This study examined how alexithymia subscales, depression and obsessive-compulsive personality(OCP) relate to eating disorder tendency (EDT) in non-clinical Japanese female adolescents.

A self-report questionnaire survey was conducted on 393 Japanese female adolescents (273 undergraduates and 120 college students, mean age=19.9yrs, SD=1.4).

A stepwise multiple regression analysis was conducted, indicating that “difficulty in identifying feelings”(DIF) (β=.17, p< .01) and “difficulty in describing feelings” (DDF) (β=−.15, p< .01), which are factors of alexithymia, depression (β=.30, p< .001) and OCP (β=.14, p< .05) predicted EDT. Depression had the strongest effect on EDT, with DIF the second strongest. Surprisingly, DDT had a significantly negative effect on EDT.

First, prevention and therapy of eating disorder should focus on depression, difficulty in identifying feelings, and obsessive-compulsive personality. Second, one aspect of discontinuity between clinical and non-clinical females with high risk of eating disorder was implied: Non-clinical females with high risk of eating disorder may tend to describe at least superficial feelings frequently, if not deep or real feelings with introspection. Further, the possibility of describing may work as a preventive factor for non-clinical females with high risk of eating disorder against suffering from clinical eating disorder.

Table 1:

Results of stepwise multiple regression analysis predicting EDT

Determine whether and how primary health care workers (PHCW) provide alcohol screening and brief interventions (SBI) and assess their interest in improving.

A questionnaire built built on WHO recommendations for alcohol prevention and harm reduction in primary health care was distributed to 130 primary health care workers (26.9% doctors, 73.1% nurses) in family medicine and emergency medicine departments in the Primary Health Care Facility Doboj.

The participation rate was 61% (79/130), of which 28 (35%) doctors and 51 (65%) nurses answered the questionnaire. 3 (10.7%) doctors and 3 (5.9%) nurses provide alcohol screening always, 15 (53.6%) doctors and 22 (43.1%) nurses sometimes, while 10 (35.7%) doctors and 25 (49%) nurses never do alcohol screening. None of the PHCW uses AUDIT, 1 uses CAGE, and others use clinical screening procedures. 12 (42.9%) doctors and 40 (78%) nurses never provide brief interventions. 22 (28%) PHCW are interested in providing alcohol screening, while 20 (71.4%) doctors and 15 (29.4%) nurses are interested in improving their SBI skills.

Primary health care workers do not provide routinely alcohol screening and brief interventions aimed at prevention and reduction of alcohol related problems. Those who do provide SBI do not follow WHO recommendations. There is a certain interest to improve, but the fact that 39% PHCW did not even answer the questionnaire is indicative. Motivation, training on SBI and follow-up of PHCW are needed.

Mild Cognitive Impairment (MCI) seems to represent an early stage of Alzheimer's disease (AD) and there is a great interest in the relationship between MCI and the progression to AD.

It has been demonstrated that patients with depression and mild cognitive impairment present a doubled risk of developing dementia of Alzheimer type as those with MCI only. Considering the importance of oxidative stress in MCI and Alzheimer disease, our current objective was to determine the level of oxidative stress in MCI patients with depression, compared with non-depressed MCI patients.

The patients were selected using Petersen criteria for mild cognitive impairment. The cognitive performance was assessed using MMSE (Mini Mental State Examination) and ADAS-cog (Alzheimer's disease Assessment Scale- cognitive subscale) and Geriatric Depression Scale for depression.

We assessed the levels of some enzymatic antioxidant defences like superoxide dismutase (SOD) and glutathione peroxidase (GPX), as well as lipid oxidation makers like MDA (malondialdehyde), from the patients peripheral blood.

The results were compared to an aged-matched non-depressed MCI group.

A significant decrease in the specific activity of both superoxide dismutase and glutathione peroxidase was found in MCI patients with depression compared with non-depressed MCI patients. Also, the concentration of serum malondialdehyde was increase in MCI patients with depression.

We conclude that patients with MCI and depression have an increased level of oxidative stress, compared with non depressed MCI patients. This could explain the increased risk of patients with depression and mild cognitive impairment in developing dementia of Alzheimer type.

To understood the influence of group psychotherapy to crisis frangibility and coping style in community residents,seek the methods and value of community psychological coping intervention,and provide the basis of psychological theory and practice for the work of community mental health.

