Effect of Vitamin D Supplementation on Outcomes in People With Early Psychosis: The DFEND Randomized Clinical Trial

IMPORTANCE

People with psychotic disorders have an increased risk of vitamin D deficiency, which is evident during first-episode psychosis (FEP) and associated with unfavorable mental and physical health outcomes.

OBJECTIVE

To examine whether vitamin D supplementation contributes to improved clinical outcomes in FEP.

DESIGN, SETTING, AND PARTICIPANTS

This multisite, double-blind, placebo-controlled, parallel-group randomized clinical trial from the UK examined adults 18 to 65 years of age within 3 years of a first presentation with a functional psychotic disorder who had no contraindication to vitamin D supplementation. A total of 2136 patients were assessed for eligibility, 835 were approached, 686 declined participation or were excluded, 149 were randomized, and 104 were followed up at 6 months. The study recruited participants from January 19, 2016, to June 14, 2019, with the final follow-up (after the last dose) completed on December 20, 2019.

INTERVENTIONS

Monthly augmentation with 120 000 IU of cholecalciferol or placebo.

MAIN OUTCOMES AND MEASURES

The primary outcome measure was total Positive and Negative Syndrome Scale (PANSS) score at 6 months. Secondary outcomes included total PANSS score at 3 months; PANSS positive, negative, and general psychopathology subscale scores at 3 and 6 months; Global Assessment of Function scores (for symptoms and disability); Calgary Depression Scale score, waist circumference, body mass index, and glycated hemoglobin, total cholesterol, C-reactive protein, and vitamin D concentrations at 6 months; and a planned sensitivity analysis in those with insufficient vitamin D levels at baseline.

RESULTS

A total of 149 participants (mean [SD] age, 28.1 (8.5) years; 89 [59.7%] male; 65 [43.6%] Black or of other minoritized racial and ethnic group; 84 [56.4%] White [British, Irish, or of other White ethnicity]) were randomized. No differences were observed in the intention-to-treat analysis in the primary outcome, total PANSS score at 6 months (mean difference, 3.57; 95% CI, -1.11 to 8.25; P = .13), or the secondary outcomes at 3 and 6 months (PANSS positive subscore: mean difference, -0.98; 95% CI, -2.23 to 0.27 at 3 months; mean difference, 0.68; 95% CI, -0.69 to 1.99 at 6 months; PANSS negative subscore: mean difference, 0.68; 95% CI, -1.39 to 2.76 at 3 months; mean difference, 1.56; 95% CI, -0.31 to 3.44 at 6 months; and general psychopathology subscore: mean difference, -2.09; 95% CI, -4.36 to 0.18 at 3 months; mean difference, 1.31; 95% CI, -1.42 to 4.05 at 6 months). There also were no significant differences in the Global Assessment of Function symptom score (mean difference, 0.02; 95% CI, -4.60 to 4.94); Global Assessment of Function disability score (mean difference, -0.01; 95% CI, -5.25 to 5.23), or Calgary Depression Scale score (mean difference, -0.39; 95% CI, -2.05 to 1.26) at 6 months. Vitamin D levels were very low in the study group, especially in Black participants and those who identified as another minoritized racial and ethnic group, 57 of 61 (93.4%) of whom had insufficient vitamin D. The treatment was safe and led to a significant increase in 25-hydroxyvitamin D concentrations.

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, no association was found between vitamin D supplementation and mental health or metabolic outcomes at 6 months. Because so few patients with FEP were vitamin D replete, the results of this study suggest that this group would benefit from active consideration in future population health strategies.

TRIAL REGISTRATION

isrctn.org Identifier: ISRCTN12424842.

Applications of Artificial Intelligence in Drug Design: Opportunities and Challenges

Artificial intelligence (AI) has undergone rapid development in recent years and has been successfully applied to real-world problems such as drug design. In this chapter, we review recent applications of AI to problems in drug design including virtual screening, computer-aided synthesis planning, and de novo molecule generation, with a focus on the limitations of the application of AI therein and opportunities for improvement. Furthermore, we discuss the broader challenges imposed by AI in translating theoretical practice to real-world drug design; including quantifying prediction uncertainty and explaining model behavior.

Vitamin D supplementation compared to placebo in people with First Episode psychosis - Neuroprotection Design (DFEND): a protocol for a randomised, double-blind, placebo-controlled, parallel-group trial

Background

People experiencing their first episode of psychosis are often deficient in vitamin D. Observational studies have reported an association between low vitamin D concentrations and poorer subsequent health outcomes in psychosis. A vitamin D deficiency in neonates and children has been linked to a later increased risk of schizophrenia and psychotic-like experiences. This trial aims to examine the effect of high-dose vitamin D supplementation on outcomes in early psychosis. We hypothesise that vitamin D supplementation will be associated with better mental health outcomes.

