First Episode Is the Best Episode: Lessons and Limitations in Duration of Untreated Psychosis (DUP) and Outcome in Schizophrenia

Background: Early intervention in psychosis is an opportunity. Research ahs shown that if any thing community members can do to prevent psychosis is to report early. This has opened newer vistas for understanding the complexity of brain and behaviour in schizophrenia. At the same time it has raised the bar of expectations regarding its correlation to outcome. It finally narrows down to meaningful public campaign for awareness, which will decide success of research to clinics in schizophrenia management. Duration of untreated psychosis (DUP) has emerged as a reliable predictor of outcome and provides credence to development of early intervention services. It is not quite clear if DUP works in isolation and what other factors along with DUP would determine outcome long-term outcome of schizophrenia is multifactorial in nature. The present study examines effect of DUP on outcome of schizophrenia Method: we conducted a ten years follow up study of first episode hospitalized DSM III-R schizophrenia and correlated multiple outcome criteria with DUP at Mumbai. We carefully determined onset of psychosis using criteria for appearance of positive symptoms, negative symptoms or significant social decline. Data was analyzed using SAS. Results: we analyzed 101 patients available at ten years. We found that mean DUP was higher for group, which showed Clinical recovery on GCIS [14.0(SD=8.0) months for recovered & 10.8 (SD=5.7) months in nonrecovered group p=0.091]. There is a significant difference in favour of DUP≤6 months in terms of subscales of PANSS; However DUP was not found to be significantly associated with the end point parameters of good clinical or social outcome. Conclusion: We find that DUP is just one factor in determinants of outcome. Several other psychopathological & phenomenological factors collectively play a role in determining outcome. Future research needs to be directed towards combination of determinants of outcome in early intervention of psychosis

Predictors and Characteristics of Response and Nonresponse: A Ten Year Follow-Up of First Episode Schizophrenia in Mumbai

▪ It is not clearly known what predicts good long-term outcome in first episode schizophrenia and what the characteristics are that differentiate patients who do and do not show good response ▪ We attempted to find the characteristics and predictors of good out-come for patients who presented with severe psychopathology and were hospitalized in their first episode psychosis in a tertiary psychiatric hospital in the city of Mumbai ▪ 101 patients of first episode schizophrenia were assessed at hospitalization, and reassessed at ten years ▪ The data was analyzed on 13 outcome parameters for predictors and characteristics of good outcome, using the SAS system of statistical analysis ▪ 61 of 101 patients showed good outcome on the CGIS after ten years ▪ Predictors of good recovery were high baseline positive symptoms and low negative symptoms, higher anxiety-depressive symptoms, lower level of depressive symptoms, lower level of aggression, higher work performance and ability to live independently. ▪ Characteristics of non-recovered patients showed higher extra pyramidal symptoms, severe aggressive symptoms, higher frequency of disorganization symptoms at baseline and higher level of family burden at the end of the term ▪ Our study shows reasonably good outcome [61.7%] in first episode-hospitalized patients ▪ Good outcome correlated with severity of positive symptoms, level of work function and ability to live independently at baselin

Do Atypical Antipsychotics Differ in Determining Long-term Outcome of First Episode Schizophrenia? A Naturalistic Outcome Study in India

Antipsychotic medications form the mainstream of treatment in schizophrenia. These drugs have several short term as well long term advantage. It is not known if atypical antipsychotics have the long-term effect in improving outcome and meeting expectations (1,2,3). The present study examined usage and association of antipsychotics drugs with clinical outcome a long-term naturalistic study

Cryogenic carbon capture

Cryogenic Carbon Capture™ (CCC) removes CO2 from flue gas in a bolt on retrofittable, cost-effective, and energy-efficient process. The process also provides grid-level energy storage capable of storing and releasing energy at hundreds of megawatt rates at high efficiency and minimal cost beyond the costs of the carbon capture technology. The energy storage can level daily load fluctuations and responds to intermittent power sources on time scales comparable to solar and wind farms. The technology cools flue gases to their condensation (desublimation) point forming solid CO2, separates the solids from the residual gases, pressurizes the solids, and reheats both streams to room temperature. The process produces two nominally ambient-temperature streams: liquid CO2 at about 150 bar and the light gases at ambient pressure. Essentially all of the sensible heating occurs through energy integration. The technology primary advantages include (a) consumes minimal energy for CO2 capture (appx. 0.7 GJe/tonne CO2 for typical coal flue gas) (b) costs relatively little (2.5 cents/kWh or less increase in COE) (c) retrofits existing plants with virtually no upstream modification (d) removes essentially all other pollutants except CO, including SOx, NOx, Hg, PMxx, and HC; (e) requires no additional cooling water; (f) requires no steam or other resources from the process other than electrical power Fully integrated versions of the technology at up to 1 tonne of CO2/day have operated on fuels including subbituminous coal, bituminous coal, natural gas, biomass, municipal waste and tires and at sites that include utility power plants, cement kilns, heat plants, and pilot-scale research combustors. This presentation summarizes the technology, field test results, and development plans for this technology. Further information is available at www.sesinnovation.com

