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O cirurgião-dentista (CD) é essencial aos cuidados preventivos e tratamentos relacionados à manutenção da saúde na cavidade oral, a importância dessa assistência se faz inclusive nos pacientes internados em unidade de terapia intensiva (UTI), a presença do CD na equipe multiprofissional da UTI traz uma atenção especializada na cavidade oral, gerando benefícios e prevenção de agravos. Contribuindo inclusive para acelerar o tempo de recuperação, com o benefício de redução dos custos hospitalares. Pacientes internados em UTI sob ventilação mecânica estão mais susceptíveis a infecções como a pneumonia, que pode ter origem bacteriana ou fúngica, tendo como porta de entrada a cavidade oral, decorrente da falta de cuidados no controle biofilme. As UTI´s são espaços de assistência multiprofissional e interdisciplinar onde é fundamental a assistência global, a presença do Cirurgião-Dentista se mostra cada dia mais necessária. Além de abrangente, o presente trabalho mostra aos estudantes de odontologia e da área de saúde, a importância da atuação do Cirurgião Dentista em UTI.

We report an unusual case of a 27-year-old previously healthy female who presented with a 15-day history of psychotic, cognitive, and unspecified somatic symptoms. She was admitted to the psychiatric ward of an early intervention in psychosis team and medicated with aripiprazole. The young age of onset, the rapid onset, the absent history of psychiatric disease, and the persistence of a marked memory deficit after the psychotic symptoms remitted strongly suggested a nonpsychiatric etiology and led us to hypothesize autoimmune encephalitis as the most probable diagnosis. An investigation was carried out for anti-N-methyl-D-aspartate (anti-NMDA) receptor antibodies in the patient's serum and cerebrospinal fluid, and both tests were positive. The patient was transferred to the neurology ward, where an endovaginal ultrasound showed an ovarian teratoma in her right ovary. She underwent laparoscopic surgery without complications. She was initially treated with intravenous immunoglobulin and methylprednisolone for 5 days, which resulted in marked improvement of her memory and attention performance. Anti-NMDA receptor encephalitis, first described in 2007 by Dalmau and colleagues, is a form of auto-immune encephalitis with prominent neuropsychiatric manifestations, particularly psychotic symptoms. At symptom onset, distinguishing the disease from a primary psychiatric disorder is challenging. This case report highlights the importance of early psychosis treatment teams considering the diagnosis of anti-NMDA receptor encephalitis when evaluating new referrals with a potential diagnosis of first-episode psychosis, particularly when young patients with no relevant personal or familial psychiatric history present with neuropsychiatric symptoms and a distinctive pattern of symptom fluctuation over time.

Various diseases that impact different systems and organs in the body may trigger manic episodes. Strokes are often associated with psychiatric symptoms, particularly depressive and, more rarely, manic. We herein report a case of bipolar disorder secondary to cerebrovascular disease in a 67-year-old man with no personal or family history of psychiatric illness who, at the age of 64, had a bilateral ischemic stroke in the middle cerebral artery territory. About 20 days after this stroke, he experienced a manic episode. Three years later, he experienced a second manic episode, with another hospitalization in a psychiatric ward. With this case, we intend to emphasize that, although rare, the diagnosis of mania after stroke should not be forgotten, and most important, one should be aware of the recurrence of affective episodes just as in non-medical-caused bipolar disorder.

