Aim To compare the species richness, and taxonomic and life‐form composition of tropical montane pteridophyte floras on two well‐documented sites: Mount (Mt) Kinabalu, Sabah, Borneo and Parque Nacional (PN) Carrasco, central Bolivia. Methods Using published lists, we compared the elevational distribution of overall species richness, specific pteridophyte families, and of life‐forms along both study sites. Additionally, we compared point‐diversity by establishing 108 plots of 400 m2 at PN Carrasco, and 15 such plots at Mt Kinabalu and three at a lowland site at Danum Valley in south‐eastern Sabah, Borneo (200 m). Results The numbers of species, genera, and families recorded on Mt Kinabalu were 14–23% higher than at PN Carrasco, most probably as a result of more intensive long‐term collecting activity. Opposed to this, species richness per 400 m2 plot was somewhat higher at PN Carrasco, especially amongst epiphytes at mid‐elevations. Overall, there was a remarkable similarity in the elevational distribution of species numbers, of individual pteridophyte families, and of life‐forms. Major differences included a more pronounced peak of species richness at 1500 m on Mt Kinabalu, considerably higher species numbers of Elaphoglossum at PN Carrasco and of Grammitidaceae at Mt Kinabalu, and a higher proportion of debris‐trapping epiphytes and lithophytic species at Mt Kinabalu and of terrestrial herbs at PN Carrasco. Main conclusions The majority of present‐day species of the studied pteridophyte floras evolved largely independently from about 66–100 common ancestors. The striking convergence of the pteridophyte floras of both sites indicates that the taxonomic and morphological composition of the pteridophyte floras is subject to selective pressure, and that specific pteridophyte families are evolutionarily pre‐disposed to occupy specific ecological niches.

Sir: Although factors influencing adherence often overlap, it is possible to differentiate between factors that are related to the patient, the patient's environment, the treating clinician, and treatment itself. 1 This differentiation may aid the practicing clinician in assessing the various reasons why a particular patient is likely to develop adherence problems. For example, there is a positive correlation between adherence and the patients' feelings of a positive effect of the drug on the illness. 2 On the other hand, weight gain has a strong impact on quality of life, 3,4 and therefore probably on adherence. Especially in children and adolescents, overweight due to second-generation antipsychotics (SGAs) might be even more pronounced compared to adults. 5 SGAs are increasingly prescribed for children and adolescents with neuropsychiatric disorders. 6 Although their specific serotonin and dopamine receptor antagonism offers certain advantages compared to typical antipsychotics, their use has been associated with various adverse effects. Most of these drugs are still prescribed in off-label use, 7 and little is known of drug-associated adverse events in pediatric patients, especially in long-term use. In our study, we investigate adherence in children and adolescents and its relationship to various potential risk factors (age, gender, time since discharge, weight gain, and pharmacologic treatment). Method. The data derived from a retrospective study investigating demographic characteristics, diagnosis, and medication of all inpatients between August 1, 2002, and August 31, 2004, who were admitted to the Department of Child and Adolescent Psychiatry of Innsbruck Medical University. Seventy inpatients were prescribed drugs for the time after discharge. Data about further drug intake, consultations (psychiatrist or general practitioner), and weight gain were evaluated by follow-up interviews. Twenty-two of the 70 could not be contacted or were not willing to give any further information, and 48 patients were included in the study. Their mean ± SD age was 15.8 ± 1.7 years (range, 10-18 years), 23 (48%) were male, and 25 (52%) were female. According to DSM-IV criteria, 8 (17%) were diagnosed with schizophrenia, 22 (46%) with mood disorders (including adjustment disorders), 11 (23%) with disruptive behavior disorders, and 7 (15%) had other diagnoses (misuse of psychoactive substances, mental retardation, personality disorders, and development disorders). They were treated with antipsychotics (48%, N = 23; risperidone, olanzapine, clozapine, quetiapine, amisulpride, and ziprasidone) and antidepressants (52%, N = 25; citalopram, mirtazapine, fluoxetine, sertraline, escitalopram, trazodone, and venlafaxine). The effects of age, gender, time since discharge (≤ 6 months, 46%; > 6 months, 54%), weight gain (< 5 kg versus ≥ 5 kg), and pharmacologic treatment (antidepressant versus antipsychotic) on adherence were investigated by means of logistic regression with backward variable selection. The same method was applied to a...

Sir: Catatonia is a clinical syndrome characterized by alterations in motor behavior and changes in thought, mood, and vigilance 1 and occurs in a variety of medical and neuropsychiatric conditions. 2 Catatonia has been documented as occurring in alcohol withdrawal in rodents, 3 but not in humans. We report the case of a patient in whom alcohol withdrawal presented as catatonia. Case report. Mr. A, aged 35 years, presented in January 2006 with a history of alcohol use over the last 10 years. He fulfilled the DSM-IV criteria for alcohol dependence for the last 5 years. He presented with tremors, irritability, anorexia, and insomnia within 24 hours of abrupt cessation of alcohol intake. Seventy-two hours after cessation of alcohol intake, he developed signs of negativism, mutism, and psychomotor agitation lasting 2 days, followed by psychomotor retardation, stereotypies, and stupor over the next 2 days, fulfilling DSM-IV criteria for catatonia. There were no psychotic or mood symptoms, clouding of consciousness, disorientation, or any general medical condition that could explain these symptoms. He had experienced a similar episode 2 years previous, following 3 days of abstinence from alcohol, that remitted upon treatment with lorazepam. Family history was positive for alcohol dependence in first-and second-degree relatives but was negative for psychotic or mood disorders. The findings of laboratory investigations were within normal limits. As the patient's condition could not be described adequately by DSM-IV criteria for alcohol withdrawal or catatonia, the diagnosis of alcohol-induced psychotic disorder was made, with onset during alcohol withdrawal and presenting with catatonia. Mr. A was treated with lorazepam 16 mg per day and with vitamin supplements. His symptoms remitted completely within 72 hours. Catatonia has been documented in alcohol dependence in relation to drug interactions involving disulfiram 4 and in delirium. 1 The temporal correlation between alcohol abstinence and the appearance of catatonia in the absence of these other causes suggests that the catatonia in this case was due to alcohol withdrawal. Perturbations in γaminobutyric acid (GABA)-ergic and glutamatergic transmission have been implicated in the pathophysiology of both catatonia 2 and alcohol withdrawal. 5,6 Furthermore, the GABA A modulator lorazepam is effective in both conditions. 1,7 To our knowledge, this case is the first such case reported in the literature.

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