Desvenlafaxine (O-desmethylvenlafaxine) is the major active metabolite of venlafaxine. Desvenlafaxine succinate is now undergoing active evaluation for its therapeutic efficacy in a variety of disorders, including major depressive disorder, vasomotor symptoms associated with menopause, fibromyalgia and diabetic neuropathy. Desvenlafaxine is a serotonin and norepinephrine reuptake inhibitor (SNRI) with similar activity to its parent compound venlafaxine, and little affinity for other brain targets, including muscarinic, cholinergic, histamine H(1) and alpha-adrenergic receptors. Desvenlafaxine has linear pharmacokinetics, low protein binding, a half-life of approximately 10 hours and is metabolized primarily via glucuronidation, and to a minor extent through CYP3A4. The desvenlafaxine succinate formulation appears to have good oral bioavailability. Clearance rates are reduced in the elderly, those with severe renal dysfunction and those with moderate to severe hepatic dysfunction, which may require dosage adjustments. Three published clinical trials have shown supportive but mixed results for the efficacy of desvenlafaxine in the treatment of major depressive disorder with daily doses ranging from 100 mg to 400 mg. One published clinical trial has shown mixed results for the efficacy of desvenlafaxine in the treatment of vasomotor symptoms associated with menopause with daily doses ranging from 50 mg to 200 mg. In these four clinical trials, desvenlafaxine was associated with several mild adverse effects, with the most common effect being nausea. Less common, but more serious, adverse effects reported in these trials included hypertension, QTc interval prolongation, exacerbation of ischemic cardiac disease, elevated lipids and elevated liver enzymes. The exact nature of these serious adverse effects, including the prevalence, clinical significance and potential risk factors, still needs to be fully elucidated. Desvenlafaxine has a low propensity for pharmacokinetic-based drug interactions, although it has the same potential for pharmacodynamic interactions as other serotonin-norepinephrine reuptake inhibitors. Desvenlafaxine is currently another treatment option for major depressive disorder. The only identified potential advantage of desvenlafaxine over venlafaxine or other antidepressant agents at this time is the apparently reduced risk for pharmacokinetic drug interactions.

The objective was to examine effects of active interventions on physician's prescribing of antipsychotic polypharmacy. Prescriptions for patients with schizophrenia at the Centre for Addiction and Mental Health, Canada were collected in 2006 (n = 648) and 2008 (n = 778). During the intervening period, a pharmacist monitored prescriptions with antipsychotic polypharmacy and contacted corresponding prescribers to provide education on risks of polypharmacy. Moreover, educational sessions on polypharmacy were presented to inpatient and outpatient teams. A three-fold decrease in the prevalence of antipsychotic polypharmacy was observed between 2006 (18.3%) and 2008 (6.6%). Thus, active monitoring of prescriptions with educational interventions could reduce antipsychotic polypharmacy.Key words: antipsychotic, monitoring, polypharmacy, prescription, schizophrenia.A NTIPSYCHOTIC POLYPHARMACY FOR the treatment of schizophrenia is common in realworld clinical settings despite limited empirical support.1 It is recognized that evidence-based guidelines alone do not influence clinical practice and it is challenging determining the optimal intervention(s) to use to positively influence clinical practice.2 A recent systematic review found that prompts from pharmacists or pharmacy systems were effective in changing a variety of prescribing practices. 2The present study was designed in the context of an ongoing double-blind placebo-controlled study in order to study the safety of reduction to monotherapy in patients maintained on two antipsychotic drugs. When antipsychotic polypharmacy was detected using the pharmacy database, a pharmacist called the prescribing physician with a scripted message. Concurrently, research staff held regular educational sessions with multidisciplinary teams consisting of a balanced discussion of the unknown efficacy and safety of maintaining patients previously stabilized on two antipsychotics. We report a change in prevalence rates of antipsychotic polypharmacy following these interventions. METHODSSystematic reviews of antipsychotic prescriptions were completed in 2006 and 2008 within all inpatient wards and ambulatory clinics within the Schizophrenia Program at the Centre for Addiction and Mental Health (CAMH). The inpatient and outpatient pharmacies within the centre use a single pharmacy database where prescription information is entered and stored. For the cross-sectional aspect of the study, individual prescriptions from the Schizophrenia Program were reviewed by a pharmacist

ClinicalTrials.gov identifier: NCT00493233.

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.

During the course of a long-term investigation, still in progress, designed to shed light on the observation of Pare, Sandler, and Stacey (1960) that certain children with mental handicap have high blood 5-hydroxytryptamine (5HT) concentrations, some data on levels in normal newborn infants were obtained which seem to be worthy of record. MethodWhole-blood 5HT levels were measured by the method of Contractor (1964) with the following modifications. (a) Capillary blood obtained from the heel with minimal squeezing was used instead of venous blood. It had previously been established in four normal adults that 5HT levels in capillary and venous blood drawn simultaneously were in close agreement. (b) The procedure was scaled down to allow the use of 1 ml. blood instead of 2 ml. and carboxymethylcellulose columns were reduced in height from 10 to 5 cm. These changes inevitably reduced the sensitivity of the procedure and increased the error of the method from ± 5 % to ± 36%, but as the observed changes in blood levels in each age-group were greater than this margin of error, they were considered to be significant.Platelets were counted by the method of Dacie and Lewis (1963). ResultsSamples of capillary blood were taken from normal full-term infants at 1 day and 1 week of life * Present address: