Clozapine as add-on medication in the maintenance treatment of bipolar and schizoaffective disorders - A case series

Atypical neuroleptics are increasingly used in the treatment of bipolar and schizoaffective disorders. Currently, numerous controlled short-term studies are available for clozapine, olanzapine, risperidone or quetiapine, but long-term data are still missing. Three patients (2 with bipolar disorder, 1 with schizoaffective disorder) are described who showed a marked reduction of affective symptomatology after clozapine had been added to mood stabilizer pretreatment. The patients were seen once a month before and after the introduction of clozapine for at least 6 months. Treatment response was evaluated using different rating scales (IDS, YMRS; GAF; CGIBP) and the NIMH Life Chart Methodology. All patients showed a marked improvement after the add-on treatment with clozapine had been initiated. Clozapine was tolerated well with only transient and moderate weight gain and fatigue as only side effects. This case series underlines the safety and efficacy of clozapine as add-on medication in the treatment of bipolar and schizoaffective disorders. Copyright (C) 2002 S. Karger AG, Basel

The Stanley Foundation Bipolar Network: Results of the naturalistic follow-up study after 2.5 years of follow-up in the German centres

The Stanley Foundation Bipolar Network (SFBN) is an international, multisite network investigating the characteristics and course of bipolar disorder. Methods (history, ratings and longitudinal follow-up) are standardized and equally applied in all 7 centres. This article describes demographics and illness characteristics of the first 152 German patients enrolled in them SFBN as well as the results of 2.5 years of follow-up. Patients in Germany were usually enrolled after hospitalisation. More than 72% of the study population suffered from bipolar I disorder and 25% from bipolar 11 disorder. The mean +/- SD age of the study participants was 42.08 +/- 13.5 years, and the mean SD age of onset 24.44 +/- 10.9 years. More than 40% of the sample reported a rapid-cycling course in history, and even more a cycle acceleration overtime. 37% attempted suicide at least once. 36% had an additional Axis I disorder, with alcohol abuse being the most common one, followed by anxiety disorders. During the follow-up period, only 27% remained stable, 56% had a recurrence, 12.8% perceived subsyndromal symptoms despite treatment and regular visits. 27% suffered from a rapid-cycling course during the follow-up period. Recurrences were significantly associated with bipolar I disorder, an additional comorbid Axis I disorder, rapid cycling in history, a higher number of mood stabilizers and the long-term use of typical antipsychotics. Rapid cycling during follow-up was only associated with a rapidcycling course in history, a higher number of mood stabilizers and at least one suicide attempt in history. Copyright (c) 2003 S. Karger AG, Basel

Morphotectonics of the central Muertos thrust belt and Muertos Trough (northeastern Caribbean)

Multibeam bathymetry data acquired during the 2005 Spanish R/V Hespérides cruise and reprocessed multichannel seismic profiles provide the basis for the analysis of the morphology and deformation in the central Muertos Trough and Muertos thrust belt. The Muertos Trough is an elongated basin developed where the Venezuelan Basin crust is thrusted under the Muertos fold-and-thrust belt. Structural variations along the Muertos Trough are suggested to be a consequence of the overburden of the asymmetrical thrust belt and by the variable nature of the Venezuelan Basin crust along the margin. The insular slope can be divided into three east–west trending slope provinces with high lateral variability which correspond to different accretion stages: 1) The lower slope is composed of an active sequence of imbricate thrust slices and closed fold axes, which form short and narrow accretionary ridges and elongated slope basins; 2) The middle slope shows a less active imbricate structure resulting in lower superficial deformation and bigger slope basins; 3) The upper slope comprises the talus region and extended terraces burying an island arc basement and an inactive imbricate structure. The talus region is characterized by a dense drainage network that transports turbidite flows from the islands and their surrounding carbonate platform areas to the slope basins and sometimes to the trough. In the survey area the accommodation of the ongoing east–west differential motion between the Hispaniola and the Puerto Rico–Virgin Islands blocks takes place by means of diffuse deformation. The asymmetrical development of the thrust belt is not related to the geological conditions in the foreland, but rather may be caused by variations in the geometry and movement of the backstop. The map-view curves of the thrust belt and the symmetry of the recesses suggest a main north–south convergence along the Muertos margin. The western end of the Investigator Fault Zone comprises a broad band of active normal faults which result in high instability of the upper insular slope