Brain-Machine Interface in Chronic Stroke: Randomized Trial Long-Term Follow-up

BACKGROUND

Brain-machine interfaces (BMIs) have been recently proposed as a new tool to induce functional recovery in stroke patients.

OBJECTIVE

Here we evaluated long-term effects of BMI training and physiotherapy in motor function of severely paralyzed chronic stroke patients 6 months after intervention.

METHODS

A total of 30 chronic stroke patients with severe hand paresis from our previous study were invited, and 28 underwent follow-up assessments. BMI training included voluntary desynchronization of ipsilesional EEG-sensorimotor rhythms triggering paretic upper-limb movements via robotic orthoses (experimental group, n = 16) or random orthoses movements (sham group, n = 12). Both groups received identical physiotherapy following BMI sessions and a home-based training program after intervention. Upper-limb motor assessment scores, electromyography (EMG), and functional magnetic resonance imaging (fMRI) were assessed before (Pre), immediately after (Post1), and 6 months after intervention (Post2).

RESULTS

The experimental group presented with upper-limb Fugl-Meyer assessment (cFMA) scores significantly higher in Post2 (13.44 ± 1.96) as compared with the Pre session (11.16 ± 1.73; P = .015) and no significant changes between Post1 and Post2 sessions. The Sham group showed no significant changes on cFMA scores. Ashworth scores and EMG activity in both groups increased from Post1 to Post2. Moreover, fMRI-BOLD laterality index showed no significant difference from Pre or Post1 to Post2 sessions.

CONCLUSIONS

BMI-based rehabilitation promotes long-lasting improvements in motor function of chronic stroke patients with severe paresis and represents a promising strategy in severe stroke neurorehabilitation.

Quantifying the link between anatomical connectivity, gray matter volume and regional cerebral blood flow: an integrative MRI study

Background

In the graph theoretical analysis of anatomical brain connectivity, the white matter connections between regions of the brain are identified and serve as basis for the assessment of regional connectivity profiles, for example, to locate the hubs of the brain. But regions of the brain can be characterised further with respect to their gray matter volume or resting state perfusion. Local anatomical connectivity, gray matter volume and perfusion are traits of each brain region that are likely to be interdependent, however, particular patterns of systematic covariation have not yet been identified.

Methodology/Principal Findings

We quantified the covariation of these traits by conducting an integrative MRI study on 23 subjects, utilising a combination of Diffusion Tensor Imaging, Arterial Spin Labeling and anatomical imaging. Based on our hypothesis that local connectivity, gray matter volume and perfusion are linked, we correlated these measures and particularly isolated the covariation of connectivity and perfusion by statistically controlling for gray matter volume. We found significant levels of covariation on the group- and regionwise level, particularly in regions of the Default Brain Mode Network.

Conclusions/Significance

Connectivity and perfusion are systematically linked throughout a number of brain regions, thus we discuss these results as a starting point for further research on the role of homology in the formation of functional connectivity networks and on how structure/function relationships can manifest in the form of such trait interdependency.

Deficient fear conditioning in psychopathy as a function of interpersonal and affective disturbances

The diminished fear reactivity is one of the most valid physiological findings in psychopathy research. In a fear conditioning paradigm, with faces as conditioned stimulus (CS) and electric shock as unconditioned stimulus (US), we investigated a sample of 14 high psychopathic violent offenders. Event related potentials, skin conductance responses (SCR) as well as subjective ratings of the CSs were collected. This study assessed to which extent the different facets of the psychopathy construct contribute to the fear conditioning deficits observed in psychopaths. Participants with high scores on the affective facet subscale of the Psychopathy Checklist-Revised (PCL-R) showed weaker conditioned fear responses and lower N100 amplitudes compared to low scorers. In contrast, high scorers on the affective facet rated the CS+ (paired) more negatively than low scorers regarding the CS- (unpaired). Regarding the P300, high scores on the interpersonal facet were associated with increased amplitudes to the CS+ compared to the CS-, while the opposed pattern was found for the antisocial facet. Both, the initial and terminal contingent negative variation indicated a divergent pattern: participants with pronounced interpersonal deficits, showed increased cortical negativity to the CS+ compared to the CS-, whereas a reversed CS+/CS- differentiation was found in offenders scoring high on the antisocial facet. The present study revealed that deficient fear conditioning in psychopathy was most pronounced in offenders with high scores on the affective facet. Event related potentials suggest that participants with distinct interpersonal deficits showed increased information processing, whereas the antisocial facet was linked to decreased attention and interest to the CS+. These data indicate that an approach to the facets of psychopathy can help to resolve ambiguous findings in psychopathy research and enables a more precise and useful description of this disorder.

