bluuebunny/crossref_metadata_2025 huggingface dataset:
134 Improvements in Clinical Global Impression of Change With Deutetrabenazine Treatment in Tardive Dyskinesia From the ARM-TD and AIM-TD Studies
Authors: Fernandez Hubert H. , Davis Mat D. , Factor Stewart A. , Hauser Robert A. , Jarskog L. Fredrik , Jimenez-Shahed Joohi , Kumar Rajeev , Ochudlo Stanislaw , Ondo William G. , Anderson Karen E.
Published: June 2018

Introduction

Tardive dyskinesia (TD) is an involuntary movement disorder that is often irreversible, can affect any body region, and can be debilitating. In the ARM-TDand AIM-TD studies, deutetrabenazine treatment demonstrated statistically and clinically significant reductions in Abnormal Involuntary Movement Scale (AIMS) scores at Week 12 compared with placebo (primary endpoint).

Objective

To evaluate the efficacy of deutetrabenazine, as measured by the Clinical Global Impression of Change (CGIC) scale, in patients with TD from the pooled ARM-TDand AIM-TD (24 and 36 mg/day doses) data sets, as compared with the pooled placebo cohort.

Methods

ARM-TD and AIM-TD were 12-week, randomized, double-blind, placebo-controlled studies that evaluated the safety and efficacy of deutetrabenazine for thetreatment of TD. The key secondary endpoint of each study was the proportion of patients “much improved” or “very much improved” (treatment success) at Week 12 on theCGIC.

Results

At Week 12, the odds of treatment success among patients treated with deutetrabenazine (n=152) was more than double that of patients given placebo (n=107; odds ratio: 2.12; P=0.005). In a categorical analysis of CGIC ratings, patients treated with deutetrabenazine showed greater improvement than patients given placebo (P=0.003). Patients treated with deutetrabenazine also had a significantly better treatment response than those given placebo (least-squares mean CGIC score treatment difference: –0.4; P=0.006).

Conclusions

Deutetrabenazine treatment led to statistically and clinically significant improvements in TD symptoms based on the CGIC result, suggesting that clinicians were able to recognize the benefit in patients treated with deutetrabenazine.

Presented at: The International Congress of Parkinson’s Disease and Movement Disorders; June 4–8, 2017; Vancouver, British Columbia, Canada.

Funding Acknowledgements

These studies were funded by Teva Pharmaceutical Industries, Petach Tikva, Israel.
136 CerefolinNAC Therapy-Induced Dizziness
Authors: Nayati Jasir T. , Hirsch Alan R.
Published: June 2018

Study Objective

CerefolinNAC (CFLN-NAC) contains L-methylfolate (6 mg), methylcobalamin (2 mg), and N-acetylcysteine [NAC] (600 mg) [Pamlab 2017]. Dizziness and lightheadedness have not heretofore been described with use of CFLN-NAC.

Methods

Case Study: A 64 year old right-handed female was started on CFLN-NAC for smell and taste issues. Over a three day period, she experienced a gradual increase in dizziness. This was a non-vertiginous lightheadedness, so severe that she was unable to walk, and would lie down the entire day to alleviate the dizziness. It was associated with nausea, but without any vomiting or falls. The dizziness would come and go, last for several hours, and was 9/10 in severity.

She admits to a past history of epochs of vertigo. The vertigo occurred three times with nausea and vomiting 13 years, 11 years, and 4 years prior to presentation. She also developed a constant, bilateral, high-pitched tinnitus 14 years prior to presentation, which obstructs her hearing. It is level 3/10 in intensity during the night and in the quiet. There were no alleviating or aggravating factors. Acupuncture was without effect, and she denies any ear pain. After ceasing CFLN-NAC for three days, a gradual reduction of dizziness to baseline ensued.

Results

Abnormalities in Physical Examination: General: Decreased blink frequency and hypokinesia. Cranial Nerve III, IV, VI: Saccadization of horizontal eye movements. Motor Examination: Tone: 1+ cogwheel rigidity in both upper extremities, left more than right. Drift Test: Bilateral Abductor Digiti Minimi sign with cerebellar spooning. Reflexes: Absent quadriceps femoris and Achilles bilaterally. Positive Hoffman reflex bilaterally. Neuropsychiatric Testing: Go-No-Go Test: 6/6 (normal). Animal Fluency Test: 19 (normal). Reliable Digit Span: 10 (normal). Clock Drawing Test: 4 (normal). Center for Neurologic Study Lability Scale: 10 (normal). Other: Audiometry and Fiberoptic Endoscopy: normal. MRI of the brain with and without contrast was normal.

Conclusion

None of the individual components in CFLN-NAC have been reported to precipitate dizziness [Pamlab 2017]. The non-vertiginous nature of the dizziness makes it unlikely to be due to vestibular involvement, raising the spectre of this drug having an impact on the autonomic nervous system. While a nocebo effect could be in action, this is unlikely since dizziness was not presented as a potential side effect on initiation of the medication. In addition, methylcobalamin can cause hyperviscosity syndrome, but due to an absence of visual disturbances and altered mental status, it is also improbable. The relatively rapid onset with initiation and resolution upon discontinuation of this medication strongly suggests that it is not a coincidence, rather an origin for the dizziness. Those who are treated with CFLN-NAC should be queried as to new onset dizziness. For those already dizzy, one should consider other treatment options.

Funding Acknowledgements

Smell and Taste Treatment and Research Foundation
137 Menstrual Synchrony of Burning Mouth Syndrome
Authors: Nayati Jasir T. , Hirsch Alan R.
Published: June 2018

Study Objective

Burning mouth syndrome (BMS) is characterized by oral mucosal burning sensations, with normal clinical and laboratory results. Menstrual synchrony of migraines and epilepsy have been discussed; however, menstrual synchrony of BMS has not heretofore been described.

