Impression Scale Research Articles

Escitalopram for antipsychotic nonresponsive visual hallucinosis: eight patients suffering from Charles Bonnet syndrome

The Charles Bonnet syndrome (CBS) is characterized by distinct visual hallucinations and ocularpathology causing visual impairment in patients with insight and the absence of psychiatric comorbidity. The number of reported cases of CBS is expanding as the population ages and the prevalence of vision disorders increases. Antipsychotic medications are often prescribed. However, their efficacy in CBS has been based on sketchy evidence. The use of serotonin selective reuptake inhibitor (SSRI) for CBS was anecdotally reported. We herein describe effectiveness of escitalopram in a series of patients suffering from CBS who were unresponsive to antipsychotic treatment. Eight consecutive patients suffering from CBS who did not respond to standard antipsychotic treatment were switched to escitalopram. CBS severity prior to escitalopram treatment was quantified using the Clinical Global Impression (CGI) scale and again after eight weeks of treatment. All had undergone brain CT and cognitive assessment. Brain CT imaging was normal except for an incidental finding of a small frontal meningioma in one patient. All had Mini-Mental Status Examination scores of ≥ 27/30. There were four men and four women, with a mean age of 81.7 ± 7.3 years. Previous antipsychotic treatment was mostly with risperidone, 1.0 to 3.0 mg/daily. Mean CGI-severity upon switching to escitalopram treatment was 5.7. This was significantly reduced to 1.8 (p < 0.001) after eight weeks of escitalopram treatment (mean dose: 11.8 mg/daily). There were no side effects, nor any adverse events were reported. This is the first case-series to show that SSRI is an effective and well-tolerated treatment for visual hallucinations associated with vision impairment such as in CBS.

2560 – Esitalopram for antipsychotic non-responsive complex visual hallucinations: eight patients suffering from charles-bonnet syndrome

Background The Charles Bonnet syndrome (CBS) is characterized by distinct visual hallucinations and visual impairment in patients with insight and the absence of psychiatric comorbidity. The number of reported cases of CBS is expanding as the population ages and the prevalence of vision disorders increases. The efficacy of antipsychotics in CBS is based on sketchy evidence. The use of serotonin selective re-uptake antidepressants (SSRI) for CBS is anecdotal. Aim To describe effectiveness of escitalopram in a series of patients suffering from CBS who were unresponsive to antipsychotic treatment. Methods Eight consecutive patients suffering from CBS who did not respond to standard antipsychotic treatment were switched to escitalopram. CBS severity prior to escitalopram treatment was quantified using the Clinical Global Impression (CGI) scale and again after 8 weeks of treatment. All had undergone brain -CT and cognitive assessment. Results There were 4 men and 4 women, mean age 81.7 ± 7.3 years. Brain-CT imaging was normal except for an incidental finding of a small frontal meningioma in one patient. All had MMSE scores ≥ 27/30. Previous antipsychotic treatment was mostly with risperidone 1.0 to 3.0 mgs/daily. Mean CGI-severity upon switching to escitalopram treatment was 5.7. This was significantly reduced to 1.8 (p Conclusions This is the first case-series to show that SSRIs are an effective and well-tolerated treatment for visual hallucinations associated with vision impairment such as in the CBS.

A 6-Week, Randomized, Multicentre, Open-Label Study Comparing Efficacy and Tolerability of Amisulpride at a Starting Dose of 400 mg/day versus 800 mg/day in Patients with Acute Exacerbations of Schizophrenia