Antimicrobial and Biological Effects of Bomphos and Phomphos on Bacterial and Yeast Cells

In this study, the antimicrobial effects of monophosphazenes such as SM, BOMPHOS, and PHOMPHOS were examined on bacterial and yeast strains. In addition, the biological effects of these compounds were tested on the Saccharomyces cerevisiae and Candida albicans cells. The SM has an antimicrobial effect on the bacterial and yeast strains within the range of 100 and 1500 µg. When the concentration was increased, the inhibition zone expanded on the growth media (P < 0.01; P < 0.001). Like SM, BOMPHOS molecule has antimicrobial activity on the bacterial and yeast cells. The most effective concentrations of BOMPHOS on the microorganisms were observed by 1500 µg (P < 0.001). The PHOMPHOS did not effect on the bacterial and yeast cells between 100 and 1000 range, but it has an antimicrobial effect in 1500 µg. In vitro media, the biological effects of these molecules were compared with vitamin E, melatonin, and fish oil on the yeast cells. In S. cerevisiae growth media, the cell densities were increased SM, BOMPHOS, and PHOMPHOS after 20, 30, and 45 h. The highest increase in the cell density were observed in media of BOMPHOS. In C. albicans growth media, the cell density was increased by melatonin after 20, 30, and 45 h, but were decreased by other supplemental groups. Lipid level of S. cerevisiae was reduced by administered 300 and 1000 µg vitamin E and fish oil (P < 0.01). In addition, the lipid level of the same yeast cell were diminished by the 1000 µg melatonin and 300 µg PHOMPHOS (P < 0.05, P < 0.01). The lipid level of C. albicans were increased by vitamin E and BOMPHOS and fish oil, but was decreased with PHOMPHOS (P < 0.01). In conclusion, while high concentration of PHOMPHOS has antimicrobial effects on the bacterial and yeast cells, the SM and BOMPHOS have antimicrobial effects in all the concentrations. PHOMPHOS decreased the lipid level of C. albicans, but BOMPHOS increased in the the same yeast cell. In addition, the antioxidants such as vitamin E, melatonin, and fish oils have affected on the lipid synthesis of yeast cells. Copyright 2000 Academic Press.

The beneficial effects of physical exercise on antioxidant status in asthmatic children

BACKGROUND

The pathogenesis of asthma involves both airway inflammation and an oxidant/antioxidant imbalance. It is demonstrated in asthmatic adults that exercise programmes improve lung function, a mechanism yet to be elucidated. The purpose of this study was to investigate the possible beneficial effects of physical exercise on antioxidant status in asthmatic children which may lead to ameliorated lung function.

METHODS

The study enrolled thirteen control and thirty asthmatic children. The asthmatic group was subdivided into two: the first group receiving only pharmacological treatment (n=15) and the second receiving pharmacological treatment with exercise programme (n=15) for 8 weeks. Blood samples were drawn from the subjects before and after treatment periods. As oxidant stress markers blood levels of malondialdehyde (MDA) and total nitric oxide (NO), and as antioxidant status, glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) enzyme activities were assessed.

RESULTS

Before any treatment was initiated, MDA and NO levels in the asthmatic group were significantly higher than the controls (3.40±0.96 nmol/ml vs 2.46±0.58 nmol/ml, and 12.53±2.10 vs 9.40±1.39 micromol/L, respectively). Both SOD (p=0.0001) and GSH-Px (p=0.023) activities were significantly lower in the asthmatic group. Pharmacological treatment and exercise programme together significantly improved lung performance and decreased the levels of oxidant stress markers, in concordance with a significantly increase in antioxidant enzyme activity measures when compared to the pharmacological treatment.

CONCLUSION

Structured exercise programme in asthmatic children resulted in better lung function, which may be attributed to its effect on antioxidant status.