Methods

Case Study: A 29 year old right-handed female exhibited intermittent BMS symptoms, one month after suffering a left parietal infarction. She describes the pain as a burningsensation, localized to the bilateral and anterior aspects of her tongue. It lasts for four days, starts three days prior to her menses, and occurs twice a month. She is unable to correlate any patterns or triggers that may cause to exacerbate her BMS. She denies any taste disturbances, hot-flashes, night sweats, and perspiration.

Results

Abnormalities during neurological examination were noted. Cranial nerves (CN) III, IV, and VI showed bilateral lateral first degree end-gaze unsustained nystagmus. CN IX and X showed decreased bilateral gag reflex. A right pronator drift with a right abductor digiti minimi sign was seen in the motor examination. The cerebellar examination was positive for bilateral dysmetria during the Finger-To-Nose examination, and exhibited Holmes rebound phenomena, right more than left. Sensory examination showed decreased light touch in the lower extremities, right more than left. Hoffman reflex was bilaterally positive. Mental status examinations demonstrated poor similarity interpretation and calculation ability. Her neuropsychiatric testing was normal, and included the Go-No-Go and Animal Fluency Testing. MRI of the brain exhibited gliosis/laminar necrosis in the left inferior parietal lobe, and an 8mm descent of cerebellar tonsils below the foramen magnum.

Conclusion

The potential mechanism for catamenial BMS is manyfold. Estrogen and progesterone both have nociceptive properties. Premenstrual drop or reduction of estrogen and progesterone may act to disinhibit pain [Vincent 2008], with pain modulation being more effective during the ovulatory phase (high estrogen and low progesterone) [Rezaii 2012]. Depression in the presence of Late Luteal Phase Dysphoric Disorder may function to exacerbate the perception of underlying pain throughout the body, including the mouth and tongue. Decrease in estrogen and progesterone levels may also alter salivary output and composition. This may allow baseline reduction of proprioceptive input on the tongue, thus acting through Melzack and Wall’s Gate Control Theory of Pain to disinhibit small C fibers, which is perceived as burning pain [Melzack 1978]. Along with menses, olfactory ability drops, and food preferences are often reported to change [Keller 2013]. A decrease in estrogen and progesterone can also enhance trigeminal nerve sensitivity [Martin 2007], which exacerbates pain. This may indirectly influence or be associated with her BMS. Such observations justifies a trial of hormonal agents for therapy of BMS.

Funding Acknowledgements

Smell and Taste Treatment and Research Foundation
141 The Effects of Valbenazine on Tardive Dyskinesia: Subgroup Analyses of 3 Randomized, Double-Blind, Placebo-Controlled Trials
Authors: Meyer Jonathan , Remington Gary , Norbash Ali , Burke Joshua , Siegert Scott , Liang Grace S.
Published: June 2018

Study Objectives

The approval of valbenazine (INGREZZA; VBZ) for the treatment of tardive dyskinesia (TD) in adults was based on results from double-blind, placebo (PBO)-controlled trials. These studies demonstrated the efficacy of once-daily VBZ based on intent-to-treat analyses. However, because many different types ofpatients can develop TD, subgroup analyses describing treatment outcomes by various patient factors were also conducted.

Methods

Data were pooled from three 6-week trials: KINECT (NCT01688037), KINECT 2 (NCT01733121), KINECT 3 (NCT02274558), with outcomes analyzed by VBZ dose (80 mg, 40 mg) and PBO. Descriptive analyses conducted using the Abnormal Involuntary Movement Scale (AIMS) total score included: mean change from baseline to Week 6; and AIMS response, defined as 50% improvement from baseline to Week 6. Subgroups were defined as follows: age (<55 years, ≥55 years), sex (male, female), psychiatric diagnosis (schizophrenia/schizoaffective disorder, mood disorder), CYP2D6 genotype (poor metabolizer [PM], non-PM), body mass index (BMI) (<18.5, 18.5 to <25, 25 to <30, ≥30 kg/m2), concomitant antipsychotic (yes, no); type of antipsychotic (atypical, typical/both); lifetime history of suicidality (yes, no); concomitant anticholinergic (yes, no); TD duration (<7 years, ≥7 years).

Results

The pooled population included 373 participants (VBZ 80 mg, n=101; VBZ 40 mg, n=114; PBO, n=158). Mean improvements from baseline to Week 6 in AIMS total score were greater overall with VBZ compared to PBO. Within subgroup categories, AIMS score improvement with VBZ 80 mg (recommended dose) was greater in CYP2D6 PMs (n=17; 80 mg, -6.8; 40 mg, 2.4; PBO, 0.5), participants taking no concomitant antipsychotics (n=64; 80 mg, -4.9; 40 mg, -3.0; PBO, 0.0), and overweight participants (BMI 25 to <30 kg/m2, n=115; 80 mg, -4.2; 40 mg, 2.7; PBO, -0.7). Overweight participants also had the highest AIMS response rates at Week 6 (80 mg, 57.7%; 40 mg, 31.6%; PBO, 11.8%), followed by participants taking typical/both antipsychotics (n=67; 80 mg, 57.1%; 40 mg, 20.0%; PBO, 25.0%), and those taking anticholinergics (n=126; 80 mg, 52.9%; 40 mg, 22.7%; PBO, 6.3%).

