Dental divisions: exploring racial inequities of dental caries amongst children

DATA SOURCES

The search strategy involved three sequential stages. Initially, MEDLINE/PubMed was explored for relevant articles, identifying pertinent terms for formal searching. Using the terms ethnic, race, minoritised and dental caries, a strategy was formed and nine databases searched. Finally, hand-searching of reference lists of included articles and sourcing grey literature from relevant government reports, national oral health surveys, and registries which had comparative data for dental caries between racial groups, completed the search.

STUDY SELECTION

Studies included were original primary research which reported dental caries and compared racially minoritised children, aged 5-11 years, to similarly aged from national, majority, or privileged populations. Dental caries had to be recorded from a clinical examination which assessed decayed, missing, and filled teeth (dmft) in primary dentitions. Studies were excluded if they used immigration status as a basis of racial status, or they were a case report, case series, in vitro study, or literature review.

DATA EXTRACTION AND SYNTHESIS

After removing duplicates, two independent researchers screened abstracts, prior to extracting critical data following full-text reviews of included articles. Information collected included study and participant characteristics, definitions of race, and dental caries measurement. The authors of studies which had missing data were contacted, whilst those not written in the English language were translated. Methodological quality of each study was independently assessed by two reviewers using a modified version of the Newcastle-Ottawa scale. All studies were included in the review regardless of quality. A narrative overview of all included studies was conducted. Meta-analyses were completed using studies that reported the mean and standard deviation of the caries outcomes in both groups. Caries outcomes included severity (defined as mean dmft) or prevalence (percentage of teeth with untreated dental caries > 0%). Due to anticipated heterogeneity, statistical analyses approaches such as I2 statistics were used to estimate between-study variability. Additional sub-group analyses were conducted based on country of study and world income index. Contour-enhanced funnel plots and trim-and-fill analysis were completed to explore potential publication bias. Sensitivity analyses were performed to ensure robustness of the findings.

RESULTS

Seventy-five studies were included from a variety of countries. A higher mean dmft score of 2.30 (0.45, 4.15) and prevalence of decayed teeth (d > 0) was 23% (95% CI: 16, 31) was noted amongst racially minoritised children compared to privileged children's populations. Notable disparities were reported in high-income countries, with minoritised children burdening the greatest distribution of caries incidence. The study faced challenges in consistent racial classification and encountered high heterogeneity in its findings, leading to varied GRADE assessment scores.

CONCLUSIONS

The study calls for global, social, and political changes to tackle the substantial disparities in dental caries among minoritised children to achieve oral health equity.

Progression of carotid intima-media thickness in patients treated with lipoprotein apheresis: real-world evidence over 12 years

Background

The extent of intervention effects on carotid intima-media thickness (CIMT) can predict the degree of atherosclerotic cardiovascular disease (ASCVD) risk reduction. There is limited evidence of long-term effects of lipoprotein apheresis on the CIMT progression.

Purpose

We hypothesized that regular lipoprotein apheresis over the course of 10 years may slow down progression of CIMT in patients with severe hypercholesterolemia.

Methods

This case series describes ten Caucasian patients (mean age 60±9 years, 70% female, 80% statin intolerant) with familial hypercholesterolemia and/or hyperlipoproteinemia(a) treated with lipoprotein apheresis at a single academic center between 2005 and 2020. The mean and maximum diastolic CIMT of the distal 1 cm of the far wall of the right and left common carotid arteries was measured by the same, trained sonographer utilizing an automated border-detection algorithm.

