Tag: 31/10/25

Categories : Mental Health Obstetrics & GynaecologyTags : Leave a comment

Postpartum Psychosis Should Be Recognised as a Distinct Disease, Experts Say

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An international panel of leading experts on women’s mental health is recommending that postpartum psychosis be recognised as a distinct category of mental illness and classified accordingly within standardised medical coding systems.

The recommendation, published in Biological Psychiatry, follows a comprehensive review of the scientific literature on the illness.

Postpartum psychosis is an acute and severe psychiatric illness that sets in within weeks after delivery. Most women with postpartum psychosis experience severe mood symptoms, including mania, mixed episodes, or depression with psychotic features. Impaired cognition, irritability, and agitation are also common.

The condition is considered a psychiatric emergency and, in most cases, requires hospitalisation of the mother. If left untreated, postpartum psychosis is associated with high risks of suicide and infanticide. However, if it is detected and treated in time, patients respond well to treatment and most women return to their previous functioning.

Despite being one of the most distinct clinical phenotypes in psychiatry, postpartum psychosis is not recognized in the Diagnostic and Statistical Manual (DSM-5) or the International Classification of Disease (ICD), which are used to code diseases and medical conditions for treatment and billing purposes.

The panel, in close collaboration with patient advocacy organisations and key interested partners, recommended classifying postpartum psychosis as a distinct category within the bipolar disorders chapter of the DSM and ICD.

“Postpartum psychosis is the most severe perinatal mental health problem, and yet one that is often misdiagnosed and mismanaged, with severe consequences for women, and their children and families. A proper nosological classification of this disorder is an essential step towards its correct identification and treatment”.Professor Paola Dazzan, Professor of Neurobiology of Psychosis, Vice Dean (International) at King’s IoPPN and a member of the research panel

Due to the risks to the patient and the infant, the rapid escalation of severity, and its severe and sudden course, it is imperative that postpartum psychosis is recognized, diagnosed, and treated as early as possible. To facilitate such care, the panel recommends DSM-5 and ICD-10 include the following criteria for a diagnosis of postpartum psychosis:

  • The onset of at least one of the following states within 12 weeks of childbirth, lasting at least one week and present most of the day, nearly every day, or any duration if hospitalisation is necessary:
    1. Mania/mixed state
    2. Delusions
    3. Hallucinations
    4. Disorganised speech or formal thought disorder
    5. Disorganised, confusional, or catatonic behaviour
    6. Depression with psychotic features
  • The episode is associated with an unequivocal change in functioning that is uncharacteristic of the postpartum period.
  • The disturbance in mood and the change in functioning are observable by others.
  • The episode is sufficiently severe enough to cause marked impairment in social functioning and in the care of the baby or to necessitate hospitalization to prevent harm to the patient, baby, or others.

“We have been working with the American Psychiatric Association and the DSM steering committee since 2020 to find a solution that will facilitate diagnostic accuracy and the provision of timely and evidence-based treatment to improve the quality of treatment and outcomes for women with postpartum psychosis and to prevent the tragic outcomes of suicide and infanticide. We are committed to continue this work,” concludes Dr Veerle Bergink, Director of the Women’s Mental Health Center at Mount Sinai and first author of the paper.

Source: King’s College London

Categories : Neurodegenerative Diseases New Compounds and TreatmentsTags : Leave a comment

A New Treatment for Huntington’s Disease Is Genuinely Promising – But Here’s Why We Still Need Caution

On By ModernMedia
Photo by Anna Shvets

Bryce Vissel, UNSW Sydney

Imagine knowing in your 20s or 30s that you carry a gene which will cause your mind and body to slowly unravel. Huntington’s disease is inherited, relentless and fatal, and there is no cure. Families live with the certainty of decline stretching across generations.

Now, a new treatment is being widely reported as a breakthrough.

Last week, gene therapy company uniQure announced that a one-time brain infusion appeared to slow the disease in a small clinical study.

If confirmed, this would not only be a landmark for Huntington’s disease but potentially the first time a gene therapy has shown promise in any adult-onset neurodegenerative disorder.

But the results, which were announced in a press release, are early, unreviewed and based on external comparisons. So, while these findings offer families hope after decades of failure, we need to remain cautious.

What is Huntington’s disease?

Huntington’s is a rare but devastating disease, affecting around five to ten people in 100,000 in Western countries. That means thousands in Australia and hundreds of thousands worldwide.

Symptoms usually start in mid-life. They include involuntary movements, depression, irritability and progressive decline in thinking and memory. People lose the ability to work, manage money, live independently and eventually care for themselves. Most die ten to 20 years after onset.