A Etnobotânica estuda a relação milenar entre as plantas e o homem. O estudo objetivou caracterizar a distribuição geográfica e quantificar a produção científica referente ao Ensino de Etnobotânica por meio de uma análise cienciometria. Os dados coletados são referentes ao período de 2009 a 2019 e foram obtidos por meio da inserção do termo Ensino de Etnobotânica nos campos de busca das plataformas: Scientific Librany Online, Biblioteca Digital de Teses e Dissertações e Google Acadêmico. Incialmente foram encontradas 354 publicações, após uma leitura seletiva em seus resumos, descartamos 335 que apresentavam apenas a temática etnobotânica sem relação alguma com o ensino ou educação. Apenas 19 atenderam ao objetivo da proposta e tiveram suas publicações analisadas. Averiguando o tipo de publicação científica, foram encontrados: 10 artigos científicos, 6 resumos de eventos científicos, 2 dissertações e 1 monografia. Na categorização de publicação por região: 8 são da região Sul, 6 da região Nordeste, 3 da região Sudeste, 1 da região Norte e 1 da região Centro-oeste. Nos anos 2011, 2016 e 2019, que equivale a 60% das publicações encontradas, destaca-se por altos níveis de indexações, em média de 3 a 4 ao ano. Dentro da categoria de revista cientifica, destaca-se a Revista Boletim do Grupo de Pesquisa da Flora, Vegetação e Etnobotânica e a Revista Eletrônica do Mestrado em Educação Ambiental. O progresso das produções cientifica sobre o ensino de etnobotânica apresentou-se de forma bem tímida, traz uma produção linear, com poucas variações anuais, com crescimento continuo desde 2016.

Paleontology is considered an essential science to understand the evolutionary process and the phenomena that occur in nature, and it must be worked in an interdisciplinary way, adapting the contents to the students' reality. Besides that to make sense of learning about this science and make it a dynamic and enjoyable process, the application of practical activities using didactic models developed according to the content covered, can make the teaching process more effective. The work aims to reflect on the use of didactic models in the teaching of Paleontology in the disciplines of Science and Biology. It is a bibliographical, exploratory and documentary research, which took place from the survey of studies and research that address the application of didactic models in the teaching of Paleontology in the disciplines of Science and Biology, with a focus on investigating the contribution of these resources in the students' teaching-learning process. The following databases were used: CAPES journals, Google Scholar, SciELO and BDTD, including the following search descriptors: didactic model, Paleontology, Science and Biology subjects, which made it possible to select and analyze 12 works. According to the results obtained, it can be observed that the use of didactic models for the teaching of Paleontology constitutes an important tool for the development of more dynamic and meaningful learning, because their use is an excellent strategy in the teaching-learning process, facilitating the understanding of the contents covered, since the student's interaction with the object awakens the feeling of belonging and insertion in the pedagogical process. La paleontología se considera una ciencia esencial para comprender el proceso evolutivo y los fenómenos que ocurren en la naturaleza, y debe trabajarse