A 24-year-old man took 20 grams of paracetamol during a hospital stay in the department of psychiatry. It was not until 60 hours later that therapy with acetylcysteine was initiated. Paracetamol intoxication has a long latency period. If there is no intervention, severe hepatic damage can develop within three days. Even after a few days have passed it is still advisable to start treating the patient with acetylcysteine.

The patient in this case report had two severe medical conditions that require oppositional treatment: prolactinoma and psychosis. A prolactinoma is a benign tumour of the pituitary gland that produces prolactin. Dopamine agonist medication is the first-line treatment in patients with prolactinoma. The psychotic symptoms started after a dosage increase of a dopamine D2-receptor agonist. Several antipsychotic medications were tried with and without the dopamine D2-receptor agonist, but severe command hallucinations remained. Cognitive behavioural therapy (CBT) was added which reduced the impact of the hallucinations to a great extent, indicating that CBT can have an additional positive effect in prolactinoma patients with psychosis that shows incomplete recovery after antipsychotic medication. Future research should be aimed at the severe and prolonged side effects of dopamine agonists in the treatment of prolactinoma patients with multiple risk factors for a psychotic decompensation.

Feeding problems are common for individuals with ASD. Researchers have most often used single case designs, a type of design appropriate for evaluating causal relations, to assess feeding interventions. Previous reviews of effectiveness have included only peer-reviewed studies (e.g., did not include gray literature) and have not analyzed outcomes via the presence of functional relations, the primary analysis method for single case research.Authors reviewed peer-reviewed and non-peer-reviewed sources including studies designed to improve mealtime behaviors for individuals with autism spectrum disorder (ASD) to determine participant characteristics, common intervention characteristics and components, and success rates (percentage of studies with functional relations).Studies often included individuals with ASD who were highly selective; common dependent variables were acceptance of food and problematic mealtime behaviors. Researchers, rather than indigenous adults, most often implemented studies in clinics, rather than typical settings. Interventions designed to improve acceptance had higher success rates (percentage of studies demonstrating a functional relation) than those targeting rumination/vomiting or problematic mealtime behavior.Outcomes were more often positive for food acceptance and less often positive for problematic mealtime behavior. More research is needed, particularly in typical contexts with indigenous implementers and including component analyses, feasibility assessment, and social validity measurement. Feeding interventions should be selected based on identified caregiver priorities (e.g., focus on problematic mealtime behavior or food acceptance) and should include consideration of behavioral function and less restrictive interventions.

Background Cognitive impairment is considered to be a core characteristic of schizophrenia. The relationship between psychosis and cognitive deterioration, however, remains unclear. This longitudinal study investigated the neuropsychological functioning of patients before and after their first psychotic episode. Cognitive functioning of participants who later developed a psychosis was compared to that of people at ultra-high risk (UHR) for psychosis who did not develop psychosis at follow-up and healthy controls. Method Participants were 41 persons at UHR for psychosis (the UHR group), of whom 17 developed psychosis between the first and second assessment. Seventeen healthy controls were included in the study. Cognitive performance was assessed at intake (T0) and again after 18 months (T1). The areas of cognitive functioning assessed include verbal memory and learning, visuospatial working memory, executive function, sustained attention and motor speed. Results The transition group did not perform significantly worse at the second assessment than at the first on any of the outcome measures. The UHR group performed better on a verbal learning and memory test at T1 compared to T0. At T0, the control group scored significantly better than the UHR group and the transition group on the verbal learning and memory test and the verbal fluency test. Conclusions The results indicate that no cognitive deterioration occurs during the first psychotic episode. Problems in verbal memory may be present before the first episode of psychosis.

Objective:The investigation into the course of ultra high risk (UHR) symptomatology of those patients who eventually do not meet the psychosis-threshold criteria within the 3-year timeframe of the study.Method:The course of UHR symptoms, GAF score and employment status was investigated in 57 patients who did not make a transition to psychosis and who were examined within the Dutch Prediction of Psychosis Study in Amsterdam, the Netherlands.Results:At the 3- year follow-up, 75% of the patients who did not make a transition to psychosis had remitted from UHR status. With a Generalized Estimation Equation Model it was shown that this group recovered from positive (F = 52.7, P < 0.0001), negative (F = 24.3, P < 0.0001), disorganization (F = 14.4, P < 0.0001) and general symptoms (F = 25.0, P < 0.0001) within the timeframe of the study. In addition, the level of global functioning and likelihood of having a job and/or education significantly improved. The largest improvements occurred within the first year. UHR symptoms did not re-occur after improvement.Conclusion:With the current UHR criteria, a large percentage of the included subjects appear to have transitory complaints and dysfunctioning. A refinement of the UHR criteria may diminish the chance of including 'false positives' in future UHR studies.