Conclusion

These preliminary analyses indicate that TD improvements were generally greater with VBZ than PBO across most subgroups. However, the small sizes of some subgroups may need to be considered when interpreting results. Additional analyses within subgroup categories are ongoing and will be presented at the meeting.

Funding Acknowledgements

This study was funded by Neurocrine Biosciences, Inc.
143 Effect of Tardive Dyskinesia on Quality of Life: Patient-Reported Symptom Severity Is Associated With Deficits in Physical, Mental, and Social Functioning
Authors: McEvoy Joseph , Carroll Benjamin , Gandhi Sanjay , Rizio Avery , Maher Stephen , Kosinski Mark , Bjorner Jakob
Published: June 2018

Introduction

Tardive dyskinesia (TD), an often-irreversible movement disorder typically caused by exposure to antipsychotics, most commonly affects the face, mouth, and tongue and may be debilitating

Objective

To investigate TD burden on patients’ quality of life and functionality

Methods

Adults with clinician-confirmed schizophrenia, bipolar disorder, or major depressive disorder participated in an observational study. Approximately half (47%) ofparticipants had a clinician-confirmed TD diagnosis. Participants completed the SF-12v2 Health Survey® (SF-12v2), Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF), social withdrawal subscale of the Internalized Stigma of Mental Illness scale (SW-ISMI), and rated the severity of their TD symptoms. Group differences in SF-12v2 physical and mental component summaries (PCS and MCS), Q-LES-Q-SF, and SW-ISMI scores were analyzed.

Results

TD (n=79) and non-TD (n=90) groups were similar in age, gender, and number of patients with schizophrenia, bipolar disorder, and major depressive disorder. TD patients reported significantly worse scores on PCS (P=0.003), Q-LES-Q-SF (P<0.001) and SW-ISMI (P<0.001) than non-TD patients. The difference in PCS exceeded the established minimal clinically important difference (MCID) of 3 points. When stratified by TD severity, those with more severe symptoms had significantly worse Q-LES-Q-SF (P<0.001) and SW-ISMI (P=0.006) scores than those with less severe symptoms. Differences in PCS (P=0.12) and MCS (P=0.89) were in the expected direction and exceeded the MCID.

Conclusions

Among patients with psychiatric disorders, TD is associated with significant physical health burden and incremental mental health burden. TD severity is also associated with lower overall quality of life and greater social withdrawal.

Presented at: Psych Congress; September 16–19, 2017; New Orleans, Louisiana, USA.

Funding Acknowledgements

This study was funded by Teva Pharmaceutical Industries, Petach Tikva, Israel.
144 A Clinical Practice Assessment In Tardive Dyskinesia: Are Physicians Up-to-Date?
Authors: Lubarda Jovana , Hughes Stacey , Correll Christoph U.
Published: June 2018

Study Objectives

To assess physicians’ current knowledge, skills, competence, and practice barriers regarding tardive dyskinesia (TD) and assess continuing medical education (CME) needs.

Assessment Methods

A 29-question clinical practice assessment survey instrument consisting of multiple-choice knowledge and case-based questions was administered online to gather abaseline “snapshot” of knowledge, skills, attitudes, and competence on TD epidemiology, risk factors, diagnosis, current guideline-based management, and emerging management strategies

The survey launched online on a website dedicated to continuous professional development on July 25, 2016, and was made available to healthcare providers without monetary compensation or charge. Data were collected through August 28, 2016

Confidentiality was maintained and responses were de-identified and aggregated prior to analyses

Results

Data were collected for the 1157 psychiatrists and 177 neurologists who responded to all survey questions during the study period. The findings were:

∙

Epidemiology: 62% of psychiatrists and 68% of neurologists were aware that TD affects approximately 20% of patients treated with neuroleptic agents

∙

Risk factors: 63% of psychiatrists and 67% of neurologists were aware of risk factors for TD, such as older age

∙

Diagnosis: 93% of psychiatrists and 71% of neurologists were aware that Abnormal Involuntary Movement Scale (AIMS) can be used to support diagnosis of TD

∙

Guidelines: 21% of psychiatrists and 11% of neurologists were aware of the American Psychiatric Association guidelines for monitoring of TD, and 56% of psychiatrists and 42% of neurologists were aware of the American Academy of Neurology guidelines on treatment of TD

New/emerging treatments: 24% of psychiatrists and 34% of neurologists were aware of the mechanisms of action of new/emerging treatments for TD, and 54% and 44%, respectively, were aware of the clinical data for valbenazine

Conclusions

This educational research yielded important insights into clinical practice gaps in TD, indicating that both psychiatrists and neurologists would benefit from continuing medical education on epidemiology, risk factors, diagnosis, guideline-based care, and information on how to incorporate new/emerging treatments for TD into practice.

Funding Acknowledgements

The educational activity and outcomes measurement were funded through an independent educational grant from Neurocrine Biosciences, Inc.
156 Improvement in Disease Severity in Patients With Treatment-Resistant Depression Following Treatment With Intranasal Esketamine
Authors: Nash Abigail , Shawi May , Singh Jaskaran , Daly Ella , Copper Kimberly , Lim Pilar , Lane Rosanne , Gogate Jagadish , DiBernardo Allitia , Hough David , Alphs Larry
Published: June 2018

Background

Recognizing the importance not only of the clinician’s opinion but also of the patient’s experience and perspective, Sequenced Treatment Alternatives to Relieve Depression (STAR*D) utilized both clinician-reported and patient-reported outcomes in a large-scale multi-step study on antidepressant effectiveness in real-world settings. Both approaches indicate that <17% of Major Depressive Disorder (MDD) patients respond to novel oral treatments after two prior antidepressant failures. To address this low response rate and continue to investigate the use of patient-rated outcomes in clinical trials, an antidepressant with a new mechanism of action is being investigated for efficacy and safety utilizing both clinician-rated and patient-reported scales.

