Sulpiride augmentation in people with schizophrenia partially responsive to clozapine. A double-blind, placebo-controlled study

BACKGROUND

We hypothesised that a combined regimen of clozapine, a relatively weak D2-dopaminergic antagonist, and sulpiride, a selective D2 blocker, would demonstrate a greater antipsychotic efficacy by enhancing the D2 blockade of clozapine.

METHOD

Twenty-eight people with schizophrenia, previously unresponsive to typical antipsychotics and only partially responsive to current treatment with clozapine, received, double-blind, 600 mg/day sulpiride or placebo, in addition to an ongoing clozapine treatment. The clinical status was evaluated before, during, and at the end of 10 weeks of sulpiride addition using the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms, and Hamilton Rating Scale for Depression.

RESULTS

The clozapine-sulpiride group exhibited substantially greater and significant improvements in positive and negative psychotic symptoms. About half of them, characterised by a younger age and lower baseline SAPS scores, had a mean reduction of 42.4 and 50.4% in their BPRS and SAPS scores, respectively.

CONCLUSIONS

A subgroup of patients with chronic schizophrenia may substantially benefit from sulpiride addition to clozapine.

Different effects of nabilone and cannabidiol on binocular depth inversion in Man

The physiological and pathophysiological roles of the central nervous endogenous cannabinoid system are not completely understood, but still represent a challenge in basic neurobiological, cognitive, and psychiatric research. The system has been implicated in the pathogenesis of schizophrenia. Binocular depth inversion, an illusion of visual perception, provides a model of impaired perception during psychotic states. Using this model the effects of nabilone, a psychoactive synthetic 9-trans-ketocannabinoid, and of cannabidiol, the main natural component of herbal cannabis, and a combined application of both substances on binocular depth inversion and behavioural states were investigated in nine healthy male volunteers. The time course of the effects of both substances on binocular depth inversion was analysed after oral administration using three different groups of natural stimuli. A significant impairment of binocular depth perception was found when nabilone was administered, but combined application with cannabidiol revealed somewhat reduced effects on binocular depth inversion. The influence of psychoactive cannabinoids on this perceptual model and the role of the endogenous cannabinoid system in visual information processing are discussed.

Comparison of reactive oxygen species concentration in seminal plasma and semen parameters in partners of pregnant and non-pregnant patients after IVF/ICSI

The aims of this study were (i) to determine and compare the concentration of reactive oxygen species (ROS) and total antioxidant status (TAS) in seminal plasma and sperm parameters of the male partners of patients undergoing IVF or intracytoplasmic sperm injection (ICSI) treatment and (ii) to establish the relationship between ROS and TAS concentrations and sperm quality and their effect on fertilization and pregnancy rate of patients who achieved a pregnancy and those who were unsuccessful. Twenty-six IVF and 22 ICSI patients were included in this study. The ROS concentration in seminal plasma and sperm concentration, vitality (eosin test), motility, morphology, membrane integrity (HOS test), maturity (chromomycin, CMA3) and DNA fragmentation (TUNEL) results and their relationship to fertilization and pregnancy were analysed. ROS concentrations were similar regarding the seminal plasma of male partners of patients who achieved a pregnancy and those who were unsuccessful. The other semen parameters, concentration, motility, vitality, membrane and DNA integrity, were comparable in both groups. However, both groups demonstrated a negative correlation between ROS concentration and sperm vitality, membrane integrity and morphology. Moreover, an inverse correlation was found between TUNEL, vitality, and membrane integrity. In conclusion, ROS concentration in seminal plasma affects the quality of spermatozoa. A negative correlation between the ROS concentration in seminal plasma and fertilization rate in both IVF/ICSI programmes was shown.

Cyproheptadine treatment in neuroleptic-induced akathisia

BACKGROUND

Cyproheptadine, an antiserotonergic agent, was used to treat neuroleptic-induced akathisia.

METHOD

In an open clinical trial 17 neuroleptic-treated patients with akathisia were administered cyproheptadine (16 mg/day) over 4 days. Assessment of akathisia, psychosis and depression were monitored by BAS, BPRS and HAM-D.

RESULTS

All subjects showed improvement in the severity of akathisia, which in the majority (15/17) was of a marked degree. There was no aggravation of psychosis or depression. Symptoms of akathisia returned when cyproheptadine was discontinued.

