Morton Hospital

OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical investigations, and adverse effects of sulpiride as a treatment for schizophrenia. DATA SOURCES: Information was selected from a MEDLINE search of English-language medical literature using "sulpiride" as the search term. Manual searches of pertinent journal article bibliographies also were performed. STUDY SELECTION: Clinical investigations with a blind, controlled, randomized design and treatment durations of at least 6 weeks were preferred. Formal assessment of a patient's schizophrenia was required. One clinical investigation using a 4-week treatment duration and 1 open investigation were included for purposes of adverse reaction assessment. DATA EXTRACTION: Clinical investigations were evaluated for design, sample size, diagnosis, duration, and outcome. Data from all investigations were selected by 1 author and reviewed by both authors. DATA SYNTHESIS: Sulpiride is a substituted benzamide with selective dopaminergic blocking activity. Early pharmacology reports hypothesized that sulpiride was selective for dopamine (D)2 receptors only, but sulpiride also blocks D3 and D4 receptors. Sulpiride does not block D1, adrenergic, cholinergic, gamma-aminobutyric acid-ergic, histaminergic, or serotonergic receptors to an appreciable extent. The oral bioavailability of sulpiride is poor, with estimates approximating 35%. Sulpiride does not appear to have an extensive first-pass metabolism, nor is it extensively protein-bound. There have been no identified active metabolites, and elimination appears to depend primarily on the kidneys. Clinical studies support sulpiride as being equally effective as active controls in the acute treatment of patients with schizophrenia. Daily doses permitted in these clinical investigations ranged from 100 to 3200 mg. Further investigation is required to determine the usefulness of sulpiride as a chronic treatment of schizophrenia and its effectiveness in treating the negative symptoms of schizophrenia. Sulpiride may cause extrapyramidal effects, autonomic effects, tardive dyskinesia, and the neuroleptic malignant syndrome. The incidence of these adverse reactions has not been established. CONCLUSIONS: Sulpiride is a safe and effective pharmacotherapeutic treatment for the acute management of schizophrenia. A unique pharmacology does not appear to provide sulpiride with a greater effectiveness than the standard antipsychotics, but may provide it with minor safety advantages.

CX516, a positive modulator of the glutamatergic alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptor, improves performance in tasks requiring learning and memory in animals. CX516 was added to clozapine in 4-week, placebo-controlled, dose-finding (N = 6) and fixed-dose (N = 13) trials. CX516 was tolerated well and was associated with moderate to large, between-group effect sizes compared with placebo, representing improvement in measures of attention and memory. These preliminary results suggest that CX516 and other "ampakines" hold promise for the treatment of schizophrenia.

Ketamine is a dissociative anesthetic and substance of abuse. Numerous effects can result from the abuse of ketamine. Death from acute direct toxicity is rare. Ketamine can alter numerous functions in the brain including color perception, memory, attention, cognition, reaction time, and sense of time and can produce psychological addiction. Chronic ketamine abuse can produce toxicity to the gastrointestinal and urinary tract. Gastrointestinal changes include epigastric pain, hepatic dysfunction, and impaired gallbladder activity. The most common urological condition from ketamine is cystitis but renal failure has been reported.

Using neurocognitive testing, the present study assessed whether obsessions and compulsions could represent a distinct cluster of symptoms in schizophrenia. We formulated our hypothesis based on data from nonschizophrenic patients, expecting to find that schizophrenic patients with obsessive-compulsive (OC) symptoms would experience more difficulties in the same cognitive areas as nonschizophrenic patients with obsessive-compulsive disorder (OCD). Patients had separate psychiatric and cognitive evaluations. The OC and non-OC schizophrenic subjects did not differ significantly on the positive and negative symptom scores. However, compared with non-OC schizophrenic patients, those with OC symptoms performed worse on cognitive areas thought to be impaired (i.e., visual-spatial skills, delayed nonverbal memory, and cognitive shifting abilities). In addition, the severity of OC scores correlated with poor performance in these areas of cognition. Our results support our hypothesis, specifically that OC symptoms may constitute a distinct cluster separate from psychosis in schizophrenia and raise the possibility of a distinct subtype of schizophrenia. The theoretical and clinical implications of these findings are discussed.

