ways: 15 to <18.5 was underweight, 18.5 to <25 was normal, 25 to <27.5 was the lower category of overweight, 27.5 to <30 was the upper category of overweight, and 30 to <55 was obese. Venous blood samples of the entire cohort were also collected during the assessment. These were used to assess inflammation levels as indicated by erythrocyte sedimentation rate (ESR), a nonspecific biomarker of inflammation. The researchers classified each study participant’s ESR as low, moderate, or high. The researchers tracked the incidences of malignant CRC in the cohort for an average of 35 years using the Swedish Cancer Registry.

Men who had been categorized as being in the upper category of overweight at the time of assessment were 2.08 times more likely to get CRC than normal weight men; obese men were 2.38 times more likely to get the disease. Both of these findings were statistically significant. The researchers also determined that a high ESR was associated with a significant 63% increased risk of CRC, using a multivariable adjustment.

“While no other studies have directly addressed the association between early-life inflammation and CRC risk, evidence supports the role of inflammation early in carcinogenesis,” the researchers wrote.

Another novelty of this study is that adolescents’ BMIs were measured instead of being based on recall, as they had been in other researchers’ attempts to determine the relationship between adolescent BMI and CRC risk in adulthood.

“With additional follow-up, and therefore, statistical power, future studies may address how adolescent inflammation and BMI interact to affect cancer risk. Further research is needed to better disentangle BMI and inflammation from associated exposures, and similarly, from exposures at other points in the life coarse,” the researchers wrote.

Read the full study in Gut (doi:10:1136/gutjnl-2014-309007).

[email protected]

Higher-than-normal body mass index and inflammation in late adolescence may be associated with colorectal cancer risk, a cohort study of 239,658 Swedish men showed.

The study’s results suggest that body mass index (BMI) and inflammation in early life may be important to the development of colorectal cancer (CRC), said Dr. Elizabeth D. Kantor and her colleagues.

The study’s participants, who were all between the ages of 16 and 20, were drawn from a cohort of men who underwent a compulsory conscription assessment for the Swedish military between 1969 and 1976 – when only men with severe disability or chronic diseases were exempt from serving in the military.

During the assessments, each young man’s height and weight was measured, which the study’s researchers used to calculate BMIs in kg/m² for the sample. The BMIs were categorized in the following ways: 15 to <18.5 was underweight, 18.5 to <25 was normal, 25 to <27.5 was the lower category of overweight, 27.5 to <30 was the upper category of overweight, and 30 to <55 was obese. Venous blood samples of the entire cohort were also collected during the assessment. These were used to assess inflammation levels as indicated by erythrocyte sedimentation rate (ESR), a nonspecific biomarker of inflammation. The researchers classified each study participant’s ESR as low, moderate, or high. The researchers tracked the incidences of malignant CRC in the cohort for an average of 35 years using the Swedish Cancer Registry.

Men who had been categorized as being in the upper category of overweight at the time of assessment were 2.08 times more likely to get CRC than normal weight men; obese men were 2.38 times more likely to get the disease. Both of these findings were statistically significant. The researchers also determined that a high ESR was associated with a significant 63% increased risk of CRC, using a multivariable adjustment.

“While no other studies have directly addressed the association between early-life inflammation and CRC risk, evidence supports the role of inflammation early in carcinogenesis,” the researchers wrote.

Another novelty of this study is that adolescents’ BMIs were measured instead of being based on recall, as they had been in other researchers’ attempts to determine the relationship between adolescent BMI and CRC risk in adulthood.

“With additional follow-up, and therefore, statistical power, future studies may address how adolescent inflammation and BMI interact to affect cancer risk. Further research is needed to better disentangle BMI and inflammation from associated exposures, and similarly, from exposures at other points in the life coarse,” the researchers wrote.

Read the full study in Gut (doi:10:1136/gutjnl-2014-309007).

[email protected]

Higher-than-normal body mass index and inflammation in late adolescence may be associated with colorectal cancer risk, a cohort study of 239,658 Swedish men showed.

The study’s results suggest that body mass index (BMI) and inflammation in early life may be important to the development of colorectal cancer (CRC), said Dr. Elizabeth D. Kantor and her colleagues.

