Inhaled loxapine for acute agitation in a psychiatric emergency service.

BACKGROUND: Rapid control of agitation in medical settings is necessary for safety and provision of care. Inhaled loxapine achieves peak plasma levels within 2 minutes of administration and is FDA-approved for managing acute agitation. METHODS: We examined the use of inhaled loxapine vs non-parenteral treatment as usual (TAU) in a psychiatric emergency service for consecutive patients with acute agitation or aggression. Data were collected retrospectively. T tests were used for continuous variables and Chi-square tests were used for categorical data. RESULTS: A total of 61 patients received inhaled loxapine and 29 received TAU. Time to outcome for patients receiving inhaled loxapine was 21 ± 21 minutes compared with 121 ± 206 minutes for TAU (t =-2.61; P = .014). At outcome, 89% of patients treated with loxapine experienced symptom resolution, compared with 69% of TAU (Chi-square = 17.4, P < .0001). Ten percent of patients receiving loxapine had no change in symptoms and 1% had worsening symptoms vs 14% in the TAU group who experienced no change in symptoms (z = 0.5, not significant), and 17% who described worsening symptoms (z = 6153.9, P < .0001). CONCLUSIONS: The rapid absorption of inhaled loxapine is associated with a 6-fold faster and more robust symptom control.

Anatomical Association Between Schizophrenia and Cerebellum.

The pathogenesis of schizophrenia is rarely attributed to dysfunction of the cerebellum. However, coordination of mental processes might involve the cerebellum and a cortico-cerebellar-thalamic-cortical circuit (CCTCC) that can mediate that process has been proposed. We present the case of a 31-year-old male patient with a family history of psychosis who developed schizophrenia in association with a slow-growing glioblastoma at the left posterior cerebellar pontine angle. Of interest is that his psychosis became refractory after surgical removal of the tumor that had no motor deficit consequences, suggesting that the greater disruption of the CCTCC due to surgical excision might be related to the worsening psychosis. The case supports the hypothesis of cognitive dysmetria and psychosis.

Can in utero Zika virus exposure be a risk factor for schizophrenia in the offspring?

Objectives: Schizophrenia is a severe psychiatric illness that has been purported to be causally related to in utero infection of neurotropic organisms. For obvious ethical reasons, this hypothesis has never been tested prospectively in humans. However, with the recent introduction of Zika virus into the New World offers the opportunity to test the hypothesis of infection in schizophrenia.Methods: This is a directed review examining the hypothesis. The literature relevant to Zika virus transmission in the New World, its biology and neurotropy is reviewed.Results: Zika virus has been associated with a wide variety of neural tube and neuroanatomical abnormalities. In its original range, Zika is only infrequently associated with congenital anomalies, but in the New World, where the majority of the population has not developed immunity, infections are associated with a wide range of neurologic abnormalities.Conclusions: The current outbreak of Zika virus in the Western Hemisphere, offers the opportunity to prospectively examine the congenital infection hypothesis of the pathogenesis of schizophrenia.

Synthetic Cannabinoids-"Spice" Can Induce a Psychosis: A Brief Review.

Synthetic cannabinoids, popularly called Spice, are common drugs of abuse in the United States. They are utilized as a substitute for marijuana, primarily for their psychoactive properties. Consumption has been rapidly increasing due to recreational effects, easy accessibility, and not being detectable by urine drug screening tests. The side effect profile of synthetic cannabinoids involves many organs and is not well known to the public. Psychoses are a common adverse result from their consumption. Primary care physicians and other medical professionals should consider synthetic cannabinoid consumption in the differential diagnoses of a patient presenting with psychosis.

Cardiac Glycosides in Human Physiology and Disease: Update for Entomologists.

