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Abstract Introduction The prevalence of neurological disorders is high among the Mexican population. Clonazepam is primarily indicated to treat panic disorders, certain kinds of epilepsy such as status epilepticus, childhood motor seizures (petit mal absence, Lennox–Gastaut syndrome, and infantile spasms), anxiety, and muscle spasm. This study was performed to compare bioequivalence between two oral tablet formulations of clonazepam 2 mg in healthy Mexican volunteers under fasting conditions. Methods This phase I, randomized, open-label, two-treatment, crossover study included 30 healthy volunteers. Subjects were randomly assigned to either test or reference formulation of clonazepam 2 mg. Each study period was separated by 21-day washout period. Blood samples were collected at pre-dose and up to 72 h after drug administration. Clonazepam concentrations were determined using a validated ultra-flow liquid chromatography–tandem mass spectrometric method. Pharmacokinetic parameters were determined using a non-compartmental method. Two formulations were considered bioequivalent if geometric mean ratios (test/reference) were between 80% and 125%. Safety was evaluated by recording adverse events. Results Pharmacokinetic parameters were comparable between test and reference formulations. The mean maximum plasma concentration (C max) was ≈ 13 ng/mL, area under the plasma concentration–time curve from time 0 to last measurable concentration (AUC0–t ) was ≈ 360 ng h/mL, time to reach maximum plasma concentration (T max) was ≈ 3 h, and elimination half-life (t 1/2) was ≈ 43 h. Geometric mean ratios (90% confidence interval) of C max (99.2–115.3%), AUC0–t (100.6–110.6%), and AUC0–∞ (98.5–111.6%) were within the bioequivalence range. Seven non-serious adverse events (mostly asymptomatic hypotension) were recorded. Conclusion The test and reference formulations of clonazepam 2 mg were bioequivalent and well tolerated in healthy Mexican volunteers under fasting conditions. Protocol Authorization Number 213301410B0051 (Approved on April 13, 2021).

Background: Anxiety refers to the pathological persistence and intensification of emotional responses to danger, affecting health from psychological and physical aspects. Serotonin is an important neurotransmitter involved in the onset of anxiety. Methods and Results: To explore the biological changes in the formation of anxiety in crustaceans under the regulation of serotonin, we applied the open field-like test method for assessing anxiety states of larval Portunus trituberculatus, a highly aggressive crustacean species with a more simple neural structure compared with rodents and mammals. Compared with the control group, serotonin treatment resulted in a significant decrease in the time spent by the larvae in the central zone, suggesting anxiety-like behavior. Clonazepam treatment reversed this result and provided further evidence that the behavior of larval P. trituberculatus displayed anxiety. Moreover, a non-targeted metabolomic analysis found a significant alteration in the metabolites involved in tryptophan metabolism pathways associated with anxiety, including L-kynurenine, N-acetyl serotonin, and serotonin. These metabolites are involved in the serotonin pathway, the kynurenine pathway, and other pathways that affect anxiety through tryptophan metabolism. There were no significant differences in tryptophan metabolism levels between the control and clonazepam treatment groups. Conclusions: Our results demonstrate the possible existence of anxiety-like behavior in the larvae of P. trituberculatus from two perspectives. Being a species with a simpler neural structure than that of mammals, the larvae of P. trituberculatus offer a convenient model for studying the mechanisms of anxiety in crustaceans.

Abnormal and excessive desire to smell certain odors or objects (desiderosmia) is reported to be seen with iron deficiency anemia. We present here four cases of desiderosmia in diagnosed patients of major depressive disorder without iron deficiency, where treatment of depression was associated with improvement in abnormal craving. [ABSTRACT FROM AUTHOR]

