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We examined the efficacy and safety of low vs. moderate olanzapine doses for the treatment of borderline personality disorder (BPD) in the largest controlled clinical trial ever conducted in this population.
This 12-week, double-blind trial involved patients 18-65 years with a diagnosis of DSM-IV BPD randomized to receive 2.5mg/day olanzapine (N=150), 5-10mg/day olanzapine (N=148), or placebo (N=153). The primary efficacy measure was the change from baseline-to-endpoint (last-observation-carried-forward) on the Zanarini Rating Scale for BPD (ZAN-BPD) total score. Rate of response and time-to-response were also examined (response defined as a >=50% reduction in ZAN-BPD total score).
Mean baseline ZAN-BPD total scores ranged from 17.01 to 17.42, indicating moderate symptom severity. Treatment with OLZ5-10 was associated with significantly greater mean change from baseline-to-endpoint in ZAN-BPD total score than placebo (-8.50 vs. -6.79, p=.010). Response rates were significantly higher for OLZ5-10 (73.6%) than for OLZ2.5 (60.1%, p=.018) and placebo (57.8%, p=.006). Time-to-response was significantly shorter for OLZ5-10 than placebo (p=.028). Treatment-emergent adverse events seen more frequently in the olanzapine groups included somnolence, increased appetite, and weight gain. Mean weight change from baseline-to-endpoint was 2.09kg for OLZ 2.5, 3.17kg for OLZ5-10, and 0.02kg for placebo.
The results of this study suggest that moderate doses of olanzapine (5-10mg/day) are effective in the treatment of overall borderline psychopathology. Also, the types of adverse events observed with olanzapine treatment were similar to those seen previously in adult populations.
Altered levels of phenylalanine and its metabolites in blood and cerebrospinal fluid have previously been reported in schizophrenia. This study attempted to examine whether phenylalanine kinetics is altered in schizophrenia using the 13C-phenylalanine breath test (13C-PBT).
Subjects were 20 patients with schizophrenia and the same number of controls. 13C-phenylalanine was administered and then 13CO2 concentration in breath was monitored for 120 minutes. The Δ 13CO2 at each collecting time, the maximal Δ 13CO2 (Cmax), the time to reach Cmax (Tmax), the area under the curve of time course of Δ13CO2 (AUC), the cumulative recovery rate (CRR) at each collecting time of the 13C-PBT were calculated for each subject.
Body weight (BW) and diagnostic status were significant predictors for Cmax. BW, age and diagnostic status were significant predictors for AUC and CRR at 120 minutes (CRR0-120). A repeated measures ANCOVA controlling for age and BW revealed a different pattern of change in CRR over time between the patients and controls and that Δ13CO2 in schizophrenia were lower than that in healthy control at all sampling point during 120 min, with an overall significant differences between healthy control and schizophrenia. The ANCOVA controlling for age and BW, showed that Cmax, AUC and CRR0-120 were significantly lower in schizophrenics than in controls.
Our data indicate the different change of Δ13CO2 and CRR over time and the decreased Cmax, AUC and CRR0-120 of 13C-PBT in schizophrenia patients compared to healthy controls, suggesting the altered phenylalanine kinetics in schizophrenia.
Public health checkups are conducted on 3-year-old children in Japan. However, it is often difficult to detect or provide ongoing support to children with developmental disorders without MR. Therefore we have conducted health checkups on 5 year olds.
The objectives are to describe the results and follow-up of health checkups in 5-year-old children and examine the utility of such checkups.
The aims are to make clear the utility of health checkups in 5-year-old children for screening for developmental disorders.
The subjects were 303 children of 5-year-old that lived in Kanie-cho and participated in health checkups. in the checkups, a child psychiatrist examined the children, and made a provisional diagnosis of a developmental disorder.
Eighty-two children were provisionally diagnosed as having developmental disorders. the follow-up allowed final diagnosis of developmental disorders (suspect diagnosis included) to be made in 39 children (12.9%), and pinpointed 19 children with ADHD, 9 children with PDD, 9 children with mild MR, and 2 children with motor skills disorder.
All children with PDD had already been informed about the possible occurrence of developmental disorders at 3 years of age. However, most of ADHD, mild MR, and motor function disorder were diagnosed in these children during the checkups at the age of 5 years.
The health checkup in 5-year-old children is useful not only as a tool to detect developmental disorders that are difficult to diagnose at the age of 3 years but also as an approach in patients lost to follow-up.
We explored the factors promoting long-term mental health among adolescent survivors of the 2008 Wenchuan earthquake in China. We examined the associations of their long-term mental health with disaster-related storytelling and school-based psychoeducation, and of school-based psychoeducation with disaster-related storytelling.