The study’s participants, who were all between the ages of 16 and 20, were drawn from a cohort of men who underwent a compulsory conscription assessment for the Swedish military between 1969 and 1976 – when only men with severe disability or chronic diseases were exempt from serving in the military.

During the assessments, each young man’s height and weight was measured, which the study’s researchers used to calculate BMIs in kg/m² for the sample. The BMIs were categorized in the following ways: 15 to <18.5 was underweight, 18.5 to <25 was normal, 25 to <27.5 was the lower category of overweight, 27.5 to <30 was the upper category of overweight, and 30 to <55 was obese. Venous blood samples of the entire cohort were also collected during the assessment. These were used to assess inflammation levels as indicated by erythrocyte sedimentation rate (ESR), a nonspecific biomarker of inflammation. The researchers classified each study participant’s ESR as low, moderate, or high. The researchers tracked the incidences of malignant CRC in the cohort for an average of 35 years using the Swedish Cancer Registry.

Men who had been categorized as being in the upper category of overweight at the time of assessment were 2.08 times more likely to get CRC than normal weight men; obese men were 2.38 times more likely to get the disease. Both of these findings were statistically significant. The researchers also determined that a high ESR was associated with a significant 63% increased risk of CRC, using a multivariable adjustment.

“While no other studies have directly addressed the association between early-life inflammation and CRC risk, evidence supports the role of inflammation early in carcinogenesis,” the researchers wrote.

Another novelty of this study is that adolescents’ BMIs were measured instead of being based on recall, as they had been in other researchers’ attempts to determine the relationship between adolescent BMI and CRC risk in adulthood.

“With additional follow-up, and therefore, statistical power, future studies may address how adolescent inflammation and BMI interact to affect cancer risk. Further research is needed to better disentangle BMI and inflammation from associated exposures, and similarly, from exposures at other points in the life coarse,” the researchers wrote.

Read the full study in Gut (doi:10:1136/gutjnl-2014-309007).

[email protected]

Last summer’s norovirus outbreak in Multnomah County, Oregon, appears to be linked to swimming in a natural lake in Blue Lake Regional Park, according to a study from the Centers for Disease Control and Prevention.

Swimming in the lake on July 12-13, 2014, was significantly associated with the 65 probable and five laboratory-confirmed cases of norovirus infection that were reported that same weekend, according to the retrospective cohort study. Among the study’s other findings was that people who swam in the lake were more than twice as likely to become ill, compared with others who visited the park that weekend but did not go swimming.

Diarrhea and vomiting were reported by 10 and 14 of the sickened individuals, respectively. A swimmer’s vomit or fecal incident on July 12 is the most likely cause of the lake’s contamination.

Engaging in strategies for preventing high-risk situations in recreational waters, such as Blue Lake’s biweekly water testing for fecal contamination, evidently do not ensure prevention of contamination, according to Amy Zlot of the Multnomah County Health Department and her colleagues.

Additionally, swimming area officials need to educate the public about healthy swimming practices, the researchers said. Toward that end, the agency has recently published a free downloadable brochure on healthy swimming.

Read the full study in the MMWR (2015 May 15;64:485-90).

[email protected]

Last summer’s norovirus outbreak in Multnomah County, Oregon, appears to be linked to swimming in a natural lake in Blue Lake Regional Park, according to a study from the Centers for Disease Control and Prevention.

Swimming in the lake on July 12-13, 2014, was significantly associated with the 65 probable and five laboratory-confirmed cases of norovirus infection that were reported that same weekend, according to the retrospective cohort study. Among the study’s other findings was that people who swam in the lake were more than twice as likely to become ill, compared with others who visited the park that weekend but did not go swimming.

Diarrhea and vomiting were reported by 10 and 14 of the sickened individuals, respectively. A swimmer’s vomit or fecal incident on July 12 is the most likely cause of the lake’s contamination.

Engaging in strategies for preventing high-risk situations in recreational waters, such as Blue Lake’s biweekly water testing for fecal contamination, evidently do not ensure prevention of contamination, according to Amy Zlot of the Multnomah County Health Department and her colleagues.

Additionally, swimming area officials need to educate the public about healthy swimming practices, the researchers said. Toward that end, the agency has recently published a free downloadable brochure on healthy swimming.

