Hazard Perception in Visually Impaired Drivers Who Use Bioptic Telescopes.

Purpose: Bioptic telescopic spectacles can allow individuals with central vision impairment to obtain or maintain driving privileges. The purpose of this study was to (1) compare hazard perception ability among bioptic drivers and traditionally licensed controls, (2) assess the impact of bioptic telescopic spectacles on hazard perception in drivers with vision impairment, and (3) analyze the relationships among vision and hazard detection in bioptic drivers. Methods: Visual acuity, contrast sensitivity, and visual field were measured for each participant. All drivers completed the Driving Habits Questionnaire. Hazard perception testing was conducted using commercially available first-person video driving clips. Subjects signaled when they could first identify a traffic hazard requiring a change of speed or direction. Bioptic drivers were tested with and without their bioptic telescopes in alternating blocks. Hazard detection times for each clip were converted to z-scores, converted back to seconds using the average response time across all videos, and then compared among conditions. Results: Twenty-one bioptic drivers and 21 normally sighted controls participated in the study. The hazard response time of bioptic drivers was improved when able to use the telescope (5.4 ± 1.4 seconds vs 6.3 ± 1.8 seconds without telescope); however, it remained significantly longer than for controls (4.0 ± 1.4 seconds). Poorer visual acuity, contrast sensitivity, and superior visual field sensitivity loss were related to longer hazard response times. Conclusions: Drivers with central vision loss had improved hazard response times with the use of bioptic telescopic spectacles, although their responses were still slower than normally sighted control drivers. Translational Relevance: The use of a bioptic telescope by licensed, visually impaired drivers improves their hazard detection speed on a video-based task, lending support to their use on the road.

Stereospecific Cu(I)-Catalyzed C-O Cross-Coupling Synthesis of Acyclic 1,2-Di- and Trisubstituted Vinylic Ethers from Alcohols and Vinylic Halides.

CuI and trans-N,N'-dimethylcyclohexyldiamine catalyze the single-step C-O bond cross-coupling between 1,2-di- and trisubstituted vinylic halides with functionalized alcohols, producing acyclic vinylic ethers. This stereospecific transformation selectively gives each of the (E)- and (Z)-vinylic ether products from the corresponding vinyl halide precursors. This method is compatible with carbohydrate-derived primary and secondary alcohols and several other functional groups. The conditions are mild enough to reliably generate vinylic allylic ethers without promoting Claisen rearrangements.

Use and Perceptions of Advanced Driver Assistance Systems by Older Drivers With and Without Age-Related Macular Degeneration.

Purpose: Advanced driver assistance systems (ADAS) have been reported to improve the safety of elderly and normally sighted drivers. The purpose of this study was to assess exposure to, perceived safety of, comfort level with, and interest in using ADAS among drivers with age-related macular degeneration (AMD). Methods: Current drivers aged 60+ years were recruited at four US sites to complete a survey about ADAS and driving habits. Frequency of use and/or perceptions of eight ADAS were investigated. An avoidance score was generated using questions about difficult driving situations. Results: The survey was completed by 166 participants (80 with AMD vs. 86 without). Participants with AMD had worse self-rated vision than those without (34% vs. 2% poor or fair rating), and drove fewer weekly miles (median [interquartile range [IQR] 30 [15 to 75] vs. 60 [30 to 121] miles, P = 0.002). Participants with AMD reported more avoidance of difficult driving situations (P < 0.001). There was no difference in the number of ADAS used by AMD status (median [IQR for AMD = 2.5 [1 to 5] vs. 3 [2 to 4] without, P = 0.87). Greater reported number of ADAS used was associated with less avoidance of difficult situations (P = 0.02). The majority perceived improved safety with most ADAS. Conclusions: Many drivers with AMD utilize common ADAS, which subjectively improve their road safety and may help to reduce self-imposed restrictions for difficult situations and mileage. Translational Relevance: Drivers with AMD are adopting readily available ADAS, for which they reported potential benefits, such as safety and less restrictive driving.

Codonopsis pilosula Polysaccharides Alleviate Aß 1-40-Induced PC12 Cells Energy Dysmetabolism via CD38/NAD+ Signaling Pathway.

