Long-standing readers of this journal know that IJPCP features papers which lie on the cusp between academic endeavour and clinical practice. This issue includes articles which provide insights into how best to use antipsychotic drugs; that highlight the influence of early trauma and recent life events in patients with chronic pain and repeated self harm; and which emphasise the importance of consultation-liaison psychiatrists in the general hospital.
Antipsychotic drugs, extrapyramidal symptoms, and weight gain
Recent concern about the potential adverse effects of second-generation antipsychotic drugs has centred largely on their propensity to increase weight and induce the metabolic syndrome of obesity, hypertension, dyslipidaemia and insulin resistance; and three papers in this issue focus on the tolerability of antipsychotics in clinical practice.
In an uncontrolled evaluation of the long-term effectiveness and tolerability of risperidone long-acting injection in the prevention of relapse in 98 patients with psychotic disorders, Kim and colleagues (Seoul, Korea) report that two-thirds of remitted patients remained well; and that whilst a small minority (6%) experienced extrapyramidal symptoms (EPS) as an adverse event, EPS were generally improved in the total sample. The differing formulations of risperidone may vary in the risk of causing EPS: in a small but elegant cross-over repeated-dose pharmacokinetic study, Yoda and Yamashita (Moroyama, Japan) found the oral solution resulted in significantly lower plasma levels of risperidone and its active metabolite, and of prolactin, before administration, when compared to the fine granule preparation; but there were no differences in these parameters after an hour: they contend that these fluctuations in level may explain difference in severity of EPS. Finally, in their comprehensive review, Veit and Barnas (Vienna, Austria) summarise the methodological problems which influence the comparison of weight management programmes for patients with schizophrenia.
Childhood trauma, unhappy events and suicidal behaviour
Psychiatrists are well aware of the malign influence of early traumatic experience on the development of problems later in life, including medically unexplained physical symptoms and repeated deliberate self-harm.
In this issue, we include two papers by Sansone and colleagues (Dayton, USA) which together explore the relationship between remote and recent experiences, current somatic concerns, and self-harm. In a cross-sectional investigation of childhood trauma in 113 medical outpatients, childhood emotional and physical abuse were both significantly associated with the severity of somatic preoccupations. In a second study, all five types of childhood trauma were found to be significantly associated with a range of self-harming behaviour in 117 outpatients with chronic pain. The accompanying paper by Schillani and colleagues (Trieste, Italy) examines the relationship between adverse life events, repetition of suicidal behaviour, and polymorphisms for the serotonin transporter gene: the number of self-harming episodes was significantly correlated with the number of negative life events, but the L/L genotype was associated with reduced repetition rates, indicating that genetic factors may be important in the trajectory of self-harming behaviour.
Transplants and disguises in the general hospital
Consultation-liaison psychiatrists can encourage their non-psychiatrist medical colleagues to adopt a comprehensive approach to patient assessment and the evaluation of the results of their medical and surgical interventions.
In a cross-sectional study of depressive symptoms and disorders in 425 consecutive general hospital medical or surgical inpatients, Su and colleagues (Chiayi, Taiwan) found that depressive symptom severity, multiple physical health problems and history of depression were all associated with greater likelihood of accurate recognition; however, whilst physicians and surgeons had similar overall recognition rates, they differed in their reasons for patient referral, suggesting a need for discipline-specific education to facilitate the “unmasking” of depression.
In a detailed investigation of living-related donor renal transplantation, Taskintuna and colleagues (Ankara, Turkey) compare anxiety and depressive symptoms and health-related quality of life in transplant donors (n=35) and recipients (n=69), and healthy controls (n=45). As expected they found recipients had greater severity of depressive symptoms and more functional impairment; but intriguingly, donors had significantly better vitality, social functioning and mental health than did controls.
Poor sleep and failing memory
Not a description of the joint editors, but rather a summary of the three remaining articles. Two papers focus on the components and determinants of sleep quality – in 250 general hospital outpatients, reported by Ebrahami and colleagues (Tehran, Iran), and in 86 remand prisoners, described by Elger and Sekera (Geneva, Switzerland) – and both conclude that careful characterisation of sleep disturbance is required for optimal care and treatment. Finally, the article from Hancock and Larner (Liverpool, UK) describes the utility of screening for depression using the Patient Health Questionnaire in 113 outpatients attending memory clinics, concluding that it is helpful in deciding whether to start antidepressant treatment.