(1) To determine whether there are sleep variables specific for obsessive-compulsive disorder (OCD) that are identifiable on polysomnographic findings; (2) to determine the possible relationship of OCD to other psychopathological disorders, with special emphasis on major depressive disorder (MDD).

Eighteen patients suffering from OCD (five of whom had a comorbid depressive disorder) were assessed by means of a standardized sleep questionnaire, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for the assessment of severity of obsessive-compulsive symptoms, and overnight polysomnography. Results were compared with those from a control group of 18 age- and sex-matched controls with no history of psychiatric disorders.

We found a significant decrease in sleep efficiency index (SEI), REM percent, REM latency, and slow wave sleep latency among OCD patients, compared with controls. The presence of comorbid major depression had no effect on the severity of OCD and had no significant effect on the sleep measures.

Sleep changes recorded polysomnographically in patients with OCD can be primary in origin and are independent of an associated major depressive disorder.

The present study explored the influence of romantic love on the expression of several obsessive–compulsive disorder (OCD) characteristics, including symptom severity, symptom dimensions, age at onset, sensory phenomena (SP), and developmental course, as well as other related comorbid disorders. It was hypothesized that love-precipitated OCD would be associated with a set of distinct characteristics and exhibit greater rates of comorbid disorders.

The analyses were performed using a large sample (n = 981) of clinical patients with a primary diagnosis of OCD (Females = 67.3%, M age = 35.31).

Love-precipitated OCD was associated with greater severity of SP and later age at onset of obsessions. However, symptom severity, symptom dimension, developmental course, and psychiatric comorbidities were not associated with love-precipitated OCD.

It was concluded that romantic love does shape the expression of OCD, especially with regard to SP and onset age. These findings encourage further exploration to determine its clinical significance as a phenotype.

Evaluate the current novel food therapy for Alzheimer and its adverse effects. What is the response to Axona (Capylidene) in different ethnicities and determine the generalizability of the drug use in diverse populations.

What genes are linked with positive responses? What are the implications of its use in high risk populations? Its role in early detection of Alzheimer’s and the arrest of the neurodegeneration in APO E4 (-) patients.

PubMed was queried with the search terms ‘Axona’ OR ‘Caprylidene’ and the following articles were collected and reviewed.

Among the articles collected and reviewed, two studies extensively evaluated the safety and efficacy of using Medium Chain Triglycerides (MCT) in Alzheimer’s disease. These studies genotyped patients for APO E4 status (positive/negative). According to the Reger et al. study in 2002, treatment of APOE4 (-ve) patients with MCTs reported a considerable improvement in comparison to placebo-treated patients (P=0.04). The second study by Henderson et al. in 2009 demonstrated an improvement in cognitive functioning determined by Alzheimer’s disease Assessment Scale- cognitive subscale (ADAS-Cog) scores in those treated with MCTs versus placebo in APOE4 -ve patients. An open label Japanese pilot study also showed improvement in cognitive functioning with Caprylidene in APOE4 (-ve) patients with Mini Mental Status Exam (MMSE) score>14.

The FDA approved treatment options in Alzheimer’s disease include acetylcholinesterase inhibitors (Rivastigmine, Donepezil and Galantamine), NMDA receptor antagonist (Memantine). These drugs only delay the progression of the disease in these patients.

MCTs are classified as medical foods, which are defined as substances that provide a specific nutritional need in a patient that cannot be satisfied by modification of a normal diet alone The FDA approved Axona as medicalfood for specific dietary management of the disease in 2009. Early metabolic changes in Alzheimer’s Diseaseprior to cognitive decline and plaque deposition can possibly be prevented by early intervention with Axona, especially in high risk population (APOE4 (þ), Downs syndrome).

These trials highlight the benefits of MCT in a discrete group, and the importance of routine genomic testing in Alzheimer patients in clinical settings. A better understanding into Caprylidene’s pharmacokinetics and pharmacodynamics will help us in the prevention and intervention of patients based on their genetic profiles.

No funding.

Specific taste quality deficits in ALS has not heretofore been described.