Read the full study in the MMWR (2015 May 15;64:485-90).

[email protected]

Last summer’s norovirus outbreak in Multnomah County, Oregon, appears to be linked to swimming in a natural lake in Blue Lake Regional Park, according to a study from the Centers for Disease Control and Prevention.

Swimming in the lake on July 12-13, 2014, was significantly associated with the 65 probable and five laboratory-confirmed cases of norovirus infection that were reported that same weekend, according to the retrospective cohort study. Among the study’s other findings was that people who swam in the lake were more than twice as likely to become ill, compared with others who visited the park that weekend but did not go swimming.

Diarrhea and vomiting were reported by 10 and 14 of the sickened individuals, respectively. A swimmer’s vomit or fecal incident on July 12 is the most likely cause of the lake’s contamination.

Engaging in strategies for preventing high-risk situations in recreational waters, such as Blue Lake’s biweekly water testing for fecal contamination, evidently do not ensure prevention of contamination, according to Amy Zlot of the Multnomah County Health Department and her colleagues.

Additionally, swimming area officials need to educate the public about healthy swimming practices, the researchers said. Toward that end, the agency has recently published a free downloadable brochure on healthy swimming.

Read the full study in the MMWR (2015 May 15;64:485-90).

[email protected]

Brexpiprazole dosages of 2-4 mg/day are effective at treating acute schizophrenia patients, a randomized, double-blind, placebo-controlled trial shows.

The investigators studied 623 people living in 10 countries who had been diagnosed with schizophrenia. Patients in the experimental group received varying amounts of brexpiprazole over the course of 6 weeks. The antipsychotic, a serotonin-dopamine activity modulator, acts as a partial agonist at specific serotonin and dopamine receptors.

Eighty-seven of the study’s participants received 0.25 mg/day of the drug. The other 358 participants in the experimental group began with a 1-mg/day dosage. By day 8, 180 of these patients’ dosages were increased to 2 mg/day. The dosages for the remaining 178 patients in the experimental group were upped to 4 mg/day. The 178 individuals in the control group took a placebo.

The entire population was “markedly ill at entry to the study,” as evidenced by Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impressions Scale (CGI) severity scores, according to Dr. Christoph U. Correll and his colleagues.

At the study’s start, the scores were 95.2 and 4.9, respectively. Within 2 weeks of beginning the experiment, the average PANSS score in the 2-mg/day and 4-mg/day groups improved significantly more than the average score in the control group, decreasing by 20.73 for the brexpiprazole 2-mg group and 19.65 for the 4-mg group, compared with a decrease of 12.01 for the control group. This trend continued throughout the remainder of the treatment period.

By week 6, the average effect of the two highest dosages of brexpiprazole on CGI severity scores also was significantly greater than the average effect of the placebo. The PANSS and CGI severity scores only changed minimally for the patients who received 0.25-mg dosages of brexpiprazole.

Although the overall incidence of treatment-emergent adverse events was lower in the entire experimental group than in the control group, akathisia was reported more frequently in the treatment groups, specifically, the 2-mg and 4-mg groups. Psychiatric disorders were the most frequently reported serious adverse events by all groups.

“Brexpiprazole at doses of 2 mg and 4 mg once daily demonstrated statistically significant efficacy compared with placebo and good tolerability for patients with an acute exacerbation of schizophrenia,” Dr. Correll and his associates wrote.

Longer-term research of a more diverse population will need to be conducted to further evaluate the benefits of treating schizophrenia with brexpiprazole and to compare the effectiveness of this drug to first-line antipsychotics, the researchers said.

Read the full study in the American Journal of Psychiatry (2015 April 16 [doi:10.1176/appi.ajp.2015.14101275]).

Brexpiprazole dosages of 2-4 mg/day are effective at treating acute schizophrenia patients, a randomized, double-blind, placebo-controlled trial shows.

The investigators studied 623 people living in 10 countries who had been diagnosed with schizophrenia. Patients in the experimental group received varying amounts of brexpiprazole over the course of 6 weeks. The antipsychotic, a serotonin-dopamine activity modulator, acts as a partial agonist at specific serotonin and dopamine receptors.

