Optic disc dose reduction in ocular brachytherapy using 125 I notched COMS plaques: A simulation study based on current clinical practice.

PURPOSE: Although notched Collaborative Ocular Melanoma Study (COMS) plaques have been widely used, optic disc dose reduction by notched COMS plaques has not been discussed in the literature. Therefore, this study investigated optic disc dose reduction in ocular brachytherapy using 125 I notched COMS plaques in comparison with optic disc dose for 125 I standard COMS plaques. METHODS: For this simulation study, an in-house brachytherapy dose calculation program was developed using MATLAB software by incorporating the American Association of Physicists in Medicine Task Group-43 Update (AAPM TG-43U1) dosimetry formalism with a line source approximation in a homogeneous water medium and COMS seed coordinates in the AAPM TG 129. Using this program, optic disc doses for standard COMS plaques (from 12 to 22 mm in diameter in 2 mm increments) and notched COMS plaques with one seed removed (Case #1, from 12 to 22 mm) and with two seeds removed (Case #2, from 14 to 22 mm) were calculated as a function of tumor margin-to-optic disc distance (DT) for various tumor basal dimensions (BDs) for prescription depths from 1 to 10 mm in 1 mm intervals. A dose of 85 Gy for an irradiation time of 168 h was prescribed to each prescription depth. Then absolute and relative optic disc dose reduction by notched COMS plaques (Cases #1 and #2) was calculated for all prescription depths. RESULTS: Optic disc dose reduction by notched COMS plaques (Cases #1 and #2) had five unique trends related to maximum optic disc dose reduction and corresponding optimal DT for each BD in each plaque. It increased with increasing prescription depth. CONCLUSIONS: The results presented in this study would enable the clinician to choose an adequate plaque type among standard and notched 125 I COMS plaques and a prescription depth to minimize optic disc dose.

Nitrogen-doped carbon nanodots prepared from polyethylenimine for fluorometric determination of salivary uric acid.

Stable and low-cost carbon dots (C-dots) were prepared from polyethylenimine (PEI) by a hydrothermal method. It is found that the fluorescence of the C-dots (best measured at excitation/emission wavelengths of 365/473 nm) is quenched by selective oxidation of surface PEI by periodate but recovers in the presence of uric acid (UA). It is assumed that this is due to the selective reduction of the nitrone groups to hydroxylamine groups by UA. The findings were used to design a fluorometric method for determination of UA that has a 2.3 nM detection limit. This is lower than that of reported fluorometric and enzymatic assays. The performance of the method has been validated by determination of UA in samples of human saliva. It is found that the results agree well with those obtained by a commercial UA assay. Graphical abstract Schematic presentation of the polyethylenimine (PEI) carbon nanodots (C-dots) as a fluorescent probe for uric acid. Their fluorescence is quenched by periodate (IO4-) due to oxidative formation of nitrone groups, an subsequently restored due to reduction by uric acid (UA).

Effect of auricular acupressure for postpartum insomnia: an uncontrolled clinical trial.

AIMS AND OBJECTIVES: This study examined the effects of auricular acupressure therapy on women with postpartum insomnia. BACKGROUND: Postpartum women generally have poor sleep quality because of frequent night-time breastfeeding during the first month after giving birth. DESIGN: A one-group pretest/post-test quasi-experiment was conducted. METHODS: A convenience sampling method was used to recruit participants at a postpartum centre (doing-the-month centre) in Northern Taiwan, from January 2014-July 2014. Thirty women with postpartum insomnia received auricular acupressure therapy on one auricular point (Shenmen point pressing) four times a day for 14 days. The Chinese version of the Pittsburgh Sleep Quality Index was used to assess sleep quality before and after the 14-day treatment. RESULTS: After the 14-day auricular acupressure treatment, the Pittsburgh Sleep Quality Index total scores of the women decreased from 8·7 (pretest) to 5·57 (post-test, 36% reduction). Scores on the subscales of the Pittsburgh Sleep Quality Index, including sleep quality, sleep latency, sleep duration and sleep disturbance, also statistically improved (p < 0·05). CONCLUSIONS: Hormone changes and frequent breastfeeding were identified as characteristics that may exacerbate poor sleep quality of postpartum women, for whom the auricular acupressure intervention may effectively improve sleep quality. RELEVANCE TO CLINICAL PRACTICE: Auricular acupressure can be an alternative complementary therapy to aid postpartum women with insomnia in improving sleep quality.

