A general characteristic of Parkinson's disease (PD) is the inability to adapt and change set quickly. The goal of this study was to assess whether PD aff ects performance in which changing set occurs over minutes, i.e., a slow and continuous form of sensorimotor set-change. Recovery from the postural lean aftereff ect following prolonged stance on an inclined surface (Experiment 1) was tested to see if the addition of light-touch tactile feedback from the fi ngertips during inclined stance increased the aftereff ect (Experiment 2). The percentage of responders in healthy Young, Older, and PD groups was similar, as were characteristics of the recovery towards vertical stance, namely the initial forward lean, range, time constant, and half-life. Tactile feedback increased the responder rate in all groups. A novel response was also observed in which the aftereff ect did not dissipate; i.e., participants remained leaning forward throughout the post-incline stance period. PD does not appear to aff ect the ability to change sensorimotor set if the change is slow.

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Introduction Valproic acid (VPA) and its various formulations can be given in conjunction with clozapine for seizure prophylaxis or for augmentation in schizophrenia. There is conflicting literature on how VPA affects clozapine metabolism and the incidence of clozapine-related side effects. The purpose of this study is to compare the effects of VPA when given concurrently with clozapine to patients on clozapine monotherapy. Methods A retrospective medical record review was completed to identify patients admitted to the inpatient psychiatry unit at an academic medical center with an order for clozapine with and without concurrent VPA from August 7, 2010 to August 7, 2020. The primary outcome was the difference in clozapine doses in patients on clozapine as monotherapy versus dual therapy with VPA. Secondary outcomes include the difference in incidence of adverse effects in monotherapy versus dual therapy, as well as clozapine and norclozapine concentrations in both treatment groups. Results During the study period, 73 patients were included in the monotherapy group and 35 patients were included in the dual therapy group. The average clozapine dose in the dual therapy group was 250 mg (95% CI = 194.7, 305.4) which was significantly higher than the average monotherapy dose of 175.9 mg (95% CI = 134.0, 208.7; P = .016). However, there was no significant difference in the average clozapine concentration between the dual therapy group (392.5 ng/mL; 95% CI = 252.8, 532.2) and monotherapy group (365.9 ng/mL; 95% CI = 260.5, 471.3; P = .756). There were higher rates of tachycardia (45.7% vs 17.8%; P = .002), sedation (51.4% vs 8.2%; P < .001), and constipation (42.8% vs 9.5%; P < .001) in the dual therapy group compared to the monotherapy group, respectively. Discussion Patients on concurrent clozapine and VPA received higher doses of clozapine and experienced a higher incidence of tachycardia, sedation, and constipation.

Although tiotropium use in treatment of persistent asthma appears to be promising, more robust clinical trials are needed to assess whether improved pulmonary function tests as well as a decrease in asthma exacerbations and corticosteroid requirements translate into improvements in quality of life. Additionally, the optimal patient population, long-term efficacy, and safety of tiotropium when delivered by various methods need to be determined before it can be recommended over current alternative asthma therapies.