Olanzapine plus carbamazepine v. carbamazepine alone in treating manic episodes

BACKGROUND: Combinations of olanzapine and carbamazepine are often used in clinical practice in the management of mania. AIMS: To assess the efficacy and safety of olanzapine plus carbamazepine in mixed and manic bipolar episodes. METHOD: Randomised, double-blind, 6-week trial of olanzapine (10-30 mg/day) plus carbamazepine (400-1200 mg/day; n=58) v. placebo plus carbamazepine (n=60) followed by open-label, 20-week olanzapine (10-30 mg/day) plus carbamazepine (400-1200 mg/day, n=86), with change in manic symptoms as main outcome measure. Safety and pharmacokinetics were also evaluated. RESULTS: There were no significant differences (baseline to endpoint) in efficacy measures between treatment groups, but at 6 weeks triglyceride levels were significantly higher (P=0.008) and potentially clinically significant weight gain (>or=7%) occurred more frequently (24.6% v. 3.4%, P=0.002) in the combined olanzapine and carbamazepine group. Carbamazepine reduced olanzapine concentrations but olanzapine had no effect on carbamazepine concentrations. CONCLUSIONS: The combination of olanzapine and carbamazepine did not have superior efficacy to carbamazepine alone. The increases in weight and triglycerides observed during combination treatment are a matter of concern.     

Pulmonary epithelial integrity in children: relationship to ambient ozone exposure and swimming pool attendance

Airway irritants such as ozone are known to impair lung function and induce airway inflammation. Clara cell protein (CC16) is a small anti-inflammatory protein secreted by the nonciliated bronchiolar Clara cells. CC16 in serum has been proposed as a noninvasive and sensitive marker of lung epithelial injury. In this study, we used lung function and serum CC16 concentration to examine the pulmonary responses to ambient O3 exposure and swimming pool attendance. The measurements were made on 57 children 10-11 years of age before and after outdoor exercise for 2 hr. Individual O3 exposure was estimated as the total exposure dose between 0700 hr until the second blood sample was obtained (mean O3 concentration/m3 times symbol hours). The maximal 1-hr value was 118 microg/m3 (59 ppb), and the individual exposure dose ranged between 352 and 914 microg/m3hr. These O3 levels did not cause any significant changes in mean serum CC16 concentrations before or after outdoor exercise, nor was any decrease in lung function detected. However, children who regularly visited chlorinated indoor swimming pools had significantly lower CC16 levels in serum than did nonswimming children both before and after exercise (respectively, 57 +/- 2.4 and 53 +/- 1.7 microg/L vs. 8.2 +/- 2.8 and 8.0 +/- 2.6 microg/L; p < 0.002). These results indicate that repeated exposure to chlorination by-products in the air of indoor swimming pools has adverse effects on the Clara cell function in children. A possible relation between such damage to Clara cells and pulmonary morbidity (e.g., asthma) should be further investigated.     

A Conceptual Schema for the Study of the Etiology of Pressure Sores

Studies related to the treatment of pressure sores have appeared in the literature. Questions remain regarding both the etiology and treatment. This article presents a conceptual schema within which current knowledge can be organized and examined and further study facilitated. The critical determinants of pressure sores are primarily the intensity and duration of pressure. A second critical concept, the tolerance of the tissue for pressure, is also discussed. Conditions contributing to prolonged and intense pressure are included within the concepts of mobility, activity, and sensory perception. Tissue tolerance for pressure is influenced by both extrinsic and intrinsic factors. Extrinsic factors such as moisture, friction, and shear impinge on the skin and underlying tissues, while the multiple influences of nutrition, the physiologic effects of stress, aging, and alterations in cellular respiration are intrinsic factors which influence the architecture and integrity of the skin and supporting structures. The schema provides broad categories capable of organizing existing knowledge and new findings.     

A review of research on procedures for teaching safety skills to persons with developmental disabilities

Safety skills are an important but often neglected area of training for persons with developmental disabilities (DD). The present study reviewed the literature on teaching safety skills to persons with DD. Safety skills involve a variety of behaviors such as knowing how to cross the street or what to do in case of a house fire. A number of studies have been conducted on teaching these skills to individuals with DD. The studies reviewed have varying degrees of success and demonstrate varying degrees of generalization, but the general finding has been that prompting, reinforcement, and role-playing are effective teaching procedures across a variety of participants, skills, and settings.     

Behavioral intervention for domestic pet mistreatment in a young child with autism

Household pets can have a positive influence on quality of life for individuals who live with them (Bryant, 1990). Little previous research has investigated issues related to interaction between individuals with developmental disabilities and pets. In this study, we used simple behavioral intervention procedures to decrease pet mistreatment by a young child with autism. Specifically, differential reinforcement of alternative behavior (DRA) and differential reinforcement of other behavior (DRO) were evaluated. DRA did not decrease the behavior but DRO produced immediate and significant decreases in pet mistreatment and the DRO interval was successfully lengthened to 10 min. All sessions were implemented by the child's regular behavioral therapy team, in the child's home.     

Teaching two household safety skills to children with autism

Appropriate reactions to potentially hazardous situations may help prevent children from incurring injury or abduction. However, children with autism and other developmental disorders may not develop safety skills without explicit intervention. This study used a simple behavioral skills training package for teaching children with autism to respond in a safe manner to doorbells and to the presence of household cleaning chemicals.     

Stimulation of both D1 and D2 dopamine receptors appears necessary for full expression of postsynaptic effects of dopamine agonists: a neurophysiological study

The abilities of 4 dopamine agonists to inhibit the tonic single unit activity of substantia nigra dopamine neurons and stimulate tonic activity of globus pallidus neurons were compared to study the agonists' effects on pre- and postsynaptic dopamine receptors, respectively. The agonists studied were apomorphine and pergolide, which interact with both D₁ and D₂ receptors, and the selective D₂ agonists quinpirole and RU 24926. Drugs were administered systematically. The 4 dopamine agonists were equipotent and equiefficacious at inhibiting the firing rates of dopamine neurons. In contrast, their effects on pallidal cells were not identical; apomorphine and pergolide induced significantly greater increases in pallidal cell activity than did quinpirole and RU 24926. In addition, pretreatment with a small dose of quinpirole did not attenuate the excitatory effect of apomorphine on globus pallidus cell activity, as low doses of apomorphine have previously been shown to do. Possible mechanisms underlying the differences in efficacy between the non-selective and D₂ selective dopamine agonists in the globus pallidus were investigated. Coadministering quinpirole with apomorphine did not significantly attenuate the effect of apomorphine, suggesting that quinpirole is not a partial agonist at postsynaptic dopamine receptors. In addition, prazosin pretreatment did not attenuate the stimulatory effect of pergolide on firing rates of pallidal cells, indicating that the greater efficacy of the non-selective agonists was not due to concurrent stimulation of ₁ adrenergic receptors and dopamine receptors. However, the effect of quinpirole on pallidal cell activity was significantly potentiated by pretreatment with the D₁ agonist RS-SKF 38393 but not its inactive enantiomer S-SKF 38393. These results suggest that concurrent D₁ and D₂ receptor stimulation may be necessary for the full expression of postsynaptic receptor-mediated effects of dopamine and dopamine agonists in the basal ganglia.