BACKGROUND: Alzheimer's disease (AD) is the most common type of dementia and has a complex pathogenesis with no effective treatment. Energy metabolism disorders, as an early pathological event of AD,have attracted attention as a promising area of AD research. Codonopsis pilosula Polysaccharides are the main effective components of Codonopsis pilosula, which have been demonstrated to regulate energy metabolism. METHODS: In order to further study the roles and mechanisms of Codonopsis pilosula polysaccharides in AD, this study used an Aß1-40-induced PC12 cells model to study the protective effects of Codonopsis pilosula polysaccharides and their potential mechanisms in improving energy metabolism dysfunction. RESULTS: The results showed that Aß1-40 induced a decrease in PC12 cells viability, energy metabolism molecules (ATP, NAD+, and NAD+/NADH) and Mitochondrial Membrane Potential (MMP) and an increase in ROS. Additionally, it was found that Aß1-40 increased CD38 expression related to NAD+ homeostasis, whereas Silent Information Regulation 2 homolog1 (SIRT1, SIRT3), Peroxisome proliferator-activated receptor γ coactivator 1-α (PGC-1α) and SIRT3 activity were decreased. Codonopsis pilosula polysaccharides increased NAD+, NAD+/NADH, SIRT3, SIRT1, and PGC-1α related to NAD+, thus partially recovering ATP. CONCLUSION: Our findings reveal that Codonopsis pilosula polysaccharides protected PC12 cells from Aß1-40-induced damage, suggesting that these components of the Codonopsis pilosula herb may represent an early treatment option for AD patients.

Concentration-time extrapolation of short-term inhalation exposure levels: dimethyl sulfide, a case study using a chemical-specific toxic load exponent.

OBJECTIVE: Dimethyl sulfide (DMS, CAS 75-18-3) is an industrial chemical. It is both an irritant and neurotoxicant that may be life-threatening because of accidental release. The effects of DMS on public health and associated public health response depend on the exposure concentration and duration. However, currently, public health advisory information exists for only a 1 h exposure duration, developed by the American Industrial Hygiene Association (AIHA). In the present work, the AIHA-reviewed data were computationally extrapolated to other common short-term durations. METHODS: The extrapolation was carried out using the toxic load equation, Cn × t = TL, where C and t are exposure concentration and duration, TL is toxic load, and n is a chemical-specific toxic load exponent derived in the present work using probit meta-analysis. The developed threshold levels were vetted against the AIHA database of clinical and animal health effects induced by DMS. RESULTS: Tier-1 levels were derived based on human exposures that resulted in an easily detectable odor, because DMS is known to have a disagreeable odor that may cause nausea. Tier-2 levels were derived from the lower 95% confidence bounds on a benchmark concentration that caused 10% incidence (BMCL10) of coma in rats during a 15 min inhalation exposure to DMS. Tier-3 levels were based on a BMCL05 for mortality in rats. CONCLUSION: Emergency responders and health assessors may consider these computationally derived threshold levels as a supplement to traditional chemical risk assessment procedures in instances where AIHA developed public health advisory levels do not exist.

Rationale and design of the PLACID study: a randomised trial comparing the efficacy and safety of inhaled loxapine versus IM aripiprazole in acutely agitated patients with schizophrenia or bipolar disorder.

