Treatment with the direct oral anticoagulants (DOACs) apixaban and rivaroxaban associated with significant worsening of behavioural and psychological symptoms of dementia (BPSD).

We report the cases of two patients who developed worsening behavioural and psychological symptoms of dementia (BPSD), coinciding with starting the factor Xa inhibitor direct oral anticoagulant medications apixaban and rivaroxaban, respectively. Both patients required detaining under the Mental Health Act. Their symptoms improved significantly, within 2 weeks, on switching to alternative anticoagulant therapies and they were both discharged from the acute psychiatric ward. Front-line staff should partake in postmarketing surveillance of medications, completing the Medicines and Healthcare products Regulatory Agency yellow cards for example (UK). There is increasing evidence for an aetiological role of cerebral mitochondrial dysfunction in neuropsychiatric disorders. Development of a rating scale of drugs that are potentially less toxic to cerebral mitochondria could inform national prescribing guidelines and enable safer treatments to be offered to older people, reducing the likely hood of them experiencing apparent BPSD.

Obesity-related knowledge and beliefs in obese adults attending a specialist weight-management service: implications for weight loss over 1 year.

OBJECTIVE: Cognitive approaches to obesity management assume that weight loss is more likely to occur if individuals perceive many benefits and few costs. Research to-date has been limited by the lack of prospective studies. METHODS: A longitudinal study design. At baseline, obese patients attending weight-management clinics (n=104) completed a questionnaire that assessed knowledge and beliefs regarding obesity's health and social/aesthetic consequences (Obesity Risk Knowledge (ORK-10) scale and the Obesity Beliefs scale), self-reported weight/height, goal weight, health-related quality of life, and sociodemographic characteristics. Medical records were also reviewed. At the 12-month follow-up, a second questionnaire assessed self-reported weight/height. RESULTS: At baseline, average ORK-10 scale scores were 4/10. At follow-up, 32 out of the 66 participants retained on the study did not gain weight (48.5%). For these participants, weight loss was associated with endorsement of the health (r(s)=0.40) and the social/aesthetic (r(s)=0.31) costs of obesity (p<0.05). CONCLUSION: Despite their high-risk status, participants demonstrated low levels of knowledge regarding obesity's health risks. Weight loss was associated with greater awareness of the health and social/aesthetic costs of obesity. PRACTICE IMPLICATIONS: This study suggests that health education is required to facilitate informed choices and supports the use of cognitive approaches which promote both the health and social/aesthetic consequences of obesity.