Trazodone and exacerbation of psychotic symptoms: an unfamiliar link.

OBJECTIVE: In this case report we attempt to emphasize the unfamiliar link between trazodone and relapse of psychotic symptoms. METHOD: Case report and literature review of relevant papers. RESULTS: We report a case of a 78-year-old woman with an established diagnosis of paranoid schizophrenia who has experienced an exacerbation of positive psychotic symptoms following initiation of 50 mg dailydose of trazodone. We noted that psychotic symptoms abated following discontinuation of trazodone. CONCLUSION: Trazodone use in patients in remission from schizophrenia may be associated with relapse of psychotic symptoms and caution is required.

A health screening and promotion clinic to improve metabolic monitoring for patients prescribed antipsychotic medication.

OBJECTIVES: We sought to determine whether the introduction of a health screening and promotion clinic might serve as a useful addition to existing services for patients prescribed antipsychotic medication. In particular, we wished to assess whether such a clinic might improve adherence to best practice guidelines. We also wished to determine the level of patient interest in such a clinic and how readily this service might be provided within the constraints of existing clinical resources. METHODS: We conducted an audit of outpatient records before and following the introduction of a health screening and promotion clinic. RESULTS: Of the eligible patients, 73% attended the clinic. The proportion of patients who had fasting blood tests within the previous 12 months increased from 45% at baseline to 85% at follow-up (χ 2 = 14.1, p < 0.001). The proportion of patients with appropriate physical observations completed increased from 5% at baseline to 80% at follow-up (χ 2 = 46.0, p < 0.001). CONCLUSIONS: We found that the introduction of a health screening and promotion clinic improved adherence to best practice guidelines. This service was well received and readily provided within the constraints of existing resources. Ultimately, the structure of services to screen and advise patients prescribed antipsychotic medication will be determined by local resource considerations and configuration of services.

Internet-based cognitive testing in multiple sclerosis.

Cognitive impairment in multiple sclerosis is difficult to study because of the heterogeneity and variability of this disease. The gold standard for measurement of cognitive function in multiple sclerosis is a full battery of neurocognitive tests, which is time consuming and expensive. Some cognitive tests like the PASAT, a measure of working verbal memory and processing speed, have been proposed for screening and follow-up of cognitive function in clinical trials. We studied whether we could measure cognitive function in multiple sclerosis over the Internet. For this we used the Cognitive Stability Index (CSI)trade mark, developed for persons with known or suspected primary central nervous system illness. The CSI was compared with formal neurocognitive testing (NPsych) and the PASAT in a cross-sectional study of 40 consecutive multiple sclerosis patients with subjective cognitive complaints. NPsych revealed that only 18 of the 40 patients (46%) were cognitively impaired. Although both the CSI and the PASAT were equalivalent in their specificity (86%), the CSI was significantly more sensitive than the PASAT (83% versus 28%). We conclude that the CSI, because of its availability over the Internet, has great potential as a tool for screening and follow up of cognitive function in multiple sclerosis.