A prospective, observational study of the safety and effectiveness of intramuscular psychotropic treatment in acutely agitated patients with schizophrenia and bipolar mania.

This naturalistic, observational pan-European study assessed the safety and early effectiveness of intramuscular (IM) psychotropic treatments in patients with acute agitation suffering from schizophrenia or bipolar mania. One thousand nine hundred and forty of 1945 patients completed the 24-hour observation period after initial IM treatment. Patients from 12 European countries were included (mean age 39 years; 58% male, 66% schizophrenia). IM treatment was at the physician's discretion. The primary objective was to describe the acute tolerability of IM psychotropic therapies in clinical practice, with particular emphasis on EPS. At baseline, 68% of the patients received IM monotherapy, with IM olanzapine most commonly prescribed (36%). During the first 24 hours, 190 (9.8%) patients experienced EPS. The occurrence of EPS was statistically significantly lower in patients treated with IM olanzapine compared to those treated with other IM psychotropic medications (mainly typical antipsychotics and benzodiazepines): acute dystonia: 1.1%, 95% CI 0.5-2.3 and 2.9%, CI 2.0-4.0; akathisia: 2.3%, CI 1.3-3.7 and 5.5%, CI 4.3-6.9; Parkinsonism: 2.9%, CI 1.8-4.4 and 7.8%, CI 6.4-9.4, respectively. Anticholinergic treatment was given to 12% IM olanzapine versus 31% non-olanzapine treated patients. Acute agitation after 24 hours was reduced by 1.68 (95% CI 1.46-1.91) points on the Clinical Global Impression of Severity (CGI-S) in IM olanzapine patients and 1.51 (95% CI 1.30-1.73) points in non-olanzapine patients. Additional psychotropic medication was required for 90% of the patients during the first 24 hours of treatment. Results provide naturalistic evidence for low EPS rates and improvement of agitation with IM psychotropic medications during acute states of patients suffering from acute mania or schizophrenia.

Factors associated with achieving minimally symptomatic status by patients with schizophrenia: results from the 3-year intercontinental schizophrenia outpatients health outcomes study.

OBJECTIVE: The aim of this study was to describe factors associated with achieving a minimally symptomatic status outcome in outpatients with schizophrenia. METHODS: Data were analysed from a 3-year, prospective observational study that examined outcomes in 7658 patients with schizophrenia. Minimally symptomatic status was defined as a postbaseline score of 1 or 2 on the Clinical Global Impressions Severity Scale-Schizophrenia version (CGI-SCH). RESULTS: Baseline CGI-SCH score had the strongest association with minimally symptomatic status followed by age, geographical region and hospitalisation status. The probability of becoming minimally symptomatic was consistently higher in the olanzapine and risperidone monotherapy groups compared with the clozapine, quetiapine or haloperidol groups [corrected]. The olanzapine group achieved the minimally symptomatic status in a shorter period of time than the other treatment groups (p < or = 0.016). CONCLUSION: The likelihood of patients achieving a minimally symptomatic status was greater in younger patients with lower baseline clinical severity and in patients whose treatment included olanzapine.

Glucose utilization and glycogen turnover are accelerated in hypertrophied rat hearts during severe low-flow ischemia.

We undertook this study to determine if the metabolism of exogenous glucose and glycogen in hypertrophied hearts differed from that in normal hearts during severe ischemia. Thus, rates of glycolysis (3H2O production) and oxidation (14CO2 production) from exogenous glucose and glycogen were measured in isolated working control (n = 13) and hypertrophied (n = 12) hearts from sham-operated and aortic-banded rats during 40 min of severe low-flow ischemia. Hearts, in which glycogen was prelabelled with [5-3H]- or [14C]-glucose, were paced and perfused with Krebs-Henseleit solution containing 1.2 mM palmitate, 5.5 mM [5-3H]- or [14C]-glucose (different from the isotope used to label glycogen), 0.5 mM lactate and 100 microU/ml insulin during ischemia. Rates of glycolysis from exogenous glucose (3301 +/- 122 v 2467 +/- 167 nmol/min/g dry wt, mean +/- S.E.M., P < 0.05) and glucose from glycogen (808 +/- 27 v 725 +/- 21 nmol/min/g dry wt, P < 0.05) were accelerated in hypertrophied hearts compared to control hearts. However, rates of oxidation of exogenous glucose and glucose from glycogen were not significantly different between the two groups. As observed in normoxic non-ischemic hearts, glucose from glycogen was preferentially oxidized compared to exogenous glucose. Additionally, rates of glycogen synthesis (167 +/- 7 v 140 +/- 9 nmol/min/g dry wt, P < 0.05) were increased in hypertrophied hearts compared to control hearts during severe low-flow ischemia indicating that glycogen turnover (i.e. simultaneous synthesis and degradation) was accelerated in the hypertrophied heart. Thus, we demonstrate that glucose utilization and glycogen turnover are accelerated in the hypertrophied heart during severe low-flow ischemia as compared to the normal heart.