Results

The median pre-treatment low-density lipoprotein cholesterol (LDL-C) level was 214 mg/dL (95% confidence interval, 145 to 248), lipoprotein(a), 26 mg/dL (15 to 109; 40% with lipoprotein(a) >60 mg/dL). Using the imputed trajectories, period-specific on-treatment time-weighted averages for LDL-C and lipoprotein(a) were 141 mg/dL (IQR, 89 to 152) and 24 mg/dL (IQR, 12 to 119), respectively. The baseline mean CIMT was 850±170μm and maximum CIMT was 1040±220μm across the age range of 46 to 70 years. Over a median duration of 12 years, regular treatment with lipoprotein apheresis resulted in an average reduction in the mean CIMT of −40μm (IQR, −50 to 20) and maximum CIMT −30μm (IQR, −60 to −10). Among tested lipid and lipoprotein fractions in this sample, the follow-up mean CIMT values strongly correlated only with the baseline lipoprotein(a) levels. Median CIMT progression rates were as follows: mean common carotid, −4μm/y (IQR, −9 to 1), mean common carotid, −12μm/3y (IQR, −26 to 4), maximal common carotid, −3μm/y (IQR, −8 to −1). This translated into 70% (7/10) of cases demonstrating composite mean CIMT below their expected chronologic age, gender and race-stratified vascular age. There was a strong direct correlation between the mean CIMT value at the end of the treatment period and the age of treatment initiation. In this cohort of primary and secondary prevention of patients with severe hypercholesterolemia, the overall rate of ASCVD was 37.5 per 1000 person-years while on lipoprotein apheresis.

Conclusions

Our observation performed in the clinical setting, demonstrated a real-world effectiveness of lipoprotein apheresis. This analysis supports implementation of aggressive lipid-modifying strategies across all ages. Surveillance with CIMT allows for continued monitoring of atherosclerosis progression and increases compliance with the lipid-modifying therapies in the high-risk patients with poor statin tolerance in the clinical setting.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): KUMC

Cortical abnormalities in bipolar disorder: an MRI analysis of 6503 individuals from the ENIGMA Bipolar Disorder Working Group

Despite decades of research, the pathophysiology of bipolar disorder (BD) is still not well understood. Structural brain differences have been associated with BD, but results from neuroimaging studies have been inconsistent. To address this, we performed the largest study to date of cortical gray matter thickness and surface area measures from brain magnetic resonance imaging scans of 6503 individuals including 1837 unrelated adults with BD and 2582 unrelated healthy controls for group differences while also examining the effects of commonly prescribed medications, age of illness onset, history of psychosis, mood state, age and sex differences on cortical regions. In BD, cortical gray matter was thinner in frontal, temporal and parietal regions of both brain hemispheres. BD had the strongest effects on left pars opercularis (Cohen's d=-0.293; P=1.71 × 10^-21), left fusiform gyrus (d=-0.288; P=8.25 × 10^-21) and left rostral middle frontal cortex (d=-0.276; P=2.99 × 10^-19). Longer duration of illness (after accounting for age at the time of scanning) was associated with reduced cortical thickness in frontal, medial parietal and occipital regions. We found that several commonly prescribed medications, including lithium, antiepileptic and antipsychotic treatment showed significant associations with cortical thickness and surface area, even after accounting for patients who received multiple medications. We found evidence of reduced cortical surface area associated with a history of psychosis but no associations with mood state at the time of scanning. Our analysis revealed previously undetected associations and provides an extensive analysis of potential confounding variables in neuroimaging studies of BD.

Potential of Earlier Detection and Treatment of Disease-Related Malnutrition with Oral Nutrition Supplements to Release Acute Care Bed Capacity

A recent systematic review and meta-analysis shows that appropriate use of oral nutrition supplements (ONS) in community patients is associated with a significant reduction in hospitalisations. Given higher use of acute care resource by malnourished versus normally nourished patients, this paper examines the potential to reduce bed utilisation by applying these results to Irish inpatient and malnutrition prevalence data. In 2013, adults admitted to hospital with medium or high malnutrition risk scores used an estimated 36% of adult acute inpatient bed days. Targeted use of ONS in community patients might reduce hospitalisation by 168,438 adult bed days per year, equivalent to 460 beds per day. This is particularly important, given high bed occupancy rates and twelve month daily averages of 254 patients on trolleys. Relevant stakeholders should consider strategies to ensure effective ONS use with a view to improving outcomes and reducing pressure on the acute care system.

