Diabetes and schizophrenia - effect of disease or drug? Results from a randomized, double-blind, controlled prospective study in first-episode schizophrenia.

OBJECTIVE: There have been innumerable advances in the pharmacotherapy of schizophrenia, but problems have emerged hand-in-glove, such as the presence of treatment-emergent glucose intolerance and frank diabetes mellitus (DM). METHOD: Medication-naïve patients with schizophrenia (n = 99) underwent baseline fasting and 2 h post-prandial plasma glucose measurements repeated after 6 weeks after randomization to receive olanzapine, risperidone or haloperidol. The results were compared with a matched healthy control group. RESULTS: A significant difference (P = 0.002) in baseline 2 h post-prandial blood sugar (PPBS) was noted between the control group and the treatment group along with a significant increase in weight (P < 0.001), fasting blood sugar (P = 0.01) and 2 h PPBS (P < 0.001) from baseline to endpoint between the groups. A statistical significance in the incidence of DM at endpoint by the WHO criteria (10.1%) was also noted. CONCLUSION: Male patients with schizophrenia are liable to develop DM. Antipsychotic treatment leads to the development of DM in a significant 10.1% within 6 weeks.

Disease mongering in psychiatry: fact or fiction?

Disease mongering starts at the top of recent accusations being hurled at psychiatry. It is used to refer to the attempts by pharmaceutical companies or others who have similar interests, to enlarge the market for a treatment by convincing people that they are sick and need medical intervention. This paper critically analyses the 'for' and 'against' arguments of disease mongering in psychiatric disorders, both new and old, such as Bipolar disorders, attention deficit hyperactivity disorder, Restless legs syndrome, Premenstrual dysphoric disorder, female sexual dysfunction, social phobia, metabolic syndrome and road rage disorder.

Tobacco cessation services in India: recent developments and the need for expansion.

Tobacco use is a major cause of preventable death and disease in India. Unfortunately, very few people in India quit tobacco use. Lack of awareness of harm, ingrained cultural attitudes, and lack of support for cessation maintains tobacco use in the community. The significant addictive property of nicotine makes quitting difficult and relapse common. Health professionals have received little training, and very few thus carry out proper assessments and interventions among tobacco users. Evidence from the developed countries suggests that brief interventions delivered by diverse health professionals are effective in tobacco cessation. Combining pharmacologic approaches with behavioral counseling produces better results than a single strategy. In India, early experiences with tobacco cessation occurred in the context of primary community education for cancer control. More recently, tobacco cessation clinics have been set up to develop models of intervention, and train health professionals in service delivery. These need to be expanded at the primary, secondary, and tertiary care levels, and cost-effective community tobacco cessation models need to be developed. Tobacco cessation forms one of the critical activities under the National Tobacco Control Program. Tobacco cessation needs to be urgently expanded by training health professionals in providing routine clinical interventions, increasing availability and subsidy on pharmacotherapy, developing wide-reaching strategies, such as quitlines and cost-effective strategies, such as group interventions.

First rank symptoms: concepts and diagnostic utility.

First Rank Symptoms (FRS) were first defined by Schneider as diagnostic of schizophrenia. Since then, there has been an immense debate on their diagnostic and prognostic utility. This review attempts to understand the concepts of FRS as depicted over the years and the diagnostic and prognostic implications of FRS in mental illnesses including schizophrenia. Review of relevant material showed that there are wide variations in the concepts of FRS which may be classified according to broad and narrow definitions. These variations have also led to the differences in the diagnostic systems currently being used. Although the diagnostic utility of FRS in schizophrenia remains, it is not clearly so with other mental illnesses in which these symptoms may also be observed. In addition there is controversy over the prognostic implications with evidence divided between poor and no influence on outcome.