Ziprasidone-induced spontaneous orgasm.

Neuroleptic treatment in schizophrenic patients has been associated with sexual dysfunction, including impotence and decreased libido. Spontaneous ejaculation without sexual arousal during typical antipsychotic treatment is a rare condition that has been described with zuclopentixol, trifluoperazine, and thiothixene. Here, we are reporting a case of spontaneous orgasm with ziprasidone in a bipolar patient. This patient began to repeatedly experience spontaneous sexual arousal and orgasm, which she had never experienced in the past. Ziprasidone might be causing an increase in sexual orgasm by 5-HT2 receptor antagonism, which preclinical evidence suggests that it facilitates dopamine release in the cortex.

Massive graviton as a testable cold-dark-matter candidate.

We construct a consistent model of gravity where the tensor graviton mode is massive, while linearized equations for scalar and vector metric perturbations are not modified. The Friedmann equation acquires an extra dark-energy component leading to accelerated expansion. The mass of the graviton can be as large as approximately (10(15) cm)(-1), being constrained by the pulsar timing measurements. We argue that nonrelativistic gravitational waves can comprise the cold dark matter and may be detected by the future gravitational wave searches.

Artefacts of electron paramagnetic resonance dosimetry caused by a mechanical effect on samples of tooth enamel.

It has been ascertained that in the process of the mechanical preparation of tooth enamel, two types of paramagnetic centres are formed. The centres of one type, the long-lived ones, occurred in the process of friction of dental borers against the enamel. Their number grew with an increase of the treated surface area and the rotation rate of the borers. The electron paramagnetic resonance signal of such radicals looked like a symmetric singlet with the width deltaHpp=0.094 mT and g=2.0029. The other, short-lived centres, occurred when tooth enamel was crushed into small granules, which caused an increase in the background signal intensity. The mechanism of formation of paramagnetic centres in enamel during the process of teeth treatment and prepartion has been considered. The estimation of an increase in the reconstructed absorbed dose due to the contribution from the mechanically induced signal has been made. Contamination of tooth enamel samples with diamond crumb during diamond borer preparation has been shown to lead to an imaginary increase in radiation-induced signal intensity and, consequently, to an increase in the reconstructed dose.

Rapid cycling bipolar disease: new concepts and treatments.

Having been recognized by Kraeplin at the beginning of the 20th century, rapid cycling was first described as a specific entity by Dunner et al. in 1974. The prevalence of rapid cycling ranges from 12% to 20% in patients with bipolar disorder who are not selected for a high rate of cycling.

Nicardipine improves the antidepressant action of ECT but does not improve cognition.

INTRODUCTION: Cognitive impairment, the most important adverse effect of electroconvulsive therapy (ECT), may involve elevated intracellular calcium ion signaling. Animal research suggests that calcium channel-blocking agents, which attenuate excessive intracellular calcium activity, may reduce cognitive dysfunction caused by ECT. METHOD: The lipid-soluble calcium channel-blocking drug nicardipine or matching placebo were randomly assigned to 26 patients with major depressive disorder receiving ECT. A rater blind to the experimental condition administered the Hamilton Depression Rating Scale, the Montgomery-Asberg Depression Rating Scale, the Beck Depression Inventory, the Mini-Mental State Examination and a comprehensive battery of neuropsychological tests prior to ECT, at the completion of ECT, and 6 months after ECT completion. RESULTS: Compared with patients receiving placebo, patients taking nicardipine had significantly lower scores on the Hamilton and Montgomery-Asberg but not the Beck Depression rating scale scores at the completion of ECT. There were no differences between placebo and nicardipine groups in depression scores 6 months after ECT. Cognitive function declined over the course of ECT and improved over the next 6 months in both groups, but changes were statistically significant for only two subtests on the neuropsychological battery. Changes in Mini-Mental State Examination scores were small and were not significant at any point. There were no significant differences between nicardipine and placebo treated groups in any assessment of cognition. DISCUSSION: Standard approaches to ECT in younger patients without preexisting neurological impairment do not produce cognitive side effects of sufficient severity for calcium channel-blocking agents to reduce these side effects demonstrably. Studies of treatments for cognitive impairment should be conducted in patients with risk factors for more severe cognitive impairment such as geriatric patients or patients with a history of interictal delirium during previous treatment with ECT. A possible effect of nicardipine in enhancing the antidepressant action of ECT requires further investigation in a study designed to test this action.

