This volume is preceded by a very timely editorial written by Marazziti on the deepening of our understanding of the “suicide bomber”. The different psychiatric problems involved in this phenomenon which we now face all over the world include post-traumatic stress disorder as well as a wide-spread sense of alarm and probably even an induction of violent behaviour. Psychiatrists as well as scientists need to work towards an increased reciprocal understanding amongst the patients and themselves. The author points out that we need to touch upon this topic in our work and debates.
The influence of neurocognitive dysfunctions and symptoms on work capacity in schizophrenia spectrum disorders is reviewed by Christensen in a systematic manner indicating that attention/vigilance seems to be highly involved in the capacity to maintain competitive work, while the benefit from rehabilitation of different work skills and behaviour heavily depends on attention/vigilance, verbal memory and executive functioning. The paper concludes that guidelines can be drawn from this review to provide clinicians with indicators for the assessment of neurocognitive functioning in relation to work capacity and rehabilitation.
In a naturalistic study, Hellewell reports on the result of an open-label non-comparative study that evaluated clinical benefits and tolerability of switching patients with schizophrenia from their existing antipsychotic to quetiapine. It emerged that EPS was better after the switch, specifically in those patients in whom the symptomatology of EPS was the cause for switching. Not only the switch from older neuroleptics, but also the switch from atypical antipsychotics other than quetiapine resulted in a benefit. This is not astonishing since atypical antipsychotics do not share the same pharmacodynamic properties. Based on this study as well as on other switching studies, it should be questioned if the term ‘atypical antipsychotic’ is justifiable, specifically for clinical purposes.
The efficacy of quetiapine on cluster B personality disorder has been studied by the group of le Bloc'h et al. Twelve patients benefited from the dosage range of 50–400 mg/day. The study echoes the first report on this topic by Hilger et al. who, however, used even higher doses, up to 800 mg. Probably the high interindividual variability in quetiapine plasma concentrations could be responsible for the different doses applied in clinical practice.
An interesting study from Latin America reports the effectiveness of antidepressants in the treatment of major depression. Duenas and colleagues studied painful physical symptoms in 899 patients, and observed that those patients with painful physical symptoms were less likely to achieve remission and were mostly prescribed selective serotonin and norepinephrenine reuptake inhibitors.
Celikel and Saatcioglu studied the topic of alexithymia and anxiety sensitivity in a cohort of Turkish patients with depressive, anxiety and somatoform disorders. Interestingly, although the concept of alexithymia was first developed in psychosomatic patients, this symptomatology did not differentiate between the psychiatric subgroups. However, the anxiety sensitivity was positively correlated with difficulty expressing feelings as has been previously documented in the literature.
The impact of partial compliance with antipsychotics on patient outcome was studied by the group of Masand based on an extensive literature search. The paper points out that long-acting oral atypical antipsychotics may improve both insight and cognitive function, but compliance with these agents is not assured.
The Hamilton Depression Scale is widely used in clinical trials as well as in depression research. Since time is quite an important factor not only in research, but also in clinical studies, the aim of this study by Bobes et al was to evaluate the psychometric properties of the HAM-D in an outpatient setting. The group of Bobes concluded that six items of the HAM-D is an appropriate scale to monitor antidepressant therapy. This finding helps both researchers and clinicians in the field when looking for effective monitoring of their patients.
First episode psychosis is a challenge for clinicians as well as for patients who need to take their medication for the well-known better outcome. A total of 193 consecutive patients who were accepted in a first episode psychosis program in Canada were started on risperidone or olanzapine. In contrast to the CATIE study, the percentage of patients taking antipsychotic agents was as high as 97–91% within the first half year. The study also pointed out that changing medication is common practice; however, this was not the case for polypharmacy, at least in this trial.
Luty et al. addressed the prevalence of childhood attention deficit hyperactivity disorder in opiate-dependent adults. This group found that 15% were likely and 49% were highly likely to have suffered from this disorder in childhood. Therefore, a proper treatment for this group of patients should be initiated at an early stage, based on this report.
The report of Sansone and colleagues supports a relationship between domestic violence victimization and suicide attempts. Based on the data obtained in 107 women, it can be concluded that inpatient clinicians need to screen patients with a history of suicide attempts for a history of domestic violence very carefully.