It has been suggested that neither dose titration nor the use of a loading dose was required for amisulpride and that 800 mg/day could be given from the first day with a low risk of extrapyramidal symptoms (EPS). However, no direct study of the need for dose titration has been conducted. This study aimed to compare the efficacy, tolerability and subjective experience of amisulpride between a group receiving an initial dose of 800 mg/day (AMI-800 group) and a group titrating up from an initial dose of 400 mg/day (AMI-400 group) over a period of 6 weeks. A total of 68 patients with acute exacerbations of schizophrenia participated in this 6-week randomized, multicentre, open-label study of amisulpride. Thirty patients were randomly assigned to the group that received an initial dose of 400 mg/day, which was then titrated up during the first 4 weeks following a fixed schedule. Thirty-eight patients were randomly assigned to the group receiving an initial dose of amisulpride 800 mg/day, which they took until the end of the fourth week. During the fifth and sixth weeks, the doses were adjusted flexibly in both groups. Our primary outcome measures were the Clinical Global Impression (CGI) scale and the changes over time in the total and subscale scores of the Positive and Negative Syndrome Scale (PANSS). We found no significant between-group differences in clinical improvement on the CGI and the PANSS. However, when responders were defined as those patients who experienced at least a 30 % reduction in the PANSS total scores obtained at baseline, a higher proportion of those in the AMI-800 group met the criterion for responsiveness from week 4 (week 4: 68.4 % vs 40.0 %, p = 0.02; week 6: 71.1 % vs 43.3 %, p = 0.02). Irrespective of treatment group, significant proportions of patients developed hyperprolactinaemia (86 %) and EPS (35 %). However, no statistically significant differences in the overall incidence of adverse events were observed between the two treatment groups. There were also no group differences in subjective quality of life and attitudes toward antipsychotic medication. These results suggest that it may be useful to begin therapy, especially for acute exacerbations of schizophrenia, with an initial dose of amisulpride 800 mg/day to obtain maximal efficacy without any significant side effects.

Institutional Outcomes in Patients Evaluated for Possible Normal Pressure Hydrocephalus: Which Factors Are Predictive of Positive Response to Ventriculoperitoneal Shunt Placement? (P02.245)

Objective: The goal of this study was to examine patient outcomes after their initial evaluation in the Movement Disorders (MD) Clinic at our institution for possible normal pressure hydrocephalus (NPH). We attempted to identify predictive factors that lead to the clinical diagnosis of NPH and ultimately to pursuit of ventriculoperitoneal shunt (VPS) placement, as well as those that lead to positive post-surgical outcomes. Background First, we wanted to review patient outcomes after VPS placement for NPH at our institution. Second, given current limitations in successfully identifying optimal surgical candidates among patients with possible NPH, we wanted to review the clinical and radiological data utilized for decision-making with each patient to see if certain factors were more predictive of positive outcome. Design/Methods: This was a retrospective chart review of patients evaluated in MD Clinic for gait disturbance between January 2007 and October 2010. Outcomes were based on the patients9 postoperative assessments in Neurosurgery and/or MD Clinic and Clinical Global Impression (CGI) scale scores. Results: Fourteen of 25 patients initally evaluated in MD Clinic for gait disturbance and possible NPH ultimately underwent VPS placement, 12 of those at our institution. Of those, 11 had post-operative CGIs between 1 (very much improved) and 3 (minimally improved). Only one patient had no change after surgery. In the patients that underwent high-volume lumbar puncture (LP) as part of evaluation for possible NPH, a higher percent change in gait speed and lower post-LP CGI were associated with surgery, but not necessarily with more positive post-surgical outcome. Conclusions: In general, patients undergoing VPS placement for probable NPH after evaluation in MD Clinic had positive outcomes, with improvement in gait dysfunction. However, measures such as percent change in gait speed after high-volume lumbar puncture, frequently used to predict response to VPS, were not necessarily predictive of the degree of improvement after surgery. Disclosure: Dr. Tate has nothing to disclose. Dr. Siddiqui has nothing to disclose.

