Osteoporosis after combined use of a neuroleptic and antidepressants.

UNLABELLED: Bone mineral density may be negatively influenced by hyperprolactinemia, which can be caused by atypic neuroleptics and antidepressants. CASE DESCRIPTION: The present paper reports about a spontaneous rib fracture in a female patient (age 52) taking neuroleptics (mainly risperidone), antidepressants (mainly sertraline), and anxiolytics (mainly lorazepam). At the time of the fracture a severe osteoporosis and a strongly enhanced plasma prolactin level (117 ng/ml; normal values: 3-24 ng/ml) were detected. The latter one normalized 2 months after abandoning sertraline and risperidone. After this normalization, the patient did not report further accidents up to now. DISCUSSION: Enhancement of plasma prolactin levels is linked to the mechanism of action of risperidone. Mammoplasia and increased plasma prolactin can occur during SSRI (Selective Serotonin Reuptake Inhibitors) or trazodone administration. The role of anxiolytics is less clear. The causal relationship between osteoporosis and long-term use of neuroleptics and antidepressants was assessed using probability scores, more particularly the Naranjo probability scale and the Bradford-Hill criteria of causality. A score of 6/13 (probable) was obtained with the Naranjo scale, whereas all 9 Bradford-Hill criteria were fulfilled. CONCLUSION: Although this case could not be fully explored, attention should be paid to bone mineral density loss in depressed patients taking a combined therapy of atypic antipsychotics and antidepressants.

The "extent of information desired"-scale in psychiatric in-patients: a behavioural approach.

OBJECTIVE: The purpose of this study was to investigate the "extent of information desired" (EID)-scale through a behavioural approach. METHODS: Standardised interviews consisting of the EID-scale and four (half) open questions were conducted in a convenience sample of psychiatric in-patients and information seeking behaviour was measured. At the same time, socially desirable behaviour was assessed by means of Marlowe-Crowne social desirability (MCSD). RESULTS: 39 patients were interviewed. The behavioural approach yielded mixed results, but there was no correlation between EID- and MCSD-scores. DISCUSSION: From the calculated correlations information seeking behaviour is perceived as socially undesirable, whereas EID-scores seem unaffected by social desirability. CONCLUSION: It is difficult to define independent variables which would reflect information seeking behaviour. The ones we used might have been confounded. We found a correlation between the EID-scale used and the information seeking behaviour, without a strong correlation with social desirability. PRACTICE IMPLICATIONS: The EID-scale used may predict patients' desire for information within a well-defined clinical context. The step to validation requires more robustness of the research model and a better profiling of patients.

Desire for information about drugs: a survey of the need for information in psychiatric in-patients.

BACKGROUND: Promoting therapy adherence requires understanding various psychosocial parameters, including patients' need for information. Drug information adapted to patients' needs may empower them and increase their confidence in drug therapy. OBJECTIVES: To explore psychiatric in-patients' information preferences and to test the reliability of a Dutch version of the Intrinsic Desire for Information (IDI) scale in psychiatric institutions in Flanders. METHODS: Standardised interviews were conducted with psychiatric patients in 11 hospitals. The interview consisted of the IDI-scale and five open questions. Patient demographics collected were sex, age, number of medicines taken, diagnosis, number of admissions during the past year, marital status, education level and occupation. RESULTS: 279 patient interviews were completed. A factor analysis on the original 12-item scale yielded 3 factors. An abbreviated scale was derived from the first factor (F1). This 6-item scale measured 'extent of information desired:' (EID) and consisted of six items (Cronbach's alpha = 0.73). A second factor (F2) measured 'information provider preference' (IPP) (alpha = 0.56) and a third factor (F3) measured 'inhibited information desire' (IID) (alpha = 0.69). EID was associated with number of medicines taken, duration of hospitalisation and marital status. CONCLUSION: The internal reliability of the EID-factor appears to be reproducible in the specific setting of psychiatric hospitals. It may be useful to help healthcare professionals develop pharmaceutical care towards psychiatric patients. Validation of the scale remains to be completed. Information need in psychiatric in-patients measured by the EID-score was comparable to the need measured in general hospitals during earlier research in England. Targeted information services seem to be desirable to enhance therapy adherence and quality of life in psychiatric patients.

Drug information in psychiatric hospitals in Flanders: a study of patient-oriented leaflets.

OBJECTIVE: This study reviews written information sources that inform patients about their drugs used in psychiatric institutions in Flanders. METHODS: Pharmacists working in psychiatry were asked to participate. Seven leaflets were collected and evaluated using the Flesh readability formula and twelve hospital pharmacists scored ten propositions on a Likert scale. Questionnaires were mailed to the participants. RESULTS: There was wide variation within the three readability parameters: reading ease varied from easy to difficult, personal interest from tedious/scientific to very interesting/illustrated magazines and the quick reading test varied from formal to very popular. Two brochures were tedious and formal. As to the content, only three were significantly considered 'very interesting for patients' (P < 0.05). Most were found to be clear and not too long. Concrete information about administration, dosage and duration of therapy appeared to be absent from several leaflets. Adverse effects and possible complications were thought to be well rendered in most screened sources. According to the respondents, the role of the pharmacist was not sufficiently mentioned. CONCLUSION: Only three leaflets appeared to be suitable as a patient-oriented information tool. Pharmacists in psychiatric institutions can contribute to patient counselling by providing high-quality leaflets.