Case Study: A 71 year old right handed female presented with a two year course of progressive reduction in strength in her hands, arms and legs with difficulty tying shoe laces, opening jars, writing and walking. She described nocturnal muscle spasms involving all extremities. Gradually, over eight months prior to presentation, all food began to taste bad and horribly bitter. Associated with no appetite and a seven pounds weight loss.

Abnormalities in Neurological examination: Cranial Nerve (CN) examination: CN IX and X: Gag absent bilaterally. Motor examination: Bulk: atrophy in thenar and hypothenar eminences and intrinsics in both upper extremities. Percussion induced fasciculation and myotonia in both shoulders and arms. Fasciculation of tongue with percussion myotonia of tongue. Strength: Intrinsic 4/5 in both upper extremities, 3/5 in abductor policis brevis bilaterally, 3/5 right gastrocnemius soleus, 4/5 bilateral anterior tibialis. Drift testing: left abductor digiti minimi sign. Gait: Heel and toe walking unstable with circumduction of left leg. Tandem gait unstable. Cerebellar: Holmes rebound phenomena positive in the left upper extremity. Deep tendon reflexes: 1+ left brachioradialis. 1+ left triceps. 3+ right ankle jerks. 0 left ankle jerk. Positive jaw jerk. Chemosensory Testing: Normosmia to: Alcohol Sniff Test (46), Pocket Smell Test (3/3) and Retronasal Smell Index (9). Taste Quadrant Testing: ageusia in the palate to sodium chloride and citric acid. Ageusia throughout the palate, tongue and whole mouth to sucrose and quinine hydrochloride. Fungiform papillae count: left 18, right 20 (normal). Lip biopsy (normal). MRI: T2 flair in bilateral corticospinal tracts, left greater than right in the spinal cord and the brain. EMG: fibrillation, positive waves with fasciculation in all four extremities. Voluntary contraction with polyphasic unstable motor unit action potentials.

While Lang found no taste loss in ALS (Lang, 2011), Pelletier found reduction in intensity of taste to all modalities in different sectors of the tongue, but paradoxically demonstrated normogeusia in whole mouth taste perception (Pelletier, 2013). Pathological specimens of those with ALS revealed degeneration in the nucleus parabrachialis medialis and tractus trigeminothalamicus dorsalis (Oyanagi, 2015), suggesting that taste deficit may be due to central white matter abnormalities. Sweet taste is localized in the most posterior and rostral aspect of the right insular cortex, immediately adjacent to bitter (Prinster, 2017), suggesting a neighborhood effect phenomena. Weight loss in ALS may be due to sensory distortion and secondary impairment of appetite. It would be worthwhile to investigate those with ALS for evidence of otherwise overlooked gustatory deficits, correction of which may improve appetite and nutritional state.

Schizophrenia is associated with health, social, and financial burdens for patients, caregivers, and society. Major systemic changes, reforms, and technological advances have happened in the USA since the prior estimate of the societal cost of schizophrenia, $155.7B in 2013. This study analyzes the most recent data and literature to update this estimate.

Direct and indirect costs associated with schizophrenia in the US in 2019 were estimated using a prevalence-based approach (ICD-10 codes: F20, F25). Direct healthcare costs were assessed retrospectively using a matched cohort design in the IBM Watson Health MarketScan Commercial, Medicare, and Medicaid databases from October 1, 2015, through December 31, 2019. Patients were matched to controls on demographics, insurance type, and index year. Direct nonhealthcare costs were estimated using published literature and government data. Indirect costs were estimated using a human capital approach and the value of quality-adjusted life years lost. Cost offsets were applied to account for basic living costs avoided. Excess costs, comparing costs for individuals with and without schizophrenia, were reported in 2019 USD.

The estimated excess economic burden of schizophrenia in the US in 2019 was $330.6B, including $62.3B in direct healthcare costs (19%), $19.7B in direct nonhealthcare costs (5%), and $251.9B in excess indirect costs (76%). The largest drivers of indirect costs were caregiving ($112.3B), premature mortality ($77.9B), and unemployment ($54.2B).

The estimated societal burden of schizophrenia in the USA in 2019 was $330.6B, which represented a 93.5% increase from 2013 to 2019, after accounting for inflation. This study underscores the increasing and apparent burden of schizophrenia not only on the patient, but also on caregivers and society.

Sunovion Pharmaceuticals