Baseline demographics, clinical features and predictors of conversion among 200 individuals in a longitudinal prospective psychosis-risk cohort.

BACKGROUND: DSM-5 proposes an Attenuated Psychosis Syndrome (APS) for further investigation, based upon the Attenuated Positive Symptom Syndrome (APSS) in the Structured Interview for Psychosis-Risk Syndromes (SIPS). SIPS Unusual Thought Content, Disorganized Communication and Total Disorganization scores predicted progression to psychosis in a 2015 NAPLS-2 Consortium report. We sought to independently replicate this in a large single-site high-risk cohort, and identify baseline demographic and clinical predictors beyond current APS/APSS criteria. METHOD: We prospectively studied 200 participants meeting criteria for both the SIPS APSS and DSM-5 APS. SIPS scores, demographics, family history of psychosis, DSM Axis-I diagnoses, schizotypy, and social and role functioning were assessed at baseline, with follow-up every 3 months for 2 years. RESULTS: The conversion rate was 30% (n = 60), or 37.7% excluding participants who were followed under 2 years. This rate was stable across time. Conversion time averaged 7.97 months for 60% who developed schizophrenia and 15.68 for other psychoses. Mean conversion age was 20.3 for males and 23.5 for females. Attenuated odd ideas and thought disorder appear to be the positive symptoms which best predict psychosis in a logistic regression. Total negative symptom score, Asian/Pacific Islander and Black/African-American race were also predictive. As no Axis-I diagnosis or schizotypy predicted conversion, the APS is supported as a distinct syndrome. In addition, cannabis use disorder did not increase risk of conversion to psychosis. CONCLUSIONS: NAPLS SIPS findings were replicated while controlling for clinical and demographic factors, strongly supporting the validity of the SIPS APSS and DSM-5 APS diagnosis.

Temporal association of stress sensitivity and symptoms in individuals at clinical high risk for psychosis.

BACKGROUND: Increased sensitivity and exposure to stress are associated with psychotic symptoms in schizophrenia and its risk states, but little is known about the co-evolution of stress sensitivity and exposure with positive and other symptoms in a clinical high-risk (CHR) cohort. METHOD: A combined cross-sectional and longitudinal design was used to examine the associations over time of stress sensitivity and exposure (i.e. life events) with 'prodromal' symptoms in a cohort of 65 CHR patients assessed quarterly for up to 4 years, and at baseline in 24 healthy controls similar in age and gender. RESULTS: Impaired stress tolerance was greater in patients, in whom it was associated over time with positive and negative symptoms, in addition to depression, anxiety and poor function. By contrast, life events were comparable in patients and controls, and bore no association with symptoms. In this treated cohort, there was a trajectory of improvement in stress tolerance, symptoms and function over time. CONCLUSIONS: Impaired stress tolerance was associated with a wide range of 'prodromal' symptoms, consistent with it being a core feature of the psychosis risk state. Self-reported life events were not relevant as a correlate of clinical status. As in other treated CHR cohorts, most patients improved over time across symptom domains.

Efficacy and safety of lidocaine-prilocaine cream for pain during circumcision.

BACKGROUND: Neonatal circumcision is a painful surgical procedure often performed without analgesia. We assessed the efficacy and safety of 5 percent lidocaine-prilocaine cream (Emla) in neonates undergoing circumcision. METHODS: We carried out a double-blind, randomized, controlled trial in 68 full-term male neonates: 38 were assigned to receive lidocaine-prilocaine cream, and 30 to receive placebo. One gram of lidocaine-prilocaine or placebo cream was applied to the penis under an occlusive dressing for 60 to 80 minutes before circumcision. Behavioral (facial activity and time spent crying) and physiologic (heart rate and blood pressure) responses were recorded during the procedure. Blood samples were obtained at various times after drug application for measurements of methemoglobin and plasma lidocaine, prilocaine, and o-toluidine (a metabolite of prilocaine). RESULTS: A total of 68 and 59 neonates were included in the safety and efficacy analyses, respectively. Demographic characteristics such as gestational age and birth weight did not differ between the lidocaine-prilocaine and placebo groups. During circumcision, the neonates in the lidocaine-prilocaine group had less facial activity (P= 0.01), spent less time crying (P<0.001), and had smaller increases in heart rate (P=0.007) than the neonates in the placebo group. Facial-activity scores were 12 to 49 percent lower during various steps of the procedure in the lidocaine-prilocaine group. As compared with neonates in the placebo group, infants in the lidocaine-prilocaine group cried less than half as much and had heart-rate increases of 10 beats per minute less. Blood methemoglobin concentrations (expressed as a percentage of the hemoglobin concentration) were similar (1.3 percent) in both groups. Lidocaine and prilocaine were detected in plasma in 23 (61 percent) and 21 (55 percent) of the infants treated with lidocaine-prilocaine cream, respectively. CONCLUSIONS: Lidocaine-prilocaine cream is efficacious and safe for the prevention of pain from circumcision in neonates.

Interactions of drugs with the developing kidney.

