Best clinical practice with ziprasidone IM: update after 2 years of experience

Acute agitation is a common psychiatric emergency often treated with intramuscular (i.m.) medication when rapid control is necessary or the patient refuses to take an oral agent. Conventional i.m. antipsychotics are associated with side effects, particularly movement disorders, that may alarm patients and render them unreceptive to taking these medications again. Ziprasidone (Geodon) is the first second-generation, or atypical, antipsychotic to become available in an i.m. formulation. Ziprasidone IM was approved by the Food and Drug Administration in 2002 for the treatment of agitation in patients with schizophrenia. In October 2004, a roundtable panel of physicians with extensive experience in the management of acutely agitated patients met to review the first 2 years of experience with this agent. This monograph, a product of that meeting, discusses clinical experience to date with ziprasidone IM and offers recommendations on its use in various settings. In clinical trials, patients treated with ziprasidone IM demonstrated significant and rapid (within 15-30 minutes) reduction in agitation and improvement in psychotic symptoms, agitation, and hostility to an extent greater than or equal to that attained with haloperidol i.m. Tolerability of ziprasidone IM was superior to that of haloperidol IM, with a lower burden of movement disorders. Clinical trials have also shown that ziprasidone IM can be administered with benzodiazepines without adverse consequences. Transition from i.m. to oral ziprasidone has been well tolerated, with maintenance of symptom control. The most common adverse events associated with ziprasidone IM were insomnia, headache, and dizziness in fixed-dose trials and insomnia and hypertension in flexible-dose trials. No consistent pattern of escalating incidence of adverse events with escalating ziprasidone doses has been observed. Changes in QTc interval associated with ziprasidone at peak serum concentrations are modest and comparable to those seen with haloperidol IM. Results of randomized clinical trials of ziprasidone IM have been corroborated in studies in real-world treatment settings involving patients with extreme agitation or a recent history of alcohol or substance abuse. In these circumstances, clinically significant improvement was seen within 30 minutes of ziprasidone IM administration, without regard to the suspected underlying etiology of agitation. Agents with a good safety/tolerability profile, such as ziprasidone IM, may be more cost effective long term than older agents, due to reduced incidence of acute adverse effects (eg, acute dystonia) that often require extended periods of observation. Additional trials of ziprasidone IM in agitated patients in a variety of clinical setting are warranted to generate comparative risk/benefit data with conventional agents and other second-generation antipsychotics.     

Parietal lobe contributions to episodic memory retrieval

Although the parietal lobe is not traditionally thought to support declarative memory, recent event-related fMRI studies of episodic retrieval have consistently revealed a range of memory-related influences on activation in lateral posterior parietal cortex (PPC) and precuneus extending into posterior cingulate and retrosplenial cortex. This article surveys the fMRI literature on PPC activation during remembering, a literature that complements earlier electroencephalography data. We consider these recent memory-related fMRI responses within the context of classical ideas about parietal function that emphasize space-based attention and motor intention. We conclude by proposing three hypotheses concerning how parietal cortex might contribute to memory.     

Genetic influences on language impairment and phonological short-term memory

It has been known for some years that specific language impairment (SLI), an unexpected failure to acquire age-appropriate language skills, is highly heritable. However, molecular genetic studies have been hampered by the heterogeneity of the disorder and the predominant lack of clear genotype-phenotype relationships. We review recent studies suggesting that a better understanding of the genetics of SLI might emerge if we move away from clinical criteria for diagnosis to look instead at a theoretically based quantitative and cognitive measure of the phenotype: a test of phonological short-term memory (STM). Deficient phonological STM has been linked to specific genetic loci, and might play a role in determining some types of reading impairment as well as SLI. Identifying those cognitive deficits that work best as indices of heritable phenotypes will help us to uncover the aetiology of developmental disorders.     

