Aripiprazole augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: a 10-week open-label study

Introduction  

Studies investigating the aripiprazole augmentation treatment of serotonin reuptake inhibitor (SRI)-resistant obsessive-compulsive disorder (OCD) are insufficient. The aim of the present pilot study was to investigate the efficacy and tolerability of flexible doses of aripiprazole as an augmenting agent in SRI-resistant OCD patients.     

Network Analysis of Symptom Comorbidity in Schizophrenia: Relationship to Illness Course and Brain White Matter Microstructure

IntroductionRecent network-based analyses suggest that schizophrenia symptoms are intricately connected and interdependent, such that central symptoms can activate adjacent symptoms and increase global symptom burden. Here, we sought to identify key clinical and neurobiological factors that relate to symptom organization in established schizophrenia. MethodsA symptom comorbidity network was mapped for a broad constellation of symptoms measured in 642 individuals with a schizophrenia-spectrum disorder. Centrality analyses were used to identify hub symptoms. The extent to which each patient’s symptoms formed clusters in the comorbidity network was quantified with cluster analysis and used to predict (1) clinical features, including illness duration and psychosis (positive symptom) severity and (2) brain white matter microstructure, indexed by the fractional anisotropy (FA), in a subset (n = 296) of individuals with diffusion-weighted imaging (DWI) data. ResultsGlobal functioning, substance use, and blunted affect were the most central symptoms within the symptom comorbidity network. Symptom profiles for some patients formed highly interconnected clusters, whereas other patients displayed unrelated and disconnected symptoms. Stronger clustering among an individual’s symptoms was significantly associated with shorter illness duration (t = 2.7; P = .0074), greater psychosis severity (ie, positive symptoms expression) (t = −5.5; P < 0.0001) and lower fractional anisotropy in fibers traversing the cortico-cerebellar-thalamic-cortical circuit (r = .59, P < 0.05). ConclusionSymptom network structure varies over the course of schizophrenia: symptom interactions weaken with increasing illness duration and strengthen during periods of high positive symptom expression. Reduced white matter coherence relates to stronger symptom clustering, and thus, may underlie symptom cascades and global symptomatic burden in individuals with schizophrenia.     

Parallel arterial trunks with discordant atrioventricular and concordant ventriculo-arterial connections in mirror-imaged arrangement

Cardiac malformations are very rare in which the great arteries arise from their appropriate ventricles, but are abnormally related to each other. Here, we present a patient with mirror-imaged atrial arrangement and a left-sided heart who has parallel arterial trunks with discordant atrioventricular and concordant ventriculo-arterial connections. The ventricles were related in supero-inferior fashion, the left ventricle being anterior and superior, this being an additional feature which, to the best of our knowledge, has not previously been described in this setting.     

The effect of low‐carbohydrate diet on left ventricular diastolic function in obese children

Background: This study was conducted to evaluate left ventricle (LV) functions using conventional and tissue Doppler imaging in childhood obesity and to identify the effects of diet on LV diastolic functions. Methods: Conventional and tissue Doppler echocardiographic measurements were compared in 34 obese children and 24 age‐ and gender‐matched lean controls. Fasting plasma glucose, insulin and homeostatic model assessment of insulin resistance levels were also obtained. Thirty‐one of the obese children were subjected to a low‐carbohydrate diet and their follow‐up measurements were obtained after 6 months. Results: Left atrial diameter, LV mass and LV mass index were higher in obese children than in lean controls. Lateral mitral myocardial early diastolic (E_m) and peak E_m/myocardial late diastolic (A_m) were lower, and mitral E/E_m and lateral mitral myocardial isovolumetric relaxation time were higher in obese subjects than in lean controls. Insulin and homeostatic model assessment of insulin resistance levels were higher in obese patients and decreased significantly after diet. After diet therapy, lateral mitral E_m and peak E_m/A_m, were increased, mitral E/E_m and myocardial isovolumetric relaxation time were decreased. Conclusions: Obesity predisposes children to increased preload reserve, left ventricular subclinical diastolic dysfunction and deterioration in diastolic filling. Weight reduction with a low‐carbohydrate diet seems to be associated with significant improvement in LV diastolic function and a decrease in diastolic filling, as well as causing reversal in insulin resistance seen in obese children.     

Systemic fungal infections after renal transplantation

In a retrospective evaluation, the incidence of systemic fungal infections (SFIs) in 296 kidney graft recipients admitted to our center between 1986 and 1999 was found to be 4%. Eighteen percent of 28 recipients transplanted in India and 8% of 12 recipients transplanted in Russia developed SFI. In contrast, SFI was encountered in only 2% of recipients transplanted at our center. The median time of diagnosis of SFI was 5 months after transplantation. The lungs and central nervous system were the most frequently affected sites. The most common etiologic agent was Aspergillus fumigatus (n = 7) but Candida spp. (n = 1), Rhizopus spp. (n = 1) and Cryptococcus neoformans (n = 1) were also encountered. In 2 patients, 2 different pathogens were isolated at the same time: A. fumigatus and Rhizopus spp. in 1 patient and Candida spp. and A. fumigatus in another. In order to determine predisposing factors for SFI, patients admitted immediately before and after those with SFI were used as controls: long-term hospitalization, long-term antibiotic use and post-transplant diabetes mellitus were found to be predisposing factors. Eight patients were treated with antifungal drugs and a good response to liposomal amphotericin B therapy was obtained in 3/5. Nine patients (75%) with SFI died. As SFIs are associated with a high mortality rate in renal transplant recipients, antifungal therapy, especially with liposomal amphotericin B, should be started whenever fungal infection is suspected, even before the results of microbiologic and/or histologic examinations are known.     

Decreased vitamin D levels in patients with familial mediterranean fever

Familial mediterranean fever (FMF) is an autosomal recessive disorder caused by mutations in the FMF gene (MEFV). The gene causing FMF, designated MEFV, encodes a protein called pyrin or marenostrin that is expressed mainly in myeloid bone marrow precursors, neutrophils, and monocytes. Since there are several etiological factors, FMF is the most common periodic fever syndrome. However, it is still unknown what triggers or ends these periodical attacks. As a pleiotropic hormone, vitamin D has immunomodulation effects. The aim of this study was to evaluate the vitamin D levels in FMF patients. The study group was comprised of 26 patients diagnosed with FMF (men/women: 12/14), and 34 healthy control (men/women: 17/17). Vitamin D levels in FMF patients and healthy controls were 11.05 ± 7.11, 17.15 ± 6.49, respectively. FMF patients had significantly decreased vitamin D levels compared with healthy controls (P < 0.001). In conclusion, it is thought that vitamin D deficiency in FMF patients may trigger the attacks. Further studies with larger patient populations need to hold to investigate the vitamin D deficiency in patients with FMF and that may assist to clarify the mechanism behind the colchicines resistant cases.