Iatrogenic disorders associated with conventional vs. atypical antipsychotics.

Pharmacotherapy is an indispensable component of the management of schizophrenia and related psychotic disorders. Antipsychotic drugs are used for their efficacy in controlling the symptoms of psychosis. However, the side effects of antipsychotic drugs can have a deleterious impact on the course of the illness by inducing iatrogenic symptoms of various severity. The side effects of first-generation or conventional antipsychotic drug were often so intolerable to patients with schizophrenia that their compliance was consistently poor, leading to frequent relapse, chronicity, and impaired functioning. The second-generation (atypical) antipsychotics, introduced 40 years after the advent of the older-generation, are proving to have better outcomes in psychosis not only because of broader symptom efficacy but also because their side-effect profile is more tolerable, leading to higher compliance and fewer relapses. The authors review the side effects of the old and the new antipsychotics and conclude that the improved tolerability of the new antipsychotics is associated with greater effectiveness, not just efficacy. Differences in tolerability among the new antipsychotics are described.

Chronic Brucella infection of the supra-patellar bursa with sinus formation.

A case of supra-patellar bursitis with the formation of discharging sinus is described. B abortus was isolated from resected bursal tissue. While osteoarticular complications of brucellosis are common and a number of different clinical syndromes are now recognised, disease of the bursae is rare and as far as is known sinus formation has not been described before in this setting.

Septicaemia caused by Pediococcus pentosaceus: a new opportunistic pathogen.

A case of septicaemia caused by Pediococcus pentosaceus is described. The role played by pediococci, and other vancomycin-resistant Gram-positive cocci, in disease states is examined. We suggest that in immunocompromised patients these organisms act as opportunist pathogens. This would appear to be the first reported case of P. pentosaceus septicaemia.

The in-vitro activity of some antimicrobial agents against methicillin-resistant Staphylococcus aureus.

A total of 185 strains of methicillin resistant Staphylococcus aureus was investigated for sensitivity to five other antimicrobial agents. The vast majority of these strains were also resistant to gentamicin and fusidic acid. Rifampicin was the most active drug tested (MIC90, 0.007 mg/l), while two newer compounds teichomycin and ciprofloxacin showed equal and appreciable activity (MIC90, 0.5 mg/l).

Pseudomonas aeruginosa cross-infection following endoscopic retrograde cholangiopancreatography.

In a 6 week period, three of 50 patients developed Pseudomonas aeruginosa septicaemia following Endoscopic Retrograde Cholangiopancreatography (ERCP). Pseudomonas aeruginosa serotype 10 was isolated from each of the patients and from the endoscope. The outbreak was related to inadequate disinfection of the air and water channel of the endoscope. Following the introduction of a modified decontamination technique, which involved rinsing the air and water channel with glutaraldehyde, no further cases of pseudomonas infection occurred, and the organism could not be isolated from the instrument. Obstruction of the biliary tract was a predisposing factor in the development of infection; and administration of antibiotics immediately following the procedure failed to prevent it. This may have been due to inadequate dosage. We suggest that patients presenting for ERCP, in whom obstruction of the biliary tract is suspected, should come prepared for immediate drainage of the obstructed system at the time of the procedure.