Towards a therapeutic window of D2/3 occupancy for treatment of psychosis in Alzheimer's disease, with [18F]fallypride positron emission tomography.

OBJECTIVE: Dopamine D2/3 receptor positron emission tomography tracers have guided antipsychotic prescribing in young people with schizophrenia by establishing a 'therapeutic window' of striatal D2/3 receptor occupancy. Older people, particularly those with dementia, are highly susceptible to motor side effects and may benefit from the appropriate application of imaging techniques. The study aimed to adapt [18F]fallypride imaging for use in occupancy studies in Alzheimer's disease (AD) and to investigate whether data acquisition could be made more tolerable by piloting the protocol in a small sample. METHODS: Six participants with AD (three men; 85.0 ± 5.6 years old; MMSE = 16.0 ± 2.4) were recruited prior to commencing amisulpride for the treatment of psychosis and associated agitation. [18F]fallypride binding potential (BPND ) was determined using an interrupted scanning protocol at baseline (n = 6) and after 27.0 ± 6.1 days of amisulpride (25-50 mg) treatment (n = 4). D2/3 occupancy was calculated by percentage reduction in BPND between scanning sessions. Image data were re-analysed after reducing individual sampling times to 20 min. RESULTS: The protocol was tolerated well, apart from the final (40 min) session of the post-treatment scan in one participant. Higher occupancies were achieved in the striatum (caudate 47-70%, putamen 31-58%) and thalamus (54-76%) than in the inferior temporal gyrus (27-43%). There was high agreement between occupancy values derived using longer and shorter sampling times (mean absolute difference 6.1% in the inferior temporal gyrus; <2% all other regions). CONCLUSIONS: The protocol is feasible for use in AD and represents the first step towards establishing dose-occupancy relationships across older clinical populations.

Families changing families: the protective function of multi-family therapy for children in education.

The Marlborough Family Education Centre (MFEC) uses a specific multi-family group approach with families where children exhibit (primarily) conduct problems and function poorly in school. Research indicates that failure to intervene with these children carries great potential cost to both the family and society. Outcomes for 50 families receiving intervention from the MFEC were compared with a control group of 28 who had access to a range of interventions, but not the multi-family group approach pioneered by the MFEC. Data on child and family social, emotional and behavioural functioning were collected at the point of referral, and at 6 and 12 months. Parents of children receiving support from the MFEC reported statistically and clinically significant improvements in their children that were maintained at 12 months whereas there was no change in the control group. In addition, measures of family functioning were fairly stable for the MFEC group, while the control group showed significant deterioration over the same time period. Other results were not significant. These findings are interpreted within the context of early intervention. The methodological limitations of the study are considered and suggestions for future research are outlined.

O cuidar do filho prematuro: percepção da mãe / Taking care of the premature child: the mother's perception

Este trabalho foi resultado de minha experiência como enfermeira-docente com mães de crianças prematuras, para apreensão dos significados do cuidar da criamça prematura na percepção da mãe...