Progress in our understanding of neural plasticity has profound implications

for the treatment of a number of psychiatric and neurodegenerative disorders, and for enhancing performance in what are considered normal subjects. One of the promising aspects of neural plasticity is that it implies that the alterations that occur are reversible, even neuronal atrophy and cell loss. Reversibility of structural as well as functional #Cytoskeletal Signaling inhibitor keyword# plasticity has already been demonstrated in response to pharmacological treatments or even behavioral therapy. As the fundamental mechanisms of neural plasticity are further elucidated, new targets and paradigms for enhancing plasticity will be revealed and will lead to more effective and faster-acting therapeutic interventions. Selected abbrewiations Inhibitors,research,lifescience,medical and acronyms BDNF brain-derived neurotrophic factor cAMP cyclic adenosine monophosphate CaRE cAMP response element CREB cAMP response element binding protein FGF-2 fibroblast growth factor-2 5-HT 5 -hydroxy tryptamine (serotonin) Inhibitors,research,lifescience,medical LTP long-term potentiation NMDA N-methyl-D-aspartate PDE4 phosphodiesterase

type IV PKA protein kinase SSRI selective serotonin reuptake inhibitor Notes This work is supported by USPHS grants MH45481 and 2 P01 MH25642, a Veterans Administration National Center Grant for posttraumatic stress disorder, and by the Connecticut Mental Health Inhibitors,research,lifescience,medical Center.
Magnetic resonance imaging (MRI) is one of the most, exciting imaging technologies for texture analysis: it offers the best soft, tissue contrast, which can be dramatically varied during imaging. Careful study of the

dependence of texture parameters on MRI data collection strategy is essential for texture analysis in order to avoid artificial texture from the scanner. This is critical, since different centers may vary their measuring sequences and acquisition protocols for their clinical investigations. Inhibitors,research,lifescience,medical The basic problem in quantitative MRI texture analysis is the large number of different measuring techniques and imaging parameters, which can be easily changed during a clinical examination. Thus, different techniques and imaging parameters produce totally different patterns in the texture parameters of the same tissues in clinical examinations Rutecarpine with different sensitivity to artificial texture overlaid by the scanner. The main problem in texture analysis with MRI is to avoid this artificial texture and minimize its influence. The presented work was performed in the framework of a European research project COST (Cooperation in the Field of Scientific and Technical Research) Bll between 1998 and 2002 by institutions from 13 European countries, aimed at the development of quantitative methods for MRI texture analysis.1 For further detail of texture analysis, parameters, and software, see the article by Materka in this volume2 or references 3 to 7.

02 ± 0.06) being lower than that of the healthy group (0.04 ± 0.08). The interaction between repayment proportion and group was also significant, F(2, 194) = 3.37, P= 0.04; post hoc results showed that patients with depression repaid a smaller ratio than healthy participants when the repayment proportion was low (R= 20%, MDD 0.03 ± 0.07 vs. controls 0.07 ± 0.11; F(1, 97) = 4.34, P= 0.04) or medium Inhibitors,research,lifescience,medical (R= 50%, MDD 0.02 ± 0.06 vs. controls

0.04 ± 0.07; F(1, 97) = 4.02, P= 0.048) (Fig. 1D). There was, however, no significant difference between both groups when the repayment proportion was high (R= 80%, P > 0.1). The interaction between risk and group was not significant (F < 1). Discussion We tested whether depressed people would make more deceptive or altruistic decisions in the modified trust game. The results support our hypotheses that people with depression would in fact make fewer altruistic and fewer deceptive responses. In this study, executing deceptive or altruistic Selleck ABT888 responses required Inhibitors,research,lifescience,medical cognitive affective processing far more complex than that required for simply repaying the suggested Inhibitors,research,lifescience,medical amount. For deceptive or altruistic responses, participants needed to consider the risk and payment conjunction

and then calculate the difference between the amount of actual repayment and the requested amount before making a decision. Therefore, cognitive load would be much higher if Inhibitors,research,lifescience,medical they chose to cheat the investor or to repay an amount different from that of those recruited as reference. People with depression have been widely reported to have compromised cognitive and affective processing (Harvey et al. 2005; Ritchey et al. 2011). Thus, it is logical to reason that these people would simply adhere to the requested payment when preferring to be honest, choose the least Inhibitors,research,lifescience,medical repayment when wanting to deceive, or repay as much as possible when deciding to respond altruistically, since other choices would tax their limited cognitive and affective resources. But if this were the case, we should

