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Juan J Fernández-Miranda,1,2,* Silvia Díaz-Fernández1,2,* 1AGC de Salud Mental V, Hospital Universitario de Cabueñes, Servicio de Salud del Principado de Asturias (SESPA), Gijón, Spain; 2Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain*These authors contributed equally to this workCorrespondence: Juan J Fernández-Miranda, AGC de Salud Mental V, Hospital Universitario de Cabueñes, Servicio de Salud del Principado de Asturias (SESPA), C/ Centro Especialidades Avelino González. Óran s/n, Gijón, Asturias, 33211, Spain, Email juanjose.fernandezmi@sespa.es; juanjofmiranda@gmail.comIntroduction: There is a need when optimizing antipsychotic treatment to know the plasmatic levels (PLs) achieved with the different doses and their relationship with effectiveness and toxicity, especially in patients with poor clinical progress. This study investigates the dose-PL-response relationship of monthly aripiprazole (AOM) and three-month paliperidone (PP3M).Methods: Observational, 52-week prospective study of patients with severe schizophrenia (CGI-S ≥ 5) treated with PP3M or AOM for at least one year before their inclusion in the study (N=68). Dose-PL relationship was determined. Subjects were included in standard-dose and high-dose (above labeled) and standard/therapeutic range-PLs and high-PLs (above range) groups. Treatment adherence, effectiveness (hospitalizations, severity), tolerability and safety were assessed. PLs and clinical response were evaluated.Results: No clear linear relationship was found between doses and PLs. In a considerable number of cases, standard doses achieved PLs above the therapeutic range. A significant clinical improvement was related to high PLs, without less safety, tolerability, or treatment compliance being involved. Clinical severity decreased more frequently in patients who received high doses and reached high PLs. Hospital admissions decreased significantly in those patients with high PLs.Conclusion: Taking into account the absence of a linear relationship between doses and PLs, the effectiveness in people with severe schizophrenia of AOM and PP3M depends on reaching high PLs, achieved with high doses, but also with standard doses in some cases, without leading to worse treatment tolerability, safety, or adherence.Keywords: schizophrenia, long-acting injectable antipsychotic, dose, plasmatic levels, effectiveness, tolerability

șIntroduction: Case management has been shown to be successful in reduction of hospitalizations and people leaving treatment. Objectives: To know the treatment adherence and the psychiatric hospitalizations of patients with severe schizophrenia (GCI-S ≥5) before (standard treatment) and during treatment in a community based, case managed program. And also the role of oral or longacting injectable antipsychotic medication. Methods: Observational study, mirror image, of ten years of followup and ten retrospectives, of patients with severe schizophrenia in a community based program, with integrated pharmacological and psychosocial treatment and intensive case management (N=344). Reasons for the Program discharge and psychiatric hospital admissions were recorded ten years before and during treatment. And also the antipsychotic medication prescribed. Results: After 10 years 12.2% of the patients were voluntary discharges (In previous standard treatment: 84.3%). CGI-S at baseline was 5.9(0.7). After ten years 51.7% of patients continued under treatment (CGI-S= 3.9(0.9); p<0.01); 19.3% were medical discharged (CGI-S=3.4(1.5); p<0.001); and 12.2 were voluntary discharges. Forty patients died during follow-up, five of them by suicide. The percentage of patients with hospital admissions and the number of admissions due to relapses decreased after beggining in the Program (p <0.0001), and as well the involuntary ones (p <0.001). To be on long-acting injectable antipsychotic treatment was related to these results (p <0.0001). Conclusions: Treatment of patients with severe schizophrenia in a integrated, case-managed community-based program achieved higher retention, and was effective in reducing psychiatric hospitalizations, compared to the previous standard treatment. To be treated with long-acting injectable antipsychotics was clearly linked to these outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The current study explores whether high-dose therapy with a SGA ILD may be of benefit in patients with schizophrenia inadequately controlled on standard dose. Objectives: To evaluate treatment retention, effectiveness and tolerability of high doses of aripìprazol once-monthly long-acting (AM) in the treatment of patients with severe (Clinical Global Impression-Severity (CGI-S) of 5 and over) schizophrenia. Methods: 36-month prospective, observational study of patients with severe schizophrenia who underwent treatment with 600 mg and over of aripiprazole once-monthly (AM)(N=30) in order to get clinical stabilization due to lack of effectiveness. Assessment included the CGI-S, the WHO Disability Assessment Schedule (WHO-DAS), laboratory tests, weight, adverse effects and reasons for treatment discontinuation. Hospital admissions in the previous three years and during the follow-up were recorded. Results: The average doses was 780 (120) mg/28 days. Tolerability was good, with few side effects reported and biological parameters alterations. There were two discharges due to side effects and one due to lack of effectiveness. Weight and prolactin levels decrease, but not significantly. After three years, CGI-S (p<0.01) and WHODAS in the four areas (self-care p<0.005; occupational p<0.01; family p<0.01; social impairment p<0.05) decreased. There were significantly less hospital admissions than during the previous 36 months: 1.3(1.1) vs. 0.3(0.2) (p<0.001). Conclusions: Tolerability of high doses of aripiprazol once-monthly was very good, being useful in improving treatment adherence in patients with severe schizophrenia, and helping this way to get clinical stabilization and better functioning. [ABSTRACT FROM AUTHOR]