The scale of crisis frangibility and BCQ were employed to evaluate and compare the mental state before and after intervention.

:

1. 1) Crisis frangibility of residents was negatively correlated with positive coping,positively correlated with negative coping.

2. 2) After group psychotherapy,scores of scale for crisis vulnerability and negative coping droped.

3. 3) Through the regression model analysis, the linear relationship between positive coping factor and the crisis vulnerable is closest.

Group psychotherapy in community is a effective method to reduce resident's crisis frangibility,and the setup of experimental model has provided the theory and the practice basis for development psychology counseling in community.

This study explores the effects of a group psychoeducations family intervention for individuals with schizophrenia and their family.

A cluster randomized controlled trial design was employed.A total of 97 patients with schizophrenia and their relatives were recruited from two street and divided into two groups.The groups consisted of a group psychoeducational family intervention group and a control group.A 12-month follow-up study was conducted.

The psychoeducational family intervention group attained a better knowledge gain related to mental illness and an increase in treatment compliance compared to the control group.Family attitudes toward the patient were positively related to the patient's clinical outcome.Family attitudes improved after 12 months of intervention.The clinical outcomes of family intervention group were enhanced and the relapse rate was significantly decreased as well.There was an increased readmission rate in the group family intervention may be due to better access to health care.Although there were no differences in overall social function,there were improvements in the specific components of marital role and care of self for the family intervention group.The patient's negative influence on society in the family intervention group decreased after 12 months of intervention.

The group psychoeducational family intervention played a important role in improving the relatives’ knowledge of mental health and attitudes towards the patients.The intervention promoted the patient's treatment compliance, decreased the relapse rate,improved clinical outcomes and social function.we think the group psychoeducational family intervention can provide the basis for future research and mental health practice in China.

The pharmacologic interface between psychiatry and neurology is AEDs as they are utilized to treat both epilepsy and psychiatric disorders. Further, AEDs are commonly utilized to treat pain disorders. Thus, AEDs are primarily prescribed for treatment of psychiatric and pain disorders, not for treatment of epilepsy. The choice of which AEDs neurologists will utilize in treatment of epilepsy is most often premised on the classic benefits/risks/alternatives equation; however, consideration should be given to psychiatric co-morbidities and which AEDs might best serve patients in both maximizing seizure control and minimizing psychiatric symptoms as patients with epilepsy (PWE) have a 50-80% lifetime prevalence of psychiatric disorders with a three-to-five-fold increased risk of suicide compared to the general population. This overview of AED treatment of psychiatric disorders with inclusion of labeled and off-labeled uses can serve as a guide for neurologists and psychiatrists in better treating psychiatric co-morbidities in PWE.

Literature review.

Of 16 AEDs reviewed, clinical studies have addressed > 30 possible uses; however only 5 AEDs (benzodiazepines, carbamazepine, valproate, lamotrigine, and pregabalin) have received FDA/EMEA psychiatric indications. Most studies are uncontrolled case reports, open-label case series, and underpowered randomized controlled trials with methodological flaws. Regardless of the limited approved indications and in some instances negative pivotal trials, AEDs continue to be utilized adjunctively or in monotherapy treatment for a plethora of psychiatric diagnoses.

AEDs are pivotal in treating psychiatric co-morbidities in PWE. Further placebo-controlled (augmentation and monotherapy) parallel-arm research with active-comparators is required in this complex field.

Glaucoma is a chronic, progressive optic neuropathy, with visual field defects (VFD) and progressive loss of the retinal ganglion cells, leading herewith to an affected light transmission to the suprachiasmatic nuclei. Progressed glaucoma has been therefore lately suggested to lead to a circadian misalignment and thus to several physiological consequences, including sleep and affective disorders.

The investigation of depressive symptoms and sleep disorders among glaucoma patients with and without VFD.

Patients with confirmed glaucoma diagnosis were recruited and divided in two groups: Patients with extensive VFD (glaucoma fere absolutum) and patients with no or minor VFD. The patients were assessed by self-rating questionnaires to depression (Beck's Depression Inventar), anxiety (State-Trait Anxiety Inventory), affectivity (Positive Affect - Negative Affect Scala) and sleep quality (Pittsburgh Sleep Quality Index).