Background Neurocognitive abnormalities are prevalent in both first episode schizophrenia patients and in ultra high risk (UHR) patients. Aim To compare verbal fluency performance at baseline in UHR in patients that did and did not make the transition to psychosis. Method Baseline verbal fluency performance in UHR-patients ( n = 47) was compared to match first episode patients ( n = 69) and normal controls ( n = 42). Results Verbal fluency (semantic category) scores in UHR-patients did not differ significantly from the score in first episode schizophrenia patients. Both the UHR group ( p < 0.003) and the patient group ( p < 0.0001) performed significantly worse than controls. Compared to the non-transition group, the transition group performed worse on verbal fluency, semantic category ( p < 0.006) at baseline. Conclusions Verbal fluency (semantic category) is disturbed in UHR-patients that make the transition to psychosis and could contribute to an improved prediction of transition to psychosis in UHR-patients.

Prediction of transition to psychosis in the prodromal phase of schizophrenia has raised interest in intervention prior to the onset of frank psychosis. The aim of this review was to examine whether interventions in the prodromal phase have a favourable benefit/risk ratio.A literature search in PubMed, EMBASE and PsycINFO was performed.Three randomized clinical trials with antipsychotic medication and/or cognitive behavioural therapy as clinical intervention suggested a positive effect at the end of treatment, but no significant differences were found at the end of follow-up periods from 1 to 4 years. Naturalistic studies present a hypothesis about a possible preventive effect of antidepressive medication. The results of eight other studies are more difficult to interpret. Side-effects of antipsychotic medication and non-adherence with medication are essential problems.At the present time, the data concerning the benefits and risks do not justify prodromal intervention as standard clinical practice.

Latent heat thermal energy storage is a promising option for efficient utilization of intermitted and instable energy. However, the intrinsically low thermal conductivity of phase-change materials (PCMs) is the major shortage, leading to low energy charging and discharging rate. An experimental setup was designed to investigate the dynamic thermal behavior of a shell-and-tube latent heat thermal storage unit. Paraffin wax was employed as the PCM, of which the thermal properties, including that of melting temperature and latent heat, were detected by Differential Scanning Calorimetry. In order to improve the heat transfer performance, copper foam and a bottom fin were compounded to the PCM. High temperature water flowed through the copper tube as the heat transfer fluid (HTF). The temperature variations of the selected detected points inside PCM and the solid–liquid interface evolution in axial plane of symmetry for three samples, including that of pure paraffin, paraffin–copper foam composites without and with the bottom fin, were recorded under the different heating temperatures and flow rates of HTF. The experimental results indicate that completely melting the PCM in composite takes over 1/3 less time than that of pure paraffin under the same operating conditions. The total charging time consumption of the composite with a bottom fin is the least, as well as the heat transfer rate is the largest among the three samples. The influence of HTF temperature on the charging process is more significant than that of the HTF flow rate.

OBJECTIVE:Increasing interest in the prodromal stage of schizophrenia over the past decade led us to perform our study to monitor people at high risk for developing a psychosis. We hypothesized that cannabis use or a cannabis use disorder at a younger age relates to high-risk symptoms at a younger age.METHOD:People referred to the Academic Medical Centre in Amsterdam, the Netherlands, with an ultra-high risk (UHR) for psychosis were interviewed with the Composite International Diagnostic Interview to assess their cannabis consumption. The Interview for the Retrospective Assessment of the Onset of Schizophrenia was used to collect data about age of onset of high-risk or prodromal symptoms. Nine high-risk symptoms were selected and clustered because of their known relation with cannabis use.RESULTS:Among the 68 included participants, 35 had used cannabis (51.5%), of whom 15 had used recently. Twenty-two participants had been cannabis abusers or cannabis-dependent (32.4%) in the past. Younger age at onset of cannabis use was related to younger age of onset of the cluster of symptoms (rho = 0.48, P = 0.003) and also to 6 symptoms individually (rho = 0.47 to 0.90, P < 0.001 to 0.04). Younger age at onset of a cannabis use disorder was related to younger age of onset of the cluster of symptoms (rho = 0.67, P = 0.001) and also to 6 symptoms individually (rho = 0.50 to 0.93, P = 0.007 to 0.03).CONCLUSION:Cannabis use or a cannabis use disorder at a younger age in a group with an UHR for transition to psychosis is related to onset of high-risk symptoms for psychosis at a younger age.

