Add-on Cariprazine in Patients with Long-term Clozapine Treatment and Treatment Resistant Schizophrenia: Two Cases of Psychotic Deterioration and Pisa Syndrome.

An increasing number of studies deal with medical options for treatment resistant schizophrenia. If no remission can be achieved with clozapine, a combination of antipsychotics can be considered. The combination of clozapine and cariprazine is rarely studied. Cariprazine is a partial agonist on dopamine D2 and D3 receptors and a pharmaceutically rational add-on to clozapine. Stimulating D3 receptors has been linked to improved cognition and mood, with negligible extrapyramidal side effects. We present two patients with long-term treatment resistant schizophrenia receiving cariprazine and clozapine. Whereas psychotic symptoms worsened, the patients developed extrapyramidal side effects with a Pisa syndrome. The syndrome remitted after discontinuation of cariprazine. Possible explanations by pharmacodynamic interactions and drug specific receptor profiles are discussed.

[The SARS-CoV-2 Pandemic and an Attempted Suicide of a Patient with Delusional Disorder]. / Die SARS-CoV-2-Pandemie und ein Suizidversuch bei wahnhafter Störung.

The SARS-CoV-2 pandemic triggered increasing symptoms of an undiagnosed delusional disorder at a mid-60-year-old woman resulting in an attempted suicide. Because of a pandemic with noticeable and visible social changes, it seems likely that people with previously subclinical psychotic illnesses are more often admitted to psychiatric care for the first time. Building a therapeutic relationship and integrating her into an outpatient clinic was possible despite her lack of insight into the illness and her rejection of medical treatment.

Analyses of pathological cranial ultrasound findings in neonates that fall outside recent indication guidelines: results of a population-based birth cohort: survey of neonates in Pommerania (SNiP-study).

BACKGROUND: Recent guidelines recommend a cranial ultrasound (CU) in neonates born at < 30 weeks gestation, admitted to the neonatal intensive care unit (NICU), or with a CU indication. Here, we addressed the need to extend these recommendations. METHODS: We retrospectively reviewed 5107 CUs acquired in the population-based Survey of Neonates in Pomerania, conducted in 2002 to 2008. Neonates with conspicuous CUs that were ≥ 30 weeks gestation without recent indications for CU were identified and assigned to the following groups: with (I) or without (II) admission to neonatal care. We designated CU conspicuities as mild (MC) or significant (SC), and we investigated related neurodevelopment during follow-up. RESULTS: Of 5107 neonates, 5064 were born at ≥30 weeks gestation and of those, 4306 received CUs without any indication for this examination. We found conspicuities in 7.7% (n = 47/610) of group I (n = 30 MC, n = 17 SC), and 3.2% (n = 117/3696) of group II (n = 100 MC, n = 17 SC). In group II, SC comprised, e.g., bilateral cysts, partial agenesis of the corpus callosum, and periventricular leukomalacia. Follow-up was available in 75% of infants in group II with MCs and SCs; of these, 12.8% had an abnormal neurological follow-up. CONCLUSIONS: We detected a high number of conspicuities in neonates without a CU indication. However, we could not demonstrate that ultrasound findings were associated with the neurological follow-up or any advantage to an earlier diagnosis. Our data did not support extending current guidelines or a general CU screening policy for all neonates.

Car backlight position and fog density bias observer-car distance estimates and time-to-collision judgments.

OBJECTIVE: A series of experiments assessed biases in perceived distance that occur while driving as a function of the backlight position of the car ahead and fog density. BACKGROUND: V. Cavallo, M. Colomb, and J. Doré (2001) have shown that smaller horizontal backlight separation and fog may result in increased estimates of the distance between an observer and a car of which only the backlights are visible. They also predicted that raising the height of the car backlights would lead to increasing distance estimates. METHOD: Distance perception was assessed in both static and dynamic computer-simulated scenarios in which the distance estimates were performed using a familiarized analog scale or using time-to-collision judgments for both pairs of backlights and single backlights. RESULTS: In a series of five experiments, the horizontal separation and fog density effects were replicated. In addition, distance estimates were consistently larger with higher than with lower vertical backlight positions. CONCLUSION: There is reason to believe that biases in distance perception may be augmented by car backlight positions and by low-visibility weather conditions. APPLICATION: Car designers should take backlight placement seriously. Speed-dependent car-to-car distance control systems seem desirable to counteract biases in distance perception.