Methods

This is a post-hoc analysis of a Janssen R&D Phase 2a clinical trial (ESKETINTRD2003). Subjects aged 20-64 withMDD without psychotic features (DSM IV) and a history of inadequate response to ≥2 antidepressants were randomized [3:1:1:1] to 1 week of twice-weekly treatment with intranasal placebo (n=33), esketamine 28 mg (n=11), 56 mg (n=11), or 84 mg (n=12). Participants taking oral antidepressants at study entry continued treatment during the study. Changes in depression severitywere measured using the Clinical Global Impression Severity (CGI-S) and the Patient Global Impression Severity (PGI-S) scales.

Results

At all esketamine doses (28 mg, 56 mg, 84 mg), subjects reported a one-point mean change in PGI-S from baseline to week one compared to no change on placebo (p-values 0.005, 0.001, 0.032 respectively). Similarly, mean CGI-S scores improved for subjects receiving esketamine at all doses (p-values 0.028, 0.004, 0.049 respectively) compared to no change inplacebo subjects. These data are consistent with previously reported data based on the Montgomery Åsberg Depression Rating Scale (MADRS) and support positive correlation between patient-reported and clinician-reported outcomes.

Discussion

Initial results from this Phase 2a study suggest clinically relevant improvement in depression symptoms in as early as one week when treated with twice-weekly intranasal esketamine as reported by both clinicians and patients. This work will help guide future investigations of esketamine in larger populations to provide better therapeutic options for treatment resistantMDD patients.

Funding Acknowledgements

Janssen
177 Management of Treatment-Resistant Schizophrenia With Clozapine Augmentation
Authors: Phyu Pwint , Arocha Emelina , Oms Juan D. , Gunaseelan Luxhman , Foroughi Golbon , Rizvi Syed A. A.
Published: June 2018

A 44-year-old woman with a history of chronic schizoaffective disorder, epilepsy, social phobia, anxiety, and panic attacks presented with concern for “feeling anxious.” After a history, physical examination, and laboratory tests, the woman received a diagnosis of treatment-resistant schizophrenia. While clozapine is the standard therapy for schizophrenia, certain patients such as the woman in this case do not respond well to clozapine monotherapy, requiring clozapine to be augmented with other antipsychotics or antidepressants. This case outlines the unique challenges of managing patients with treatment-resistant schizophrenia, especially when they present with comorbid conditions such as epilepsy that can limit treatment options. A multipronged approach, including pharmacologic therapy as well as cognitive behavioral therapy, should also be considered.

Funding Acknowledgements

No funding.
179 Dasotraline in Children With Attention Deficit Hyperactivity Disorder: Results of a Randomized, Double-Blind, Placebo-Controlled Study
Authors: Goldman Robert , Adler Lenard , Spencer Thomas , Findling Robert , Hopkins Seth C. , Koblan Kenneth K. , Sarma Kaushik , Hsu Jay , Loebel Antony
Published: June 2018

Objectives

Once-daily dosing with dasotraline, a novel dopamine and norepinephrine reuptake inhibitor, achieves stable plasma concentrations over 24 hours with once-daily dosing. This study evaluated dasotraline in children aged 6–12 years (NCT02428088).

Methods

Patients were randomized 1:1:1 to 6 weeks of once-daily, fixed-dose dasotraline 2 or 4 mg/day, or placebo. The primary efficacy endpoint was change from baseline (CFB) at Week 6 in ADHD Rating Scale Version IV – Home Version (ADHD RS-IV HV) total score, using a mixed model for repeated measures (MMRM) in the intent-to-treat (ITT) population. Secondary endpoints included Clinical Global Impression-Severity (CGI-S) score and safety endpoints.

Results

The mean age of 342 randomized patients was 9.1 [SD: 1.9] years; 66.7% were male. Overall, 79% of patients completed the study. In the ITT population (N=336), ADHD RS-IV HV total score improved significantly with dasotraline 4 mg/day vs placebo(least squares [LS] mean [SE] CFB at Week 6: –17.53 [±1.31] vs –11.36 [±1.29], respectively, p<0.001; effect size [ES]: 0.48). Inattentiveness and hyperactivity/impulsivity subscale scores significantly improved with 4 mg/day vs placebo at Week 6 (p=0.001, p=0.003, respectively). Improvement in CGI-S score was statistically significant with dasotraline 4 mg/day vs placebo(LS mean [SE] CFB at Week 6: –1.39 [±0.12] vs –1.04 [±0.12], respectively, p=0.040; ES: 0.29). No significant improvement was observed on the ADHD RS-IV HV total score and the CGI-S score for dasotraline 2 mg/day vs placebo. The most frequent treatment-emergent AEs (≥5% and higher than placebo) were (2 mg/day; 4 mg/day; placebo): insomnia (15.3%; 21.7%; 4.3%, all terms combined), decreased appetite (12.6%; 21.7%; 5.2%), weight loss (5.4%; 8.7%; 0%), irritability (3.6%; 7.0%; 6.0%), nasopharyngitis (0.9%; 5.2%; 0.9%), and nausea (0%; 5.2%; 2.6%).

Conclusions

Compared with placebo, dasotraline 4 mg/day significantly improved ADHD symptoms in children, as assessed by ADHD RS-IV HV total score and inattentiveness and hyperactivity/impulsivity subscale scores. Dasotraline was generally well tolerated; most common AEs were insomnia, decreased appetite, weight loss and irritability.

