Supersensitivity psychosis in a case with clozapine tolerance.

Despite its serious side effects, clozapine is still the golden standard in treatment of schizophrenia due to its effectiveness and lack of extrapyramidal side effects. Some studies have mentioned withdrawal symptoms, including withdrawal psychosis after stopping clozapine, and have tried to explain this severe symptom through dopamine receptor supersensitivity. This phenomenon, called supersensitivity psychosis, can be explained by the development of tolerance towards the effect of the medication. In literature, there are several cases of supersensitivity psychosis while using other neuroleptics. However, to our knowledge, there are no published cases reporting an association between clozapine and supersensitivity psychosis. The current patient, who has been diagnosed as resistant schizophrenia, responded well to the clozapine in the beginning of treatment. Due to an effective dose of clozapine, he had psychotic exacerbation with significant positive symptoms. We discuss the probable reasons causing this situation and the relationship between tolerance to the treatment effect and the dopamine supersensitivity.

Checkerboard self-patterning of an ionic liquid film on mercury.

Å-resolution studies of room temperature ionic liquid (RTIL) interfaces are scarce, in spite of their long-recognized importance for the science and many applications of RTILs. We present an Å-resolution x-ray study of a Langmuir film of an RTIL on mercury. At low (high) coverage [90 (50) Å2/molecule] a mono-(bi)layer of surface-parallel molecules is found. The molecules self-assemble in a lateral ionic checkerboard pattern, unlike the uniform-charge, alternate-ion layers of this RTIL at its bulk-solid interface. A 2D-smectic order is found, with molecules packed in parallel stripes, forming long-range order normal to, but none along, the stripes.

Surface layering at the mercury-electrolyte interface.

X-ray reflectometry reveals atomic layering at a liquid-liquid interface--mercury in a 0.01 M NaF solution. The interface width exceeds capillary wave theory predictions and displays an anomalous dependence on the voltage applied across it, displaying a minimum positive of the potential of zero charge. The latter is explained by electrocapillary effects and an additional intrinsic broadening of the interface profile, tentatively assigned to polarization of the conduction electrons due to the electric field of the electrochemical double layer at the interface.

The 5/95 Gap on the dissemination of mental health research: The World Psychiatric Association (WPA) task force report on project with editors of low and middle income (LAMI) countries.

The World Psychiatric Association (WPA) Task Force and a small group previously convened by the WPA publications committee initiated three activities between 2006-2008 that aimed to respond to the need for greater support for psychiatry journals in LAMI countries. In a joint venture with participants from the Global Mental Health Movement the Task Force editors from LAMI countries in Africa, Asia, Eastern Europe and Latin America were contacted to identify potential journals to target for indexation (Medline and ISI). The committee analyzed the editors' applications on the following criteria: a) geographical representativeness; b) affiliation to a professional mental health society; c) regular publication of at least 4 issues per year over the past few years; d) comprehensive national and international editorial boards; e) publication of original articles, or at least abstracts, in English; f) some level of current indexation; g) evidence of a good balance between original and review articles in publications; and h) a friendly access website. The committee received 26 applications (11 from Latin America, 7 from Central Europe, 4 from Asia and 4 from Africa), and selected 8 journals, 2 from each geographical area, on the basis of the overall scores obtained for the items mentioned, to participate in an editors meeting held in Prague in September 2008. The aims of the committee are twofold: a) to concentrate support for those selected journals; and b) to assist all LAMI mental health editors in improving the quality of their journals and fulfilling the requirements for full indexation. This report summarizes the procedures conducted by the committee, the assessment of the current non-indexed journals, and offers suggestions for further action.

Langmuir films of chiral molecules on mercury.

Homo- and heterochiral Langmuir films of a chiral derivative of stearic acid are studied in situ on the surface of liquid mercury as a function of surface coverage by surface tensiometry and surface-specific synchrotron X-ray diffraction and reflectivity. A transition from a phase of surface-parallel molecules to a phase of standing-up molecules is found. The former shows no surface-parallel long-range order. The standing-up phase of both homochiral and heterochiral compositions exhibit long-range order. However, the former has an oblique unit cell with parallel molecular planes, and the later has a centered rectangular unit cell with a herringbone molecular packing. For both cases, the standing-up molecules are tilted by 44 degrees from the surface normal and pack at a density of 19.5 A(2)/molecule in the plane normal to the molecular long axis. Important differences are found, and discussed, between this behavior and that of a Langmuir film of the nonchiral stearic acid on mercury.

Post-stroke sexual functioning in first stroke patients.