de manera interdisciplinaria, adaptando los contenidos a la realidad de los estudiantes. Además, para tener sentido aprender sobre esta ciencia y convertirla en un proceso dinámico y agradable, la aplicación de actividades prácticas utilizando modelos didácticos desarrollados de acuerdo con el contenido abordado puede hacer que el proceso de enseñanza sea más efectivo. El trabajo tiene como objetivo reflexionar sobre el uso de modelos didácticos en la enseñanza de la Paleontología en las disciplinas de la Ciencia y la Biología. Se trata de una investigación bibliográfica, exploratoria y documental, que se desarrolló a partir del relevamiento de estudios e investigaciones que abordan la aplicación de modelos didácticos en la enseñanza de la Paleontología en las disciplinas de la Ciencia y la Biología, con un enfoque en investigar el aporte de estos recursos en la proceso de enseñanza-aprendizaje de los estudiantes. Se utilizaron las siguientes bases de datos: revistas CAPES, Google Scholar, SciELO y BDTD, incluyendo los siguientes descriptores de búsqueda: modelo didáctico, asignaturas de Paleontología, Ciencias y Biología, lo que permitió seleccionar y analizar 12 trabajos. De acuerdo con los resultados obtenidos, se puede observar que el uso de modelos didácticos para la enseñanza de la Paleontología constituye una herramienta importante para el desarrollo de un aprendizaje más dinámico y significativo, ya que el uso de los mismos constituye una excelente estrategia en la enseñanza- aprendizaje, facilitando la comprensión de los contenidos cubiertos, ya que la interacción del alumno con el objeto despierta el sentimiento de pertenencia e inserción en el proceso pedagógico. A Paleontologia é considerada uma ciência essencial para a compreensão do processo evolutivo e dos fenômenos que ocorrem na natureza, devendo ser trabalhada de forma interdisciplinar, adequando os conteúdos à realidade dos alunos. Além disso, para dar sentido ao aprendizado dessa ciência e torná-la um processo dinâmico e prazeroso, a aplicação de atividades práticas com utilização de modelos didáticos desenvolvidos de acordo com o conteúdo abordado, pode tornar o processo de ensino mais eficaz. O trabalho objetiva refletir sobre a utilização de modelos didáticos no ensino de Paleontologia nas disciplinas de Ciências e Biologia. Trata-se de uma pesquisa bibliográfica, exploratória e documental, que se deu a partir do levantamento de estudos e pesquisas que abordam a aplicação de modelos didáticos no ensino de Paleontologia nas disciplinas de Ciências e Biologia, com enfoque na investigação da contribuição desses recursos no processo de ensino-aprendizagem dos alunos. Foram utilizadas as bases de dados: Periódicos CAPES, Google Acadêmico, SciELO e BDTD, incluindo os seguintes descritores de busca: modelo didático, Paleontologia, disciplinas de Ciências e Biologia, o que possibilitou selecionar e analisar 12 trabalhos. De acordo com os resultados obtidos, pode-se observar que a utilização dos modelos didáticos para o ensino de Paleontologia constitui uma importante ferramenta para o desenvolvimento de uma aprendizagem mais dinâmica e significativa, pois o uso dos mesmos constitui excelente estratégia no processo de ensino-aprendizagem, facilitando a compreensão dos conteúdos abordados, uma vez que a interação do aluno com o objeto desperta o sentimento de pertencimento e inserção no processo pedagógico.

