The effects of abrupt antipsychotic discontinuation in cognitively impaired older persons: a pilot study.

BACKGROUND: Antipsychotic use for behavioural and psychological symptoms of dementia (BPSD) is controversial. Guidelines advise to reduce antipsychotics given the adverse effects and limited efficacy, to limit dose and treatment duration as well as to undertake discontinuation. METHODS: A pilot study with 40 hospitalised geriatric cognitively impaired patients, in which the effects of abrupt antipsychotic discontinuation were investigated, using neuropsychiatric inventory (NPI) scores before and one month after discontinuation. Withdrawal symptoms were monitored thrice a day with a checklist during five consecutive days. RESULTS: Participants (n = 40) had a mean age of 84 years (range 67-95) and 53% were male. The total mean baseline NPI score was 21 (SD 12) with predominantly behavioural rather than psychological disturbances. After abrupt discontinuation, mild withdrawal symptoms were observed in 72% of the patients, with frequencies of symptoms peaking on day 2 (53%) and day 3 (48%). After one month, 31 patients (85%) were still off antipsychotics and improved on the majority of NPI domains, with a total mean NPI score decreasing from 18 (SD 13) to 12 (SD 8, p = 0.003). In the relapse group, there was no deterioration associated with the abrupt discontinuation and subsequent resumption of therapy with a total mean NPI score decreasing from 31 (SD 12) at baseline to 27 (SD 8) at one-month follow-up (p = 0.345). CONCLUSION: Abrupt antipsychotic discontinuation appears to be feasible in older individuals with BPSD. Systematically performed discontinuation efforts in clinical practice are needed to differentiate between patients where antipsychotics have no added value and patients where the benefits outweigh the risks.

[The syndrome of Cotard: an overview]. / Het syndroom van Cotard. Een overzicht.

BACKGROUND: There is increasing controversy about whether psychiatric illnesses should be divided into categories. One of the reasons is that such a categorial system, by its very nature, cannot provide a detailed description of specific psychopathological symptoms. A patient with Cotard's syndrome, for instance, is characterised by a nihilistic delusion relating to his own body and the syndrome does not fit into any one category. We report on a case of Cotard's syndrome encountered at our clinic. AIM: To provide an overview of the characteristics of Cotard's syndrome, including its history, phenomenology, pathogenesis and treatment. METHOD: A Medline search was conducted for the period 1980-2006 using the search term 'Cotard$'. This resulted in 68 publications, of which 18 were not used. Cross-references were used as well. RESULTS: Cotard's syndrome cannot be fitted unambiguously into any one category of the current classification system. Current evidence regarding Cotard's syndrome is based mainly on case studies and therefore no clarity can be obtained about the various aspects of the syndrome, such as prevalence, pathogenesis, treatment.

Desmin (a low molecular weight dermatan sulphate) versus heparin in the treatment of patients with deep venous thrombosis.

OBJECTIVE: There is theoretical and experimental evidence which indicates that Desmin, a low molecular weight dermatan sulphate, could be an attractive alternative to heparin in the treatment of deep venous thrombosis (DVT). The present study compares both compounds in patients with established DVT. METHODS: Seventeen consecutive patients admitted with DVT were included in a randomised open study comparing continuous intravenous administration of Desmin and continuous intravenous administration of heparin. Clinical, laboratory and imaging parameters were used to assess the efficacy and safety of both treatments. RESULTS: The results of the coagulation tests confirmed the published data on the antithrombotic profile of Desmin. A trend towards better biochemical tolerance was observed with Desmin. Repeated echo duplex examinations of the deep venous system could not document further thrombus extension in any patient. Pre- and post-treatment phlebographic Marder scores showed a non-significant trend towards superior efficacy of Desmin. Overall, the results regarding efficacy and safety were not significantly different in the two groups. CONCLUSION: Desmin can be safely studied as an alternative to conventional anticoagulation in the treatment of DVT.

A prospective study in healthy volunteers of the topical absorption of a 5% rifaximin cream.

