Safety and efficacy of long-term low-dose clozapine aftercare treatment in a patient with learning difficulties who suffered from neuroleptic malignant syndrome

INTRODUCTION : Antipsychotic medication continues to be an essential component in the treatment of schizophrenia. Neuroleptic malignant syndrome (NMS) is one of the most serious complications of neuroleptic treatment and the optimal therapeutic aftercare regimen for patients is unclear. Also, it is not clear if low-dose neuroleptic maintenance in such patients is safe and efficient enough over time. METHOD : We present a case of a 56-year-old woman suffering from schizoaffective disorder, who was successfully treated with a low dosage of clozapine for 6.5 years following a NMS episode. RESULT : To the best of our knowledge this is the first report of such a long-term beneficial use of low-dose clozapine in a patient who previously underwent such a serious complication. CONCLUSION : Large-scale studies are needed to substantiate this observation. (Int J Psych Clin Pract 2002; 6: 121-123)     

从中医学角度浅析新型冠状病毒肺炎愈后遗症防控

2019年爆发的新型冠状病毒肺炎(NCP)属于中医"伏气瘟疫"中的一种,由于有湿浊毒的性质及潜伏性、反复性和特殊的病位使得该病易产生多种遗症。本文通过分析NCP的特点及梳理中医先辈们通过长期的临床观察实践所总结的瘟疫遗症相关调理要点,制定了NCP愈后遗症的防控措施,为病患的痊愈提供进一步保障。     

鉴往知来：分化型甲状腺癌术后随访模式探索

分化型甲状腺癌(DTC)的术后随访是整体治疗过程中的重要环节。近年来,各相关领域学者对其随访模式的重视程度不断加深,各级学会也为之不断探索,但截至目前,仍缺少清晰的思路和发展方向。笔者以临床视角,分析DTC术后管理现状,结合国外随访模式和团队随访工作中的困境,对如何构建符合中国国情的DTC术后随访模式进行探讨。     

Aftercare attendance and post-treatment functioning of severely substance dependent residential treatment clients

The present study evaluated the impact of a structured aftercare programme following residential treatment for severe alcohol and/or heroin dependent clients. Over 17 months, 77 participants were recruited to the study and allocated randomly to either a structured aftercare (SA) programme or to unstructured aftercare (UA) of crisis counselling on request. Independent clinicians interviewed participants and collaterals, at 4-month (median) intervals, for 12 months following residential treatment. SA compared to UA was associated with a fourfold increase in aftercare attendance and one-third the rate of uncontrolled principal substance use at follow-up. Participants who attended either type of aftercare relapsed a median of 134 days later than those who attended no aftercare. Overall, 23% of monitored participants remained abstinent throughout, 21% maintained controlled substance use and 56% relapsed, within a median of 36 days following residential treatment. The only significant predictor of days to relapse, controlling for age, was pretreatment use of additional substances. Participants with pretreatment additional substance use relapsed a median of 192 days earlier than those who had used no other substances. The degree of agreement between participant self-reports and collateral reports was fair-to-moderate and moderate among collaterals. Intention-to-treat analyses revealed significant and clinically meaningful reductions in substance use in this sample of severely dependent residential treatment clients. The generalizability of these results is limited because of significant differences in age and presenting substance between the study sample and other clients admitted to the service during the study. This latter group of younger, male, heroin-dependent clients with polydrug use who refuse opioid pharmacotherapy, are more likely to drop out of treatment or relapse early following treatment and continue to present a challenge to treatment services. [Sannibale C, Van den Bossche E, O'Connor D, Zador D, Capus C, Gregory K, McKenzie M. Aftercare attendance and post-treatment functioning of severely substance dependent residential treatment clients. Drug Alcohol Rev 2003;22:181 - 190]     

Modifying the Process of Treatment to Meet the Threat of AIDS

Treatment for drug users is unlikely to receive sufficient resources to expand to the level of treatment need. Moreover, there is indication that a substantial minority of injection drug users have never initiated needed treatment in spite of long histories of injecting drugs. Given the potential for that population to contract and spread AIDS, it is important that we explore street-based treatment alternatives derived from findings regarding the efficacy of outreach/intervention programs. Those programs were found both to reduce drug-taking behaviors of injecting drug users and to prepare those users for clienthood. Additional strategies that need to be explored include: aftercare, behavioral counseling for sex partners of drug treatment clients, and partial (i.e., survival) treatment services for clients who cannot be accommodated within existing treatment capacity.     

Twelve-month follow-up of aftercare for adolescents with alcohol use disorders

Adolescents with alcohol use disorders (AUDs) previously completed a randomized controlled outpatient aftercare study (Y. Kaminer, J. A. Burleson, & R. H. Burke, 2008) in which they were randomly assigned to in-person, brief telephone, or no-active aftercare. Youth were assessed at end of aftercare and at 3-, 6-, and 12-month follow-up on frequency and quantity of alcohol use. It was predicted that active aftercare (in-person and brief telephone) would be superior to no-active aftercare in reducing alcohol use, as shown in the original study. No subject or therapy group attributes were significant moderators of outcome. Active aftercare in general maintained short-term favorable effects by reducing relapse in youth with AUD and should be considered as part of standard procedures in therapeutic interventions for all alcohol and other substance use. In-person and the brief telephone procedures did not differ in their effectiveness. Structured communications with AUD youth during and after treatment by use of electronic technology rather than in-person contact might therefore be more fully investigated.     

Effect of Non‐Surgical Periodontal Treatment on Gingival Crevicular Fluid and Serum Endocan,Vascular Endothelial Growth Factor‐A,and Tumor Necrosis Factor‐Alpha Levels

Background: Periodontitis is a chronic inflammatory disease that occurs due to the interaction between pathogenic microorganisms and host defenses. Endocan is a proteoglycan secreted by endothelial cells under the control of inflammatory cytokines. Aims of the study are to determine serum and gingival crevicular fluid (GCF) endocan levels in the pathogenesis of periodontal diseases, supported with vascular endothelial growth factor (VEGF‐A) and tumor necrosis factor (TNF)‐alpha levels. This study additionally aims to evaluate correlation between GCF endocan levels, VEGF‐A, and TNF‐α levels with periodontal probing depth (PD). Methods: The study consists of two groups: group 1 (n = 20), healthy individuals; group 2 (n = 20), individuals with generalized chronic periodontitis (CP). Clinical measurements were recorded; GCF and serum samples were obtained from each participant before and 6 weeks after therapy. Levels of biomarkers were measured by enzyme‐linked immunosorbent assay. Intergroup comparisons of biochemical and clinical parameters were analyzed by Kruskal–Wallis/Bonferroni‐adjusted Mann–Whitney U test using statistical software. Results: Serum and GCF endocan, VEGF‐A, and TNF‐α levels were significantly higher in patients with CP than in healthy individuals (P <0.001) and decreased after treatment (P <0.03). A significant correlation was observed between GCF TNF‐α and PD (4 mm ≤ PD ≤5 mm and PD ≥6 mm). A significant relationship was found among GCF endocan and TNF‐α, VEGF‐A, CAL, and GI for all groups (P <0.05). Conclusions: Endocan and TNF‐α levels, both in GCF and serum, increased from health to periodontitis and decreased with non‐surgical periodontal treatment. Within the limits of the study, endocan may be considered as a potential inflammatory marker for periodontal disease.