Background: The comparison of high-risk populations with different developmental pathways to psychosis may lend more insight into the heterogeneity of the manifestation of the psychotic syndrome, and possible differing etiological pathways.Aim: To compare high-risk traits and symptoms in two populations at risk for psychosis, i.e. (1) help-seeking adolescents presenting with prodromal symptoms meeting the criteria for At Risk Mental State (ARMS), and (2) adolescents with Multiple Complex Developmental Disorder (MCDD), a PDD-NOS subtype characterized by severe, early childhood-onset deficits in affect regulation, anxieties, disturbed social relationships, and thought disorder.Method: 80 ARMS- and 32 MCDD-adolescents (12-18 years) were compared on prodromal symptoms (Structured Interview of Prodromal Symptoms, and Bonn Scale for the Assessment of Basic Symptoms-Prediction list), and autism traits (Social Communication Questionnaire). In addition, both high-risk groups were compared with 82 healthy controls on schizotypal traits (Schizotypal Personality Questionnaire-Revised).Results: Although the high-risk groups clearly differed in early developmental and treatment histories as well as autism traits, they did not differ with regard to schizotypal traits and basic symptoms, as well as disorganized and general prodromal symptoms. There were, however, group differences in positive and negative prodromal symptoms. Interestingly, 78% of the adolescents with MCDD met criteria for ARMS.Conclusion: These findings suggest that children diagnosed with MCDD are at high risk for developing psychosis later in life, and support the notion that there are different developmental pathways to psychosis. Follow-up research is needed to compare the rates of transition to psychosis in both high-risk groups. (C) 2007 Elsevier B.V. All rights reserved.

The mild cognitive decline associated with type 2 diabetes (T2DM) has been suggested to be reversible with improved glycemic control. In order to characterise this cognitive decline and study the effects of improved glycemic control we have studied patients with T2DM (N = 28) and healthy control subjects (N = 21). One group of patients with diabetes (N = 15) were given a 2-month treatment of intensified glycemic control, whereas the other group (N = 13) maintained their regular treatment.Cognitive function in four different domains, auditory event-related potentials (ERPs) and resting EEG power spectrum were studied in the two groups of patients and in healthy control subjects before and after the 2-month trial period.There were significant differences at baseline (p < 0.02) between patients with T2DM and controls. Patients had lower scores in two cognitive domains: verbal fluency (p < 0.01) and visuospatial ability (p < 0.03). T2DM also affected ERP with a decrease in N100 amplitude (p < 0.04) and an increase in P300 latency (p < 0.03). Furthermore, resting EEG activity in the beta band (13–30 Hz) was reduced (p < 0.04). The change between 1st and 2nd investigation was significantly different in the three groups of patients/subjects (p < 0.03). Patients receiving intensified treatment for glycemic control had an improvement of cognitive ability in visuospatial ability (p < 0.02) and semantic memory performance (p < 0.04) together with increased resting EEG activity in the alpha band (8–13 Hz, p < 0.02) and connectivity in the theta (4–8 Hz, p < 0.03) and alpha bands (p < 0.03) over central and lateral regions. Furthermore, there was an increase in the connectivity in the beta band (p < 0.04) over the central regions of the scalp.In conclusion, subjects with T2DM had a similar type of cognitive function impairment and EEG/ERP abnormality as previously demonstrated for subjects with type 1 diabetes (T1DM). Intensified therapy showed cognitive improvement not shown for regular treatment, suggesting that the negative effect of T2DM on cognition is reversible by means of improved glycemic control. Furthermore, there was an improvement in electro-physiological measures, suggesting increased availability of compensatory mechanisms in subjects with intensified treatment.