Sertraline treatment of patients with major depressive disorder who failed initial treatment with paroxetine or fluvoxamine

This study was undertaken to examine the long-term effectiveness and safety of switching to sertraline from other selective serotonin reuptake inhibitors (SSRIs) in the treatment of non-remitted or treatment-intolerant major depressive disorder. The study included 25 patients with major depressive disorder according to DSM-IV-TR criteria. None had achieved remission with paroxetine or fluvoxamine, but each had been used in an adequate dose for an adequate time period or had been intolerant of these SSRIs. Most patients (n=22, 88%) were non-remitters. Switching was accomplished by gradual cross-titration and tapering. We conducted assessments at baseline and at weeks 1, 2, 3, 4, 6, 8, 12, 16, 20, and 24. Outcomes were assessed using the Quick Inventory of Depressive Symptomatology-Self-Report, Japanese version (QIDS-SRJ) score (primary outcome), the 17-item Hamilton Depression Rating Scale (HDRS), and the Clinical Global Impressions (CGI) scale. Mean QIDS-SRJ and HDRS scores improved significantly from baseline to week 8 and week 24. At the respective endpoints of weeks 8 and 24, remitters on QIDS-SRJ (≤5) were 2 of 25 (8%) and 4 of 25 (16%). At weeks 8 and 24, 11 of 25 (44%) were responders on QIDS-SRJ (≥50% reduction). Five patients (20%) terminated early, before week 8, because of side effects and/or lack of efficacy. These preliminary data suggest that the switching strategy from paroxetine or fluvoxamine to sertraline might be effective and well-tolerated in patients with non-remitted or treatment-intolerant major depressive disorder.

P-771 - The use of new generation antipsychotics in people with intellectual disability

The New Generation Antipsychotics (NGAs) are frequently used in People with Intellectual Disability (PWID), especially for treating aggressive behaviour. However there is very limited research to fully establish evidence-based approaches for their use in this population. Aim To evaluate the effectiveness of NGAs, in particular olanzapine and risperidone, in treating aggressive behaviour in PWID for who previous medication with First Generation Antipsychotics (FGAs) were not effective. Method 62 subjects with intellectual disability underwent to a two-arm, parallel group pragmatic trial of olanzapine and risperidone with balanced randomisation and blind assessment of outcomes after a switch from a treatment with FGAs. Psychiatric disorders were evaluated by Diagnostic Assessment for the Severely Handicapped (DASH). Aggressive behaviour was assessed by Overt Aggression Scale (OAS) and clinical outcome by Clinical Global Impression (CGI) Scale. Side effects were assessed with specific scales, laboratory and instrumental tests. Results Both risperidone and olanzapine resulted to be more effective than FGAs in reducing aggressive behavior and in treating concurrent psychiatric disorders. The degree of improvement in our sample was very high for OAS and CGI scores. Both compounds resulted to be well tolerated, with side-effects similar to those encountered in other patient populations. Conclusion Our findings seem to confirm previous literature on that olanzapine and risperidone can be effective in reducing aggressive behaviour in PWID. Although NGAs have shown greater efficacy and safety than FGAs, there is still a need for controlled trial and more methodically researches to confirm their benefit.

P-953 - Treatment biomarker: blood brain barrier (P-gp) polymorphisms predict antidepressant dose and response - a candidate gene association study

Overview Pharmacokinetically important polymorphisms could guide dosing, ensuring adequate CNS bioavailability in a particular individual during a therapeutic trial. Hepatic enzyme (CYP450) polymorphisms have been extensively studied. Less work has been done on the permeability glycoprotein (P-gp) - the key efflux pump at the blood brain barrier (BBB). Methods An eight week prospective multi-centre candidate gene association study of 113 patients with psychiatrist diagnosed DSM-IV MDD was conducted. Subjects were treated with escitalopram (ESCIT) or venlafaxine (VEN) in a naturalistic clinical setting. Treatment outcome was assessed with the 17-item HDRS and Clinical Global Impression (CGI) Scales. Side effects were rated with a comprehensive adverse reactions scale (UKU). All response ratings were blinded to genotype. P-gp, CYP2D6, and CYP2C19 polymorphisms were assayed using microarray methodology. Results BBB (P-gp) polymorphisms associated with less antidepressant CNS entry were associated with need for higher medication dosage and less overall clinical improvement. Patients with higher BBB block polymorphism need 1.45 (p = 0.018) times the dose of escitalopram than those with lower blood brain barrier block polymorphism. Patients with lower BBB block genotype had a 1.602 time greater reduction in depression compared to subjects with higher block polymorphisms (p = 0.043). Subjects with lower BBB block and poorer metaboliser status at cytochrome P450 2D6 and 2C19 genotype were significantly more likely to respond on the HDRS (RR = 1.60, 95%CI 1.095–2.339, p = 0.015). Conclusions This is the first study to demonstrated that P-gp polymorphisms predict antidepressant dose, and that combined P450 and P-gp polymorphisms predict antidepressant response.