Cardiac glycosides, cardenolides and bufadienolides, are elaborated by several plant or animal species to prevent grazing or predation. Entomologists have characterized several insect species that have evolved the ability to sequester these glycosides in their tissues to reduce their palatability and, thus, reduce predation. Cardiac glycosides are known to interact with the sodium- and potassium-activated adenosine triphosphatase, or sodium pump, through a specific receptor-binding site. Over the last couple of decades, and since entomologic studies, it has become clear that mammals synthesize endogenous cardenolides that closely resemble or are identical to compounds of plant origin and those sequestered by insects. The most important of these are ouabain-like compounds. These compounds are essential for the regulation of normal ionic physiology in mammals. Importantly, at physiologic picomolar or nanomolar concentrations, endogenous ouabain, a cardenolide, stimulates the sodium pump, activates second messengers, and may even function as a growth factor. This is in contrast to the pharmacologic or toxic micromolar or milimolar concentrations achieved after consumption of exogenous cardenolides (by consuming medications, plants, or insects), which inhibit the pump and result in either a desired medical outcome, or the toxic consequence of sodium pump inhibition.

Sexual behavior in patients with bipolar illness.

BACKGROUND: There is a dearth of information regarding sexual behavior in patients with bipolar illness. METHODS: A questionnaire regarding sexual and reproductive behavior was administered to all willing attendees of an academic bipolar clinic. Information regarding onset, maintenance, and nature of sexual behaviors, as well as marriage and children, was collected. RESULTS: Patients with bipolar disorder have less children on average (1.6) than the U.S. general population (1.87). Patients were 3 times more likely to have planned children before diagnosis than after; however, the average number of unplanned children remained the same before and after diagnosis. In the U.S., 55.7% of those age 18 and older are married, compared with 32.8% among bipolar patients. The majority of patients, 52.9%, believed that stigma towards bipolar illness had affected relationships, and 32.4% believed that stigma affected finding sexual partners, but measurement of subjective stigma did not correlate with reproductive success. CONCLUSIONS: Individuals with bipolar illness have a wide range of sexual experiences. However, reproductive success of people diagnosed with bipolar illness is limited.

How to Stop Smoking.

Despite the known dangers of cigarette smoking, many smokers do not use effective means for cessation. Smoking-cessation guidelines recommend a variety of psychological and medicinal options that include nicotine-replacement products, pharmaceuticals, and electronic cigarettes. This article describes these smoking-cessation options and provides guidance for physicians.

SOCS-1 rescues IL-1ß-mediated suppression of epithelial sodium channel in mouse lung epithelial cells via ASK-1.

BACKGROUND: Acute lung injury (ALI) is characterized by alveolar damage, increased levels of pro-inflammatory cytokines and impaired alveolar fluid clearance. Recently, we showed that the deletion of Apoptosis signal-regulating kinase 1 (ASK1) protects against hyperoxia-induced acute lung injury (HALI) by suppressing IL-1ß and TNF-α. Previously, our data revealed that the suppressor of cytokine signaling-1 (SOCS-1) overexpression restores alveolar fluid clearance in HALI by inhibiting ASK-1 and suppressing IL-1ß levels. Furthermore, IL-1ß is known to inhibit the expression of epithelial sodium channel α-subunit (ENaC) via a p38 MAPK signaling pathway. OBJECTIVE: To determine whether SOCS-1 overexpression in MLE-12 cells would protect against IL-1ß-mediated depletion of αENaC by suppressing ASK-1 expression. METHODS: We co-transfected MLE-12 cells with SOCS-1 overexpressing plasmid with or without IL-1ß in the presence or absence of sodium channel inhibitor, amiloride. We measured potential difference, transepithelial current, resistance, and sodium uptake levels across MLE-12 cells. We studied the effect of ASK-1 depletion, as well as ASK-1 and SOCS-1 overexpression on αENaC expression. RESULTS: SOCS-1 overexpression sufficiently restored transepithelial current and resistance in MLE-12 cells treated with either IL-1ß or amiloride. The αENaC mRNA levels and sodium transport were increased in SOCS-1 overexpressing MLE-12 cells exposed to IL-1ß. Depletion of ASK-1 in MLE-12 cells increased αENaC mRNA levels. Interestingly, SOCS-1 overexpression restored αENaC expression in MLE-12 cells in the presence of ASK-1 overexpression. CONCLUSION: Collectively, these findings suggest that SOCS-1 may exert its protective effect by rescuing αENaC expression via suppression of ASK-1.

What can we do about the Zika virus in the United States?

Control measures include using insect repellents, aerial spraying of insecticides, eliminating mosquito breeding sites, covering water tanks, and using mosquito nets or door and window screens. Infection during pregnancy is the greatest concern because of congenital anomalies (including microcephaly) that negatively affect brain development.