Perceived barriers towards healthy eating and their association with fruit and vegetable consumption.

Background: Improving dietary intakes is a key public health target. Perceived barriers to healthy eating (PBHE) are an important component of the Health Belief Model which aims to understand why individuals do not adopt preventive health measures. This study investigates the relationship between PBHE and reported fruit and vegetable (F&V) consumption. Methods: Data from the Scottish Health Survey 2008-11 (n = 8319) for PBHE and self-reported F&V consumption were used in Probit regression models to test the association between meeting the 400 g per day F&V recommendation and PBHE. Results: Regression models show women who reported a lack of cooking skills were 10.4% less likely to meet the F&V recommendations (P = 0.001). Not liking the taste of healthy foods or finding them too boring (10.2%, P = 0.022), preparation time (5.6%, P = 0.020) or willpower (3.0%, P = 0.021) were also significant. For men, reporting not liking the taste of healthy foods or finding them too boring (6.8%, P = 0.02) was the only significant result. Price, a commonly reported PBHE, was not significantly associated with F&V consumption. Conclusions: Not all commonly reported perceived barriers to healthy eating are significantly associated with meeting the recommended F&V intake.

A case of clozapine-induced tonic-clonic seizures managed with valproate: implications for clinical care.

We describe a case of clozapine-induced seizures in a patient with treatment-resistant schizophrenia. She had previously been treated unsuccessfully with a number of atypical antipsychotic medications, before she was eventually started on clozapine. She experienced two separate episodes of observed fits whilst on an initial daily dose of 125 mg and, subsequently, on a daily dose of 237.5 mg. Following discontinuation of clozapine, she was rechallenged and again was observed to have seizures. Appropriate investigations ruled out any organic cause of the fits and clozapine was successfully restarted, together with sodium valproate. By the time of treatment stabilization, the patient had not experienced any further fits. These findings suggest that clozapine-induced seizures can be successfully treated, that gradual dose titration can reduce the likelihood of further episodes of seizures and that concomitant use of a suitable mood stabilizer/anti-epileptic medication can improve the outcome of treatment-resistant schizophrenia. Furthermore, the concomitant use of fluoxetine and clozapine is discouraged, with citalopram suggested as a suitable antidepressant in those depressed patients receiving clozapine.

Antiretroviral therapy-induced psychosis: case report and brief review of the literature.

OBJECTIVE: We present a case of psychosis in an individual with known HIV infection whose symptoms developed approximately 1 month following the commencement of combination antiretroviral therapy consisting of abacavir (ABC), nevirapine and combivir. She presented with severe persecutory delusions, accompanied by mutism, posturing and catatonia. Following cessation of therapy and the introduction of a low-dose antipsychotic, her mental state resolved to a stable premorbid level, and no further disturbances of behaviour were noted. Furthermore, when re-challenged with the above combination minus ABC, there were no further episodes of psychosis. It is proposed that the aetiology of the psychosis was related to her antiretroviral therapy. METHODS: Cessation of antiretroviral medication and initiation of antipsychotic medication with appropriate monitoring and assessment. RESULTS: Subjective and objective improvements in psychotic symptoms and presentation. CONCLUSION: The current case suggests that sudden onset psychotic disturbances in HIV-infected individuals in the absence of other known organic or other causal factors could be related to treatment with antiretroviral therapy, and that cessation of this can markedly improve psychiatric morbidity. Furthermore, treatment with antipsychotic medication can lead to alleviation of psychotic symptoms and enable the re-introduction of antiretroviral medication.

A comparison of buspirone, diazepam, and placebo in patients with chronic anxiety states.

Buspirone is an antianxiety compound that has been extensively evaluated in clinical trials: it has proved superior to placebo and comparable to diazepam in the treatment of patients with generalized anxiety disorder. In this study, 33 outpatients with generalized anxiety disorder were entered into a crossover study of 3 weeks each of placebo, buspirone 10 to 30 mg daily, and diazepam 10 to 30 mg daily. Psychiatrist and patient ratings were made, together with psychological tests and EEG and skin conductance measures before and after each treatment. Of the nine dropouts, six were on buspirone at the time of dropout. For the remaining 24 patients, the mean daily doses attained of buspirone and diazepam were both 20 mg. On most clinical ratings diazepam was superior to buspirone and placebo, which did not differ. Diazepam produced minor psychomotor changes and the expected major effects on the EEG. Buspirone was without effect. Side effects on buspirone were mainly nausea and giddiness and on diazepam, drowsiness. The lack of efficacy of buspirone is discussed in terms of the previous benzodiazepine exposure--23/24 patients had had previous exposure and only 10 were able to tolerate a pretrial placebo washout period. The implications are considerable for the introduction of any new antianxiety agent not cross-tolerant with the benzodiazepines into a chronically anxious group of patients with previous long-term benzodiazepine therapy.

A comparison of buspirone and placebo in relieving benzodiazepine withdrawal symptoms.

Buspirone is a new antianxiety compound of a totally new type which may avoid the dependence problems of its predecessors. This study was designed to evaluate any possible cross-tolerance to the benzodiazepines. Twenty-four outpatients on long-term therapeutic dose benzodiazepine treatment, who wished to discontinue treatment, were allocated randomly to placebo substitution or buspirone substitution and then withdrawal over a total of 10 weeks. Assessments were made at weekly intervals. Of the 24 patients entered into the trial, 13 received buspirone and 11 placebo. Only five of the buspirone and six of the placebo patients successfully completed withdrawal. Some anxiolytic action of buspirone was detected, but it was insufficient to materially assist the withdrawal. No evidence was found that buspirone was cross-tolerant to the benzodiazepines. It was concluded that buspirone does not help benzodiazepine withdrawal and does not suppress benzodiazepine withdrawal symptoms.

Psychotropic effects of enalapril maleate in normal volunteers.

In order to establish any psychotropic effects of the angiotensin-converting enzyme inhibitor enalapril, the drug was administered in doses of 20 mg every morning for 14 days to 12 normal subjects, and compared with placebo on a battery of physiological, psychological and subjective tests, before and after the dose on the 1st and 14th days. Diastolic blood pressure was significantly reduced and heart-rate increased by enalapril as compared with placebo; one component (P1-N1) of the auditory evoked EEG response was increased and tapping rate quickened. The commonest side effect was tiredness. It was concluded that enalapril (unlike most other antihypertensive agents) did not lower mood but could enhance attention and alertness.

Depression following withdrawal from long-term benzodiazepine use: a report of four cases.

Depression following withdrawal from long- or short-term use of benzodiazepines is not uncommon, yet it is under-reported in the benzodiazepine withdrawal literature. Four cases of depressive illness supervening during benzodiazepine withdrawal are reported. Depression may, it is suggested, be an integral part of the benzodiazepine withdrawal syndrome.