BACKGROUND:If schizophrenia and related disorders are diagnosed and treated early, symptoms will be less severe and the prognosis will be more favourable. There is little point in screening for schizophrenia in the general population because the illness has such a low incidence. However, we do need to find out whether it is meaningful to screen genetically impaired individuals (high risk group) and specific groups of psychiatric patients (ultra high risk group).AIM:To survey the research into the (high and ultra high) risk factors for developing a first psychosis and to find out whether it makes good sense to screen certain groups of persons.METHOD:We conducted extensive desk-research and a wide-ranging search of the literature from 1990 to 2004. The key words we used in our search were 'prodrome', 'high risk', 'ultra high risk', in conjunction with 'psychosis' and 'schizophrenia'.RESULTS:In the genetically impaired group risk factors for developing schizophrenia seem to be transient psychiatric problems in childhood, schizotypical traits, anxiety, behavioural problems in adolescence, being brought up in an unstable environment and producing deviant results in neurocognitive tests. Among the patients referred to a psychiatrist it is possible to identify a special group of patients with an ultra high risk of developing a psychosis. Within ayear 40% of patients who had mild or short-term psychotic symptoms or who were genetically impaired adolescents with decreased functioning had developed a psychosis.CONCLUSION:Screening all genetically vulnerable persons in the general population has no consequencesfor treatment. Early diagnosis by psychiatrists is certainly advisable. However, larger groups and longer studies are needed in order to demonstrate conclusively the preventive effect of interventions prior to a first psychosis.

Repetitive transcranial magnetic stimulation (rTMS) applied to the left frontal lobe is discussed to be a promising add-on treatment for negative symptoms in schizophrenia. The Positive and Negative Syndrome Scale (PANSS) has been used as outcome parameter in several previous rTMS trials, but studies focusing on PANSS factor analyses are lacking. For this purpose, we used the available PANSS data of the ‘rTMS for the Treatment of Negative Symptoms in Schizophrenia’ (RESIS) trial to calculate different literature-based PANSS factors and to re-evaluate the impact of rTMS on negative symptoms in this trial. In an exploratory re-analysis of published data from the RESIS study (Wobrock et al. 2015), we tested the impact of rTMS applied to the left dorsolateral prefrontal cortex on two PANSS factors for negative symptoms in psychotic disorders as well as on a PANSS five-factor consensus model intending to show that active rTMS treatment improves PANSS negative symptom subscores. In accordance to the original analysis, all PANSS factors showed an improvement over time in the active and, to a considerable extent, also in the sham rTMS group. However, comparing the data before and directly after the rTMS intervention, the PANSS excitement factor improved in the active rTMS group significantly more than in the sham group, but this finding did not persist if follow-up data were taken into account. These additional analyses extend the previously reported RESIS trial results showing unspecific improvements in the PANSS positive subscale in the active rTMS group. Our PANSS factor-based approach to investigate the impact of prefrontal rTMS on different negative symptom domains confirmed no overall beneficial effect of the active compared to sham rTMS.

In this study, we examine whether adolescent emotional and behavior problems vary by history of early alcohol experiences. A national sample of 6974 alcohol-naïve and 4337 alcohol-experienced youths aged 15–18 years were identified within the 2004 National Survey of Illegal Drug Use among Adolescents in Taiwan. Four alcohol experience groups were created based on recency and frequency of alcohol use: (1) naïve; never drank alcohol, (2) trial use; first and only consumption of alcohol occurred more than 6 months preceding the assessment, (3) past use; alcohol used on more than one occasion but had not had a drink in the 6 months prior to the assessment, and (4) current use; consumed alcohol more than once and drank within the 6 months preceding the interview. A Chinese adaptation of the Youth Self-Report (YSR) assessed eight behavior syndromes: withdrawn, anxious/depressed, somatic complaints, social problems, thought problems, attention problems, rule-breaking behavior, and aggressive behavior. Multivariate response models (GLM/GEE) were used to examine the relationship of alcohol experiences with emotional and behavior problems. Alcohol-using youth were more likely to experience several specific emotional or behavioral syndromes than their alcohol-naïve counterparts. For example, youth with a history of alcohol use had an estimated 30–60% increase in the odds of experiencing items within the aggressive behavior syndrome as compared with alcohol-naïve youth. The type of early alcohol involvement in adolescence may exert differential effects on emotions and behaviors expressed across and within syndromes; these may warrant distinctions in informing etiological research and preventive efforts.