A pragmatic randomized controlled exploratory trial of the effectiveness of Eye Movement Desensitization and Reprocessing therapy for psychotic disorder.

BACKGROUND: People with severe mental illness are often excluded from trials related to Eye Movement Desensitization and Reprocessing (EMDR) therapy. Principal concerns are that they may not tolerate treatment, might risk relapse or that psychotic symptoms may worsen. There is however building evidence of a traumatogenic etiology of psychotic disorder that may benefit therapeutically from EMDR. However, EMDR in this role is done mainly in specialist tertiary settings. AIM: To conduct a randomized exploratory trial of prospective treatment of EMDR for people with psychotic disorder and a history of trauma in an adult community mental health service. METHODS: A randomized exploratory trial with a controlled pilot design was employed to conduct a prospective treatment and six-month follow-up study with an interim 10-week analysis in a rural county in the UK (population 538,000). We recruited participants with psychotic disorder who had a reported history of trauma and were interested in receiving trauma therapy. They were then randomized to either receive EMDR or treatment as usual (TAU). The primary instrument used was the Impact of Events Scale (IES) with secondary instruments of Positive and Negative Symptoms of Psychotic Disorder (PANSS), PTSD Checklist (PCL-C), and subjective Quality of Life (MANSA). RESULTS: IES scores showed significant improvements in the EMDR group (n = 24, age 42.0 SD (14.5), 42% male) compared to the TAU group (n = 12, age 34.4 SD (11.3), 50% male) at 10 weeks and at six months (p < 0.05). There were significant improvements in PCL-C and PANSS negative symptoms scores associated with treatment (p < 0.05). All other scales showed positive trends. CONCLUSIONS: This study demonstrates that EMDR can reduce the impact of traumatic events for patients with a psychotic disorder in a clinical setting in the UK. The improvements in psychotic disorder persisted for six months after treatment. TRIAL REGISTRATION: ISRCTN43816889.

Aqueous chemistry of chlorocyclophosphazenes: phosphates {PO(2)}, phosphamides {P(O)NHR}, and the first phosphites {PHO} and pyrophosphates {(PO)(2)O} of these heterocycles.

Cyclotriphosphazenes have been functionalized with various oxo-groups at one of the ring phosphorus atoms. Starting from geminal dichlorides (A) which are equipped with amino groups at the other two phosphorus atoms {(Z'(2)P)(2)N(3)PCl(2) (Z' = NHCy) and (Z''P)(2)N(3)PCl(2) (Z'' = {EtN(C(3)H(6))NEt}), respectively}, phosphate (B), pyrophosphate (C), phosphamide (D), and phosphite (E) derivatives have been prepared. The zwitterionic phosphate (Z'(2)P)(2)N(3)H(2)PO(2) B is obtained via the 4-dimethylamino pyridine (dmap)-catalyzed hydrolysis of A in a biphasic mixture of aqueous KOH and tetrahydrofuran (thf). B contains a PO(2) moiety neighboring two protonated ring nitrogen sites. It crystallizes as the tetrahydrate (Z'(2)P)(2)N(3)H(2)PO(2).4H(2)O, which consists of a double helix: A helical chain of hydrogen bonded zwitterions is intertwined with a helical chain of water molecules. The reaction of A with only dmap in CHCl(3) produces the dication [(Z'(2)P)(2)N(3)P(dmap)(2)](2+), which binds two dmap ligands at one phosphorus atom. The tetrahydrate dehydrates at 160 degrees C in vacuo under formation of the pyrophosphate {(Z'(2)P)(2)N(3)HPO}(2)O C, which contains a O=P-O-P=O residue linking the two phosphazene rings. When heated in a mixture of aqueous KOH, primary amine, and thf, A undergoes a concurrent aminolysis-hydrolysis reaction, which gives the phosphamide (Z(2)P)(2)N(3)HP(O)NHR D featuring a P(=O)NHR residue. The corresponding reaction of A with alpha,alpha'-diamino-p-xylene in a 2:1 ratio leads to the formation of {(Z'(2)P)(2)N(3)HP(O)NHCH(2)}(2)C(6)H(4), in which two phosphamide moieties are linked by a xylylene bridge. Phosphites E containing PHO moieties are obtained via reduction of the dichloride with potassium and subsequent treatment with KOH. The product consists of a hexameric potassium complex, which features a central K(6)O(6) double cube arrangement and contains the anionic ligand [(Z''P)(2)N(3)PHO](-) that offers two bidentate N-P-O coordination sites. Addition of NH(4)Cl yields the neutral phosphite (Z''P)(2)N(3)HPHO. The title compounds are amphiphilic featuring hydrophilic NH and PO(x) moieties and hydrophobic alkyl groups. In addition, they show amphiprotic behavior via protonation/deprotonation at ring N atoms.

The N-donor stabilised cyclotriphosphazene hexacation [P3N3(DMAP)6]6+.

The cyclotriphosphazene P(3)N(3)Cl(6) reacts with six equivalents of DMAP (4-(dimethylamino)pyridine) in superheated chloroform to form crystals of composition [P(3)N(3)(DMAP)(6)]Cl(6).19CHCl(3) comprising [P(3)N(3)(DMAP)(6)](6+) ions, which host five chloride ions in basket-type cavities on either side of the ring and at equatorial positions via tetradentate ortho-H-donor arrangements.

Zwitterionic phosphazenium phosphazenate ligands.

Zwitterionic ligands are readily prepared from phosphazenes (RNH)6P3N3 by successive alkylation of ring nitrogen sites and deprotonation of exocyclic NH sites.