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The results show that, in general, physicians found problem-oriented drug information to be of high quality, and that it had an impact on their clinical practice. Problem-oriented drug information could be a method to change clinical practice among physicians.

study in which indicators of insulin sensitivity were associated with suicide risk. 1 The explanation for the reverse J shaped association seen when diabetes was included as a fifth category alongside insulin resistance may be due to patients with a clinical diagnosis of diabetes developing depression as a result of this diagnosis.We based our assessment of depression on current use of medication and self reports of past diagnoses and current mood rather than clinical assessment with international diagnostic criteria. However, the consistency of our findings across the three different assessments supports a causal association, and any measurement error in our assessment of depression would tend to dilute the results. Insulin resistance is positively associated with diabetes and cardiovascular disease, and we do not believe that our results should be used to discourage appropriate interventions to prevent and treat insulin resistance. Further, these are novel findings and need to be replicated in other studies. However, if our findings are confirmed there may be an indication for assessing depressive symptoms among individuals receiving treatments that affect insulin resistance, since depressive symptoms are often disabling and could affect compliance with treatment and quality of life. (Accepted 30 September 2003) Drug points Pulmonary embolism possibly associated with olanzapine treatmentInger Marie Waage, Ane Gedde-Dahl Antipsychotic drugs have been associated with an increased risk of venous thromboembolism. 1 We report for the first time the case of a patient who developed a pulmonary embolism after starting treatment with olanzapine.A 28 year old man was admitted to hospital due to a psychotic disorder. Treatment with olanzapine (10 mg/ day) was started, and the dose was gradually increased to 30 mg/day. He also received levomepromazine (50 mg/ day), oxazepam (10 mg/day), and flunitrazepam (1 mg/ day). After 10 weeks, the patient complained of respiratory pain and he had two episodes of haemoptysis. Clinical examination showed no auscultatory findings, no dyspnoea, no tachypnoea, no fever, and normal blood pressure and heart rate. Blood analysis showed raised concentrations of C reactive protein (113 mg/l (normal range < 10 mg/l)), fibrinogen (6 g/l (2-4 g/l)), and d-dimer (0.89 mg/l ( < 0.50 mg/l)). Spiral computed tomography showed a pulmonary embolism in the left lower lobe. Standard anticoagulant treatment was started, and the patient recovered. Olanzapine was discontinued, and his medication changed to quetiapine.Recent reports suggest an association between clozapine and venous thromboembolic events.2-5 However, thromboembolic complications have not previously been described in patients taking olanzapine. The sedating effects as well as the weight gain associated with this antipsychotic treatment can lead to a more sedentary lifestyle, thus creating predisposing conditions for venous thrombosis. In this case, the patient was overweight (body mass index 28.5), but his weight had not substantially chan...

Pharmacists submit valuable ADR reports which provide information complimentary to physicians' reports. This emphasises that pharmacist ADR reporting might constitute an important addition to the spontaneous reporting system.

CaCo-2 monolayers, cultured for 1 week after reaching confluence, were incubated with micellar solutions of fatty acids for up to 7 days. These conditioned cells were incubated acutely (5 h) with eicosapentaenoic acid and oleic acid, and the levels of cell-associated and secreted triacylglycerol were determined. With acute addition of oleic acid, both cell-associated and secreted triacylglycerol were decreased in cells chronically exposed to eicosapentaenoic acid. This effect was observed after as little as 2 days of chronic incubation with eicosapentaenoic acid. A further decrease was found when these cells were incubated acutely with eicosapentaenoic acid, regardless of which radioisotopes were used to label precursors in the incubation media. The secretion of both labelled and total triacylglycerol and apolipoprotein B was reduced approximately 50% in cells incubated chronically with eicosapentaenoic acid. The amounts of triacylglycerol and apolipoprotein B within the cells were not decreased by chronic exposure to eicosapentaenoic acid. Our data indicate that CaCo-2 cells chronically incubated with eicosapentaenoic acid secrete significantly less triacylglycerol than cells incubated chronically with oleic acid. When eicosapentaenoic acid was also included acutely, triacylglycerol secretion was reduced even more. We conclude that chronic exposure of eicosapentaenoic acid to this intestinal cell type reduces the rate of chylomicron secretion and may help explain the decreased postprandial lipaemia observed in humans taking fish oil supplements.