Clozapine-associated cardiac dysfunction during a gastroenteritis outbreak.

We report that two young adult patients who were initiated with clozapine for severe psychosis during a hospital-wide gastroenteritis outbreak went into severe shock. Neither patient had troponin elevation. Each required left ventricular assist device support for myocarditis. Endomyocardial biopsy revealed lymphocytic myocarditis in one patient and eosinophilic myocarditis in the other. The former patient expired. Polymerase chain reaction testing was negative for Coxsackie virus. These two patients illustrate that myocarditis can occur at usual incipient doses and that there may be an epidemiologic risk associated with gastroenteritis. Although the white blood cell (WBC) count is expected to decrease with clozapine, these patients had persistently elevated WBC counts. In conclusion, physicians should exercise caution when prescribing clozapine, especially for those with diarrhea.

Effects of a Collaborative Problem-Solving Approach on an Inpatient Adolescent Psychiatric Unit.

OBJECTIVE: Effects of collaborative problem-solving (CPS) approaches on an inpatient adolescent psychiatric unit were investigated during this study, modeling Dr. Ross Greene's CPS theory, which considers that cognitive deficits are associated with adolescent behavioral dysfunction; his research, treatment, and subsequent results on similar units were notably successful. PROBLEM: The staff viewed prestudy, negative behavior modification and resultant punitive consequences as culturally acceptable. New York State's Office of Mental Health (OMH) disapproved these strategies, necessitating cultural transformation and alteration of routine responses to patients' maladaptive behaviors. METHOD: The study incorporates quantitative, comparative, quasi-experimental design, utilizing retrospective staff surveys and hospital medical records to compare behavioral outcomes and staff perceptions during pre- and post-training phases of this 5-year study. RESULTS: A significant decrease in punitive strategies and techniques (p = .001), reduction in behaviors related to the need for restraints, and significant decline in self-inflicted injury (p = .005), length of stay (p = .001), and need for security staff involvement (p = .001) were noted.

Male chimpanzee behavior in relation to female ano-genital swelling.

This study examined the relationships between male agonistic, affiliative, and sexual behaviors and female estrus condition in captive adolescent and young-adult chimpanzees (Pan troglodytes). Data on agonistic, affiliative, and sexual behaviors of 11 males living in three social groups were collected during daily 45 minute observations over a 5 month period. Female estrus condition was assessed daily using the relative size of the female's ano-genital swelling. It was hypothesized that the presence of maximally tumescent females would generate conflicts between males, so an increase in inter-male agonism was predicted. Males exhibited higher rates of agonism toward other males when at least one female in the group was maximally tumescent. Male affiliative behavior directed toward other males and social play with males were affected by the presence and number of maximally tumescent females. Male sexual behavior increased when maximally tumescent females were present.