SynopsisIn a study of pre-morbid personality in 56 head-injured subjects, subjects' self-ratings of pre-morbid personality were compared with informants' ratings of the subjects' pre-morbid personality on two personality questionnaires (the Eysenck Personality Inventory (EPI) and the Marke-Nyman Temperament Scale (MNTS)). Correlations between self-ratings and informantratings were positive and significant for all three MNTS and for EPI Extraversion and Lie scales, but not for EPI Neuroticism, where the lack of subject-informant correlation was attributed to contamination of the self-rating of the trait measure by current abnormalities of mental state. Further analyses supported previous evidence that the MNTS ‘Validity’ scale may predict the development of psychiatric symptoms.
Seventeen patients with schizophrenic symptoms were assessed before and after ECT to elicit possible factors predictive of outcome. The strongest associations with good outcome were shown by short duration of illness and paucity of pre-morbid schizoid personality traits; significant associations were also shown by short duration of current episode, paucity of paranoid pre-morbid personality traits, and the presence of perplexity. The diagnosis of schizoaffective disorder was not related to outcome. Questionnaires completed by 16 patients after ECT showed their attitudes to be generally favourable to the procedure.
SUMMARY This study compares nine different measures of social outcome applied to 56 patients seen 0 to 4 years after head injury. Social outcome was found to be heterogeneous: correlations between the measures and a principal components analysis both indicated that time off work (as a percentage of time since injury) was independent of most other measures of social performance. In the group studied, the best measures of non-work social performance were the Katz Adjustment Scales form 2 (socially expected activity) and Bond's Social Scale, which both showed good agreement between subject and informant ratings. If a single outcome measure is desired (to include work and non-work social performance), the most suitable measure was found to be the Glasgow Outcome Scale, original and extended versions.
Background: Sedation is a common and incapacitating clozapine adverse effect, but the factors associated with sedation and its pharmacological management remain poorly studied.
Methods:We conducted a retrospective cohort study based on deidentified electronic clinical records of clozapine-treated patients from the secondary mental health care provider for Cambridgeshire and Peterborough, United Kingdom. We first evaluated cross-sectionally the influence of clozapine dose, clozapine, and norclozapine plasma levels on self-reported hours slept, as a proxy for sedation, using bivariate correlation and then the longitudinal effect of changes in clozapine dose and other 23 medications using linear mixed effect models. We followed 241 clozapine-treated patients for 56 months on average, with 2237 face-to-face assessments in total.Results: Patients slept for a mean of 9.35 h/d, with 46% reporting 10 h/d or more. Cross-sectionally, sleep duration did not correlate with clozapine dose (r = 0.14, P = 0.106), but with clozapine plasma levels (r = 0.38, P < 0.0001) and norclozapine plasma levels (r = 0.25, P = 0.005). Longitudinally, the final mixed-effects model revealed 4 pharmacological variables that had a significant impact on hours slept: clozapine, risperidone augmentation, and atenolol were associated with increased sleep, whereas aripiprazole augmentation was associated with decreased sleep. We found that 20 other psychotropic medications measured were not associated with changes in sleep when added to clozapine. Excess sleep is a clozapine level-dependent adverse effect.
Conclusions:The impact of different augmentation strategies might help clinicians decide on the most adequate strategy, albeit further studies should confirm our results.
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