Reconstruction of individual absorbed doses by tooth enamel on the base of non-linear simulation of their EPR-spectra.

Model of separate spectral lines composing EPR-spectra of tooth enamel can be described with fine accuracy by integral of convolution of three distribution functions: Lorenzian, Gaussian and anisotropy. Simulation of spectra was done by the method of optimisation of non-linear parameters combined with the Gauss method of exclusion for linear parameters to obtain the minimum of the sum of the squares of the differences between the experimental EPR-spectrum and its model. The final result was the deconvolution of complex EPR-spectrum into its components (the background and radiation-induced signals) with the following reconstruction of the individual absorbed dose.

Statistics of clustering of ultrahigh energy cosmic rays and the number of their sources.

Observation of clustering of ultrahigh energy cosmic rays (UHECR) suggests that they are emitted by compact sources. Assuming small ( <3 degrees ) deflection of UHECR during the propagation, the statistical analysis of clustering allows an estimate of the spatial density of the sources h(*), including those not yet observed. When applied to astrophysical models involving extragalactic sources, the estimate based on 14 events with energy E>10(20) eV gives h(*) approximately 6x10(-3) Mpc(-3). With increasing statistics, this estimate may lead to exclusion of some models.

Treatment resistance in anxiety disorders.

As primary care physicians become more comfortable prescribing treatments for anxiety disorders, mental health specialists increasingly are encountering patients with refractory anxiety. In this article, the authors briefly review causes of treatment resistance and approaches to failure to respond to treatment of specific anxiety disorders.

Use of clozapine in 10 mentally retarded adults.

The cost, side effect profile, and required weekly blood draws associated with clozapine may dissuade some clinicians from prescribing this atypical neuroleptic to mentally retarded patients. All publications on clozapine use in mentally retarded patients are reviewed and the treatment of 10 such patients is described, bringing the total number of published cases to 84. Clozapine is efficacious and well tolerated in this population and should be considered for those patients with psychosis or bipolar illness who are intolerant of or unresponsive to other agents.

The impact of a history of childhood abuse on hospital outcome of affective episodes.

OBJECTIVE: Despite increased awareness of the prevalence of a history of childhood abuse among adults with psychiatric disorders, the implications for treatment and outcome are generally unknown. This study examined the impact of childhood sexual abuse (in some cases combined with physical abuse) on the hospital treatment of severe mood disorders. METHODS: A chart review was conducted of 110 cases of consecutively admitted adult inpatients with affective disorders. The abused and nonabused groups were compared in terms of demographic variables, severity of illness, treatment history, duration of hospitalization, and outcome of the hospital treatment episode. RESULTS: A history of childhood abuse was associated with younger age, comorbid personality disorders, and shorter duration of hospitalization. Other measures, such as level of functioning at discharge and recidivism, were not related to abuse status. CONCLUSIONS: The results suggest that childhood abuse may be associated with earlier onset of affective episodes and personality disorders but is not strongly associated with other clinical and outcome measures in the acute treatment setting.

Impact of shorter lengths of stay on status at discharge in bipolar mania.

UNLABELLED: This study assesses the impact of shortening the inpatient length of stay on status at discharge in patients with mania. METHODS: The authors performed a chart review on 131 patients with discharge diagnoses of bipolar disorder, current episode manic type, admitted to the private attending service at Colorado Psychiatric Hospital between 1985 and 1995. In 1990, a new program (the alternatives program) that provides a continuum of acute care services and shorter inpatient lengths of stay was instituted. Retrospectively assessed GAF, CGI, treatment outcome rating scores, and length of stay (LOS) were compared for the prealternatives (1985-1989), early alternatives (1990-1992), and recent alternatives (1993-1995) program treatment eras. A progressive decrease in inpatient LOS, duration of the acute care episodes, and total service utilization was seen across eras. Despite the more recent shortening in LOS, no significant differences were seen in GAF and treatment outcome rating scores at discharge. GAF and treatment outcome rating scores on hospital days 3 and 7, however, suggested that patients were improving more rapidly in the more recent eras. Inpatient LOS and duration of the acute care episodes have significantly decreased over the last 10 years, but patients appear no more ill at discharge. The authors postulate that changes in psychopharmacologic practice and the inpatient treatment model may have facilitated the more rapid clinical improvement seen in the more recent eras. The authors caution that we need prospective studies that include postdischarge follow-up to assess further the impact of shorter inpatient stays on the posthospital course of manic patients.