CONCLUSIONS

Cyproheptadine may be useful in neuroleptic-induced akathisia.

The effects of tetrahydrocannabinol on the recognition of emotionally charged words: an analysis using event-related brain potentials

The effects of synthetic tetrahydrocannabinol (THC) on event-related brain potentials (ERPs) were assessed in 19 healthy male volunteers while they performed a visual continuous word recognition task. The study used a double-blind cross-over design. Specifically, word lists were manipulated to contain an equal number of emotionally neutral, negative, and positive words. Most words were repeated after several intervening items with the subject's task to classify each word as old (previously seen) or new. Behaviorally, a decrease in recognition rate was observed under THC but no influence of the emotional charge of a word on recognition rate was seen. The ERPs showed a typical difference between old and new words taking the form of an enhanced positivity for old words beginning 250 ms poststimulus. The effects of THC were confined to the positive words, for which an enhancement of the positivity to the old words was seen. This effect was interpreted in terms of a congruity of the drug-induced mood state and the material to be recognized. The dissociation between ERPs and behavioral indices suggested that the former primarily reflect implicit memory processes.

Injuries in attempted suicide by jumping from a height

This study was undertaken to investigate the pattern of injuries and the management of 28 patients who attempted suicide by jumping from a height. Most of the patients had serious psychiatric disorders. All but two of the patients sustained multiple injuries. The most common injury patterns were fractures of the spine and lower extremities. It was concluded that, in addition to urgent orthopaedic and surgical care, early psychiatric assessment and therapy with transfer to a psychiatric department as soon as possible facilitates the recovery and rehabilitation of these patients.

Nursing perceptions of patient safety climate in the Gaza Strip, Palestine

AIMS

This study was undertaken to assess the perception of nurses about patient safety culture and to test whether it is significantly affected by the nurses' position, age, experience and working hours.

BACKGROUND

Patient safety has sparked the interest of healthcare mangers, yet there is limited knowledge about the current patient safety culture among nurses in the Gaza Strip.

METHODS

This was a descriptive cross-sectional study, administering the Arabic Safety Attitude Questionnaire (Short Form 2006) to 210 nurses in four public general hospitals.

RESULTS

Job Satisfaction was the most highly perceived factor affecting patient safety, followed by Perception of Management. Safety culture varied across nursing position, age, work experience and working hours. Nurse Managers had more positive attitudes towards patients than frontline clinicians did. The more experience nurses had, the better their attitudes towards patient safety. Nurses who worked the minimum weekly required hours and who were 35 years and older had better attitudes towards all patient safety dimensions except for Stress Recognition. Nurses with a positive attitude had better collaboration with healthcare professionals than those without a positive attitude.

LIMITATION

Generalization is limited, as nurses who worked in private and specialized hospitals were excluded.

CONCLUSION

Evaluation of the safety culture is the essential starting point to identify hindrances or drivers for safe patient care. Job Satisfaction, Perception of Management and Teamwork necessitate reinforcement, while Working Conditions, Stress Recognition and Safety Climate require improvement.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Ensuring job satisfaction through adequate staffing levels, providing incentives and maintaining a collegial environment require both strategic planning and institutional policies at the higher administrative level. Creation of a non-punitive and learning environment, promoting open communication and fostering continuous education should be fundamental aspects of hospital management. A policy of mixing experienced nurses with inexperienced nurses should be considered.

Reduced total complement haemolytic activity in schizophrenic patients

Serum concentrations of the third and fourth components of the complement system and total complement haemolytic activity were measured in 167 psychiatric patients. Total complement haemolytic activity was decreased in chronic schizophrenic patients as compared to healthy controls and bipolar patients. The relatively diminished total haemolytic activity was not attributable to drug treatment. It is not clear if the reduced total haemolytic activity is an epiphenomenon or related to the involvement of an autoimmune process in the pathophysiology of schizophrenia.