Gilles de la Tourette syndrome (GTS) is a neurobehavioral disorder comprising motor and vocal tics. In most cases it is associated with other disorders such as obsessive-compulsive disorder (OCD). In refractory cases deep brain stimulation (DBS) is a valid treatment option. This paper describes the case of a 15-year-old adolescent with an extremely refractory GTS with associated OCD. The patient developed catatonia associated with OCD, which partially remitted after electroconvulsive therapy. At the peak of the disease the Yale Global Tic Severity Scale (YGTSS) was 100 and the patient required sedation and intubation. All medical treatment options were unsuccessful. Bilateral DBS of the anterior limb of internal capsule (ALIC)/bed nucleus of stria terminalis (BST) region was performed, using a target below the BST and a trajectory through the ALIC, with stimulation of contacts 0 and 3. Two weeks after surgery sedatives were suspended and the patient was successfully extubated. One year after surgery the patient reached a YGTSS of 19, representing an 81% improvement. OCD completely resolved. Adverse events were a superficial infection and weight gain. In conclusion, this ALIC/BST stimulation appears to have been an effective and safe treatment for GTS with OCD in this case. Young age should not be an exclusion criterion for DBS in severe GTS and OCD. Further studies should be pursued for this target.

The objective of this study was to evaluate the use of luteal color doppler (CD) ultrasonography and plasma concentrations of pregnancy-associated glycoproteins (PAG) for early pregnancy diagnosis in Bos taurus beef cows. Additionally, CD and PAG were evaluated as potential predictors of late embryonic/early fetal mortality (LEM). Postpartum beef cows (n = 212) were exposed to estrus synchronization followed by fixed-time artificial insemination (day 0). On days 20 and 22, B-mode and CD ultrasonography were performed to evaluate corpus luteum (CL) morphometries and blood perfusion. Moreover, blood samples were collected on days 25 and 29 to quantify circulating concentrations of PAG. Conventional ultrasonography on days 29 and 100 was utilized as the gold-standard method for pregnancy diagnosis. Cows that experienced pregnancy loss between days 29 and 100 were classified as LEM. Pregnant cows had larger and more vascularized CL compared with nonpregnant cows on days 20 and 22 (P0.001 for all response variables). Accuracy for CD on days 20 and 22 were 87% and 92%, respectively. Accuracy for PAG on days 25 and 29 were 84% and 99%, respectively. No false negative (FN) results were observed for CD on both days 20 and 22; however, there were 7.1% FN results for PAG on day 25. Cows that experienced LEM had decreased (P = 0.04) circulating PAG on day 29 of gestation compared with cows that maintained pregnancy; however, there were no differences in luteal blood perfusion on days 20 and 22 (P ≥ 0.53) or circulating PAG on day 25 (P = 0.46) between LEM cows and cows that maintained pregnancy. Sensitivity and specificity of PAG on day 29 as predictors of LEM were 83% and 77%, respectively. In conclusion, CD resulted in accurate pregnancy diagnosis in B. taurus beef cows on both days 20 and 22 of gestation, while having no FN results. Circulating concentrations of PAG were decreased in cows that experienced LEM; however, further research is required to utilize PAG as a predictor of LEM commercially.Early pregnancy detection allows cattle producers to increase reproductive efficiency. Pregnancy failures associated with embryonic mortality represents an economic burden to the beef production industry. The present study evaluated the use of color doppler (CD) ultrasonography of specific ovarian structures and pregnancy-associated glycoproteins (PAG) in plasma as potential alternatives to diagnose pregnancy earlier than industry-standard methods in beef cows with Bos taurus genetics. Additionally, the present study evaluated the use of these methods to predict embryonic mortality during early gestation. The results of the present study indicate that: 1) CD can accurately recognize most nonpregnant cows with B. taurus genetics as early as 20 days after breeding. 2) Plasma concentrations of PAG resulted in suboptimal accuracy on day 25 of gestation. 3) Cows that undergo pregnancy loss between 29 and 100 d after breeding have decreased concentrations of PAG in their circulation on day 29, even though they were identify as pregnant with ultrasonography on the same day. 4) Both blood concentrations of PAG and luteal blood perfusion estimated by CD failed to accurately predict pregnancy loss.

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http:// creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data., Background: Suicide is one of the main causes of excess of premature death in psychotic patients. Published studies found that suicide risk begins in ultra-high risk of psychosis and continues in early years of the disease. Previous studies identifying predictive and risk factors associated with suicidality in first-episode psychosis (FEP) are highly inconsistent. Also, there are relatively few longitudinal studies on suicidal behaviour in FEP. The aim of this study was to examine prevalence, evolution and predictors of suicidal behaviour at baseline and the 12-month follow-up in patients presenting with FEP. Methods: One hundred and eighteen patients presenting with FEP were recruited from two early psychosis units in Portugal. A comprehensive assessment examining socio-demographic and clinical characteristics was administered at baseline and the 12-month follow-up. Odds ratio were calculated using logistic regression analyses. McNemar test was used to evaluate the evolution of suicidal behaviour and depression prevalence from baseline to 12 months of follow-up. Results: Follow-up data were available for 60 participants from the 118 recruited. Approximately 25.4% of the patients had suicidal behaviour at the baseline evaluation, with a significant reduction during the follow-up period to 13.3% (p = 0.035). A multivariate binary logistic regression showed that a history of suicidal behaviour and depression at baseline independently predicted suicidal behaviour at baseline, and a history of suicidal behaviour and low levels of total cholesterol predicted suicidal behaviour at the 12-month follow-up. A significant proportion of patients also had depression at the baseline evaluation (43.3%), with the last month of suicidal behaviour at baseline independently predicting depression at this time. Conclusions: The findings of our study indicate that suicidal behaviour was prevalent on the year after FEP. Patients with a history of suicidal behaviour, depression at baseline and low levels of cholesterol should undergo close evaluation, monitoring and possible intervention in order to reduce suicide risk in the early phases of psychosis.