Benzodiazepine prescription among patients with severe mental illness and co-occurring alcohol abuse/dependence in Taiwan.

OBJECTIVE: Because benzodiazepines (BZDs) may be abused, prescribing them is debatable. The purpose of this study was to investigate the prescription of BZDs to explore the current status of BZD use at discharge and at 4 months after discharge. METHODS: From 1 January 2006 to 31 December 2006, prescribed doses for BZDs at discharge and at 4 months after discharge were recorded for all discharged inpatients with schizophrenia, bipolar I disorder, and major depressive disorder. Two­way analysis of variance was used to analyze the effects of severe mental illness and co­occurring alcohol abuse/dependence on BZD doses at discharge and at 4 months after discharge. RESULTS: Patients with severe mental illness prescribed with significantly higher rates and higher doses of BZDs at discharge and at 4 months after discharge are more likely to have major depressive disorder and to have co­occurring alcohol abuse/dependence problems. No significant interactions were found between severe mental illness and co­occurring alcohol abuse/dependence. CONCLUSIONS: These findings suggest that caution should be applied in prescribing BZDs to patients with severe mental illness, particularly those with major depressive disorder and co­occurring alcohol abuse/dependence. Future studies require being conducted in many different mental health­care systems in Taiwan to generalize the findings.

Optic Disc Dose Comparison Between 125I and 103Pd Collaborative Ocular Melanoma Study (COMS) Plaques Based on Current Clinical Practice.

Purpose The purpose of this study is to compare optic disc dose (ODD) between 125I and 103Pd Collaborative Ocular Melanoma Study (COMS) plaques in ocular brachytherapy. Methods A previously validated in-house brachytherapy dose calculation program was used for ODD calculations. ODD was calculated as a function of tumor margin-to-optic disc distance (DT) up to 5 mm for various tumor basal dimensions (BDs), for a prescription depth of 5 mm, and for standard and notched COMS plaques loaded with 125I (model: IAI-125A) and 103Pd (model: IAPd-103A) seeds. ODD calculations were repeated for prescription depths from 2 mm to 10 mm in 1 mm intervals. A prescribed dose of 85 Gy (irradiation time: 120 hours) was normalized to each prescription depth. Dose conversion factors (DCFs) for each prescription depth were calculated by taking a ratio of [total reference air kerma (TRAK) per seed]prescription depth to [TRAK per seed]5 mm. ODD reduction by notched COMS plaques was calculated for each prescription depth by subtracting ODD for notched COMS plaques from ODD for standard COMS plaques. Results Trends of ODD as a function of DT for various BDs are similar between the two seed types in both standard and notched COMS plaques. However, due to the energy difference, there exists a transition distance (dt) for each BD in each plaque at which ODD for 125I COMS plaques equals that for 103Pd COMS plaques. For small BDs, at DT dt, the opposite is observed. For the largest 1-3 BD(s), contrarily, dt occurs within the tumor, and thus, ODD for 125I COMS plaquesis always higher. Trends of ODD reduction by notched COMS plaques as a function of DT for various BDs are the same for the two seed types except that maximum ODD reduction by 103Pd COMS notched plaques is larger. DCF increases with increasing prescription depth for both seed types. Conclusions There exist ODD differences between 125I and 103Pd COMS plaques and the differences depend on DT, BD, plaque size, and prescription depth.

Factors affecting time to rehospitalization in Han Chinese patients with schizophrenic disorder in Taiwan.

Schizophrenic disorder is a lifelong illness. Hospitalization is a major event for the patient and his/her family, often indicating that the clinical symptoms have reached an intolerable level. The purpose of this study was to investigate the risk factors affecting the time to rehospitalization. Rehospitalization status was monitored for all schizophrenic patients discharged from Kai-Suan Psychiatric Hospital from January 1, 2002 to December 31, 2002. Patients were followed-up regarding rehospitalization until December 31, 2003. The Kaplan-Meier method was used to calculate the mean time to rehospitalization. Risk factors associated with rehospitalization were examined by Cox proportional hazards regression model. Three hundred and thirty-six patients were recruited for this study. The mean time to rehospitalization was 239 +/- 7 days, with a rehospitalization rate of 54.5%. The mean time to discontinuation was 329 +/- 5 days. Age at onset (hazard ratio = 0.978, 95% CI = 0.959-0.998, p = 0.031) and the number of previous hospitalizations (hazard ratio = 1.108, 95% CI = 1.058-1.161, p < 0.001) were found to be risk factors of shorter time to rehospitalization within 1 year after discharge. Further research should be carried out to test risk factors in a prospective study, and to assess the cost-effectiveness of interventions to prevent rehospitalization.