Funding Acknowledgements

Study sponsored by Sunovion Pharmaceuticals Inc.
182 Unintentional Overdose on Long-Acting Injectable Risperidone
Authors: Pasha Saira , Schilling Shirin
Published: June 2018

Study Objectives

Understand the mechanism and pharmacokinetics involved in an unintentional overdose of injectableantipsychotic medication; identify how to transition between long acting injectable antipsychotics; formulate steps to ensure patient safety in an event of an unintentional overdose of injectable antipsychotic

Method

Review of a case study involving a 47-year-old male, with history of schizoaffective disorder and previous episodes of loss of consciousness of unknown etiology, who was admitted to the inpatient psychiatry unit at UConn Health John Dempsey Hospital for stabilization of psychotic symptoms and monitoring of unintentional overdose after initially being admitted to the ICU. He was found unconscious at home following a period of days where he self-injected four of 37.5mg Risperidone injections (estimated 150mg) along with limited adherence to prescribed oral clozapine, doxepin and lorazepam. He reported self-injecting additional medication to treat paranoia, auditory, visual and olfactory hallucinations. In the ICU, he was evaluated by Toxicology and Neurology for loss of consciousness thought to be from seizures, with no clear outcome. He was awake and alert within 24 hours of medical admission but became agitated, hostile, and psychotic prompting psychiatric admission. When his worsening paranoia had resulted in termination of his visiting nurse services that administered injections and in home assessments, his outpatient psychiatrist allowed him to self-administer bi-monthly injections. Over three weeks in the hospital, he was evaluated for signs and symptoms of antipsychotic overdose.

Results

Initial literature review did not reveal information involving an overdose of injectable Risperidone. Thus, the time frame and symptoms to monitor were uncertain. As the injectable medication was expected to peak in 2-3 weeks and persist for 4-6 weeks, there was a concern about delayed potential side effects such as EPS, sedation, QTC prolongation and electrolytes imbalances. He was treated with oral antipsychotic medication. Clozapine and doxepin were discontinued due to patient non-adherence, side effects, and drug interactions. He exhibited signs of EPS and was started on benztropine. To simplify his regimen, he was switched to another long acting injectable, Paliperidone Palmitate, prior to his discharge.

Conclusions

Given the nature of the presentation, he was advised not to self-administer injectable medication and was referred for visiting nurse services. He was educated on the potential side effects of injectable antipsychotic medication. As there was a change in antipsychotic medications, follow up was recommended in an intensive outpatient program for psychotic symptoms and prolonged side effects. Due to the patient’s concordant episode of loss of consciousness, he was advised to follow up with an outpatient long term EEG monitoring and complete Neurology evaluation.

Funding Acknowledgements

No funding.
185 Second Generation Antipsychotics and Catatonia: A Literature Review
Authors: Slauer Ryan , Boazak Mina , Lowley Michael , Lawrence Jeffrey , Hudson Zachary , Goldsmith David , Cotes Robert
Published: June 2018

Introduction

Catatonia is an underrecognized neuropsychiatric syndrome affecting approximately 10% of individuals hospitalized on inpatient psychiatric units. First-line treatments for this condition include benzodiazepines (BZD) and/or electroconvulsive therapy (ECT). However, 20-40% of individuals do not respond to BZD alone and ECT is not always accessible. Second generation antipsychotics (SGA) have been used to treat catatonia in these circumstances. Here, we review the literature pertaining to the efficacy and safety of SGA in the treatment of catatonia.

Methods

We conducted a PubMed search for articles linking catatonia to antipsychotics, under the search heading “catatonia” or “kahlbaum” and “risperidone”, “amisulpride”, “iloperidone”, “olanzapine”, “aripiprazole”, “paliperidone”, “clozapine”, “brexpiprazole”, or “cariprazine”. Reports commenting on SGA treatment efficacy and/or their role in the development of catatonia were included in the analysis. Selected articles were reviewed for patient demographics, psychiatric/medical history, symptoms, cause of catatonia and treatment, and co-administered agents. For each SGA, we calculated the number of cases in which catatonia was likely improved with antipsychotic treatment, and the number of cases in which catatonia was precipitated or worsened with antipsychotic treatment (improved/worsened ratio). Case data was assessed using the Naranjo Adverse Drug Reaction Probability Scale. Descriptive statistics were used to analyze the data.

Results

At the time this abstract was written, we reviewed 480 of the original 507 articles. One hundred and seventeen of the 480 met inclusion criteria. There was one randomized controlled trial (RCT), five prospective studies, four retrospective studies and 107 case reports. Of all reviewed literature quetiapine (34:3, 92%), aripiprazole (16:2, 89%), amisulpride (18:1, 95%), andclozapine (19:1, 95%) had the highest improved/worsened ratio, conversely paliperidone (0:5, 0%) had the lowest improved/worsened ratio.

Conclusion

Of the available literature quetiapine, amisulpride, aripiprazole, and clozapine were found to be relatively safe andeffective as treatment options in catatonia, while palipderidone was found to have reports pointing to its role in the development/worsening, but none on the improvement, of catatonia. These results need to be interpreted with caution. In the majority of cases where SGA’s were effective, patients were co- treated with other pharmacologic agents (most frequently benzodiazepines), making it difficult to assess the role of the antipsychotic alone. Also, given that the preponderance of studies were case reports, publication bias may be an important limitation. Further studies are needed to examine the safety and efficacy of SGA in treating catatonia.