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Esta pesquisa usa dados detalhados da FAO GAEZ sobre potenciais de produtividade agrícola para medir os impactos mudanças de preço e climáticas na oferta de culturas agrícolas. Aplicamos um modelo de escolha discreta para descrever as decisões do agricultor sobre o uso da terra. Utilizamos uma abordagem de coeficientes aleatórios que permite padrões de substituição flexíveis entre culturas, o que fornece uma nova visão sobre as elasticidades de preços cruzados entre culturas e sobre os possíveis impactos das mudanças climáticas. Os resultados apontam para um maior impacto dos preços das culturas voltadas a exportação sobre as demais, mas há uma clara especialização geográfica que limita esse impacto. Além disso, os resultados mostram que a oferta de alimentos pode variar muito de acordo com os cenários climáticos, que impactam as vantagens comparativas totais no país e a distribuição geográfica da produção agrícola. This research uses detailed data from FAO GAEZ on agricultural potential yields to measure the impacts of price and climate change on crops supply. We apply a discrete choice model to describe farmer’s decisions on their land use. We use a random-coefficients approach that allows for flexible substitutions patterns between crops, which provides new sight on cross-price elasticities between crops and on the possible impacts of climate change. Results point to higher impact of export oriented commodities prices on others, but there is a clear geographical specialization that limits that impact. Also, the results show that food supply may vary a lot according to climate scenarios, which impact total comparative advantages in the country and the geographical distribution of production.

A Paleontologia é considerada uma ciência essencial para a compreensão do processo evolutivo e dos fenômenos que ocorrem na natureza, devendo ser trabalhada de forma interdisciplinar, adequando os conteúdos à realidade dos alunos. Além disso, para dar sentido ao aprendizado dessa ciência e torná-la um processo dinâmico e prazeroso, a aplicação de atividades práticas com utilização de modelos didáticos desenvolvidos de acordo com o conteúdo abordado, pode tornar o processo de ensino mais eficaz. O trabalho objetiva refletir sobre a utilização de modelos didáticos no ensino de Paleontologia nas disciplinas de Ciências e Biologia. Trata-se de uma pesquisa bibliográfica, exploratória e documental, que se deu a partir do levantamento de estudos e pesquisas que abordam a aplicação de modelos didáticos no ensino de Paleontologia nas disciplinas de Ciências e Biologia, com enfoque na investigação da contribuição desses recursos no processo de ensino-aprendizagem dos alunos. Foram utilizadas as bases de dados: Periódicos CAPES, Google Acadêmico, SciELO e BDTD, incluindo os seguintes descritores de busca: modelo didático, Paleontologia, disciplinas de Ciências e Biologia, o que possibilitou selecionar e analisar 12 trabalhos. De acordo com os resultados obtidos, pode-se observar que a utilização dos modelos didáticos para o ensino de Paleontologia constitui uma importante ferramenta para o desenvolvimento de uma aprendizagem mais dinâmica e significativa, pois o uso dos mesmos constitui excelente estratégia no processo de ensino-aprendizagem, facilitando a compreensão dos conteúdos abordados, uma vez que a interação do aluno com o objeto desperta o sentimento de pertencimento e inserção no processo pedagógico.

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We explored the adherence to a home-delivered, computer-based, cognitive remediation protocol in a first-episode psychosis outpatient cohort. Seventeen patients underwent a cognitive training protocol for 6 months using an online platform accessible from their home under the supervision of a qualified neuropsychologist. Neuropsychological, psychopathological, and functional data were collected at baseline and postintervention, whereas qualitative appraisal of the intervention was assessed monthly. Overall, participants' evaluation of the program was positive. This was reflected in a good adherence rate with 12 (70%) of 17 patients completing 80% of the prescribed sessions. Exploratory analysis revealed significant improvements in sustained attention (p = 0.020) and verbal memory (p = 0.018). A decrease in negative symptoms and an improvement on the Clinical Global Impression were also found (p = 0.009). We believe these are encouraging results to further explore the adopted delivery approach, which could facilitate access to cognitive training earlier and to a larger group of patients.

This paper estimates the socioeconomic impacts of the emergence and expansion of e-hailing services in Sao Paulo, Brazil. Combining data from a major service provider, individual level data from a representative travel diary survey and a structural traffic network simulation, we evaluate the impact of e-hailing on commuters' travel time and accessibility. We then estimate the effect of these changes on workers' productivity. Finally, using a Spatial Computable General Equilibrium (SCGE) model, we estimate the effect of these productivity shocks on broader economic outcomes. Our main results indicate that 83% of current e-hailing trips derived from trips that were previously made by traditional motorized private modes. We also find that the current e-hailing supply has mostly negligible effects on travel times and congestion; however, some individuals experienced important accessibility gains due to the emergence of this alternative mode. We then simulate e-hailing expansion and development scenarios, including the case of larger vehicle occupancy. Total economic activity expands by 1.089% if average vehicle occupancy reaches 3 passengers per trip and all motorized private trips are substituted by e-hailing.

