Efficacy and tolerability of clozapine in Japanese patients with treatment-resistant schizophrenia: results from a 12-week, flexible dose study using raters masked to antipsychotic choice.

Japan approved clozapine for treatment-resistant schizophrenia in June 2009. The aim of this study was to evaluate clozapine's efficacy and tolerability in Japanese patients. A twelve-week, single-arm clinical trial of clozapine in treatment-resistant schizophrenia inpatients, was conducted under real-world conditions using raters masked for type of antipsychotic. Thirty-eight patients were recruited, with 33 (86.8%) completing the trial. At week 12, clozapine was associated with significant improvement in the Positive and Negative Syndrome Scale (PANSS) total (p < 0.0001), PANSS positive (p < 0.0001), negative (p = 0.0055) and general subscale scores (p < 0.0001). Significant improvements occurred in all PANSS scores by week 4, the first post-baseline psychopathology rating. Altogether, 50.0% of patients showed ≥20% reduction in PANSS total score, 20.6% had ≥30% reduction and 14.7% had >40% reduction. Eighteen patients (47.4%) were discharged before week 12. However, all patients experienced ≥1 adverse event. Two of 38 patients (5.2%) dropped out due to moderate leucopenia and one of them developed agranulocytosis after stopping clozapine. However, both patients recovered. Eight adverse events (hypersalivation, fatigue, sedation, constipation, insomnia, nausea/vomiting, chest pain and leucopenia) were observed in 34-79% of patients. These findings suggest that clozapine is beneficial in Japanese treatment-resistant schizophrenia patients. However, attention should be paid to patients' adverse events.

FGF alters epithelial competence for EGF at the initiation of branching morphogenesis of mouse submandibular gland.

Embryonic day 13 mouse submandibular gland (E13-SMG) rudiments with two to four clefts have been commonly used in culture experiments to show that growth factors, such as epidermal growth factor (EGF) -family and fibroblast growth factor (FGF) -family ligands, are involved in branching morphogenesis. In the present study, we focused on E12 rudiments and attempted to elucidate the roles of EGF- and FGF-family ligands in SMG development from E12 to E13. In mesenchyme-free, Matrigel-embedded cultures, EGF + lysophosphatidic acid (LPA) induced branching in E13 epithelium, whereas E12 epithelium remained spherical and no branching occurred under the same culture conditions; however, both E12 and E13 epithelia elongated in response to FGF10. Reverse transcriptase-polymerase chain reaction studies showed that the expression of ErbB1 among four EGF receptors and Lpa3 among three LPA receptors was lower in E12 than in E13 epithelia. Fgf10, Fgf7, and their major receptor Fgfr2b were highly and equally expressed in E12 and E13 rudiments. After 24 hr of mesenchyme-free culture with FGF10 or FGF7, E12 epithelium was primed to initiate branching morphogenesis in response to EGF + LPA coincident with ErbB1 and Lpa3 up-regulation. These results suggest that the EGF-family ligand-receptor system is undeveloped at E12 and that it becomes primed on E13 by the FGF ligand-receptor system to play an important role in the induction of branching morphogenesis.

Influence of negative cognition on the parental bonding instrument (PBI) in patients with major depression.

The aim of this study was to examine the effects of negative cognition on PBI score before and after treatment for depression. Forty major depressive disorder outpatients were assessed with the PBI scale and Structured Interview Guide for Hamilton Rating Scale for Depression (SIGH-D) at the time of the first medical examination (baseline) and 8 weeks later. The SIGH-D scores decreased by about 50% from baseline to 8 weeks, but there was no significant change in the PBI scores of the depressed outpatients from baseline to 8 weeks. Analysis of covariance with the SIGH-D scores as covariate was conducted for PBI scores between baseline and 8 weeks to remove effects of MDD. No significant differences were found on any of the PBI scales. Even though the therapeutic values on the SIGH-D of the depressed patients indicated that depressive symptoms were reduced by about 50%, depression level did not influence the PBI scores. This study provides evidence for the stability of parental representations throughout treatment, as measured by the PBI.