P-515 - CGI Rating to predict antidepressant treatment under naturalistic conditions

Introduction Recent studies have shown that psychopathological rating by the Hamilton Depression Rating scale (HAMD) is well established and highly predictive for later response. In this study we aimed to find out if Clinical Global Impression (CGI) scale is suitable to guide antidepressive treatment under naturalistic conditions. Methods Inpatients with a major depressive disorder and treatment with citalopram were included and rated using in parallel the HAMD scale and the CGI scale weekly at baseline to day 35. According to CGI the sample has been divided in “CGI improver” (CGI = 2–4) and “CGI non-improver” (CGI = 5–6). Response was defined as HAMD sum score reduction by at least 50%. Results 55 patients were included. A HAMD score reduction of ≥24% on day 14 was highly predictive (p = 0.016) for both response and non-response on day 35. Among patients who improved on CGI scale at week two 33% became responder at week five vs 44% when improvement on HAMD scale was achieved. HAMD sum scores correlated well on the CGI scale (53–74%, p = 0.000). Patients who were “improved” according to CGI scale on day 14 exhibited less reduction on the HAMD scale on day 35 than patients who were “improved” according to HAMD (35% vs 46%, respectively). CGI rating on day 14 predicted response on day 35 with only 44% specificity (p = 0.255). Conclusion Our findings revealed that the CGI rating scale is not predictive for later response on day 35.

P-1373 - Does electroconvulsive therapy change the response to pharmacological treatment in patients with treatment-refractory schizophrenia?

Electroconvulsive therapy (ECT) is a standard treatment for mood disorders, and is sometimes utilized to treat psychotic disorders. We evaluated whether ECT changed the response to antipsychotic treatment in patients with treatment refractory schizophrenia. Objective To measure the change of mental status, medication dosage, and adverse effect of medication in patients with treatment refractory schizophrenia after administering ECT. Aim To objectively demonstrate the change of pharmacological response in patients with treatment refractory schizophrenia after receiving ECT. Methods A retrospective study of seventeen patients was done. All patients were diagnosed with schizophrenia and received ECT as secondary indications in a psychiatric hospital in Japan from 2004 to 2010. As part of the evaluation protocol, Clinical Global Impression (CGI) scale was administered at the baseline and twelve months after taking ECT. The dosages of antipsychotics were also evaluated as Chlorpromazine (CPZ) equivalents. Results On twelve months, nine patients were able to maintain their improvement with pharmacological treatment only. On the contrary, eight patients failed to pharmacological treatment and were rehospitalized. Five of them required additional course of ECT. Two patients continued to take maintenance ECT. Mean CPZ equivalents were reduced from 1,505 mg to 1,130 mg. Conclusions ECT may revitalize the pharmacological response to antipsychotic medications even if the same medication failed to gain satisfactory improvement before. ECT may also reduce the dosage of antipsychotics required to avoid relapse although the change of dosage was small. We need large samples and further studies to determine the clinical significance of these findings.

Long-term efficacy and safety of galantamine in outpatients with mild cognitive disorder

Materials and methods A multicenter, open label, prospective, observational study enrolled 800 patients, more 50 years old with Mild Neurocognitive Disorder (DSM IV criteria), during 24 months of treatment with galantamine 16 mg./day. Assessments included the Mini Mental State Examination (MMSE), Clinical Dementia Rating (CDR), Alzheimer’s Disease Assessment Scale (ADAS-GOG), Seven minutes test, Wisconsin card sorting test, Boston naming test, Token test, Raven Test, Brow-Peterson test, Trail making test, Functional Activities Questionnaire (FAQ), GO-NO-GO test, Global Deterioration Scale, Global Clinical Impression (GCI) and UKU scale of Adverse Effects.

