Belinda Fay Bradley

Effects of orally administered lavender essential oil on responses to anxiety‐provoking film clips

Lavender odour is commonly used to alleviate mild anxiety. Double blind studies are difficult to conduct with odours, and there are few reliable investigations of lavenders efficacy.

The effects of prolonged rose odor inhalation in two animal models of anxiety.

AIM To investigate the anxiolytic effects of prolonged rose odor exposure, mature gerbils were exposed to acute (24 h), chronic (2 week) rose odor, or a no odor condition. Anxiolytic effects were assessed using the elevated plus maze and black white box. Rose odor profiles were compared with diazepam (1 mg/kg) i.p. The Jonckheere-Terpstra test was used, with the Mann-Whitney U test to examine significant group differences. In the elevated plus maze, spatiotemporal measures, altered by diazepam, were unaffected by rose oil, whereas exploration, increased (headdip frequency: acute U=100, p<0.001; chronic U=13, p<0.001). In the black white box, rose oil had anxiolytic spatiotemporal and exploratory behavior effects: latency to move from the white to the black compartment (acute U=182, p<0.01, chronic U=179, p<0.05), percentage time in the white compartment (acute U=168, p<0.01, chronic U=149, p<0.01) and exploration, rear-sniff frequency white (acute U=100, p<0.001; chronic U=99, p<0.001) increased. The percentage of time in the dark area decreased (acute U=160, p<0.01, chronic U=178, p<0.05). This anxiolytic profile strengthened after chronic exposure to rose odor, transitions between the compartments (U=167, p<0.01) and percentage of time moving around the arena (U=154, p<0.001) increased. CONCLUSION This profile was more representative of modern anxiolytics, for example some serotonergic agents, rather than benzodiazepine type drugs.

Anxiolytic and anxiogenic drug effects on male and female gerbils in the black-white box

Neurokinin-1, (NK1) receptor antagonists offer strong potential as anxiolytic drugs with few side effects. The use of the Mongolian gerbil for anxiety research offers advantages because gerbil NK1 receptors share a greater homology with human NK1 receptors than those of other rodents. Studies are needed to validate existing tests of anxiety for use with this species. This study examined the effects of two anxiolytics (buspirone and diazepam) and two anxiogenics (caffeine and FG142) on male and female gerbil behaviour in the black-white box (BWB). Diazepam was anxiolytic in males but not females. The anxiolytic effects of buspirone were apparent at the lower doses in both males and females. Higher doses resulted in sedative effects in both sexes. Caffeine produced mild anxiogenesis in females at the lowest dose, and in males at the highest dose. FG7142 was mildly anxiogenic in males and not at all in females. Findings are discussed in light of previous research. The gerbil BWB should not be used as a valid test of anxiety in its current form.

The relationships of ‘ecstasy’ (MDMA) and cannabis use to impaired executive inhibition and access to semantic long-term memory

This study aimed to examine the relationship between the consumption of ecstasy (3,4‐methylenedioxymethamphetamine (MDMA)) and cannabis, and performance on the random letter generation task which generates dependent variables drawing upon executive inhibition and access to semantic long‐term memory (LTM). The participant group was a between‐participant independent variable with users of both ecstasy and cannabis (E/C group, n = 15), users of cannabis but not ecstasy (CA group, n = 13) and controls with no exposure to these drugs (CO group, n = 12). Dependent variables measured violations of randomness: number of repeat sequences, number of alphabetical sequences (both drawing upon inhibition) and redundancy (drawing upon access to semantic LTM). E/C participants showed significantly higher redundancy than CO participants but did not differ from CA participants. There were no significant effects for the other dependent variables. A regression model comprising intelligence measures and estimates of ecstasy and cannabis consumption predicted redundancy scores, but only cannabis consumption contributed significantly to this prediction. Impaired access to semantic LTM may be related to cannabis consumption, although the involvement of ecstasy and other stimulant drugs cannot be excluded here. Executive inhibitory functioning, as measured by the random letter generation task, is unrelated to ecstasy and cannabis consumption. Copyright

Choosing the place of death: Empowering motor neurone disease/amyotrophic lateral sclerosis patients in end-of-life care decision making.

