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Dietary variations are known to predict the prevalence of physical illnesses such as diabetes and heart disease but the possible influence of diet on mental health has been neglected.
To explore dietary predictors of the outcome of schizophrenia and the prevalence of depression.
Ecological analysis of national dietary patterns in relation to international variations in outcome of schizophrenia and prevalence of depression.
A higher national dietary intake of refined sugar and dairy products predicted a worse 2-year outcome of schizophrenia. A high national prevalence of depression was predicted by a low dietary intake of fish and seafood.
The dietary predictors of outcome of schizophrenia and prevalence of depression are similar to those that predict illnesses such as coronary heart disease and diabetes, which are more common in people with mental health problems and in which nutritional approaches are widely recommended. Dietary intervention studies are indicated in schizophrenia and depression.
Diabetes is more common in people with schizophrenia than in the general population.
To explore the possible reasons for the association between diabetes and schizophrenia.
Diet and other lifestyle factors in patients with schizophrenia were reviewed as risk factors for diabetes.
People with schizophrenia show features of the metabolic syndrome at the onset of illness, before treatment. They also eat a poor diet, take little exercise and have high rates of smoking. Food intake may be increased further by antipsychotic medication. Nutritional factors appear to have a key role in the development of diabetes in patients with schizophrenia and may also affect the outcome and severity of schizophrenia. A common pathway through which diet might contribute to the development of both diabetes and schizophrenia is proposed.
Lifestyle factors may influence outcomes in both diabetes and schizophrenia. Lifestyle interventions are the key to improving the long-term health of people with schizophrenia.
Almost all current research into developing new pharmacological treatment for depression and schizophrenia is focused directly on modulating neurotransmitter receptors in the brain. This approach was stimulated by the chance discovery of the prototype psychotropic drugs such as chlorpromazine and imipramine and the subsequent development of hypotheses based on the presumed mode of action of these drugs. Even clozapine was first introduced as yet another dopamine receptor blocker, and it was only after it was recognised that clozapine shows improved efficacy that hypotheses were developed as to its possible mode of action. Subsequent research based on the receptor approach has led to improved side-effect profiles for modern psychotropic agents, but has not resulted in any improvement of efficacy over and above that of the drugs discovered by good fortune rather than by hypotheses.
The rate of treatment-emergent switch into mania has been calculated from all available clinical trial data on the selective serotonin re-uptake inhibitors (SSRIs) fluoxetine, fluvoxamine, paroxetine, and sertraline, relative to comparative groups treated with tricyclic antidepressants (TCAs) or placebo. In predominantly unipolar depressives, the rate of manic switch is less than 1% and differences between drugs and placebo are statistically but not clinically significant. In bipolar depressives, manic switch occurs substantially more often with TCAs (11.2%) than with SSRIs (3.7%) or placebo (4.2%).
A videotape lecture and written hand-out containing factual information about lithium were given to 30 attenders at a lithium clinic. A further 30 patients acted as a control group and were not given the programme until later in the study. The educational programme resulted in substantial and significant increases in patient knowledge about lithium, such that knowledge increased from a baseline comparable with that of social workers to a level similar to that of community psychiatric nurses. Patients' attitudes to lithium also became more favourable after education.
During a controlled education programme, the medication compliance of 60 attenders at a lithium clinic was tested using reported tablet omissions and intra-erythrocytic lithium levels. Both measures improved, along with patients' knowledge and attitude. These effects were examined and related to aspects of obsessional trait and health locus of control.
A case is described of NMS during treatment with sulpiride. The subsequent psychosis resolved during treatment with carbamazepine. It is proposed that this patient may have suffered from a supersensitivity psychosis, and that resolution of her post-NMS psychosis could have been spontaneous.
A case of Gilles de la Tourette's syndrome (TS) is described, in which a state of akinesia developed during an attempt to withdraw lorazepam by diazepam substitution. This was followed by sustained amelioration of the TS symptoms.
The community mental health movement remains an important force in American psychiatry and a shift towards community orientated mental health care is now being actively promoted in Britain. Nevertheless, concepts of community mental health care are not clearly defined, and the term has been variously misused, as a label applied to existing facilities without real change in philosophy, as a political justification for closing large mental hospitals, and as a platform for the propagation of anti-medical ideology. The development of community orientated services involves a change in role for the psychiatrist, which many find difficult to accept. Psychiatrists have been warned that they are at risk of being left behind in the current moves towards community mental health care in Britain.