Sleep-related eating disorder (SRED) is a non-REM parasomnia with potentially significant negative effects on general health (dangerous activities during night eating episodes, obesity, or metabolic syndrome, for example). Although the history of SRED encompasses more than six decades, public awareness and even the awareness of the mental health specialists of this disorder is very limited, a phenomenon that hinders the development of research in this field. Therefore, a systematic review based on PRISMA 2020 guidelines explored the available evidence for SRED found in four electronic databases (PubMed, Cochrane Collaboration, Google Scholar, and Clarivate/Web of Science). A number of 94 primary and secondary reports were retrieved, investigating aspects regarding the risk factors, epidemiology, clinical data and differential diagnosis, epidemiology, structured evaluation, and treatment of SRED. Based on the results of these reports, Z-drugs, but also certain benzodiazepines, antidepressants, antipsychotics, and psychostimulants may trigger the onset of SRED. Psychiatric and neurologic disorders have also been associated with SRED, either as risk factors or comorbid conditions. Cerebral glucose metabolism dysfunctions, neurotransmitter dysfunctions, and genetic factors have been invoked as pathogenetic contributors. Structured assessment of SRED is possible, but there is a dearth of instruments dedicated to this purpose. Data on the prevalence and treatment of SRED exist, but good-quality epidemiological studies and clinical trials are still missing. In conclusion, future research is expected to address the shortcomings of SRED exploration by creating the conditions for better quality and larger group clinical research. The need for such investigation is granted by the importance of this pathology and its negative functional consequences.

A young man from Pakistan had his first-ever tonic-clonic seizure while playing cricket. Since age 12 years, he had reported involuntary jerks and tremulousness, sometimes with falls, particularly with bright lights. Family history included a brother who developed seizures with myoclonus in his mid-20s and parental consanguinity. Developmental history was normal. Examination identified cognitive impairment with action myoclonus. His clinical presentation raised suspicion of a progressive myoclonus epilepsy. MR scan of the brain showed white matter changes suggesting leucodystrophy with cortical atrophy. Electroencephalogram showed generalised epileptiform abnormalities with photoparoxysmal responses, including at low frequencies (1 Hz). Cortical hyperexcitability was confirmed with giant median somatosensory evoked potentials and long loop reflexes at rest. Multichannel electromyography showed action myoclonus with variable synchronous and asynchronous agonist and antagonist muscle activation with short-burst duration of 25-75 ms, and jerk-locked back-averaging showed premyoclonic potentials consistent with cortical myoclonus. Genetic sequencing identified a homozygous missense variant in the CLN6 gene (c.768C>G p. (Asp256Glu), confirming Kufs disease type A. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of neurological disorders is high among the Mexican population. Clonazepam is primarily indicated to treat panic disorders, certain kinds of epilepsy such as status epilepticus, childhood motor seizures (petit mal absence, Lennox–Gastaut syndrome, and infantile spasms), anxiety, and muscle spasm. This study was performed to compare bioequivalence between two oral tablet formulations of clonazepam 2 mg in healthy Mexican volunteers under fasting conditions. Methods: This phase I, randomized, open-label, two-treatment, crossover study included 30 healthy volunteers. Subjects were randomly assigned to either test or reference formulation of clonazepam 2 mg. Each study period was separated by 21-day washout period. Blood samples were collected at pre-dose and up to 72 h after drug administration. Clonazepam concentrations were determined using a validated ultra-flow liquid chromatography–tandem mass spectrometric method. Pharmacokinetic parameters were determined using a non-compartmental method. Two formulations were considered bioequivalent if geometric mean ratios (test/reference) were between 80% and 125%. Safety was evaluated by recording adverse events. Results: Pharmacokinetic parameters were comparable between test and reference formulations. The mean maximum plasma concentration (Cmax) was ≈ 13 ng/mL, area under the plasma concentration–time curve from time 0 to last measurable concentration (AUC0–t) was ≈ 360 ng h/mL, time to reach maximum plasma concentration (Tmax) was ≈ 3 h, and elimination half-life (t1/2) was ≈ 43 h. Geometric mean ratios (90% confidence interval) of Cmax (99.2–115.3%), AUC0–t (100.6–110.6%), and AUC0–∞ (98.5–111.6%) were within the bioequivalence range. Seven non-serious adverse events (mostly asymptomatic hypotension) were recorded. Conclusion: The test and reference formulations of clonazepam 2 mg were bioequivalent and well tolerated in healthy Mexican volunteers under fasting conditions. Protocol Authorization Number: 213301410B0051 (Approved on April 13, 2021). [ABSTRACT FROM AUTHOR]

