News

Treating personality disorders

The Department of Health has published its response to the consultation on a new pathway approach for the treatment and management of offenders with serious personality disorders ( www.dh.gov.uk/health). It says ‘... it is clear ... that there is broad support for our plans and ... respondents agree that the National Offender Management Service (NOMS) and the NHS should work together to design and implement integrated pathways for managing and treating offenders with severe personality disorders, building on local and regional structures.’ The full response is available online.

Coincidentally, NICE has been consulting on whether to update its 2009 clinical guideline (CG78) on borderline personality disorder. New clinical trial evidence about drug treatment could invalidate the current guideline, NICE believes. The consultation period is now closed but the review decision is expected in January 2012 ( http://guidance.nice.org.uk/CG78).

Dimethyl fumarate promising for MS

Results from the Phase III CONFIRM trial (Comparator and an Oral Fumarate In RRMS) show that dimethylfumarate (BG‐12), Biogen Idec's oral treatment for relapsing‐remitting multiple sclerosis, met the primary endpoint for reducing the annualised relapse rate (by 44‐51 per cent after two years compared with placebo). The trial also included a treatment arm with glatiramer acetate (but not directly compared with dimethyl fumarate), which reduced the annualised relapse rate by 29 per cent compared with placebo.

Dimethyl fumarate activates the Nrf2 pathway and may reduce the impact of inflammatory cells on the CNS and induce direct cytoprotective responses. To date, the incidence of adverse events appears to be similar to that reported with placebo. CONFIRM supports the findings of the Phase III DEFINE trial, the results of which were announced earlier this year.

Dementia costs UK £34 billion

The UK is second only to Germany among pre‐expansion EU countries in the amount it spends on dementia each year, say Oxford researchers (J Alzheimer's Dis 2011; 27:in press). Total spending in the 15 western European countries is around £165 billion annually and the UK alone spends £34 billion. Health and social care costs £13 000 per patient annually in the UK compared with a western European average of £8 600.

In western Europe as a whole, 68 per cent of the total costs were due to informal care, 26 per cent to social care (residential/nursing homes), 5 per cent to the health‐care system and one per cent to productivity losses.

Funding child mental health therapies

The Government has announced an investment of £32 million to fund psychological therapies for children and young people with mental health disorders. The initiative is the first phase of the children and young person's Improving Access to Psychological Therapies (IAPT) programme ( www.iapt.nhs.uk/children‐andyoung‐peoples‐iapt/) within the Government's No Health Without Mental Health strategy. Three joint projects between Child and Adolescent Mental Health Services (CAMHS), universities and teaching providers are being supported to develop ways in which children and families can become more involved in changing services.

In a move designed to encourage uptake of best evidence‐based practice, the Chief Medical Officer and the NHS Medical Director are writing to clinicians to remind them of NICE guidelines on a range of mental health conditions affecting children and teenagers, including ADHD.

Prodrug for ADHD – European trial data

Lisdexamfetamine dimesylate – a once‐daily prodrug of dexamfetamine – significantly improved symptom scores compared with placebo in children with ADHD, a pan‐European Phase III trial has shown. The results, announced by manufacturer Shire Pharmaceuticals, will add to the evidence base for an application for EU marketing authorisation.

The trial included 336 children aged 6‐17 years in 48 European sites including the UK. Lisdex amfetamine dimesylate was significantly superior to placebo and (although no direct statistical comparison was made) comparable with the osmotic controlled extended‐release (OROS) formulation of methylphenidate in reducing the primary endpoint, ADHD Rating Scale‐IV score. Lisdex amfetamine dimesylate also improved symptoms, as measured by the Clinical Global Impressions ‐Global Improvement Scale (CGII) in 78 per cent of patients, compared with 14 per cent in the placebo group and 61 per cent in the methylphenidate group. The commonest adverse events associated with lisdexamfetamine dimesylate were reduced appetite, headache, insomnia, weight loss, nausea and anorexia.

NHS multiple sclerosis services static

There has been no improvement in NHS services in England and Wales for people with multiple sclerosis in the past five years, a national audit by the Royal College of Physicians ( www.rcplondon.ac.uk) has shown.

The audit revealed that NICE guidance has largely been ignored, with none of the key 2003 recommendations widely implemented. Seven quality requirements of the National Service Framework for long‐term conditions relevant to people with multiple sclerosis showed a low level of attainment and will not be achieved by the target date of 2015. One‐third of Trusts reported no plans to improve neurological services in the forthcoming year. On the plus side, the prevalence of pressure ulcers, proposed by NICE as a sentinel marker, fell from 9 to 4 per cent since 2006.

NICE is currently updating its multiple sclerosis guideline but no date has been set yet for publication ( http://guidance.nice.org.uk/CG/WaveR/115).

EPDA Consensus Statement for PD

The European Parkinson's Disease Association (EPDA) has launched a document detailing how people with Parkinson's disease should be managed across Europe. The European Parkinson's Disease Standards of Care Consensus Statement suggests an optimum management model aimed at improving standards of care.

The Consensus Statement was developed by Parkinson's specialists, people with Parkinson's disease, carers and 45 Parkinson's disease organisations across Europe. The statement calls on policymakers to support initiatives that ensure all people with Parkinson's disease receive equal access to good‐quality specialised care. The document is available to download at www.epda.eu.com/ parkinsons‐consensus‐statement

Paliperidone palmitate approved in Scotland

Paliperidone palmitate, a new once‐monthly long‐acting inject able atypical antipsychotic, has been approved by the Scottish Medicines Consortium as a treatment option for patients with schizophrenia within NHS Scotland. Paliperidone palmitate received EC approval for the treatment of schizo phrenia in March. In England and Wales, the drug is not being individually assessed by NICE as it falls under the schizophrenia guidance.

National Audit of Psychological Therapies reveals good standards of care

A report published by the Royal College of Psychiatrists on NHS‐funded psychological therapy services for patients with anxiety and depression indicates good overall standards of care, but with substantial variation in quality.

The National Audit of Psychological Therapies (NAPT) report showed that 80 per cent of patients felt well supported by their therapist and 49 per cent had recovered by the end of psychological therapy. Moreover, 83 per cent of patients with a diagnosis for which there is a NICE guideline were given the recommended therapy for their condition. Most patients were seen quickly once referred; however, one in seven had to wait more than three months for their first appointment. For further details, visit www.rcpsych.ac.uk/napt. Copyright © 2011 John Wiley & Sons, Ltd.