Evaluating movement disorders in pediatric patients receiving risperidone: a comparison of spontaneous reports and research criteria for TD

Background  

Movement disorders (MD) in children are relatively common and may be associated with medication use. Objective methods (ie rating scales) and specific research criteria may be helpful in identifying MD-related adverse events that would otherwise not be apparent from spontaneous reports. We assessed whether more stringent and rigorous criteria would provide MD rates similar to those derived subjectively from spontaneous reports.     

Effects of switching from olanzapine to risperidone on the prevalence of the metabolic syndrome in overweight or obese patients with schizophrenia or schizoaffective disorder: analysis of a multicenter, rater-blinded, open-label study

BACKGROUND: A major contributor to mortality inpatients with schizophrenia or schizoaffective disorder is cardiovascular disease, an important risk factor for which is the cluster of clinical abnormalities that define the metabolic syndrome (eg, abdominal/visceral obesity, hypertriglyceridemia, impaired glucose tolerance). OBJECTIVE: The aim of this article was to examine the effects of switching from the antipsychotic olanzapine to risperidone on the prevalence of the metabolic syndrome in high-risk overweight or obese patients with schizophrenia or schizoaffective disorder. METHODS: This post hoc analysis was based on data from a previous 2-phase, 20-week, multicenter (19 US sites), rater-blinded, open-label study. High-risk overweight or obese (body mass index [BMI], >26 kg/m(2)) patients aged 18 to 65 years with schizophrenia or schizoaffective disorder whose treatment was switched from olanzapine to risperidone were enrolled. Patients who entered the phase 1 switch from olanzapine to risperidone (6 weeks) and the phase 2 extension (14 weeks) were included in the assessment. The primary end point was the difference from baseline in the prevalence of the metabolic syndrome at week 20, determined using measurements of weight, BMI, waist circumference, and systolic and diastolic blood pressure (SBP/DBP). RESULTS: Baseline assessments for the metabolic syndrome were available from 121 of 123 patients recruited for phase 1 of the study (61 men, 60 women; mean [SD] age, 41.1 [10.2] years; mean [SD] BMI, 33.9 [6.9] kg/m(2)); 71 patients entered phase 2 (29 men, 42 women; mean [SD] age, 40.2 [10.3] years; mean [SD] BMI, 35.1 [7.3] kg/m(2)), of whom 39 (54.9%) ere diagnosed with schizophrenia, and 32 (45.1%) with schizoaffective disorder. The metabolic syndrome was identified in 63 (52.1%) patients at study entry. In the 71 patients with data available from baseline and week 20 (using the last observation carried forward method), the prevalence of the metabolic syndrome was reduced from 38 (53.5%) patients at baseline to 26 (36.6%) at study end (McNemar chi(2) = 8.0, P < 0.005). Significant improvements at study end were seen in mean weight (P = 0.031), BMI (P = 0.002), waist circumference (P = 0.003), SBP (P = 0.006), and DBP (P = 0.010). There was no significant difference in the reduction in the prevalence of the metabolic syndrome between patients who did or did not receive the behavioral therapy for weight loss. CONCLUSIONS: In this post hoc analysis of switching from the antipsychotic olanzapine to risperidone on the prevalence of the metabolic syndrome in high-risk overweight or obese patients with schizophrenia or schizoaffective disorder, the metabolic syndrome was highly prevalent at baseline. Switching from olanza- pine to risperidone was associated with a significant reduction in this prevalence.     

Sleepiness in children and adolescents: clinical implications

Over the past decade, excessive sleepiness among children and adolescents has been identified as a major societal concern. Professionals working with pediatric groups must increasingly factor sleepiness into assessments of waking function. We define and discuss excessive sleepiness in children and adolescents and review available evidence regarding effects on behavior, mood, and performance. Findings for daytime sleepiness and subsequent impairment in these domains are classified as robust to unknown. Empirical evidence clearly indicates that children and adolescents experience significant daytime sleepiness as a result of inadequate or disturbed sleep. The specific effect of sleepiness on functional domains in pediatric groups are less well-studied, but existing data suggests that children are likely to experience impairment in behavioral, mood, and performance domains. However, such variables as developmental differences in the type and degree of impairment, the degree of sleep disturbance required to produce impairments, and potential risk and protective factors for the effects of sleepiness in children have yet to be described. Further research is clearly warranted, and we discuss important questions and methodological concerns to encourage inquiry in both clinical and experimental settings. Advice is offered with regard to screening for sleep problems and associated sleepiness with children and adolescents.     

Experimental restriction of sleep opportunity in children: effects on teacher ratings

STUDY OBJECTIVE: To determine the effects of experimental restriction of sleep opportunity on teacher ratings of academic performance and behavior in healthy normal children. DESIGN: Home-based, within-subjects design in which participants followed 3 week-long sleep schedules-Baseline (self-selected), Optimized, and Restricted-while attending school, with order of conditions counter-balanced (Optimized and Restricted). PARTICIPANTS: Seventy-four children (39 boys; aged 6 to 12 years, mean = 10) screened for medical and psychological health. MEASUREMENTS AND RESULTS: Teachers masked to assigned hours of sleep completed paper-and-pencil questionnaires at the end of each study condition. Questionnaire items were selected from several published measures. Summary scores included Academic Problems, Hyperactive-Impulsive Behaviors, Internalizing, Oppositional-Aggressive, Sleepiness, Total Attention Problems, and Mean Severity of Attention Problems. Main effects of sleep condition were found forAcademic Problems, Sleepiness, Total Attention Problems, and Mean Severity of Attention Problems. Restricting sleep increased ratings of Academic Problems (medium effect) relative to both Baseline (P < .01, eta(p)2 = .11) and Optimized (P < .05, eta(p)2 = .10) conditions and increased the Mean Severity of Attention Problems (medium effect) relative to Baseline (P < .01, eta(p)2 = .12). CONCLUSIONS: These findings provide experimental support for widely held beliefs about the importance of sufficient time-in-bed for academic functioning in children. Reducing sleep opportunity had a direct effect on academic performance, as rated by teachers, even among healthy students with no history of behavioral problems or academic difficulty. Findings also support insufficient sleep as a direct source of variability in the manifestation of attention problems but not hyperactivity.     

Additional studies with new insecticides as residual sprays in buildings naturally infested with Anopheles quadrimaculatus

Because some species of Anopheles mosquitos have been developing resistance to DDT and dieldrin, field studies have been conducted to evaluate the effectiveness of recently developed insecticides as residual sprays in buildings naturally infested with adults of Anopheles quadrimaculatus. As a deposit at 2 g/m², o-isopropoxyphenyl methylcarbamate remained highly effective for more than one year. This compound and 6-chloro-3,4-xylyl methylcarbamate were still producing excellent control 11-12 weeks after application at 1 g/m². Other highly effective materials were m-isopropylphenyl methylcarbamate and 4-(methylthio)-3,5-xylyl methylcarbamate at 2 g/m². At the present time, o-isopropoxyphenyl methylcarbamate appears to offer the best prospects for use in residual spray programmes because it has long residual action, affects mosquitos rapidly, has only a slight odour and appears to be safe to use if spraymen take reasonable precautions.