Editorial

I am delighted that this issue has no contributions from the UK (where the journal is based) but only those from further afield. Indeed, the international impact of Therapeutic Advances in Psychopharmacology is aptly reflected by Pubmed’s recent decision to index papers from the journal.

Mitra Safa and colleagues from Iran take an old subject and report something new. SSRIs are well known to cause sexual dysfunction but reports the nature and incidence of this dysfunction are rather inconsistent. Here, Safa and co-workers show that sexual dysfunction occurs in three-quarters of patients prescribed SSRIs and more often in women than in men. Difficulties with orgasm was the most frequently reported problem, again more often in women. What marks this study out from many others is the careful assessment of sexual function by direct, systematic questioning.

From India, Somnath Mondal and colleagues report on a different but related aspect of SSRI use – hyperprolactinaemia causing menstrual disturbance and galactorrhoea. Changes in prolactin are very occasionally reported with SSRIs but their rare and idiosyncratic frequency makes elucidation of the exact mechanism somewhat difficult. Five cases are described in some detail as, importantly, are the steps taken to resolve the problem. Several putative mechanisms are proposed.

From Japan comes a study on the safety and efficacy of olanzapine and haloperidol injection in elderly patients. Haloperidol, long the mainstay of treatment of psychotic agitation, has seen its popularity drop over recent years because of its link to QT prolongation. Olanzapine is probably less dysphoric than haloperidol but interacts with concomitant benzodiazepine. Hibenobu Sukuki and colleagues show that intramuscular olanzapine was both more effective and better tolerated than haloperidol. Observations that will do little to resurrect haloperidol as an emergency treatment.

From the USA comes a case report and review from Kevin Reeves and co-workers. The report describes the successful use of amoxapine – a neglected tricyclic antidepressant – as a treatment for psychosis. Many readers will know that amoxapine is chemically very similar to the antipsychotic loxapine. In fact amoxapine is a monoamine re-uptake inhibitor and a dopamine antagonist. In this case it was effective when added to previously ineffective treatment with risperidone and depot haloperidol. The authors make the bold suggestion that its activity in this case might be result of an additional pharmacological property – inhibition of glycine re-uptake resulting in activation of NMDA receptors.

Also from the USA, Ankit Kansagra and colleagues describe the unusual case of severe hypothermia occurring as a result of the use of olanzapine. Older antipsychotics were well known to cause lowering of body temperature but atypical drugs probably have a stronger association with hyperthermia. In this case, olanzapine appeared to cause a very severe and prolonged hypothermia both of which, as the authors’ comprehensive literature review shows, are extremely uncommon; other cases being mild and short-lived.

I give my thanks to these authors who have submitted their excellent work to Therapeutic Advances in Psychopharmacology and look forward to receiving many more from around the world.