Eighty-seven of the study’s participants received 0.25 mg/day of the drug. The other 358 participants in the experimental group began with a 1-mg/day dosage. By day 8, 180 of these patients’ dosages were increased to 2 mg/day. The dosages for the remaining 178 patients in the experimental group were upped to 4 mg/day. The 178 individuals in the control group took a placebo.

The entire population was “markedly ill at entry to the study,” as evidenced by Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impressions Scale (CGI) severity scores, according to Dr. Christoph U. Correll and his colleagues.

At the study’s start, the scores were 95.2 and 4.9, respectively. Within 2 weeks of beginning the experiment, the average PANSS score in the 2-mg/day and 4-mg/day groups improved significantly more than the average score in the control group, decreasing by 20.73 for the brexpiprazole 2-mg group and 19.65 for the 4-mg group, compared with a decrease of 12.01 for the control group. This trend continued throughout the remainder of the treatment period.

By week 6, the average effect of the two highest dosages of brexpiprazole on CGI severity scores also was significantly greater than the average effect of the placebo. The PANSS and CGI severity scores only changed minimally for the patients who received 0.25-mg dosages of brexpiprazole.

Although the overall incidence of treatment-emergent adverse events was lower in the entire experimental group than in the control group, akathisia was reported more frequently in the treatment groups, specifically, the 2-mg and 4-mg groups. Psychiatric disorders were the most frequently reported serious adverse events by all groups.

“Brexpiprazole at doses of 2 mg and 4 mg once daily demonstrated statistically significant efficacy compared with placebo and good tolerability for patients with an acute exacerbation of schizophrenia,” Dr. Correll and his associates wrote.

Longer-term research of a more diverse population will need to be conducted to further evaluate the benefits of treating schizophrenia with brexpiprazole and to compare the effectiveness of this drug to first-line antipsychotics, the researchers said.

Read the full study in the American Journal of Psychiatry (2015 April 16 [doi:10.1176/appi.ajp.2015.14101275]).

Brexpiprazole dosages of 2-4 mg/day are effective at treating acute schizophrenia patients, a randomized, double-blind, placebo-controlled trial shows.

The investigators studied 623 people living in 10 countries who had been diagnosed with schizophrenia. Patients in the experimental group received varying amounts of brexpiprazole over the course of 6 weeks. The antipsychotic, a serotonin-dopamine activity modulator, acts as a partial agonist at specific serotonin and dopamine receptors.

Eighty-seven of the study’s participants received 0.25 mg/day of the drug. The other 358 participants in the experimental group began with a 1-mg/day dosage. By day 8, 180 of these patients’ dosages were increased to 2 mg/day. The dosages for the remaining 178 patients in the experimental group were upped to 4 mg/day. The 178 individuals in the control group took a placebo.

The entire population was “markedly ill at entry to the study,” as evidenced by Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impressions Scale (CGI) severity scores, according to Dr. Christoph U. Correll and his colleagues.

At the study’s start, the scores were 95.2 and 4.9, respectively. Within 2 weeks of beginning the experiment, the average PANSS score in the 2-mg/day and 4-mg/day groups improved significantly more than the average score in the control group, decreasing by 20.73 for the brexpiprazole 2-mg group and 19.65 for the 4-mg group, compared with a decrease of 12.01 for the control group. This trend continued throughout the remainder of the treatment period.

By week 6, the average effect of the two highest dosages of brexpiprazole on CGI severity scores also was significantly greater than the average effect of the placebo. The PANSS and CGI severity scores only changed minimally for the patients who received 0.25-mg dosages of brexpiprazole.

Although the overall incidence of treatment-emergent adverse events was lower in the entire experimental group than in the control group, akathisia was reported more frequently in the treatment groups, specifically, the 2-mg and 4-mg groups. Psychiatric disorders were the most frequently reported serious adverse events by all groups.

“Brexpiprazole at doses of 2 mg and 4 mg once daily demonstrated statistically significant efficacy compared with placebo and good tolerability for patients with an acute exacerbation of schizophrenia,” Dr. Correll and his associates wrote.

Longer-term research of a more diverse population will need to be conducted to further evaluate the benefits of treating schizophrenia with brexpiprazole and to compare the effectiveness of this drug to first-line antipsychotics, the researchers said.