Journal Article Serum triglyceride levels in patients treated with clozapine Get access Padideh Ghaeli, Padideh Ghaeli Psychiatric Clinical Pharmacy Specialist, ValueRx-HPI and Taunton State Hospital, Taunton, M.A; at the time of this study, she was a postdoctoral fellow in psychiatric pharmacy. University of Rhode Island (URl), Kingston Search for other works by this author on: Oxford Academic Google Scholar Robert L. Dufresne Robert L. Dufresne Associate Professor of Pharmacy, College of Pharmacy, URI, and Psychiatric Clinical Pharmacy Specialist, Veterans Affairs Medical Center, Providence, Rl Address reprint requests to Dr. Dufresne at the College of Pharmacy, University of Rhode Island, 144 Fogartv Hall, Kingston, RI 02881. Search for other works by this author on: Oxford Academic Google Scholar American Journal of Health-System Pharmacy, Volume 53, Issue 17, 1 September 1996, Pages 2079–2081, https://doi.org/10.1093/ajhp/53.17.2079 Published: 01 September 1996

Obsessive-compulsive disorder (OCD) is a common heterogeneous psychiatric disorder manifesting with obsessions and compulsions. Obsessions are intrusive, recurrent, and persistent unwanted thoughts. Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to the obsessions. The heterogeneity of OCD includes themes of obsessions, types of rituals, presence or absence of tics, etiology, genetics, and response to pharmacotherapy. Complications of OCD include interpersonal difficulties, unemployment, substance abuse, criminal justice issues, and physical injuries. Areas of the brain involved in the pathophysiology include the orbitofrontal cortex, anterior cingulate gyrus, and basal ganglia. Overall, OCD may be due to a malfunction in the cortico-striato-thalamo-cortical circuit in the brain. Neurotransmitters implicated in OCD include serotonin, dopamine, and glutamate. Numerous drugs such as atypical antipsychotics and dopaminergic agents can cause or exacerbate OCD symptoms. The etiology includes genetics and neurological insults. Treatment of OCD includes psychotherapy, pharmacotherapy, electroconvulsive therapy, transcranial magnetic simulation, and in extreme cases surgery. Exposure and response prevention is the most effective form of psychotherapy. Selective serotonin reuptake inhibitors (SSRIs) are the preferred pharmacotherapy. Higher doses than listed in the package insert and a longer trial are often needed for SSRIs than compared to other psychiatric disorders. Alternatives to SSRIs include clomipramine and serotonin/norepinephrine reuptake inhibitors. Treatment of resistant cases includes augmentation with atypical antipsychotics, pindolol, buspirone, and glutamate-blocking agents.

Biowarfare has been used for centuries. The use of biological weapons in terrorism remains a threat. Biological weapons include infectious agents (pathogens) and toxins. The most devastating bioterrorism scenario would be the airborne dispersal of pathogens over a concentrated population area. Characteristics that make a specific pathogen a high-risk for bioterrorism include a low infective dose, ability to be aerosolized, high contagiousness, and survival in a variety of environmental conditions. The most dangerous potential bioterrorism agents include the microorganisms that produce anthrax, plague, tularemia, and smallpox. Other diseases of interest to bioterrorism include brucellosis, glanders, melioidosis, Q fever, and viral encephalitis. Food safety and water safety threats are another area of concern.

A total of 1,000 blood samples from patients suspected of having a bacteremia were analyzed concurrently, where possible, by three methods: (i) Trypticase soy broth with sodium polyanethol sulfonate and a CO2 atmosphere: (ii) pour plates with either brain heart infusion agar or Sabouraud dextrose agar; and (iii) centrifugation of the suspected organism in a hypertonic solution. There were 176 positive cultures. The centrifugation technique recovered 73% of the positive cultures. The broth and pour plate techniques recovered 38 and 49%, respectively. The centrifugation technique showed an increased isolation rate for Pseudomonas, fungi, and gram-positive cocci. In general, for each organism the time required for the detection of a positive culture was shortest for the centrifugation technique.