A secondary school-based cross-sectional survey was conducted 6 years after the disaster. Participants with traumatic experiences such as injury, loss, witnessing someone's death/injury and home destruction (N = 1028, mean age 15, standard deviation 1.38, male 51%) were eligible. Mental health/disaster education (MHE/DE) was defined as taking one or more lessons in MHE and/or DE at school since the earthquake. Experiences of storytelling about the disaster involved expressing distressing memories and feelings regarding the earthquake since the disaster happened, according to four groups: never expressed distressing memories and feelings, expressed them through writing/drawing, expressed them through talking to lay supporters and expressed them through talking to health professionals. Analysis of covariance was used to compare mean scores on five selected subscales of the Symptom Checklist-90 (SCL-90), the Athens Insomnia Scale (AIS) and the Psychotic-Like Experiences (PLEs) scale among the four storytelling groups. Linear regression analysis was used to identify the relationships between MHE/DE and current mental health as measured by the SCL-90, AIS and PLEs. The relationship between education and storytelling was probed by χ2 test.
The talked-to-lay-supporters group showed better mental health on the SCL-90 (p ⩽ 0.001), AIS (p < 0.001) and PLEs (p = 0.004), while the consulted-health-professionals group showed worse mental health on the three dimensions of the SCL-90: depression (p = 0.05), anxiety (p = 0.02) and fear (p = 0.04), and on PLEs (p = 0.02) compared with the never-expressed group. MHE and DE were inversely associated with SCL-90, AIS and PLE scores. Participants who received these forms of education talked about their disaster experiences to lay supporters more than those who did not.
MHE and DE at school may promote adolescents’ mental health after a disaster. Experience of storytelling about the disaster to lay supporters may be helpful for long-term psychological recovery, and may be a potential mediating factor for school-based education and better mental health. Because of the cross-sectional nature of this study, causality cannot be inferred; therefore, further prospective intervention studies are needed to elucidate the effect of these factors on adolescent survivors’ mental health.
Mars is the fourth planet from the Sun and the outermost of the rocky, terrestrial planets that make up the inner solar system. Mars is the second smallest planet; only Mercury is smaller. Surface gravity on Mars is 3.71 m s–2, which is 37.6% that of the Earth. The present atmospheric pressure is low (~0.6 kPa) relative to Earth’s (101 kPa), and the atmosphere is mostly carbon dioxide (95%). The obliquity of Mars (tilt of the axis of rotation relative to the plane of orbit) is presently 25 degrees and may have varied by tens of degrees over the past tens of millions of years and longer (Laskar et al., 2004).
The rugged highland terrains of Noachis Terra and Terra Sabaea dominate the region. The higher-standing, tectonically deformed, and densely cratered Terra Sabaea contains Scylla and Charybdis Scopuli. Also present are Denning, Bouguer, Lambert, Dawes, Pollack, Schiaparelli, Tuscaloosa, and Bakhuysen craters. To the west, the relatively subdued, but still rugged highland region of Noachis Terra has Newcomb, Wislicenus, and Mädler craters; and Marikh and a portion of Evros Valles. Numerous other moderately to highly degraded craters are scattered throughout the area. Valley networks ranging from tens of kilometers to thousands of kilometers in length dissect much of the topography. Wide grabens scar parts of Terra Sabaea. The region slopes from close to 3,000 m above datum in Terra Sabaea to as low at –1,500 m in the northwest. The northeast region is a portion of the zone that occurs between highland terrains to the south and transition terrain of Arabia Terra to the north (MC-12).
Eridania quadrangle is composed almost entirely of the ancient cratered highland terrain of Terra Cimmeria, at 0–2 km elevation. The largest crater, Kepler, is about 230 km in diameter. Less-cratered, relatively low-lying plains are scattered throughout the quadrangle, including Eridania Planitia in the northwest corner and Planum Chronium in the southwest part of the quadrangle. Ridge systems occur throughout the quadrangle, with northeast-trending Eridania Scopulus forming the most prominent ridge.
The Iapygia quadrangle consists almost entirely of heavily cratered highlands, as high as 3 km above datum, descending to the northern basin rim (0–3 km below datum) and floor (3 to over 5 km below datum) of Hellas, and a piece of the southwestern rim of Isidis basin. Terra Sabaea makes up the western two-thirds of the quadrangle, whereas Tyrrhena Terra makes up the third that is east of a topographic divide, at ~75° E. An arcuate, north-facing series of scarps, Oenotria Scopuli, crosses this divide and appears to be concentric to Isidis basin. Huygens forms a prominent impact basin, with an outer rim of ~470 km in diameter, and it has an inner (250-km-diameter) and partial intermediate (350-km) ring.
The global landscape of Mars is diverse, and this diversity tells a story of its surface history. Geographic regions and zones, each unique in character, are dominated by specific landforms and materials. These in turn express processes and histories, including geologic and climate-driven activity. Understanding the major geographic regions of Mars, as on Earth, then, is essential to unraveling the factors involved in global and regional geologic activity. It also provides context for study of local areas and individual features or sets of features. In addition, some of the major regions of Mars are indicative of heterogeneities in the crust and mantle (see Chapter 5).
