[Problems when switching antipsychotics]. / Problemer ved skift af antipsykotika.

Most patients with schizophrenia switch antipsychotics (APs) either due to lack of efficacy or due to side effects. Changing AP, especially switching from clozapine, may lead to deterioration in the patient's condition because of pharmacodynamic differences between the existing and the new AP. A meta-analysis including four studies found no differences between switch strategies while three recent studies each found a positive short term effect of a crossover strategy compared to an abrupt switch. Based on the lack of evidence we recommend a slow withdrawal with a crossover strategy when switching AP.

[Paliperidone--a novel second-generation antipsychotic]. / Paliperidon--et nyt andengenerations-antipsykotikum.

Paliperidone Depot (PAL ER) is a new second-generation antipsychotic with pharmacodynamics resembling those of risperidone. PAL ER is slowly and smoothly released in 24 hours. Its half-life is about 24 hours. PAL is primarily eliminated unchanged in urine. Three short-term studies and one relapse study found PAL ER to be significantly more effective than placebo in all doses (3-15 mg once a day). There are no head-to-head comparisons with other antipsychotics, including risperidone. On the existing evidence it is not possible to ascertain whether PAL ER is better than risperidone in terms of effects and tolerability.

Drug therapy of dementia in elderly patients. A review.

Today drug therapy of dementia in elderly patients is possible. Owing to a huge increase in the number of elderly people throughout the Western world in the coming years, evidence-based treatment of dementia in this group is needed. The article reviews double-blind, randomized trials on the effect in dementia of donepezil, galantamine, rivastigmine and memantine up to 2003. A total of 27 studies were included. Donepezil, galantamine, rivastigmine and memantine improve cognition and the global level of functioning in mild to moderate Alzheimer's disease (AD). Most evidence exists for donepezil and galantamine. The effect of rivastigmine is best documented in Lewy body dementia (LB). Galantamine, memantine and donepezil may improve cognition in vascular dementia (VD). Galantamine may improve behavioural psychological symptoms of dementia (BPSD). No solid evidence for drug therapy in severe dementia exists. Elderly patients with mild to moderate AD should be offered drug therapy. One should also consider expanding the indication of dementia treatment to LB and VD. An international consensus on what primary efficacy variables to use is needed.

[Diagnosis and treatment of depression in general practice. A questionnaire study]. / Diagnostik og behandling af depression i almen praksis. En spørgeskemaundersøgelse.

INTRODUCTION: The purpose of this questionnaire study was to assess the knowledge and attitude of general practitioners (GPs) towards the use of diagnostic criteria in clinical practice, and the extent to which diagnostic tools are used as a prerequisite for the treatment of depressive patients in general practice. MATERIAL AND METHODS: A total of 758 out of 1,700 randomly selected GPs responded to the questionnaire. The GPs' demographic data (age, sex, number of years in practice, supplementary education), diagnostic practice (knowledge of depressive core symptoms and diagnostic tools and scales), and clinical practice (assessment of the effectiveness of treatment, duration of treatment, aim of treatment, and use of psychotherapy) were registered. RESULTS: The study showed that GPs, who had taken part in supplementary training in psychiatric issues within the preceding year, to a higher extent than the rest of the GPs used diagnostic tools for all or most patients. This group of GPs also had a significantly greater knowledge of the depressive core symptoms as described in the ICD-10. When compared with the other group of GPs, they also felt themselves more confident of the diagnosis of depression before prescribing antidepressive medication. The vast majority of both groups felt that many depressive patients remained undiagnosed, because they simply do not consult their GPs. They also found that it was often questionable whether the symptoms were caused by life crisis or depression--and whether or not the depressive symptoms of these patients required drug treatment. DISCUSSION: The questionnaire study shows that the GPs' level of knowledge of diagnostics of depression is insufficient. There is an obvious need for supplementary training in general practice, thereby increasing the knowledge and the use of diagnostic criteria in order to make diagnoses of depression more correct and to improve treatment.

[Why is QT interval interesting?]. / Hvorfor skal vi interessere os for QT-intervallet?

A prolonged Q-T interval is generally associated with increased risk of ventricular arrhythmias, like torsade de pointes, and death. It has recently become apparent that not only antiarrhythmic drugs such as sotalol and Kinidin, but also a variety of nonantiarrhythmic drugs, like certain antihistamines, antimicrobial drugs, psychiatric drugs, and cisapride, may induce prolongation of the Q-T interval and torsade de pointes. Special concern should be drawn to the co-administration of drugs that interfere with the metabolism and elimination of these drugs, such as ketoconazole. Patients with congenital long Q-T syndrome, patients with heart disease, with hypokalaemia or hypomagnesaemia, and women have an increased risk. Every sign on dizziness or syncope should be regarded as a warning sign of possible arrhythmia in patients treated with drugs that potentially prolong the Q-T interval. Measurement of the Q-T interval before and during treatment is generally recommended in high-risk patients.