have found a larger ratio of either altruistic or deceptive choices in depressed patients. Instead, compared with healthy participants, people with depression made a smaller ratio of choices on both deceptive and altruistic decisions. The special behavioral patterns of Cediranib (AZD2171) the depressed patients in this study should therefore not have resulted from their limited cognitive or affective resources. Since the between-group difference was significant in some but not all conditions, this implies that depressed patients were responsive to the varying level of repayment proportion involved in the experiment. Compared with the healthy volunteers, the depressed patients made deceptive responses less frequently and by a smaller ratio only when the repayment proportion was high; they also made altruistic responses less frequently and by a smaller ratio only when the repayment proportion was medium or low.

34 Researchers from Italy have investigated the efficacy of intravesical instillation of a naturally occurring peptide, nociceptin/orphanin FQ (N/OFQ) for the Sotrastaurin treatment of BPS/IC. Twenty-three subjects with BPS/IC received N/OFQ twice a week for 4 weeks by intravesical instillation. The authors noted a statistically significant decrease in the O’Leary-Sant IC problem index but not the O’Leary-Sant IC symptom Inhibitors,research,lifescience,medical index. There was a decrease in Visual Analogue Scale (VAS) and about half of the patients were satisfied with the results of treatment. These preliminary results suggest that N/OFQ may provide benefit to patients with BPS/IC and certainly further

randomized, placebo-controlled trials would be mandatory Inhibitors,research,lifescience,medical to confirm this initial impression.35 Intratrigonal injection of botulinum toxin A has been reported in patients with BPS/IC who have been refractory to first-line therapy. Investigators evaluated the therapeutic effect of repeated intratrigonal injection of onabotulinumA in 14 women with BPS/IC refractory to first-line treatment. The patients received four consecutive intratrigonal injections under general anesthesia. The investigators reported that all patients reported Inhibitors,research,lifescience,medical subjective improvement

following each injection and that each treatment provided symptomatic relief for a period of between 9 and 12 months. No cases of voiding dysfunction or urinary Inhibitors,research,lifescience,medical retention were reported. This study suggested that intratrigonal injection of botulinum toxin A is safe, effective, and has a maintained effect after repeated injection in patients with treatment refractory BPS/IC.36 Two studies that were more basic science in nature suggested further therapeutic avenues that should be explored in BPS/IC. A study with mice showed that treatment with selective cannabinoid receptor 2 (CB2) agonists reduced the severity of acrolein-induced

cystitis and inhibited bladder inflammation-induced increased peripheral sensitization to mechanical stimuli. The data would indicate that CB2 might play an inhibitory role in bladder inflammation and Inhibitors,research,lifescience,medical subsequent changes in pain perception. CB2 agonists have been developed and clinical trials are being initiated in 2011 for this particular indication.37 Another interesting Ketanserin and somewhat innovative basic science study investigated the beneficial effects of honey on histamine release from LAD2 cells. Honey has long been used for the treatment of wounds and has more recently demonstrated to have beneficial effects on wound healing. Mechanisms include antibacterial properties, cytokine interaction, and antioxidant effects as well as on mass cell activity. The investigators concluded that a constituent of most honeys inhibits spontaneous and stimulated mass cell degranulation in a cell line model. Certainly this interesting observation warrants further investigation as a possible intravesical agent in the treatment of BPS/IC.

These data have led to varying conclusions. Interpretations include that there #Dynasore cost randurls[1|1|,|CHEM1|]# is no difference between first- and second-generation antipsychotics, that second-generation antipsychotics are superior to first-generation antipsychotics, that some second generation antipsychotics are superior

to either all or some first-generation antipsychotics, in general, or in certain efficacy and/or side effect domains, or in patient subgroups that are not yet easily identified prior to choosing a specific agent. Inhibitors,research,lifescience,medical Since such a number of divergent interpretations have been offered, this indicates that blanket statements do not do justice to the complex data base. Moreover, in comparative trials, design issues are highly relevant to interpretation of the data,25 including sample size, choice of dose of the study drug and active comparator, prior treatment, blinding, duration of treatment, patient and rater expectations and biases, choice of outcomes, handling of dropouts and interpretation of the data, all of which we will discuss in detail below. Shifting Inhibitors,research,lifescience,medical adverse event focus to physical health Following the predominant use Inhibitors,research,lifescience,medical of second -generation antipsychotics, there has been a shift in side effect concerns from Parkinsonism and tardive dyskinesia, to physical health risks and outcomes that are