Ismenius Lacus is located in the northern mid-latitudes of the eastern hemisphere of Mars. It includes sections of both the southern highlands and northern plains. The topographic transition is defined by gently sloping surfaces, steep scarps, linear to sinuous channels, and isolated knobs and plateaus. The southern part of the quadrangle is defined by the northernmost extent of the high-standing, ancient cratered highlands of Arabia Terra and Terra Sabaea, at elevations near datum to –3,000 m. The regional highlands in Ismenius Lacus contain large, ancient channel systems – Okavango and Mamers Valles (Figure 5.A; Mangold and Howard, 2013) – as well as networks of linear depressions – Ismeniae and Coloe Fossae. These physiographic features all record complex geologic processes that are associated with the long-term break-up and marginal erosion of the cratered highlands. From the north to the south, the highland–lowland transition in Ismenius Lacus is marked by the high-standing plateaus of Deuteronilus and Protonilus Mensae as well as the irregularly-shaped depressions of Deuteronilus Colles and Colles Nili. The lowlands in the north typically lie at –4,000 m or lower. The 236-km-diameter Lyot crater and its radial and lobate ejecta blanket dominate the center of the quadrangle.
The Argyre basin spans the west half of the quadrangle, while part of Noachis Terra, at 0–2 km elevation, lies to the east. Argyre, as deep as –3 km elevation, is the best preserved of the largest multi-ringed impact basins on Mars, and is comparable in size to the Orientale basin of the Moon. The size and number of rings in the basin, which are generally expressed by discontinuous, concentric ridges and basin-facing scarps, are debated (three to seven rings or more), owing to later modification. The most common diameter assigned to a prominent, inner ring is 800–900 km, while the entire structure may be 1800 km or more across. Valleys drain toward Argyre from the south and east, while large channels may connect Argyre to the Uzboi–Ladon–Morava (see MC-19) system to the north. Drainage into the northwestern flank of the basin from surrounding plains is blocked by concentric, broad ridges. The hummocky floor of Argyre is 3–4 km below the average terrain elevation beyond the rim (Hiesinger and Head, 2002) and includes a variety of landforms. Noachis Terra is typical of the southern cratered highlands of Mars and gives its name to the oldest period of geologic time on Mars (MC-27).
The Phaethontis quadrangle is dominated by the cratered highlands of Terra Sirenum, which display prominent, marginal basins and tectonic structures, reaching thousands of kilometers in length. Except for the interiors of larger craters, elevations are generally 1–3 km above datum. Tharsis lava-flow materials inundate and partially cover the rugged, ancient terrain in the northeast corner of the quadrangle. Some of the structural basins in the northwestern part of the quadrangle display disrupted floors, referred to as chaotic terrain, most notably Atlantis Chaos and Gorgonum Chaos. The segmented, narrow graben systems of Sirenum Fossae and Icaria Fossae extend southwestward from the Tharsis rise, northeast of the quadrangle, cutting both ancient cratered highland materials and some of the older Tharsis lava flows.
In this quadrangle, the deepest canyon system on Mars and one of the most spectacular in the solar system, Valles Marineris, extends more than 2,500 km across the map, cutting the northern part of the Thaumasia plateau (informal name). Parts of the floor are more than 5,000 m below datum and as much as 10,000 m below the plateau rim. The system of canyons includes Melas, Candor, and Ophir Chasmata, prominent at its central part, Coprates along its eastern part, and Ius and Tithonium Chasmata, forming its western arm. Echus, Hebes, Juventae, and Ganges Chasmata form additional, separate canyons, north of the main canyon system. The canyons of Noctis Labyrinthus, west of the map (MC-17), join Valles Marineris, which connects eastward with the chaos-filled canyons of Capri and Eos Chasmata. Some of the other chasmata are linked to outflow channels north (MC-10) and east of the map (MC-19). Sinai, Solis, and Thaumasia Plana make up high plains that span the western to south–central parts of the Coprates quadrangle. Together they constitute much of the Thaumasia plateau, a dish-shaped, elevated region at 3,000–5,000 m. At their eastern edges, the Thaumasia plateau and Ophir Planum drop as much as 3,000 m down to variably cratered plains of Noachis and Xanthe Terrae, respectively. The informally named Coprates rise is a prominent north-trending mountain range, forming the eastern margin of the Thaumasia plateau, south of Coprates Chasma. Crossing this entire region are north- to northeast-trending wrinkle ridges as well as local sets of narrow grabens and pit chains.
Elysium Mons rises 14 km above the surrounding plains, while nearby Albor Tholus is 4 km high. Much of the quadrangle consists of plains near datum to –3,000 m, but in the east, Tartarus Montes, Tartarus Colles, and the rimmed depression, Orcus Patera, constitute a more rugged region, largely made up of knobs and low plateaus and ridges that separate Elysium Planitia from Amazonis Planitia to the east (MC-8). To the south of Orcus, Marte Vallis extends from Elysium Planitia into the Amazonis basin. Elysium Planitia includes the landing site of the InSight mission, which is exploring the interior of Mars using geophysical measurements.