Objective: The authors reviewed the recent literature regarding the treatment of catatonia as a syndrome of multiple etiologies. Given the historical and clinical association of catatonia with schizophrenia, the authors' examined the assumption that the first-line treatment of catatonia is antipsychotic medication. Methods: Articles published between January 1, 1985 and December 31, 1994 were located using the Paperchase® medical literature search system. Additionally, references from those identified articles were examined for possible inclusion in this review. To be included in this review, articles had to be written in English and report specific symptoms of catatonia to determine, retrospectively, if DSM-IV criteria for catatonia were met. Results: Seventy publications met inclusion criteria and reported on a total of 178 patients and included 270 separate treatment episodes. Most of the articles were case-reports, although a few case-series were identified. Multiple causes of catatonia were identified in these reports. The most commonly reported treatment for catatonia was with benzodiazepines which were effective in 70 percent of the cases, with lorazepam demonstrating the highest frequency of use and a 79 percent complete response rate. Electroconvulsive therapy (ECT) was also efficacious (85%) and was more likely to provide a positive outcome in cases of malignant catatonia. Antipsychotics demonstrated poor efficacy. Conclusions: Catatonia is a nonspecific syndrome with multiple etiologies. Treatment of catatonia should be based on the underlying cause when it is identifiable. Lorazepam appears to offer a safe, effective first-line treatment of catatonia. ECT should be considered when rapid resolution is necessary (e.g., malignant catatonia) or when an initial lorazepam trial fails.
This paper reports on some results to date from a program of study to better understand the influence of factors which influence the long-term float behaviour of lead-acid batteries used in telecommunication applications. Data from high resolution, long-term, real-time logging of the float performance of in-service VRLA batteries in the network is also presented.
The neuropathogenesis of bipolar disorder remains poorly described. Previous work suggests that patients with bipolar disorder may have abnormalities in neural pathways that are hypothesized to modulate human mood states. We examined differences in brain structural volumes associated with these pathways between patients with bipolar disorder hospitalized with mania and healthy community volunteers.
Methods
Twenty-four patients with bipolar disorder and mania were recruited from hospital admission records. Twenty-two healthy volunteers were recruited from the community who were similar to the patients in age, sex, race, height, handedness, and education. All subjects were scanned using a 3-dimensional radio-frequency–spoiled Fourier acquired steady state acquisition sequence on a 1.5-T magnetic resonance imaging scanner. Scans were analyzed using commercial software. Prefrontal, thalamic, hippocampal, amygdala, pallidal, and striatal volumetric measurements were compared between the 2 groups.
Results
Patients with bipolar disorder demonstrated a significant (Λ=0.64; F6,37=3.4;P=.009) overall differencae in structural volumes in these regions compared with controls. In particular, the amygdala was enlarged in the patients. Brain structural volumes were not significantly associated with duration of illness, prior medication exposure, number of previous hospital admissions, or duration of substance abuse. Separating patients into first-episode (n=12) and multiple-episode (n=12) subgroups revealed no significant differences in any structure (P>.10).
Conclusion
Patients with bipolar disorder exhibit structural abnormalities in neural pathways thought to modulate human mood.
This Paper describes the establishment of a User-based field trial of a Vanadium Energy Storage System (VESS) incorporating a 250 kW/520 kWh Vanadium Redox Battery (VRB) in Stellenbosch, South Africa. The trial has been established to show the versatile configuration and operation of VESS, with the single installation demonstrating applications ranging from sub-second UPS ride-through capabilities through to power quality and emergency power back-up. The Stellenbosch VESS Trial is significant in that it is the first large-scale commercial trial of User-based applications for the VRB outside Japan.
Objective: The authors studied the 12-month course of illness following hospitalization for a manic or mixed episode of bipolar disorder to identify potential outcome predictors. Method: They recruited 134 patients with DSM-III-R bipolar disorder who were consecutively admitted for the treatment of a manic or mixed episode. Diagnostic, symptomatic, and functional evaluations were obtained at the index hospitalization. Patients were reevaluated at 2, 6, and 12 months after discharge to assess syndromic, symptomatic, and functional outcome. Factors associated with outcome were identified by using multivariate analyses. Results: During the 12-month follow-up period, there were no significant differences in outcome between patients with manic compared with mixed bipolar disorder. Although syndromic recovery occurred in 48% of the overall group, symptomatic recovery occurred in only 26% and functional recovery in only 24%. Predictors of syndromic recovery included shorter duration of illness and full treatment compliance. Medication treatment compliance was inversely associated with the presence of comorbid substance use disorders. Symptomatic and functional recovery occurred more rapidly and in a greater percentage of patients from higher social classes. Conclusions: A minority of patients with bipolar disorder achieved a favorable outcome in the year following hospitalization for a manic or mixed episode. Shorter duration of illness, higher social class, and treatment compliance were associated with higher rates of recovery and more rapid recovery.
Background: We studied the 12-month course of illness after a first hospitalization for affective psychosis to identify potential outcome predictors in this rarely studied patient population.Methods: For this study, 109 patients consecutively admitted for their first psychiatric hospitalization for treatment of affective psychosis were recruited.Diagnostic, symptomatic, and functional evaluations were obtained at the index hospitalization and at 2, 6, and 12 months after discharge to assess syndromic, symptomatic, and functional outcome predictors.Factors associated with outcome were identified by means of multivariate analyses.Results: Fifty-six percent of the patients achieved syndromic recovery during the 12-month follow-up.Full treatment compliance was associated with more frequent and rapid syndromic recovery.
An experimental comparison of face-milled and face-hobbed spiral bevel gears was accomplished. The two differently manufactured spiral bevel gear types were tested in a closed-loop facility at NASA Glenn Research Center. Strain, vibration, and noise testing were completed at various levels of rotational speed and load. Tests were conducted from static (slow-roll) to 12600 rpm and up to 269 N-m (2380 in.-lb) pinion speed and load conditions. The tests indicated that the maximum stress recorded at the root locations had nearly the same values, however the stress distribution was different from the toe to the heel. Also, the alternating stress measured was higher for the face-milled pinion than that attained for the face-hobbed pinion (larger minimum stress). The noise and vibration results indicated that the levels measured for the face-hobbed components were less than those attained for the face-milled gears tested.
LEARNING OBJECTIVES After participating in this activity, the psychiatrist should be better able to: Evaluate the potential benefits of asenapine, paliperidone extended release, quetiapine, and ziprasidone in the treatment of bipolar disorder from new clinical trial results. Analyze the strengths and limitations of data regarding trials of tamoxifen, N-acetyl cysteine, and armodafinil in bipolar disorder. Apply the data from these new studies into evidence-based treatment of patients with bipolar disorder.
The aim of this study was to examine the outcome and comorbidity of patients with bipolar disorder presenting with first-episode as compared with multiple-episode mania. Based on studies from the prepharmacological era and the sensitization model of bipolar disorder, we hypothesized that compared with multiple-episode mania, first-episode mania would be associated with better outcome, milder severity, and less psychiatric comorbidity. Seventy-one hospitalized patients, age 12 years and older and meeting DSM-III-R criteria for bipolar disorder, were recruited over a 1-year period. Thirty-four (48%) first-episode and 37 (56%) multiple-episode patients were compared regarding demographics, phenomenology, comorbidity, family history, and short-term course. Compared with multiple-episode mania, first-episode mania was associated with significantly shorter hospitalization and a higher rate of comorbid impulse control disorders. These data provide indirect support for the sensitization model of bipolar disorder.