associated with decreased longevity.26-30 Even more so than the study of tardive dyskinesia, the study of adverse effect risks that are either rare or distal outcomes that occur after many years of illness

and antipsychotic exposure pose formidable challenges. This applies to study of sudden cardiac death as a potential consequence Inhibitors,research,lifescience,medical or QTc prolongation or other arrhythmogenic properties of antipsychotics,31 as well as to diabetes and cardiovascular and cerebrovascular morbidity and mortality. Since these outcomes Inhibitors,research,lifescience,medical occur generally after many years or represent premature onset of disorders that also occur in the general population, RCTs might not be the best way to assess the comparative safety of antipsychotics.32 In fact, RCTs have largely focused on the assessment of risk factors Megestrol Acetate (such as weight gain, lipid and glucose abnormalities) for cardiovascular and cerebrovascular illness, rather than on the development of such illnesses themselves. An exception is the assessment of death and cerebrovascular events associated with antipsychotics in the elderly, which, by definition, is an enriched, high-risk cohort. Even here, however, the increased risk with antipsychotics was only uncovered after pooling all data from placebo controlled RCTs in meta-analyses.33 These examples highlight the fact that for some outcomes, such as rare and temporally distal events, meta-analyses,34 pharmacoepidemiologic studies,31,35 and cohort studies36 or registries are more useful than RCTs. This is true, despite the considerable limitations of meta-analyses and pharmacoepidemiologic studies and registries.

Masking Changes in the environment (temperature or light intensity and duration), and changes in internal states and behaviors such as movement and immobility, fatigue and sleep, hunger and eating, can modify the pattern of biological rhythms.38 These are known as masking effects,39 to indicate that the circadian or ultradian rhythms would differ in the absence of these factors. For example, going to sleep is accompanied by a decrease in core body temperature, while the contrary occurs at the time of physical or mental effort. Also, the circadian rhythm of TSH is more Inhibitors,research,lifescience,medical marked if subjects maintain their usual

feeding schedule and professional activities rather than staying in bed and receiving no food.40 Masking effects could in part explain the decreased amplitude in temperature and TSH circadian rhythms described in depressed patients by several authors,41 Inhibitors,research,lifescience,medical since these patients might have had a lower level of physical activity within the hospital. Social and lifestyle factors also play a role

in the measurable phenotype of biological clock physiology.42 The so-called constant routine studies enable to overcome or neutralize masking effects; in such studies, subjects lie recumbent in constant light and receive frequent snacks. These protocols are Inhibitors,research,lifescience,medical complex, but they are necessary to explore the functioning of the biological clock in manners that separate the endogenous and exogenous components of rhythms. Ontogeny and senescence of Inhibitors,research,lifescience,medical eniogenous rhythms Biological clocks play a role at the cellular level by modulating the rate of mitosis.43 At the macroscopic level, preterm infants of 35 weeks already have bouts of activity and sleep44 and, based on extrapolation from animal research, the human SCN might become sensitive to light around the sixth month of pregnancy,45 and even low levels of light, of 200 lux, entrain the SCN.46 After birth, a circadian periodicity of body temperature and other variables

is present at 1 month and develops over the following month.47 Children stabilize a circadian rather than an ultradian rhythm of wake-sleep around the age of Inhibitors,research,lifescience,medical 3 to 6 months,48 although differences in activity and sleep can be detected very soon after birth in some infants. Of note is the fact that the prenatal development of biological clocks is sensitive much to fetal exposure to teratogens and other toxins, such as alcohol.49 Circadian clock physiology can also be altered by postnatal maternal DAPT secretase research buy deprivation in rodents, and the changes persist into adulthood.50 According to the results of a survey of 25 000 inhabitants in Europe, there is a sudden change in sleep habits that marks the end of the tendency to sleep later during childhood and adolescence. Indeed, around the age of 20, most young adults tend to go to sleep and wake up earlier. Roenneberg and collaborators even suggested that this change could be a marker of the end of adolescence.