Key Elements of Gingival Epithelial Homeostasis upon Bacterial Interaction

Epithelia are structurally integral elements in the fabric of oral mucosa with significant functional roles. Similarly, the gingival epithelium performs uniquely critical tasks in responding to a variety of external stimuli and dangers through the regulation of specific built-in molecular mechanisms in a context-dependent fashion at cellular levels. Gingival epithelial cells form an anatomic architecture that confers defense, robustness, and adaptation toward external aggressions, most critically to colonizing microorganisms, among other functions. Accordingly, recent studies unraveled previously uncharacterized response mechanisms in gingival epithelial cells that are constructed to rapidly exert biocidal effects against invader pathobiotic bacteria, such as Porphyromonas gingivalis, through small danger molecule signaling. The host-adapted bacteria, however, have developed adroit strategies to 1) exploit the epithelia as privileged growth niches and 2) chronically target cellular bactericidal and homeostatic metabolic pathways for successful bacterial persistence. As the overgrowth of colonizing microorganisms in the gingival mucosa can shift from homeostasis to dysbiosis or a diseased state, it is crucial to understand how the innate modulatory molecules are intricately involved in antibacterial pathways and how they shape susceptibility versus resistance in the epithelium toward pathogens. Thus, in this review, we highlight recent discoveries in gingival epithelial cell research in the context of bacterial colonizers. The current knowledge outlined here demonstrates the ability of epithelial cells to possess highly organized defense machineries, which can jointly regulate host-derived danger molecule signaling and integrate specific global responses against opportunistic bacteria to combat microbial incursion and maintain host homeostatic balance. These novel examples collectively suggest that the oral epithelia are equipped with a dynamically robust and interconnected defense system encompassing sensors and various effector molecules that arrange and achieve a fine-tuned and advanced response to diverse bacteria.

Anti-VEGF treatment suppresses remodeling factors and restores epithelial barrier function through the E-cadherin/β-catenin signaling axis in experimental asthma models

Besides maintaining a physical barrier with adherens junctional (AJ) and tight junctional proteins, airway epithelial cells have important roles in modulating the inflammatory processes of allergic asthma. E-cadherin and β-catenin are the key AJ proteins that are involved in airway remodeling. Various mediators such as transforming growth factor-β (TGF-β), epidermal growth factor (EGF), fibroblast growth factor (FGF), platelet derived growth factor (PDGF), insulin-like growth factor (IGF), tumor necrosis factor-α (TNF-α) and angiogenic factors, such as vascular endothelial growth factor (VEGF), are released by the airway epithelium in allergic asthma. The signaling pathways activated by these growth factors trigger epithelial-mesenchymal transition (EMT), which contributes to fibrosis and subsequent downregulation of E-cadherin. The present study used a mouse asthma model to investigate the effects of anti-VEGF, anti-TNF and corticosteroid therapies on growth factor and E-cadherin/β-catenin expression. The study used 38 male BALB/c mice, divided into 5 groups. A chronic mouse asthma model was created by treating 4 of the groups with inhaled and intraperitoneal ovalbumin (n= 8 per group). Saline, anti-TNF-α (etanercept), anti-VEGF (bevacizumab) or a corticosteroid (dexamethasone) were applied to each group by intraperitoneal injection. No medication was administered to the control group (n=6). Immunohistochemistry for E-cadherin, β-catenin and growth factors was performed on lung tissues and protein expression levels assessed using H-scores. Statistically significant differences were observed in E-cadherin, β-catenin, EGF, FG, and PFGF (P<0.001 for all) as well as the IGF H-scores between the five groups (P<0.005). Only anti-VEGF treatment caused E-cadherin and β-catenin levels to increase to the level of non-asthmatic control groups (P>0.005). All treatment groups had reduced TGF-β, PDGF and FGF H-scores in comparison with the untreated asthma group (P=0.001). The EGF and IGF levels were not significantly different between the untreated asthmatic and non-asthmatic controls. The results suggested that anti-VEGF and TNF-α inhibition treatments are effective in decreasing growth factors, in a similar manner to conventional corticosteroid treatments. Anti-VEGF and TNF inhibition therapy may be an effective treatment for remodeling in asthma while offering an alternative therapeutic option to steroid protective agents. The data suggested that anti-VEGF treatment offered greater restoration of the epithelial barrier than both anti-TNF-α and corticosteroid treatment.