OBJECTIVE: Mountaineering and mountain-related sports are growing in popularity and are associated with significant risk of injury. There is a perception that mountaineers possess unique personality characteristics that attract them to the sport. We aim to determine whether there are any identifiable differences between the personality characteristics of experienced mountaineers and a normal control population and to determine whether there is an association between specific personality traits and risk of injury. METHODS: Questionnaires were utilized to obtain data on demographics, accidents, and personality characteristics from a population of experienced mountaineers. The Temperament and Character Inventory (TCI) was used, and the results were compared with normative data from age-matched controls. RESULTS: Forty-seven mountaineers from 8 different countries enrolled in the study. The mean age was 33 years, and 44 (90%) had been mountaineering for more than 5 years. Twenty-three climbers (49%) had been involved in a total of 33 accidents. Mountaineers scored higher on novelty seeking (P < .05) and self-directedness (P < .05) and lower on harm avoidance (P < .001) and self-transcendence (P < .001). There was a significant association between the character measure of cooperativeness and the total number (-.33, P < .05) and severity (-.475, P < .05) of accidents. CONCLUSIONS: Mountaineering is associated with significant risk of injury. Wide variation in the scores of personality traits suggests that there is not a tightly defined personality profile among mountaineers. Scores on cooperativeness may assist in determining risk of injury in mountaineers.

Background and Purpose. The purposes of this study were (1) to describe the disabilities of patients with pulmonary disease and (2) to examine the relationships among impairments, functional limitations, and disability, as described by the disablement process model. Subiects. Subjects were 154 patients with chronic pulmonary disease (64% female, 36% male; mean age=59 years, SD= 14, range=24-86). Methods. Information was abstracted from physical therapy records, including measurements of pulmonary impairment, &minute walk distance (GMWD), and Functional Status Questionnaire (FSQ scores. Multivariate analyses were used to examine the relationships among measurements of impairment, GMWD, and FSQ scores. Results. Mean FSQ scores ranged from 52.6 for instrumental activities of daily living to 83.3 for basic activities of daily living, where 100 represents the highest level of ability. Fifty percent of patients were not working because of health problems. Percentage of predicted 1-second forced expiratory volume (FEV, ) , oxyhemoglobin saturation, and the ratio of FEV, to forced vital capacity were related to 6hWD but not to FSQscores. The 6MWD was associated with scales of the FSQ including basic activities of daily living (R2=.24), instrumental activities of daily living (R2=.35), and social activity (R2=.26). Conclusion and Discussion. Patients entering a pulmonary rehabilitation program have clinically important disabilities. The results support the use of the disablement process model and suggest that different and important information is obtained from measurements of impairment, functional limitation, and disability in patients with pulmonary disease. [

This study gives voice to a unique group of youngsters who are observed and discussed frequently but rarely engaged in the debate about their development. Emerging research on the adjustment of children being raised by same-sex parents focuses on measuring achievements and outcomes. Missing from the literature are studies that capture the voice of the adolescent and his or her experience of growing up in same-sex parented families. These are the same individuals who are caught in the public eye amid a storm of political, legal, and social change. To expand the existing base of knowledge, 14 adolescents who range from 13 to 18 years of age were interviewed. This qualitative method of study allowed for each participant to explore their thoughts, feelings, and perceptions, thus creating an opportunity to assign meaning to their experiences. Study findings include themes of (1) Family Concepts, (2) Development of Self, (3) Tough Times and Tough Transitions, (4) Coming Out, and (5) Communities of Understanding. This unique perspective from inside the gay- or lesbian-parented family highlights topics that must be studied further.