BACKGROUND AND PURPOSE: Although physical problems after stroke have been well studied, there is little information on one of the crucial aspects of the quality of life of those patients, namely sexual functioning and satisfaction. The aim of this study was to assess the impact of stroke on sexual functioning in a stable cohort of Turkish stroke patients with mild or no disability and to assess the relationship between post-stroke sexuality and a number of socio-demographic, clinical and laboratory variables. METHODS: The sexual functioning of 103 Turkish stroke patients with no disability or mild disability was assessed in two consecutive interviews along with clinical and sociodemographic features. NIH stroke, Glasgow coma, Barthel, and Rankin scales were also applied to assess neurologic status and disability. RESULTS: Most of the patients were male (61%) and illiterate (70%). There was a significant difference between the baseline and post-stroke frequency of sexual activity of the patients. The differences between baseline and post-stroke vaginal lubrication, orgasms and satisfaction were all statistically significant. This latter difference was significant for both genders. Frequency of coitus both prior to and after the stroke was significantly different between males and females. Erection and ejaculation of the males was significantly affected by the stroke, and lubrication and orgasm was affected in the females. Interestingly, fear of recurrent stroke did not differ between genders. DISCUSSION AND CONCLUSION: Our study has shown that Turkish stroke survivors have sexual health needs during the rehabilitation process, though this has not been addressed previously. Sexual health needs seem to be affected by cultural factors and biases.

Wetting, mixing, and phase transitions in Langmuir-Gibbs films.

Millimolar bulk concentrations of the surfactant cetyltrimethylammonium bromide (CTAB) induce spreading of alkanes, H(CH(2))(n)H (denoted C(n)) 12< or =n< or =21, on the water surface, which is not otherwise wet by these alkanes. The novel Langmuir-Gibbs film (LGF) formed is a liquidlike monolayer comprising both alkanes and CTAB tails. Upon cooling, an ordering transition occurs, yielding a hexagonally packed, quasi-2D crystal. For 11< or =n< or =17 this surface-frozen LGF is a crystalline monolayer. For 18< or =n< or =21 the LGF is a bilayer with a crystalline, pure-alkane, upper monolayer, and a liquidlike lower monolayer. The phase diagram and film structure were determined by x-ray, ellipsometry, and surface tension measurements. A thermodynamic theory accounts quantitatively for the observations.

Alkyl-thiol Langmuir films on the surface of liquid mercury.

The coverage dependent phase behavior of monolayers of alkyl thiols (CH3(CH2)(n-1)SH, denoted as CnSH) on mercury was studied for chain lengths 9

The surface structure of concentrated aqueous salt solutions.

The surface-normal electron density profile rhos(z) of concentrated aqueous salt solutions of RbBr, CsCl, LiBr, RbCl, and SrCl2 was determined by x-ray reflectivity (XR). For all but RbBr and SrCl2 rhos(z) increases monotonically with depth z from rhos(z)=0 in the vapor (z<0) to rhos(z)=rhob of the bulk (z>0) over a width of a few angstroms. The width is commensurate with the expected interface broadening by thermally excited capillary waves. Anomalous (resonant) XR of RbBr reveals a depletion at the surface of Br- ions to a depth of approximately 10 A. For SrCl2, the observed rhos(z)>rhob may imply a similar surface depletion of Cl- ions to a depth of a few angstorms. However, as the deviations of the XRs of RbBr and SrCl2 from those of the other solutions are small, the evidence for a different ion composition in the surface and the bulk is not strongly conclusive. Overall, these results contrast earlier theoretical and simulational results and nonstructural measurements, where significant surface layering of alternate, oppositely charged, ions is concluded.

Surface freezing in binary alkane-alcohol mixtures.

Surface freezing was detected and studied in mixtures of alcohol and alkane molecules, using surface tensiometry and surface-specific x-ray scattering methods. Considering that surface freezing in pure alkanes forms an ordered monolayer and in alcohols it forms an ordered bilayer, the length mismatch repulsion was minimized by varying the carbon number of the alkane component around 2n, where n is the carbon number of the alcohol molecule. A solutionlike behavior was found for all mixtures, where the ideal liquid mixture phase-separates upon freezing both in the bulk and the surface. The solid exhibits a herringbone crystalline phase below an alkane mole fraction phi(t) approximately 0.8 and a rotator phase above it. The surface frozen film below phi(t) is an alkane monolayer exhibiting a next-nearest neighbor molecular tilt of a composition-dependent magnitude. Above phi(t), no diffraction peaks were observed. This could be explained by the intrinsically shorter-range order of the rotator phase and a possible proliferation of defects.

Crystalline phases of alkyl-thiol monolayers on liquid mercury.

The structure of octadecanethiol monolyers on liquid Hg surfaces, measured with subangstrom resolution, evolves with increasing coverage from a laterally disordered phase of surface-parallel molecules to ordered rotator phases of surface-normal molecules. For the latter, an abrupt transition is found at 19 A(2)/molecule from a rectangular packing of molecules tilted by 27 degrees in the nearest-neighbor direction to a hexagonal unit cell of untilted molecules. The unit cell of the tilted phase is centered for the chains and noncentered for the headgroups. The thiol headgroups associate in pairs with a single Hg atom, and the bonds form long-range orientational order. The different order of thiols on Au(111) and on Hg highlights the subphase's role in determining the overlayer's structure.

Temperature dependence of the structure of Langmuir films of normal-alkanes on liquid mercury.

