To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Clozapine has several major side-effects for example agranulocytosis. There are however several severe cardiac side-effects associated with the use of clozapine.
We present two psychotic patients, who were treated with clozapine. One patient developed myocarditis and the other patient developed cardiomyopathy. These findings raised questions about the frequency of cardiac side-effects due to clozapine treatment.
Awareness of cardiotoxic side-effects of clozapine; Creation of a clinical guideline for myocarditis and cardiomyopathy in clozapine treatment
Two case reports, one male 57 years, suffering from paranoid schizophrenia developing myocarditis, the other a female of 62 years also suffering from paranoid schizophrenia, developing cardiomyopathy during clozapine treatment are presented.
Secondly, an extensive literature search with keywords: Myocarditis; cardiomyopathy, heartfaillure and clozapine has been performed.
The incidence of myocarditis and cardiomyopathy associated with clozapine use are possibly around 1 percent, 10-100 times higher than previously assumed.
Myocarditis and cardiomyopathy are cardiac side-effects of clozapine use which are severe and have a possible fatal outcome. Diagnosis of namely myocarditis can be difficult.
Research suggests that these side-effects might be less rare as thought of until recently. A clinical guideline for monitoring of these side-effects didn’t really exist to this moment. A proposition for a clinical guideline has been made in this presentation consisting of namely: anamnestic findings laboratory tests and ECG controls. Awareness for myocarditis is especially necessary during the first 4 weeks of clozapine treatment.
Clozapine treatment has been recognized as a superior treatment in schizophrenia. Clozapine treatment has also be accompanied with several rare but severe adverse events, like neutropenia, agranulocytosis, myocarditis, pericarditis and polyperositis. We report a patient that suffers from hyperleucocytemia, eosinophilia and pleuritis, due to clozapine treatment, the adverse events disappeared after a switch to aripiprazole.
To review the literature on reports on pleuritis and polyserositis in order searching for guidance in these clinical situation, like the need tot interrupt the medication, the prognosis and if rechallenges are reported. Another objective was to discover if something is known about the underlying mechanism.
To review the literature, we used the following terms: clozapine, treatment, immunological reaction, neutropenia, leucopenia, epicarditis, polyserositis, pleuritis, pleural effusion, underlying mechanisms, risk factors.
A literature search was performed in Pubmed® and Embase Psychiatry® in the period longing from 1972 till October 2010
Risk factors as well as the underlying mechanisms offer no guidance for dealing with the clinical critical situations.
There are only a few reports on pleural effusion, there are some reports on pleural effusion in combination with epicarditis, there are some reports on polyserositis including pleural effusion.
No rechallenges are reported of clozapine on pleural effusion.
There is no information in the literature on the risk that a pleuritis will extend to other organs, like the heart and the liver, when continuing the clozapine treatment.
Hypotheses about the underlying mechanism will be presented. A program of additional diagnostics will be described
Studies on neighbourhood characteristics and depression show equivocal results.
This large-scale pooled analysis examines whether urbanisation, socioeconomic, physical and social neighbourhood characteristics are associated with the prevalence and severity of depression.
Cross-sectional design including data are from eight Dutch cohort studies (n= 32 487). Prevalence of depression, either DSM-IV diagnosis of depressive disorder or scoring for moderately severe depression on symptom scales, and continuous depression severity scores were analysed. Neighbourhood characteristics were linked using postal codes and included (a) urbanisation grade, (b) socioeconomic characteristics: socioeconomic status, home value, social security beneficiaries and non-Dutch ancestry, (c) physical characteristics: air pollution, traffic noise and availability of green space and water, and (d) social characteristics: social cohesion and safety. Multilevel regression analyses were adjusted for the individual's age, gender, educational level and income. Cohort-specific estimates were pooled using random-effects analysis.
The pooled analysis showed that higher urbanisation grade (odds ratio (OR) = 1.05, 95% CI 1.01–1.10), lower socioeconomic status (OR = 0.90, 95% CI 0.87–0.95), higher number of social security beneficiaries (OR = 1.12, 95% CI 1.06–1.19), higher percentage of non-Dutch residents (OR = 1.08, 95% CI 1.02–1.14), higher levels of air pollution (OR = 1.07, 95% CI 1.01–1.12), less green space (OR = 0.94, 95% CI 0.88–0.99) and less social safety (OR = 0.92, 95% CI 0.88–0.97) were associated with higher prevalence of depression. All four socioeconomic neighbourhood characteristics and social safety were also consistently associated with continuous depression severity scores.
This large-scale pooled analysis across eight Dutch cohort studies shows that urbanisation and various socioeconomic, physical and social neighbourhood characteristics are associated with depression, indicating that a wide range of environmental aspects may relate to poor mental health.