BACKGROUND: The management of acute agitation manifesting in patients with schizophrenia or bipolar disorder requires swift pharmacological intervention to provide rapid symptomatic relief and prevent escalation to aggression and violence. Antipsychotic medications are widely used in this setting and the availability of an inhaled formulation with deep lung absorption of the antipsychotic loxapine has the potential to deliver a faster onset of therapeutic effect than the available intramuscular formulations of antipsychotics. METHODS: The efficacy of inhaled loxapine and the alternative antipsychotic aripiprazole delivered via intramuscular (IM) injection will be compared in the Phase IIIb PLACID study. Adults (18-65 years) with a confirmed diagnosis of schizophrenia or bipolar I disorder presenting with acute agitation will be randomly assigned to open-label treatment in a 1:1 ratio. Clinical evaluation will be conducted by raters blinded to treatment assignment. The primary efficacy endpoint is time to response (defined as a Clinical Global Impression of Improvement [CGI-I] score of 1 [very much improved] or 2 [much improved]). Secondary endpoints will include the percentage of responders at different time points after dosing; the proportion of patients who receive 1 or 2 doses of study drug; time to second dose; time to rescue medication; satisfaction with study drug (evaluated using Item 14 of the Treatment Satisfaction Questionnaire for Medication); and safety and tolerability. Approximately 360 patients will be recruited with an interim analysis conducted once 180 patients have completed the study to decide whether to stop for futility or continue with or without an increase in the sample size up to additional 288 patients. DISCUSSION: The PLACID trial will assess the efficacy and safety of inhaled loxapine with deep lung absorption compared with the IM antipsychotic, aripiprazole, in acutely agitated patients with schizophrenia or bipolar disorder. In the event that the median time to response of inhaled loxapine is significantly shorter than that of the intramuscular aripiprazole, the PLACID study has the potential to support the inhaled antipsychotic therapy as the standard of care in this setting. TRIAL REGISTRATION: The study protocol was registered with the European Clinical Trials Database on the 31 October 2014 (EudraCT number 2014-000456-29 ).

Measurement of Perceived Stress in Age-Related Macular Degeneration.

PURPOSE: To validate the Perceived Stress Scale (PSS) in patients with age-related macular degeneration (AMD) using Rasch analysis. METHODS: Study participants with AMD were recruited from the retina service of the Department of Ophthalmology at the Ohio State University during clinical visits for treatment or observation. Visual acuity with habitual distance correction was assessed. A 10-item version of the PSS was administered in large print or by reading the items to the patient. Rasch analysis was used to investigate the measurement properties of the PSS, including fit to the model, ability to separate between people with different levels of perceived stress, category response structure performance, and unidimensionality. RESULTS: A total of 137 patients with a diagnosis of AMD were enrolled. The mean (±SD) age of participants was 82 ± 9 years. Fifty-four percent were female. Median Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity of the better eye was 65 letters (Snellen 20/50), with a range of approximately 20/800 to 20/15. Forty-seven percent of participants were receiving an anti-VEGF injection on the day of the study visit. The response category structure was appropriate. One item, "How often have you felt confident in your ability to handle your personal problems?" was removed due to poor fit statistics. The remaining nine items showed good fit to the model, acceptable measurement precision as assessed by the Rasch person separation statistic, and unidimensionality. There was some evidence of differential item functioning by age and visual acuity. CONCLUSIONS: The Perceived Stress Scale demonstrated acceptable measurement properties and may be useful for the measurement of perceived stress in patients with AMD.

Are women with a history of abuse more vulnerable to perinatal depressive symptoms? A systematic review.

The objective of this paper is to examine the association between maternal lifetime abuse and perinatal depressive symptoms. Papers included in this review were identified through electronic searches of the following databases: Pubmed Medline and Ovid, EMBASE, PsycINFO, and the Cochrane Library. Each database was searched from its start date through 1 September 2011. Keywords such as "postpartum," "perinatal," "prenatal," "depression," "violence," "child abuse," and "partner abuse" were included in the purview of MeSH terms. Studies that examined the association between maternal lifetime abuse and perinatal depression were included. A total of 545 studies were included in the initial screening. Forty-three articles met criteria for inclusion and were incorporated in this review. Quality of articles was evaluated with the Newcastle-Ottawa-Scale (NOS). This systematic review indicates a positive association between maternal lifetime abuse and depressive symptoms in the perinatal period.

Clinical and serotonergic predictors of non-affective acute remitting psychosis in patients with a first-episode psychosis.

OBJECTIVE: The study aimed to establish clinical predictors of non-affective acute remitting psychosis (NARP) and assess whether these patients showed a distinct serotonergic profile. METHOD: First-episode never treated psychotic patients diagnosed of paranoid schizophrenia (n=35; 21 men and 14 women) or NARP (n=28; 15 men and 13 women) were included. RESULTS: NARP patients showed significantly lower negative symptomatology, better premorbid adjustment, shorter duration of untreated psychosis, more depressive symptomatology and a lower number of 5-HT2A receptors than the paranoid schizophrenia patients. In the logistic regression, the four variables associated with the presence of NARP were: low number of 5-HT2A receptors; good premorbid adjustment; low score in the item 'hallucinatory behaviour' and reduced duration of untreated psychosis. CONCLUSION: Our findings support the view that NARP is a highly distinctive condition different from either affective psychosis or other non-affective psychosis such as schizophrenia, and highlight the need for its validation.