A practical approach to estimating optic disc dose and macula dose without treatment planning in ocular brachytherapy using 125I COMS plaques.

BACKGROUND: It has been reported that proximity of the tumor to the optic disc and macula, and radiation dose to the critical structures are substantial risk factors for vision loss following plaque brachytherapy. However, there is little dosimetry data published on this. In this study, therefore, the relationship between distance from tumor margin and radiation dose to the optic disc and macula in ocular brachytherapy using 125I Collaborative Ocular Melanoma Study (COMS) plaques was comprehensively investigated. From the information, this study aimed to allow for estimation of optic disc dose and macula dose without treatment planning. METHODS: An in-house brachytherapy dose calculation program utilizing the American Association of Physicists in Medicine Task Group-43 U1 formalism with a line source approximation in a homogenous water phantom was developed and validated against three commercial treatment planning systems (TPS). Then optic disc dose and macula dose were calculated as a function of distance from tumor margin for various tumor basal dimensions for seven COMS plaques (from 10 mm to 22 mm in 2 mm increments) loaded with commercially available 125I seeds models (IAI-125A, 2301 and I25.S16). A prescribed dose of 85 Gy for an irradiation time of 168 h was normalized to a central-axis depth of 5 mm. Dose conversion factors for each seed model were obtained by taking ratios of total reference air kerma per seed at various prescription depths (from 1 mm to 10 mm in 1 mm intervals) to that at 5 mm. RESULTS: The in-house program demonstrated relatively similar accuracy to commercial TPS. Optic disc dose and macula dose decreased as distance from tumor margin and tumor basal dimension increased. Dose conversion factors increased with increasing prescription depth. There existed dose variations (<8%) among three 125I seed models. Optic disc dose and macula dose for each COMS plaque and for each seed model are presented in a figure format. Dose conversion factors for each seed model are presented in a tabular format. CONCLUSIONS: The data provided in this study would enable clinicians in any clinic using 125I COMS plaques to estimate optic disc dose and macula dose without dose calculations.

Early prediction of olanzapine-induced weight gain for schizophrenia patients.

The aim of this study was to determine whether weight changes at week 2 or other factors predicted weight gain at week 6 for schizophrenia patients receiving olanzapine. This study was the secondary analysis of a six-week trial for 94 patients receiving olanzapine (5 mg/d) plus trifluoperazine (5 mg/d), or olanzapine (10 mg/d) alone. Patients were included in analysis only if they had completed the 6-week trial (per protocol analysis). Weight gain was defined as a 7% or greater increase of the patient's baseline weight. The receiver operating characteristic curve was employed to determine the optimal cutoff points of statistically significant predictors. Eleven of the 67 patients completing the 6-week trial were classified as weight gainers. Weight change at week 2 was the statistically significant predictor for ultimate weight gain at week 6. A weight change of 1.0 kg at week 2 appeared to be the optimal cutoff point, with a sensitivity of 0.92, a specificity of 0.75, and an AUC of 0.85. Using weight change at week 2 to predict weight gain at week 6 is favorable in terms of both specificity and sensitivity. Weight change of 1.0 kg or more at 2 weeks is a reliable predictor.

Dosimetric verification and commissioning for a small animal image-guided irradiator.