Background: Masturbation is a self-stimulating pleasurable behavior of the child, which occurs between the ages of 3 months and 5 years. Clonazepam was recorded to reduce the frequency of sexual behavior during sleep. Objective: This study aimed to investigate the benefits of adding clonazepam to the general behavioral treatment of infantile and childhood masturbation. Patients and Methods: This was randomized controlled trails (RCTs) conducted on a total number of 52 infants and pre-adolescent children with masturbation attending the Neurology Outpatient Clinic in Mansoura University Children Hospital (MUCH). Patients were classified into 2 groups: Group on behavioral therapy and clonazepam and group on behavioral therapy only. The response was observed in both groups as regards the frequency after treatment and duration till complete response Results: Masturbation was common among females, and cases with moderate socioeconomic level. Combined therapy was associated with a significant improvement in response compared to behavioral therapy only. Conclusion: Combined behavioral therapy and clonazepam is more effective and superior to behavioral therapy alone in ameliorating masturbation phenomena in infants and children. [ABSTRACT FROM AUTHOR]

In a recent survey of 16,694 people receiving treatment for Restless Legs Syndrome (RLS), approximately 25% were treated with benzodiazepines either singly or in combination with other RLS treatments. Because of the large number of people receiving benzodiazepines for treatment of RLS, we conducted a historical overview of the therapeutic role of benzodiazepines in RLS and its associated condition Periodic Limb Movements in Sleep (PLMS). We found 17 articles on the use of clonazepam in RLS, PLMS, or both, 3 on triazolam and PLMS, 1 on alprazolam and RLS, 1 on temazepam and PLMS, and 1 on nitrazepam and PLMS. The order of benefit of benzodiazepines from the summarized literature is Sleep>RLS>PLMS and arousals > PLMS. Most of the studies on clonazepam employed dosages of 0.5–2.0 mg. Dosages of 3 or 4 mg caused lethargy, somnolence and confusion. An epidemiological study on the therapy of RLS suggests that treatment of RLS with most types of RLS medications including benzodiazepines in combination with other RLS therapies lowers the future cardiovascular risk associated with RLS. The major effect of benzodiazepines is through potentiation of the effect of GABA on the GABA A receptor. Neuroimaging studies suggest that GABA is altered either positively or negatively in various brain regions in RLS and genetic studies suggest that there are alterations in the GABA receptor in RLS. These results suggest that medications with different GABAergic mechanisms such as tiagabine (Gabitril) or others should be investigated in RLS for their possible therapeutic benefit. Highlights: Benzodiazepines are frequently used as therapy in Restless Legs Syndrome (RLS) and Periodic Limb Movements in Sleep. The order of benefit is Sleep>RLS>PLMS and arousals > PLMS. For clonazepam dosages of 0.5 mg–2.0 mg/day are most frequently employed. Benzodiazepines exert their therapeutic effect through GABA-ergic mechanisms. [ABSTRACT FROM AUTHOR]

Ocular flutter (OF) is a rare oculomotor syndrome. The most common etiologies are paraneoplastic, postinfectious and toxic-metabolic. However post-vaccinal etiology was rarely reported in OF. Here, we reported a post-vaccinal clinical syndrome characterized by OF-myoclonus and ataxia associated with oligoclonal bands (OCBs). A 60-year-old male who presented with dizziness, unsteady gait, involuntary movements, involuntary conjugate eye oscillations and extremity jerks that started 3 days after the second dose of mRNA BNT162b2 Covid-19 vaccine. Routine biochemical and serological analysis were within normal limits. No pathological finding was detected in brain MRI. Paraneoplastic and autoimmune encephalitis tests were unremarkable in cerebrospinal fluid (CSF). Oligoclonal band s were positive in CSF. This is the first description of the relationship between vaccines against SARS-CoV-2 and the clinical syndrome of OF, Myoclonus and Ataxia (OFMAS). Humoral immune mechanisms seem to play an important role in OFMAS. Presence of OCBs in CSF may also be associated with this condition. [ABSTRACT FROM AUTHOR]

Confusional arousal, classified under parasomnias, is a condition in which patients exhibit wakeful behaviors while still apparently asleep. It may be associated with shouting or sleepwalking and usually lasts for a few minutes to several hours. Patients tend to have no memory of the occurrence of such episodes. We report two cases of confusional arousals, the first, a 15-year-old boy suffering from autism spectrum disorder, and the second, a 10-year-old boy, with no other significant history.

Crossing the Blood Brain Barrier constitutes a challenge in drug administration to the brain. In this context, nose-to-brain delivery is explored as an alternative route in the treatment of central nervous system disorders, and nanotechnology constitutes a promising tool for drug delivery to the brain. In this work, we explored niosomes and chitosan-coated niosomes (chitosomes) as possible tools for nose-to-brain delivery of clonazepam. The formulations have been optimised using different chitosan concentrations and different preparation methods as Thin Layer Evaporation-paddle (TLE-P), Evaporation (E), and Solvent Displacement Technique (SDT). The most suitable formulations were loaded with clonazepam (CLZ) and a full physicochemical characterization was performed. Chitosomes presented a size of around 200 nm, PDI < 0.3, a positive surface charge, spherical shape and a CLZ encapsulation above 60%. Chitosomes were stable for 12 weeks under storage conditions at 4ºC, in simulated nasal fluid for 24 h as well as after a lyophilization-sonication process. A CLZ release of 50% was also achieved after 4 h in this media. The mucoadhesive properties of chitosomes were also confirmed, with a 1.5-fold reduction of CLZ toxicity after encapsulation and a 10-fold increase of its permeability.

The study aims to present a case of atypical poisoning with lithium carbonate in a 57-yearold woman treated for bipolar affective disorder with lithium carbonate for about 30 years. The patient was admitted to the hospital with significant agitation. An important finding obtained from the family interview was the patient's significant weight loss over the past year. In the hospital, the patient received haloperidol and clonazepam. Laboratory tests showed a very high blood lithium concentration of 3.79 mmol/l (N: 0.6-1.2 mmol/l) and elevated serum concentrations of creatinine (3.6 mg/dl) and urea (110 mg/dl). The patient was transferred to the toxicology department, where hemodialysis was performed and intensive treatment initiated. Despite the rapid decrease in lithium levels, her condition gradually deteriorated. The patient died on the fifth day of hospitalization. The autopsy revealed polycystic kidney disease (PKD). During the preparation of the medico-legal report on the correctness of the medical treatment, it was assumed that the cause of death was lithium carbonate poisoning in the course of advanced chronic kidney disease due to PKD, probably a consequence of long-term lithium therapy. The analysis of medical records revealed that despite her psychiatrist's recommendation, the patient had been refusing the monitoring of lithium levels for the past 18 years. This case demonstrates that both psychiatrists and toxicologists should be aware of possible lithium poisoning upon the deterioration of renal function. Therefore, assessment of renal function should be an integral part of lithium therapy monitoring. [ABSTRACT FROM AUTHOR]

Objective: The current study aimed to compare the impact of acupressure and clonazepam tablets on the quality of sleep in hemodialysis patients in light of the rising prevalence of chronic kidney disease (CKD), the high prevalence of sleep disturbance in these patients, and the side effects of hypnotic drugs. Method: A total of 60 patients were selected for this randomized, controlled clinical trial and randomly assigned to two groups. For two weeks during the researcher's evening shift, one group received acupressure (six spots bilaterally for three minutes each day). The opposing group was administered clonazepam tablets (0.5 mg) for two weeks. The Pittsburgh Sleep Quality Index (PSQI), which measures sleep quality, was used to compare sleep in the two groups before and after the intervention. Results: There was no statistically significant difference between the two groups prior to the intervention (P = 0.75) in terms of the mean pre-intervention PSQI scores for the acupressure and clonazepam groups, which were 15.83 ± 1.51 and 16.17 ± 0.91, respectively. However, the average PSQI scores after the intervention in the clonazepam and acupressure groups were 13.25 ± 2.88 and 8.97 ± 4.29, respectively, indicating a statistically significant difference (P < 0.0001). Both the acupressure and the clonazepam groups showed improvements in their post-intervention sleep quality among the patients. However, when the percentage changed in the mean scores of the total score and all of the PSQI components were calculated for each group, it became clear that acupressure was more effective at enhancing sleep than clonazepam tablets. Conclusion: The findings of the present investigation demonstrate that acupressure has a greater impact on patients' sleep quality compared to clonazepam tablets. Depending on the circumstances, acupressure can be used as a simple, safe, and non-drug way to enhance hemodialysis patients' quality of sleep. [ABSTRACT FROM AUTHOR]