Resultados de efectividad de olanzapina en pacientes psicóticos agudos con agitación en servicios de urgencias: resultados del estudio NATURA / Effectiveness results of olanzapine in acute psychotic patients with agitation in the emergency room setting: results from NATURA study

Introducción. Se carece de descripciones adecuadas de los patrones de uso de antipsicóticos en urgencias. El objetivo del presente estudio es describir la efectividad y eficacia del uso de olanzapina en pacientes con psicosis aguda y agitación en urgencias. Métodos. En este estudio prospectivo observacional realizado en 16 servicios de urgencias se incluyeron 278 pacientes consecutivos con psicosis aguda y agitación, los cuales recibieron tratamiento psicofarmacológico, que incluyó olanzapina, según el criterio clínico del investigador. Se recogieron datos prospectivos de demografía, diagnóstico, medicación concomitante, utilización de contención mecánica y grado de agitación. La evolución clínica durante la estancia en urgencias se evaluó mediante la componente de excitación de la PANSS, la ICG-G y la Escala de evaluación de agitación-sedación (ACES) al ingreso, antes de cualquier reintervención (si procedió) y al alta del servicio de urgencias, evaluándose asimismo la seguridad. Resultados. Olanzapina como monoterapia se administró a 148 pacientes (53,2%), la mayoría (77,7%) con diagnóstico de esquizofrenia y psicosis relacionadas. Fueron 38(25,7%) los pacientes que precisaron contención mecánica. El cambio medio (intervalo de confianza [IC] 95 %) de basal al alta fue significativo en todas las escalas: PANSS-CE: –7,46(–8,2, –6,7); ICG-G: –1,82 (–2, –1,6); ACES: 1,28 (1,1, 1,5). Al alta, el 70,3% de los pacientes se trasladó a unidades de hospitalización. Cinco pacientes (3,4 %) presentaron acontecimientos adversos: bradicardia, boca seca, sedación, hipertensión, hipotensión e hipotensión ortostática, ninguno de los cuales fue grave. Conclusiones. La utilización de olanzapina empleada como monoterapia disminuyó la agitación en pacientes psicóticos en urgencias, con una baja incidencia de acontecimientos adversos (AU)

Introduction. Patterns of use of antipsychotics are not well described in emergency units. The objective of this study was to describe the effectiveness and safety of use of olanzapine in patients with acute psychosis and agitation in the emergency rooms. Methods. In this prospective observational study 278 patients with acute psychosis and agitation were consecutively admitted in 16 psychiatric emergency wards and treated with any oral psychopharmacology treatment, including olanzapine, according to investigators clinical criteria. Data were collected prospectively including demographics, diagnosis, concomitant medications, utilization of mechanical restraints, and severity of agitation. Clinical evolution during emergency room stay was assessed with PANSS-Excitement Component, CGI-S, and Agitation and Calmness Evaluation Scale (ACES) at baseline, before any re-intervention (if needed) and at discharge from the emergency room. Safety was also evaluated. Results. Olanzapine alone was used in 148 (53.2 %) patients. Most of them (77.7 %) were diagnosed of schizophrenia and related psychoses. Up to 38 patients (25.7 %) required mechanical restraints. Mean change (confidence interval [CI] 95%) from baseline to discharge was significant in all rating scales; PANSS-EC: –7.46 (–8.2,–6.7); CGI-S: –1.82 (–2, –1.6); ACES: 1.28 (1.1, 1.5). At discharge 70.3% of patients went to inpatient units. Five patients (3.4 %) reported adverse events including: bradycardia, dry mouth, sedation, hypertension, hypotension, and orthostatic hypotension. None of them was serious. Conclusions. The utilization of olanzapine alone decreased agitation in psychotic patients in emergency room settings. Incidence of adverse events was low and it was well tolerated (AU)

[Effectiveness results of olanzapine in acute psychotic patients with agitation in the emergency room setting: results from NATURA study]. / Resultados de efectividad de olanzapina en pacientes psicóticos agudos conagitación en servicios de urgencias: resultados del estudio NATURA.