Survival after neoadjuvant chemotherapy with or without bevacizumab or everolimus for HER2-negative primary breast cancer (GBG 44-GeparQuinto)†

BACKGROUND

The GeparQuinto study showed that adding bevacizumab to 24 weeks of anthracycline-taxane-based neoadjuvant chemotherapy increases pathological complete response (pCR) rates overall and specifically in patients with triple-negative breast cancer (TNBC). No difference in pCR rate was observed for adding everolimus to paclitaxel in nonearly responding patients. Here, we present disease-free (DFS) and overall survival (OS) analyses.

PATIENTS AND METHODS

Patients (n = 1948) with HER2-negative tumors of a median tumor size of 4 cm were randomly assigned to neoadjuvant treatment with epirubicin/cyclophosphamide followed by docetaxel (EC-T) with or without eight infusions of bevacizumab every 3 weeks before surgery. Patients without clinical response to EC ± Bevacizumab were randomized to 12 weekly cycles paclitaxel with or without everolimus 5 mg/day. To detect a hazard ratio (HR) of 0.75 (α = 0.05, β = 0.8) 379 events had to be observed in the bevacizumab arms.

RESULTS

With a median follow-up of 3.8 years, 3-year DFS was 80.8% and 3-year OS was 89.7%. Outcome was not different for patients receiving bevacizumab (HR 1.03; P = 0.784 for DFS and HR 0.974; P = 0.842 for OS) compared with patients receiving chemotherapy alone. Patients with TNBC similarly showed no improvement in DFS (HR = 0.99; P = 0.941) and OS (HR = 1.02; P = 0.891) when treated with bevacizumab. No other predefined subgroup (HR+/HER2-; locally advanced (cT4 or cN3) or not; cT1-3 or cT4; pCR or not) showed a significant benefit. No difference in DFS (HR 0.997; P = 0.987) and OS (HR 1.11; P = 0.658) was observed for nonearly responding patients receiving paclitaxel with or without everolimus overall as well as in subgroups.

CONCLUSIONS

Long-term results, in opposite to the results of pCR, do not support the neoadjuvant use of bevacizumab in addition to an anthracycline-taxane-based chemotherapy or everolimus in addition to paclitaxel for nonearly responding patients.

CLINICAL TRIAL NUMBER

NCT 00567554, www.clinicaltrials.gov.

Pattern of intake of food additives associated with hyperactivity in Irish children and teenagers

A double-blind randomized intervention study has previously shown that a significant relationship exists between the consumption of various mixes of seven target additives by children and the onset of hyperactive behaviour. The present study set out to ascertain the pattern of intake of two mixes (A and B) of these seven target additives in Irish children and teenagers using the Irish national food consumption databases for children (n = 594) and teenagers (n = 441) and the National Food Ingredient Database. The majority of additive-containing foods consumed by both the children and teenagers contained one of the target additives. No food consumed by either the children or teenagers contained all seven of the target food additives. For each additive intake, estimates for every individual were made assuming that the additive was present at the maximum legal permitted level in those foods identified as containing it. For both groups, mean intakes of the food additives among consumers only were far below the doses used in the previous study on hyperactivity. Intakes at the 97.5th percentile of all food colours fell below the doses used in Mix B, while intakes for four of the six food colours were also below the doses used in Mix A. However, in the case of the preservative sodium benzoate, it exceeded the previously used dose in both children and teenagers. No child or teenager achieved the overall intakes used in the study linking food additives with hyperactivity.