Interactions between drugs and the kidney are necessary for renal drug elimination, metabolism, and occasionally for therapeutic effect. These interactions may result also in renal toxicity. Understanding the kidney's role in drug-handling helps the clinician to be aware of potential drug interactions and toxicity. Drug disposition, elimination, and toxicity may differ with development and are to be considered when prescribing drugs for children. Nephrotoxicity associated with drugs, although common, is usually reversible with discontinuation of the drug; however, when drug therapy with a well-known nephrotoxic drug (e.g., cisplatin) is necessary, pharmacologic modulators may play a role in limiting the associated nephrotoxicity.

Halachic perspective on involuntary psychiatric care of the mentally ill.

According to most mental health statutes in force around the world, doctors may involuntarily treat only acutely psychotic patients who present some danger to themselves, others or property. Chronic patients who, owing to volitional or cognitive defects, present a similar danger may not be thus treated. This may cause situations to arise where dangerous chronically ill patients who refuse treatment may cause serious harm because of physicians' inability to treat them. This article suggests changes to contemporary mental health statutes, in line with Judaic Halachic codes, which view all mentally ill patients as potentially harmful, and require physicians to treat--voluntarily or involuntarily--all mentally ill persons.

The safety of nitrofurantoin during the first trimester of pregnancy: meta-analysis.

Asymptomatic bacteriuria is common during pregnancy and may adversely affect both the mother and her fetus. Nitrofurantoin (NF) has been long recognized as an effective agent in both nonpregnant and pregnant women suffering from urinary tract infections. This meta-analysis was conducted in order to evaluate the safety of NF ingested during early pregnancy. Of twenty-two studies, only four met the inclusion criteria and their analysis could not demonstrate any significant correlation between NF ingestion and fetal malformation. The pooled odds ratio was 1.29 with 95% confidence interval 0.25-6.57. Although the number and quality of the studies included are limited, we thought it important to present the existing data. More extensive controlled studies are urgently needed in order to increase the significance of our study.

Religiosity, criminality and types of offences of Jewish male prisoners.

The study examined whether the percentage of religious criminals was lower than the percentage of religious people in the population and whether the types of crimes committed by religious prison inmates differed from those committed by non-religious inmates. The 193 religious criminals studied consisted of all the religious male prisoners in the men's prisons in Israel. The percentage of religious criminals (3.7%) was found to be far below the percentage of religious people in the population (about 20%). In general both groups committed the same types of crimes. The exceptions were that religious criminals committed more sex and white-collar crimes and less security crimes than non-religious criminals.

Clinical criminology: a bridge between forensic professionals.

In recent decades a new profession has developed--clinical criminology. The purpose of this article is to highlight its development. Criminology is defined as a interdisciplinary super-profession. We tend to view criminology as a basic profession with a number of specializations. Clinical criminology is one of these specializations. Forensic psychiatry and clinical criminology have common roots in psychiatry, law and behavioural sciences. They overlap in some fields. Members of both professions work in the same setting and share some of the tasks, but the formal and professional responsibilities differ significantly. We perceive clinical criminology and forensic psychiatry as complementary professions belonging to medicine. The multidisciplinary educated clinical criminologist is the only professional in the forensic system who is qualified to moderate between the mental health and legal expert.

Rape death and resurrection: male reaction after disclosure of the secret of being a rape victim.

Males are also rape victims. The scant information we have on this phenomenon can be explained by its rarity or by the reluctance of male victims to disclose their past victimization. In this study, 23.8% of 235 prisoners that were interviewed disclosed their past sexual abuse. Eleven suffered an acute reaction (for example, attempted suicide). 77.7% of the prisoners who did not have an acute reaction after this disclosure were sex offenders. Sexual abuse has a special meaning for the male victim. Their gender identity and gender image are tarnished by the use which another male had with their body. It seems that sex offenders come to terms with this fact by acting out or by proving their sexual virility in a strange and cruel way. This article describes male prisoners' reactions after their disclosure of having been a rape victim, and suggests a tentative explanation, based on theory and therapeutic experience.

Effect of histamine H2 receptor antagonists on the secretion of cerebrospinal fluid in the cat.

Following a recent report that epithelial cells of the choroid plexus possess histamine H2 receptors, the effect of cimetidine and ranitidine, histamine H2 receptor antagonists, on the secretion and electrolyte content of CSF was examined. Fifty cats were divided into one control (n = 6) and six experimental groups. CSF was collected by puncture of the cisterna magna following pentobarbital anesthesia, and its volume, concentrations of Na+, K+, Cl-, and pH were determined. Cimetidine or ranitidine (50, 20, or 10 mg/kg) was injected intravenously 2 h after the start of the test, and their concentrations were measured in hourly blood samples and in 30-min aliquots of CSF in the 50 mg/kg experimental groups. Whereas the secretion of CSF did not change over 6 h in the control group, it decreased significantly by 30-60 min after injection of cimetidine or ranitidine and remained low for the following 6 1/2 h in all experimental groups except the 10-mg ranitidine group. Peak cimetidine and ranitidine concentrations in CSF in the 50-mg experimental groups were noted 60 and 90 min, respectively, after intravenous injection. CSF electrolyte concentrations and pH did not change during the test in any group. We conclude that intravenous cimetidine or ranitidine can significantly reduce CSF secretion in the cat, possibly by competitive inhibition of the histamine effect on H2 receptors located on the choroid plexus epithelial cell, or by a direct effect on the capillaries of the choroid plexus.