88 patients have been recruited, of them 57% with VFD. The prevalence of depression was significantly higher in patients with VFD (p = .037). The VFD group also showed significantly higher trait anxiety rates (p = .027), but no significant differences concerning negative emotion. In addition, the subjective sleep quality in men with VFD was significantly worse than in the control group (p = .048), while VFD was significantly correlated with a longer lag time to fall asleep (p = .026).

This study verifies a high prevalence of untreated depression and sleep disorders among glaucoma patients with VFD, which could be an evidence for a circadian derangement. Subsequently, a psychochronobiological melatonergic depression treatment should be considered in this group.

Atypical antipsychotics are used in large scale in reason of their few side effects, as extrapyramidal symptoms. Dispite of this safety they can cause severe dystonia as Pisa Syndrome.

This case brings an example of Pisa Syndrome induced by the use of Ziprasidone.

A thirty five year old female, diagnosed with Bipolar disorder was treated in a psychiatry ambulatory with lithium 1200mg and haloperidol 10mg. As the psycosis persisted it was necessary to change the antipsychotic and ziprasidone was chosen.

Three months after the introduction of ziprasidone, the patient began to present severe dystonia symptoms. In the occasion could be noticed sustained involuntary flexion of the body and head to one side as well as slight rotation of the trunk.

In reason of the extrapyramidal symptoms, ziprasidone was suspended.

The case was treated with anticholinergic drugs. Prometazine and biperidene were tried but neither was effective.

Two months after the suspension of Ziprasidone the patient recovered completely and did not present any signs of dystonia.

Pisa Syndrome can be caused by atypical neuroleptics as ziprasidone.

The treatment is difficult and anticholinergics are not effective.

In some situations Pisa Syndrome can be definitive.

The use of atypical antipsychotics requires knowledgment and experience from the psychiatrist. The potencial of atypical antipsychotics to cause extrapyramidal symptoms as Pisa Syndrome can not be forgotten.

The pathophysiology of extrapyramidal side effects of typical antipsychotic drugs and the role of gender as a risk factor is poorly understood.

To elucidate the role of gender and the oestrogen hypothesis in extrapyramidal side effect severity.

To investigate gender differences in side effects of antipsychotic drugs and explore the role of oestrogen levels in side effect severity.

25 women and 23 men with a diagnosis of schizophrenia were examined for side effects using the Extrapyramidal Side Effects Rating Scale (ESRS), the Simpson Angus Rating Scale for Extrapyramidal Side Effects and the Abnormal Involuntary Movements Scale (AIMS).

Higher antipsychotic doses and use of anticholinergics were noted in males.Women had higher ESRS scores and Simpson Angus scores. Men had higher mean scores for AIMS and the Barnes Akathisia Rating Scale. Age was significantly correlated with scores on ESRS, AIMS and Simpson Angus Rating Scale. There was a highly significant correlation between ESRS score and absence of a regular menstrual cycle. No association with age or antipsychotic dose was found between the groups. Women without a regular cycle scored significantly higher on Simpson Angus Rating Scale. Women with regular cycles scored significantly higher on Barnes Akathisia Rating Scale. There was no difference in AIMS score between the groups. No significant difference was found on any measure between women who were in the high and low oestrogen phases of the cycle.

Gender, age and the presence of a menstrual cycle should be considered when prescribing antipsychotic medication.

Mr. Y is a 36 year old male patient diagnosed with simple schizophrenia that has complained of insomnia since the age of sixteen. During the last three years the treatment that the patient was following was stable and consisted of 100 mg of diazepam, 300 mg of levomepromazine and 120 mg of clotiapine every night. During the last year 60 mg of duloxetine were added to treat a moderate depression. His mood improved with the prescribed treatment, but eleven months later it worsened. In an attempt to simultaneously treat the mood and the sleep disorder, during a period of 4 days, a dosis of 12.5 mg of aglomelatin at dinner was introduced while the morning dose of duloxetine was reduced to 30mg. On the fifth day, agomelatine was increased to 25 mg at dinner while duloxetine was suspended. The antipsychotic treatment was kept stable while the patient was instructed to reduce 10 mg of diazepam every week until next appointment one month later. In the next appointment the patient had completely suspended diazepam one week before the appointment. The patient referred improved sleep quality and no rebound insomnia.

Agomelatine may be a valid treatment of insomnia in schizophrenia.

Paroxetine is a SSRI, widely used nowadays for treating diverse psychiatric pathologies, such as anxiety disorders, affective disorders… It is well known by clinician that paroxetine used is doses between 10-50 mg has evident benefits in the therapeutic process.