Safety and efficacy of long‐acting injectable risperidone in patients with schizophrenia spectrum disorders: A 6‐month open‐label trial in Asian patients

The study aimed to evaluate the efficacy of long-acting injectable risperidone (LAR) in Asian patients with schizophrenia spectrum disorders. Twenty-five patients enrolled in this 6-month open labelled study. They were switched from their current antipsychotic to LAR without a prior oral risperidone run-in phase. Efficacy was assessed by the positive and negative syndrome scale (PANSS) and clinical global impression (CGI) scales. Extra-pyramidal side effects (EPSE) was assessed using the Simpson Angus Scale (SAS), and weight and plasma levels of fasting blood glucose, lipids and prolactin were measured. Baseline and last visits differences were tested by paired t-test and Wilcoxon signed-rank test; ratings measured over time were analysed using repeated measures ANOVA. Participants' mean age was 30.3 (+/-6.6) years. Principal reason for switching to LAR was non-compliance (40.0%). Thirteen (52%) patients completed the trial. Over 6 months, there were significant reductions in total PANSS (p = 0.008) and CGI (p = 0.001) scores. There were significant increases in weight (p < 0.001), levels of plasma cholesterol and fasting glucose. LAR was effective in improving symptom severity within the first month of starting treatment. However, significant increases in weight and plasma levels of fasting glucose and cholesterol raise concern about metabolic side effects.

Amisulpride Versus Olanzapine in the Treatment of Schizophrenia in Indian Patients: Randomized Controlled Trial

Atypical antipsychotics are increasingly drugs of first choice in schizophrenia. Amisulpride, a new atypical antipsychotic, is reported to be effective for both positive and negative symptoms of schizophrenia in Western countries but Indian experience is limited. The aim of the present study was therefore to conduct a trial of amisulpride versus olanzapine in Indian schizophrenia patients. Eighty adult patients of either sex were randomized to receive standard doses of the two drugs orally, in a single blind manner, for 12 weeks, with follow up at 4 and 8 weeks. Effectiveness was assessed by changes in scores on the Brief Psychiatric Rating Scale (BPRS), Scale for Assessment of Positive Symptoms (SAPS), Scale for Assessment of Negative Symptoms (SANS), and physician-administered Clinical Global Impression (CGI) scale. Tolerability was assessed by treatment-emergent adverse drug reactions (ADRs). Evaluable were 39 patients on amisulpride and 38 on olanzapine. The groups were comparable at baseline with respect to demographics, illness duration and rating scores. Final BPRS score was lower for olanzapine (33.2 +/- 9.44) than for amisulpride (37.7 +/- 9.67). SAPS and SANS scores and CGI rating improved individually in both arms but remained comparable between groups throughout the study period, but olanzapine reduced SAPS score to a greater extent. ADRs were encountered in 67.5% and 47.5% of patients (p = 0.113) on amisulpride and olanzapine, respectively. Tremor and insomnia were more frequent with amisulpride, while olanzapine caused more weight gain and sedation. No serious ADRs occurred. Amisulpride, although comparable to olanzapine on some measures, did not match the improvement seen with the latter drug in BPRS and SAPS scores. Despite differences in ADR profiles, overall tolerability was satisfactory for both drugs. In Indian patients, amisulpride should therefore be an alternative to olanzapine to a limited extent, such as when weight gain and sedation are undesirable.

A clinical comparative study of citalopram augmented with aripiprzole on depression

Objective To explore the efficacy of low-dose aripiprazole combining with citalopram on the depression. Methods A total 57 patients with depression were randomly assigned to the study group and the control group. Either group was treated with a fixed dose 20 mg citalopram per day, and the study group was simultaneously titrated to low dose (5～10mg/d) of aripiprazole at initiating dose 2.5 mg per day within two weeks. They were evaluated with Hamilton Depression Scale (HAMD).Clinical Global Impression (CGI-SI) and Treatment Emergent Symptom Scale(TESS) before treatment and at the end of 1st, 2nd, 4th and 6th week after treatment. The study lasted for 6 weeks. Results HAMD total score of either group were 11.54 ± 5.58 and 16.59 ± 6.67 respectively, which had statistically significant difference between two groups(t = 2.961, P 0.05). TESS scores were not statistically significant difference between two groups at each point of measure. Conclusion The results suggest low dose of aripiprazole augmentation of citalopram may be effective and safe in the treatment of depression. Key words: Depression; Citalopram; Aripiprazole