The temperature dependent phase behavior of Langmuir films of n-alkanes [CH3(CH2)(n-2)CH3, denote Cn] on mercury was studied for chain lengths 19< or =n< or =22 and temperatures 15< or =T< or =44 degrees C, using surface tensiometry and surface x-ray diffraction methods. In contrast with Langmuir films on water, where molecules invariably orient roughly surface normal, alkanes on mercury are always oriented surface parallel and show no long-range in-plane order at any surface pressure. A gas and several condensed phases of single, double, and triple layers of lying-down molecules are found, depending on n and T. At high coverages, the alkanes studied here show transitions from a triple to a double to a single layer with increasing temperature. The transition temperature from a double to a single layer is found to be approximately 5 degrees C, lower than the bulk rotator-to-liquid melting temperature, while the transition from a triple to a double layer is about as much below the double-to-single layer transition. Both monolayer and bulk transition temperatures show a linear increase with n with identical slopes of approximately 4.5 degrees C/CH2 within the range of n values addressed here. It is suggested that the film and bulk transitions are both driven by a common cause: the proliferation of gauche defects in the chain with increasing temperature.

Fatty acid Langmuir films on liquid mercury: X-ray and surface tension studies.

The structure and phase behavior of liquid-mercury-supported molecular films of fatty acids (CH3(CH2)n-2COOH, denoted CnOOH) were studied for molecular lengths 7 < or = n < or = 24, by surface tensiometry and X-ray methods. Two qualitatively different film structures were found, depending on coverage. For high coverage, the film consists of a monolayer of roughly surface-normal molecules, showing a pressure-dependent sequence of structures similar, though not identical, to that of the corresponding water-supported Langmuir films. At low coverage, phases consisting of surface-parallel molecules are found, not observed on the aqueous subphases employed to date. In this range, a two-dimensional (2D) gas followed by a single and, for 14 < or = n < or = 24, also by a double layer of surface-parallel molecules is found as coverage is increased. Depending on chain length, the flat-lying phases have a crystalline 2D-ordered, a smectic-like 1D-ordered, or a disordered in-plane structure consisting of molecular dimers. The structure and thermodynamics of the films are discussed.

The structure and phase diagram of Langmuir films of alcohols on mercury.

The coverage-dependent phase behavior of molecular films of alcohols (CH3(CH2)n-2CH2OH, denoted as CnOH) on mercury was studied for chain lengths 8 < or = n < or = 28, using surface tensiometry and surface specific X-ray methods. Phases with surface-normal-oriented molecules are found at high coverage, showing the CS, S, and LS phases found also on water. Phases comprising surface parallel molecules, which do not exist on water, are found here at low coverage. For the lowest coverage a two-dimensional gas phase is found, followed, upon increasing the coverage, by an n-dependent sequence of condensed phases of up to four layers of surface-parallel molecules before converting to the surface-normal phases. In contrast with the surface-normal phases, all of the surface-parallel phases are found to lack long-range order in the surface-parallel direction. Adsorption energies are derived from the phase diagram for the alkyl chain and the alcohol headgroup.

Suicide during clozapine treatment: a case report.

The risk of suicide among patients with schizophrenia is greater than that in the general population. Although clozapine, along with its other significant features, has been reported to decrease suicidality and suicide rate among schizophrenia patients, physicians should remain vigilant for general risk factors of suicide in patients with schizophrenia during a treatment course and assess them carefully. Awareness of the effect of the illness, a sense of inadequacy to achieve goals, a change in the course of the illness, an improvement after relapse and a proposed discharge from the hospital in the near future are factors that should be noted especially within these general risk factors for suicide. In this case report, we presented a schizophrenia patient with several risk factors who committed suicide during clozapine treatment. Risk factors prominent in this case including increased awareness after improvement in chronic state, planned discharge in the near future, and the notion of reduced suicidality in schizophrenia patients during clozapine treatment are discussed in this article based on the literature and the case.

Association between idiopathic mitral valve prolapse and panic disorder.

AIM: To evaluate the association between idiopathic mitral valve prolapse and panic disorder. METHODS: The study comprised 50 patients with idiopathic mitral valve prolapse, 50 patients with panic disorder, and 50 healthy controls. All subjects underwent echocardiographic evaluation. If idiopathic mitral valve prolapse was present, the level of prolapse was measured. To reach psychiatric diagnosis, the Structured Clinical Interview for DSM-IV Axis I Disorders, clinician version, was administered to all subjects. For psychometric evaluation, all subjects completed the Symptom Check List, Beck Depression Inventory, and State and Trait Anxiety Inventory. RESULTS: The prevalence of panic disorder was 16% in patients with idiopathic mitral valve prolapse, and 2% in healthy controls (p=0.03). The average scores on all psychometric scales were the highest in the panic disorder group, whereas average scores in idiopathic mitral valve prolapse group were significantly higher than in the control group (p<0.001). Idiopathic mitral valve prolapse and panic disorder groups displayed similar features of panic attack symptoms. Panic disorder cases with idiopathic mitral valve prolapse and those without it did not significantly differ in terms of psychometric evaluations and clinical symptoms. CONCLUSION: The possibility of comorbidity of panic disorder and idiopathic mitral valve prolapse should be taken into account in the approach to the patients diagnosed with either of the disorders.