Rifaximin, the active ingredient of an antibiotic cream, is a synthetic antibiotic derived from rifamycin and characterized by minimal absorption. In animals, no absorption was detected after topical application on the skin. The question as to whether there is detectable absorption in man by the same administration route is answered by this study in healthy volunteers. One gram of the cream containing 5% rifaximin was massaged on a sizable surface of skin prepared prior to application by mechanical abrasion. Rifaximin concentrations in blood and urine were then determined by means of HPLC-electrochemical-coulometrical detection. Concentrations in all samples being less than 2.5 ng/ml, the method's limit of detection, it is concluded that there is no detectable absorption in man. No adverse reactions were reported during this one day study. The results confirm studies performed in animals which showed that rifaximin is not absorbed and is well tolerated.

Observation of Pigeon herpesvirus 1 re-excretion during the reproduction period in conventionally reared homing pigeons.

Pigeon herpesvirus 1 (PHV1) re-excretion by latently infected mature homing pigeons was followed during the reproduction period under natural conditions. All latently infected pigeons re-excreted PHV1 during the reproduction period and most of them during squab-gorging.

Latamoxef (moxalactam) in acute exacerbations of chronic bronchitis.

Forty-three patients admitted to the hospital with acute exacerbations of chronic bronchitis were treated with latamoxef (moxalactam) twice daily intramuscularly for 10 days. Five patients received 0.5 g injections, 23 patients 1 g and 15 patients were given 2 g. Three patients dropped out of the study; one died suddenly, one was treated with another antibiotic because of suspected Gram-negative pneumonia and one developed pneumococcal septicaemia after the active treatment course. Most strains of Haemophilus influenzae, H. parainfluenzae and Branhamella catarrhalis were successfully eradicated but, by day 17, there were 7 patients with reinfections with Streptococcus pneumoniae. Latamoxef MIC values for Str. pneumoniae varied from 0.03 to 2 g mg/1, but most were in the region of 1 mg/1. Sputum concentrations reached approximately 1.5 mg/1 on the highest dosage but only 0.25 to 1 mg/1 on the lower doses. Peak Serum concentrations with the increasing doses averaged 14, 27 and 45 mg/1 respectively. The role and dosage of latamoxef in respiratory infections in the possible presence of streptococci are discussed.

The effect of the combined use of a clean air system and one day prophylactic administration of cefamandole in total hip replacement.

238 patients undergoing primary total hip replacement had on a routine basis both "clean air system" prophylactic conditions and a one day lasting prophylactic Cefamandole treatment on the day of surgery. All patients had a follow-up during at least one year; the follow-up in some patients was up to 25 months. Deep infections were not seen in any of the patients and E.S.R. returned to normal values one year after the intervention in all patients. Superficial wound infections were seen in 2% of the patients. One fifth of the patients had significant bacteriuria on the day of the intervention. This did not seem to have any implication. In our series both laminar air flow and prophylactic administration of Cefamandole on the day of intervention give an adequate prophylactic coverage to prevent the dangerous deep infection as a complication in total hip surgery.

Neurological toxicity of vindesine used in combination chemotherapy of 51 human solid tumors.

The authors treated 51 patients with solid tumours with vindesine 4 mg/m2, generally every third week, in combination chemotherapy protocols scheduled according to diurnal variability of kinetics. No dose-related sensory disorders were observed: On the contrary, motor toxicity appeared cumulative: 1) Early depression of osteotendinous reflexes from the first course onward, with progressive deterioration. No more normal reflexes could be evoked after 55 mg; 2) Early appearance of neurogenic pattern in the electromyograph after 5-10 mg. Progressive alteration with no normal detection recordings after 45 mg; 3) Late slowing down of conduction speeds (normal in 50% of cases up to 55-60 mg). Improvement or even complete recovery of neuropathy was documented following reduction of the unit dose, increased time interval between doses, or discontinuation of the treatment. The drug had to be withheld in only three patients: in two cases a low dosage related to individual sensitivity was being used.