Summary: Among those who use of liver-enzyme inducing anticonvulsant medication for more than 2 years, 27% have a prevalent vertebral fracture on vertebral fracture assessment (VFA) lateral spine imaging. VFA imaging at the time of bone densitometry may be appropriate for older individuals who are chronic users of these medications. Purpose: It is unclear whether prevalent vertebral fractures are associated with use of anticonvulsant drugs, especially those that induce liver enzymes (LEI) that metabolize drugs and vitamin D. Our purpose was to estimate the prevalence of vertebral fracture on densitometric lateral spine images according to duration of prior anticonvulsant medication use. Methods: Our study population was 11,822 individuals (mean [sd] age 76.1 [6.8] years, 94% female) who had bone densitometry with VFA between 2010 and 2018. Cumulative prior exposure to LEI anticonvulsants (carbamazepine, phenobarbital, phenytoin, valproic acid, n = 538), non-LEI anticonvulsants (clonazepam, gabapentin, levetiracetam, others, n = 2786), and other non-clonazepam benzodiazepines (n = 5082) was determined using linked pharmacy records. Prevalent vertebral fractures were identified on VFA images using the modified ABQ method. Logistic regression models were used to estimate the association of anticonvulsant drug exposure with prevalent vertebral fractures. Results: Prevalence of one or more vertebral fractures was 16.1% for the entire analytic cohort, and 27.0%, 19.0%, and 18.5% for those with ≥ 2 years of prior LEI anticonvulsant use, non-LEI anticonvulsant use, and other benzodiazepine use, respectively. Adjusted for multiple covariates, use of prior LEI anticonvulsant medication for ≥ 2 years was associated with prevalent fracture on VFA (OR 1.48 [95% CI 1.04, 2.10]). Conclusion: LEI anticonvulsant use for ≥ 2 years is associated with higher vertebral fracture prevalence. Lateral spine VFA imaging at the time of bone densitometry may be appropriate for older individuals who have used LEI anticonvulsant medications for ≥ 2 years. [ABSTRACT FROM AUTHOR]

Biallelic variants in the Golgi SNAP receptor complex member 2 gene (GOSR2) have been reported in progressive myoclonus epilepsy with neurodegeneration. Typical clinical features include ataxia and areflexia during early childhood, followed by seizures, scoliosis, dysarthria, and myoclonus. Here, we report two novel patients from unrelated families with a GOSR2-related disorder and novel genetic and clinical findings. The first patient, a male compound heterozygous for the GOSR2 splice site variant c.336+1G>A and the novel c.364G>A,p.Glu122Lys missense variant showed global developmental delay and seizures at the age of 2 years, followed by myoclonus at the age of 8 years with partial response to clonazepam. The second patient, a female homozygous for the GOSR2 founder variant p.Gly144Trp, showed only mild fine motor developmental delay and generalized tonic–clonic seizures triggered by infections during adolescence, with seizure remission on levetiracetam. The associated movement disorder progressed atypically slowly during adolescence compared to its usual speed, from initial intention tremor and myoclonus to ataxia, hyporeflexia, dysmetria, and dystonia. These findings expand the genotype–phenotype spectrum of GOSR2-related disorders and suggest that GOSR2 should be included in the consideration of monogenetic causes of dystonia, global developmental delay, and seizures. [ABSTRACT FROM AUTHOR]

(1) Background: The use of benzodiazepines for the treatment of acute mania remains prevalent. This systematic review and meta-analysis provides an updated assessment of Clonazepam's antimanic efficacy, tolerability, and acceptability. (2) Methods: A systematic search of multiple databases and clinical trial registries was conducted, aiming to identify any controlled studies of Clonazepam vs. placebo or any other pharmacotherapy for the treatment of acute mania. Pairwise meta-analytic evaluations were performed. (3) Results: Six studies were included with a total number of 192 participants, all of which were randomized controlled trials. Clonazepam may be superior to a placebo in the acute phase of treatment and no different to Lithium and Haloperidol in terms of efficacy, both acutely and in the medium to long term. Clonazepam may be an acceptable and well-tolerated treatment for acute mania, especially when used as an augmentation strategy. Comparisons were underpowered, with minimal sample sizes and only one study per comparison in many cases, thus limiting the generalizability of our findings and hindering firm clinical conclusions. (4) Conclusions: Given the prevalence of benzodiazepine use in current practice, more and larger studies are urgently needed. [ABSTRACT FROM AUTHOR]