Social anxiety in body dysmorphic disorder

Although clinical impressions suggest that patients with body dysmorphic disorder (BDD) experience distress in social situations, social anxiety in BDD has received little investigation. This study examined social anxiety in 81 patients with BDD and change in social anxiety with pharmacotherapy. Subjects completed the Social Avoidance and Distress Scale (SADS) and were assessed with measures of BDD symptomatology. Participants in a placebo-controlled fluoxetine trial completed measures at baseline and endpoint. The mean SADS score was 1.3 SD units higher than nonclinical sample means but consistent with other clinical sample means. Social anxiety was significantly correlated with BDD severity. Greater depressive symptoms as well as comorbid avoidant personality disorder, but not comorbid social phobia, were also associated with higher SADS scores. Social anxiety did not improve more with fluoxetine than placebo, yet it improved significantly more in fluoxetine responders than in nonresponders. Understanding social anxiety in BDD has implications for reducing rates of misdiagnosis and treatment dropout.     

Differences in heaviness in relation to density and weight

Eight Ss (Group L) judged differences in heaviness between all pairs of stimuli in three series of five weights each, in the range of 100–300 g, presented randomly. Series L varied in weight and density, Series LVW varied only in weight, and Series LVD varied only in density. Another eight Ss (Group H) judged heaviness differences between all pairs of stimuli in three similar series (H, HVW, and HVD) in the range 700–900 g. Differences in density alone yielded relatively greater impressions of difference in heaviness in Group H than in Group L. Predictions from Ross and Di Lollo’s vector theory were confirmed.     

A consistent failure of the power law for lifted weight

The apparent size of squares was determined as a function of physical area and of surface complexity using the method of magnitude estimation. Apparent area increases as a power function of physical area with a slope of about 0.90. The judged areas also increased as a function of complexity of patterns upon the surface, the most complex surfaces being judged approximately 30% larger than the most simple surfaces.     

Videtur Quod: On Method in Theology

Abstract: Theological language has always faced a fundamental dilemma: it seeks to put the divine reality into limited human language. While this dilemma can obfuscate our theological pathways, it can also generate a new awareness of the task and possibilities of the discipline. New testimonials, or uniquely accented human experiential utterances, have emerged in theological discourse in the past decades, greatly increasing our vision of the expansiveness of theology. The tools for integration into systematic or discursive development are still, however, lacking. This article suggests that an extension of the innovative methodology of Thomas Aquinas, beginning and ending with ‘what seems’ to be the case, putting testimony into discursive forms, and testing for a fittingness with the mysterious and excessive mystery of the divine reality, offers a promising path for discerning common and trustworthy theological language.     

Projection in the Face of Centrism: Voter Inferences About Candidates' Party Affiliation in Low-Information Contexts

When are voters more likely to project their own political position onto a candidate for office? We investigate this question by examining the assumed partisanship of a (self-declared) centrist politician, using data from a survey experiment fielded in Canada, the United Kingdom, and the United States. In doing so, we build on the social categorization model as well as recent U.S.-focused political science research on projection and ingroup/outgroup racial divides—extending our analysis to incorporate racial and class similarities/differences across three countries where these divides likely vary in salience. We thus seek: (1) to contribute to research on the inferences citizens draw in nonpartisan elections and low-information contexts generally and (2) to highlight some potential methodological complications of using partisanship-less candidates in vignette experiments. Results suggest that even in the face of a self-declared centrist, voters from across the political spectrum tended to assume shared partisanship in Canada, the United Kingdom, and the United States. Examining projection by ingroup/outgroup divisions indicated that class appears to shape projection across all three countries, but that the racial divide only mattered in the United States. Finally, we also find evidence of counterprojection toward outgroup members—but once again only in the American context.     

The influence of types of character on processing background information in narrative discourse

The background sentenceThe air was cold and clammy depicts setting information which may or may not be of significance to a given character in a narrative. We tested the hypothesis that such information is processed with respect to the main character in a narrative rather than with respect to a secondary character. In Experiment 1, subjects making attributions of awareness of such background states were more likely to attribute such awareness to main than to secondary characters. In Experiment 2, using self-paced reading, we showed that such information is more important for main than for secondary characters during reading. Thus, unattached background information is processed with respect to main characters. This bias provides a source of control over the processing necessary to establish a coherent representation during the reading of narratives. Experiment 3 eliminated the possibility that the effects were due to generally shallower processing of sentences centered on secondary characters.