The locus coeruleus (LC), the major origin of noradrenergic modulation of the central nervous system, may play an important role in neuropsychiatric disorders including Parkinson's disease and Alzheimer's disease. The pattern of age-related change of the LC across the life span is unclear. We obtained normalized, mean LC signal intensity values, that is, contrast ratios (CRs), from magnetization transfer–weighted images to investigate the relationship between LC CR and age in cognitively normal healthy adults (N = 605, age range 18–88 years). Study participants were part of the Cambridge Centre for Ageing and Neuroscience—an open-access, population-based data set. We found a quadratic relationship between LC CR and age, the peak occurring around 60 years, with no differences between males and females. Subregional analyses revealed that age-related decline in LC CR was confined to the rostral portion of the LC. Older adults showed greater variance in overall LC CR than younger adults, and the functional and clinical implications of these observed age-related differences require further investigation. Visualization of the LC in this study may inform how future scanning parameters can be optimized, and provides insight into how LC integrity changes across the life span.

Background: Our aim was to identify and compare modifiable risk factors associated with adverse pregnancy outcomes in women with type 1 and type 2 diabetes and to identify effective maternity clinics. Methods:We included 17,375 pregnancies in 15,290 women with diabetes in a populationbased cohort study across 172 maternity clinics in England, Wales and the Isle of Man.Obstetric complications (preterm delivery, large birthweight) and adverse pregnancy outcomes (congenital anomaly, stillbirth, neonatal death) were obtained for pregnancies completed between 01 January 2014 and 31 December 2018. We assessed associations between modifiable (glycaemia, obesity, clinic) and non-modifiable risk factors (age, deprivation, ethnicity) with pregnancy outcomes.Results: Of 17,375 pregnancies, 8,690 (50.0%) were in women with type 1 and 8,685 (50.0%) in women with type 2 diabetes. The rates of preterm delivery (42.5% type 1, 23.4% type 2), and large birthweight (52.2% type 1, 26.2% type 2) were higher in type 1 diabetes (p<0.001).The prevalence of congenital anomaly (44.8/1000 type 1, 40.5/1000 type 2; p=0.175), and stillbirth (10.4/1000 type 1, 13.5/1000 type 2; p=0.072) did not differ but neonatal death rates (7.4/1000 type 1, 11.2/1000 type 2; p=0.013) were higher in type 2 diabetes. Independent risk factors for perinatal death were third trimester HbA1c > 48mmol/mol (OR 3.06, 95% CI 2.16 to 4.33), living in the highest deprivation quintile (OR 2.29 95% CI 1.16 to 4.52) and having type 2 diabetes (OR 1.65 95% CI 1.18 to 2.31). Variations in glycaemia and large birthweight were associated with maternal characteristics (diabetes duration, deprivation, BMI) without substantial differences between clinics.Interpretation: Our data highlight persistent adverse pregnancy outcomes in type 1 and type 2 diabetes. Maternal glycaemia and obesity are the key modifiable risk factors. No clinics were achieving appreciably better outcomes, suggesting that healthcare system changes are needed

ObjectivesThis review provides a broad overview of the effectiveness of interventions for subjective cognitive decline (SCD) in improving psychological well-being, metacognition and objective cognitive performance.MethodsDatabases including PubMed, Web of Science and Cochrane Systematic Reviews were searched up to August 2017 to identify randomised controlled trials evaluating interventions for SCD. Interventions were categorised as psychological, cognitive, lifestyle or pharmacological. Outcomes of interest included psychological well-being, metacognitive ability and objective cognitive performance. To assess the risk of bias, three authors independently rated study validity using criteria based on the Critical Appraisal Skills Programme. Random-effects meta-analyses were undertaken where three or more studies investigated similar interventions and reported comparable outcomes.ResultsTwenty studies met inclusion criteria and 16 had sufficient data for inclusion in the meta-analyses. Of these, only seven were rated as being high quality. Group psychological interventions significantly improved psychological well-being (g=0.40, 95% CI 0.03 to 0.76; p=0.03) but the improvement they conferred on metacognitive ability was not statistically significant (g=0.26, 95% CI −0.22 to 0.73; p=0.28). Overall, cognitive training interventions led to a small, statistically significant improvement in objective cognitive performance (g=0.13, 95% CI 0.01 to 0.25; p=0.03). However, the pooled effect sizes of studies using active control groups (g=0.02, 95% CI −0.19 to 0.22; p=0.85) or reporting global cognitive measures (g=0.06, 95% CI –0.19 to 0.31; p=0.66) were non-significant.ConclusionsThere is a lack of high-quality research in this field. Group psychological interventions improve psychological well-being and may also improve metacognition. A large, high-quality study is indicated to investigate this further. There is no evidence to suggest that cognitive interventions improve global cognitive performance and the clinical utility of small improvements in specific cognitive domains is questionable. There is a lack of research considering lifestyle interventions and poor quality evidence for pharmacological interventions.PROSPERO registration numberCRD42017079391.