Efficacy and tolerability of switching to ziprasidone from olanzapine, risperidone or haloperidol: an international, multicenter study

To compare the effectiveness of a switch from haloperidol (N=99), olanzapine (N=82), or risperidone (N=104) to 12 weeks of treatment with 80-160 mg/day ziprasidone in patients with stable schizophrenia or schizoaffective disorder. Stable outpatients with persistent symptoms or troublesome side effects were switched using one of three 1-week taper/switch strategies as determined by the investigator. Efficacy was assessed using the Brief Psychiatric Rating Scale score, Clinical Global Impression, Positive and Negative Symptom Scale, Montgomery-Asberg Depression Rating Scale, and the Global Assessment of Functioning Scale, and tolerability by using standard measures of weight change, extrapyramidal symptoms, and laboratory findings. Suboptimal efficacy was the primary reason for switching. The preferred switch strategy was immediate discontinuation, and the preferred dosing regimen was 120 mg/day. Completer rates were 68, 60, and 86% in the haloperidol, risperidone, and olanzapine pre-switch groups, respectively. At week 12, a switch to ziprasidone resulted in statistically significant improvement from baseline on the Brief Psychiatric Rating Scale score, Clinical Global Impression-Improvement, Positive and Negative Symptom Scale, and Global Assessment of Functioning scales, reduction in extrapyramidal symptoms and a neutral impact on metabolic parameters. Switch from olanzapine and risperidone resulted in weight reduction and from haloperidol in some weight increase. In conclusion, oral ziprasidone of 80-160 mg/day with food was a clinically valuable treatment option for stable patients with schizophrenia or schizoaffective disorder experiencing suboptimal efficacy or poor tolerability with haloperidol, olanzapine, or risperidone.

Atomoxetine in children with attention-deficit hyperactivity disorder with prior stimulant therapy: a prospective open-label study

The objective of the study is to evaluate the effectiveness and tolerability of atomoxetine in youth, ages 6-17 years with ADHD, who had a prior trial of stimulant treatment. This was a 6-week prospective open-label study of atomoxetine, dosage up to 1.4 mg/kg per day in 34 children and adolescents with DSM-IV ADHD. Primary measures of response included the ADHD Rating Scale (ADHD RS) and the Clinical Global Impression (CGI) Scale. Analyses were intention-to-treat. The treatment with atomoxetine was associated with statistical and clinical significant reduction in clinician rated ADHD RS symptoms, compared with baseline. Statistical significant improvement was attained by the second week of treatment. Fifty-six percent (N = 18) met criteria for our a priori definition of response; much or very much improved on the CGI plus more than 30% reduction in ADHD RS symptoms. In conclusion, atomoxetine was generally well tolerated; 85% of subjects completed the trial. Atomoxetine was effective and well tolerated in a 6-week open study of ADHD youth with a prior history of stimulant treatment.

Winter/summer seasonal changes in malondialdehyde formation as a source of variance in oxidative stress schizophrenia research

Background. Malondialdehyde (MDA), an oxidative stress biological marker, is one of the most frequently used markers of lipid peroxidation in schizophrenia research. Data regarding MDA levels in schizophrenia are controversial. Our aim is to study the existence of winter/summer seasonal changes in serum MDA levels in schizophrenic patients. Methods. Twenty-three clinically stable treated chronic paranoid schizophrenic outpatients were studied in summer and winter. Blood was sampled between 08:30 and 09:00 h. Serum MDA was determined by the thiobarbituric acid reactive substances technique. The clinical state was assessed by means of the Clinical Global Impression (CGI) scale. Results. Mean serum MDA levels were significantly higher in summer than winter (2.49±0.25 vs. 1.86±0.11 nmol/ml, P<0.03). Summer MDA was increased by a 33.9% compared to winter MDA. Age, gender, smoking status, body mass index, psychopharmacological treatment, illness duration, age of illness onset and CGI did not affect significantly MDA levels. Conclusion. Our results show that serum MDA presents a winter/summer rhythm of formation, with higher levels in summer than winter. It is strongly advisable to take into account the summer/winter variation in MDA levels when researching into this field.