Trisomy 8 mosaicism syndrome. Two cases demonstrating variability in phenotype

The paper presents clinical manifestations and results of cytogenetic examination of two patients with trisomy 8 mosaicism syndrome. The findings confirm the extreme phenotype variability of this syndrome. Both the first patient, a mentally retarded child with multiple dysmorphic changes, and the second, a 31-year-old woman with normal IQ and hypogammaglobulinemia as a predominant sign, revealed osteoarticular anomalies. Dermatoglyphic studies in both patients were typical for trisomy 8, and correlated with deep skin furrows. The chromosomal analysis was based on two types of lymphocyte cultures: 3-day and 2-day. A decreased percentage of trisomic cells in 3-day cultures in comparison to 2-day cultures may suggest the influence of environmental factors on spontaneous elimination of trisomic cells in vitro.

HLA-G polymorphism and in vitro fertilization failure in a Polish population

To investigate whether human leukocyte antigen-G (HLA-G) gene polymorphism is associated with in vitro fertilization (IVF) failure, we sequenced exons 2-4 of the HLA-G gene in 50 couples with three or more IVFs (including 10 couples with five or more IVFs) and 58 control fertile couples from a Polish population. Of the 10 different HLA-G alleles identified in our study subjects, neither allele was found to be associated with IVF. We also genotyped 50 couples with IVF and 71 control couples for the -725C>G variant in the promoter region and the 14 bp insertion or deletion polymorphism in the 3' untranslated region of the HLA-G gene. The frequency of -725GG or GC genotype in women with IVF and in control fertile women was similar [26% vs 25.3%; odds ratio (OR) = 1.0; P = 1.0]. The 14 bp ins/ins or ins/del genotype was more common in women with IVF than in control women (76.9% vs 59.1%; OR 2.4; P = 0.03), but the difference was not significant after Bonferroni correction for multiple comparisons. The frequency of the ins/ins or ins/del genotype was particularly high (90%) in women who experienced five or more IVFs (OR = 6.2; P = 0.08), but again, the excess was not statistically significant, possibly because of small sample sizes. These results are in line with functional studies that show lower levels of HLA-G mRNA and protein related to the HLA-G allele including the 14 bp sequence and suggest that the insertion allele may be associated with an increased risk of IVF.

Psychiatric aspects of hyperemesis gravidarum

Hyperemesis gravidarum is a potentially dangerous disorder of pregnancy characterized by severe and protracted vomiting. It is suggested that psychosocial factors may have a role in determining whether the pregnant woman experiences a transient spell of mild vomiting or progresses towards the much rarer but more significant pernicious vomiting. Psychotherapy, hypnotherapy and behavior therapy have been reported to contribute to the treatment of patients with hyperemesis gravidarum. A review of the etiological factors as well as of the therapeutic approaches is presented.

Apparent velocity of ultrasound (AVU) at the patella in comparison to bone mineral density at the lumbar spine in normal males and females

It has been reported that apparent velocity of ultrasound (AVU) at the patella discriminates as well between osteoporotic and normal subjects as measurement of bone mineral density (BMD) using dual photon absorptiometry. To investigate the relationship between AVU and peak bone mass, we compared AVU (Signet, Osteo-Technology, Framingham, MA) at the patella and BMD (QDR 1000, Hologic, Waltham, MA) at the lumbar spine in a large sample of healthy males and females. The study population consisted of 153 males (aged 20-60 years) and 129 premenopausal females (aged 20-52 years). Vertebral BMD showed no significant difference between males and females (1.03 +/- 0.16 g/cm2 for males vs. 1.07 +/- 0.14 g/cm2 for females, NS), while AVU values were significantly higher in males compared with females (1967 +/- 64 m/s vs. 1938 +/- 76 m/s, P < 0.05). In men there was a significant decrease in BMD with aging (r = -0.27, P < 0.05), in premenopausal females we found no age-related change in BMD. Similarly in males AVU decreased significantly with age (r = -0.2, P < 0.05), whereas in females AVU values showed relative stability over the age range. There was a significant correlation between AVU and BMD (r = 0.36 for males, r = 0.34 for females, P < 0.05). Our study demonstrates only a weak correlation between AVU at that patella and BMD at the lumbar spine, supporting the view that AVU not only reflects bone quantity but possibly also qualitative properties of bone structure. The sex difference in AVU but not in BMD suggests that the trabecular bone at the patella differs significantly from axial trabecular bone. The identical peak BMD at the lumbar spine for young males and females underscores the importance of the menopause for later manifestation of vertebral fractures.