Topotecan weekly versus routine 5-day schedule in patients with platinum-resistant ovarian cancer (TOWER): A randomized, two-stage phase-II study of the North-Eastern German Society of Gynaecological Oncology (NOGGO)

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Background: Optimizing the therapeutic index (that is, maintaining drug effectiveness while reducing toxicity) is a major goal in chemotherapy for platinum-resistant ovarian cancer. Early phase-I/II studies suggest that weekly topotecan (T) might be effective and apparently better tolerated than the established 5-day regimen. As yet, no randomized comparison of both regimes was attempted. To prove the hypothesis of an improved therapeutic index with weekly T, we conducted a randomized, multicenter, two-stage phase-II trial, and herein present the data of the planned interim analysis. Methods: Pts with platinresistent ovarian and fallopian tube cancers or primary peritoneal carcinoma, measurable or assessable disease (GCIG-CA-125 response criteria), were eligible. Pts were randomized to receive either weekly T (d1,8,15/q28d, 4 mg/m2) or T from d1–5/q21d at a dose of 1.25 mg/m2. According to Gehan’s two-stage-design, both arms were handled as independent studies. Overall response rate (CR + PR) was defined as primary study endpoint, secondary endpoints of the interim analysis were toxicity and safety. Results: 28 pts in the weekly and 21 pts in the conventional group, enrolled at 38 centers form the basis of this report. 230 cycles of chemotherapy were evaluated for toxicity analyses. Median age was 61 years (range, 36 - 82 years). Demographic baseline characteristics, including tumor stage and grade were well balanced between treatment arms. There were 2/28 and 5/21 responses in weekly and the conventional arm, respectively (Risk Ratio [RR] 0.30, 95% confidence interval [CI] 0.06 - 1.40, p=0.122). The risk of early treatment termination due to tumor progression (RR 1.39, 95%CI 0.75 - 2.56), haematological (RR 0.20, 95% CI 0.01 - 3.97) or non- hematological toxicities (RR 1.96, 95% CI 0.18 - 20.83) did not differ significantly between groups. The only three events of neutropenic fever occurred in the conventional arm (RR 1.70, 95% CI 0.99 - 1.16). Conclusions: Weekly T is well tolerated and potentially active. The second stage of this study will require additional 46 patients each arm. Complete enrolment is expected to be accomplished in May 2007.

No significant financial relationships to disclose.

A national census of Irish general practice training programme graduates 1990-1996

We followed the career pathways of all graduates of Irish general practice training schemes between 1990 and 1996 inclusive, with specific reference to their current positions, ten year aspirations, perceived barriers to their ideal career and attitudes to out of hours work. A postal survey using a structured questionnaire was performed. Addresses were identified for 253 of the 266 graduates (95%). A total of two hundred and nine responses were received (84% of those with an identifiable address). 173 (83%) have remained in general practice; 90% in Ireland and 60% in the same health board of their training programme. The preferred career option for 79% was to be a general practice principal; this differed significantly between males (89%) and females (74%) (p=0.016). Being a single-handed general practitioner was the preferred option for 2%; 43% considered this unacceptable. A half would prefer to work in a country town; one third considered a rural location as unacceptable. 'Out of hours' commitment and availability of local posts were the most commonly perceived barriers to career progress (53% and 45% respectively). 26% were not prepared to do any out of hours work; this differed significantly between males (10%) and females (30%) (p<.001). 17% have permanently left a career in general practice. Female general practitioners were not significantly more likely than male general practitioners to have left (19% vs. 14%, p=0.3). The most common reason given for leaving general practice was other career interest (78%). The significant increase in female general practice graduates over the past twenty years is highlighted. The vast majority of these female graduates wished to be a principal in a group practice and were prepared to undertake out of hours work. There is also a mismatch between career aspirations and the present structure of general practice in Ireland. The urgent need for changes in health system organisation to ensure that these intentions can be fulfilled is emphasised.

