Dopamine partial agonists: a discrete class of antipsychotics.

Worldwide, there are now three marketed dopamine D2 partial agonists: aripiprazole, brexpiprazole and cariprazine. These three drugs share a number of properties other than their action at D2 receptors. Pharmacologically, they are 5HT2 antagonists and D3 and 5HT1A partial agonists but with little or no alpha-adrenergic, anticholinergic or antihistaminic activity. They also share a long duration of action. Clinically, D2 partial agonists are effective antipsychotics and generally have useful antimanic and antidepressant activity. They are usually well tolerated, causing akathisia and insomnia only at the start of treatment, and are non-sedating. These drugs also share a very low risk of increased prolactin and of weight gain and accompanying metabolic effects. They may also have a relatively low risk of tardive dyskinesia. There is some evidence that they are preferred by patients to dopamine antagonists. Individual dopamineD2 partial agonists have much in common and as a group they differ importantly from dopamine D2 antagonists. Dopamine D2 partial agonists should be considered a distinct class of antipsychotics.Key pointsD2 partial agonists share many pharmacological and clinical propertiesD2 partial agonists differ in several important respects from D2 antagonistsD2 partial agonists should be considered a discrete class of antipsychotics.

Past climate, future perspective: an exploratory analysis using climate proxies and drought risk assessment to inform water resources management and policy in Maine, USA.

In recent decades, significant progress has been made toward reconstructing the past climate record based on environmental proxies, such as tree rings and ice core records. However, limited examples of research that utilizes such data for water resources decision-making and policy exist. Here, we use the reconstructed record of Palmer Drought Severity Index (PDSI), dating back to 1138AD to understand the nature of drought occurrence (severity and duration) in the state of Maine. This work is motivated by the need to augment the scientific basis to support the water resources management and the emerging water allocation framework in Maine (Maine Department of Environmental Protection, Chapter 587). Through a joint analysis of the reconstructed PDSI and historical streamflow record for twelve streams in the state of Maine, we find that: (a) the uncertainties around the current definition of natural drought in the Chapter 587 (based on the 20th century instrumental record) can be better understood within the context of the nature and severity of past droughts in this region, and (b) a drought index provides limited information regarding at-site hydrologic variations. To fill this knowledge gap, a drought index-based risk assessment methodology for streams across the state is developed. Based on these results, the opportunities for learning and challenges facing water policies in a changing hydroclimate are discussed.

Diet, smoking and cardiovascular risk in schizophrenia in high and low care supported housing.

BACKGROUND: People suffering from schizophrenia have markedly increased physical morbidity and mortality. A poor diet and sedentary lifestyle make a significant contribution to this ill health. Healthcare professionals need to include assessments of diet and to promote a 'healthy living' lifestyle. AIMS: To describe the dietary habits and cardiovascular risk factors of people with chronic schizophrenia living in supported accommodation and to audit the provision of cardiovascular health screening in this population. METHOD: The dietary habits of 69 people with chronic schizophrenia living in community settings were assessed. Tobacco smoking, body mass indices and waist circumference were also measured. The dietary behaviour of patients living in high care settings with care staff present every day was compared with those in low care settings. RESULTS: Residents in both levels of care made poor dietary choices. Patients in high care were consuming more fast food than those in low care. The dietary habits of men and women in both levels of care were worse than reported by surveys of the general population in England. All patients had seen their GP in the previous year though only 3 had received diabetes screening and fewer than half had lipid profiles. CONCLUSIONS: People with schizophrenia do not improve their diet just by the provision of healthy food as was the case in high care settings. Secondary care services must address physical health monitoring as well as mental health if the increased mortality of patients with schizophrenia is to be addressed effectively. More effective interventions are necessary to improve and sustain a healthy diet.