Background Auditory verbal hallucinations (AVH) are a cardinal symptom of psychosis but are also present in 6–13% of the general population. Alterations in sensory feedback processing are a likely cause of AVH, indicative of changes in the forward model. However, it is unknown whether such alterations are related to anomalies in forming an efference copy during action preparation, selective for voices, and similar along the psychosis continuum. By directly comparing psychotic and nonclinical voice hearers (NCVH), the current study specifies whether and how AVH proneness modulates both the efference copy (Readiness Potential) and sensory feedback processing for voices and tones (N1, P2) with event-related brain potentials (ERPs). Methods Controls with low AVH proneness (n = 15), NCVH (n = 16) and first-episode psychotic patients with AVH (n = 16) engaged in a button-press task with two types of stimuli: self-initiated and externally generated self-voices or tones during EEG recordings. Results Groups differed in sensory feedback processing of expected and actual feedback: NCVH displayed an atypically enhanced N1 to self-initiated voices, while N1 suppression was reduced in psychotic patients. P2 suppression for voices and tones was strongest in NCVH, but absent for voices in patients. Motor activity preceding the button press was reduced in NCVH and patients, specifically for sensory feedback to self-voice in NCVH. Conclusions These findings suggest that selective changes in sensory feedback to voice are core to AVH. These changes already show in preparatory motor activity, potentially reflecting changes in forming an efference copy. The results provide partial support for continuum models of psychosis.

Aim There is currently no national plan for early intervention in first-episode psychosis in Portugal. Consequently, there is some heterogeneity in the evaluation and treatment of first-episode psychosis across the country. The aim of this article is to provide a complete description of the early intervention programme Programa de Intervencao nas Fases Iniciais da Psicose (PROFIP) in Lisbon, a pioneering team in Portugal for treating first-episode psychosis (FEP) patients. We also describe the baseline socio-demographic and clinical data obtained from new patients over a 1-year period. PROFIP programme accepts all cases of FEP, taking a transdiagnostic approach. Methods Description of PROFIP programme and baseline socio-demographic and clinical data obtained from new patients over a 1-year period. Results The team was constituted to provide early detection, treatment and support to people aged 16 to 35 years with affective and non-affective FEP. Over a 1-year period, 39 patients were included in the PROFIP programme. The majority of patients were young male patients with a diagnosis of non-affective psychosis, and with 56% of patients reporting cannabis use. Patients received pharmacological and psychosocial interventions based on evidence and individual needs. Conclusions Our team allowed young people with early psychosis to receive effective care. We do need improvements, namely in referrals and the education of health professionals. More teams in our country should be constituted, allowing larger numbers of patients with early psychosis to be treated by specialized teams.

Hypokalemia is the most frequent electrolyte abnormality seen in clinical practice. Hypokalemia is defined as serum potassium below 3.5 mEq/L and is usually asymptomatic and only identified in routine laboratory analysis. However, in some cases, symptoms include hypertension, palpitations, muscle weakness, easy fatigability, cramping and myalgias, memory impairment, disorientation and confusion, depressed or anxious mood, and irritability. Although rare, hypokalemia has been associated with psychosis. In particular, hypokalemia has been associated with psychotic exacerbations in patients with chronic psychotic disorder. We present a case report of a young female who developed a first presentation of acute psychosis and in which complementary investigations revealed hypokalemia. The psychosis resolved in few hours after replacement therapy with potassium chloride. The patient returned her usual functioning after discharge and there were no signs of psychosis at six-month follow-up.