In recent years, small animal image-guided irradiators have been widely utilized in preclinical studies involving rodent models. However, the dosimetry commissioning of such equipment involving kilovoltage small-field dosimetry has not received as much interest as the megavoltage small-field dosimetry used clinically. To date, a paucity of measured kilovoltage beam data, especially for field sizes less than 3 mm, can be found in the literature. For improvement of rodent treatments in the future, this work aims to provide comprehensive and accurate beam data for the small animal radiation research platform (SARRP, Xstrahl) using EBT3 Gafchromic films and Monte Carlo calculation, with submillimeter resolution and accuracy. This work includes three primary tasks: (1) establish an optimized film measurement protocol for small field dosimetry of kilovoltage photon beam. (2) Acquire dosimetric data including (a) depth dose curves from the surface to 6 cm depth (b) beam profiles, (c) penumbra, (d) cone factors and (e) 2D dose distribution. These tasks were undertaken for a 220 kVp photon beam with five different small field widths and 33 cm source to surface distance (0.5 mm and 1 mm circular fields, 3 × 3 mm2, 5 × 5 mm2, 10 × 10 mm2 square fields). Beam data was measured with EBT3 films. (3) Provide comparative dosimetry for film measurements, Monte Carlo calculations, and the dose calculations performed with the SARRP treatment planning system, Muriplan. For the majority of parameters, film measurement agreed with Monte Carlo simulation within 1%. There were, however, discrepancies between measured beam data and Muriplan treatment planning data. Specifically, for PDD, Muriplan underestimates the dose for field sizes of 0.5 mm and 1 mm. For beam profiles comparisons, the calculation from Muriplan predicts a smaller lateral distance between the 50% isodose lines compared to film measurement. There is a difference of 0.18, 0.72, 0.6 mm between Muriplan and film for field sizes of 3, 5, 10 mm, respectively. This work demonstrates that accurate and precise kilovoltage small-field dosimetry can be conducted using EBT3 Gafchromic film with an optimized protocol. In addition, discrepancies between measured beam data and Muriplan were identified.

Dosimetric and geometric characteristics of a small animal image-guided irradiator using 3D dosimetry/optical CT scanner.

PURPOSE: The precise dosimetric and geometric characteristics of small animal irradiators are essential to achieving reproducible dose delivery, especially in cases where image-guidance is utilized. Currently, radiochromic film is the established measurement tool used to evaluate beam characteristics for these systems. However, only 2D information can be acquired with film. This study characterized both the dosimetric and geometric properties of the small animal research radiation platform (SARRP, Xstrahl) for commissioning purposes using a 3D radiochromic dosimetry system with a submillimeter resolution optical computed tomography (OCT) scanner. METHODS: Like a modern clinical linear accelerator, the SARRP features both a beam delivery system and a cone beam computed tomography (CBCT) imaging system. Dosimetric and geometric characteristics of the SARRP were studied using EBT3 radiochromic film and 3D PRESAGE dosimeters. Dosimetric measurements included percent depth dose (PDD) curves and beam profiles. For geometric evaluation, the isocenter sizes of the treatment stage and gantry rotations as well as their coincidence were measured using star shot patterns. A commercial Epson Expression 11000XL flatbed scanner was used for readout of irradiated EBT3 films at 300 dpi resolution. Each irradiated PRESAGE dosimeter was scanned using a submillimeter resolution single laser beam OCT scanner. Acquired data were reconstructed with a resolution of 0.3 mm/pixel. RESULTS: PDD data measured from films and 3D dosimeters agree to within ±3% for depths up to 5 cm, for both 3 × 3 and 10 × 10 mm2 fixed collimation. Profiles were analyzed at 10, 20, and 30 mm depth for 3 × 3 mm2 and 10 × 10 mm2 fields. The FWHM measurements for both dosimeters agreed to within 0.01 mm, and the penumbras agreed to within 0.1 mm for 3 × 3 mm2 and 0.5 mm for 10 × 10 mm2 . Gantry and treatment stage isocenter sizes were determined to be 0.21 and 0.43 mm using EBT3 film, and 1.72 and 0.75 mm using PRESAGE dosimeters. Absolute isocenter shifts, evaluated with 3D phantoms, were 0.80 mm for the gantry rotation isocenter (treatment isocenter) with respect to the laser-defined setup isocenter, and 0.71 mm for the gantry rotation isocenter relative to treatment stage rotation isocenter (CBCT isocenter). The difference between CBCT isocenter and laser-defined setup isocenter was 0.68 mm. CONCLUSIONS: This study demonstrated that 3D PRESAGE dosimeters can be used for verification of precise targeting for the SARRP. This 3D dosimetry system can be utilized to obtain information on both geometric and dosimetric properties, as well as acquire beam data parameters for the purpose of commissioning image-guided small animal irradiator systems.

Three-year follow-up study of the relationship between posttraumatic stress symptoms and quality of life among earthquake survivors in Yu-Chi, Taiwan.