Impaired metacognition is associated with difficulties in the daily functioning of people with psychosis. Metacognition can be divided into four domains: Self-Reflection, Understanding the Other's Mind, Decentration, and Mastery. This study investigated whether Metacognitive Reflection and Insight Therapy (MERIT) can be used to improve metacognition.
This study is a randomized controlled trial. Patients in the active condition (n = 35) received forty MERIT sessions, the control group (n = 35) received treatment as usual. Multilevel intention-to-treat and completers analyses were performed for metacognition and secondary outcomes (psychotic symptomatology, cognitive insight, Theory of Mind, empathy, depression, self-stigma, quality of life, social functioning, and work readiness).
Eighteen out of 35 participants finished treatment, half the drop-out stemmed from therapist attrition (N = 5) or before the first session (N = 4). Intention-to-treat analysis demonstrated that in both groups metacognition improved between pre- and post-measurements, with no significant differences between the groups. Patients who received MERIT continued to improve, while the control group returned to baseline, leading to significant differences at follow-up. Completers analysis (18/35) showed improvements on the Metacognition Assessment Scale (MAS-A) scales Self Reflectivity and metacognitive Mastery at follow-up. No effects were found on secondary outcomes.
On average, participants in the MERIT group were, based on MAS-A scores, at follow-up more likely to recognize their thoughts as changeable rather than as facts. MERIT might be useful for patients whose self-reflection is too limited to benefit from other therapies. Given how no changes were found in secondary measures, further research is needed. Limitations and suggestions for future research are discussed.
Which neighbourhood factors most consistently impact on depression and anxiety remains unclear. This study examines whether objectively obtained socioeconomic, physical and social aspects of the neighbourhood in which persons live are associated with the presence and severity of depressive and anxiety disorders.
Cross-sectional data are from the Netherlands Study of Depression and Anxiety including participants (n = 2980) with and without depressive and anxiety disorders in the past year (based on DSM-based psychiatric interviews). We also determined symptom severity of depression (Inventory of Depression Symptomatology), anxiety (Beck Anxiety Inventory) and fear (Fear Questionnaire). Neighbourhood characteristics comprised socioeconomic factors (socioeconomic status, home value, number of social security beneficiaries and percentage of immigrants), physical factors (air pollution, traffic noise and availability of green space and water) and social factors (social cohesion and safety). Multilevel regression analyses were performed with the municipality as the second level while adjusting for individual sociodemographic variables and household income.
Not urbanization grade, but rather neighbourhood socioecononomic factors (low socioeconomic status, more social security beneficiaries and more immigrants), physical factors (high levels of traffic noise) and social factors (lower social cohesion and less safety) were associated with the presence of depressive and anxiety disorders. Most of these neighbourhood characteristics were also associated with increased depressive and anxiety symptoms severity.
These findings suggest that it is not population density in the neighbourhood, but rather the quality of socioeconomic, physical and social neighbourhood characteristics that is associated with the presence and severity of affective disorders.
The prevalence and severity of neurocognitive dysfunctioning of patients with somatic symptom and related disorders (SSRD) is unknown. Furthermore, the influence of comorbid depression and anxiety has not been evaluated. This study examines neurocognitive dysfunctioning of patients with SSRD and explores if comorbid depression and anxiety is associated with specific neurocognitive dysfunctioning.
Cross-sectional study with consecutive patients suffering from SSRD visiting an outpatient specialty mental health care Centre of Excellence for SSRD. Extensive neuropsychological assessment and assessment of depression and anxiety symptom levels using the Patient-Health-Questionnaire-9 and General Anxiety Disorder questionnaire-7 were performed at intake. Multivariate analysis was performed.
The study sample consisted of 201 SSRD patients, with a mean age of 43 years (Standard deviation = 13) years; 37.8% were male. Neurocognitive dysfunction in the domains information processing speed, sustained and divided attention, working memory, verbal and visual memory were reported, compared with normative data. Comorbid depression and anxiety occurred frequently within the sample (75.1% and 65.7%, respectively). Neurocognitive dysfunctioning was worse in patients suffering from comorbid depression [multivariate F (7,161) = 2.839, p = 0.008] but not in patients with comorbid anxiety.
Poor neurocognitive performance of patients with SSRD is common and worsens in case of comorbid depression. This may explain treatment dropout of patients with SSRD from neurocognitive behavioral therapy. Research on novel interventions is needed targeting neurocognitive functioning of patients with SSRD, particularly those with comorbid depression.
Imaging soft matter by transmission electron microscopy (TEM) is anything but straightforward. Recently, interest has grown in developing alternative imaging modes that generate contrast without additional staining. Here, we present a dark-field TEM technique based on the use of an annular objective aperture. Our experiments demonstrate an increase in both contrast and signal-to-noise ratio in comparison to conventional bright-field TEM. The proposed technique is easy to implement and offers an alternative imaging mode to investigate soft matter.