INTRODUCTION: Bundling of services, typically into a 90-day episode of care, is intended to facilitate cost reduction. The purpose of this study was to determine the impact of a private insurance bundling program on the costs of outpatient total shoulder arthroplasty (TSA) at a freestanding ambulatory surgery center. METHODS: A cost minimization analysis was done of patients who had anatomic TSA by a single surgeon at a single freestanding ambulatory surgery center, including line-by-line comparisons of demographic and comorbidity factors for all patients treated within the 90-day episode of care. RESULTS: Seventy-six primary anatomic TSAs were included, 39 in the bundled group and 37 outside of the program. The bundled group was on average older (58 years) than the unbundled group (54 years, P = 0.021), but the groups were otherwise similar in demographics. The average total implant charges were significantly less for the bundled group ($24,822.43 versus $28,405.51, P = 0.014). Average total surgery supply charges and anesthesia supply charges were similar (P > 0.05). Mean total outpatient surgical day charges (implants, surgical, and anesthesia equipment) were significantly less for the bundled group ($29,782.43 versus $33,238.68, P = 0.022), as were average operating room staffing costs ($135.37 versus $162.55, P = 0.015). During the 90-day postoperative period, charges were similar. CONCLUSIONS: Primary anatomic TSA using a bundled care program in an outpatient setting coincides with markedly lower charges. The primary driver of this reduction is implant pricing, which is negotiated as part of the bundle. Surgeons must carefully analyze their unique practices in the changing economic health care environment when creating an outpatient TSA and/or bundling program. LEVEL OF EVIDENCE: Level III economic analysis.

Passive transfer of delayed hypersensitivity was achieved, with normal transfer factor, in patients with Hodgkin's disease in remission. The cellular immune responses of the recipients improved. It is suggested that, in addition to specific effect the transfer factor (or factors) has a nonspecific effect causing improvement in the state of delayed hypersensitivity of the recipient in general. The average number of E-rosette T lymphocytes was 46.3% after the transfer factor treatment in Hodgkin's disease. The control patients with Hodgkin's disease, not receiving transfer factor, had a value of 37.8%. Removal of 4.9 X 10(9) to 1.08 X 10(10) lymphocytes did not diminish the delayed hypersensitivity of the donor. Side effects attributable to transfer factor were not seen.

OBJECTIVE: Routine screening of cognitive function during a course of electroconvulsive therapy (ECT) is recommended in several guidelines. However, there is little evidence regarding which measures are practical, change early in treatment, and are likely to predict longer term cognitive problems. We aimed to investigate the practicality of early formal cognitive screening in routine clinical practice of ECT. METHODS: Thirty-three patients aged 25 to 84 years were recruited from 2 ECT clinics. Assessment consisted of the Rey Verbal Learning Test (RAVLT), The Short Form of the Colombia University Autobiographical Memory Interview, Digit Span Forwards and Backwards, and Modified Mini-Mental State Examination (3MSE) and was conducted at baseline, between the third and the fourth treatment of ECT and 2 months after the last treatment. Analysis examined which measures changed after 3 treatments and whether this correlated with change at the 2 month follow-up. RESULTS: After 3 treatments, there was a significant reduction in immediate (F1,27 = 14; P = 0.001) and 30-minute delayed (F1,25 = 34; P < 0.001) recall of the RAVLT. There was also a significant reduction in autobiographical memory score but no significant change in digit span or 3MSE. There was no correlation between reductions in scores on the RAVLT and The Short Form of the Colombia University Autobiographical Memory Interview, after 3 treatments and reductions at 2 month follow-up. CONCLUSIONS: This small pilot study suggests that significant changes in memory function can be detected as early as after 3 treatments of ECT and that such monitoring can be done in routine clinical practice. There was, however, no evidence that these changes correlated with longer term changes.