Hence the inferences from these studies with regards to ALI pathogenesis and potential prevention targets are limited. Potential future prevention strategies include, but are not limited to 1) quality improvement interventions to limit specific hospital acquired exposures (delayed treatment of infection

and shock, aspiration triggers, high tidal volume ventilation, plasma transfusion from alloimmunized donors), and 2) the use of systemic and inhaled anticoagulants, antiplatelet agents, anti-inflammatory drugs and antioxidants. Some of these therapies have already been tested Inhibitors,research,lifescience,medical in preliminary clinical trials with encouraging result. This is in contrast to uniformly negative results of mechanistic interventions when applied later in the course of illness, once ALI is established. Conclusion This population based observational cohort study will define 1) the population of patients at high risk for ALI at the time of hospital admission 2) the most significant second hit in-hospital exposures that may modify the development Inhibitors,research,lifescience,medical and progression of ALI and 3) attributable burden of ALI in the community. The results will inform future mechanistic studies and clinical trials Inhibitors,research,lifescience,medical with an ultimate goal of preventing this devastating complication of critical illness. buy MGCD0103 Competing interests The authors declare that they have no competing interests. Authors’ contributions All authors made substantial

contribution to the study design and methods. SJT, LT, AA and MKR drafted Inhibitors,research,lifescience,medical the manuscript and all other authors critically revised

it for important intellectual content. MMM, JAS and OG performed the statistical analysis. OG, RC and CT conceived the study, and participated in its design and coordination. All authors read and approved the final manuscript. Pre-publication history The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-227X/10/8/prepub Acknowledgements Inhibitors,research,lifescience,medical The authors acknowledge Guangxi Li and Vitaly Herasevich for technical help with ICU Datamart. This research is supported by Mayo Foundation.
Acute and chronic mercury exposure represents a potential threat to community health. Mercury poisoning can occur as a result of occupational hazard or suicide attempt. Mercury is silver-colored and liquid at Suplatast tosilate room temperature. Mercury is available in inorganic and organic forms. All compounds of mercury are toxic but differ in the routes of absorption, clinical findings, and responses to therapy. Methylmercury, the soluble form is neurotoxic. Elemental (organic) mercury is especially hazardous for children since it is in liquid form and can easily be found around [1]. The clinical effects of mercury poisoning depend on the form and the route of entry to the organism. Neurologic, gastrointestinal and renal systems are predominantly affected depending on the route of exposure.

Surprisingly, the US Food and Drug Administration has declined to approve rimonabant, primarily due to its slight potential to enhance anxiety and suicidal thoughts. The atmosphere of consternation of possible legal action due to side effects may have led to this decision. The other side of the same coin is anorexia. While in obese populations weight loss is the main goal, in other populations, Inhibitors,research,lifescience,medical such as patients with cancer or AIDS, it is an immense problem. Dronabinol (synthetic THC, known

as Marinol and approved for the treatment of nausea and vomiting in cancer and AIDS patients) is associated with consistent improvement in appetite.69 It was found to be safe and effective for anorexia associated with weight loss in patients with AIDS, and is associated with increased appetite, improvement in mood, and decreased

nausea. In clinical trials, weight was stable in dronabinol patients, while placebo recipients lost weight.70,71 Dronabinol was found to be safe and effective for treatment of HIV wasting syndrome,72 Inhibitors,research,lifescience,medical as well as in patients with Alzheimer’s disease73 and with advanced cancer,73,74 The possible mechanisms of these actions have been reviewed.75 Cannabinoids have a positive effect in controlling chemotherapy-related sickness.76 They are more effective Inhibitors,research,lifescience,medical buy Tasocitinib antiemetics than the dopamine receptor antagonists such as chlorpromazinetype Inhibitors,research,lifescience,medical drugs.77 Direct comparisons with serotonin (5-HT)3 antagonists, which are widely used as antiemetics, have not been reported. However, while these antagonists are not effective in delayed vomiting, THC is known to reduce this side effect of chemotherapy. Pain Cannabis has been used for millennia as a pain-relieving substance. Evidence suggests that cannabinoids may prove useful in pain modulation by inhibiting neuronal Inhibitors,research,lifescience,medical transmission in pain pathways. Considering the pronounced antinociceptive effects produced by cannabinoids,

they were proposed to be a promising therapeutic approach for the clinical management of trigeminal neuralgia.78 THC, CBD, and CBD-dimethyl heptyl (DMH) were found to block the release of serotonin from platelets induced by plasma obtained from the patients during migraine attack.79 However, in other reports cannabinoids are much less successful in pain-relieving. Mephenoxalone In a clinical trial THC did not have any significant effect on ongoing and paroxysmal pain, allodynia, quality of life, anxiety/depression scores and functional impact of pain. These results do not support an overall benefit of THC in pain and quality of life in patients with refractory neuropathic pain.80 Similarly, in an additional clinical trial, no evidence was found81 of analgesic effect of orally administered THC in postoperative pain in humans. Other studies show much better results of pain relief.