Read the full study in the American Journal of Psychiatry (2015 April 16 [doi:10.1176/appi.ajp.2015.14101275]).

Rapid cycling bipolar disorder and migraines are independently associated with each other, a cross-sectional study shows.

“Our findings provide further evidence that comorbid migraine in [bipolar disorder] represents a more homogenous subgroup of [bipolar disorder] that may be associated with an unstable rapid cycling illness course,” wrote K. Gordon-Smith, Ph.D., and her colleagues.

The United Kingdom–based study included 1,488 individuals with lifetime clinical characteristics of bipolar disorder (BD). Of the study’s sample, 375 had comorbid migraines. Both patients with bipolar disorder I and bipolar disorder II participated in the self-report research project.

Among the study’s findings is that numerous clinical characteristics occurred significantly more often in the migraine group. Such characteristics included having a history of panic attacks, rapid cycling (defined as experiencing four or more episodes in a 12-month period), family history of affective disorders, and younger age at illness onset. The study also found that significantly more subjects in the migraine group had a lower history of psychiatric admission, and less impairment in functioning during their worst episode of (hypo)mania. The study confirmed the finding of previous research showing that bipolar patients with comorbid migraines are more likely to be female.

Further in-depth analyses of this patient population with more detailed information about the migraine phenotype is needed, the researchers said.

Read the full study in Journal of Affective Disorders (doi: 10.1016/j.jad.2015.01.024).

Rapid cycling bipolar disorder and migraines are independently associated with each other, a cross-sectional study shows.

“Our findings provide further evidence that comorbid migraine in [bipolar disorder] represents a more homogenous subgroup of [bipolar disorder] that may be associated with an unstable rapid cycling illness course,” wrote K. Gordon-Smith, Ph.D., and her colleagues.

The United Kingdom–based study included 1,488 individuals with lifetime clinical characteristics of bipolar disorder (BD). Of the study’s sample, 375 had comorbid migraines. Both patients with bipolar disorder I and bipolar disorder II participated in the self-report research project.

Among the study’s findings is that numerous clinical characteristics occurred significantly more often in the migraine group. Such characteristics included having a history of panic attacks, rapid cycling (defined as experiencing four or more episodes in a 12-month period), family history of affective disorders, and younger age at illness onset. The study also found that significantly more subjects in the migraine group had a lower history of psychiatric admission, and less impairment in functioning during their worst episode of (hypo)mania. The study confirmed the finding of previous research showing that bipolar patients with comorbid migraines are more likely to be female.

Further in-depth analyses of this patient population with more detailed information about the migraine phenotype is needed, the researchers said.

Read the full study in Journal of Affective Disorders (doi: 10.1016/j.jad.2015.01.024).

Rapid cycling bipolar disorder and migraines are independently associated with each other, a cross-sectional study shows.

“Our findings provide further evidence that comorbid migraine in [bipolar disorder] represents a more homogenous subgroup of [bipolar disorder] that may be associated with an unstable rapid cycling illness course,” wrote K. Gordon-Smith, Ph.D., and her colleagues.

The United Kingdom–based study included 1,488 individuals with lifetime clinical characteristics of bipolar disorder (BD). Of the study’s sample, 375 had comorbid migraines. Both patients with bipolar disorder I and bipolar disorder II participated in the self-report research project.

Among the study’s findings is that numerous clinical characteristics occurred significantly more often in the migraine group. Such characteristics included having a history of panic attacks, rapid cycling (defined as experiencing four or more episodes in a 12-month period), family history of affective disorders, and younger age at illness onset. The study also found that significantly more subjects in the migraine group had a lower history of psychiatric admission, and less impairment in functioning during their worst episode of (hypo)mania. The study confirmed the finding of previous research showing that bipolar patients with comorbid migraines are more likely to be female.

Further in-depth analyses of this patient population with more detailed information about the migraine phenotype is needed, the researchers said.

Read the full study in Journal of Affective Disorders (doi: 10.1016/j.jad.2015.01.024).

The percentage of postpartum women who filled codeine prescriptions significantly declined after regulatory bodies announced that breastfeeding by mothers taking the opioids may cause infant death, according to a study.