INTRODUCTION: Patterns of use of antipsychotics are not well described in emergency units. The objective of this study was to describe the effectiveness and safety of use of olanzapine in patients with acute psychosis and agitation in the emergency rooms. METHODS: In this prospective observational study 278 patients with acute psychosis and agitation were consecutively admitted in 16 psychiatric emergency wards and treated with any oral psychopharmacology treatment, including olanzapine, according to investigators clinical criteria. Data were collected prospectively including demographics, diagnosis, concomitant medications, utilization of mechanical restraints, and severity of agitation. Clinical evolution during emergency room stay was assessed with PANSS-Excitement Component, CGI-S and Agitation and Calmness Evaluation Scale (ACES) at baseline, before any re-intervention (if needed) and at discharge from the emergency room. Safety was also evaluated. RESULTS: Olanzapine alone was used in 148 (53.2%) patients. Most of them (77.7 %) were diagnosed of Schizophrenia and related psychoses. Up to 38 patients (25.7 %) required mechanical restraints. Mean change (confidence interval [CI] 95 %) from baseline to discharge was significant in all rating scales; PANSS-EC: -7.46 (-8.2, -6.7); CGI-S: -1.82 (-2, -1.6) ACES: 1.28 (1.1, 1.5). At discharge 70.3% of patients went to inpatient units. Five patients (3.4%) reported adverse events including: bradycardia, dry mouth, sedation, hypertension, hypotension, and orthostatic hypotension. None of them was serious. CONCLUSIONS: The utilization of olanzapine alone decreased agitation in psychotic patients in emergency room settings. Incidence of adverse events was low and it was well tolerated.

[Course and prognosis of a case of central pontine myelinolysis in eating behavior disorder]. / Evolución y pronóstico de un caso de mielinólisis central pontina en al trastorno de la conducta alimentaria.

Central pontine myelinolysis (CPM) is a serious disorder that has been described in multiple diseases, generally involving important metabolic and hydroelectrolyte alterations. Although initially, its prognosis was usually fatal, there are a growing number of cases where the clinical symptoms begin abruptly and end after a short period, albeit with a persistence of the neuroimaging lesions. The case of a 22 year-old woman with a 6 year history of serious eating disorder with important physical deterioration and neurological and psychiatric symptoms suggestive of CPM is described. Despite the confirmation of the brain lesions through magnetic resonance imaging, neurological and psychiatric symptoms fully disappeared within a few weeks while the typical lesions of CPM remained. Although the risk of appearance of CPM exists during the course of an eating disorder, its prognosis does not seem to be as fatal as it was previously thought. Close monitoring of the clinical symptoms and neuroimaging findings should be carried out in these patients during the first months.

Evolución y pronóstico de un caso de mielinólisis central pontina en el trastorno de la conducta alimentaria / Course and prognosis of a case of central pontine myelinolysis in eating behavior disorder

La mielinólisis central pontina (MCP) es una alteración grave cuya aparición se ha descrito en múltiples procesos patológicos que generalmente cursan con alteraciones metabólicas e hidroelectrolíticas importantes. Aunque inicialmente su pronóstico se consideró siempre grave, cada vez se describen más casos en los que la sintomatología se inicia de manera brusca y cede en poco tiempo, aunque permanezcan lesiones en las imágenes neurorradiológicas. Se describe el caso de una mujer de 22 años con historia de trastorno de la conducta alimentaria grave de 6 años de evolución, con un importante deterioro del estado general, que se inicia con síntomas neurológicos y psiquiátricos sugestivos de MCP durante el tratamiento. A pesar de la confirmación de la lesión a través de resonancia magnética, los síntomas desaparecieron totalmente a las pocas semanas, mientras que permanecieron las lesiones típicas de MCP. Aunque existe el riesgo de aparición de MCP a lo largo de la evolución de un trastorno de la conducta alimentaria, su pronóstico no parece ser tan funesto en todos los casos como se pensaba previamente, debiéndose realizar un seguimiento de la evolución de los síntomas clínicos y de la neuroimagen a lo largo de los primeros meses