Gestational age impacts birth to placental weight ratio and umbilical cord oxygen values with implications for the fetal oxygen margin of safety

Background: We determined the impact of gestational age (GA) from near term to term to post-term on birth/placental weight ratio and cord oxygen values with implications for placental transport efficiency for oxygen, fetal O2 consumption relative to delivery or fractional O2 extraction, and oxygen margin of safety. Materials and methods: A hospital database was used to obtain birth/placental weight ratios, cord PO2 and other information on patients delivering between Jan 1, 1990 and Jun 15, 2011 with GA \u3e 34 completed weeks (N=69,852). Oxygen saturation was calculated from the cord PO2 and pH data, while fractional O2 extraction was calculated from the oxygen saturation data. The effect of GA grouping on birth/placental weight ratio, cord PO2, O2 saturation, and fractional O2 extraction values, was examined in all patients adjusting for pregnancy and labor/delivery covariates, and in a subset of low-risk patients. Results: Birth/placental weight ratio and umbilical venous O2 values increased with advancing GA, supporting the conjecture of increasing placental transport efficiency for oxygen. However, umbilical arterial O2 values decreased while fractional O2 extraction increased with successive GA groupings, indicating that fetal O2 consumption must be increasing relative to delivery. Conclusions: Fetal O2 consumption can be seen as ever ‘outgrowing’ O2 delivery over the last weeks of pregnancy and leading to a continued lowering in systemic oxygen levels. While this lowering in oxygen may trigger feedback mechanisms with survival benefit, the ‘oxygen margin of safety’ will also be lowered increasing perinatal morbidity and mortality which appear to be hypoxia related

Persistent suicide risk in clinically improved schizophrenia patients: challenge of the suicidal dimension

BACKGROUND: Suicide is a major problem in schizophrenia, estimated to affect 9%-13% of patients. About 25% of schizophrenic patients make at least one suicide attempt in their lifetime. Current outcome measures do not address this problem, even though it affects quality of life and patient safety. The aim of this study was to assess suicidality in long-term clinically improved schizophrenia patients who were treated in a nongovernmental psychiatric treatment centre in Mumbai, India. METHOD: Participants were 61 patients out of 200 consecutive hospitalized first-episode patients with schizophrenia diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders who were much improved on the Clinical Global Impression Scale-Improvement (CGI-I) scale at the endpoint of a 10-year follow-up. Clinical assessment tools included the Positive and Negative Syndrome Scale for Schizophrenia, CGI-I, Global Assessment of Functioning, and suicidality. RESULTS: Many of the patients, although clinically improved, experienced emerging suicidality during the 10-year follow-up period. All of the patients reported significant suicidality (ie, suicide attempts, suicidal crises, or suicidal ideation) at the end of the study, whereas only 83% had reported previous significant suicidality at baseline. No sociodemographic and clinical variables at baseline were predictive of suicidal status at the end of the 10-year follow-up. CONCLUSION: Schizophrenia is a complex neurobehavioral disorder that appears to be closely associated with suicidal behavior. Adequate assessment and management of suicidality needs to be a continual process, even in patients who respond well to treatment

The Role of Radiation Therapy on Medically Inoperable Clinically Localized Non-small Cell Lung Patients: London Regional Cancer Program (LRCP) Clinical Experience

Lung cancer is the most frequent cause of cancer death in both men and women in North America. In 2006, an estimated 22,700 Canadians will be diagnosed with lung cancer and 19,300 will die of it (Canadian Cancer Statistics 2006). Approximately 15-20% of NSCLC patients present with early or localized disease. Surgical resection of T1-2N0 NSCLC remains the treatment of choice for this population, and results in a 5-year survival rate of 50-70%. Patients deemed medically inoperable have been treated with non-surgical therapies, such as radiation therapy(RT), while some patients have simply been observed without any tumor therapy because of their co-morbid illnesses. Potential confounding issues in this patient population include some patients who are not referred to our Centre due to co-morbid disease, and some who are referred, but are not offered radical RT due to poor outcome expectations. In addition, patients may refuse treatment when offered. We have reviewed thepast 19 years’ experience at LRCP inmanagement of this group of patients

Oral administration of morphine versus ibuprofen to manage postfracture pain in children: A randomized trial

Background: Recent warnings from Health Canada regarding codeine for children have led to increased use of nonsteroidal anti-inflammatory drugs and morphine for common injuries such as fractures. Our objective was to determine whether morphine administered orally has superior efficacy to ibuprofen in fracture-related pain