Infants who are breastfed are at elevated risk of death, if their mothers carry polymorphisms for increased activity of an enzyme that metabolizes codeine to morphine, Kate Smolina, Ph.D., and her colleagues reported in a research letter in JAMA.

The study included 320,351 live births to 224,532 women in British Columbia, Canada, between January 1, 2002 and December 31, 2011. The researchers studied dispensation rates of codeine and other opioid drugs to women during the first 6 months after giving birth. New mothers’ use of cephalexin and hydrocortisone cream, which are commonly prescribed to postpartum women, served as the control measure. The announcements on the risks of breastfeeding while taking codeine were made by the U.S. Food and Drug Administration in August 2007 and Health Canada in October 2008. Prior to the FDA announcement, on average, nearly 17% of the postpartum mothers filled at least one codeine prescription. Between September and December 2011, the monthly average was down to 9% – representing a relative reduction of 45% over 4 years. Postpartum use of the opioids tramadol, hydromorphone, oxycodone, and morphine increased, but not at a large enough rate “to offset the reduction in codeine use,” according to the researchers.

The rates of prescription filling did not significantly change for cephalexin and hydrocortisone cream.

Read the study in JAMA 2015 May 12 (doi:10.1001/jama.2015.3642).

The percentage of postpartum women who filled codeine prescriptions significantly declined after regulatory bodies announced that breastfeeding by mothers taking the opioids may cause infant death, according to a study.

Infants who are breastfed are at elevated risk of death, if their mothers carry polymorphisms for increased activity of an enzyme that metabolizes codeine to morphine, Kate Smolina, Ph.D., and her colleagues reported in a research letter in JAMA.

The study included 320,351 live births to 224,532 women in British Columbia, Canada, between January 1, 2002 and December 31, 2011. The researchers studied dispensation rates of codeine and other opioid drugs to women during the first 6 months after giving birth. New mothers’ use of cephalexin and hydrocortisone cream, which are commonly prescribed to postpartum women, served as the control measure. The announcements on the risks of breastfeeding while taking codeine were made by the U.S. Food and Drug Administration in August 2007 and Health Canada in October 2008. Prior to the FDA announcement, on average, nearly 17% of the postpartum mothers filled at least one codeine prescription. Between September and December 2011, the monthly average was down to 9% – representing a relative reduction of 45% over 4 years. Postpartum use of the opioids tramadol, hydromorphone, oxycodone, and morphine increased, but not at a large enough rate “to offset the reduction in codeine use,” according to the researchers.

The rates of prescription filling did not significantly change for cephalexin and hydrocortisone cream.

Read the study in JAMA 2015 May 12 (doi:10.1001/jama.2015.3642).

The percentage of postpartum women who filled codeine prescriptions significantly declined after regulatory bodies announced that breastfeeding by mothers taking the opioids may cause infant death, according to a study.

Infants who are breastfed are at elevated risk of death, if their mothers carry polymorphisms for increased activity of an enzyme that metabolizes codeine to morphine, Kate Smolina, Ph.D., and her colleagues reported in a research letter in JAMA.

The study included 320,351 live births to 224,532 women in British Columbia, Canada, between January 1, 2002 and December 31, 2011. The researchers studied dispensation rates of codeine and other opioid drugs to women during the first 6 months after giving birth. New mothers’ use of cephalexin and hydrocortisone cream, which are commonly prescribed to postpartum women, served as the control measure. The announcements on the risks of breastfeeding while taking codeine were made by the U.S. Food and Drug Administration in August 2007 and Health Canada in October 2008. Prior to the FDA announcement, on average, nearly 17% of the postpartum mothers filled at least one codeine prescription. Between September and December 2011, the monthly average was down to 9% – representing a relative reduction of 45% over 4 years. Postpartum use of the opioids tramadol, hydromorphone, oxycodone, and morphine increased, but not at a large enough rate “to offset the reduction in codeine use,” according to the researchers.

The rates of prescription filling did not significantly change for cephalexin and hydrocortisone cream.

Read the study in JAMA 2015 May 12 (doi:10.1001/jama.2015.3642).

A new teaching tool based on the acronym mnemonic PSA may help doctors to screen for psoriatic arthritis in patients with psoriasis or a strong family history of it.

