No abstract

Drug prescription and polypharmacy are commonly seen in the management of borderline personality disorder (BPD) in clinical practice, and the ‘placebo effect of medications’ in BPD patients is significant. However, it is to be noted that ‘no drug’ has a UK market authorisation or Food & Drug Administration approval in the USA for BPD. Here Dr Yadav reviews the guidelines.

Acute infection has been shown in some case reports to cause serum clozapine to rise to toxic levels. Here, Drs Yadav and Singh report the case of a patient with treatment‐resistant schizophrenia who developed toxic levels of serum clozapine during a bout of acute urethritis.

Clozapine is effective in treating refractory cases of schizophrenia and schizoaffective disorder, however, it can induce the serious side‐effect of neutropenia. There is an evolving evidence base in which lithium is used to increase the neutrophil and white cell count in patients who develop neutropenia from clozapine treatment, thus allowing clozapine treatment to continue. Dr Yadav et al. describe such a case.

Cases presenting with recurrent confusion, alteration of psychomotor activity, and brief psychosis with good inter-episode recovery have many differing etiologies. Only rarely does one diagnose such cases as cycloid psychosis. Even among budding psychiatrists, there seems to be a lack of awareness of this unique disorder. This may be because the present international diagnostic classification systems, ICD10 and DSM IV, do not recognize it as a separate entity. A high index of suspicion is required to diagnose cycloid psychosis. Awareness and recognizing such cases would be helpful clinically as cycloid psychosis entails a distinct prognosis and may require a specific treatment.