Funding Acknowledgements

No funding.
186 Hospital Utilization Rates Following Antipsychotic Dose Reductions Among Patients With Schizophrenia
Authors: Caroff Stanley N. , Mu Fan , Ayyagari Rajeev , Schilling Traci , Abler Victor , Carroll Benjamin
Published: June 2018

Introduction

Tardive dyskinesia (TD), an often-irreversible movement disorder, develops in patients treated withantipsychotics. Although antipsychotic dose reduction has been utilized in the management of TD, the benefits and risks of lowering doses have not been well studied and could cause additional burden to patients.

Objective

To analyze the healthcare burden of antipsychotic dose reduction in patients with schizophrenia.

Methods

Medical claims from six US states spanning 6 years are retrospectively analyzed for ≥10% or ≥30% antipsychotic dosereductions and compared with those from patients receiving stable doses. Outcomes measured include inpatient admissions and emergency room (ER) visits for schizophrenia, all psychiatric disorders, and all causes.

Results

Baseline analysis revealed 17,984 patients with ≥10% and 14,029 patients with ≥30% dose reduction. Patients with≥10% dose reduction and matched controls were similar in age (mean 45.5 years), gender (51% male) and healthcare plan type. Preliminary analyses indicate that ≥10% dose reduction is associated with increased risk of admission or ER visit for schizophrenia (hazard ratio [HR] 1.26; 95% confidence interval [CI] 1.18, 1.35; P<0.001) and all psychiatric disorders (HR 1.18; 95% CI 1.11, 1.25; P<0.001) versus controls, which may be even greater with ≥30% dose reduction. Final updated results of ongoing analyses will be presented at the meeting.

Conclusions

Patients with antipsychotic dose reductions may be at risk for significant increases in hospital utilization rates. This suggests that dose reductions may increase overall healthcare burden in some schizophrenia patients, and highlights the need for alternative strategies in the management of TD.

Presented at: Psych Congress; September 16–19, 2017; New Orleans, Louisiana, USA.

Funding Acknowledgements

This study was funded by Teva Pharmaceutical Industries, Petach Tikva, Israel.
193 A New Syndrome: Phantogeusia-Induced Phantosmia
Authors: Ahmad Umar , Hirsch Alan R.
Published: June 2018

Case Objective

While phantosmia-induced phantogeusia has been described (Ahmed, 20173), the reverse, phantogeusia-induced phantosmia, has not heretofore been described. Such a case is presented.

Methods

Case Study: A 39-yr-old left-handed (pathological) male, six years prior to presentation, noted a sudden onset of phantogeusia of roast cooking, pizza, fruit, strawberries, or a sour taste, and shortly thereafter he would develop unpleasant phantosmias which would sometimes combine with the ambient aroma. These would occur 3-10 times per week and would last for the duration of the phantogeusia, for as long as 1-2 hours. Occasionally the phantosmia would occur first and then induce the phantogeusia of asour taste.

Results

Abnormalities in Neurologic examination: Mental status examination: Immediate recall: Digit span: 6 digits forward and 3 digits backwards. CN XI, X: Decreased gag bilaterally. Motor Examination: Drift: left pronator drift with right abductor digiti minimi sign and right cerebellar spooning. Gait Examination: Tandem Gait: unstable. Cerebellar Examination: Holmes Rebound Phenomena: bilaterally positive, left greater than the right. Sensory Examination: Ipswich Touch Test: decreased in left lower extremity. Temperature: decreased in left lower extremity. Rydel-Seiffer Vibratory Test: bilateral upper extremities 5, bilateral lower extremities 3. Reflexes: upper extremities 1+, absent lower extremities. Neuropsychiatric Examination: Go-No-Go Test: 6/6 (normal). Animal Fluency Test: 15 (normal). Clock Drawing Test: 3 (abnormal). Center for Neurologic Study Lability Scale: 16 (Pseudobulbar affect).

Conclusion

Close connection of the tertiary smell and taste integration areas, where smell and taste converge, in the posterior orbitofrontal cortex, anterior to the insular taste cortex, and posterior to the granular orbitofrontal cortex may have allowed activation of memory engrams connecting these two (Rolls, 19944). Alternatively, electrical discharge from the primary taste area may have spread to involve the cortical representation of smell. Since the cortical area involved in the interpretation and hedonics of taste co-localize with the area involving olfactory hedonics, spread from one area to the other area may occur. As a result of electrical discharge (from an epileptiform focus) or as a result of well-connected and developed memory engrams with associated hedonics, phantom tastes may induce phantom smells. Alternatively, this may represent a distorted retronasal smell whereby the olfactory component of the gustatory hallucination causes a discharge of the olfactory epithelium (a pseudoretronasal smell).

Given the above, treatment of those with both phantosmia and phantogeusia may respond to treatment of phantogeusia alone. Under this construct, the phantosmia is the slave of the phantogeusia whereby management of the taste hallucination will thus eliminate the smell hallucination.

Funding Acknowledgements

Smell and Taste Treatment and Research Foundation.
198 Who Am I: Delusion of Misidentification of Self
Authors: Moustafa Yara W. , Dalkilic Alican
Published: June 2018

Delusional misidentification syndromes are rare psychotic disorders, in which the patient believes that the identity of a person, object, or place has been changed or replaced by another. These disorders include Capgras syndrome, Fregoli syndrome, and inter-metamorphosis. Reverse types of misidentification syndromes were introduced to distinguish alteration of the self rather than of others.

Reverse Capgras syndrome refers to the psychological change of the self as opposed to others, while reverse Fregoli syndrome is the delusional belief in which the patient has undergone fundamental changes in physical makeup without any psychological changes, and reverse intermetamorphosis is a variant in which patients believe that they have undergone physical and psychological transformation.