Novel alternatives and supplements to lithium and anticonvulsants for bipolar affective disorder.

BACKGROUND: Most clinicians are familiar with the traditional anticonvulsants as alternatives to lithium in the treatment of bipolar mood disorders. METHOD: This review of the English, French, German, and Italian language literature on novel treatments, including electroconvulsive therapy, calcium channel blocking agents, antipsychotic drugs, benzodiazepines, thyroid hormone, psychosurgery, and two new antiepileptic drugs, that have not been studied as extensively as lithium, carbamazepine, and valproate but that may have promise as alternatives or supplements to traditional thymoleptics when the standard treatments are not effective or are poorly tolerated. We searched MEDLINE and PSYCHINFO data bases using the keywords bipolar, mood, and/or treatment. We then searched bibliographies of articles retrieved by the first strategy. RESULTS: The theoretical rationale for each treatment is discussed, followed by a critical discussion of the evidence supporting its efficacy. CONCLUSION: The potential risks and benefits of each treatment in actual clinical practice are placed in perspective.

Dissociative symptoms in psychotic mood disorders: an example of symptom nonspecificity.

Dissociative symptoms have been the subject of psychiatric inquiry since the beginning of this century (Putnam 1992; Sanders 1986; van der Kolk and van der Hart 1989). Although recent investigations have focused on the four specific dissociative disorders (American Psychiatric Association 1994) and their relationship to early traumatic experiences (Chu and Dill 1990; Putnam 1985; Terr 1991), dissociative symptoms have been reported in virtually every major psychiatric disorder (Bremner et al. 1992; Goff et al. 1992; Steinberg 1992), and, in less severe forms, even in nonpatient populations (Briere 1988; Putnam 1992; Ross and Joshi 1992). These observations raise questions about the clinical significance of dissociative symptoms that occur when other mental disorders are also present (Coons 1984; Fahy 1988).

Selection bias in an inpatient outcomes monitoring project.

Managed care organizations increasingly tout clinical outcomes assessment as the mechanism by which we will ensure quality and compare providers. The authors report on their experience with a multisite inpatient outcomes monitoring project by comparing patients who accepted (N = 51), refused (N = 36), or were not asked (N = 110) to participate in the project. The patients who were asked to participate had significantly longer inpatient stays compared with the unasked group (11.2 vs 6.9 days). Patients who agreed to participate in the project were more likely to have a bipolar (43.1% vs 19.2%) or any affective disorder (94.1% vs 79.5%), and less likely to have a schizophrenic disorder (2.0% vs 11.6%) than the refused and unasked groups. The project participants also had higher 90-day readmit rates (27.5% vs 9.6%), more readmissions (0.51 vs 0.16), and more education (14.59 vs 13.51 years) than nonparticipating patients. In this preliminary study, patient-related variables were found to influence who the staff asked and who consented to participate in this clinical outcomes monitoring project. The authors distinguish clinical outcomes monitoring from treatment effectiveness research and discuss the need to develop methodologies that deal with nonrepresentative patient sampling and intersite variability in recruitment practices.

The first international intercomparison of EPR-dosimetry with teeth: first results.

Intercomparison of EPR-dosimetric techniques using tooth enamel had been performed in order to check whether the results produced by different laboratories are consistent and accurate. Participants were supposed to evaluate doses applied to pulverized enamel samples, using routine techniques from their laboratories. The intercomparison has demonstrated a great variety of methods used for dose reconstruction. Peculiarities of experimental approaches are discussed systematically in terms of procedure for recording the EPR-spectra, determination of the amplitude of the radiation induced signal, determination of the dose, and error propagation.