Complementary and alternative medicine in psychotic disorders

The use of complementary and alternative medicine (CAM), including alternative therapies (ALT) and natural health products (NHP) such as vitamin and herbal supplements, is increasingly accepted in both the general population as well as in patients with mood and anxiety disorders. The level of acceptance and use of CAM, however, is unknown among patients being treated for psychotic disorders. Psychotic patients were surveyed about their use of and attitudes toward CAM. Questions included basic demographic and socio-economic items as well as the lifetime and 12-month use of CAM. Data were collected from June to October 2005. A sample of 172 participants representing 8.4% of the total eligible population of the outpatient clinics within the Schizophrenia Program at the Centre for Addiction and Mental Health in Toronto Canada completed the survey. Considering all forms of CAM, the lifetime and 12-month prevalence rate were 88% and 68%, respectively. The use and perceived safety of CAM by this population is similar to that reported by the general population. Clinical and public health implications of these findings are discussed.peer-reviewe

Nutrient and microbial water quality of the upper Ganga river, India: identification of pollution sources

The Ganga River is facing mounting environmental pressures due to rapidly increasing human population, urbanisation, industrialisation and agricultural intensification, resulting in worsening water quality, ecological status and impacts on human health. A combined inorganic chemical, algal and bacterial survey (using flow cytometry and 16S rRNA gene sequencing) along the upper and middle Ganga (from the Himalayan foothills to Kanpur) was conducted under pre-monsoon conditions. The upper Ganga had total phosphorus (TP) and total dissolved nitrogen concentrations of less than 100 μg l−1 and 1.0 mg l−1, but water quality declined at Kannauj (TP = 420 μg l−1) due to major nutrient pollution inputs from human-impacted tributaries (principally the Ramganga and Kali Rivers). The phosphorus and nitrogen loads in these two tributaries and the Yamuna were dominated by soluble reactive phosphorus and ammonium, with high bacterial loads and large numbers of taxa indicative of pathogen and faecal organisms, strongly suggesting sewage pollution sources. The high nutrient concentrations, low flows, warm water and high solar radiation resulted in major algal blooms in the Kali and Ramganga, which greatly impacted the Ganga. Microbial communities were dominated by members of the Phylum Proteobacteria, Bacteriodetes and Cyanobacteria, with communities showing a clear upstream to downstream transition in community composition. To improve the water quality of the middle Ganga, and decrease ecological and human health risks, future mitigation must reduce urban wastewater inputs in the urbanised tributaries of the Ramganga, Kali and Yamuna Rivers

Adjunctive versus monotherapeutic treatment for schizophrenia : addressing antipsychotic side effects

In the article by Joo-Cheol Shim, M.D., Ph.D., et al., published in the September 2007 issue of the Journal, aripiprazole was added to haloperidol to evaluate the benefcial effects on haloperidol-induced hyperprolactinemia. The authors pointed out that switching is “not always possible in clinical practice, especially if the patient has responded well to the antipsychotic that produced the hyperprolactinemia” (1, p. 1404). The addition of aripiprazole significantly decreased prolactin levels and improved negative symptoms, sleep, and extrapyramidal side effects. The authors attributed these effects to aripiprazole’s unique mechanism(s) of action (2). We do not take issue with the scientific merit of this study but are concerned with the clinical implications, specifically the apparent promotion and justification of the adjunctive use of aripiprazole.peer-reviewe