Background: Hemichorea and hemiballismus are rare movement disorders caused by central nervous system toxoplasmosis. Objective: To describe the case of a male patient with treatmentnaïve HIV who initiated with right hemichorea and hemiballismus. Case report: We present a 29-year-old male with a history of untreated HIV. He presented to the emergency room with rightsided hemichorea and hemiballismus. The neurological examination was unremarkable, except for the presence of abnormal movements characterized by non-rhythmic, large-amplitude, violent and occasionally choreiform movements in the right side of his body. Brain MRI revealed a ringenhancing lesion in the left basal nuclei, raising suspicion of CNS toxoplasmosis. Further serologic tests confirmed the diagnosis. Treatment was initiated with trimethoprim-sulfamethoxazole, pyrimethamine/clindamycin and antiretrovirals. Haloperidol, aripiprazole, and clonazepam were administered to alleviate abnormal movements. Subsequent MRI scans showed radiological improvement, and the patient was discharged. Conclusion: Hemichorea-hemiballismus is a neurological manifestation unfrequently related to CNS toxoplasmosis. Prompt initiation of antiretroviral therapy and antimicrobial treatment is crucial to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background SYNGAP1 is a significant genetic risk factor for global developmental delay, autism spectrum disorder, and epileptic encephalopathy. De novo loss-of-function variants in this gene cause a neurodevelopmental disorder, for example, early-onset and drug-refractory seizures. We report two children with global developmental delay and epileptic encephalopathy, which are caused by SYNGAP1 gene novel mutations, and drug treatment is effective. Case presentation We report a boy and a girl presented with global developmental delay when they were young babies; as they grew up, cognitive impairment and social-communication disorder became more and more prominent; unfortunately, the patients developed into various seizure types, including eyelid myoclonia, myoclonic and absences when the boy was 1 year 8 mouths old and the girl was 3 years old. The two patients were found two previously unknown mutations by high throughput sequencing [c.3271_ c.3272insT; (p.L1091L fs*62), c.2515A > T (p.K839*)] in exon 15 of the SYNGAP in the proband. Sanger sequencing confirmed the heterozygous nature, and neither of their parents carried the same mutation. The girl treated with valproic acid and prednisone became seizure-free, and valproic acid and levetiracetam combined with clonazepam were influential in the other. Conclusions The global developmental delay and epileptic encephalopathy of the children were probably due to the pathogenic mutation of the SYNGAP1 gene, and prednisone and clonazepam may be effective in achieving seizure-free.

Background: Globus is a feeling of a sensation of a lump in the throat. A variety of explanations (physical and psychological) have been proposed in its etiology, but it is nonspecific nature and high incidence makes a causative association hard to establish or refute. Objective: To associate the role of Anxiety in the etiology of globus pharyngeus. Materials and Methods: A prospective study was conducted in a rural private hospital in South India. One hundred and ninety-three patients with a sensation of lump in the throat were assessed after obtaining consent. A strict inclusion and exclusion criteria meant only 54 made it to the final study. A pan endoscopy was conducted to rule out local lesions. In each patient with absence of a local lesion, Hamilton-A Anxiety (HAM-A) Scale was issued for the levels of anxiety (values between 0 and 56) and the visual analog scale (VAS) for uneasiness experienced (values between 1 and 10) before and after 12-weeks treatment. Management included oral escitalopram and clonazepam. Results: At the end of the study, the average score for HAM-A Scale was 13.96 compared to 26.17 before treatment, an improvement of 46.65%. The average values before and after treatment in the VAS before and after treatment were 7.43 and 3.33, an improvement of 55.18%. Conclusion: In the absence of a local cause, the diagnosis of globus should be looked at from psychological viewpoints. Undiagnosed or untreated anxiety can cause globus and it is more commonly seen in women in the age group of 36–45 years. The P value was significant in this study where we treated anxiety leading to globus (

The electrochemical oxidation of clonazepam (CLNP) has been studied in presence of some aryl sulfinic acids as nucleophiles in aqueous buffered solution by means of cyclic voltammetry, and controlled- potential coulometry. Voltammetric studies of electrochemical behavior of clonazepam have also been investigated in different pH values (pH 1.0 to 10.0) in absence and presence of toluenesulfinic acid (1a) as well as benzenesulfinic acid (1b). The results indicated that peak current and peak potential depends on the level of pH. Finally, the synthetizing new sulfonamide derivatives was conducted through constant current electrolysis of clonazepam in presence of arylsulfinic acids at carbon rod electrodes, employing a green electrochemical protocol. CLNP which has cathodically produced hydroxylamine species is oxidized at the anode to generate nitroso species, participate in reaction with the arylsulfinic acids, converts it to the corresponding new sulfonamide derivatives. The new products have been characterized by IR, MS, 1H NMR and 13C NMR methods.

