The toxic effects of gas-phase singlet oxygen, 1O2, on the ciliated respiratory epithelium of hamster trachea have been demonstrated. Tracheal explants treated with 1O2 showed a dose-dependent decrease in cilia beating frequency and focal ciliostasis. A statistically significant decrease in ciliary activity occurred at 1O2 concentrations as low as 154 ppb after a 2-hr exposure. Cytological alterations in the mucociliary epithelium were observed in explants exposed to 235 ppb 1O2 or greater. When cytotoxic effects were related to the time of exposure to 1O2, maximum effects occurred after a 4-hr exposure. In vitro recovery studies indicate that ciliary activity returned to normal between 4 and 8 hr after exposure.

Aripiprazole, a partial dopamine agonist has been reported to help reduce symptoms of tardive dyskinesia (TD). In a prospective, open label study of a series of cases, we examined the effectiveness of aripiprazole in reducing TD symptoms. Six clinically stable patients with schizophrenia or Schizoaffective disorder and a moderate to severe TD participated in this study. They were systematically cross-titrated from their current medication to aripiprazole and maintained for 16 weeks. The mean extra pyramidal symptom score measured by Abnormal Involuntary Movement Scale (AIMS) improved from a baseline score of 15.8 to final score of 5 (paired t-test; P=0.0009). The severity of psychiatric symptoms remained unchanged. This study supports our hypothesis that clinically stable patients with moderate tardive dyskinesia who are under treatment with other first- or second-generation antipsychotics may benefit from switching to aripiprazole with a reduction of TD symptoms but with out any significant benefit in psychiatric symptoms. The results need to be viewed with caution and not considered as indicative of a viable treatment option for TD as this is an open label study, and a small sample size.

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CME Educational Objectives 1. Review the epidemiology and clinical manifestations of delusional disorders. 2. Discuss the challenges associated with diagnosing and treating delusional disorders, particularly delusional disorder of the somatic type. 3. Summarize the challenges faced in identifying and treating mental illness in medically ill patients.