Use of solid phase extraction for the isolation and clean-up of a derivatised furazolidone metabolite from animal tissues

A method is presented for the determination of protein-bound residues of furazolidone in animal tissue. The use of furazolidone in food-producing animals has been banned in the EU. Illegal use of furazolidone can be monitored most effectively by testing for bound residues containing the 3-amino-2-oxazolidone (AOZ) moiety which, unlike the parent drug, is stable and can be detected for prolonged periods after cessation of treatment. This paper reports the development of an extraction and clean-up procedure for AOZ from liver using solid phase extraction. The method replaces solvent extraction and provides extensive sample clean-up with removal of approximately 99% of the derivatising agent, 2-nitrobenzaldehyde, which may interfere with the determination. It also offers the advantage of being suitable for automation, thereby increasing throughput of samples. The extraction procedure may be used for HPLC and ELISA screening techniques. The method has been validated in fortified and incurred pig liver samples, yielding mean recovery of AOZ in excess of 60%.

Hyperlipidaemia management after primary coronary artery bypass surgery: a survey of patients and general practitioners

BACKGROUND

It is well established that, in patients with increased cholesterol concentrations and vascular disease, decreasing the cholesterol concentration significantly reduces the risk of coronary events. After coronary artery bypass graft surgery (CABG), the risk of further coronary events is likely to be reduced if there is effective control of cholesterol concentrations. The aim of the survey was to review awareness among general practitioners and patients of the need for maintenance of serum cholesterol values, frequency of serum cholesterol checks, dietary advice and lipid-decreasing medication in patients after CABG.

METHODS

Hospital notes of 200 patients who underwent primary, coronary artery bypass surgery from January 1994 to 1996 were examined and postal questionnaires sent to patients and their general practitioners inquiring whether they had had their serum cholesterol tested in the past 3 years; whether dietary advice had been given if cholesterol concentrations were increased to more than 5.2 mmol/l; whether a repeat serum cholesterol test was performed 3 months later if values were greater than 5.2 mmol/l; and (for those with serum cholesterol values greater than 5.2 mmol/l), whether they were on lipid-decreasing medication.

RESULTS

We considered 146 (76%) replies to be complete. Hospital and general practitioner records of these patients showed, that in the previous 3 years, after CABG, only 63% (n=92) had their serum lipid profile checked and, of these, 74% (n=68) had increased serum cholesterol concentrations of more than 5.2 mmol/l. Only 46% (n=31) received dietary advice alone. After dietary advice had been given, serum cholesterol was rechecked in 26% (n=8) of patients and only 3% (n=1) had a decrease in serum cholesterol to less than 5.2 mmol/l. Among the patients with increased serum cholesterol, 50% (n=34) received lipid-decreasing medication, but serum cholesterol was rechecked in only 52% (n=17) of patients. In 9% (n=3) of these, serum cholesterol concentrations had decreased to less than 5.2 mmol/l. Among the 146 complete replies from patients, 95% (n=139) indicated that control of serum cholesterol was important, 82% (n=120) had received dietary advice and 39% (n=57) were on lipid-decreasing medication.

CONCLUSION

General practitioners and patients were generally aware of cholesterol control after CABG. However, a relatively low proportion of patients underwent serum cholesterol checks and received documented dietary advice, lipid-decreasing medication, or both. Dietary advice alone may be inadequate in controlling lipid concentrations and, in many cases, needed to be supplemented with adequate lipid-decreasing therapy.

Early clinical experience with the Tissuemed porcine bioprosthesis

BACKGROUND

Tissuemed (Leeds, England) porcine bioprostheses are freshly mounted and dilated for correct functional sizing and commissural alignment, then fixed under low pressure. These valves closely approximate the natural leaflet geometry, reduce opening commissural bending stresses, and may provide a solution to structural valve failure from calcification and tears. To evaluate the performance of the bioprosthesis 207 Tissuemed bioprostheses were implanted in 203 patients, 114 men and 89 women (mean age 73 years; range 56 to 94 years), between 1991 and 1996. Preoperatively 66% of the patients were in New York Heart Association functional class III or IV. There were 175 aortic, 22 mitral, 2 tricuspid, and 4 multiple replacements. Concomitant procedures were performed in 26.1% (53 of 203) of patients. Follow-up was 99.5% (total cumulative follow-up 447.5 patient-years).