Different adverse effects are commonly expected when using paroxetine, and some other side effects are considered rare, meaning that are shown in 1 or more every 10.000 patients but less than 1/1000.

Comprehensive review of the scientific literature (Medline, Psychoinfo, Medex) on hyperprolactinemia secondary to SSRI treatments published over the last years.

This is a case report of a 32 year-old- female treated with paroxetine, suffering from panick attacks frequently in the context of an anxiety disorders. After 2 years she quited consuming cocaine in 2007.

The patient after a couple of months being treated with paroxetine observes lactation, galactorrhea, and amenorrea.

Analysis were done, in the beginning an increase in prolactine levels was found, after changing the treatment although prolactine levels were lowering the galactorrhea persisted in time.

Before considering paroxetine as a factor, she started to be studied in a fertilization program, where she still is.

Galactorrhea cases with tricyclic antidepressants, as well as with selective serotonin reuptake inhibitors are rarely reported. The observed lactation is presumed to be secondary to a drugmediated increase in prolactine levels. This is the report of a case of hyperprolactinemia and galactorrhea following treatment with paroxetine in a young female with an anxiety disorder.

There is increasing concern about the use of multiple medications in psychiatric patients.Older adults make up 15% of the population yet they account for 30% of the prescribed medications. There is increased risk of falls, confusion and consequent functional decline as a result of potential interactions and adverse drug events.

To document the extent of polypharmacy and potential drug interactions in elderly inpatient population at the point of discharge.

25 consecutive discharge summaries from an elderly mixed (organic and functional) inpatient unit were evaluated.

out of 25 (15 female and 10 male) patients with age range of 59-97 years, an average of 6.5 drugs (Range:2-17; Median:6) were prescribed. An average of 3.1 pair of interactions (Range:0-15; Median:3) were noted. Potentially hazardous interactions (Average 0.68; Range:0-4) was a worrying trend in this patient group.

Polypharmacy is commonplace in elderly patients and is worrisome. Different strategies like in-house pharmacist may offer some safeguards though further research is needed.

To determine how informed psychiatric outpatients are about the role of anticholinergic drugs in their treatment.

Using a clinician-administered questionnaire designed by the authors; socio-demographic data and views about the role of Benzhexol in their treatments were obtained from all patients whose case records showed that they were currently prescribed Benzhexol.

98 patients met inclusion criteria, mostly males (n=54; 55.1%). The respondents were predominantly in the age range 25 - 44years (n=67; 68.4%) and single (n=52; 53%). Two-thirds had no more than secondary education. Though more than half of respondents reported having being on their current combination of drugs for more than 1 year, 34% could not give the names of any of their medications. A third reported not knowing the role of Benzhexol in their treatment and of those who claimed to know, 64% (n=42) gave responses that reflected no understanding. Majority (n=31; 74%) of such responses were adjudged to have potentially deleterious implications on their health and outcome. There was no statistically significant association between educational status and knowledge of the role of Benzhexol in patients’ treatment. Only 18% reported ever being educated about the role of Benzhexol in their treatment.

The study provides evidence that majority of the patients may not be well informed about important aspects of their treatment and that health workers may have neglected to educate them. It further calls for an urgent need to improve the patient-information aspects of service delivery in our clinics.

Concomitant antipsychotic prescription is common in clinical psychiatry, although it is not an evidence-based practice. The aim of the study was to describe the prescription of antipsychotics in inpatients with schizophrenia and identify which are the factors associated with this tendency.

We reviewed retrospectively the psychotropic drugs prescribed at the time of discharge of 177 inpatients who met criteria for schizophrenia [DSM-IV-TR] on an acute psychiatry unit from 2007 to 2008.

One hundred and two patients (57.6%) were male. Mean age (SD) was 38.1 (14.6) years. The percentage of patients discharged on treatment with two or more antipsychotics was 43.5%. Although in the strict sense we should not consider it as polipharmacy, the most frequent combination was long acting injectable risperidone with oral risperidone (21.5%), followed by long acting injectable typical antipsychotic with oral risperidone (3.4%). There was a significant association between the number of prescribed antipsychotics and the total number of previous hospitalizations and the number of hospitalizations during the previous year (ANOVA p=0.001 and p< 0.001 respectively). No correlation was found between polypharmacy and age. There was a significant association between the number of antipsychotics prescribed and the use of anticholinergic treatment (t-test p=0.005).