The tool tells physicians to ask patients whether they are experiencing core features of psoriatic arthritis (PsA). Such features are tied to the acronym PSA. P stands for pain in the joints, S stands for stiffness more than 30 minutes after a period of inactivity and for sausage digits, and A represents axial spine involvement or back pain associated with stiffness that improves with activity. If patients with psoriasis and/or a strong family history of psoriasis say they are experiencing at least two of those features, then they “would have a higher than average chance of a PsA diagnosis,” according to Jeffrey M. Cohen and his colleagues.

Benefits of the tool include its ease of use and short administration time; it also covers “the core domains” of the disease, just like many of the current PsA screening tools.

The tool is limited, however, because it is unlikely to be as specific as the longer PsA screening instruments and it calls for questioning patients about features of PsA that are also features of other pathologies. Additionally, the tool is more specific to diagnosing seronegative peripheral and axial spondyloarthritides than inflammatory arthritis. It also is useful for distinguishing between noninflammatory arthritis and inflammatory arthritis.

“We feel this teaching tool, while not specific for PsA, will help the nonrheumatologist begin to differentiate inflammatory from noninflammatory musculoskeletal pain and therefore prompt an appropriate referral for work-up,” the researchers wrote.

Read the full paper in the Journal of the American Academy of Dermatology (doi:10.1016/j.jaad.2014.12.008).

A new teaching tool based on the acronym mnemonic PSA may help doctors to screen for psoriatic arthritis in patients with psoriasis or a strong family history of it.

The tool tells physicians to ask patients whether they are experiencing core features of psoriatic arthritis (PsA). Such features are tied to the acronym PSA. P stands for pain in the joints, S stands for stiffness more than 30 minutes after a period of inactivity and for sausage digits, and A represents axial spine involvement or back pain associated with stiffness that improves with activity. If patients with psoriasis and/or a strong family history of psoriasis say they are experiencing at least two of those features, then they “would have a higher than average chance of a PsA diagnosis,” according to Jeffrey M. Cohen and his colleagues.

Benefits of the tool include its ease of use and short administration time; it also covers “the core domains” of the disease, just like many of the current PsA screening tools.

The tool is limited, however, because it is unlikely to be as specific as the longer PsA screening instruments and it calls for questioning patients about features of PsA that are also features of other pathologies. Additionally, the tool is more specific to diagnosing seronegative peripheral and axial spondyloarthritides than inflammatory arthritis. It also is useful for distinguishing between noninflammatory arthritis and inflammatory arthritis.

“We feel this teaching tool, while not specific for PsA, will help the nonrheumatologist begin to differentiate inflammatory from noninflammatory musculoskeletal pain and therefore prompt an appropriate referral for work-up,” the researchers wrote.

Read the full paper in the Journal of the American Academy of Dermatology (doi:10.1016/j.jaad.2014.12.008).

A new teaching tool based on the acronym mnemonic PSA may help doctors to screen for psoriatic arthritis in patients with psoriasis or a strong family history of it.

The tool tells physicians to ask patients whether they are experiencing core features of psoriatic arthritis (PsA). Such features are tied to the acronym PSA. P stands for pain in the joints, S stands for stiffness more than 30 minutes after a period of inactivity and for sausage digits, and A represents axial spine involvement or back pain associated with stiffness that improves with activity. If patients with psoriasis and/or a strong family history of psoriasis say they are experiencing at least two of those features, then they “would have a higher than average chance of a PsA diagnosis,” according to Jeffrey M. Cohen and his colleagues.

Benefits of the tool include its ease of use and short administration time; it also covers “the core domains” of the disease, just like many of the current PsA screening tools.

The tool is limited, however, because it is unlikely to be as specific as the longer PsA screening instruments and it calls for questioning patients about features of PsA that are also features of other pathologies. Additionally, the tool is more specific to diagnosing seronegative peripheral and axial spondyloarthritides than inflammatory arthritis. It also is useful for distinguishing between noninflammatory arthritis and inflammatory arthritis.

“We feel this teaching tool, while not specific for PsA, will help the nonrheumatologist begin to differentiate inflammatory from noninflammatory musculoskeletal pain and therefore prompt an appropriate referral for work-up,” the researchers wrote.