RESULTS

The 30 day mortality, influenced by age and valve position, was 11.8% with no early valve-related deaths. Patient survival at 5 years was 76% (standard error 3.3%). Valve-related complication rates (expressed as percent per patient-year and number of events) were thromboembolism 1.1% (5), hemorrhage 0.7% (3), bacterial endocarditis 0.2% (1), nonstructural valve failure 0.2% (1), and reoperation 0.5% (2). At 5 years freedom from valve-related events were as follows: thromboembolism 92.9% (standard error 2.7%), hemorrhage 96.1% (standard error 1.9%), endocarditis 98.1% (standard error 1.8%), nonstructural valve failure 99.2% (standard error 0.7%), structural valve dysfunction 100% (standard error 0.0%), and reoperation 98.1% (standard error 1.8%). At follow-up 73.8% of the patients were in New York Heart Association functional class I or II.

CONCLUSIONS

There were no early valve-related deaths, no episodes of structural valve failure, and valve-related complications compared favorably with other porcine series. There was overall clinical improvement in patient symptoms. Our experience suggests that the Tissuemed porcine bioprosthesis is a safe and reliable heart valve providing good clinical improvement in patient symptoms. Long-term clinical follow-up is, however, essential to complete the evaluation.

Sources of inaccuracy in the use of the Hawksley random-zero sphygmomanometer

OBJECTIVE

To identify possible causes of inaccuracy in the use of the Hawksley random-zero sphygmomanometer and methods that could reduce this.

METHODS

Four Hawksley random-zero sphygmomanometers were compared with a standard sphygmomanometer under static conditions. Two methods (standard and rapid) were used to release pressure from the inflated cuff with pressures recorded by independent blinded observers. The rate at which the hand valve released pressure was analysed. The effects of varying filling times and pressures on the size of the final zero correction were investigated.

RESULTS

The Hawksley devices all under-recorded pressure compared with that measured by using a standard machine. A rapid means of pressure release approximately halved this error in each case. Pressure release through the hand valve was shown to have a characteristic and prolonged exponential decay. Using low filling times and pressures reduced the observed range of zeros seen, with the production of a correlation between the size of the zero and the inflation pressure used.

CONCLUSION

These findings suggest that overestimation of the final zero correction is a common and major source of error in the use of the Hawksley sphygmomanometer. A simple change in the design of the final pressure release would improve the machine's reliability in clinical usage. The machine's zero mechanism is susceptible to unintentional misuse. Such misuse could occur when the machine is used in accordance with current sphygmomanometry guidelines.

Enhanced endothelium-dependent vasodilator responses in patients with systemic vasculitis

The aim of the study was to investigate endothelium-dependent vasodilator responses in the forearm vasculature of patients with systemic vasculitis. We studied 10 patients with systemic vasculitis and 16 healthy control subjects using forearm venous occlusion plethysmography to assess changes in forearm blood flow in response to acetylcholine (ACh). NG-monomethyl-L-arginine (L-NMMA), was also used to assess the contribution of endothelium derived relaxing factor/nitric oxide (EDRF/NO) to the vasodilator responses to acetylcholine. A significantly greater vasodilator response to ACh was seen in the patient group at all doses infused (p < 0.01). After pre-infusion of L-NMMA, the differences in ACh dilator responses were no longer significant. There was a greater magnitude of inhibition of ACh responses by L-NMMA in the patient group. The enhanced vasodilator response to ACh observed was in part abolished by L-NMMA, suggesting that EDRF/NO is produced in excess in systemic vasculitis. The precise role played by EDRF/NO in the pathogenesis of systemic vasculitis requires further study.

