Dear colleagues,
Welcome to our second issue in the year 2005, which includes a number of original articles as well as an up-to-date review article on obsessive-compulsive disorder and the Belgian consensus on metabolic problems associated with atypical antipsychotics.
One of the world-leading experts on obsessive–compulsive disorder (OCD), Eric Hollander from the Mount Sinai School of Medicine, New York, reviews the evidence for an OCD spectrum which includes a group of disorders that share certain features with OCD, including clinical symptoms, neurobiology, and the preferred response to medication affecting the serotonergic pathway. Body dysmorphic disorder, pathological gambling as well as autism fall into the OCD spectrum and it can be demonstrated that targeted treatments, specifically the usage of selective serotonin reuptake inhibitors (SSRIs), are effective.
Belgian colleagues report on a workshop attended by psychiatrists, diabetologists, as well as pharmacists, on the topic of second-generation antipsychotics, which are involved in the development of a metabolic syndrome, specifically impaired glucose tolerance, diabetes mellitus, and dyslipidemia. Based on the existing knowledge, the panelists formulate recommendations for practicing psychiatrists for initiating maintenance therapy with second-generation antipsychotics. Furthermore, recommendations for patient counselling and the cooperation between psychiatrists and other medical disciplines are provided. It emerges that greater awareness should exist in Europe about the metabolic risk profile associated with chosen second-generation antipsychotics, and that patients as well as their relatives should be informed about the management of their mental illness and the metabolic risk factors induced by such a medication. Recommendations include the regular monitoring of weight and waist circumference, the monitoring of blood pressure as well as fasting blood glucose and fasting blood lipids.
Mirtazapine has been studied in depression and it emerged that it is a fast-acting antidepressant compound, which works not only in moderate but also in severe depression. Although the pharmacodynamic properties of mirtazapine would make it a candidate for treatment of anxiety disorders there is a lack of studies for this indication. Montañés-Rada and colleagues studied patients suffering from panic disorder treated with either mirtazapine or paroxe-tine in an open-label fashion: it emerged that mirtazapine is as effective as paroxe-tine, and this warrants studies of this compound in a larger data set. However, since the worldwide patent of this substance expired it is unlikely that such a study will be conducted by the pharmaceutical industry, and therefore academic centres or healthcare organizations should take a lead for the development of mirtazapine for the indication of panic disorder.
Schimmelmann and colleagues studied 63 inpatients suffering from schizophrenia or schizophreniform disorders prospectively, and found that a low degree of subjective well-being is predictive of non-adherence and a less favourable outcome. It also emerged that side effects, specifically extrapyramidal side effects, are linked to the same phenomenon.
In an extensive survey, Salib and Agnew studied suicide and undetermined death by drowning in England and Wales from 1979 to 2001. The data were obtained from national statistics in the UK and national population estimates were used to calculate age-specific rates and age-standardized rates of death by drowning. It emerged that, over a time span of 23 years, there has been a gradual and significant reduction in drowning deaths. The study critically reflects that suicide by drowning is probably not amenable to prevention, and furthermore the study findings suggest that the elderly are not more often thought to benefit from suicide prevention than younger adults.
La Torre and colleagues studied urinary incontinence in schizophrenic patients treated with atypical antipsychotics, based on urodynamic findings. Among the patients presenting urinary incontinence during treatment with atypical antipsychotics, only a few had normal urodynamic patterns. Detrusor overactivity was associated with urinary incontinence in patients treated with atypical antipsychotics. Therapeutic perspectives of this debilitating side effect, with strong repercussions on compliance and rehabilitation in schizophrenic patients, are discussed.
The impact of fluoxetine on sexual drive and desire in women with premenstrual dysphoric disorder has been investigated by Steiner and colleagues. Contrary to expectations, it emerged that fluoxetine treatment is able to restore sexual function in women who experienced the symptomatology within their premenstrual dysphoric disorder. The authors conclude that further trials with antidepressants should include specific measures of sexual functioning for assessment of these side effects and how they relate to phases of the menstrual cycle.
The National Institute for Clinical Excellence (NICE) from the UK has recommended the use of atypical antipsychotics for the treatment of schizophrenia. In March 2004, Mace and Taylor studied 36 inpatient units that submitted data for 2012 patients. It emerged that antipsychotic polypharmacy was commonplace: 28.6% of patients were prescribed a typical alongside an atypical antipsychotic, and 19.3% were co-prescribed with a high-dose antipsychotic. Interestingly, co-prescription was more prevalent in patients aged 40 years and older. The study revealed that consensus guidelines are not followed in daily practice and that, despite any clear evidence on the benefits of antipsychotic polypharmacy, it appears to be widespread in the UK, as it is in other parts of Europe as well as in the US.
Case reports deal with the topics of panic disorder due to the ingestion of single-dose ecstasy as well as acute psychological stress-induced water intoxication. Ortuño and colleagues studied schizophrenic patients and reported that this group exhibits a shift away from dexterity as confirmed by the literature. However, they elaborated that only a few of these positive studies distinguish between left-handedness and mixed-handedness and therefore lack specificity. They observed a significant relationship between strong mixed-handedness and schizophrenia in male patients.
The report of Döme and colleagues indicates that, in Hungary, the rates of current and lifetime smoking are significantly higher among patients with unipolar major depression, bipolar disorder, schizophrenia, and schizoaffective disorder, but not among patients with panic disorder without major depression. These findings are in line with those of other countries, which observe a strong relationship between cigarette smoking and major mood and schizophrenic spectrum disorders. Given the higher rates of the metabolic syndrome in these diseases, strategies need to be developed for reducing this additional risk factor for cardiovascular diseases.