Adenoma ; complications ; pathology ; Adult ; Antipsychotic Agents ; adverse effects ; therapeutic use ; Aripiprazole ; Benzodiazepines ; adverse effects ; therapeutic use ; Bromocriptine ; adverse effects ; therapeutic use ; Dopamine Antagonists ; adverse effects ; therapeutic use ; Female ; Hormone Antagonists ; adverse effects ; therapeutic use ; Humans ; Hyperprolactinemia ; complications ; etiology ; Piperazines ; adverse effects ; therapeutic use ; Pituitary Neoplasms ; complications ; pathology ; Quinolones ; adverse effects ; therapeutic use ; Risperidone ; adverse effects ; therapeutic use ; Schizophrenia ; drug therapy ; etiology ; pathology ; Serotonin Antagonists ; adverse effects ; therapeutic use ; Trifluoperazine ; adverse effects ; therapeutic use

Objective: The occurrence of thrombocytopenia with valproate and clozapine combination therapy has not been noted in the literature. This case report highlights thrombocytopenia as a potential outcome of drug-drug interaction between valproate and clozapine, and serves to remind practitioners that regular monitoring of platelet counts is necessary in such combination therapy. Method: We report on a patient on valproate therapy who developed thrombocytopenia when clozapine was added to her treatment regime. Results: Thrombocytopenia resolved 1 week after valproate was tailed off and the patient was placed on clozapine monotherapy. Conclusions: A precise pathophysiologic understanding of valproate and clozapine-induced thrombocytopenia is lacking, and further studies are required.

Objective: This review summarises the existing evidence on the effects that recreational and medical use of cannabis and cannabinoids have on cognitive performance. Methods: Databases (PubMed, Medline, and Google Scholar) were searched from inception to March 2017 by adopting the following key terms: dronabinol, nabilone, nabiximols, cannabis, marijuana, cognition, neurology, and neuropsychology. A total of 94 documents, including reviews, preclinical and clinical studies, industrial and government agencies reports were included in this review. Results: We found that recreational use of cannabis doubles the risk of a fatal traffic accident by impairing attention and lengthening reaction time. Short-term use lowers performance in working memory, attention, executive functions and visual perception tasks. Chronic recreational use in adolescents also doubles the risk of early school-leaving, cognitive impairment and psychoses in adulthood. Adverse effects of cannabis-based medication – dronabinol, nabiximol and nabilone – and ingestion/inhalation of marijuana allowed for medical use include dizziness, drowsiness and short-term memory impairment. Conclusion: Cannabis consumption is associated with significant impairments in a range of cognitive abilities. Of particular concern, early and chronic exposure to cannabis, especially in the adolescence, seems to be associated with irreversible cognitive impairments.

INTRODUCTIONMetabolic Syndrome (MetS) is associated with cardiovascular morbidity and mortality. Studies proposed that waist circumference (WC) and body mass index (BMI) are good indicators of MetS. In this study, we examined and compared the predictive utility of clinical measures such as WC, blood pressure and BMI and determined the cutoff points in which these measures are most reliable in identifying MetS in Singaporean Chinese.

MATERIALS AND METHODSTwo hundred and forty-four subjects aged between 21 and 50 years of Chinese ethnicity were recruited into the study. Sociodemographic, height, weight and blood pressure information were obtained. High-density lipoprotein cholesterol (HDL-C), triglycerides (TG) and glucose levels were evaluated. Presence of MetS was examined according to American Heart Association (AHA)/National Heart, Lung and Blood Institute (NHLBI) guidelines. Predictive utility of BP, WC and BMI was examined using receiver operating curve and discriminant indices were determined accordingly.

RESULTSForty-one (16.8%) subjects were identified to have MetS. Our analysis revealed that waist circumference was most accurate in identifying MetS (area under the curve (AUC) = 0.88, 95% confidence interval (CI), 0.83 to 0.93, P <0.001) followed by BMI (AUC = 0.84, 95% CI, 0.77 to 0.91, P = 0.035), systolic BP (AUC = 0.83, 95% CI, 0.76 to 0.90, P = 0.036) and diastolic BP (AUC = 0.80, 95% CI, 0.71 to 0.88, P = 0.042). Waist circumference cut-off values of >92.5 cm in males and >86.5 cm in females were found to be most sensitive and specific in discriminating MetS.

CONCLUSIONOur finding has immediate and significant clinical implications as WC can be easily obtained. However, as the study included only Singaporean Chinese, findings cannot be generalised for other ethnic groups.