New psychoactive substances (NPS) are a heterogeneous group of substances. They are associated with a number of health and social harms on an individual and societal level. NPS toxicity and dependence syndromes are recognised in primary care, emergency departments, psychiatric inpatient and community care settings. One pragmatic classification system is to divide NPS into one of four groups: synthetic stimulants, synthetic cannabinoids, synthetic hallucinogens and synthetic depressants (which include synthetic opioids and benzodiazepines). We review these four classes of NPS, including their chemical structures, mechanism of action, modes of use, intended intoxicant effects, and their associated physical and mental health harms. The current challenges faced by laboratory testing for NPS are also explored, in the context of the diverse range of NPS currently available, rate of production and emergence of new substances, the different formulations, and methods of acquisition and distribution.

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The range of Ixodes scapularis is expanding in Ontario, increasing the risk of Lyme disease. As an effective public health response requires accurate information on disease distribution and areas of risk, this study aims to establish the geographic distribution of I. scapularis and its associated pathogen, B. burgdorferi, in northwestern Ontario. We assessed five years of active and passive tick surveillance data in northwestern Ontario. Between 2013 and 2017, 251 I. scapularis were submitted through passive surveillance. The submission rate increased over time, and the proportion infected with B. burgdorferi was 13.5%. Active tick surveillance from 2014 to 2016 found few I. scapularis specimens. In 2017, 102 I. scapularis were found in 10 locations around the city of Kenora; 60% were infected with B. burgdorferi, eight tested positive for A. phagocytophilum, and one for POWV. I. scapularis ticks were found in 14 locations within the Northwestern Health Unit area, with seven locations containing B. burgdorferi-positive ticks. We found abundant I. scapularis populations in the southern portion of northwestern Ontario and northward expansion is expected. It is recommended that I. scapularis populations continue to be monitored and mitigation strategies should be established for rural northern communities.

BackgroundNeuropsychiatric symptoms are common in Parkinson’s disease (PD) and predict poorer outcomes. Reward processing dysfunction is a candidate mechanism for the development of psychiatric symptoms including depression and impulse control disorders (ICDs). We aimed to determine whether reward processing is impaired in PD and its relationship with neuropsychiatric syndromes and dopamine replacement therapy.MethodsThe Ovid MEDLINE/PubMed, Embase and PsycInfo databases were searched for articles published up to 5 November 2020. Studies reporting reward processing task performance by patients with PD and healthy controls were included. Summary statistics comparing reward processing between groups were converted to standardised mean difference (SMD) scores and meta-analysed using a random effects model.ResultsWe identified 55 studies containing 2578 participants (1638 PD and 940 healthy controls). Studies assessing three subcomponent categories of reward processing tasks were included: option valuation (n=12), reinforcement learning (n=37) and reward response vigour (n=6). Across all studies, patients with PD on medication exhibited a small-to-medium impairment versus healthy controls (SMD=0.34; 95% CI 0.14 to 0.53), with greater impairments observed off dopaminergic medication in within-subjects designs (SMD=0.43, 95% CI 0.29 to 0.57). Within-subjects subcomponent analysis revealed impaired processing off medication on option valuation (SMD=0.57, 95% CI 0.39 to 0.75) and reward response vigour (SMD=0.36, 95% CI 0.13 to 0.59) tasks. However, the opposite applied for reinforcement learning, which relative to healthy controls was impaired on-medication (SMD=0.45, 95% CI 0.25 to 0.65) but not off-medication (SMD=0.28, 95% CI −0.03 to 0.59). ICD was the only neuropsychiatric syndrome with sufficient studies (n=13) for meta-analysis, but no significant impairment was identified compared tonon-ICD patients (SMD=−0.02, 95% CI −0.43 to 0.39).ConclusionReward processing disruption in PD differs according to subcomponent and dopamine medication state, and warrants further study as a potential treatment target and mechanism underlying associated neuropsychiatric syndromes.

Energy drinks are nonalcoholic beverages that are widely consumed in the general population, and worldwide usage is increasing. The main stimulant component of energy drinks is typically caffeine. Few case reports exist that link energy drink consumption to psychosis, and similarly few reports exist that associate energy drink consumption with acute renal failure. We present a patient who simultaneously developed psychosis and acute renal failure associated with excessive energy drink consumption. The patient required haemodialysis, and his psychosis resolved on cessation of energy drinks and a brief course of antipsychotic medication. We perform a review of similar cases where excessive caffeinated energy drink consumption has been linked to psychosis or acute renal failure. To our knowledge, this is the first case report describing both renal failure and psychosis occurring simultaneously in a patient. Recognising the spectrum of disorders associated with excessive energy drink consumption is vital for both physicians and psychiatrists, as this has important implications for both prognosis and treatment.