Motor neurone disease/amyotrophic lateral sclerosis (MND/ALS) is a fatal neurodegenerative disease that requires special attention at the end-of-life, particularly because disability is relentlessly progressive and death generally occurs in a predictable fashion.1,2 In the absence of a cure, palliative care and advance care planning (ACP) are key management strategies.1,2 The quality of care provided throughout the illness profoundly influences the end-of-life care (EOLC).1–3 The ‘End of Life Care Strategy’ aims at promoting excellence in EOLC.3 The central aspect of this strategy concerns patients’ preference for place of death. There is little in the literature about enabling MND/ ALS patients to make choices about their EOLC, particularly relating to the preferred place of death (PPD). Honouring patient’s choice for PPD is important, and this can be achieved through ACP.2,3 The Preferred Priorities for Care (PPC) document is a patient-held dynamic record that can be used as an ACP tool to promote discussion and documentation of wishes, preferences and priorities for care in relation to end-of-life issues.3,4 The Preston MND care and research centre serving a population of 1.6 million in North West England offers PPC document to all MND/ALS patients. We reviewed the case notes of patients who died in 2012 and 2013 to investigate whether completion of PPC document affected actual place of death or hospital use towards end-of-life. There were a total of 99 deaths, of which 33 (33.3%) occurred in hospital. PPC document was completed by 52 patients (52.5%); 29 (55.8%) identified home as a PPD and the rest identified hospice/home (n = 11; 21.2%), hospice (n = 10; 19.2%) or nursing home (n = 2; 3.8%). None identified hospital as a PPD. The majority of patients completing the document (completers) died at home (n = 18; 34.6%) or hospice (n = 16; 30.8%); 12 (23.1%) died in hospital and 6 (11.5%) died at nursing home. PPC document was not completed in 47 cases (47.4%). Majority of those who did not complete (non-completers) the document died in hospital (n = 21; 44.7%), while 16 (34%) died at home, 6 (12.8%) at nursing home, 3 (6.4%) at hospice and 1 (2.1%) while on holiday (Figure 1). A chi-squared test demonstrates statistically significant difference between whether patients completed the document and where they died (χ2(16) = 71.06, p < 0.001). Odds ratios indicate that non-completers were 1.96 times more likely to die in hospital. In contrast, completers were 4.84 times more likely to die in a hospice. The main reason for admission in both groups was respiratory failure/shortness of breath (12 non-completers; 6 completers); 4 non-completers and none of the completers were admitted with general deterioration. Other causes for admission included falls, breakdown of care and other medical reasons. The major reason for non-completion of PPC document was reluctance or refusal by the patient to discuss EOLC issues (51%). Other reasons included late diagnosis, inability to make wishes known due to cognitive impairment and unexpected deterioration. Majority of people would prefer to die at home, but unfortunately, this is not the reality they experience.3 Healthcare towards end-of-life places a major resource burden on the health service.3,5 A retrospective study of 1600 hospitalisations in patients with MND/ALS demonstrated prolonged and expensive admissions, a high in hospital mortality rate and few routine discharges.5 Most of our patients who completed the PPC document were Choosing the place of death: Empowering motor neurone disease/ amyotrophic lateral sclerosis patients in end-of-life care decision making

Motor neurone disease in Lancashire and South Cumbria in North West England and an 8 year experience with enteral nutrition

Motor neurone disease (MND) is a fatal neurodegenerative disease of unknown aetiology. Malnutrition is a common occurrence and an independent risk factor for worse prognosis. However, it remains unclear whether provision of enteral nutrition (EN) through a gastrostomy tube offers any survival advantage. Our aim was to describe the demographic and clinical characteristics of MND in Lancashire and South Cumbria in North West England and the impact of EN on survival in the 8 year period of 2005-2012. Four hundred and seven patients with MND were identified through the Preston MND care and research centre registry giving a crude incidence rate of 3.15/100,000. Three hundred and forty patients with adequate information were included in the final analysis of whom 53.2% were male. The presentation was limb/spinal in 62.1% and bulbar in 37.9% of patients, bulbar onset being more common in elderly females. Mean age of onset was 67.28 years (standard deviation 11.06; range 22.78-93.06). Median survival was 1.98 years (range 1.18-3.05). Ninety-one patients received EN of whom 67% had bulbar onset disease. EN was not associated with a statistically significant survival advantage except for the subgroup who received EN more than 500 days after symptom onset. In conclusion, the early requirement for EN may indicate a prognostically less favourable subgroup.

Enteral feeding in motor neurone disease: Patients’ perspectives and impact on quality of life

Symptomatic treatment remains the mainstay of management in motor neurone disease (MND).1,2 Malnutrition is a common occurrence and enteral feeding (EF) is usually offered to patients at risk of malnutrition.1 However, the evidence for a survival advantage with EF is inconclusive.2 Moreover, there is little in the literature on the impact of EF on quality of life (QOL).2 This study aimed to explore patients’ experiences with EF and its impact on their QOL.