Homicide by schizophrenic patients in Israel

Thirty-three schizophrenic inpatients aged 45.3 +/- 13.5 years who had been found not guilty of homicide by reason of insanity were compared with 28 schizophrenic patients matched for age, sex and duration of disease who had not committed any crime. Statistical analysis revealed a high rate in the study group of individual factors associated with aggression, such as alcohol abuse, previous contact with the police, aggressive behavior and threats (P < 0.05). Significantly more of them were also immigrants (P < 0.05). There was no between-group difference in familial factors. These findings support earlier studies indicating that schizophrenic patients with the profile of alcoholism, aggressiveness and foreign country of origin are at high risk of homicidal behavior.

Antinuclear autoantibodies in chronic schizophrenia

We determined the presence of antinuclear autoantibodies (ANA), antinative DNA and histone-reactive ANA in 3 groups of chronic schizophrenic patients (n=85): haloperidol-treated patients (for at least 3 months) (n=35), drug-free for at least 3 months (n=35) and neuroleptic-naive patients (n=15). The autoantibody titers were compared with those of healthy controls (n=37). A significantly higher frequency of positive ANA was found among chronic schizophrenic patients (approximately 20%) as compared with the controls (approximately 5%), irrespective of drug treatment, sex and age. No antinative ANA autoantibodies or histone reactive ANA were detected in either schizophrenic patients or controls. Further studies are needed to isolate and characterize in ANA-positive schizophrenic patients a putative specific ANA profile.

Modeling the Potential Global Distribution of Honeybee Pest, Galleria mellonella under Changing Climate

Beekeeping is essential for the global food supply, yet honeybee health and hive numbers are increasingly threatened by habitat alteration, climate change, agrochemical overuse, pathogens, diseases, and insect pests. However, pests and diseases that have unknown spatial distribution and influences are blamed for diminishing honeybee colonies over the world. The greater wax moth (GWM), Galleria mellonella, is a pervasive pest of the honeybee, Apis mellifera. It has an international distribution that causes severe loss to the beekeeping industry. The GWM larvae burrow into the edge of unsealed cells that have pollen, bee brood, and honey through to the midrib of the wax comb. Burrowing larvae leave behind masses of webs that cause honey to leak out and entangle emerging bees, resulting in death by starvation, a phenomenon called galleriasis. In this study, the maximum entropy algorithm implemented in (Maxent) model was used to predict the global spatial distribution of GWM throughout the world. Two representative concentration pathways (RCPs) 2.6 and 8.5 of three global climate models (GCMs), were used to forecast the global distribution of GWM in 2050 and 2070. The Maxent models for GWM provided a high value of the Area Under Curve equal to 0.8 ± 0.001, which was a satisfactory result. Furthermore, True Skilled Statistics assured the perfection of the resultant models with a value equal to 0.7. These values indicated a significant correlation between the models and the ecology of the pest species. The models also showed a very high habitat suitability for the GWM in hot-spot honey exporting and importing countries. Furthermore, we extrapolated the economic impact of such pests in both feral and wild honeybee populations and consequently the global market of the honeybee industry.

Catatonia as an unusual presentation of posttraumatic stress disorder

A patient with posttraumatic stress disorder (PTSD) had several episodes of catatonia in the past 44 years. These episodes were characterized by a sudden onset of intense excitement, mild pyrexia, often moderate elevation of serum creatinine phosphokinase and the development of a full catatonic state. We could not relate the symptomatology exhibited to any one of the accepted etiologies of catatonia. We assume, following careful evaluation of the clinical picture, and thorough biochemical and imaging work-up, that in this case the catatonic states represented an overwhelming psychic response to associated traumatic recollections, bringing to extreme the avoidance, numbness and motor responses usually encountered in PTSD.

Occupational, life stress and family functioning: does it affect semen quality?

BACKGROUND AND AIMS

Although psychological stress has been implicated as a cause of idiopathic infertility in both men and women, it has received little scientific attention among males as compared to females. The aim of the study was to examine the association between occupational, life stress, family functioning and semen quality.