OBJECTIVE: To prospectively evaluate the relationship between the clinical course of posttraumatic stress symptoms (PTSS) and quality of life (QOL) among Taiwan earthquake survivors for 3 years. METHODS: A population survey was done in a Taiwan township near the epicenter of a severe earthquake (7.3 on the Richter scale). Trained assistants used the Medical Outcomes Study Short Form-36 (MOS SF-36) and the Disaster-Related Psychological Screening Test to interview earthquake survivors 16 and older. A total of 1756 respondents were surveyed during the 3-year follow-up period. RESULTS: At 0.5 and 3 years after the earthquake, the estimated rate of PTSS (cutoff point, 3/4) was 23.8% and 4.4%, respectively. The survivors with PTSS scored lower for each concept of the MOS SF-36 at these two intervals. Three years after the earthquake, the survivors in the persistently healthy group showed the highest scores in all subscales and domains of the MOS SF-36; second-highest was the recovering group; third-highest was the delayed PTSS group; and the persistent PTSS group showed the lowest scores in all concepts and domains. Notably, survivors with delayed onset PTSS exhibited a lower QOL when PTSS occurred. CONCLUSIONS: Three years after the earthquake, the estimated rate of PTSS had declined, and the QOL of the survivors varied according to how their PTSS had progressed.

An Event-Related Potential Study on the Perception and the Recognition of Face, Facial Features, and Objects in Children With Autism Spectrum Disorders.

The study investigated whether children with autism spectrum disorders (ASD) showed atypical patterns of brain specialization for face processing, whether the response to familiar and unfamiliar faces, facial features, and objects were different from typically developing children. Event-related potentials were recorded in 5- to 8-year-old children (12 children with ASD, 12 typically developing children) using passive viewing paradigm. The fastest P1 latencies to faces and the largest P1 amplitudes to objects were observed in both participant groups. Both groups exhibited larger N170 response to faces and eyes, F(3, 66) = 46.94, p < .0001). However, earlier P1 and N170 latencies were found on left hemisphere in children with ASD, respectively, F(1, 83) = 4.32, p = .04; F(1, 83) = 6.73, p = .01, indicating an atypical face processing pattern. All children showed a significant effect of familiarity for objects and mouths, F(1, 71) = 33.97, p < .0001; F(1, 71 = 15.94, p = .0002. Children with ASD revealed smaller negative central to faces relative to typically developing children. Face processing abnormalities revealed in children with ASD very likely exist.

A randomized, double-blind, comparison of the efficacy and safety of low-dose olanzapine plus low-dose trifluoperazine versus full-dose olanzapine in the acute treatment of schizophrenia.

OBJECTIVE: Antipsychotic polypharmacy is common in clinical practice, but not recommended in guidelines for treating schizophrenia patients. This study aimed to compare the efficacy and safety of low-dose olanzapine plus low-dose trifluoperazine (a first-generation antipsychotic [FGA]) to full-dose olanzapine (a second-generation antipsychotic [SGA]) in the treatment of acute schizophrenia. METHOD: In this 6-week, double-blind, fixed-dose study, patients were randomized to receive 5mg/day of olanzapine plus 5mg/day of trifluoperazine or 10mg/day of olanzapine for 6weeks. Efficacy measures, including the Positive and Negative Syndrome Scale (PANSS) and other scales, safety measures, side effect measures, and quality of life were assessed regularly. Response was defined as at least a 30% reduction in the PANSS total score. RESULTS: Both groups were similar in: 1) baseline characteristics, 2) score changes in all efficacy measures, safety measures, side effect measures, and quality of life, and 3) response rates at each visit. The polypharmacy group with low-dose olanzapine did not have less weight gain and lower lipid levels than the monotherapy group with full-dose olanzapine. CONCLUSION: Polypharmacy is as efficacious and safe as, but cheaper than, monotherapy in the acute treatment of schizophrenia. Whether our findings can be generalized to other combinations of an appropriate ratio of one FGA to another SGA dosage, which can achieve favorable clinical responses and side effect profiles, needs further investigation.

Comparison of time to rehospitalization among schizophrenic patients discharged on typical antipsychotics, clozapine or risperidone.

BACKGROUND: The purpose of this study was to compare the time to rehospitalization of schizophrenic patients who were discharged from a psychiatric hospital while being treated with typical antipsychotics, clozapine or risperidone. We also assessed other possible predictors of time to rehospitalization. METHODS: The study monitored the rehospitalization status of all the schizophrenic patients who were discharged from a psychiatric hospital between July 1, 2001 and June 30, 2002 while they were taking typical antipsychotics (n=272), clozapine (n=61) or risperidone (n=49). Rehospitalizations were tracked over a 2-year period using the Kaplan-Meier method. Risk factors associated with rehospitalization were examined by the Cox proportional hazards regression model. RESULTS: No significant differences in time to rehospitalization were observed among the groups in the first or second year after discharge. Age at onset of schizophrenia was a risk factor for time to rehospitalization over the 1- and 2-year periods. CONCLUSION: This study demonstrated that atypical antipsychotics did not lengthen the time to rehospitalization. The earlier the age at onset of schizophrenia, the shorter is the time to rehospitalization. Some other factors thought to impact rehospitalization need to be further assayed.