Read the full paper in the Journal of the American Academy of Dermatology (doi:10.1016/j.jaad.2014.12.008).

Rheumatoid arthritis (RA) patients’ severity of morning stiffness and morning pain have stronger correlations with their disease’s activity than does the duration of their morning stiffness, according to an analysis of 350 patients who participated in a randomized, controlled trial.

During the 12-week study of patients with symptomatic RA despite treatment with disease-modifying antirheumatic drugs, 231 of the patients added delayed-release prednisone to their treatment and the remaining 119 patients took a placebo. The patients’ disease activity was measured with the ACR20, 28-joint Disease Activity Score (DAS28), and the Health Assessment Questionnaire-Disability Index, while Pearson correlations were used to determine relationships between patients’ responses to treatment and their disease activity.

The correlations between severity of morning stiffness or intensity of pain on waking and DAS28 or ACR20 ranged from 0.44 to 0.48 for the full study cohort. The weaker correlation between duration of morning stiffness and disease activity ranged from 0.24 to 0.28. The researchers also found a statistically significant 0.91 correlation between the severity of morning stiffness and intensity of morning pain.

“These findings suggest that severity and duration of morning stiffness may provide subtly different measures of RA and its impact on patients. The superior measurement characteristics of the severity of morning stiffness favor this as the preferred outcome measure,” wrote first author Dr. Maarten Boers and his colleagues.

Find the full study in Arthritis Care & Research (doi:10.1002/acr.22592).

Rheumatoid arthritis (RA) patients’ severity of morning stiffness and morning pain have stronger correlations with their disease’s activity than does the duration of their morning stiffness, according to an analysis of 350 patients who participated in a randomized, controlled trial.

During the 12-week study of patients with symptomatic RA despite treatment with disease-modifying antirheumatic drugs, 231 of the patients added delayed-release prednisone to their treatment and the remaining 119 patients took a placebo. The patients’ disease activity was measured with the ACR20, 28-joint Disease Activity Score (DAS28), and the Health Assessment Questionnaire-Disability Index, while Pearson correlations were used to determine relationships between patients’ responses to treatment and their disease activity.

The correlations between severity of morning stiffness or intensity of pain on waking and DAS28 or ACR20 ranged from 0.44 to 0.48 for the full study cohort. The weaker correlation between duration of morning stiffness and disease activity ranged from 0.24 to 0.28. The researchers also found a statistically significant 0.91 correlation between the severity of morning stiffness and intensity of morning pain.

“These findings suggest that severity and duration of morning stiffness may provide subtly different measures of RA and its impact on patients. The superior measurement characteristics of the severity of morning stiffness favor this as the preferred outcome measure,” wrote first author Dr. Maarten Boers and his colleagues.

Find the full study in Arthritis Care & Research (doi:10.1002/acr.22592).

Rheumatoid arthritis (RA) patients’ severity of morning stiffness and morning pain have stronger correlations with their disease’s activity than does the duration of their morning stiffness, according to an analysis of 350 patients who participated in a randomized, controlled trial.

During the 12-week study of patients with symptomatic RA despite treatment with disease-modifying antirheumatic drugs, 231 of the patients added delayed-release prednisone to their treatment and the remaining 119 patients took a placebo. The patients’ disease activity was measured with the ACR20, 28-joint Disease Activity Score (DAS28), and the Health Assessment Questionnaire-Disability Index, while Pearson correlations were used to determine relationships between patients’ responses to treatment and their disease activity.

The correlations between severity of morning stiffness or intensity of pain on waking and DAS28 or ACR20 ranged from 0.44 to 0.48 for the full study cohort. The weaker correlation between duration of morning stiffness and disease activity ranged from 0.24 to 0.28. The researchers also found a statistically significant 0.91 correlation between the severity of morning stiffness and intensity of morning pain.

“These findings suggest that severity and duration of morning stiffness may provide subtly different measures of RA and its impact on patients. The superior measurement characteristics of the severity of morning stiffness favor this as the preferred outcome measure,” wrote first author Dr. Maarten Boers and his colleagues.

Find the full study in Arthritis Care & Research (doi:10.1002/acr.22592).