Atypical antipsychotic poisoning in young children: a multicentre analysis of poisons centres data

Although paediatric patients frequently suffer from intoxications with atypical antipsychotics, the number of studies in young children, which have assessed the effects of acute exposure to this class of drugs, is very limited. The aim of this study was to achieve a better characterization of the acute toxicity profile in young children of the atypical antipsychotics clozapine, olanzapine, quetiapine, and risperidone. We performed a multicentre retrospective analysis of cases with atypical antipsychotics intoxication in children younger than 6years, reported by physicians to German, Austrian, and Swiss Poisons Centres for the 9-year period between January 1, 2001 and December 31, 2009. One hundred and six cases (31 clozapine, 29 olanzapine, 12 quetiapine, and 34 risperidone) were available for analysis. Forty-seven of the children showed minor, 28 moderate, and 2 severe symptoms. Twenty-nine cases were asymptomatic. No fatalities were recorded. Symptoms predominantly involved the central nervous and cardiovascular systems. Minor reduction in vigilance (Glasgow Coma Scale score >9) (62%) was the most frequently reported symptom, followed by miosis (12%) and mild tachycardia (10%). Extrapyramidal motor symptoms were observed in one case (1%) after ingestion of risperidone. In most cases, surveillance and supportive care were sufficient to achieve a good outcome, and all children made full recovery. Conclusions: Paediatric antipsychotic exposure can result in significant poisoning; however, in most cases only minor or moderate symptoms occurred and were followed by complete recovery. Symptomatic patients should be monitored for central nervous system depression and an electrocardiogram should be obtained

A global assessment of actors and their roles in climate change adaptation

An assessment of the global progress in climate change adaptation is urgently needed. Despite a rising awareness that adaptation should involve diverse societal actors and a shared sense of responsibility, little is known about the types of actors, such as state and non-state, and their roles in different types of adaptation responses as well as in different regions. Based on a large n-structured analysis of case studies, we show that, although individuals or households are the most prominent actors implementing adaptation, they are the least involved in institutional responses, particularly in the global south. Governments are most often involved in planning and civil society in coordinating responses. Adaptation of individuals or households is documented especially in rural areas, and governments in urban areas. Overall, understanding of institutional, multi-actor and transformational adaptation is still limited. These findings contribute to debates around ‘social contracts’ for adaptation, that is, an agreement on the distribution of roles and responsibilities, and inform future adaptation governance

Reform der Personalstruktur an deutschen Hochschulen

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