Clinical and social correlates with the use of depot antipsychotic drugs in outpatients with schizophrenia in China.

BACKGROUND: To date, no study has investigated the use of depot antipsychotic medication (DA) in Chinese outpatients with schizophrenia. This study explored the frequency and sociodemographic and clinical correlates of DA in schizophrenia outpatients in both Hong Kong (HK) and Beijing (BJ), China. METHODS: 505 clinically stable outpatients with schizophrenia were randomly selected and interviewed in HK and BJ using standardized assessment instruments. Their basic sociodemographic and clinical data and psychotropic drug prescriptions were collected at the time of a diagnostic interview. RESULTS: 117 (23.2%) patients were prescribed DA, 36.1 and 10% of the HK and BJ samples, respectively. Prescription of DA was associated with a history of suicide, less use of clozapine, more frequent antipsychotic polypharmacy (APP), more frequent admissions, and study site (HK vs. BJ). In multiple logistic regression analysis, study site, less frequent prescription of clozapine, history of suicide, and more frequent use of APP remained significantly associated with DA. CONCLUSION: There was wide variation in the frequency of DA prescribing between HK and BJ even though the ethnic and clinical characteristics of the two samples were nearly identical. This suggests that sociocultural and economic factors, as well as traditions in psychiatric training and practice all played a role in determining the use of DA.

Clinical and social determinants of long-term use of benzodiazepines and its impact on quality of life of Chinese schizophrenia patients.

AIMS: To date there have been no studies investigating prescription patterns of benzodiazepine agents (BZDs) in Chinese outpatients with schizophrenia. This study examined the frequency and socio-demographic and clinical correlates of BZD prescription in Hong Kong (HK) and Beijing (BJ), China. METHODS: Five hundred and five clinically stable outpatients with schizophrenia were randomly selected and interviewed in HK and BJ using standardized assessment instruments. Basic socio-demographic and clinical data and psychotropic drug prescriptions were collected at the time of a diagnostic interview. RESULTS: One-hundred and fifty one (29.9%) patients were prescribed BZDs in the whole sample; 25.1% and 34.8% of the HK and BJ samples, respectively. Use of BZDs was associated with sex, employment status, history of suicide, less use of clozapine, more frequent use of typical antipsychotics (APs), higher doses of APs, severity of positive symptoms, extrapyramidal side effects (EPS) and insomnia. In multiple logistic regression analysis, severity of depressive symptoms, study site, sex, employment status, less use of clozapine and history of suicide remained significantly associated with BZDs. CONCLUSION: Although the ethnic and clinical characteristics of the two samples were nearly identical, there was a wide variation in the frequency of BZD prescriptions between HK and BJ suggesting that socio-cultural and economic factors as well as traditions of psychiatric training and practice all played a role in determining the use of BZDs. Prescription of BZDs in either site was not in line with current recommendation.

Clinical and social determinants of antipsychotic polypharmacy for Chinese patients with schizophrenia.

Most prescription pattern surveys have found a high rate of antipsychotic polypharmacy. To date few studies have investigated antipsychotic polypharmacy in Chinese patients with schizophrenia in general and outpatients in particular. This study examined the frequency and sociodemographic and clinical correlates of antipsychotic polypharmacy in Hong Kong (HK) and Beijing (BJ), China. Three hundred and ninety-eight clinically stable outpatients with schizophrenia were randomly selected and interviewed in HK and BJ using standardized assessment instruments. Antipsychotic polypharmacy was found in 17.6% ( N=70) of the whole sample and in 28% and 7.1% of the HK and BJ samples, respectively. Polypharmacy was associated with monthly income, severity of negative symptoms and extrapyramidal side effects (EPS), use of depot antipsychotic and anticholinergic drugs, doses of antipsychotics, and the number of hospitalizations. In multiple logistic regression analysis, younger age, number of hospitalizations, site (HK vs. BJ), and the use of depot antipsychotics were all significantly associated with antipsychotic polypharmacy. Although the ethnic and clinical characteristics of the two cohorts were nearly identical, there was a wide variation in the prescription frequency of antipsychotic polypharmacy between HK and BJ, suggesting that sociocultural and economical factors and traditions of psychiatric practice all played a role in determining antipsychotic polypharmacy. Clinicians should bear in mind that, at least for clinically stable patients, no scientifically sound therapeutic principles for antipsychotic polypharmacy exist.

[Study of the detection characteristics of clozapine, N-desmethyl clozapine and olanzapine with high performance liquid chromatograph-electrochemical detector].

In order to analyze clozapine, N-desmethyl clozapine and olanzapine, their detection characteristics with high performance liquid chromatograph-electrochemical detector (HPLC-ECD) were investigated. The separation was performed on an ODS-3 column with the mobile phase of methanol and 0.1 mol/L phosphate buffer(60:40, V/V). The retention times of clozapine, N-desmethyl clozapine and olanzapine were all prolonged with higher pH of the mobile phase. These three compounds could be separated on the baseline at pH 4.56 and 5.56. The relationships of peak heights and detection voltages shown typical "S" shaped curves, and these curves shifted to the left with higher pH. To get stable detection current, the detection voltages for clozapine, N-desmethyl clozapine and olanzapine must be higher than 0.60 V, 0.60 V and 0.35 V at pH 4.56, and 0.48 V, 0.48 V and 0.30 V at pH 5.56, respectively. The typical "S" shaped ampere-volt curves were very important for the selection of suitable voltage for quantitative detection, and could be used for the qualitative detection of these three compounds.

[Distribution of luteinizing hormone (LH) and human chorionic gonadotropin (hCG) in the nervous system, Hatschek's pit and gonads of protochordata].

Immunocytochemical localization of the nervous system, Hatschek's pit and gonads in protochordata was carried out using two specific antibodies against human LH and hCG. The results indicate that there are two different kinds of LH- and hCG-like immunopositive cells in the brain vesicle and nerve tuber of amphioxus, and nerve ganglion in Styela plicata showed immuno-negative reaction to LH and hCG antibodies. At the same time, we found for the first time that LH- and hCG-like immuno-positive cells existed in the early gonads (ovaries and testis) in protochordata. Positive substance distributed in the cytoplasm, nucleoplasm and nucleolar membrane of oogonia as well as early spermatogenic cells in testis. Afterwards, this positive substance was still distributed in the cytoplasmic membrane, cytoplasm, nuclear membrane and nucleoplasm of oocyte during the development and maturation of ovary, and spermatid and spermatozoa showed immuno-negative reaction in testis. These results will provide a new mophological proof that LH and hCG may be directly involved in regulation of the gonadal development and maturation of protochordata.

Use of the appendix to replace the choledochus.

Ten cases of choledochal cyst (CC) were treated by biliary-appendicoduodenostomy. The follow-up comprised a patient interview, ultrasonography (US), and single-proton ejected computerized tomography (SPECT) scanning. In all cases an anti-reflux submucosal tunnel was added to the distal appendico-duodenostomy; all showed an uneventful postoperative course. All the dilated intrahepatic bile ducts had normalized on B-US postoperatively. Four children under went SPECT examination; all of them had patent neo-bile ducts. In the authors' opinion: (1) Anastomosing the cecal end of the appendix to the common hepatic duct seemed more favorable than the other way around, because the cecal end could be easily trimmed to the size of the common hepatic duct, which was more or less dilated in the presence of a CC; (2) It is necessary to add a submucosal tunnel to the distal appendicoduodenostomy to achieve a more reliable anti-reflux effect; and (3) Transposing the vascularized appendix through the retro-transverse colon simplified the procedure and might reduce the risk of retroperitoneal complications if bile leakage should occur.