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Clozapine is an effective atypical antipsychotic drug, but its use may be compromised by its side effects. Agranulocytosis may be fatal, but sialorrhea occurs more frequently and plays a major role in patients' noncompliance. A MEDLINE search from 1975-2000 revealed that treatment of clozapine-induced sialorrhea is predominantly based on case reports. Due to its elusive mechanism, physicians have attempted to treat this side effect with agents that counteract clozapine's adrenergic and muscarinic properties. We evaluated reported treatment options and other possible strategies from a pharmacologic standpoint. Antimuscarinic agents and alpha-receptor agonists are both viable options but must be administered and monitored cautiously in patients with psychiatric disorders. Although not yet available in the United States, pirenzepine, a selective muscarinic receptor antagonist, has the most promising mechanism. Other selective, peripherally acting agents must be investigated in controlled clinical trials to determine their efficacy as possible alternatives.

The treatment of schizophrenia has frustrated clinicians for over 50 years. Despite advances in neurotransmitter identification and the development of drugs targeting these transmitters, total remission of the disease is not always achieved. Potential etiologies other than neurotransmitter dysfunction merit consideration. One intriguing concept is the possible contribution of autoimmunity in patients with the disease. This breakdown of self-tolerance has been implicated in patients with other chronic diseases, such as type 1 diabetes mellitus and myasthenia gravis. The literature on autoimmunity as a possible mechanism in the pathogenesis of schizophrenia can be conflicting, but there is a substantial amount of circumstantial, although not conclusive, evidence of immune dysfunction in patients with schizophrenia.

This study attempted to investigate the effects of communication on organizational commitment (employee loyalty). Based on data from 521 nurses in four general care hospitals, the relationships among three communication variables, four demographic variables, job satisfaction, and organizational commitment were statistically analyzed. The results of the study suggest that communication does affect organizational commitment, that communication affects job satisfaction (employee morale), but that job satisfaction does not affect organizational commitment. A model of these relationships is proposed.

Over the last six decades, the treatment of schizophrenia has focused primarily on interactions at monoamine neurotransmitter receptor sites, including those for dopamine and serotonin. While first-generation antipsychotics demonstrate antagonism at the dopamine 2 receptor, newer atypical agents involve multiple receptors at various neurotransmitter sites. Despite the advent of these newer agents, the treatment of schizophrenia continues to elude clinicians, perhaps owing to a lack of information about the factors contributing to the development of the disease. While the etiology is complex and not yet fully delineated, we suggest that treating clinicians be willing to look beyond neurotransmitters and entertain other potential factors involved in the pathogenesis of schizophrenia. One such factor that is often overlooked is the possible contribution of autoimmunity to disease development in at least a subset of patients. In this article we make an argument for consideration of immune dysfunction in the development of schizophrenia and suggest future directions for the field.

Students' impressions of campus recruiters influence students decisions on eventual job choice. In this study, the authors attempted to assess the effects of three variables—recruiter's age, recruiter's title, and recruiter's presentation—on students' impressions. A three factor factorial analysis of variance with three separate post hoc tests indicated that recruiter title and recruiter age significantly influenced impressions, while nonfluent presentation may have had a selective influence on impressions.

Zonisamide is a broad-spectrum antiepileptic drug used to treat various types of seizures. Although visual hallucinations have not been reported as an adverse effect of this agent, we describe three patients who experienced complex visual hallucinations and altered mental status after zonisamide treatment was begun or its dosage increased. All three had been diagnosed earlier with epilepsy, and their electroencephalogram (EEG) findings were abnormal. During monitoring, visual hallucinations did not correlate with EEG readings, nor did video recording capture any of the described events. None of the patients had experienced visual hallucinations before this event. The only recent change in their treatment was the introduction or increased dosage of zonisamide. With either discontinuation or decreased dosage of the drug the symptoms disappeared and did not recur. Further observations and reports will help clarify this adverse effect. Until then, clinicians need to be aware of this possible complication associated with zonisamide.

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