We report on the status of the R&D for a digital Time Projection Chamber based on Micromegas detectors using the CMOS chip TimePix as a direct readout anode protected by highly resistive a-Si:H layer. A small chamber was built as a demonstrator of the 2-D and 3-D imaging capabilities of this technique. We illustrate the new capabilities of this detector for x-ray observation with data taken from radioactive sources. This small TPC is a very useful tool both for studying gas properties thanks to its good efficiency for single electrons, and for reconstructing photoelectron direction for use as a soft x-ray polarimeter.
Four temperature response models were compared describing the emergence rate of Solanum sisymbriifolium (L.) over a broad range of suboptimal temperatures and at different soil water potentials. In the laboratory, the effects were tested on germination rates at constant (9.1–21.8°C) and diurnally fluctuating temperatures at different soil water potentials. Linear, Q10, expolinear and quadratic models were fitted to the data on rate of emergence against temperature. For model validation, field emergence was monitored in 11 sowings conducted in 2001–2004. Emergence rate increased with temperature and was relatively high at soil water potentials in the range of − 0.21 MPa to − 2.6 × 10− 3 MPa, but was almost zero at − 0.96 MPa and − 1.8 × 10− 3 MPa. Diurnal temperature fluctuations did not have a differing influence on germination rates or final germination percentages compared with constant temperatures. The expolinear and the quadratic models were most accurate in explaining variation of laboratory data, especially at temperatures close to the minimum germination temperature of S. sisymbriifolium. These two models had root mean square errors for predicting field emergence rates (5.9 to 38.4 d) of 0.81 and 0.87 d, respectively, and were considered more appropriate to predict the time to 50% germination for crops grown in conditions near their ‘base temperature’ than the widely used linear temperature (thermal time) models. The Gompertz function was fitted to percentage germination versus the time-accumulated germination rate (using the expolinear function to describe the rate–temperature relation). This combined model adequately predicted the temporal pattern of emergence in the field.
Distal hereditary motor neuropathies (distal HMNs) are characterised by degeneration of anterior horn cells of the spinal cord resulting in muscle weakness and atrophy. Distal HMN type II is genetically linked to chromosome 12q24.3 and located within a 13 cM region flanked by markers D12S86 and D12S340. We previously excluded the human phospholipase A2 group 1B gene (PLA2G1B) as the disease causing gene. Here, we report the mutation analysis of five other candidate genes localised within the distal HMN II region: the cytoskeletal proteins paxillin (PXN) and restin (RSN); the acidic ribosomal phosphoprotein, large P0 subunit (RPLP0); a nucleoside diphosphate kinase (NME2B); and the β 3 subunit of the voltage-gated calcium channel (CACNB3). DNA sequencing of the coding regions was performed but no disease causing mutations could be identified, hence excluding these five genes for distal HMN type II.
HNA is an autosomal dominant recurrent focal neuropathy involving
the brachial plexus. The
etiology of HNA is unknown but the genetic defect most likely affects a
non-neuronal tissue. We
previously described linkage to chromosome 17q24–q25 in two HNA-families.
Here we report the
mutation analysis of two candidate genes: a cDNA encoding a putative sialyltransferase
SFRS2 splicing factor including the c-myb ET-locus which
is encoded on the opposite strand of the
SFRS2 gene. The complete protein coding regions of both genes
were studied by direct DNA
sequencing. We did not find a disease associated mutation indicating that
these genes are most likely
not involved in the pathogenesis of HNA. However, we identified and characterized
a rare AvaII
polymorphism in the SFRS2 gene and detected a sequencing error,
leading to an amino acid change
(Val11Leu) in the published sequence of the putative sialyltransferase.
The long term corrosion of two reference Belgian high-level waste glasses (SAN60 and SM58) were investigated in pure water. The corrosion was studied using powdered glass at a high surface area to volume ratio and temperatures of 90 and 120°C. The experimental data at 90°C reveal a “final” leach rate which decreases with time. At 120°C this “final” state is transient and followed by an enhanced dissolution, which was correlated with extensive surface crystallization. Modelling using the PHREEQE and GLASSOL computer codes described the initial corrosion, but was unable to account for the enhanced dissolution at 120°C.
Six alternative TRU waste forms and seven waste immobilization processes are comparatively assessed on the basis of both product properties and process costs and risks. The waste forms are characterized for their leachability, mechanical strength, and thermal and radiation stability. The processes are evaluated in terms of costs (for processing, transportation, and repository disposal) and in terms of occupational exposure, industrial hazard, and quality assurance. Cast cement is recommended for immobilization of defense TRU wastes. A glass system, either borosilicate or aluminosilicate, is recommended for immobilization of commercial TRU wastes.
Email your librarian or administrator to recommend adding this to your organisation's collection.