Treatment of schizophrenia with antipsychotic drugs is frequently sub-optimal. One reason for this may be heterogeneity between patients with schizophrenia. The objectives of this study were to identify patient, disease and treatment attributes that are important for physicians in choosing an antipsychotic drug, and to identify empirically subgroups of patients who may respond differentially to antipsychotic drugs. The survey was conducted by structured interview of 744 randomly-selected psychiatrists in four European countries who recruited 3996 patients with schizophrenia. Information on 39 variables was collected. Multiple component analysis was used to identify dimensions that explained the variance between patients. Three axes, accounting for 99% of the variance, were associated with disease severity (64%), socioeconomic status (27%) and patient autonomy (8%). These dimensions discriminated between six discrete patient subgroups, identified using ascending hierarchical classification analysis. The six subgroups differed regarding educational level, illness severity, autonomy, symptom presentation, addictive behaviors, comorbidities and cardiometabolic risk factors. Subgroup 1 patients had moderately severe physician-rated disease and addictive behaviours (23.2%); Subgroup 2 patients were well-integrated and autonomous with mild to moderate disease (6.7%); Subgroup 3 patients were less well-integrated with mild to moderate disease, living alone (11.2%); Subgroup 4 patients were women with low education levels (5.4%), Subgroup 5 patients were young men with severe disease (36.8%); and Subgroup 6 patients were poorly-integrated with moderately severe disease, needing caregiver support (16.7%). The presence of these subgroups, which require confirmation and extension regarding potentially identifiable biological markers, may help individualizing treatment in patients with schizophrenia.

This article addresses points to consider when switching patients to the second-generation antipsychotic (SGA), ziprasidone, in everyday clinical practice: 1) the pharmacologic properties of the pre-switch antipsychotic and of ziprasidone; 2) switch and dosing strategies to ensure maintenance or attainment of efficacy; 3) recognition and management of possible rebound effects of the pre-switch medication discontinuation; 4) recognition and management of potential side effects of ziprasidone; and 5) education and support for patients/caregivers concerning correct ziprasidone administration.A Medline search (up to July 7, 2010) identified studies in which adult patients with schizophrenia were switched to ziprasidone from another antipsychotic. In addition, based on their extensive clinical experience, an expert faculty of European psychiatrists provided advice on identifying patients who may be appropriate candidates for switching to ziprasidone, and on establishing optimal strategies for switching to ziprasidone in everyday clinical practice.Data from 10 studies, in which 1395 patients were switched to ziprasidone, showed that switching from first-generation antipsychotics (FGAs) or SGAs generally resulted in maintenance or improvement of efficacy across all studied symptom domains, improvements in tolerability, and acute and long-term benefits regarding cardiometabolic parameters, including body weight. Maintenance of efficacy is most likely to be achieved using a plateau cross-titration strategy, with a rapid uptitration of ziprasidone to a dose range of 60 to 80 mg administered twice daily with food. Temporary coadministration of benzodiazepines, anticholinergics, or beta-blockers should be considered for the management of potential rebound effects.Optimal switching of patients with schizophrenia from FGAs or SGAs to ziprasidone requires careful attention to differences in the pharmacological profiles of the pre-switch medication and of ziprasidone, which may impact efficacy and tolerability. Good communication between the clinician and patient/caregiver about the goals of switching, the importance of adherence to the chosen switch strategy, and the correct administration of ziprasidone are essential.

Limited information is available on the clinical issues and strategies for optimal clinical usage of ziprasidone in the treatment of adult patients with acute manic or mixed episodes of bipolar disorder.To address those issues, information from clinical trials addressing the efficacy and tolerability of ziprasidone in acute bipolar mania was reviewed and supplemented with the input from an expert faculty of European psychiatrists with extensive experience in treating patients with bipolar mania, both in clinical trials and in everyday clinical practice.Effective use of oral ziprasidone in the treatment of acute bipolar mania requires rapid titration to doses in the range 120 - 160 mg/day and administration with meals of ≥ 500 kcal. As in the clinical trials, temporary short-term use of benzodiazepines (in particular lorazepam for agitation or temazepam for insomnia) could be advisable. Available evidence from randomized clinical trials in combination with clinical experience supports the use of ziprasidone as one of the first-line effective and safe treatments for acute manic or mixed episodes associated with bipolar I disorder.