Digest

News NICE guideline on ADHD Consultation on the NICE guideline on ADHD (CG72) has now ended. The scheduled review will consider new evidence on diagnosis, management and the organisation of care emerging since the guideline was published in 2008. New clinical trials confirm current recommendations for the treatment of children, NICE says, and support the use of methylphenidate as firstline therapy in adults followed by atomoxetine or dexamfetamine for patients who do not respond to or who are intolerant of six weeks' treatment with methylphenidate. NICE stroke recommendations About half of patients with suspected stroke are initially managed in line with NICE's recommendations, according to an audit by the Royal College of Physicians ( www.rcplondon.ac.uk ). The College's Stroke Improvement and National Audit Programme (SINAP) assessed English hospital performance against 12 indicators of care during the first 72 hours of admission. The NICE standards were admission to a stroke unit within four hours (met for 55 per cent of patients); specialist assessment within 24 hours (53 per cent); nutrition and swallowing assessment within 72 hours (85 per cent); and antiplatelet therapy where appropriate within 72 hours, adequate nutrition and hydration (63 per cent). Consultations on the NICE draft guideline on stroke rehabilitation will continue until 25 October. Guide to the harmfulness of recreational drugs A new guide to the harms of recreational use of legal and illicit drugs has been published by the Department of Health and the National Treatment Agency for Substance Misuse ( www.dh.gov.uk ). A Summary of the Health Harms of Drugs , collated by the Centre for Public Health at Liverpool John Moores University and peerreviewed, updates 2003's Dangerousness of Drugs . It covers the acute and chronic problems associated with drug use, including multiple drug use and the significance of adulterants. The information is summarised in tabular form and fully referenced. FDA warning on highdose citalopram The US Food and Drug Administration ( www.fda.gov ) has informed health professionals and patients in the USA that citalopram should no loger be used at dosages greater than 40mg daily because of the association with arrhythmias, including Torsade de Pointes. Treatment at dosages greater than 40mg daily are not associated with greater efficacy, the FDA says, but the risk of prolongation of the QT interval increases with dose. It cites a study of 119 subjects in which QT prolongation was 8.5 milliseconds at 20mg daily, 12.6 milliseconds at 40mg daily (estimated) and 18.5 milliseconds at 60mg daily. The UK product licence for Cipramil allows a maximum dosage of 60mg daily for the treatment of depression or panic disorder if the response is inadequate after several weeks at a lower dosage, but the Summary of Product Characteristics warns of the increased risk of undesirable effects at higher doses. Link between physical illness and suicide The independent thinktank Demos ( www.demos.co.uk ) has published a pamphlet exploring the background to suicide in the UK. The Truth About Suicide aims to fill the evidence gap on the role of severe physical illness as a contributory factor in suicide and includes a policy review, a survey of PCTs and interviews with coroners and expert organisations. Improving the lives of people with dementia A search for ideas to improve the lives of people with dementia has been launched by the Department of Health jointly with the Design Council. They are looking for five teams to develop designled improvements in products and services that will make life ‘simpler, better and more enjoyable’ for people with dementia and their carers. Successful teams will share funding of £360 000 and receive professional support to develop their ideas, scheduled to be showcased by March 2012. More information is available on the Design Council website( www.designcouncil.org.uk/dementia ). The Dementia Engagement and Empowerment Project (DEEP, a joint initiative of the Alzheimer's Society, the Mental Health Foundation and Innovations in Dementia, funded by the Joseph Rowntree Foundation) is asking people with dementia and those involved in their care to help influence policy and service development. Those interested can complete an online questionnaire on the Mental Health Foundation website describing their involvement with groups and projects ( www.mentalhealth.org.uk ). Preventing Alzheimer's disease Drugs to prevent Alzheimer's disease could be a reality within six years, claim researchers at Lancaster University who have just received a grant of almost €500 000 to fund the development of nanoparticles for diagnosis and treatment of Alzheimer's disease. The project, in collaboration with 18 other research centres in Europe, aims to develop nanoparticles capable of crossing the bloodbrain barrier and destroying amyloid plaques. Alzheimer's Research UK has provided a further £35 000 for equipment to detect low levels of amyloid and markers of other neurological disorders such as Parkinson's disease and motor neurone disease. Care Quality Commission survey The Care Quality Commission ( www.cqc.org.uk ) has published the 2011 survey of people who use NHS mental health services. The survey involved 17 000 service users in 65 mental health trusts in England. Most expressed positive views about their experience but large gaps remain. Fewer than half said they ‘definitely’ understood their care plan, over a quarter who were prescribed new medication said they were not told about the possible adverse effects and 47 per cent said their mental health or social care worker had not discussed talking therapy with them in the past 12 months. Botox for neurologicallyrelated urinary incontinence Botulinum toxin type A (BOTOX) has been approved by the Irish Medicines Board for the management of urinary incontinence in adults with neurogenic detrusor overactivity resulting from neurogenic bladder due to stable subcervical spinal cord injury or multiple sclerosis. The decision was made following the results of the Phase III DIGNITY trial. Under the EU mutual recognition procedure, other states have 90 days to approve the indication based on the Irish decision. Laquinimod MS trial Teva Pharmaceuticals has reported disappointing results from its BRAVO Phase III trial of oral laquinimod for relapsingremitting multiple sclerosis. Laquinimod did not reduce annualised relapse rate (ARR, the primary endpoint) compared with placebo, though interferon beta1a did. However, after adjustment for baseline differences in MRI characteristics between the laquinimod and placebo arms, laquinimod was associated with a 21 per cent reduction in ARR, a 27 per cent reduction in brain volume loss and a 33 per cent reduction in the risk of disability progression. Studying progressive multifocal leukoencephalopathy Research priorities have been agreed for studying drugrelated progressive multifocal leukoencephalopathy following a joint meeting between the European Medicines Agency and the US Food and Drug Administration. The two agencies met during the summer, with 170 experts and stakeholders to identify key targets for research and informationsharing, and potential funding mechanisms. Presentations from the workshop are available on the EMA's website ( www.ema.europa.eu ). Copyright © 2011 Wiley Interface Ltd