Psychiatric Medications and Hypertension.

PURPOSE OF REVIEW: The purpose of this review is to provide an overview of psychiatric medications that impact blood pressure in adult patients either as a direct side effect or indirectly, via negative metabolic impact or interactions with other medications. In addition, pertinent interactions between psychiatric medications and antihypertensive agents will be discussed. RECENT FINDINGS: Although the novel intranasal antidepressant, esketamine, has been shown to increase blood pressure shortly after dosing, treatment with antihypertensive medications is not typically required. In addition, no increase in serious adverse cardiac events was reported with this medication. The negative metabolic impact of antipsychotic medications has been shown to occur within the first month of treatment and necessitates early monitoring. When compared with the general population with cardiovascular disease, mortality risk in patients with severe and persistent psychiatric illness is higher, and death occurs 10 years earlier. There are several psychiatric treatments that increase blood pressure directly as well as indirectly, via negative metabolic impact and drug/diet interactions. Fortunately, there are no absolute contraindications for use of any psychiatric medication in patients with pre-existing hypertension. Given data which suggests that patients diagnosed with more severe psychiatric disorders are known to receive inadequate medical care for hypertensive illness and experience increased mortality risk from cardiovascular disease, it is important for all physicians to be aware of the increased risk in this population and for both thorough assessment and treatment to occur.

Adolescent suicide and household access to firearms in Colorado: results of a case-control study.

PURPOSE: To determine whether, compared with age- and sex-matched controls who did not commit suicide, adolescents who committed suicide by firearms were more likely to have had household access to firearms (after adjusting for significant risk factors for adolescent suicide). METHODS: A case-control study design was used; case subjects were Colorado adolescents who committed suicide between 1991 and 1993; controls were sex- and age-matched adolescents who were randomly selected from the same school the subjects had attended. Interviews were conducted with the parent or guardian of cases and controls. RESULTS: Of the 36 case subjects in this study, 67% committed suicide using a gun obtained from their home. Adolescent suicide victims who committed suicide by firearms were significantly more likely to have a firearm in their home (72%) than age- and sex-matched community controls (50%), after adjusting for significant risk factors. Conduct disorder and previous mental health treatment were also found to be independent risk factors for adolescent firearm suicide. CONCLUSIONS: Two types of public health interventions to prevent adolescent firearm suicides are likely to be successful: (a) limiting household access to firearms, and (b) identifying adolescents at high risk of firearm suicide.

Prediction accuracy and financial savings of four screening tests for a sequential test of clinical performance.

BACKGROUND: Sequential testing of clinical performance is an effective strategy to reduce cost of testing. PURPOSE: To evaluate prediction accuracy and financial savings of 4 screening tests of clinical performance. METHODS: Screening tests were created from a 13-case examination taken by 434 medical students at 4 schools. Regression analysis determined prediction accuracy for 2 test outcomes. Financial savings were computed from published estimates. RESULTS: Zero false passes were obtained with the "Total Number of Cases Passed" screening test, but it saved only 27%. Sixty-two percent savings with 5% false passes occurred with the "Classification" screening test. The "Scale" and "Mini Test" screening tests would have excused 79% and 67% examinees with 5% and 1% false passes, respectively. CONCLUSIONS: Prediction accuracy varies with screening test and outcome measure. Sequential testing of clinical performance can save 40% to 60% with low false pass rates. However, programs need to consider loss of information for curriculum and individual feedback relative to financial savings.

Hydrocracking of the oils of Botryococcus braunii to transport fuels.

Hydrocarbon oils of the alga Botryococcus braunii, extracted from a natural "bloom" of the plant, have been hydrocracked to produce a distillate comprising 67% gasoline fraction, 15% aviation turbine fuel fraction, 15% diesel fuel fraction, and 3% residual oil. The distillate was examined by a number of standard petroleum industry test methods. This preliminary investigation indicates that the oils of B. braunii are suitable as a feedstock material for hydrocracking to transport fuels.

Behavioral characteristics of high- and low-IQ autistic children.

The authors are developing the Behavior Observation Scale to objectively differentiate autistic, normal, and mentally retarded children aged 30--60 months. They describe operational definitions and procedures and report data on the frequency of selected behaviors among 114 children. Prior studies have revealed that to assess the clinical significance of behaviors in autistic children, both frequency of occurrence per subject and the number of children exhibiting the behaviors must be considered concurrently. This study confirms the hypothesis that it is critical to consider the IQ of the child when assessing the clinical significance of individual behaviors and groups of behaviors.

A thermodynamic assessment of possible substrates for sulphate-reducing bacteria.

A thermodynamic feasibility study was applied as a means of predicting suitable energy-yielding substrates for growth of sulphate-reducing microorganisms. The average free energy release per electron pair for a substrate-sulphate oxidoreduction may be more or less than the energy requirement for ATP synthesis from ADP and Pi. Substrates were divided into two groups on this thermodynamic basis and the division was shown to accord with previous experimental reports; those substrates which released an average of at least 8-4 kcal per electron pair (35-2 kJ per electron pair) were able to support growth whilst those releasing less than 8-4 kcal were unable to do so. It is proposed that the thermodynamic assessment could be applied to a wide range of possible substrates to predict the likelihood of their serving as sole substrates for growth of these organisms. The literature concerning the use of hydrocarbons by sulphate reducers is confused and indefinite, but inclines toward the idea that use of long-chain hydrocarbons by these organisms is possible. In contrast, however, thermodynamic analysis showed that the highest energy release is from the short-chain alkynes.