Methods/design

The DFEND study is a multicentre double-blind placebo-controlled parallel-group trial of vitamin D supplementation in people with early psychosis. Patients with an ICD-10 diagnosis of functional psychosis will be randomised in a 1:1 ratio to receive either 120,000 IU/month of vitamin D (cholecalciferol) or a matched placebo for 6 months. The primary outcome is the total Positive and Negative Syndrome Scale (PANSS) score at the 6-month follow-up for all patients. Secondary outcomes include assessment of mood (Calgary Depression Scale), general function (Global Assessment of Functioning), cardiovascular risk (body mass index, waist circumference, C-reactive protein, cholesterol and HbA1c) and vitamin D levels at the 6-month follow-up. Additionally, 3- and 6-month total PANSS scores will be analysed for those with inadequate vitamin D levels at the baseline.

Discussion

The DFEND study is the first trial to examine whether vitamin D supplementation in early psychosis is associated with better mental health outcomes. The findings of this study may help to resolve the clinical equipoise regarding the benefits and cost-effectiveness of routine vitamin D supplementation in people with psychosis.

Trial registration

ISRCTN, ISRCTN12424842. Registered on 25 February 2015.

Detection of asphyxia using heart rate variability

The long-term aims of this study are to find a parameter derived from the ECG that has a high sensitivity and specificity to asphyxia and, once we know or suspect that asphyxia occurred, to estimate how severe it was. We carried out a pilot study in which 24 adult Wistar rats were anaesthetised and subjected to controlled asphyxia for specified durations. We measured the pH, 'neurological score' and the ECG, extracting from this heart rate and heart rate variability (HRV). We have developed a technique capable of detecting asphyxia in less than 1 min, based on monitoring the ECG and estimating HRV by measuring the standard deviation of normal RR intervals (the RR interval is the time interval between two consecutive R-points of the QRS complex). In all cases the heart rate decreased and HRV increased, by an average of 46 +/- 33 ms in relation to the baseline, at the onset of asphyxia. The comparison of the base level of HRV after and before asphyxia shows promise for the estimation of the severity of the episode; however, the limitations of this study should be noted as they include the small size of the cohort and the methods of analysis.

Mental illness in one district of Uganda

AIMS

To estimate the prevalence of psychiatric disorder in one district of Uganda.

METHODS

Data were collected from a survey of a random sample of households in Kabarole, West Uganda. Interviews were carried out with household members. Further information was obtained from interviews of key community informants and from Focus Group discussions conducted in each Parish.

RESULTS

Some 384 households were surveyed. Of these, 99 households identified members with a mental illness in the previous year and a total of 130 individuals were identified, 12 of whom were children. Few individuals had been seen by formal mental health services and traditional methods of treatment were commonly used.

CONCLUSIONS

The estimated prevalence of 30.7% in adults is higher than that of 25.3% found in the only other community based survey of mental illness previously conducted in Uganda. A well conducted study using modern case defining methods needs to be carried out in Uganda.

Acute nicotine interactions with nicotinic and muscarinic antagonists: working and reference memory effects in the 16-arm radial maze

In the 8-arm radial maze and other tests, acute nicotine administration has been found to improve memory performance significantly, whereas acute administration of the nicotinic antagonist mecamylamine has been found to impair memory performance. However, questions remain concerning the behavioral and pharmacological nature of acute nicotine effects on memory. In the current studies, we examined acute nicotine effects on working and reference memory in a 16-arm radial maze. In the first study, nicotine caused a significant improvement in working memory but not in reference memory. The muscarinic antagonist scopolamine caused significant deficits in working memory but not in reference memory. Nicotine did not significantly attenuate the scopolamine-induced deficit. In the second study, with rats trained to near-perfect performance, a low dose of mecamylamine (1.25 mg/kg) caused a significant working memory impairment in the 16-arm maze. This deficit was significantly attenuated by concurrent acute administration of nicotine. These studies show that acute nicotine, like chronic nicotine, preferentially improves working compared with reference memory in the radial-arm maze. Mecamylamine can impair working memory performance in the 16-arm maze at low doses which are less likely to have effects at N-methyl-D-aspartate receptors. Nicotine can selectively reverse mecamylamine-induced deficits.

Detection of salmonellas in animal feeds by electrical conductance

A comparison was made between standard culture methods and electrical conductance using a Malthus AT Microbiological Analyser for the examination of animal feeds for salmonella. Conductance testing with a selenite cystine/trimethylamine-N-oxide/dulcitol medium resulted in the detection of salmonellas in 49 of 55 known positive animal feeds, 13 of 19 spiked feed samples and 36 of 47 salmonella cultures. Testing with a lysine decarboxylase/glucose medium gave significantly better results (P less than 0.05) than with selenite cystine medium but five lysine decarboxylase negative strains of salmonella were undetected. When both media were used in parallel all salmonella positive samples were detected. No difference was found between preenrichment in buffered peptone water containing trimethylamine/mannitol and that containing lysine/glucose. Positive detection criteria for selenite medium of conductance peak at greater than or equal to 500 microsiemens (microS) with a rate of change of greater than or equal to 60 microS/h or 400-499 microS with a rate of change of greater than or equal to 40 microS/h and for lysine medium with a peak of greater than or equal to 100 microS have been established. The method offers savings in media and operating costs over conventional standard culture methods, provides results within 48 h and is recommended for statutory feed monitoring purposes.