Clozapine rechallenge and initiation despite neutropenia- a practical, step-by-step guide.

Clozapine remains the only drug treatment likely to benefit patients with treatment resistant schizophrenia. Its use is complicated by an increased risk of neutropenia and so there are stringent monitoring requirements and restrictions in those with previous neutropenia from any cause or from clozapine in particular. Despite these difficulties clozapine may yet be used following neutropenia, albeit with caution. Having had involvement with 14 cases of clozapine use in these circumstances we set out our approach to the assessment of risks and benefits, risk mitigation and monitoring with a practical guide.

Brief report: Assessing youth well-being in global emergency settings: Early results from the Emergency Developmental Assets Profile.

The 13-item Emergency Developmental Assets Profile measures the well-being of children and youth in emergency settings such as refugee camps and armed conflict zones, assessing whether young people are experiencing adequate positive relationships and opportunities, and developing positive values, skills, and self-perceptions, despite being in crisis circumstances. The instrument was found to have acceptable and nearly identical internal consistency reliability in 22 administrations in non-emergency samples in 15 countries (.75), and in 4 samples of youth ages 10-18 (n = 1550) in the emergency settings (war refugees and typhoon victims, .74) that are the measure's focus, and evidence of convergent validity. Confirmatory Factor Analysis showed acceptable model fit among those youth in emergency settings. Measures of model fit showed that the Em-DAP has configural and metric invariance across all emergency contexts and scalar invariance across some. The Em-DAP is a promising brief cross-cultural tool for assessing the developmental quality of life as reported by samples of youth in a current humanitarian crisis situation. The results can help to inform international relief program decisions about services and activities to be provided for children, youth, and families in emergency settings.

Ascophyllum nodosum SWE enhances root anatomy, but not POD activity in both a salt-tolerant and salt-sensitive soybean ( Glycine max) variety exposed to salt stress.

There is growing evidence that seaweed extracts (SWE) may be a solution for mitigating the negative effects of salt stress on crop yield and quality, as they introduce bioactive ingredients able to regulate the expression of growth-inducing and stress-responsive genes. We demonstrate that SWE slightly ameliorated the negative physical growth effects of salt stress, especially in the root anatomy of the salt-sensitive (Clark) variety. The SWE did not stimulate or enhance peroxidase (POD) activity in either the salt-sensitive (Clark) or salt-tolerant variety (Manokin). However, a complete assessment of other antioxidant enzymes (SOD, CAT, APX) involved in the ROS detoxification process is further required.

A Narcissism/Vanity Distinction? Reassessing Vanity Using a Modern Model of Narcissism Based on Pride, Empathy, and Social Behaviors.

The primary purpose of this study is to evaluate the role of vanity in its longstanding theoretical association with narcissism. This is particularly germane, as the conceptualization and measurement of narcissism have evolved in recent years. This is observed in the development of spectrum and/or dimensional models of narcissism, concomitant with the conceptual developments of vanity that have emerged since its original inclusion in the Narcissism Personality Inventory. Specifically, our research question evaluated whether vanity remains as traditionally construed, i.e., as a facet of narcissism, or is better conceptualized as a distinct construct separated from the earlier models of narcissism and therefore provide novel implications in understanding personality and social behavior. Based on the traits of pride, empathy, and several social behavior variables, it was hypothesized that a differentiation between narcissism and vanity would be observed. The participants were 441 undergraduate students from a large public midwestern university who participated in a self-report online survey. Correlation and regression analyses were conducted. The results revealed that the characterization of vanity is limited to pride and an absence of empathy and social behavior. Findings reaffirm behavior patterns of grandiose and vulnerable narcissism regarding selflessness, image management, and sensitivity to others. The core motivations of vanity are explicated as based on social comparison theory to assess one's subjective and/or objective value though it is not characterized as a "social" trait or by social behavior, in contrast to how narcissism is characterized. Based on our findings and an improved understanding of the narcissism model, we conclude that vanity is more closely related to the grandiose dimension of narcissism and discuss how the underlying motivations of vanity improve our understanding of grandiose narcissism. We discuss the implications that these findings provide to the developing, modern conceptualizations of narcissism and affirm and expand our understanding of vanity in personality.

Clozapine re-challenge and initiation following neutropenia: a review and case series of 14 patients in a high-secure forensic hospital.

OBJECTIVE: Clozapine remains the most effective intervention for treatment resistant schizophrenia; however, its use is prohibited following neutropenias. We review neutrophil biology as applied to clozapine and describe the strategies to initiate clozapine following neutropenia used in a case series of 14 consecutive patients rechallenged in a United Kingdom (UK) high-secure psychiatric hospital. We examine outcomes including the use of seclusion and transfer. METHODS: A case series of 14 male patients with treatment resistant schizophrenia treated with clozapine despite previous episodes of neutropenia between 2006 and 2015 is presented. Data were collected during 2015 and 2019. Using this routinely collected clinical data, we describe the patient characteristics, causes of neutropenia, the strategies used for rechallenging with clozapine and clinical outcomes. RESULTS: Previous neutropenias were the result of benign ethnic neutropenia, clozapine, other medications and autoimmune-related. Our risk mitigation strategies included: granulocyte-colony stimulating factor (G-CSF), lithium and watch-and-wait. There were no serious adverse events; at follow up half of the patient's had improved sufficiently to transfer them to conditions of lesser security. There were dramatic reductions in the use of seclusion. CONCLUSION: Even in this extreme group, clozapine can be safely and effectively re/initiated following neutropenias, resulting in marked benefits for patients. This requires careful planning based on an understanding of neutrophil biology and the aetiology of the specific episode of neutropenia.

Changes in smoking status, mental state and plasma clozapine concentration: retrospective cohort evaluation.

AIMS AND METHOD: To investigate the percentage of patients who commenced smoking after transferring out of a non-smoking forensic psychiatric unit, the corresponding clozapine dose adjustments, the effects on plasma clozapine/norclozapine concentrations and observed changes in mental state. We reviewed the notes and plasma clozapine/norclozapine concentrations of 46 patients transferred to medium secure units between July 2008 and December 2013. RESULTS: Thirty-five patients commenced smoking. Their median clozapine dose was increased by 50 mg/d. In the non-smokers, the median clozapine dose remained unchanged. Plasma clozapine/norclozapine concentrations were significantly reduced in smokers despite dosage adjustment. Eighteen patients experienced deterioration in mental state after transfer; almost all these patients were smokers. CLINICAL IMPLICATIONS: Approximately three-quarters of patients who were non-smokers by virtue of being in a secure non-smoking environment commenced smoking after transfer. Monitoring of clozapine serum levels and assessment of mental state in the immediate period after a change in smoking status is indicated.