Central pontine myelinolysis (CPM) is a serious disorder that has been described in multiple diseases, generally involving important metabolic and hydroelectrolyte alterations. Although initially, its prognosis was usually fatal, there are a growing number of cases where the clinical symptoms begin abruptly and end after a short period, albeit with a persistence of the neuroimaging lesions. The case of a 22 year-old woman with a 6 year history of serious eating disorder with important physical deterioration and neurological and psychiatric symptoms suggestive of CPM is described. Despite the confirmation of the brain lesions through magnetic resonance imaging, neurological and psychiatric symptoms fully disappeared within a few weeks while the typical lesions of CPM remained. Although the risk of appearance of CPM exists during the course of an eating disorder, its prognosis does not seem to be as fatal as it was previously thought. Close monitoring of the clinical symptoms and neuroimaging findings should be carried out in these patients during the first months

Lower weight gain with the orally disintegrating olanzapine than with standard tablets in first-episode never treated psychotic patients.

OBJECTIVE: A post-hoc analysis of the data from a randomised clinical trial involving prescription of antipsychotic treatment to never treated first-onset psychotic patients was used to compare the weight change after 6-week olanzapine treatment (standard tablets vs. orally disintegrating formulation). METHOD: In the subgroup of 38 patients randomised to olanzapine, standard olanzapine tablets were non-randomly and consecutively prescribed to the first 19 patients, with the orally disintegrating formulation being prescribed to the following 19 patients. RESULTS: After 6-week treatment with olanzapine, a significant higher increase in weight was noted in those patients on standard tablets (mean weight increase 6.3 +/- 1.9 Kg) as compared to those on orally disintegrating olanzapine (mean weight increase 3.3 +/- 3.2 Kg) (F = 7.7; p = 0.009). BMI increase was also significantly higher in the olanzapine tablet group (mean increase of 2.1 Kg/m(2) as compared with 1.1 Kg/m(2) in the orally disintegrating group) (F = 4.7; p = 0.036). Substantial weight gain (SWG) (> or =7% increase from baseline weight) was noted in 84.2% (n = 16) of the olanzapine tablet patients and in 31.6% (n = 6) of the orally disintegrating olanzapine patients, with the olanzapine tablet group showing a significant increase in the mean percentage of weight gain (F = 4.0; p = 0.014). CONCLUSIONS: Partial sublingual absorption occurring with orally disintegrating olanzapine may bypass gastrointestinal metabolisation and hence lead to differences in metabolite versus parent compound ratios. However, the need arises to replicate the present study with a longer follow-up.

A naturalistic multicenter study of intramuscular olanzapine in the treatment of acutely agitated manic or schizophrenic patients.

BACKGROUND: We conducted a naturalistic, multicenter, 24-hour, nonrandomized, observational study describing for the first time the effectiveness and safety of intramuscular (IM) olanzapine to control agitation and aggression in "real world" patients with psychosis. The data thus obtained was compared with that reported from randomized double-blind clinical trials. METHOD: 92 patients attending psychiatric emergency settings were enrolled. The study subjects were 44 male and 48 female patients with a mean age of 36.5+/-12 years and DSM-IV-TR diagnoses of schizophrenia (48.9%), psychotic disorder not specified (23.9%) or bipolar disorder (27.2%). 10 mg IM olanzapine was administered to all patients. An optional second injection was permitted> or =2 hours later in line with hospital policy. Evaluations (PANSS-EC and CGI-S) were performed at baseline and 2 and 24 hours following the IM injection. RESULTS: Two hours after IM olanzapine was administered, a mean decrease of -9.6 in the PANSS-EC from a baseline score of 26.5 was recorded. At the 24-hour endpoint a statistically and clinically significant reduction in the PANSS-EC scores (11.6+/-5.3) was observed as compared with values at study entry (26.5+/-5.9) and at 2 hours endpoint (16.9+/-9.3), which represent a mean decrease of -14.9 and -5.3, respectively. CONCLUSION: The present naturalistic study provides naturalistic data on the effectiveness of IM olanzapine in the treatment of acute agitation in patients with schizophrenia or bipolar mania that is in line the data obtained in randomized double-blind clinical trials.

Pharmacological management of acutely agitated schizophrenic patients.