Here we present an interesting case of a transgender woman presenting with delusional misidentification of the self in the context of Schizophrenia. A review of literature, with emphasis on etiological factors, forensic implications and association with violence is presented.

Funding Acknowledgements

No funding.
Alignment of comparable documents: Comparison of similarity measures on French–English–Arabic data
Authors: LANGLOIS D. , SAAD M. , SMAILI K.
Published: June 2018

The objective, in this article, is to address the issue of the comparability of documents, which are extracted from different sources and written in different languages. These documents are not necessarily translations of each other. This material is referred as multilingual comparable corpora. These language resources are useful for multilingual natural language processing applications, especially for low-resourced language pairs. In this paper, we collect different data in Arabic, English, and French. Two corpora are built by using available hyperlinks for Wikipedia and Euronews. Euronews is an aligned multilingual (Arabic, English, and French) corpus of 34k documents collected from Euronews website. A more challenging issue is to build comparable corpus from two different and independent media having two distinct editorial lines, such as British Broadcasting Corporation (BBC) and Al Jazeera (JSC). To build such corpus, we propose to use the Cross-Lingual Latent Semantic approach. For this purpose, documents have been harvested from BBC and JSC websites for each month of the years 2012 and 2013. The comparability is calculated for each Arabic–English couple of documents of each month. This automatic task is then validated by hand. This led to a multilingual (Arabic–English) aligned corpus of 305 pairs of documents (233k English words and 137k Arabic words). In addition, a study is presented in this paper to analyze the performance of three methods of the literature allowing to measure the comparability of documents on the multilingual reference corpora. A recall at rank 1 of 50.16 per cent is achieved with the Cross-lingual LSI approach for BBC–JSC test corpus, while the dictionary-based method reaches a recall of only 35.41 per cent.
Examining the Factor Structure and Psychometric Properties of a Guilt Management Scale (GMS)
Authors: McIvor Katy , Degnan Amy , Pugh Lauren , Bettney Laura , Emsley Richard , Berry Katherine
Published: June 2018

Background: Guilt is commonly associated with distress and psychopathology. However, there is a lack of validated measures that assess how people cope with this aversive emotional and cognitive experience. Aims: We therefore developed and validated a self-report measure that assesses how people manage their guilt: the Guilt Management Scale (GMS). Method: The GMS was administered to a non-clinical (n = 339) and clinical (n = 67) sample, alongside other validated measures of guilt severity, coping, thought control and psychological distress. Results from a principal component analysis (PCA) and assessments of test–retest reliability and internal consistency are presented. Results: The PCA yielded a six subscale solution (Self-Punishment, Reparation, People-Focused, Spirituality, Avoidance and Metacognition), accounting for 56.14% of variance. Test–retest reliability and internal consistency was found to be good–excellent for the majority of subscales. Across samples, Self-Punishment was related to higher levels of guilt and distress whilst Metacognition and Reparation were related to less guilt and distress in the non-clinical sample only. Conclusions: This paper provides preliminary evidence for the psychometric properties of the GMS in a non-clinical sample. With development and validation in clinical samples, the GMS could be used to inform psychological formulations of guilt and assess therapy outcomes.
Phonology-based bilingual activation among different-script bilinguals?
Authors: JIANG NAN
Published: June 2018

Multilink developed by Dijkstra et al. (2018) is a computational model of monolingual and bilingual lexical access in comprehension and production. The non-selective activation of a bilingual's two languages is handled in the model by assuming that bilinguals have an integrated lexicon and that orthographic overlap between the input and the lexical representation drives lexical activation. Hence, an orthographic unit such as the letter T may activate words from multiple languages that contain the letter, resulting in simultaneous activation of multiple languages. This basic mechanism for explaining non-selective activation is similar between Multilink and its predecessors BIA and BIA+.
Integrated primary care: patient perceptions and the role of mental health stigma
Authors: Miller-Matero Lisa R. , Khan Shehryar , Thiem Rachel , DeHondt Tiffany , Dubaybo Hala , Moore Daniel
Published: June 2018

Some patients are more willing to see a behavioral health provider within primary care. The purpose of this study was to evaluate the patients’ perspectives of having access to a psychologist within primary care and to investigate whether mental health stigma affected preferences. In total, 36 patients completed questionnaires after seeing a psychologist in primary care. Patients were satisfied with having a primary care psychologist involved in their care. Most patients were more likely to see the psychologist in primary care and those who preferred this indicated higher levels of mental health stigma. The overarching theme for why patients saw a psychologist in primary care was convenience. Mental health stigma may also have played a role. Results suggest that providing integrated services may reach patients who may not have otherwise sought services in a behavioral health clinic. Findings from this study encourage the continued integration of behavioral health services.
Monitoring mechanisms designed to serve persons with intellectual disabilities: exploring the implementation of Article 16 CRPD in Cyprus
Authors: Kakoullis Emily Julia
Published: June 2018

