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.

Psychopharmacologic Management in Integrated Care: Challenges for Residency Education.

The integration of psychiatric care in primary care is becoming a reality. Psychiatric training programs are facing multiple challenges to accommodate this transition. We here present the perspectives of Group for the Advancement of Psychiatry Committee on Psychopharmacology. The members of the group respond to the concerns raised by a resident currently confronting this changing landscape. By discussing the training, clinical, and communicating challenges of integrated care, they shed light on many of the questions being tackled by residency training programs. This commentary on the timely discussion about integrated care seeks to provide insight on the future of training in psychiatry by outlining the core questions of this change.

The physiological and behavioral effects of carbon dioxide on Drosophila melanogaster larvae.

Adult and larval insects are rapidly anesthetized by carbon dioxide (CO2); however, the mechanisms have not been addressed. In this study, we use larval Drosophila to investigate the actions of CO2 to explain the behavioral effects of rapid immobilization and cardiac arrest with acute exposure to CO2. To determine if the central nervous system (CNS) is required, studies were performed with and without the CNS. The effects of low pH induced by exposure to CO2 were also examined. An acidic saline increases the heart rate in contrast to saline containing CO2. Synaptic transmission at the skeletal neuromuscular junction (NMJ) is blocked by CO2 but not by low pH. The site of action is postsynaptic by a decreased sensitivity to glutamate, the neurotransmitter at Drosophila NMJs. The CNS remains active in synaptic transmission when exposed to CO2 which is in contrast to the synapses at the NMJ. In summary, the effects of CO2 are directly mediated on the heart to stop it and at skeletal NMJs by a reduced sensitivity to glutamate, the released neurotransmitter, from the motor nerve terminals. The rapid behavioral and physiological effects cannot be accounted for by action on the CNS within the larvae nor by a pH effect indirectly induced by CO2. The glutamate receptors in the D. melanogaster preparation are similar in function to ionotropic glutamate receptors in vertebrates which could account for the observational phenomena of CO2 not yet explained mechanistically in vertebrates.