METHODS AND RESULTS

The study population consisted of 327 men who were attending an infertility clinic for diagnostic purposes. Psychological stress was assessed based on two questionnaires: The Subjective Work Characteristics Questionnaire and the Perceived Stress Scale. The level of satisfaction with family functioning and support was evaluated by means of the APGAR Family Scale. The findings suggest that, on the one hand, exposure to occupational stressors can be negatively associated with semen quality (there was a positive association between stress and the percentage of sperm with DNA damage (p = 0.03) and atypical sperm (p = 0.05)); on the other hand, there was no correlation between the level of life stress and semen quality indicators. Negative associations were found between satisfaction with family functioning and the percentage of motile sperm cells (p = 0.02), VAP (p = 0.05), VSL (p = 0.05) and VCL (p = 0.04).

CONCLUSION

The study indicates that occupational stress can affect male semen quality; however, due to limited data on this issue, the obtained results should be confirmed in longitudinal studies.

Event-related potentials in drug-naive schizophrenic patients

Decreased amplitudes of late components of event-related potentials (ERPs) in schizophrenia were ascribed to either psychotic features or to neuroleptic treatment of the patients. To rule out the drug effect, ERPs to stroboscopic stimuli were recorded in drug-naive schizophrenics and control subjects during no-task and simple-task sessions. Patients had significantly lower amplitudes of the late ERP components during both sessions, thus confirming similar results with treated schizophrenics. On the other hand, drug-naive patients did not differ from controls in the task-related relative facilitation of late ERP components. These results differ from findings of minimal ERP facilitation to task in treated schizophrenics. This discrepancy is discussed in the context of the effects of neuroleptic treatment and task demands on ERPs.

First month of neuroleptic treatment in schizophrenia: only partial normalization of the late positive components of visual ERP

In a previous study we recorded visual event-related potentials (ERP) in drug-naive schizophrenics during passive-attention and active-attention tasks. Patients, compared to normal controls, had much lower late positive components (LPC) in both sessions, but nearly normal LPC increase from passive to active task. The present sample consisted of drug-naive and drug-free patients who were tested before and during the first month of neuroleptic treatment. Neuroleptics initiated gradual amelioration of psychiatric symptoms expressed by reduced Brief Psychiatric Rating Scale (BPRS) scores. Schizophrenics compared to controls showed a session-related increase in LPC amplitude, but this process of LPC recovery was too minor to fully normalize the low LPC amplitudes in patients. Furthermore, the treatment either did not improve or even reduce the LPC reaction to the active-attention task. These findings indicate that normalization of low LPC in schizophrenia might require a long period of treatment, and that patients' reduced LPC reactivity to the task might be contributed, rather than treated, by neuroleptics.

Antinuclear autoantibodies in relation to bipolar affective disorder and lithium therapy

We investigated the presence of antinuclear antibodies (ANA) in 63 drug free and lithium treated bipolar patients as compared to 37 healthy controls. Increased frequency of positive ANA was detected in bipolar patients in comparison to controls (19% vs 5%, respectively, P < 0.05). This finding was unrelated to lithium treatment. No antinative DNA antibodies or antihistone reactive antibodies were detected among the ANA positive subjects.

Choreoathetosis as toxic effect of lithium treatment

Two cases of lithium neurotoxic effects are reported. Both cases are expressed by choreoathetotic movements and in both of them intoxication was caused by combined drug therapy. In our opinion caution is advised when lithium is administered in combination with drugs, especially in elderly patients.

Numerical analysis of the transport and fate of nitrate in the soil and nitrate leaching to drains

In this study, the transport and fate of nitrate within the soil profile and nitrate leaching to drains were analyzed by comparing historic field data with the simulation results of the DRAINMOD model. The nitrogen version of DRAINMOD was used to simulate the performance of the nitrogen transport and transformation of the Hooibeekhoeve experiment, situated in the sandy region of the Kempen (Belgium) and conducted for a 30-year (1969-1998) period. In the analysis, a continuous cropping with maize was assumed. Comparisons between experimentally measured and simulated state variables indicate that the nitrate concentrations in the soil and nitrate leaching to drains are controlled by the fertilizer practice, the initial conditions, and the rainfall depth and distribution. Furthermore, the study reveals that the model used gives a fair description of the nitrogen dynamics in the soil and subsurface drainage at field scale. From the comparative analysis between experimental data and simulation results it can also be concluded that the model after calibration is a useful tool to optimize as a function of the combination "climate-crop-soil-bottom boundary condition" the nitrogen application strategy resulting in an acceptable level of nitrate leaching for the environment.