5% afternoon, and 48.6% evening worsening. Melancholic symptom features were associated with DV, regardless of pattern. Using a neuropsychological test battery, the morning pattern of impairment in the melancholies was comprehensive, affecting attention and concentration/working memory, episodic memory, reaction time, and speed of simultaneous match to sample.18 Significantly improved neuropsychological function was seen in the melancholic patients in the evening, in line with diurnal improvement in mood. Some functions remained impaired in the evening compared with controls; others improved. Inhibitors,research,lifescience,medical Another study also found that complex tests of executive function were sensitive measures of DV19 Mood variability

‘ITic concept of mood variability, rather than Inhibitors,research,lifescience,medical any specific pattern of mood change, has arisen from long-term studies.20 Women with premenstrual syndrome had greater mood variability than normal subjects. Patients with borderline personality CP-868596 datasheet disorder also revealed a high degree of mood variability, but random in nature from one day to the next.20 ‘This suggests that mechanisms regulating mood stability may differ from those regulating overall mood state. Dynamic patterns of mood variation were revealed using complex time series analyses of self-assessments of Inhibitors,research,lifescience,medical anxiety and depression for each hour awake during a 30-day period.21 Controls

displayed circadian rhythms with underlying chaotic variability, whereas depressed patients no longer had circadian rhythms, but. retained chaotic dynamics. Days with no DV or with typical DV (morning low, afternoon/evening high) occurred with similar frequency in both melancholic patients and

controls.22 In other words, circadian mood variations vary substantially inter- Inhibitors,research,lifescience,medical and intraindividually. Interesting are the attributions: melancholic patients experience spontaneous mood variations as uninfluenceable, whereas healthy controls consider them almost exclusively related to their own activities and/or external circumstances.22 DV and chronotype Many of the above findings of worse morning mood suggest, a late chronotype in MDD. Three new Inhibitors,research,lifescience,medical studies have looked at large populations of bipolar patients, and replicably found a predisposition for late chronotypes.23-25 Additionally, individuals Sodium butyrate with higher depression scores are more likely to be late chronotypes.25 One of the characteristics of circadian rhythms is that the lower the strength of synchronizing agents (zeitgebers), the later they drift. Less light, exposure in winter could underline the reported delayed chronotype in winter depression.26 Could the lower lifestyle regularity and activity level indices (as codified in the Social Rhythm Metric) in bipolar disorder patients compared with controls be an indication of such a diminution of zeitgebers?27 In addition, the timing of five, mostly morning, activities was phase-delayed in patients not only compared with control subjects but with themselves when well.

Means were calculated for continuous variables and frequencies were calculated for categorical variables overall and by country. All personal data collected during the study were treated confidentially. The study sponsor had no role in the data collection or analysis. Institutional Review Board (IRB) approval was not sought in this study as this constituted market research. Results Sociodemographic selleck compound profile A total of 61 psychiatrists from six countries completed the survey [USA (n = 15), Germany (n = 10), France (n = 12), Spain (n = 10), Hong Kong (n = 6) and Australia (n = 8)]. Gender and Inhibitors,research,lifescience,medical working environment distributions were

similar between countries. Overall, the sample was 64% male and 36% female. More than 80% of the participants reported working in an urban environment. Hong Kong was an exception, with all male participants Inhibitors,research,lifescience,medical working in an urban environment. The average psychiatrist in the sample had 18 years of clinical practice experience. This number was slightly lower in Hong Kong, with an average of 12.5 years of clinical experience. The distribution of public and private workers Inhibitors,research,lifescience,medical differed among countries. In the USA, most participants

worked in private organizations, while in Hong Kong all participants worked privately. In France, Germany and Australia, the majority of participants worked in the public sector. In Spain, all participants worked in the public sector (Table 1). Table 1. Summary of the demographic and professional background of the selected psychiatrists. Patients’ profile On average, participants saw approximately 67 MDD patients per month. Inhibitors,research,lifescience,medical The highest mean number of MDD patients seen was in the USA (n = 102) and Germany (n = 96). Australia saw the lowest mean number of MDD patients (n = 34) (Table 2). The majority of participants reported regularly assessing cognitive dysfunction in their MDD patients. Those who reported not assessing cognition in MDD (7%) reported