AIM: To examine demographic, morbidity, and mortality findings in a population of mountain climbers in New Zealand. METHODS: A baseline survey and a 4-year follow-up took place among a population of mountain climbers. The purpose of this survey was to determine the frequency and characteristics of mountain-climbing accidents and to estimate the climbing-related death rate. RESULTS: Forty-nine climbers enrolled in the study. Baseline findings revealed that 44 (90%) climbers had been involved in the sport for more than 5 years and 23 (47%) climbers had been involved in a total of 33 accidents. At 4-year follow-up, results were available on 46 (94%) climbers. There were nine further accidents and four deaths from climbing misadventure. CONCLUSION: Mountain climbing is associated with a high risk of serious injury and mortality.

INTRODUCTION: Our purpose was to determine whether the chronic use of preoperative narcotics adversely affected clinical and/or radiographic outcomes. METHODS: Seventy-three patients (79 shoulders) with primary total shoulder arthroplasty for osteoarthritis were evaluated clinically and radiographically at preoperative visits and postoperatively at a minimum follow-up of 2 years: 26 patients (28 shoulders) taking chronic narcotic pain medication for at least 3 months before surgery and 47 patients (51 shoulders) who were not taking narcotics preoperatively. RESULTS: Postoperatively, significant differences were noted between the narcotic and nonnarcotic groups regarding American Shoulder and Elbow Surgeons scores and visual analog scale scores, as well as forward elevation, external rotation, and all strength measurements (P < 0.01). The nonnarcotic group had markedly higher American Shoulder and Elbow Surgeons scores, better overall range of motion and strength, and markedly lower visual analog scale scores than the narcotic group. CONCLUSION: Chronic preoperative narcotic use seems to be a notable indicator of poor outcomes of anatomic total shoulder arthroplasty for glenohumeral osteoarthritis.

Alcoholism is described from a theoretical communications-interaction-al-transactional-systems viewpoint. The alcoholic uses his drunkenness and haplessness as a style of interaction; his spouse or other important person accepts it as the focus of interaction.

BARDAWIL, WADI A. M.D.; HERTIG, ARTHUR T. M.D.; VELARDO, JOSEPH T. Ph.D. Author Information

Attention-deficit/hyperactivity disorder (ADHD) is a neurobiological condition of childhood onset with the hallmarks of inattention, impulsivity, and hyperactivity. Inattention includes excessive daydreaming, disorganization, and being easily distracted. Impulsivity manifests as taking an action before fully thinking of the consequences. Hyperactivity includes an excessive rate of speech and motor activity. Complications of ADHD include academic failure, low self-esteem, poor work performance, substance abuse, criminal justice issues, and social problems. ADHD is predominately due to decreased activity in the frontal lobe. Dopamine and norepinephrine are the main neurotransmitters involved in the pathophysiology of ADHD. Pharmacological treatment of ADHD includes psychostimulants, norepinephrine reuptake inhibitors, α2 agonists, bupropion, and monoamine oxidase inhibitors. The most effective medications are the psychostimulants. Nonpharmacological treatment of ADHD includes coaching, providing structure, academic accommodations, and work accommodations.

Medium-term results of the Discovery elbow replacement are presented. We reviewed 51 consecutive primary Discovery total elbow replacements (TERs) implanted in 48 patients. The mean age of the patients was 69.2 years (49 to 92), there were 19 males and 32 females (37%:63%) The mean follow-up was 40.6 months (24 to 69). A total of six patients were lost to follow-up. Statistically significant improvements in range movement and Oxford Elbow Score were found (p < 0.001). Radiolucent lines were much more common in, and aseptic loosening was exclusive to, the humeral component. Kaplan-Meier survivorship at five years was 92.2% (95% CI 74.5% to 96.4%) for aseptic loosening. In four TERs, periprosthetic infection occurred resulting in failure. A statistically significant association between infection and increased BMI was found (p = 0.0268). Triceps failure was more frequent after the Mayo surgical approach and TER performed after previous trauma surgery. No failures of the implant were noted. Our comparison shows that the Discovery has early clinical results that are similar to other semi-constrained TERs. We found continued radiological surveillance with particular focus on humeral lucency is warranted and has not previously been reported. Despite advances in the design of total elbow replacement prostheses, rates of complication remain high.