Assay of the c-erbB-2 oncogene encoded protein by ELISA and immunocytochemistry in human breast cancer

The c-erbB-2 gene is amplified in a wide variety of different adenocarcinomas. Generally, gene amplification correlates with increased expression of the c-erbB-2 oncoprotein. Previous assays for the c-erbB-2 oncoprotein have been qualitative or semi-quantitative. In this investigation using human breast cancers, c-erbB-2 oncoprotein levels as measured by enzyme-linked immunosorbent assay (ELISA) correlated significantly with semi-quantitation by immunocytochemistry (r = 0.843, P < 0.0001, n = 97). The cut-off point for the ELISA which gave the strongest agreement with immunocytochemistry was 15 units/micrograms protein. It is concluded that detection of c-erbB-2 oncoprotein by ELISA is quantitative and objective.

Enzyme-linked immunosorbent assay of c-erbB-2 oncoprotein in breast cancer

Amplification or increased expression of the c-erbB-2 gene has previously been reported to be a prognostic marker for breast cancer. Gene amplification is usually measured by Southern blotting, whereas increased protein expression is usually detected by immunocytochemistry. We measured c-erbB-2 protein with an enzyme-linked immunosorbent assay (ELISA). High concentrations of oncoprotein were found in 25 of 161 (16%) primary breast cancers and in 3 of 6 (50%) breast cancer metastases. High concentrations were not found in normal breast tissue or benign breast tumors. In the primary cancers, high concentrations of c-erbB-2 protein were found more frequently (a) in estrogen receptor-negative tumors than in estrogen receptor-positive tumors, (b) in progesterone receptor-negative tumors than in progesterone-positive tumors, and (c) in axillary node-positive cancers than in node-negative cancers. Patients with tumors containing high amounts of the c-erbB-2 protein had a significantly shorter (P less than 0.001) disease-free interval and overall survival rate than did patients with low amounts. We conclude that assay of c-erbB-2 protein by ELISA is simple, rapid, and quantitative and offers important prognostic information in breast cancer.

CSF norepinephrine in schizophrenia is elevated prior to relapse after haloperidol withdrawal

Thirty-two male DSM-III diagnosed schizophrenic patients received a lumbar puncture (LP) during chronic haloperidol treatment that was followed by replacement with placebo for up to 6 weeks. Fourteen patients relapsed on placebo within 6 weeks. Patients received a second LP at the time of relapse or at the end of 6 weeks if they had not relapsed. Bunney-Hamburg Global Psychosis Ratings of the day and the hours of sleep of the night before the LP were obtained, as were the Brief Psychiatric Ratings Scale (BPRS) ratings during the week of the LPs. CSF norepinephrine (NE), 3-methoxy-4-hydroxyphenylglycol (MHPG), homovanillic acid (HVA), and 5-hydroxyindoleacetic acid (5 HIAA) concentrations were measured with high-pressure liquid chromatography (HPLC). Patients who relapsed had significantly higher CSF NE levels on and off haloperidol than patients who did not relapse. CSF MHPG was higher in the relapsers in the drug-free condition only, but CSF HVA and 5-HIAA were not significantly different in either condition. In the drug-free relapsed patients, CSF NE correlated significantly with the psychosis ratings of the day and hours of sleep the night prior to the LP. Our data indicate that elevated CSF NE levels during neuroleptic treatment may predict behavioral decompensation after discontinuing the medication.

Clonidine improves memory function in schizophrenia independently from change in psychosis. Preliminary findings

This study provides initial evidence that the alpha 2-adrenergic receptor agonist, clonidine, enhances memory functioning in hospitalized schizophrenics. Ten patients were tested while drug free and while on stable doses of clonidine (0.4-1.4 mg/day) for approximately 3 weeks. Throughout the duration of the study, all patients, as well as the examiner, were blind to medication status. Memory test scores were significantly better during the clonidine trials. This improvement occurred independently of change in psychosis. Clonidine does not improve memory in normal adults or in young and unimpaired animals, but has been shown to improve memory in Korsakoff's patients and non-human primates who are old or have dorsolateral prefrontal cortical lesions. The present results have implications for the role of the noradrenergic system in memory as well as for our understanding of the nature of the cognitive deficits associated with schizophrenia.