A geographical assessment of vegetation carbon stocks and greenhouse gas emissions on potential microalgae-based biofuel facilities in the United States

The microalgae biofuels life cycle assessments (LCA) present in the literature have excluded the effects of direct land use change (DLUC) from facility construction under the assumption that DLUC effects are negligible. This study seeks to model the greenhouse gas (GHG) emissions of microalgae biofuels including DLUC by quantifying the CO₂ equivalence of carbon released to the atmosphere through the construction of microalgae facilities. The locations and types of biomass and Soil Organic Carbon that are disturbed through microalgae cultivation facility construction are quantified using geographical models of microalgae productivity potential including consideration of land availability. The results of this study demonstrate that previous LCA of microalgae to biofuel processes have overestimated GHG benefits of microalgae-based biofuels production by failing to include the effect of DLUC. Previous estimations of microalgae biofuel production potential have correspondingly overestimated the volume of biofuels that can be produced in compliance with U.S. environmental goals.

Chemical compositions, radical scavenging capacities and antimicrobial activities in seeds of Satureja hortensis L. and Mentha spicata L. subsp. spicata from Turkey

The present study determined some biological compounds, radical scavenging activity and antimicrobial capacity in seeds of Satureja hortensis L. and Mentha spicata L. subsp. spicata. Alpha-linolenic acid (C18:3 n3) has been found to be the major polyunsaturated fatty acid of Satureja hortensis L. (66.24 ± 1.24%) and Mentha spicata L. subsp. spicata (48.17 ± 1.01%). Linoleic acid (C18:2 n6) is identified as the second major polyunsaturated fatty acid in the present study and oleic acid (C18:1 n9) is determined as the major monounsaturated fatty acid. Current study showed that Satureja hortensis L. and Mentha spicata L. subsp. spicata have low levels of saturated fatty acids. It has been demonstrated that ergosterol (263.1 ± 2.14 µg/g), stigmasterol (39.07 ± 0.91 µg/g) and beta-sitosterol (14.64 ± 0.49 µg/g) have been found in Mentha spicata L. subsp. spicata, while ergosterol (69.41 ± 1.75 µg/g) and beta-sitosterol (19.81 ± 1.14 µg/g) have been determined in Satureja hortensis L. Also, this study determined that Satureja hortensis L. and Mentha spicata L. subsp. spicata have low lipide-soluble vitamin content. Furthermore, it has been found that Satureja hortensis L. contains naringenin (612.57 ± 2.57 µg/g), morin (86.97 ± 1.12 µg/g), quercetin (22.87 ± 0.75 µg/g), and kaempferol (20.11 ± 0.94 µg/g) while naringenin (135.91 ± 1.91 µg/g), naringin (61.23 ± 2.15 µg/g) and quercetin (47.51 ± 1.17 µg/g) have been detected as major flavonoids in the seeds of Mentha spicata L. subsp. spicata. The results of the present study suggest that methanol extracts of Satureja hortensis L. and Mentha spicata L. subsp. spicata have significant free radical scavenging activity. The present results revealed that Satureja hortensis L. and Mentha spicata L. subsp. spicata showed major activity against gram-positive and gram-negative microorganisms, fungi and yeast.

Unenhanced respiratory-navigated NATIVE® TrueFISP magnetic resonance angiography in the evaluation of renal arteries: Comparison with contrast-enhanced magnetic resonance angiography

PURPOSE

To compare unenhanced three-dimensional (3D) NATIVE^® true fast imaging with steady-state precession (TrueFISP) magnetic resonance (MR) angiography with the more conventional MR angiography technique obtained after intravenous administration of a gadolinium chelate in the evaluation of renal arteries and their branches in patients with suspected renal artery stenosis.

MATERIALS AND METHODS

A total of 39 patients (25 men, 14 women) with a mean age of 51.4±17.5years (SD) (range: 10-82years) were included in the study. All patients with suspected renal artery stenosis underwent unenhanced 3D NATIVE^® TrueFISP MR angiography and contrast-enhanced MR angiography. The two MR angiography methods were compared by two independent readers for image quality using a four-point scale, diagnostic performance and grading of renal artery stenosis on a total of 78 renal arteries.

