Cataract occurrence with antipsychotic drugs.

Chlorpromazine and several other phenothiazine neuroleptic drugs appear to induce cataract formation. However, the newer generation of antipsychotic agents has shown no evidence of an etiologic relationship with cataract occurrence. Research did reveal cataract occurrence in dogs who received quetiapine, which prompted concern despite there being no known causal link between quetiapine and lens opacities in humans. Nevertheless, quetiapine's manufacturer issued formal recommendations for ophthalmological follow-up examinations with the use of this drug. Infrequent occurrences of cataract development have been documented in people taking olanzapine but, again, without established causative association; a similar situation is seen with ziprasidone. Periodic ocular examinations of the lens are suggested for patients prescribed long-term treatment with phenothiazines or quetiapine.

Body weight changes associated with psychopharmacology.

OBJECTIVE: The authors discuss changes in body weight associated with various psychopharmaceuticals. METHODS: A large number of articles and books about drug-induced changes in body weight, selected on the basis of various literature searches and the authors' clinical experiences with psychopharmaceuticals, were reviewed. RESULTS: Many psychotropic drugs with antipsychotic, mood stabilizing, and antidepressant properties are associated with weight gain. Others, such as fluoxetine, isocarboxazid, nefazadone, topiramate, and psychostimulants, may cause weight loss. The antipsychotic drugs chlorpromazine, clozapine, and olanzapine are often associated with weight gain. Among antidepressants, amitriptyline and mirtazapine are known to cause weight gain. However, reductions are sometimes observed, and each antidepressant has its own unique weight-effect profile. Mood stabilizers, especially valproate-related products, are also associated with weight gain. CONCLUSIONS: Careful monitoring and consideration of alternative therapies are essential.

School dysfunction: evaluative aspects.

Inability of a child to function in a formal school setting necessitates a review of potential physical, mental, emotional, and behavioral etiologies. A thorough, systematic history and examination is expected; the time of onset, age, and grade of the patient helps to narrow the differential diagnosis. A careful assessment should determine the work-up, correct diagnosis, and treatment. Additional primary care physician responsibilities in school dysfunction cases include patient education, family support, and specialist referral, if necessary.