Welcome to this issue of the Journal. We strive to ensure the contents of each issue are relevant to day-to-day psychiatric practice, by including original research articles that either evaluate current treatment approaches, or indicate how clinical outcomes might be improved through changes to treatment decisions or the organisation of mental health services. This issue focuses on the pharmacological treatment of patients with schizophrenia, treatment of major depression, and on common management problems in consultation-liaison psychiatry.
In the first of two naturalistic studies of second generation antipsychotic drugs in patients with schizophrenia or related disorders, Nick and colleagues (Solothurn, Switzerland) describe the effects of 6 months of treatment of 60 patients with risperidone, by long-acting injection. Treatment was associated with a reduction in severity of positive and negative symptoms, an improvement in global functioning, and high levels of reported patient satisfaction. In the second study, Lambert and colleagues (Hamburg, Germany) describe the overall effectiveness and tolerability of oral quetiapine in a large (n=1322) outpatient sample, emphasising improvements of subjective well-being that were seen over 3 months of treatment. Studies such as these lack the finesse of randomised controlled trials, but nevertheless provide useful insights into the usefulness of treatment in situations that closely approximate real-life clinical practice. In an accompanying paper, Sobhan and colleagues (Norfolk, United States) review treatment options in the management of patients with previously treatment-resistant schizophrenia, and highlight health economic considerations.
The role of the psychiatrist in general medical settings is discussed over the course of three papers, two of which report the findings of cross-sectional studies. In the first, case–control study, Ozgocmen and colleagues (Elazig, Turkey) compare pain threshold, health perception and disability status in female patients with fibromyalgia or multiple sclerosis with healthy controls, and argue that the disability associated with fibromyalgia is greatly influenced by emotional status. In the second cross-sectional study, in 100 inpatients undergoing alcohol detoxification, Liappas and colleagues (Athens, Greece) report a significant reduction in the severity of anxiety and depressive symptoms, and improvements in liver function test results, after 4 weeks. Finally, Sethi and Uppal (Haryana, India) report the findings of a questionnaire survey of the attitudes of emergency room health professionals toward patients who present following attempted suicide, and demonstrate that much remains to be done to address dysfunctional attitudes towards patients with mental health problems.
Two papers focus on the treatment of patients with mood disorders. Min-Soo Lee and colleagues (College of Medicine, Korea) present an algorithm for the treatment of major depression, devised by the Korean Society of Depressive and Bipolar Disorders, in the hope this may improve clinical outcomes: it would be good to include an evaluation of the impact of this algorithm in the Journal, in due course. Assessments of the impact of treatment guidelines or algorithms must focus on treatment acceptability as well as effectiveness. An evaluation of open-label treatment in 111 patients, reported by Žourková and Novotná (Prague and Brno, Czech Republic), reminds us that treatment-emergent sexual dysfunction is uncommon with trazodone.
It has been argued that the case report has undergone a premature death. In this issue, we include two case reports, and a discussion of case-based research in professional literature. Yalug and colleagues (Kocaeli, Turkey) describe the development of amenorrhoea during treatment with the selective noradrenaline re-uptake inhibitor reboxetine; and through an intriguing account, Tényi and colleagues (Pecs, Hungary) discuss psychopathological phenomena in folie communiqué and folie simultanée. These reports are prefaced by a thoughtful consideration, from Dattlilio (Harvard Medical School, United States) of the educational strengths, weaknesses and relevance of case-based research findings in psychiatric practice.
We hope you will find these papers stimulating. The content of the Journal is determined by the quality and range of articles submitted to our editorial offices, so please continue sending manuscripts describing original research findings (including systematic reviews) to the publishers’ office! David Baldwin and Siegfried Kasper