Case series on aripiprazole and dopamine supersensitivity psychosis.

A potential link between switching to aripiprazole and worsening of psychosis was first reported in the early 2000s. There have since been numerous published case reports describing this phenomenon, but only recently has the concept of a theoretical aripiprazole-induced dopamine supersensitivity psychosis (DSP) caused by D2 receptor activation in patients undergoing a switch to aripiprazole appeared in the literature. There is less awareness in clinical practice of the possibility of inducing DSP with aripiprazole, which may be particularly severe in some patients. The objective of this article is to present four cases demonstrating rapid and dramatic onset of DSP during switching to aripiprazole. In each case, a patient with a Diagnostic and statistical manual of mental disorders (5th ed.) diagnosis of schizophrenia experienced severe worsening of psychosis within 4-5 days of abrupt switching to aripiprazole from a full D2 antagonist. To our knowledge, this is the first case series characterizing the previously well-documented worsening of psychosis during switching to aripiprazole specifically as aripiprazole-induced DSP. We discuss clinical relevance, prevention and future directions. Careful cross-titration per clinical practice guidelines may reduce occurrence of DSP during aripiprazole switching or augmentation treatment.

Superior outcome using cyclosporin A alone versus cyclosporin A plus methotrexate for post-transplant immunosuppression in children with acute leukemia undergoing sibling hematopoietic stem cell transplantation.

PURPOSE: The outcome of cyclosporin A (CSA) alone (n = 19) as graft-versus-host disease (GVHD) prophylaxis was compared to that of CSA combined with methotrexate (MTX) (n = 43) in children with acute leukemia who underwent hematopoietic stem cell transplantation. METHODS: All respective donors were HLA-identical siblings. All patients received CSA at a dose of 3 mg/kg/day starting on day -1. A CSA level of 80-130 ng/ml was aimed for. The 43 patients in the historical control were given an additional 10 mg/m(2) dosage of MTX on days 1, 3, 6, and 11. RESULTS: Patients who received CSA alone had a significantly reduced cumulative incidence of relapse (5 vs. 40 %; p = 0.002), a significantly increased 5-year event-free survival (84 vs. 35 %; p = 0.001), and a significantly increased 5-year overall survival (84 vs. 42 %; p = 0.004). The incidence of acute GVHD grade II-IV and chronic GVHD in patients in the CSA group was equivalent to the CSA+MTX group (26 vs. 19 %; p = 0.440, and 32 vs. 23 %; p = 0.428). CONCLUSIONS: In conclusion, post-transplant immunosuppression consisting of CSA alone is well tolerated and may contribute to a superior outcome.

Alaska Native parental attitudes on cervical cancer, HPV and the HPV vaccine.

OBJECTIVES: To describe Alaska Native parents' knowledge of and attitudes towards cervical cancer, the human papillomavirus (HPV) and the HPV vaccine. STUDY DESIGN: This was a qualitative study composed of 11 focus groups (n = 80) that were held in 1 small village, 2 towns and 1 large urban centre in Alaska. METHODS: A convenience sample of Alaska Native parents/guardians was recruited in each community to participate in focus groups and to fill out a quantitative survey. RESULTS: While many parents had heard about HPV, most were unaware of its link with cervical cancer. The majority wanted to vaccinate their daughters because they had health and safety concerns; believed that vaccines work; had personal experiences with cancer; or believed that their daughters were susceptible to HPV. Reasons for refusal included general concerns about vaccines; a need for more information; a fear of side effects; wanting more vaccine research; and a fear of being in an experimental trial. CONCLUSIONS: The majority of parents were interested in having their daughters vaccinated. Acceptance of the vaccine was primarily based on a parent's desire to protect her/his child from cancer; while reasons for refusal revolved around trust issues and fear of unknown negative consequences of the vaccine.