Accumulated mental stress study using the meridians of traditional Chinese medicine with photoplethysmography.

OBJECTIVES: To investigate accumulated mental stress according to the concept of the meridians of Traditional Chinese Medicine (TCM). This stress was quantified by using pulse spectrum analysis of finger-tip photoplethysmography (PPG). Stress accumulation is one of the main causes of cardiovascular disease and depression in humans, resulting in chronic physiologic malfunctions; however, few studies have thoroughly assessed the quantitative evaluation of accumulative stress using the concept of TCM. DESIGN: This study investigated accumulated mental stress from the perspective of TCM based on an 8-day experiment. The theory of organ resonance was integrated into the proposed PPG sensing instrument to capture the nine harmonics of TCM. Participants were given daily mental arithmetic tasks over 1 week to simulate stress accumulation, and trends in the proportion of the nine harmonics of TCM were extracted over several days and analyzed to identify the affective factors related to cumulative stress. RESULTS: The experimental results showed that the kidney harmonic proportion (C2) and stomach harmonic proportion (C5) were significant only on the first few days because of a physiologic phenomenon of temporary stimulation. Most important, the trend of the liver harmonic proportion (C1) from days 3 to 8 dramatically increased and became gradually saturated because of the influence of accumulated mental stress. CONCLUSIONS: The results strongly suggest that pulse spectrum analysis of the PPG signal provides physiologically and pathologically important information on accumulated mental stress and can be useful for TCM analysis.

A comparison of inpatients with anxious depression to those with nonanxious depression.

Anxiety symptoms are common for patients with major depressive disorder (MDD). Anxious depression has been considered MDD with high levels of anxiety symptoms. The objective of this study was to investigate the factors associated with anxious depression for Chinese inpatients with MDD. A total of 174 acutely ill patients were enrolled. Baseline demographic variables, suicide risk, depression severity, quality of life (QOL), and daily functional impairment were assessed. Those MDD patients with a 17-item Hamilton Depression Rating Scale (HAMD-17) anxiety/somatization factor score≥7 were defined as anxious depression. Logistic regression was employed to examine the factors associated with anxious depression. One hundred and forty-one (81.0%) of the subjects reported anxious depression. Patients with anxious depression were more likely to have melancholic features, to be older, to experience more severe depression, to be at greater risk of suicide, to have more pain, poorer quality of life, and more severe functional impairment. Anxious depression is common in inpatients with MDD. These findings suggest that anxious depression significantly differs from nonanxious depression on several clinically relevant variables. These data add to a growing body of evidence that anxious depression is a more complex presentation of depression.

Antipsychotic combination using low-dose antipsychotics is as efficacious and safe as, but cheaper, than optimal-dose monotherapy in the treatment of schizophrenia: a randomized, double-blind study.

The use of antipsychotic combination has been increasing during the last decade. This study aimed to compare the efficacy and safety of low-dose amisulpride plus low-dose sulpiride with full-dose amisulpride in the treatment of acute schizophrenia. In this 6-week, double-blind, fixed-dose study, patients were randomized to antipsychotic combination (400 mg/day amisulpride plus 800 mg/day sulpiride, N=46) or monotherapy (800 mg/day amisulpride, N=46) groups. Efficacy measurements included the Positive and Negative Syndrome Scale (PANSS) and subscales, and other scales. Safety and quality of life were also assessed. Response was defined as a 30% reduction in the PANSS total score. Both groups were similar in terms of the following: (a) clinical characteristics at baseline, (b) response rates, and (c) score changes in all psychopathology measures, quality of life, and all side-effect scales after 6 weeks of treatment. There were also no significant between-group differences in changes in other safety measurement. However, the combination strategy did reduce treatment costs. The current study suggests that an antipsychotic combination of low-dose antipsychotics is as efficacious and safe as, but cheaper than, optimal-dose monotherapy in the treatment of schizophrenia.