Alexandra B. Whitworth

T-cell subsets in schizophrenia: a comparison between drug-naive first episode patients and chronic schizophrenic patients

T-cell subsets (CD3+, CD4+, CD8+, NK-cells) and the CD4+/CD8+ ratio were measured in 56 schizophrenic patients admitted to hospital with an acute psychosis. Thirty-five patients with chronic schizophrenia and 21 drug-naive first episode schizophrenic patients were compared with 16 healthy controls. T-cell subsets were quantified in the acute state of the illness (day 0), after 7 days of treatment and at the time of discharge. In the acute state, schizophrenic patients showed higher CD3+ and CD4+ cells (p = 0.05) and a higher CD4/CD8 ratio (p = 0.02) than healthy controls, while NK-cells were lower (p = 0.05). In first episode patients, all T-cell alterations normalized during treatment. In the chronic group the ratio remained high, whereas the initially low number of NK-cells normalized over time. These findings, supporting immune system dysregulation in schizophrenia, are discussed in relation to psychopathology, the stage of illness and effects of medication.

A multicenter double-blind trial of paroxetine versus amitriptyline in depressed inpatients

The phenylpiperidine derivative paroxetine is a selective serotonin reuptake inhibitor. In a double-blind 6-week trial, paroxetine was compared with amitriptyline in hospitalized patients suffering from major depression (DSM-III). One hundred fifty-three patients were enrolled in the study in seven centers in Austria and Germany. Results showed similar efficacy of both drugs after 6 weeks. The differences between groups in Mont-gomery-Asberg Depression Rating Scale and Clinical Global Impression ratings did not reach statistical significance at any time. Side effects were distributed similarly but with a significantly higher incidence of anticholinergic effects in patients treated with amitriptyline (p < 0.001), whereas agitation and insomnia were registered more often in the paroxetine group. This study supports the antidepressive efficacy of paroxetine in a sample of severely depressed inpatients.

Hippocampal volume reduction in male schizophrenic patients

Using magnetic resonance imaging of the brain, we examined volumetric measurements of total brain, hemispheres, lateral ventricles and the hippocampus/amygdala complex in male subjects (41 first-episode schizophrenics, 30 chronic schizophrenic patients and 32 healthy controls). We found significantly smaller total brain size in the chronic schizophrenic group, significantly larger lateral ventricles in both patient groups and hippocampal volume reduction bilaterally in first-episode patients (-13.2% left, -12.05% right) and chronic patients (-10.6% left, -10.5% right) compared to controls--irrespective of diagnostic subtype, family history for psychiatric diseases, psychopathology, duration of illness or age at onset.

Are patterns of benzodiazepine use predictable ? A follow-up study of benzodiazepine users

A sample of 171 patients taking benzodiazepines (BZDs) who had been investigated in 1988 was followed up in 1991. From 140 patients who were still alive and willing to participate, 25% had stopped BZDs after an average duration of intake of 34 months. Of the 105 persons still taking a BZD, 37% were taking the same dose, 26% had reduced the dose and 37% had increased it. Characteristics of BZD long-term users and patients potentially at risk for abuse and/or dependence that were established from the 1988 data were reexamined: patients with continued BZD use more often suffered from somatic illness which often had deteriorated, they had a longer duration of intake and used higher daily doses. In most cases the indication was insomnia. Patients with a clinically relevant dose increase were more often males, frequently found to be dependent on alcohol and/or illegal drugs.

Characteristics of benzodiazepine long-term users: investigation of benzodiazepine consumers among pharmacy customers.

A sample of 171 benzodiazepine (bzd) users was investigated in the pharmacy where the patients filled in their prescriptions. Of the sample, 29.8% were males and 70.2% were females. About 60% of the patients had their current prescription from a general practitioner, the rest from different specialists. 70.8% stated to take bzds on more than 3 days of the week. The mean duration of intake of the entire sample was 4.5 years. The most frequent reasons for bzd intake were sleep disturbance followed by nervousness and somatic diseases. A total of 74.9% of the patients turned out to be well informed about the potential dependence hazards of bzd long term intake, but less than half of them had been informed by the prescribing physician. In a second step it could be demonstrated by means of multiple stepwise logistic regression analysis that certain characteristic parameters differentiate long-term users and persons with signs of potential abuse and dependence from other bzd users.

New risk factors for donor site seroma formation after latissimus dorsi flap breast reconstruction: 10-year period outcome analysis ☆

INTRODUCTION Latissimus dorsi flap breast reconstruction is associated with a high incidence of donor site seromas. After using several preventive operative techniques, we were able to reduce postoperative complications in a standard operation procedure. The aim of this study was to evaluate the effect of various risk factors related to incidence, volume and frequency of seroma aspiration. METHODS A retrospective review of 87 latissimus dorsi breast reconstructions over a 10-year period was carried out. Associations between potential risk factors and outcome (total drainage volume, number of aspirations and total seroma volume) were investigated on a descriptive level by means of correlation analysis and on an analytical level by multiple linear regression analysis. RESULTS Correlation analysis showed that co-morbidity and higher body mass index (BMI, in kilograms per square metre) were associated with larger seroma volumes. BMI remained a significant risk factor also after adjustment for other co-variates (p<0.001, linear regression). Moreover, patients receiving selective serotonin reuptake inhibitors (SSRIs) presented significantly higher seroma volumes (p=0.047, linear regression). At a trend level (p<0.1), post-operative hypertension, lower Ca ± - levels and a reduction in haemoglobin levels (before vs. after operation) were also associated with larger seroma volumes. DISCUSSION This study, besides observing the effects of well-established risk factors such as age, BMI and surgical operation techniques, identified new risk factors, in particular the perioperative use of SSRIs and the calcium balance, which should be considered in patients in pre- and postoperative care.

A Comparison of Patterns of Tranquiliser Intake, Anxiety and Health Locus ofControl between Short- and Long-TermBenzodiazepine Users

This study investigates the impact of physical illness, health locus of control and anxiety level on long- and short-term benzodiazepine (BZD) use in patients of an internal medicine department. There was no significant difference observed between the continuing and discontinuing group after hospital admission in terms of average daily dose of BZD. However, the continuing patients rated the condition of their somatic illness significantly higher than the discontinuing group, although this difference was not confirmed by the objective assessment of the treating physician. The non-continuing group displayed significantly higher control over health- and sickness-related events. The somatic and physical anxiety factor was significantly higher in the continuing group at initial investigation as well as at follow-up. On the basis of these results, we conclude that an increased focus on the psychosomatic element might reduce the risk of long-term tranquiliser use in patients with physical illness.

Psychopharmacological treatment of schizophrenia during pregnancy and lactation

Purpose of review It is necessary, in every-day clinical life when treating pregnant women with mental diseases, to reach quick decisions derived from recent comprehensive information. The knowledge of the use of antipsychotics in pregnancy has increased considerably in the last years. This review tries to summarize important considerations and facilitate clinical decisions. Recent findings This review will cover not only the effects of exposure during pregnancy on outcomes, postnatal adaption syndrome and lactation, but also pharmacokinetic considerations on the use of antipsychotics during pregnancy. Summary The recent publications have found only minimally increased risks for certain malformations, after using ever more sophisticated statistical models of analysis and reassuring amounts of data. Taken together, the quality of the studies has greatly improved and the results are reassuring with respect to the safety of the use of antipsychotics during pregnancy. The rates of weight gain and gestational diabetes warrant closer attention in the clinical setting.