Folks,

Weight loss has been shown to improve mild sleep apnea.  The study reported this month suggests the more weight loss, the better the results, e.g., loss of 33 lbs associated with 88% no longer having the apnea.

For those who have yet to read this month’s AJP, a couple of articles of clinical interests:

1. A single case report of memantine, 5 mg/d initially, increased to 5 mg BID, dramatically improved the symptoms of pediatric OCD in a 15 y/o girl with a decade of symptoms and failure of CBT, sertraline, fluvoxamine, and citalopram to improve her condition.  While memantine was given the credit, I gather that citalopram, 80 mg/d, and CBT were ongoing while on the memantine.

2. A meta-analysis of atypicals found olanzapine more efficacious than the others, but the differences were not overwhelming, leaving us where we were before – medicate based on side-effect issues with each pt. Surprising to the authors was that olanzapine did better than clozapine. They justified continuing to see clozapine as superior for various reasons in the refractory pt [not mentioned by the authors is that clozapine is not superior in the acute non-refractory pt]. 

There is more on olanzapine recently.  Dr. Goldstein found a study that olanzapine did NOT do better than placebo in treating cocaine dependence. 

[Recently brought to my attention was a geriatric pt on 5 mg/d olanzapine, developed pancreatitis, blood glucose of almost 1800, then hospitalized, survived, and is now doing OK on risperidone 1 mg BID.]

This month’s LAWYERS USA, which tracts malpractice opportunities, reviewed the Lilly agreement as to Lilly’s alleged effort to persuade us to use Zyprexa off label, resulting in a $1.4 billion settlement.  Past Lilly salespersons made up the plaintiffs, people believing they should not have been ordered to promote off-label. 

Speaking of off-label, in this month’s JOURNAL WATCH, Peter Roy-Byrne: “So far only one atypical agent, aripiprazole, has been approved to treat refractory depression. Clinicians should be highly cautious when considering other atypical agents with less compelling data for this indication or for other off-label.”

The Army report of suicides exceeding combat deaths has led anti-medication groups to claim that this is the result of the considerable prescribing of SSRIs in the Army. In the meantime, an Italian study found that SSRIs reduced suicidal risks in adults.

FDA has approved a deep brain stimulation device for OCD.

Rationality continues to have its limitations in the empirical world of medicine. Pay for Performance studies fail to find that pts are actually better off as a result of such. A JAMA article this month found that programs to coordinate care of chronically ill Medicare pts could not show reduced hospitalizations or reduced costs.

APA election results are supposed to be available next Monday.

Roger