The disease is caused by an expanded stretch of certain DNA repeats (CAG) in the huntingtin gene. The number of repeats strongly influences when symptoms begin, with longer expansions usually linked to earlier onset.

Looking for a treatment

The gene that causes Huntington’s disease was identified in 1993, 32 years ago. Soon afterwards, mouse studies showed that switching off the mutant huntingtin protein even after symptoms had begun could reverse signs and improve behaviour.

This suggested lowering the toxic protein might slow or even partly reverse the disease. Yet for three decades, every attempt to develop a therapy for people has failed to show convincing clinical benefit. Trials of huntingtin-lowering drugs and other approaches did not slow progression.

What is the new treatment?

The one-time gene therapy, called AMT-130, involves brain surgery guided by MRI. Surgeons infuse an engineered virus directly into the caudate and putamen brain regions, which are heavily affected in Huntington’s.

The virus carries a short genetic “microRNA” designed to reduce production of the affected huntingtin protein.

By delivering it straight into the brain, the treatment bypasses the blood–brain barrier. This natural wall usually prevents medicines from entering the central nervous system. That barrier helps explain why so many brain-targeted drugs have failed.

What did they find?

Some 29 patients received treatment, with 12 in each group (one low-dose, and one high-dose) followed for three years. According to uniQure, those given the higher dose declined much slower than expected.

The study compared how much participants’ movement, thinking and daily function declined, compared to a matched external group from a global Huntington’s registry (meaning they weren’t part of the study). The company claimed those given the higher dose had a 75% slowing in their decline.

On a functional scale focused on independence, the company reported a 60% slowing in decline for the higher dose group.

Other tests of movement and thinking also favoured treatment. Nerve-cell damage in spinal fluid was lower for study participants than would be expected for untreated patients.

Why should we be cautious?

These findings are an early snapshot of results reported by the company, not yet peer-reviewed. The study compared treated patients to an external matched control group, not people randomised to placebo at the same time. This design can introduce bias. The numbers are also small – only 12 patients at the three-year mark – so we can’t draw solid conclusions.

The company reports the therapy was generally well tolerated, with no new serious adverse events related to the drug since late 2022. Most problems were related to the neurosurgical infusion itself, and resolved. But in a disease that already causes such severe symptoms, it is often hard to know what counts as a side effect.

The company uniQure has said it plans to seek regulatory approval in 2026 on the basis of this dataset.

Regulators will face difficult decisions: whether to allow access sooner before all the questions and uncertainties are addressed – based on the needs of a community with no effective options – and wait for further data while people are being treated, or to insist on larger trials that confirm results before approval.

What does it mean?

If upheld, these results represent the first convincing signs that a gene-targeted therapy can slow Huntington’s disease. They may also be the first evidence of benefit from a gene therapy in any adult-onset neurodegenerative disorder. That would be a milestone after decades of failure.

But these results do not prove success. Only larger, longer and fully peer-reviewed studies will show whether this treatment truly changes lives. Even if approved, a complex neurosurgical gene therapy may not be easily accessible to all patients.

The company has said the drug’s price would be similar to other gene therapies – which can cost over A$3 million per patient – and will have the added cost of brain surgery.

The takeaway

For families who carry this gene, the hope is profound. But caution is just as important.

We may be witnessing the first credible step toward slowing an inherited adult-onset neurodegenerative disease, or just an early signal that may not hold up.

Ultimately, only time and rigorous science will show whether this treatment delivers the benefits so urgently needed.

Bryce Vissel, Cojoint Professor, School of Clinical Medicine, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Categories : AgeingTags : Leave a comment

1st-generation Antihistamines Linked to Delirium Risk in Older Hospitalised Patients

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An analysis in the Journal of the American Geriatrics Society reveals that older inpatients admitted to physicians who prescribe higher amounts of first-generation antihistamines face an elevated risk of delirium while in the hospital.

First-generation antihistamines, such as diphenhydramine, are among the leading causes of medication-related harms in older adults, and although these medications are indicated for histamine-related conditions such as hives and anaphylaxis, they may be prescribed inappropriately.

When investigators analysed data on 328 140 patients aged 65 years and older who were admitted by 755 attending physicians to 17 hospitals in Ontario, Canada in 2015–2022, they found that the overall prevalence of delirium was 34.8%. Patients admitted to physicians who more commonly prescribed first-generation antihistamines had 41% increased odds of experiencing delirium compared with patients admitted to physicians who rarely prescribed first-generation antihistamines.

“We hope our study raises awareness among hospitalists that sedating antihistamines can be harmful, and should be prescribed with caution,” said corresponding author Aaron M. Drucker, MD, of the University of Toronto and Women’s College Hospital.

