[Schizophrenia and antipsychotics associated with the metabolic syndrome. An overview]. / Schizofrenie en antipsychotica: samenhang met het metabool syndroom.

BACKGROUND: Cardiovascular morbidity and mortality are higher in patients with schizophrenia than in the general population because the metabolic side-effects of antipsychotics and schizophrenia increase the risk of cardiovascular disease (cvd) and diabetes mellitus type 2 (DM2). The metabolic syndrome is defined in order to discover which patients have a high risk of developing cvd and DM2. AIM: To survey the current knowledge about the relationship between schizophrenia and the metabolic syndrome, the influence of the use of antipsychotics on the development of the metabolic syndrome, and the possible differences in the effects that first and second generation antipsychotics have on the syndrome. METHOD: The PubMed and Medscape databases were searched for relevant articles published between 2000 and July 2008. results Schizophrenia and the use of antipsychotics increase the prevalence of abdominal obesity, dyslipidemia and DM2 (i.e. the metabole syndrome). Second generation antipsychotics tend to cause a marked increase in the prevalence of abdominal obesity and dyslipidemia, whereas first generation antipsychotics hardly have any of these effects. Both first and second generation antipsychotics increase the risk of DM2. CONCLUSION: The metabolic syndrome has a significant effect on the morbidity and mortality of patients with schizophrenia because it increases the risk they will develop cvd and DM2. The risk increases still further if patients are taking antipsychotics. The risk of cvd can be decreased if patients with schizophrenia are screened in time and are monitored regularly.

[Auto-injection with epinephrine in the finger of a 5-year-old child]. / Auto-injectie met epinefrine in de vinger bij een 5-jarig kind.

A 5-year-old boy with food allergies complicated by anaphylactic reactions with dyspnoea and angioedema had been prescribed an autoinjector with epinephrine (0.15 mg) so that his parents could treat him at home if necessary. The patient accidentally injected himself in a finger, which likely makes him the youngest patient to receive an epinephrine auto-injection reported to date. Treatment consisted of phentolamine (0.15 mg in 0.5 ml normal saline) injected subcutaneously at the site of accidental injection; the dose and volume were not adapted according to the age and body weight of the patient as only a local effect was intended. Finger circulation was restored within 20 minutes. Headache, nausea and vomiting were observed after 30 minutes and were most likely a systemic side effect of phentolamine. No other complications occurred. The patient recovered fully and was discharged the following morning. Intramuscular epinephrine autoinjection is standard therapy for severe anaphylactic reactions. The epinephrine autoinjector was introduced in 1980. As allergy and anaphylaxis become more common, increasing numbers of autoinjectors are prescribed, and it is likely that the number of accidental digital autoinjections will also increase. These digits are then at risk of ischaemic necrosis. There is no consensus on therapeutic strategies in such cases. Phentolamine administration appears to be an effective intervention. However, several recent studies have shown that epinephrine may be used safely in hand surgery, which suggests that accidental digital epinephrine autoinjection may not always require immediate treatment.