A study of the reasons for prescribing and misuse of gabapentinoids in prison including their co-prescription with opioids and antidepressants.

PURPOSE: Electronic medical case files of male prisoners in a category B prison in London were studied to establish a prevalence during an eight-month period of the use of and the reasons for prescribing gabapentinoids in prison and also to establish prescribing standards in prison and compliance with these. In addition, the prevalence of co-prescription of gabapentinoids with opioids and antidepressants, particularly tricyclic antidepressants such as amitriptyline, was also assessed in light of the increased risk of respiratory depression resulting in death when these drugs are used in combination. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH: A retrospective, SystmOne case-file based survey was undertaken searching by SNOMED CT supplemented by examination of free text, in a category B prison for males (Capacity 1,500 prisoners; Average turnover of prisoners up to 6,000 per year), to establish practice standards related to the prescription of Gabapentinoids in the prison and determine compliance with these. FINDINGS: In total, 109 cases were identified of prisoners having been prescribed gabapentinoids, pregabalin in 66 cases (61 per cent) and gabapentin in 43 cases (39 per cent). In 36 cases (33 per cent) prescriptions were for unlicensed indications. This in fact represented 50 per cent of the cases where the indications were documented. In 51 cases (47 per cent) gabapentinoids were prescribed with an opioid substitute. In 14 cases (13 per cent), prescribed gabapentinoids were diverted to other prisoners. PRACTICAL IMPLICATIONS: The initiation of gabapentinoids in prison should be avoided. For prisoners who are also receiving opioid substitutes or are abusing opiates, it may be unsafe to continue on gabapentinoids. Issues raised by this study are likely to apply to other prisons, secure forensic psychiatric facilities and indeed community mental health and primary care as well. SOCIAL IMPLICATIONS: Risk of dependance on gabapentinoids including risk of mortality when taken with opioids and opioid substitutes. ORIGINALITY/VALUE: This is an original study conducted at a category B prison in London.

Comparison of Two Creatinine Based Equations for Routine Estimation of GFR in a Speciality Clinic for Diabetes.

OBJECTIVE: To compare the bias, absolute bias, precision and accuracies between the equations, viz., CKD-EPI (Scr), CKD-EPI (Scys) and MDRD in Indian patients with type 2 diabetes. METHODS: 198 patients who underwent 24 h urinary collection for assessing kidney function between November 2014-January 2015 were included. Cohen's κ coefficient, Bland-Altman plot were calculated between estimated kidney function equations, and bias, precision, accuracies was calculated between the formulae. RESULTS: The mean eGFR based on MDRD, CKD-EPI (Scr) and CKD-EPI (Scys) equations were 64.5±21.9, 70.2±25.1 and 74.7±31.0 ml/min/ 1.73m2 respectively. The overall mean absolute bias was smallest for MDRD vs CKD EPI (Scr). The precision was also least for MDRD vs CKD EPI (Scr) indicating that the agreement between these equations is consistent for the range of values. MDRD vs CKD EPI (Scr) had the highest accuracy in comparison to other compared formula. The performance between MDRD versus CKD EPI (Scys) was different. There was a good agreement between MDRD and CKD EPI (Scr).in both stage 3 and stage 4 CKD. The MDRD vs CKD EPI (Scr) classified 72.2% of the patients correctly. CONCLUSIONS: In conclusion, there was a good agreement between CKD-EPI (Scr) and MDRD equations. CKD-EPI equation based on creatinine estimation is widely accepted method and clinicians may use this equation in routine clinical practice to assess kidney function among patients with type 2 diabetes.

Presence of elevated non-HDL among patients with T2DM with CV events despite of optimal LDL-C - A report from South India.

Elevated non-high density lipoprotein cholesterol (non-HDL-C) was the commonest lipid abnormality among T2DM patients with cardiovascular events (CV) events. Prevalence of elevated non-HDL-C was 21.6% among patients who were on statin therapy and with optimal low density lipoprotein-cholesterol (LDL-C) levels. Despite an optimal LDL-C level, 47% of the T2DM patients with CV events had elevated non-HDL-C.

Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: a randomised controlled trial.

BACKGROUND: Aggressive challenging behaviour is frequently reported in adults with intellectual disability and it is often treated with antipsychotic drugs. However, no adequate evidence base for this practice exists. We compared flexible doses of haloperidol (a typical, first-generation antipsychotic drug), risperidone (an atypical, second-generation antipsychotic), and placebo, in the treatment of this behaviour. METHODS: 86 non-psychotic patients presenting with aggressive challenging behaviour from ten centres in England and Wales, and one in Queensland, Australia, were randomly assigned to haloperidol (n=28), risperidone (n=29), or placebo (n=29). Clinical assessments of aggression, aberrant behaviour, quality of life, adverse drug effects, and carer uplift (positive feelings about the care of the disabled person) and burden, together with total costs, were recorded at 4, 12, and 26 weeks. The primary outcome was change in aggression after 4 weeks' treatment, which was recorded with the modified overt aggression scale (MOAS). Analysis was by intention to treat. This study is registered as ISRCTN 11736448. FINDINGS: 80 patients had adherence of 80% or more to prescribed drug. Aggression decreased substantially with all three treatments by 4 weeks, with the placebo group showing the greatest change (median decrease in MOAS score after 4 weeks=9 [95% CI 5-14] for placebo, 79% from baseline; 7 [4-14] for risperidone, 58% from baseline; 6.5 [5-14] for haloperidol, 65% from baseline; p=0.06). Furthermore, although no important differences between the treatments were recorded, including adverse effects, patients given placebo showed no evidence at any time points of worse response than did patients assigned to either of the antipsychotic drugs. INTERPRETATION: Antipsychotic drugs should no longer be regarded as an acceptable routine treatment for aggressive challenging behaviour in people with intellectual disability.