Nowadays, consent to use donor bodies for medical education and research is obtained from the body donors and their families before the donation. Recently, the International Federation of Associations of Anatomists (IFAA) published guidelines that could restrict the appearance of cadaveric images in commercial anatomical resources such as textbooks and other educational products. These guidelines state that the donor must expressly consent to using such images for this purpose. Cadaveric photos and drawings made from dissections of cadavers have been used in anatomy textbooks and atlases for hundreds of years. They are invaluable for anatomy students and clinical/surgical practitioners. The IFAA guidelines should not restrict the use of those older books; to do so would infringe the rights of those seeking knowledge from these resources. As the images in such textbooks and atlases are anonymized and are used for teaching and research, and the donors and their families are informed about this before the donation, we believe no additional consent is needed. It is impossible to separate educational from "commercial" usage entirely in any situation, e.g., publications from publishers and the use of cadavers in medical schools. Therefore, our best efforts to avoid unethical use of cadaveric images by following traditional consent processes are still needed so that more people will reap the benefits from them. As senior textbook/atlas authors/editors from over 10 countries, we believe that using cadaveric images in anatomy textbooks is appropriate, and no additional consent should be necessary. Such usage falls within the good faith of professionals using these invaluable gifts., (© 2025 American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

Abstract: Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by renal phosphate wasting and impaired bone mineralization secondary to secretion of fibroblast growth factor 23 (FGF23) from mesenchymal tumors (phosphaturic mesenchymal tumors, PMTs). PMTs have wide anatomical distribution but typically affect extremities and craniofacial bones. Diagnosis of TIO/PMT is often delayed, and a high index of suspicion is essential in patients with unexplained fractures, but many physicians lack familiarity with TIO/PMT and simply attribute fractures to the more common diagnosis of osteoporosis. We present 5 cases of TIO, with 4 having long histories of multiple insufficiency fractures prior to recognition of TIO and localization of a PMT. Four patients were treated surgically, while 1 preferred medical management. Two patients had lesions localized to the skull base, both of which showed marked hypervascularity on arterial spin label perfusion imaging. Thus, arterial spin label may not only help to localize these tumors, but may also be a helpful supplemental imaging finding in supporting this diagnosis. PMT should be considered in the differential diagnosis for hypervascular skull base masses, especially if the patient has any history of insufficiency fracture or imaging evidence of osteopenia, as early diagnosis of TIO can help prevent disabling complications., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)