Abstract
Adverse effects are essentially the collateral damage caused by therapeutic drugs. In many areas of medicine, people are willing to tolerate sometimes devastating adverse effects (e.g. from cancer chemotherapy) in anticipation of substantial benefit. However, psychotic conditions have at their core a belief that no disorder is present and so adverse effects are less likely to be tolerated: patients perceive they have no illness to be treated. Assessment and treatment of adverse effects of antipsychotics are therefore of crucial importance if psychosis is to be successfully treated. On this issue an international group of experts led by Peter Haddad describe their brief but comprehensive scale (SMARTS) designed to evaluate common adverse effects of antipsychotics. This scale helps identify which particular adverse effects (of 11 listed) are troubling patients with scope for patients to describe other possible adverse effects not covered by the scale. One question that is included reflects problems with weight gain and appetite, known adverse effects of olanzapine. Marina Salviato Balbao and colleagues from Brazil in this issue describe observations of 12 months’ treatment with olanzapine. Average weight increased by more than 10 kg and body mass index (BMI) rose from 24.4 to 28.1. There were corresponding adverse changes in waist circumference and plasma cholesterol. These gross changes suggest that an alternative to olanzapine is desperately needed, notwithstanding its somewhat better efficacy than many other antipsychotics. Rene Ernest Nielsen and coworkers from Denmark describe results of their comparison of olanzapine with sertindole, a disused atypical with interesting properties. No differences in outcomes were found but recruitment of subjects was too limited to draw firm conclusions about efficacy or tolerability.
Two papers in this issue broadly address cognitive dysfunction and its evaluation. In the first study, Emna El Hammi and colleagues from France and the USA examine international perspectives on cognitive dysfunction occurring in depression. Psychiatrists were asked how they assessed cognitive dysfunction and what proportion of depressed patients they felt had cognitive difficulties. Most respondents relied on patient history to evaluate cognitive changes. Of those who used instruments to assess function only 6 of 29 scales named by psychiatrists could be considered appropriate. Estimates of the proportion of patients with no cognitive impairment ranged from 0% to 55%. In the other study, Hidenobu Suzuki and coworkers from Japan report on the consequences of discontinuing donepezil in subjects with severe Alzheimer’s disease. The stopping of long-term donepezil caused no worsening of behavioural symptoms and resulted in no greater use of other psychotropics.
Finally, Maju Mathew Koola and colleagues from the USA describe two cases where high-dose prazosin was used for post-traumatic stress disorder (PTSD). Prazosin is an alpha-receptor antagonist mainly used to treat hypertension. Doses of up to 16 mg/day have been used to treat PTSD and alcoholism. These are higher doses than used in hypertension but tolerance to the drug’s hypotensive effects does develop. In the two cases described, prolonged titration allowed doses of 45 and 30 mg/day to be used successfully.
As can be seen, this issue contains papers on a wide range of subjects, authored by clinicians from all across the globe. I hope you enjoy reading it.