Source: Wiley

Categories : Cancer Environmental EffectsTags : Leave a comment

No Increased Childhood Cancer Risk near UK Nuclear Sites, Study Finds

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Children living near nuclear power stations in the UK are not at increased risk of childhood cancers, according to a new analysis.

The research was led by scientists at Imperial College London and University of Bristol and commissioned by the UK Committee on the Medical Aspects of Radiation in the Environment (COMARE). The results, published in International Journal of Epidemiology, found no evidence of increased risk of childhood cancers among children living near 28 nuclear installations between 1995 and 2016.

Researchers analysed cancer incidence data for nearly 50 000 cases of childhood leukaemia, non-Hodgkin’s lymphoma (LNHL), central nervous system (CNS) tumours, and other solid tumours in children aged 0–14 years.

They looked at data for communities living within 25 kilometres of installations, including those which have been linked to historical concerns about potential health impacts – such as Sellafield in Cumbria and Dounreay in northern Scotland.

The analysis found no evidence of increased risk of childhood cancers among children living near 28 nuclear installations between 1995 and 2016.
(Credit: Davies, B. et al. Int J Epidemiol, 2025)

Using these data and advanced statistical modelling, they found no increased incidence of childhood cancers in these areas compared to national averages.[1] They also found no evidence that cancer risk increased the closer children lived to the nuclear sites.

Dr Bethan Davies, from Imperial’s School of Public Health and lead author of the study, said: “For many years there have been public concerns about the potential health impacts of living near nuclear installations. Our analysis suggests that children living near these sites today are not at increased risk.”

The latest study builds on decades of research following reports in the 1980s of clusters of cancer cases near nuclear facilities in England, Scotland and Germany[2] – following which, the UK Government set up COMARE to advise on the health effects of radiation.

Early investigations confirmed clusters of cases of some cancers near nuclear installations, particularly LNHL.

However, subsequent studies failed to show any direct link between these cases and radiation exposure from nuclear facilities.

In 2016, a COMARE report[3] suggested other potential explanations for these case clusters, including infections introduced due to population mixing in the areas.

The new findings come at a time of renewed interest in nuclear energy as part of the UK’s strategy to meet net-zero carbon targets and the government committing £14.2bn to build a new nuclear power station in Suffolk and develop small modular reactors.

The researchers say that while their study offers reassurance, they support COMARE’s recommendations for ongoing surveillance of cancer incidence near nuclear sites.

The authors acknowledge a number of limitations with their study, including the use of residential address at diagnosis as a proxy for exposure.

They were also unable to account for individual-level risk factors – such as genetic or medical conditions. However, they emphasise that the study’s design and comprehensive data make it one of the most detailed assessments to date.

Dr Davies added: “As the UK government announces a multibillion-pound investment for new nuclear energy infrastructure, our findings should provide reassurance that the historical clusters of childhood cancers reported near sites such as Sellafield and Dounreay are no longer evident.”

Professor Mireille Toledano, Mohn Chair in Population Child Health in Imperial’s School of Public Health, said: “These findings are both timely and important. As the UK and other countries expand their nuclear energy capacity, it’s vital that public health remains a central consideration. It’s reassuring that our study found that the historic case clusters have resolved, but it remains important we continue to monitor public health data around such sites across the UK for any emerging trends of concern.”

The full study, published today in the International Journal of Epidemiology, was supported by funding from the National Institute for Health and Care Research (NIHR), Health Data Research UK (HDRUK) and the UK Medical Research Council (UK Research and Innovation (UKRI)).

The work was carried out through the NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards – a partnership between the UK Health Security Agency (UKHSA) and Imperial College London.

The work was also supported by the NIHR Imperial Biomedical Research Centre, a translational research partnership between Imperial College Healthcare NHS Trust and Imperial College London.

–

[1] Researchers obtained national incident cases of cancer diagnosed between 1995 and 2016 in children under 15 years of age from NHS England (formerly Public Health England), Welsh Cancer Intelligence and Surveillance Unit and Health Protection Scotland.

[2] A cluster of cases of leukaemia in children living close to the Sellafield nuclear plant was reported in 1983. An Independent Advisory Group confirmed the cluster and the UK government established COMARE to advise on the health effects of radiation. Subsequent studies identified increased risks of cancers in children and young adults living near Sellafield, Dounreay (Scotland), and Hamburg (Germany) nuclear installations.

[3] Committee on Medical Aspects of Radiation in the Environment (COMARE) – Seventh report (2016) https://assets.publishing.service.gov.uk/media/5a7f70ed40f0b6230268f83c/COMARE_17th_Report.pdf

Source: Imperial College London