[Clozapine-Associated Neuroleptic Malignant Syndrome Followed by Catatonia: A Case Report].

[Clozapine-associated neuroleptic malignant syndrome followed by catatonia: a case report].

Turk Psikiyatri Derg. 2013; 24(2): 140-4
Erol A, Putgül G, Sert E, Mete L

Neuroleptic malignant syndrome (NMS) is a rare life-threatening condition associated with the use of antipsychotics and other drugs that influence dopaminergic transmission. Although NMS is typically associated with classical antipsychotics, it can also be induced by atypical antipsychotics. In this paper, we report a case of NMS associated with clozapine use.A 27-year-old male was diagnosed as schizophrenia in 2006 and zuclopenthixol depot was administered parenterally. Following the second injection, NMS was diagnosed and he was switched to clozapine. After 4 years of clozapine use, one day, he suddenly stopped eating, stayed in bed all day, and had incontinence. Upon examination at our hospital the patient had muscle rigidity, high fever, leukocytosis, and a high creatine phosphokinase level, and NMS was diagnosed. He was put on bromocriptine. NMS resolved, but psychotic relapse and catatonia developed. 10 sessions of electro convulsive treatment (ECT) were administered. Quetiapine 25 mg/day was introduced and titrated up to 600 mg/day afterwards. He has been using quetiapine 600 mg/day for 18 months and at the time this manuscript was written has not had any signs of psychosis or NMS.NMS is usually induced by the use of agents with high dopaminergic affinity. Incomplete or extraordinary NMS cases have been reported due to clozapine and atypical antipsychotics. The presented case is noteworthy due to the complete and typical presentation of NMS. It should always be kept in mind that all atypical antipsychotics including clozapine have the probability to induce NMS although not common. HubMed – eating


[Self-efficacy and hemodialysis treatment: a qualitative and quantitative approach].

Turk Psikiyatri Derg. 2013; 24(2): 84-93
Boothby MR, Salmon P

The theoretically driven approach to the measurement of self-efficacy fails to capture the challenges that hemodialysis patients experience in following their dietary and fluid restrictions.A combination of qualitative and quantitative research is necessary to identify the range of challenges associated with these restrictions and to quantify them if clinicians are to be guided in their consultations with patients. In this study the construct of self-efficacy was grounded on the basis of challenges to dietary and fluid restrictions, and the findings were used to develop a questionnaire to quantify the patients’ perceptions of their ability to overcome each challenge.The sample for the qualitative study consisted of 16 hemodialysis patients and the quantitative study included 156 hemodialysis patients.The qualitative findings showed that the patients experienced a range of specific challenges to dietary and fluid restrictions. Among these were practical constraints, being with others, the view of hemodialysis as compensating for dietary non-compliance, and emotional challenges including discomfort, distress, and boredom with dietary and fluid restrictions. The most common challenge to fluid restrictions was eating while not having any fluid allowance left. Boredom with diet was the most common challenge to diet. Hemodialysis treatment was a justification for a significant number of patients to neglect their dietary and fluid restrictions.The findings suggest that grounded self-efficacy is a unitary phenomenon, but that it incorporates a wide spectrum of specific challenges. The challenges identified herein have provided an evidence base for educational interventions to improve compliance with dietary and fluid restrictions. HubMed – eating


Association Between District and State Policies and US Public Elementary School Competitive Food and Beverage Environments.

JAMA Pediatr. 2013 Jun 10; 1-9
Chriqui JF, Turner L, Taber DR, Chaloupka FJ

IMPORTANCE Given the importance of developing healthy eating patterns during early childhood, policies to improve the elementary school food and beverage environments are critical. OBJECTIVE To examine the association between district and state policy and/or law requirements regarding competitive food and beverages and public elementary school availability of foods and beverages high in fats, sugars, and/or sodium. DESIGN AND SETTING Multivariate, pooled, cross-sectional analysis of data gathered annually during elementary school years 2008-2009 through 2010-2011 in the United States. PARTICIPANTS Survey respondents at 1814 elementary schools (1485 unique) in 957 districts in 45 states (food analysis) and 1830 elementary schools (1497 unique) in 962 districts and 45 states (beverage analysis). EXPOSURES Competitive food and beverage policy restrictions at the state and/or district levels. MAIN OUTCOME AND MEASURE Competitive food and beverage availability. RESULTS Sweets were 11.2% less available (32.3% vs 43.5%) when both the district and state limited sugar content, respectively. Regular-fat baked goods were less available when the state law, alone and in combination with district policy, limited fat content. Regular-fat ice cream was less available when any policy (district, state law, or both) limited competitive food fat content. Sugar-sweetened beverages were 9.5% less available when prohibited by district policy (3.6% vs 13.1%). Higher-fat milks (2% or whole milk) were less available when prohibited by district policy or state law, with either jurisdiction’s policy or law associated with an approximately  15% reduction in availability. CONCLUSIONS Both district and state policies and/or laws have the potential to reduce in-school availability of high-sugar, high-fat foods and beverages. Given the need to reduce empty calories in children’s diets, governmental policies at all levels may be an effective tool. HubMed – eating


Outcomes of an Early Feeding Practices Intervention to Prevent Childhood Obesity.

Pediatrics. 2013 Jun 10;
Daniels LA, Mallan KM, Nicholson JM, Battistutta D, Magarey A

OBJECTIVE:The goal of this study was to evaluate outcomes of a universal intervention to promote protective feeding practices that commenced in infancy and aimed to prevent childhood obesity.METHODS:The NOURISH randomized controlled trial enrolled 698 first-time mothers (mean ± SD age: 30.1 ± 5.3 years) with healthy term infants (51% female) aged 4.3 ± 1.0 months at baseline. Mothers were randomly allocated to self-directed access to usual care or to attend two 6-session interactive group education modules that provided anticipatory guidance on early feeding practices. Outcomes were assessed 6 months after completion of the second information module, 20 months from baseline and when the children were 2 years old. Maternal feeding practices were self-reported by using validated questionnaires and study-developed items. Study-measured child height and weight were used to calculate BMI z scores.RESULTS:Retention at follow-up was 78%. Mothers in the intervention group reported using responsive feeding more frequently on 6 of 9 subscales and 8 of 8 items (all, P ? .03) and overall less controlling feeding practices (P < .001). They also more frequently used feeding practices (3 of 4 items; all, P < .01) likely to enhance food acceptance. No statistically significant differences were noted in anthropometric outcomes (BMI z score: P = .10) nor in prevalence of overweight/obesity (control 17.9% vs intervention 13.8%; P = .23).CONCLUSIONS:Evaluation of NOURISH data at child age 2 years found that anticipatory guidance on complementary feeding, tailored to developmental stage, increased use by first-time mothers of "protective" feeding practices that potentially support the development of healthy eating and growth patterns in young children. HubMed – eating