Factors Informing Clinicians’ Decisions Regarding Risk for Violence and Discharge Recommendations for Insanity Acquittees in Texas

The insanity defense has been in place for centuries to address cases in which mental illness is thought to underlie criminal behavior. Those who are found not guilty by reason of insanity (NGRI) are usually involuntarily committed to an inpatient facility until they are deemed to be rehabilitated in terms of their psychiatric symptoms and are no longer considered dangerous. Data from violence risk assessments plays an important role in release decisions for NGRI acquittees. Yet, there are no standard procedures in place for assessing risk for future violence. The identified demographic, criminal, and clinical variables influencing release recommendations vary across regions and hospitals, and possibly practitioners. Additionally, the use of risk assessment instruments has also been shown to vary greatly across studies. The present study uses archival data from a Texas state hospital—specifically, information from risk assessments completed with NGRI patients between 2010 and 2018—with the goal of improving understanding of practical realities of risk assessments and release recommendations. The current study found that several clinical variables (delusions, insight problems, homicidal ideation, psychosocial treatment noncompliance, and violence in the hospital) were associated with clinicians’ risk level determinations; however, the HCR-20 score was the single most impactful predictor of violence risk level. While HCR-20 and some clinical variables (delusions, hallucinations, insight problems, psychosocial treatment noncompliance, and violence in the hospital) were related to release recommendations provided by clinicians; this time, gender was the most significant predictor. Risk level determinations were significantly associated to release recommendations. When looking at changes in dynamic risk factors across repeated risk assessments, the change (or lack thereof) in violent behaviors in the hospital was the most prominent predictor of whether an acquittee was or was nor recommended for release during the studied period

Quantitative analysis of the dystrophin gene by real-time PCR

Duchenne and Becker muscular dystrophy (DMD/BMD) are severe X-linked neuromuscular disorders caused by mutations in the dystrophin gene. Our aim was to optimize a quantitative real-time PCR method based on SYBR® Green I chemistry for routine diagnostics of DMD/BMD deletion carriers. Twenty female relatives of DMD/BMD patients with previously detected partial gene deletions were studied. The relative quantity of the target exons was calculated by a comparative threshold cycle method (ΔΔCt). The carrier status of all subjects was successfully determined. The gene dosage ratio for non-carriers was 1.07±0.20, and for carriers 0.56±0.11. This assay proved to be simple, rapid, reliable and cost-effective

Analysis of association between polymorphisms of MTHFR, MTHFD1 and RFC1 genes and efficacy and toxicity of methotrexate in rheumatoid arthritis patients

A folate analogue methotrexate (MTX) is the most commonly used disease-modifying drug in the treatment of rheumatoid arthritis. However, the clinical response of RA patients treated with MTX shows interindividual differences and 30% of patients discontinue therapy due to the side effects. In a group of 184 RA patients treated with MTX we have investigated whether polymorphisms in MTHFR (rs1801133, rs1801131), MTHFD1 (rs2236225) and RFC1 (rs144320551) genes may have impact on MTX efficacy and/or adverse drugs effects (ADEs). The efficacy of the MTX therapy has been estimated using the disease activity score in 28 joints (DAS28-ESR) based on EULAR criteria and relative DAS28 values (rDAS28) and all adverse drug events were recorded. Patients were genotyped for selected polymorphism by PCR-RFLP method. According to the EULAR response criteria after 6 months of MTX therapy 146 (79.3%) patients were classified as responders, (17 patients (11.6%) were good and 129 patients (88.4%) were moderate responders) and 38 patients (20.7%) as non-responders. ADEs were observed in 53 (28.8%) patients. The majority of ADEs were mild (36 (19.56%) patients) to moderate (12 (6.25%) patients). Five patients (2.7%) had serious ADEs. Association studies have been conducted between obtained genotypes and the efficacy and toxicity of MTX. We have observed no association between polymorphisms and efficacy or toxicity of MTX in RA patients. [Projekat Ministarstva nauke Republike Srbije, br. 175091