Inhibitors,research,lifescience,medical that this was not a relevant aspect of the disease. Table 2. Patients’ profile covered by the survey. When participants estimated the level of cognitive dysfunction in their MDD patients, US psychiatrists reported that roughly 45% of their MDD patients were cognitively impaired; among these, 6% were reported to be severely cognitively impaired. In Australia, 51% of patients were judged to have no cognitive impairment. Psychiatrists in all other countries estimated ≥50% of their MDD patients had cognitive Rebamipide dysfunction. In Hong Kong, psychiatrists estimated 100% of MDD patients were cognitively impaired and 29% of these were severely impaired (Table 2). Assessment of cognitive dysfunction for patients with MDD In assessing cognitive dysfunction, most psychiatrists (61%) relied solely on the patient history interview. The remainder reported using cognitive instruments or a combination of cognitive instruments and patient history interview for cognitive evaluation.

Given his unrevealing evaluation, all nonessential medications,

including olanzapine, were held. Antibiotics were discontinued after 6 days when no source of infection was found and all selleck products cultures were without growth. Over the next 2 days after admission, his CrCl dropped to 16 ml/min, despite adequate resuscitation. He was anuric for the first 4 h after arrival in the ICU. His urine output initially responded well to intravenous fluid hydration, but dropped to less than 500 ml over 24 h on ICU day 4. Nephrology was consulted and felt that his acute kidney injury (AKI) was most consistent with acute tubular necrosis (ATN) complicating CKD. With conservative management, Inhibitors,research,lifescience,medical his oliguric AKI resolved slowly with improved urine output by ICU day 6, and he did not require dialysis. The hypothermia began to improve on Inhibitors,research,lifescience,medical day 7, with a mean daily temperature of 35°C off the warming blanket, but with continued falls in temperature to 33.3°C. His temperature normalized without intermittent episodes of hypothermia on hospital day 9 with a mean temperature of 36.1°C (97°F). With improvement in his temperature, the patient’s heart rate increased to the 60s. His CrCl never recovered, remaining in the 15–20 ml/min range. Olanzapine and all other atypical antipsychotics were permanently discontinued. He was eventually discharged to a rehabilitation facility after a 15-day hospitalization. As other

causes of hypothermia including environmental Inhibitors,research,lifescience,medical exposure, myxedema coma, neurologic malignancy, adrenal insufficiency, and sepsis had Inhibitors,research,lifescience,medical been excluded,

olanzapine use in the setting of CKD complicated by AKI was concluded to be the cause of his prolonged hypothermia. Discussion Thermoregulation occurs in the preoptic region of the anterior hypothalamus through multiple mechanisms [van Marum et al. 2007; Kreuzer et al. 2012b]. Olanzapine’s antagonism to dopaminergic D1, D2, D4, serotoninergic Inhibitors,research,lifescience,medical 5-HT2A, 5-HT2C, histaminergic H1, cholinergic M1–M5, and α1-adrenergic receptors results in multiple, occasionally conflicting, clinical symptoms in cases of acute poisoning [Ciszowski et al. 2011]. Although clinicians are familiar with the risks of development of hyperthermia and malignant neuroleptic syndrome with antipsychotic medications, hypothermia is also a serious and unpredictable adverse reaction [Blass and Chuen, 2004; Ciszowski et al. 2011]. Hypothermia due to antipsychotics may be severe, resulting in hospitalization and possibly death [Kreuzer also et al. 2012b]. A review of 480 cases of hypothermia associated with the use of antipsychotic medications from the World Health Organization (WHO) database concluded that patients are at highest risk for hypothermia in the first few days after starting or after increasing the dose of antipsychotics [van Marum et al. 2007]. Patients with normal mental status will sense changes in temperature regulation and commence protective behaviors to reduce hypothermia.