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Original Research Expression of Depressive Symptoms in a Nonclinical Brazilian Adolescent Sample
Clarice Gorenstein, PhD, Laura Andrade, MD, PhD, Elaine Zanolo, Rinaldo Artes, PhD
(PDF)

Posttraumatic Stress Disorder and General Psychopathology in Children and Adolescents Following a Wildfire Disaster
Brett M McDermott, MBBS, Cert Child Psych, FRANZCP, Erica M Lee, BA, Dip Psych, Marianne Judd, BSc Psych, MEd, Peter Gibbon, PhD
(PDF)

Individual Change in Methylphenidate Use in a National Sample of Children Aged 2 to 11 Years
Elisa Romano, PhD, Raymond H Baillargeon, PhD, Isabel Fortier, PhD, Hong-Xing Wu, MSc4, Philippe Robaey, MD, Mark Zoccolillo, MD, Richard E Tremblay, PhD
(PDF)

An Introduction to Economic Evaluation: What’s in a Name?
Jeffrey S Hoch, MA, PhD, Carolyn S Dewa, MPH, PhD
(PDF)

Recherche Originale *Méthadone et Syndrome d’Apnées du Sommeil
Philippe Durst, MD, Jérôme Palazzolo, MD, PhD, Jean-Pierre Peyrelong, MD, Michel Berger, MD, Michel Chalabreysse, MD, Michel Billiard, PhD, André Vialle, MD
(PDF)

Review Paper
Using Metaanalysis to Evaluate Evidence: Practical Tips and Traps
Raymond W Lam, MD, FRCPC, Sidney H Kennedy, MD, FRCPC
(PDF)

Brief Communication
Experimental Affective Symptoms in Panic Disorder Patients
Thea Overbeek, MD, PhD, Koen Schruers, MD, PhD, Ine Docters van Leeuwen, BSc, Tineke Klaassen, MD, PhD, Eric Griez, MA, MD, PhD
(PDF)

Book Reviews
(PDF)

The Treatment of Drinking
Problems: A Guide for the Helping Professions.
Review by
Nady el-Guebaly, MD, FRCPC

Bipolar Disorder: A Clinician’s Guide to Biological Treatments.
Review by
Review by: Rakesh Jain MD, MPH
Shailesh Jain, MD, MPH


Handbook of Female Psychopharmacology
Review by
Laura Calhoun, FRCPC

Sleep and Dreaming: Scientific Advances and Reconsiderations.
Review by
Alan Douglass, MD

Cognitive-Behavioral Treatment of Obesity. A Clinician’s Guide.
Review by
Hany Bissada, MD, FRCPC

Cognitive Therapy of Personality Disorders. Second Edition.
Review by
W John Livesley

Letters to the Editor
(PDF)

Hemorrhages During Escitalopram–Venlafaxine– Mirtazapine Combination Treatment of Depression

Re: Lorazepam-Induced Prolongation of the QT Interval in a Patient With Schizoaffective Disorder and Complete AV Block

Reply: Lorazepam-Induced Prolongation of the QT Interval in a Patient With Schizoaffective Disorder and Complete AV Block

Lithium-Associated Anencephaly

Aripiprazole-Induced Seizure

Prevalence of Bipolar Disorder and Major Depression Among Patients Seen in Primary and Secondary Care in Finland

The Need for More Community Nursing for Adults With Intellectual Disabilities and Mental Health Problems

Improvement in Tardive Dyskinesia With Aripiprazole Use

Letters to the Editor

Reply: Lorazepam-Induced Prolongation of the QT Interval in a Patient With Schizoaffective Disorder and Complete AV Block

Dear Editor:

Thank you for the opportunity to respond to Dr Crockford’s letter. As active members of a drug safety program in psychiatry in Europe (Arzneimittelsicherheit in der Psychiatrie [AMSP]), we are always interested in discussing complex cases of pharmacotherapy. The AMSP is a drug safety program that ensures the continual assessment of severe adverse drug reactions in psychiatric inpatients under the naturalistic conditions of routine clinical treatment (1). The AMSP aims to collect information on the type and frequency of severe adverse drug reactions, to identify specific risk factors with regard to patient characteristics and such treatment- related factors as interactions caused by drug combinations or drug dosage, and to provide more information on how to adequately handle adverse drug reactions. Currently, 45 hospitals participate in the program.

Recent studies show that a high number of patients with severe cardiac drug reactions have frequent cardiac comorbidity (2). In addition, most receive drug combinations wherein drugs with similar adverse reaction profiles are often coprescribed. We agree with Dr Crockford that the case we presented and discussed is definitely complex with preexisting cardiovascular risks. However, we do not agree that lorazepam is not possibly associated with QT prolongation in that particular case, and we would like to comment on a few of Dr Crockford’s points. First, the electrolyte status revealed no abnormal findings, and the liver enzymes were moderately elevated. Second, the relevance of the half-life of lorazepam in relation to the duration of the QT prolongation is uncertain. Various undesired adverse drug reactions, for example skin reactions and blood dyscrasia, appear after single drug doses. Third, while we agree that a unique mechanism of action for lorazepam, distinct from the other benzodiazepines, seems to be unlikely, daily clinical work shows that substances with almost an identical chemical structure cause different side effects. Fourth, as Dr Crockford points out, there are multiple confounding factors; however, this does not preclude the possibility that lorazepam set off the mechanisms of the persisting QT prolongation.

Inspired by our work in the AMSP, we decided to present our provocative conclusions in this complex case. This case shows that, in patients taking drug combinations and having preexisting cardiovascular risks, physicians should be aware of possible unlikely adverse drug reactions. On our way from case reports to quality management of drug treatment, controversial discussions are important to classify severe adverse drug reactions. As well, further research is needed to elucidate the underlying physiological mechanisms. We definitely agree with Dr Crockford that clinicians should not change their practice with regard to lorazepam in general. Lorazepam is an important and useful drug in daily psychiatric clinical work. As with any drug, it can have side effects, some of which may be rare and peculiar.

References

1. Grohmann R, Engel RR, Rüther E, Hippius H. The AMSP Drug Safety Program: methods and global results. Pharmacopsychiatry 2004;37 (Suppl 1):S4–S11.

2. Schmid C, Grohmann R, Engel RR, Rüther E, Kropp S. Cardiac adverse effects associated with psychotropic drugs. Pharmacopsychiatry 2004;37 (Suppl 1):S65–S69.

Marc Ziegenbein, MD
Stefan Kropp, MD
Hanover, Germany