Our polypharmacy rates are comparable with prior European data (30-76%). Despite of the clinical guidelines, antipsychotic polipharmacy is an extended therapeutic strategy not necessarily related with resistant schizophrenia. Most of the antipsychotic associations identified are not evidenced-based practice. More clinical trials are needed to determine the efficacy of different combinations.

Olanzapine is a novel antipsychotic agent. It has a pleotrophic pharmacology and affects dopaminergic, serotonergic, muscarinic and adrenergic activities. The therapeutic advantage of recent antipsychotics (so-called atypical antipsychotics) has been attributed to alpha-2 adrenergic antagonist effects.

The aim of this study was to evaluated effectiveness of Olanzapine in patients with schizophrenia.

Study was designed for 8-week, observational study. 40 patients, both genders, aged 20-65 years, with diagnosed various types of schizophrenia were enrolled in the study as outpatient and inpatient setting. The patients had to have a total score ≥40 on Positive and Negative scale - two parts of the Positive and Negative Syndrome Scale (PANSS). The efficacy parameter was the percent of score difference between baseline and week 8 of therapy on two above-mentioned PANSS subscales. The difference was considered as significant improvement if decrease from the baseline was 20% or more.

All 40 enrolled patients completed the study. After the 8 weeks of treatment, 32/40 patients (80%) had clinically significant improvement of 20% or more decreased total PANSS score (Positive and Negative subscale). In 8/40 patients (20%) clinical improvement was also reported with < 20% decreased total PANSS score.

In this observational study olanzapine appears to be very good effectiveness in patients with schizophrenia.

The poor compliance to antipsychotic medication is a major problem in ambulatory treatment of patients with psychotic symptoms, leading to an increased risk of exacerbation and inpatient readmission.

Our objective is to clarify if the administration of prolonged release antipsychotics (PRAP) is a relevant factor in the decrease of inpatients readmissions.

Through a retrospective study, we assessed the socio-demographic and psychopathological features of a sample of patients with diagnostic of Schizophrenia and Schizoaffective disorder (DSM-IVTR), who were admitted to a psychiatric inpatient unit, in the period of two years (January 2007 to December 2008). This sample was divided in two groups (with readmissions/without readmissions), considering as having readmissions the patients that were readmitted in the nine months after the first medical discharge. We compared the use of PRAP versus oral antipsychotics (OAP) at the time of the first medical discharge, assessing if these differences had any impact in the readmissions.

Sample of 88 patients, 55,68% (n=49) male, 53,41% (n=47) unemployed, 64,77% (n=57) single. The most frequent diagnostic was Paranoid schizophrenia (73,86%, n= 65), followed by Schizoaffective disorder (17.05%, n= 15). Of the patients that had readmissions (n=15; 17,05%), 40,00% were medicated with PRAP (n=6) compared with 49,32% (n=36) of the patients with no readmissions (n=73). These differences had no statistic significance.

Taking in consideration the small sample of patients, the frequency of readmissions was low. About 50% of the patients were medicated with PRAP+OAP, with no evidence that this decision had reduced the readmissions.

Schizophrenia is a debilitating and cronic disease for which full recovery is typically not considered to be a realistic treatment endpoint. Symptomatic remission, however, may be an objectively attainable treatment goal.

We wanted to assess remission rates over 52 weeks in patients with schizophrenia treated with ziprasidone

Remission rates were calculated using data from a 52 week study in which patients diagnosed with acute schizophrenia were stabilized with ziprasidone (n=30, dose 120-140mg/day) For this analysis, remission was operationalized according to the consensus-based symptomatic remission criteria established by the Remission in Schizophrenia Working Group. Accordingly, patients were required to achievescores Syndrome Scale (PANSS) items (delusions, unusual thought content, hallucinatory behavior, conceptual disorganization, mannerisms/posturing, blunted affect, social withdrawal, lack of spontaneity) and to maintainthe item score threshold for at least 6 consecutive months.

Thirty-seven percent of ziprasidone treated patients satisfied the criteria for symptomatic remission within the 52-week trial period. Approximately 7% of patientslost their remission status prior to the end of thetrial, with mean time in remission of 6.5 months. Forty-six percent of patients never met the PANSS item threshold. During the 52-week study, few patients discontinued due to adverse events other than worsening of symptoms(7%) or received concomitant medication for EPS (18%)

Nearly one third of the patients treated with ziprasidone achieved remission status within 6 months. Most patients who achieved remission remained in remission for more than 9 months until trial termination. Overall CGI-Is of these patients were significantly better than for patients without remission.

