Is the Evidence Strong Enough to Warrant Long-Term Antipsychotic Use in Compulsory Outpatient Treatment?

Debate surrounding assisted outpatient treatment has mostly focused on issues of due process, cost-effectiveness, and efficacy as measured by readmission and incarceration rates. Less attention has been paid to whether long-term use of antipsychotic treatment is supported by sufficient evidence to warrant its compulsory use in assisted outpatient treatment programs. The authors examine the rationale and evidence for long-term use of antipsychotics, noting the pervasive belief within the psychiatric community that psychotic illness, especially schizophrenia, requires lifelong medication. They argue that although antipsychotics are clearly indicated for patients in the acute phase of psychotic illness, the evidence for long-term use is less convincing and may not justify compulsory long-term use.

The value and underutilization of simple reading glasses in geropsychiatry inpatient settings.

For almost everyone, the need for reading glasses is an inevitable part of the second half of life. Forgetting one's reading glasses at a restaurant can be a disturbing reminder of one's dependence on them. For geriatric inpatients, however, the value of reading glasses in improving quality of life and preventing delirium may be overlooked. Subsequently, the authors present a brief review of visual impairment, the relationship of visual impairment and cognition and the cost of reading glass, and the results of a survey that was conducted to determine the proportion of inpatient geriatric psychiatry inpatient units in the United States, which provide reading glasses to inpatients as well as to assess the knowledge of medical directors of these units regarding the cost and perceived value of providing reading glasses to hospitalized patients.

A case of severe airbag related ocular alkali injury.

While airbags have saved many lives and are clearly beneficial overall, sodium hydroxide (NaOH) powder produced by the inflation reaction can cause significant alkali ocular injury if not irrigated promptly. Here we report a case of severe airbag related ocular alkali injury as a way to bring attention to the need for prompt ocular irrigation following motor vehicle accidents (MVA) with airbag deployment. A 47-year-old man was involved in a MVA with airbag deployment in a rural setting. Attention was paid to several other life-threatening traumatic injuries, however, ocular irrigation was not performed until some 6-7 hours after the MVA. Over the course of 6 months, airbag related alkali injury caused severe limbal ischemia, conjunctivalization of the cornea, corneal epithelial defects, cicatricial scarring, haze, and corneal/limbal vascularization despite amniotic membrane graft. Awareness of the importance of ocular irrigation following airbag deployment must be raised both in the ophthalmology and emergency medicine communities.

Survey on Visual Impairment and Refractive Errors on Ta'u Island, American Samoa.

PURPOSE: To assess the prevalence of presenting visual impairment and refractive errors on the isolated island of Ta'u, American Samoa. METHODS: Presenting visual acuity and refractive errors of 124 adults over 40 years of age (55 male and 69 female) were measured using the Snellen chart and an autorefractometer. This sample represented over 50% of the island's eligible population. RESULTS: In this survey, all presenting visual acuity (VA) was uncorrected. Of the included sample, 10.5% presented with visual impairment (visual acuity lower than 6/18, but equal to or better than 3/60 in the better eye) and 4.8% presented with VA worse than 6/60 in the better eye. Overall, 4.0% of subjects presented with hyperopia (+3 D or more), 3.2% were myopic (-1 D or less), and 0.8% presented with high myopia (-5 D or less). There was no significant difference between genders in terms of visual impairment or refractive errors. CONCLUSION: This study represents the first population-based survey on presenting visual acuity and refractive errors in American Samoa. In addition to providing baseline data on vision and refractive errors, we found that the prevalence of myopia and hyperopia was much lower than expected.

Evidence for a continuing gap in rural/urban adult obesity in the Samoan archipelago.

Significant differences in adult obesity prevalence exist between rural and urban settings throughout the world. Here, we estimate and evaluate the prevalence of adult obesity in rural Independent Samoa, rural American Samoa, and urban American Samoa in 2009. Volunteers over the age of 40 years were weighed and measured by convenience sampling in rural Independent Samoa (N = 85), rural American Samoa (N = 124), and urban American Samoa (N = 95) Mean BMI increased from rural Independent Samoa (32.2 males; 33.3 females) to rural American Samoa (33.5 males; 34.9 females) to urban American Samoa (36.9 males; 39.7 females). Differences among groups were statistically significant (P = 0.004, ANOVA). In all locations, women were substantially more obese than men. While obesity is a major health problem in the Samoan archipelago, significant differences exist between rural and urban settings. A substantial rural/urban gap in adult obesity has been in existence since at least the 1970s. However, results of our study, combined with those of previous studies, indicate that the prevalence of obesity in both rural and urban environments has been on the rise since the 1970s.

Alcohol consumption and gender in rural Samoa.

INTRODUCTION AND AIMS: There are significant gender differences in alcohol consumption throughout the world. Here we report the results of an alcohol consumption survey on the rural island of Savaii, in the Pacific nation of Samoa. DESIGN AND METHODS: Eleven villages were selected for sampling using a randomized stratified cluster sampling methodology. A total of 1049 inhabitants over the age of 40 years (485 males and 564 females) were surveyed about alcohol consumption over the past year, and a 72.2% participation rate was achieved. RESULTS: A SIGNIFICANT GENDER DIFFERENCE IN ALCOHOL CONSUMPTION WAS FOUND: 97.3% of women and 59.4% of men reported no alcohol consumption over the past year. This is one of the most significant gender differences in alcohol consumption in the world. No significant difference between genders was seen in those who consume only 1-5 alcoholic drinks per week (P = 0.8454). However, significantly more males than females consumed 6-25 drinks per week (P < 0.0001), 26-75 drinks per week (P < 0.0001), and 75+ drinks per week (P < 0.0001). DISCUSSION AND CONCLUSION: This extreme gender difference in alcohol consumption is attributed to several factors, both general (alcoholic metabolism rates, risk-taking behaviors, general cultural taboos, etc) and specific to Samoa (church influence, financial disempowerment, and Samoan gender roles).

Dictazolines A and B, bisspiroimidazolidinones from the marine sponge Smenospongia cerebriformis.

An extensive study of the secondary metabolites produced by the marine sponge Smenospongia cerebriformis has led to the isolation of two new bisspiroimidazolidinone derivatives, dictazolines A (1) and B (2), along with the known soft coral metabolites tubastrindoles A (3) and B (4). The structures were assigned by 2D NMR spectroscopic methods.