BackgroundLittle is known about the cause and psychopathology of delirious mania, a type of disorder where delirium and mania occur at the same time. This condition still has no formal diagnostic classification. To provide more information about this potentially life-threatening condition, we studied five patients with delirious mania.MethodsWe describe the cases of five patients with delirious mania admitted to an acute inpatient psychiatric unit between January 2005 and January 2007, and discuss the cases in the context of a selective review of the clinical literature describing the clinical features and treatment of delirious mania.ResultsTwo patients had two episodes of delirious mania. Delirium usually resolved faster than mania though not always the case. Delirious mania remitted within seven sessions of the electroconvulsive therapy (ECT).ConclusionsDelirious mania is a potentially life-threatening but under-recognized neuropsychiatric syndrome. Delirious mania that is ineffectively treated may induce a new-onset manic episode or worsen an ongoing manic episode, and the patient will need prolonged hospitalization. Delirious mania also has a close relationship with catatonia. Early recognition and aggressive treatment, especially with electroconvulsive therapy, can significantly reduce morbidity and mortality.
The highly homeostasis-resistant nature of cancer cells leads to their escape from treatment and to liver metastasis, which in turn makes pancreatic ductal adenocarcinoma (PDAC) difficult to treat, especially the squamous/epithelial-to-mesenchymal transition (EMT)-like subtype. As the molecular mechanisms underlying tumour heterogeneity remain elusive, we investigated whether epigenetic regulation might explain inter-individual differences in the progression of specific subtypes. DNA methylation profiling performed on cancer tissues prior to chemo/radiotherapy identified one hypermethylated CpG site (CpG6882469) in the VAV1 gene body that was correlated with demethylation of two promoter CpGs (CpG6772370/CpG6772811) in both PDAC and peripheral blood. Transforming growth factor β treatment induced gene-body hypermethylation, dissociation of DNMT1 from the promoter, and VAV1 expression via SMAD4 and mutant Kras. Pharmacological inhibition of TGFβ-VAV1 signalling decreased the squamous/EMT-like cancer cells, promoted nuclear VAV1 localization, and enhanced the efficacy of gemcitabine in prolonging the survival of KPC mice. Together, the three VAV1 CpGs serve as biomarkers for prognosis and early detection, and the TGFβ-VAV1 axis represents a therapeutic target.
P-I. Sleep quality in heroin addicts under methadone maintenance treatment.Background: Sleep disturbance is a common phenomenon among opiate addicts. The side effects of opiate addiction or opiate withdrawal might result in sleep disturbance. However, their problems might be related to sedative medication abuse, alcohol abuse or heroin relapse. Sleep is an important issue in this population. Objective: To evaluate the prevalence of sleep disorders in heroin addicts receiving methadone maintenance treatment (MMT) and analyse the correlation between related factors, such as age at opiate exposure, opiate exposure duration, duration in MMT, methadone current dosage, methadone attendance rate and the severity of sleep disorders. Method: We enrolled 121 heroin addicts who were receiving MMT. We collected data on the duration of insomnia, hypnotic history, Visual Analogue Scale-10 of sleep quality, Pittsburgh Sleep Quality Index (PSQI), methadone dosage, methadone history and opiate history. Results: The mean of the PSQI was 9.1 ± 5.4, and 70.2% of patients had PSQI scores >5, indicating they were poor sleepers. We also found the PSQI scores were correlated significantly with the methadone dosage. Conclusions: The sleep disturbance prevalence rate of opiate addicts under MMT was high in Taiwan, as shown in the previous studies, and the severity of sleep disturbance has been underestimated.
Significant outcomes• About 70.2% of heroin addicts in methadone maintenance treatment had a sleep disorder in our survey. • The severity of sleep disorder in our survey was a mean of Pittsburgh Sleep Quality Index (PSQI) 9.1 ± 5.4. • PSQI scores were correlated significantly with the methadone dosage.
Limitations• Lack of polysomnography to provide objective sleep evaluation. • Limited data on the patients' abuse of hypnotics, alcohol and other substance. • Our samples were from only one site. • The sample size was small.
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