Search

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Borderline Personality Disorder aims to improve care and treatment outcomes for individuals with BPD. The guideline provides evidence-based statements to enhance knowledge and optimize assessment and treatment. It addresses the high prevalence of BPD in clinical populations, the challenges of co-occurring disorders, and the importance of reducing stigma and discrimination. The document outlines assessment, treatment planning, psychosocial interventions, and pharmacotherapy recommendations based on available evidence and expert opinion. [Extracted from the article]

Objective: In 2006, the Housestaff Association presented the Dean at Oregon Health and Science University (OHSU) with a proposal to effectively end the influence of the pharmaceutical industry on campus. The Dean convened a workgroup to examine the issue, and faculty, residents, and medical students were surveyed on their views and interactions. Authors present here the responses from medical students. Methods: A web-based, anonymous survey was sent to all OHSU medical students in 2007; 59% completed it. The survey included items measuring attitudes about the pharmaceutical industry and interactions with pharmaceutical representatives (PRs). Results: Only 5% of clinical and 7% of preclinical students agreed that PRs have an important teaching role, and fewer than 1 in 6 believed that PRs provided useful and accurate information on either new or established drugs; 54% of clinical students indicated that PRs should be restricted from making presentations on campus, versus 32% of preclinical students, and only 30% of clinical students agreed that accepting gifts had no impact on their own prescribing, versus 50% of preclinical students. Students who acknowledged the influence of PRs and perceived less educational benefit were less likely to accept gifts such as textbooks; however, 84% of clinical students had attended an on-campus event sponsored by a pharmaceutical company in the previous year. Conclusions: Only a small proportion of OHSU medical students value interactions with PRs, but many still attend events sponsored by pharmaceutical companies.

Objective: Sales visits, or detailing, by pharmaceutical industry representatives at academic institutions has been increasingly criticized. The authors surveyed psychiatric residents and faculty members on their views and interactions with representatives of the pharmaceutical industry. Methods: In 2007, a 46-item online survey measuring attitudes toward and interactions with pharmaceutical industry representatives was sent to 49 faculty psychiatrists and 40 psychiatric trainees (residents and fellows) at a Northwest academic medical center. Results: Sixty-five percent (N=58) of surveys were completed. Two-thirds of respondents did not agree that pharmaceutical representatives have an important teaching role. Only 24% of faculty and 18% of trainees agreed that pharmaceutical representatives provide useful and accurate information on new drugs. Forty-one percent of faculty and 53% of trainees agreed that pharmaceutical representatives should be restricted from making presentations on campus. Trainees were less likely than faculty to agree that they would maintain contact with representatives if no gifts or food were distributed. Nevertheless, most respondents endorsed that pharmaceutical companies supported important conferences, and more than 90% had attended an industry-sponsored event in the previous year. In open-ended questioning, respondents revealed worries that bans would undermine the ability to secure national speakers and to support other activities that residents valued. Conclusion: Faculty and psychiatric residents and fellows do not view pharmaceutical representatives as having an important teaching role and mistrust the information they offer but believe that loss of industry financial support does adversely affect educational and other highly valued activities. They favor greater policy restrictions but do not support an outright ban on pharmaceutical support.

Objective: Susceptibility to neuroleptic-induced extrapyramidal syndromes varies widely, even within age and sex subgroups. Individual vulnerability to extrapyramidal syndromes has been assumed to explain this, but the utility of past history for predicting future occurrence of extrapyramidal syndromes has not been studied extensively. This investigation was undertaken to determine whether patients' previous histories of extra pyramidal syndromes predict future episodes of extra pyramidal syndromes and to compare the importance of this predictive factor with patient age, sex, neuroleptic dose, and anticholinergic dose as predictors of extrapyramidal syndromes. Method: The charts of 62 schizophrenic patients with multiple neuroleptic treatment episodes were reviewed. Extrapyramidal syndromes, neuroleptic drug doses, and anticholinergic drug doses during the first 21 days of each treatment episode were recorded. Results: Previous extra pyramidal syndromes correctly predicted extrapyramidal syndromes in subsequent treatments for 84% of the patients. Variations in neuroleptic potency, neuroleptic dose, and anticholinergic dose partially explained incorrect predictions. Conclusions: These results support the hypothesis that patients with a history of extrapyramidal syndromes are at greater risk for future extrapyramidal syndromes. If confirmed, these results strongly support individual susceptibility as a major predictor of extrapyramidal syndromes and indicate that prophylaxis of extrapyramidal syndromes should be considered for patients who have previously suffered extrapyramidal syndromes from similarly prescribed neuroleptic therapy. [ABSTRACT FROM AUTHOR]

The authors analyzed data from nine studies comparing the incidence of acute dystonia induced by neuroleptic agents with and without concomitant use of anticholinergic agents. Anticholinergic agents reduced the rate of dystonia by 1.9-fold in all patients treated with different neuroleptics and by 5- to 8-fold in patients treated with high-potency neuroleptics. In addition, the incidence of dystonia and the efficacy of anticholinergic prophylaxis were related inversely to age. These results sup port the efficacy of anticholinergic agents in preventing neuroleptic-induced dystonia, particularly in young male patients treated with high-potency neuroleptics. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented unexpected intracerebral pathology in older schizophrenics.

A letter to the editor is presented regarding the interaction of fluoxetine and pentazocine.

A letter to the editor is presented regarding neuroleptic malignant syndrome associated with withdrawal from carbamazepine.

(Reprinted with permission from The American Journal of Psychiatry 2020; 177:868-872)., (Copyright © 2020 by the American Psychiatric Association.)