Quetiapine and Ziprasidone as Adjuncts in Treatment-Resistant Obsessive-Compulsive Disorder

While serotonin reuptake inhibitors (SRIs) are first-line pharmacological agents in the treatment of obsessive-compulsive disorder (OCD), 40-60% of patients with the disorder do not respond to these agents. This suggests that other neurotransmitters may play a role in OCD. In this regard, there has been particular interest in the dopaminergic system, with various antipsychotic drugs having been used as adjunctive therapy for refractory OCD. The aim of this study was to compare the efficacy of quetiapine and ziprasidone as adjuncts for treatment-resistant OCD. A total of 24 OCD patients treated with either quetiapine (n = 15) or ziprasidone (n = 9) as adjunctive therapy to high-dose SRI treatment were included in this retrospective evaluation. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Clinical Global Impression (CGI) scale scores were used to evaluate baseline clinical status and clinical improvement at 1, 2, 3 and 6 months of follow-up. Clinical improvement was established in 80% of the quetiapine group and in 44.4% of the ziprasidone group with an overall mean improvement rate on the Y-BOCS scale of 66.7%. Both Y-BOCS and CGI mean scores were higher in the ziprasidone group at 2, 3 and 6 months follow-up than in the quetiapine group. In the first reported study of its role in this setting, ziprasidone was found to be less effective than quetiapine in the treatment of refractory OCD.

‘Reporting Back’: Al Jazeera English

Al Jazeera English is the first international news channel headquartered in the Middle East. It is also arguably the first non-western news channel of this scale. With an anticipated reach of 80 million homes from the outset, facilitated by 87 cable and satellite distribution deals, Al Jazeera English’s ambitious aim is to be on par with leading international channels such as CNN and the BBC. Operating studios in Doha, London, Kuala Lumpur and Washington, 18 bureaux worldwide with access to another 42 bureaux of its Qatari parent, the channel lacks the economic limitations usually associated with ‘alternative’ media. During the building phase the gas-rich Emirate’s financial backing enabled the channel to poach high profile staff from rival channels on an impressive scale, prompting indications that Qatar ‘is not short of cash to pursue its global ambitions’ (Financial Times, 15.11.2006: 9).

Eyes on the LHC

Particle physicists don’t know for sure what explorations at the Large Hadron Collider will bring. But they do know that many mysteries in their field point toward solutions at the LHC’s impressive TeV energy scale.

Psychometric properties of the Hamilton Depression Rating Scale and other physician-rated psychiatric scales for the assessment of depression in ESRD patients undergoing hemodialysis in Turkey

This study aimed to examine the reliability and validity of clinician-rated psychiatric scales for end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) treatment in Turkey. For this, the Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Global Assessment of Functioning (GAF) Scale, Clinical Global Impression (CGI) Scale, and Mini Mental State Exam (MMSE) were administered to 45 ESRD outpatients undergoing HD treatment. Regarding the reliability of HDRS and HARS, internal consistency and split-half reliability analyses revealed acceptable coefficients. The test – retest reliability coefficients were also examined for all measures after a period of a month, and despite this relatively long time interval, test – retest reliability coefficients were above .60 for all measures. Concerning the validity studies, all these scales revealed suitable convergent, discriminant, and criterion validity outcomes. A cut-off point of 10 for HDRS is suggested for the identification of depression in this population. In general, the findings of this study indicate that HDRS, HARS, CGI, GAF, and MMSE are reliable and valid instruments that can be used among ESRD patients undergoing HD.