RESULTS

For both readers image quality of unenhanced 3D NATIVE^® TrueFISP MR angiography (3.12 to 3.63) was greater than that of contrast-enhanced MR angiography (1.94 to 2.71) for renal artery ostium-trunk and the left renal artery segmental branches. The sensitivity of 3D NATIVE^® TrueFISP MR angiography for the diagnosis of renal artery stenosis was 100% for both readers for the right renal artery and 66% and 80% for the left renal artery for reader 1 and reader 2, respectively. Agreement between 3D NATIVE^® TrueFISP MR angiography and CE-MR angiography was 95% (74/78) for reader 1 and 92% (72/78) for reader 2.

CONCLUSION

Unenhanced NATIVE^® TrueFISP magnetic resonance angiography can play an additional role in the evaluation of renal arteries in patients with hypertension, especially in subjects at risk of nephrogenic systemic fibrosis.

Lower cocaine- and amphetamine-regulated transcript levels pose a risk for developing PCOS

Cocaine- and amphetamine-regulated transcript (CART) is an anorectic neuropeptide abundantly expressed in the central, peripheral, and enteric nervous systems, as well as in several different endocrine cell types. Besides regulating food intake and endocrine function, it is also proposed to modulate ovarian function during follicular waves in cattle and has potent inhibitory effects on follicular development. Polycystic ovary syndrome (PCOS), presenting itself with multiple follicular ovarian cysts, is the most common endocrinological disorder among women of reproductive age. Here we aimed to investigate the association of this peptide with PCOS. Our research was designed as a case-control study, in which a total of 148 subjects (73 with PCOS and 75 age- and BMI-matched CONTROLS) were consecutively recruited. Fasting blood glucose (FBG), insulin, high-sensitivity C-reactive protein, lipids, follicle stimulating hormone, luteinizing hormone, estradiol, CART, and free testosterone levels were measured in all participants. Homeostasis model assessment of insulin resistance (HOMA-IR) and body mass index (BMI) were calculated. CART levels were found to be significantly lower in patients with PCOS (PCOS: 90.77 ± 5.98 pg/ml,

CONTROLS

93.24 ± 8.17 pg/ml, p=0.038). Pearson's correlation analysis showed that CART was significantly and negatively correlated with BMI and waist circumference in both (PCOS and control) groups. In CONTROLS only, CART was positively correlated with insulin and HOMA-IR, and negatively correlated with FBG. Logistic regression analysis results are suggestive of a possible protective effect of CART against PCOS (OR: 0.94, 95% CI=0.888-0.997, p=0.038).

Potential of Laurencia obtusa as a substrate for the development of a probiotic Saccharomyces cerevisiae

Laurencia obtusa (Ceramiales, Rhodophyta) has tremendous nutritional value, being high in proteins, oligosaccharides, vitamins, essential minerals, and fatty acids, and it is a rich source of amino acids and trace elements. In this study, L. obtusa was extracted and subjected to phenolic, sugar and flavonoid analyses.The fatty acid, vitamin and phytosterol contents in Saccharomyces cerevisiae were evaluated when it was incubated with L. obtusa dry biomass. The fatty acids in the lipid extract were analysed after converting them into methyl esters using gas chromatography, and vitamin concentrations were measured using high-performance liquid chromatography (HPLC). According to the achieved results, the total fatty acid levels and vitamin contents of the S. cerevisiae prepared with algal extract increased at different rates. Our results showed that α-tocopherol decreased in the group in which the S. cerevisiae was added the algal extract. When compared to the control group, ergesterol increased in the group in which L. obtusa extract was added. Additionally, when compared to the control group in which L. obtusa extract was added, stearic acid (18:0), oleic acid (18:1) and linoleic acid (18:2) increased in the other groups. Palmitoleic acid (16:1) increased in the L. obtusa culture medium, but palmitic acid decreased in the L. obtusa culture medium. In conclusion, it was determined that the L. obtusa extract added to the development medium of S. cerevisiae caused differences in the synthesis of some vitamins and fatty acids.

Comparison of icodextrin with thymoquinone: A new hope for postoperative adhesions

OBJECTIVE

The purpose of this study was to compare the effects of thymoquinone and icodextrin in rats within the framework of an experimental adhesion model.

MATERIALS AND METHODS

Rats were separated into three groups: (1) a control group consisting of rats that had 2 ml of isotonic solution administered intraperitoneally, (2) an ICO group administered with 2 ml of 4% icodextrin, and (3) a TQ group administered thymoquinone (10 mg/kg), all following cecal abrasion. The three groups underwent a reoperation on the 7th postoperative day. Hydroxyproline levels were analyzed in the resected adhesive tissues, and histopathological investigations were conducted. Blood samples were collected for biochemical analyses.

