In This Issue

People with psychiatric disorders are overrepresented among those who die of pulmonary embolism. Factors contributing to thrombus formation include low-potency antipsychotics and other medications, extended immobility due to catatonia or restraints, increased cortisol and catecholamine production, medication-induced metabolic conditions, smoking, and lack of general medical care. Electroconvulsive therapy may dislodge preexisting blood clots. Barnhorst and Xiong (p. 1155) describe possible prophylactic measures, which include alternatives or modifications to restraints. Compression stockings and subcutaneous heparin are possibilities for patients who are predisposed to immobility. Physicians should be aware of the thrombogenic medications, such as clozapine.

Six weeks of extended-release quetiapine at a dosage of 150 mg/day significantly reduces symptoms of borderline personality disorder. In the trial by Black et al. (p. 1174), 300 mg/day was not significantly superior to placebo and produced more side effects than low-dosage quetiapine. In an editorial, Tohen (p. 1139) cites the 3-lb weight gain in the group receiving 300 mg/day of quetiapine—compared with 1 lb for placebo and low-dosage quetiapine—and stresses the need for consideration of long-term effects.

The combination of varenicline plus bupropion produced higher rates of smoking cessation than varenicline alone in male and highly dependent smokers who did not reduce smoking by 50% in previous nicotine patch treatment. Rose and Behm (CME, p. 1199) found overall abstinence rates of 51% and 44% in men and highly dependent smokers, respectively, at the end of treatment and 29% in both groups at 6-month follow-up. In an editorial, Potter (p. 1148) reviews additional evidence of lower efficacy of nicotinic treatments and lower quit rates for female than for male smokers.