July 2010

Omega-3 Fatty Acids and Exercise for Psychosis?
Omega-3 fatty acid supplementation and exercise are relatively benign interventions that might prevent symptoms and improve outcome in patients with or at high risk of developing chronic psychotic disorders.

Long-Acting Injectable Risperidone Often Discontinued
In a study of patients with schizophrenia in the US Department of Veterans Affairs health care system, clozapine (Clozaril and others) had the highest continuation rate over 1 to 2 years, while long-acting injectable risperidone (Risperdal Consta) was discontinued by over half of patients for whom it was prescribed.

Can Molindone Help with Weight Loss?
Molindone (Moban) may produce modest benefits for weight loss in patients taking antipsychotics but carries the risk of long-term movement disorders and is no longer available in the United States.

In Brief
Depression Care Initiative Reduces Suicide Rate to Zero; Ecstasy Decreases Serotonin Transporter Binding in Brain Regions Associated with Memory

Adjunctive Aspirin Reduces Schizophrenia Symptoms
Preliminary data suggest aspirin might reduce schizophrenia symptoms through its anti-inflammatory properties.

Torsade de Pointes and Ziprasidone
The second case of torsade de pointes following ziprasidone (Geodon) overdose reported in the medical literature involved multiple risk factors for triggering the life-threatening ventricular arrhythmia.

In Brief

July 2010

An integrated and aggressive approach to preventing suicides in a health care system can work. That's the lesson learned from the Perfect Depression Care program of Behavioral Health Services (BHS) at the Henry Ford Health System. In 2001, this suicide-reduction proposal was selected by the Robert Wood Johnson Foundation as 1 of 12 grants to demonstrate that new Institute of Medicine (IOM) strategies could serve as a roadmap to build a stronger US health care system (T. Hampton JAMA 2010;303:1903-1905). Henry Ford redesigned its approach to depression care, using six aims detailed in the IOM report—safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity ( Over the first 4 years of the initiative, the annual suicide rate in their large health maintenance organization decreased from 89 suicides per 100,000 members to 22. Over the next 2 years, suicides in both inpatients and outpatients fell to zero! According to C. Edward Coffey, MD, the CEO of BHS, they designed, tested, and implemented multiple practice improvements over several years, but "the determination to strive for perfection, rather than incremental goals, had a particularly powerful effect." Their approach to suicide prevention includes encouraging patients to rid their homes of weapons, assessing and stratifying all patients on the basis of suicide risk, and offering group counseling sessions. All behavioral health care staff complete a course on suicide risk and prevention once a year and must score 100% on the follow-up test or receive additional education.

The recreational drug ecstasy (3,4-methylene-dioxymethamphetamine) may have long-term effects in human serotonin systems. Although ecstasy can damage brain serotonin neurons in animals, data in humans have been inconsistent. Kish and others measured brain serotonin transporter binding in 49 chronic ecstasy users withdrawn from the drug for a mean of 45 days and 50 control subjects (Brain 2010;133:1779-1797). Ecstasy users typically had taken 1 to 2 tablets twice a month for a mean of 4 years, and most were also taking other psychoactive drugs, as confirmed by hair analysis. A highly specific positron emission tomography radioligand was used to measure both cerebral cortical and subcortical brain regions. There was a significant decrease in serotonin transporter binding in cerebral cortex and hippocampus, but not in basal ganglia and midbrain. The magnitude of the serotonin transporter binding reduction was related to the extent of drug use (number of years and maximum dose). The decrease was not associated with structural brain changes, major hormonal level differences, gender, psychiatric status, or recent use of other stimulant drugs. The ecstasy group had small deficits on some tests of attention, executive function, and memory.

Heather S. Hopkins