In its concluding observations for Cyprus, the UN Convention on the Rights of Persons with Disabilities (CRPD) Committee stated that it ‘is concerned about the insufficiency of legal provisions and accessible mechanisms to detect, report, prevent and combat all forms of violence’.1This paper focuses on the independent monitoring obligation Article 16(3) CRPD places on states parties, and discusses the implications of the insufficient implementation of Article 16(3) as it affects adults with intellectual disabilities in Cyprus. It examines the existing monitoring frameworks, explains why they do not meet with Article 16(3) CRPD requirements and explores the relationship of the national human rights institutions (NHRIs) with Article 16(3). This paper enables understanding as to how, despite pre-existing monitoring frameworks in place, no independent monitoring action has been taken since the ratification of the CRPD. It argues that there is an immediate need for measures to achieve the implementation of Article 16(3) and makes recommendations for Cyprus and other states parties.
Dayside Magnetospheric and Ionospheric Responses to a Foreshock Transient on 25 June 2008: 2. 2‐D Evolution Based on Dayside Auroral Imaging
Authors: Wang Boyi , Nishimura Yukitoshi , Hietala Heli , Shen Xiao‐Chen , Shi Quanqi , Zhang Hui , Lyons Larry , Zou Ying , Angelopoulos Vassilis , Ebihara Yusuke , Weatherwax Allan
Published: June 2018

The foreshock region involves localized and transient structures such as foreshock cavities and hot flow anomalies due to solar wind‐bow shock interactions, and foreshock transients have been shown to lead to magnetospheric and ionospheric responses. In this paper, the interaction between a foreshock transient and the magnetosphere‐ionosphere system is investigated using dayside aurora imagers revealing structures and propagation in greater detail than previously possible. A foreshock transient was detected by Time History of Events and Macroscale Interactions during Substorms B and C during 1535–1545 UT on 25 June 2008. Time History of Events and Macroscale Interactions during Substorms A, D, and E observed magnetopause compression, cold plasma enhancement, and ultralow frequency waves in the dayside magnetosphere. The all‐sky imager at South Pole observed that both diffuse and discrete aurora brightened locally soon after the appearance of this foreshock transient. The diffuse aurora brightening, which corresponded to a region a few Re size in geocentric solar magnetospheric Y in the equatorial plane, propagated duskward with an average speed of ~100 km/s. Soon after the diffuse aurora brightened, discrete aurora also brightened and extended duskward, which was consistent with the motion of the foreshock transient as it swept through the magnetosheath while impacting the magnetopause. Equivalent horizontal currents measured by magnetometers revealed a pair of field‐aligned currents moving duskward consistent with motion of the discrete aurora patterns. We conclude that the high‐resolution and two‐dimensional observation of auroral responses by ground‐based all‐sky imager can help to estimate the evolution and propagation of upstream foreshock transients and their substantial impacts on the magnetosphere‐ionosphere coupling system, including magnetospheric compression and currents in the ionosphere.
Magnetically Controlled Density Structures in the Martian Ionosphere: Are they Stably Recurring?
Authors: Mohanamanasa P. , Venkateswara Rao N. , Yaswanth Ch. , Rao S. V. B.
Published: June 2018

MARSIS instrument aboard the Mars Express spacecraft regularly detects the magnetically controlled density structures (MCDSs) in the Martian ionosphere. In this paper, we studied the recurrence characteristics of these MCDSs using long‐term (more than a decade) MARSIS observations over a selected region of 35° to 40° longitude and −10° to 10° latitude, where a strong magnetic anomaly is present. Instead of a conventional echogram analysis, we used the peak density echogram analysis as the latter is able to consider all the vertical and oblique echoes even if their peak densities are varying. The results of the present study show that MCDSs are in fact formed persistently on all dayside periapsis passes. More importantly, there are discontinuities in the hyperbola shape in a peak density echogram display that appear at different locations on different orbital passes. In addition, the apices of the hyperbolas associated with an MCDS are observed at different latitudes on different orbital passes. From these results, we infer that the locations and shapes of MCDSs are disturbed by some time‐varying external factors so that some parts of the MCDS cannot give specular reflections. These hypotheses were demonstrated with some simple ray propagation simulations. Nearly similar features are observed with the nightside MCDS, but they occur only 60% of the passes. We surmise that wave dynamics associated with tides and gravity waves and so forth might be responsible for altering the shape and location of MCDS, both on the dayside and nightside.
Tracking the Strength of the Walker Circulation With Stable Isotopes in Water Vapor
Authors: Dee Sylvia G. , Nusbaumer Jesse , Bailey Adriana , Russell James M. , Lee Jung‐Eun , Konecky Bronwen , Buenning Nikolaus H. , Noone David C.
Published: June 2018

General circulation models (GCMs) predict that the global hydrological cycle will change in response to anthropogenic warming. However, these predictions remain uncertain, in particular, for precipitation (Intergovernmental Panel on Climate Change, 2013, https://doi.org/10.1017/CBO9781107415324.004). Held and Soden (2006, https://doi.org/10.1175/JCLI3990.1) suggest that as lower tropospheric water vapor concentration increases in a warming climate, the atmospheric circulation and convective mass fluxes will weaken. Unfortunately, this process is difficult to constrain, as convective mass fluxes are poorly observed and incompletely simulated in GCMs. Here we demonstrate that stable hydrogen isotope ratios in tropical atmospheric water vapor can trace changes in temperature, atmospheric circulation, and convective mass flux in a warming world. We evaluate changes in temperature, the distribution of water vapor, vertical velocity (ω), advection, and water isotopes in vapor (δDV). Using water isotope‐enabled GCM experiments for modern versus high‐CO2 atmospheres, we identify spatial patterns of circulation change over the tropical Pacific. We find that slowing circulation in the tropical Pacific moistens the lower troposphere and weakens convective mass flux, both of which impact the δD of water vapor in the midtroposphere. Our findings constitute a critical demonstration of how water isotope ratios in the tropical Pacific respond to changes in radiative forcing and atmospheric warming. Moreover, as changes in δDV can be observed by satellites, our results develop new metrics for the detection of global warming impacts to the hydrological cycle and, specifically, the strength of the Walker circulation.