Assessing and Reporting the Adverse Effects of Antipsychotic Medication: A Systematic Review of Clinical Studies, and Prospective, Retrospective, and Cross-Sectional Research

Objective: Adverse effects (AEs) of antipsychotic medication have important implications for patients and prescribers in terms of wellbeing, treatment adherence and quality of life. This review summarises strategies for collecting and reporting AE data across a representative literature sample to ascertain their rigour and comprehensiveness. Methods: A PsycINFO search, following PRISMA Statement guidelines, was conducted in English-language journals (1980–July 2014) using the following search string: (antipsychotic* OR neuroleptic*) AND (subjective effect OR subjective experience OR subjective response OR subjective mental alterations OR subjective tolerability OR subjective wellbeing OR patient perspective OR self-rated effects OR adverse effects OR side-effects). Of 7,825 articles, 384 were retained that reported quantified results for AEs of typical or atypical antipsychotics amongst transdiagnostic adult, adolescent, and child populations. Information extracted included: types of AEs reported; how AEs were assessed; assessment duration; assessment of the global impact of antipsychotic consumption on wellbeing; and conflict of interest due to industry sponsorship. Results: Neurological, metabolic, and sedation-related cognitive effects were reported most systematically relative to affective, anticholinergic, autonomic, cutaneous, hormonal, miscellaneous, and non-sedative cognitive effects. The impact of AEs on patient wellbeing was poorly assessed. Cross-sectional and prospective research designs yielded more comprehensive data about AE severity and prevalence than clinical or observational retrospective studies. 3 Conclusions: AE detection and classification can be improved through the use of standardised assessment instruments and consideration of subjective patient impact. Observational research can supplement information from clinical trials to improve the ecological validity of AE data.

The Effect of Water Consumption on Schoolchildren's Fine Motor Skills, Cognitive Function and Mood

Previous research has suggested that dehydration may have a negative effect on some aspects of mood, cognitive performance and motor skills (Benton, 2011). Furthermore, a large proportion of children arrive at school in a dehydrated state (Baron, Courbebaisse, Lepicard, & Friedlander, 2015). The present work investigated whether supplementing children with water may, as a consequence of reducing dehydration, improve their cognitive performance and motor skills. In studies 1, 2, 3 and 5, it was found that tasks that predominantly tested motor skills, were improved in children who had a drink, compared to those who did not. Furthermore, study 3 showed that this effect was moderated by hydration status. One theoretical explanation for the poorer performance of dehydrated children is that they may lack the neurological resources to sustain their effort and thus performance does not improve over time. In support of this, these studies showed that, when re-hydrated, performance on these tasks improves to the level of non-dehydrated children. Study 2 showed that the number of errors increased in a StopSignal task in children that had high self-rated levels of thirst, compared to low levels: and hydration status did not moderate this effect. A possible explanation for the increased number of errors in children with high self-rated thirst is that the thirst sensation diverts attention away from the task, causing task performance to deteriorate. In study 4, it was observed that there was a large variation in intra-individual and inter-individual hydration scores throughout the day, which was not related to volume drank or levels of thirst. Further studies should use imaging techniques to study brain activity during dehydration and rehydration, and during periods of high thirst, to help to further elucidate the mechanism underlying the negative effect of dehydration on motor performance, and the effect of self-rated thirst on attention.

Alcohol gel ingestion amongst homeless Eastern and Central Europeans in London: assessing the effects on cognitive functioning and psychological health

Background: Intentional consumption of alcohol based hand gels has been reported especially amongst non-UK national, alcohol dependent, homeless individuals in London. Whilst alcohol misuse is known to be associated with impaired cognitive functioning and mental health problems, the effects of additional ingestion of alcohol gel are unknown. Objectives: To explore cognitive and psychological functioning in users who intentionally ingest alcohol gel compared with ethyl-alcohol only misusers and controls. Methods: Male, Central and Eastern European alcohol only misusers, (n=14; mean age 39 years), alcohol gel users (n=14; mean age 43 years) and controls (n=12; mean age 31 years) were recruited from a London Homeless Service during 2013/14. Alcohol misusers, alcohol gel users and controls were compared on the Forwards and Backwards Digit Span Test; Block Design test; Retrospective and Prospective Memory Questionnaire (PRMQ) and the Hospital and Anxiety Depression Scale (HADS). Results: Alcohol gel users performed significantly worse on the Block Design task (p<0.01) and PRMQ (p<0.01) relative to both alcohol only and control groups, and significantly worse on the digit span relative to controls (p=0.01). Both alcohol misusing groups scored comparatively on digit span backwards (p<0.01), with both groups performing significantly worse than controls. The alcohol gel group reported significantly higher levels of anxiety relative to controls (p=0.02). Conclusions: Whilst there could be constitutional differences between alcohol misusers who additionally abuse alcohol gel, the findings suggest that alcohol gel ingestion may have a greater impact on psychological functioning than traditional alcohol misuse.