Agitation is commonly seen in acute schizophrenic patients and core symptoms include a wide range of symptom. It requires rapid and effective treatment approaches in order to protect patient and caregiver from potential injury. Clinician's decision of pharmacological treatment should be individualized to the needs and circumstances of the patient. Benzodiazepines, typical antipsychotics, and combinations of typical antipsychotics and benzodiazepines have been widely used as treatment options. Atypical antipsychotics have clear advantages over the typical drugs as they generally show a much better safety and tolerability profile, particularly to EPS and related side effects, however clinical perception regarding efficacy in treating acutely agitated psychotic patient is controversial. New intramuscular atypical antipsychotic formulations offer evidence of being at least as effective as typical antipsychotics in controlling agitation. Therefore, they should be considered as first line therapy in agitated schizophrenic patients.

[Rhabdomyolysis due to polydipsia in a patient with psychotic disorder]. / Rabdomiólisis por polidipsia aguda en un paciente con trastorno psicótico.

Polydipsia is a frequent clinical entity in psychiatric patients, especially in those with a psychotic disorder. Acute episodes of polydipsia can produce important metabolic alterations and even coma and death. Psychogenic polydipsia is a underestimated diagnosis, due to multiple causal factors and an etiology that has not been clearly established. We present the case of a patient with psychiatric background who was seen due to a clinical situation of severe acute renal failure by high rhabdomyolysis that needed hemodialysis, due to acute polydipsia. We also review some of the epidemiological and clinical factors and etiopathogeny of the polydipsia. It is considered necessary to keep in mind the in mind the diagnosis of polydipsia in any psychiatric patient showing acute symptoms of confusion.

Rabdomiólisis por polidipsia aguda en un paciente con trastorno psicótico / Rhabdomyolysis due to polydipsia in a patient with psychotic disorder

La polidipsia es un cuadro clínico frecuente en pacientes psiquiátricos, especialmente en pacientes psicóticos. En episodios agudos puede producir alteraciones metabólicas importantes, e incluso coma y muerte. La polidipsia psicógena es un diagnóstico infravalorado debido a tener múltiples factores causales y una etiopatogenia no claramente establecida. Se presenta el caso de un paciente con antecedentes psiquiátricos que es atendido por un cuadro clínico de insuficiencia renal aguda severa por intensa rabdomiólisis que requirió hemodiálisis, relacionado con conducta aguda de polidipsia. Se revisan también algunos de sus factores epidemiológicos, clínicos y etiopatogénicos de la polidipsia. Se establece la conveniencia de tener en cuenta el diagnóstico de potomanía ante cualquier paciente psiquiátrico que presente síntomas agudos de confusión (AU)

[Combination therapy with reboxetine for major depression patients who are partial or nonresponders to serotonin selective reuptake inhibitors]. / Tratamiento de combinación con reboxetina en pacientes con depresión mayor no respondedores o con respuesta parcial a inhibidores selectivos de la recaptación de serotonina.

INTRODUCTION: Recent studies have confirmed the usefulness of the therapeutical combination of two antidepressants from different pharmacological families in patients with single drug therapy resistant depression. METHODS: In this prospective 6 weeks open-labeled study, efficacy of combination strategy was evaluated. This included the addition of reboxetine to 34 outpatients with DSM-IV major depressive disorder, who had not responded previously, or who partially responded to conventional treatment in single drug therapy with serotonin selective reuptake inhibitors (SSRI). Data were analyzed on a intent-to-treat basis. RESULTS: Mean decrease in the 21 item Hamilton depression rating scale (HDRS) score was 49.4% (from 26.9 to 13.6; p<0.0001) and in the clinical global impressions scale (CGI) was 40.4% (from 4.6 to 2.7; p < 0.0001). At the end of the treatment, 47.1% of the patients we re considered in remission (HDRS < or = 10), 55.9% evaluated as responders (HDRS < or = 50%) and 58.8% considered as having improvement (CGI<4). No serious side effects were observed during combination therapy, the most frequent being nervousness and the urinary hesitancy (5.9%). CONCLUSIONS: The results of this study suggest that addition of reboxetine to SSRI may be an effective and well-tolerated strategy in treatment-resistant patients who have failed to adequately respond to single drug therapy with SSRI.