RESULTS

Fewer postoperative adhesions were observed in the ICO and TQ groups compared with the control group. A comparison of the TQ and ICO groups revealed lowers levels of postoperative adhesions in the TQ group. Compared with the control group, malondialdehyde, 8-OH-deoxyguanosine/deoxyguanosine (8-OHdG/10dG), Coenzyme Q10 (CoQ10), and CoenzymeQ10/reduced CoenzymeQ10 (CoQ10/CoQ10H) values were found to be lower in the TQ and ICO groups. When the TQ and ICO groups were compared with respect to their biochemical parameters, the results for all of the four parameters were found to be statistically significantly lower in the TQ group (P < 0.000). The levels of hydroxyproline in the control, ICO, and TQ groups were found to be (mean ± standard deviation) 502.25 ± 90.39 μg/g, 342.13 ± 66.61 μg/g, and 287.88 ± 49.59 μg/g, respectively.

CONCLUSIONS

A comparison of the antiadhesive effects of thymoquinone and icodextrin revealed thymoquinone to be more effective. These results indicate that thymoquinone is an efficient and strong antiadhesive molecule.

Rupture of the Prepubic Tendon in a Quadruplet Pregnant Romanov Ewe

 A case of prepubic tendon rupture in a Romanov ewe in which four live lambs were removed by cesarean section is presented. A three-year-old ewe, on the 142±3 days of the second gestation was brought to the Siirt University Animal Health Application and Research Center with a sudden downward expansion of the abdomen during the last one day.  When ewe was examined reluctance to locomotion, mild depression, tachycardia, tachypnea and abdominal peculiar enlargement on the left side more than right side were noticed. Because of this case was detected early the general condition was not so bad and clinical examination revealed that swelling was non-painful and non-edematous. Ultrasonography was performed to detect viability of the fetuses, and to eliminate possibility of hernia of the abdominal muscles. Based on anamnesis, abdominal palpation, and clinical examination, this case was diagnosed with prepubic tendon rupture. The prognosis of saving the lives of ewe and fetuses depends on successfully handling all aspects of the case in the last period of pregnancy. Although it is not possible to repair the abdominal integrity surgically in cases of prepubic tendon rupture in the ewe, a planned cesarean operation is indicated to increase the survival rates of both ewe and lambs. 

Real-World Evidence of Antipsychotic Monotherapy Versus Polypharmacy in the Treatment of Schizophrenia Spectrum Disorders

PURPOSE/BACKGROUND

It is still not well known whether antipsychotic monotherapy versus polypharmacy differs in terms of efficacy in the emergency department (ED) utilization, presentation with agitation/aggression, and rehospitalization in schizophrenia spectrum disorders (SSD) patients. This study aimed to determine the effectiveness of antipsychotic monotherapy and polypharmacy for these outcomes in the real world.

METHODS/PROCEDURES

The study was conducted with electronic health records of 669 SSD patients admitted to the ED. Patients were evaluated in 4 groups according to antipsychotic use at the first admission to ED: antipsychotic noncompliance for more than 90 days, antipsychotic noncompliance for 15 to 90 days, antipsychotic monotherapy, and polypharmacy. All patients followed up for at least 1 year after index admission. The primary outcomes determined an association between antipsychotic monotherapy versus polypharmacy and all-cause psychiatric hospitalization between the groups after index admission in the SSD.

FINDINGS/RESULTS

The groups, including patients with antipsychotic noncompliance, had higher ED visits, more hospitalizations, and more admissions with agitation/aggression compared with antipsychotic monotherapy or polypharmacy. However, no differences were found between monotherapy and polypharmacy groups regarding these outcomes. In addition, there was no difference in the risk of hospitalization in monotherapy antipsychotic users compared with polypharmacy users. Patients discharged with monotherapy or polypharmacy also had similar rehospitalization rates at follow-up.

IMPLICATIONS/CONCLUSIONS

There is no positive evidence that recommending polypharmacy over antipsychotic monotherapy is superior with regard to the resulting frequency of ED visits, ED admissions with agitation/aggression, hospitalization, and rehospitalization. In this context, antipsychotic monotherapy may be preferred over polypharmacy in patients who are not resistant to treatment.