Nursing theories and conceptual models shape nursing knowledge. This study applied the philosophical and theoretical basis of the Neuman Systems Model, which focuses on the use of primary, secondary, and tertiary nursing prevention for retention, attainment, and maintenance of patient system wellness, to a patient with pre-existing mental health conditions struggling to cope with depression and COVID-19 in a dedicated COVID-19 hospital in an urban area of Iran. The single intrinsic case study design used interviews, nursing observations, and document analysis to evaluate environmental factors and intra-, inter-, and extra-personal stressors. An advanced, outcome-oriented nursing care plan was developed. [ABSTRACT FROM AUTHOR]

A hypnic jerk is an abrupt, involuntary, nonrepetitive contraction of muscles of the body that occurs during the onset of sleep in stage 1 of nonrapid eye movement sleep. Various physiological and stressful stimuli can precipitate hypnic jerks with no further neurological sequelae. Although selective serotonin reuptake inhibitor (SSRI) medications are well known to disturb the normal sleep cycle and cause rapid eye movement sleep behavioral disorders, there were only a few case reports of them causing hypnic jerks and those were reported due to Escitalopram only. Here is a case series of four cases of hypnic jerks found to be associated with the use of various SSRIs, Escitalopram, Sertraline, and Fluoxetine. Clonazepam was found to be very effective in reducing the hypnic jerks associated with SSRIs. In all the cases, the sleep-induced Electroencephalogram was normal. [ABSTRACT FROM AUTHOR]

Organic and nonorganic/functional psychosis present with unique symptoms which can propel in differentiating these entities. Not always the distinction is clear-cut which poses challenges with the treatment approach to ensure that the patient responds to the medication. We are presenting a case with initial evidence suggestive of organic causation. On revaluation of the case, as no further pointers towards as organic basis was found. Futher management of case as functional psychosis showed clinical and functional improvement. This case report highlights the blurring of the distinction between organic and functional etiologies of psychosis. [ABSTRACT FROM AUTHOR]

Background and Objectives: Benzodiazepines are the first treatment line in status epilepticus (SE). Despite their well-established benefit, benzodiazepines are frequently underdosed with potential detrimental consequences. In some European countries, clonazepam (CLZ) is commonly used as the first line treatment. The aim of this study was to explore the correlation between CLZ loading doses and SE outcome. Methods: This study included a retrospective analysis of a prospective registry in Lausanne, Switzerland (CHUV Lausanne University Hospital), including all SE episodes treated between February 2016 and February 2021. Only adults (> 16 years old) were included with CLZ used as the first treatment line. Post-anoxic SE were excluded because of significant differences in physiopathology and prognosis. Patient characteristics, SE features, the validated SE severity score (STESS), and treatment characteristics were prospectively recorded. We considered loading doses of 0.015 mg/kg or higher (following commonly recommended loading doses) as high doses. We analyzed outcome in terms of number of treatment lines after the CLZ, proportion of refractory episodes, intubation for airways protection, intubation for SE treatment, and mortality. We performed univariable analyses to investigate the association between loading doses and clinical response. A multivariable stepwise backward binary logistic regression was applied for adjusting for potential confounders. Multivariable linear regression was similarly used to analyze CLZ dose as a continuous variable. Results: We collected 251 SE episodes in 225 adult patients. Median CLZ loading dose was 0.010 mg/kg. CLZ high doses were used in 21.9% of SE episodes (in 43.8% for > 80% of the high dose). Thirteen percent of patients with SE were intubated for airways control, while intubation was needed in 12.7% for SE treatment. High CLZ loading doses were independently associated with younger age (median 62 versus 68 years old, p = 0.002), lesser weight (65 kg versus 75 kg, p = 0.001) and more frequent intubation for airways protection (23% vs 11%, p = 0.013), but differing CLZ dose was not associated with any outcome parameter. Conclusion: CLZ high doses were more frequently used for SE treatment in younger patients with healthy weight and were more often associated with intubation for airways protection, probably as an adverse event. Varying CLZ dose did not alter outcome in SE, raising the possibility that commonly recommended doses are above what is needed, at least in some patients. Our results suggest that CLZ doses in SE may be individualized depending on the clinical setting. [ABSTRACT FROM AUTHOR]