Providing quality care to patients with schizophrenia.

With the increasing use of evidence-based medicine and the welcome introduction of innovations such as computer technology into daily practice, there is now the opportunity to link these two new approaches to the awareness of quality measurement within psychiatry. As awareness of costs in medical treatment increases, the emphasis on quality management increases, which makes it increasingly more important that quality standards are set using the available treatment guidelines. When set, these standards can be applied and eventually measured. Only then can quality management be put into practice. The use of treatment guidelines for the holistic treatment of psychiatry patients now is being actively encouraged in many treatment settings. These guidelines form a potential basis for more effective treatment. Only by implementing a measurement process of treatment outcomes will the true value of these guidelines be appreciated.

Citalopram.

Citalopram is a selective serotonin (5-HT) reuptake inhibitor (SSRI) developed by H. Lundbeck A/S in Denmark. It is the most selective serotonin antidepressant with proven efficacy, a favourable pharmacokinetic profile and a low potential for interactions with other concomitant medication. The drug has a low incidence of side effects, even when compared to the other SSRIs and good patient compliance and satisfaction is a feature of this drug. These factors make the drug a good choice for depressed patients who require continuation and long-term treatment, as well as for elderly patients. Copyright 2000 John Wiley & Sons, Ltd.

Treatment of schizophrenia in low-income countries.

The introduction of the novel antipsychotics has had a major impact upon the treatment of schizophrenia. However, the greater acquisition costs of these drugs puts them beyond the reach of large sectors of the world's population. Consequently, the gap between the levels of care in high-income and low-income countries is likely to widen even further. Co-ordinated global action is necessary to ensure greater accessibility of these drugs. Cost-effectiveness studies in low-income countries need to be undertaken. The considerable evidence for improved safety and efficacy of low-dose compared to high-dose classical antipsychotics offers an alternative that could be implemented immediately in low-income countries.