Adult ; Area Under Curve ; Blood Glucose ; analysis ; Blood Pressure ; physiology ; Body Height ; physiology ; Body Mass Index ; Body Weight ; physiology ; China ; ethnology ; Cholesterol, HDL ; blood ; Forecasting ; Health Status Indicators ; Humans ; Metabolic Syndrome ; diagnosis ; Middle Aged ; ROC Curve ; Sensitivity and Specificity ; Singapore ; Triglycerides ; blood ; Waist Circumference ; physiology ; Young Adult

Adolescent ; Adult ; Aged ; Child ; Disease Outbreaks ; Humans ; Middle Aged ; Obesity ; epidemiology ; Singapore ; epidemiology ; Young Adult

The Mandatory Treatment Order (MTO) became a sentencing option for select offenders with psychiatric illness in Singapore in 2011. This article aimed to study the psychiatric characteristics of the offenders in the first year of the MTO; Methods: A clinical audit was conducted on all the cases referred to the Institute of Mental Health for assessment as to their suitability to receive an MTO from January to December 2011. A psychiatrist went through all the case records. Data on the demographics, forensic history and psychiatric diagnoses were obtained from records; Results: There were differences seen between the genders in the likelihood of being granted an MTO. Gender also played a role in the length of MTOs granted and in the diagnoses of the individuals. The reasons for an MTO not being granted are presented. Conclusion: Some discussion is made regarding the availability of court diversion legislature in other countries for mentally ill offenders and the directions such diversion might take are highlighted. Potential areas for future research are pointed out.

Adult ; Antisocial Personality Disorder ; Homicide ; psychology ; Humans ; Korea ; ethnology ; Male ; Mass Casualty Incidents ; psychology ; Suicide ; psychology ; United States ; Universities ; Virginia

Cost of Illness ; Humans ; Schizophrenia ; complications ; mortality ; therapy

BACKGROUND:Medication errors are a common source of adverse healthcare incidents particularly in the emergency department (ED) that has a number of factors that make it prone to medication errors. This project aims to reduce medication errors and improve the health and economic outcomes of clinical care in Hong Kong ED.METHODS:In 2009, a task group was formed to identify problems that potentially endanger medication safety and developed strategies to eliminate these problems.RESULTS:Responsible officers were assigned to look after seven error-prone areas. Strategies were proposed, discussed, endorsed and promulgated to eliminate the problems identified. A reduction of medication incidents (MI) from 16 to 6 was achieved before and after the improvement work.CONCLUSION:This project successfully established a concrete organizational structure to safeguard error-prone areas of medication safety in a sustainable manner.

The discovery of endocannabinoid’s role within the central nervous system and its potential therapeutic benefits have brought forth rising interest in the use of cannabis for medical purposes. The present review aimed to synthesize and evaluate the available evidences on the efficacy of cannabis and its derivatives for psychiatric, neurodegenerative and movement disorders. A systematic search of randomized controlled trials of cannabis and its derivatives were conducted via databases (PubMed, Embase and the Cochrane Central Register of Controlled Trials). A total of 24 reports that evaluated the use of medical cannabis for Alzheimer’s disease, anorexia nervosa, anxiety, dementia, dystonia, Huntington’s disease, Parkinson’s disease, post-traumatic stress disorder (PTSD), psychosis and Tourette syndrome were included in this review. Trial quality was assessed with the Cochrane risk of bias tool. There is a lack of evidence on the therapeutic effects of cannabinoids for amyotrophic lateral sclerosis and dystonia. Although trials with positive findings were identified for anorexia nervosa, anxiety, PTSD, psychotic symptoms, agitation in Alzheimer’s disease and dementia, Huntington’s disease, and Tourette syndrome, and dyskinesia in Parkinson’s disease, definitive conclusion on its efficacy could not be drawn. Evaluation of these low-quality trials, as rated on the Cochrane risk of bias tools, was challenged by methodological issues such as inadequate description of allocation concealment, blinding and underpowered sample size. More adequately powered controlled trials that examine the long and short term efficacy, safety and tolerability of cannabis for medical use, and the mechanisms underpinning the therapeutic potential are warranted.
Amyotrophic Lateral Sclerosis ; Anorexia Nervosa ; Anxiety ; Bias (Epidemiology) ; Cannabinoids ; Cannabis ; Central Nervous System ; Dementia ; Dihydroergotamine ; Dyskinesias ; Dystonia ; Medical Marijuana* ; Mental Disorders ; Movement Disorders ; Neurodegenerative Diseases* ; Psychotic Disorders ; Sample Size ; Stress Disorders, Post-Traumatic ; Therapeutic Uses ; Tourette Syndrome