To explore the relationship between symptomatic and functional outcomes in adults (age 18-65 years) with ADHD during open label treatment with PR OROS MPH.

Post hoc analyses of a 7-week open-label extension (OLE) (N=370) of a 5 week, placebo controlled double-blind study (DB) which explored safety, efficacy, functional and quality of life outcomes in subjects with a diagnosis of ADHD (DSM-IV). Medication was flexibly dosed (18-90 mg/day) and adjusted individually to best effect during OLE. Regression analyses were performed on the change from DB baseline at OL endpoint in functionality and quality of life as measured by the Sheehan Disability Scale (SDS) and Quality of Life (Q-LES-Q). Baseline score, country, randomization group, sex, change from baseline in CAARS Hyperactivity / Impulsivity, CAARS Inattention and CGI-S at DB endpoint were included as covariates in the analyses.

337 / 370 patients completed the 7-week open label treatment. Improvement on CAARS Hyperactivity / Impulsivity at DB endpoint was significantly related with improvement in SDS “work”, “social life”, “family life” (at least p< 0.005) and “total score” as well as quality of life (p< 0.05) at the end of open label treatment. Change in CGI-S and CAARS Inattention at DB endpoint vs. DB baseline were not related with improvements in any of the functional or quality of life scales at OL endpoint (p>0.05).

These results indicate that improvement in daily functioning and QOL under active treatment may be particularly related to improvement in hyperactivity symptoms.

Sexual dysfunction (SD) is an important underestimated adverse effect of antidepressant drugs. Patients, in fact, if not directly questioned, tend to scarcely report them. The aim of the present meta-analysis was to quantify SD caused by antidepressants on the basis of studies where sexual functioning was purposely investigated through direct inquiry and specific questionnaires.

A literature search was conducted using MEDLINE, ISI Web of Knowledge, and references of selected articles. Selected studies performed on patients without previous SD were entered in the Cochrane Collaboration Review Manager (RevMan version 4.2). Our primary outcome measure was the rate of total treatment-emergent SD. Our secondary outcome measures were the rates of treatment-emergent desire, arousal, and orgasm dysfunction.

Our analyses indicated a significantly higher rate of total and phase-specific treatment-emergent SD compared with placebo for the following drugs in decreasing order of impact: sertraline, venlafaxine, citalopram, paroxetine, fluoxetine, imipramine, phenelzine, duloxetine, escitalopram, and fluvoxamine, with SD ranging from 25.8% to 80.3% of patients. No significant difference with placebo was found for the following antidepressants: agomelatine, amineptine, bupropion, moclobemide, mirtazapine, and nefazodone.

Treatment-emergent SD caused by antidepressants is a considerable issue with a large variation across compounds. Some assumptions, such as the inclusion of open-label studies or differences in scales used to assess SD, could reduce the significance of our findings. However, treatment-emergent SD is a frequent adverse effect that should be considered in clinical activity for the choice of the prescribed drug.

Olanzapine plasma concentration ≥ 23, 2 ng/ml have been identified as a predictor of clinical response in acutely ill patients with schizophrenia. Aim was to determine relation between plasma concentration of olanzapine in a sample of inpatients or outpatients with acute mania by defining a plasma threshold (above which a better clinical response was obtained).

Open label, longitudinal, multicentric study including patients with acute mania and treated by olanzapine for 6 weeks; plasma concentration of olanzapine was measured at 3 and 6 weeks by high-performance liquid chromatography. Patients were considered “responsive” if they showed at least a 50% reduction in Young Mania Rating Scale score and a Clinical Global Impression Severity scale score of ≤ 3.

Twenty patients were including (13 men and 7 women), mean age 57.4 yr. The mean olanzapine dosage was 11.46 mg/day (SD=2.49) at the same dosage for 16.8 days (SD=6.5). Receiver operating characteristic curve analysis determined a plasma threshold to be 15, 9 ng/ml.

It's the first time that a threshold of Olanzapine is determined in bipolar mania into a consequent population. This result could be considered as additional tools to adjust posology for improve cares, when manic patients are resistant.