RESUMO
An increasing number of studies deal with medical options for treatment resistant schizophrenia. If no remission can be achieved with clozapine, a combination of antipsychotics can be considered. The combination of clozapine and cariprazine is rarely studied. Cariprazine is a partial agonist on dopamine D2 and D3 receptors and a pharmaceutically rational add-on to clozapine. Stimulating D3 receptors has been linked to improved cognition and mood, with negligible extrapyramidal side effects. We present two patients with long-term treatment resistant schizophrenia receiving cariprazine and clozapine. Whereas psychotic symptoms worsened, the patients developed extrapyramidal side effects with a Pisa syndrome. The syndrome remitted after discontinuation of cariprazine. Possible explanations by pharmacodynamic interactions and drug specific receptor profiles are discussed.
RESUMO
The SARS-CoV-2 pandemic triggered increasing symptoms of an undiagnosed delusional disorder at a mid-60-year-old woman resulting in an attempted suicide. Because of a pandemic with noticeable and visible social changes, it seems likely that people with previously subclinical psychotic illnesses are more often admitted to psychiatric care for the first time. Building a therapeutic relationship and integrating her into an outpatient clinic was possible despite her lack of insight into the illness and her rejection of medical treatment.
Assuntos
Infecções por Coronavirus/psicologia , Pneumonia Viral/psicologia , Esquizofrenia Paranoide , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Tentativa de Suicídio , Betacoronavirus , COVID-19 , Feminino , Alemanha , Humanos , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2RESUMO
BACKGROUND: Recent guidelines recommend a cranial ultrasound (CU) in neonates born at < 30 weeks gestation, admitted to the neonatal intensive care unit (NICU), or with a CU indication. Here, we addressed the need to extend these recommendations. METHODS: We retrospectively reviewed 5107 CUs acquired in the population-based Survey of Neonates in Pomerania, conducted in 2002 to 2008. Neonates with conspicuous CUs that were ≥ 30 weeks gestation without recent indications for CU were identified and assigned to the following groups: with (I) or without (II) admission to neonatal care. We designated CU conspicuities as mild (MC) or significant (SC), and we investigated related neurodevelopment during follow-up. RESULTS: Of 5107 neonates, 5064 were born at ≥30 weeks gestation and of those, 4306 received CUs without any indication for this examination. We found conspicuities in 7.7% (n = 47/610) of group I (n = 30 MC, n = 17 SC), and 3.2% (n = 117/3696) of group II (n = 100 MC, n = 17 SC). In group II, SC comprised, e.g., bilateral cysts, partial agenesis of the corpus callosum, and periventricular leukomalacia. Follow-up was available in 75% of infants in group II with MCs and SCs; of these, 12.8% had an abnormal neurological follow-up. CONCLUSIONS: We detected a high number of conspicuities in neonates without a CU indication. However, we could not demonstrate that ultrasound findings were associated with the neurological follow-up or any advantage to an earlier diagnosis. Our data did not support extending current guidelines or a general CU screening policy for all neonates.
Assuntos
Encéfalo/diagnóstico por imagem , Triagem Neonatal , Guias de Prática Clínica como Assunto , Ultrassonografia , Encéfalo/patologia , Estudos de Coortes , Alemanha , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Hemorragias Intracranianas/diagnóstico por imagem , Leucomalácia Periventricular/diagnóstico por imagem , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: A series of experiments assessed biases in perceived distance that occur while driving as a function of the backlight position of the car ahead and fog density. BACKGROUND: V. Cavallo, M. Colomb, and J. Doré (2001) have shown that smaller horizontal backlight separation and fog may result in increased estimates of the distance between an observer and a car of which only the backlights are visible. They also predicted that raising the height of the car backlights would lead to increasing distance estimates. METHOD: Distance perception was assessed in both static and dynamic computer-simulated scenarios in which the distance estimates were performed using a familiarized analog scale or using time-to-collision judgments for both pairs of backlights and single backlights. RESULTS: In a series of five experiments, the horizontal separation and fog density effects were replicated. In addition, distance estimates were consistently larger with higher than with lower vertical backlight positions. CONCLUSION: There is reason to believe that biases in distance perception may be augmented by car backlight positions and by low-visibility weather conditions. APPLICATION: Car designers should take backlight placement seriously. Speed-dependent car-to-car distance control systems seem desirable to counteract biases in distance perception.