BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7436.414 (Published 12 February 2004) Cite this as: BMJ 2004;328:414

Maintaining people with schizophrenia on neuroleptics (the accepted standard care) may actually be doing them a disservice. According to a 50 year review, long term treatment worsens long term outcomes, and up to 40% of people would do better without neuroleptics. Initiation of treatment only after a subsequent episode and helping patients who are stabilised on neuroleptics to gradually withdraw from them would increase recovery rates and reduce the proportion of patients who become chronically ill (Medical Hypotheses 2004;62: 5-13).

There's a new rage on the streets. It's called “wrapping rage.” As packaging of household items gets tougher, the levels of frustration and injury sustained increases. A poll of people aged over 50, commissioned by Yours magazine (February 2004, pages 16-8) found that 71% had hurt themselves when struggling to open packaging, and 70% admitted they'd had to abandon at least one product because they simply couldn't open it.

Bioluminescent imaging helped scientists to track the location of infection from the moment they inoculated mice with Listeria monocytogenes. To their surprise, they spotted bacterial replication going on within the lumen of the gall bladder, in addition to the liver (the organ conventionally associated with listeria). They say their observations might account for some of the foibles of human listeriosis: immune evasion, intrinsic resistance to antibiotic treatment, and asymptomatic carriage (Science 2004;303: 851-3).

People who perceive their psychosocial work environment negatively have more complaints about the indoor environment and attribute more symptoms to the indoor air, according to a questionnaire survey of over 11 000 employees (Occupational and Environmental Medicine 2004;61: 143-9). The association is robust and was found across both sexes, all ages, and smokers and non-smokers. Association with job classification couldn't be examined, however, as not enough respondents had replied to the question about their role in the organisation they work for.

Fresh data from the Baltimore longitudinal study of ageing seem to indicate that calculated free testosterone concentrations are lower in men who develop Alzheimer's disease and that the difference occurs before diagnosis. The obvious question is, do higher endogenous free testosterone concentrations protect against the disease in older men? (Neurology 2004;62: 188-93).

Children with special needs get admitted to hospital quite frequently but usually don't end up staying for very long. A five year survey of 86 children found that 44% of the 914 inpatient episodes recorded were self referrals and 35% came through a general practitioner. The average length of stay was five days, and the most common cause for admission was respiratory tract infections and seizures (Archives of Disease in Childhood 2004;89: 165-9).

There's a recognised risk of post-traumatic stress disorder after diagnosis of a life threatening disease. In line with this, researchers measured CD4 cell counts, salivary cortisol concentrations, and adherence to active antiviral therapy in people with HIV. Their unexpected findings were that while the reported symptoms of post-traumatic stress disorder were related to worse adherence to treatment, they were also associated with lower morning salivary cortisol concentrations and higher CD4 cell counts (AIDS Care 2004;16: 247-60).

An international round-up of the latest cremation rates around the world shows that Japan has the highest rate per population (99.5%) and Cuba has the lowest (0.5%). Great Britain comes in at 71.9%, and the United States at just 27.8%. The variation may depend on several factors, including geographical space, cultural beliefs, and the number of crematoriums available. Japan has 1600, while Cuba reports just one (Pharos International Winter 2003: 24-36).

Endometriosis presents in many ways and causes a great deal of distress, much of which is misunderstood by both patients and doctors. The variability of the definition and inconsistency in diagnostic methods makes the prevalence of endometriosis difficult to calculate. A descriptive study of the symptoms reported by women with endometriosis reported in the Journal of Obstetric, Gynecologic, and Neonatal Nursing (2004;33: 71-9) says that the high levels of uncertainty experienced by women with the condition show that there's still a large unmet need for information and support.

The latest issue of Nature Genetics (2004; advance online publication 8 February, doi:10.1038/ng1311) reports the identification of the first gene to be associated with a higher risk of both heart attacks and strokes. The gene, known as ALOX5AP, works to stimulate the conversion of fats to molecules critical in inflammation and atherosclerosis. Scientists now have a way to investigate the interplay between diet, genes that increase risk of cardiovascular disease, and anti-inflammatory drugs.

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A 77 year old woman was admitted with a one week history of shortness of breath. She had lost weight and been anorexic in the preceding few months. She had no chest pain. On examination she was cachetic and disoriented and had low oxygen saturations and reduced expansion and air entry on the left side of the chest. The chest radiograph showed a leaking thoracic aneurysm with a communicating haemothorax (which was later confirmed at postmortem examination). This appearance could easily be confused with bronchogenic carcinoma.

B J Altemimi, senior house officer in general internal medicine, Dewsbury District Hospital, Dewsbury WF13 4HS, H A Altemimi, senior house officer in general internal medicine, N A Cooper, specialist registrar in general internal medicine and care of the elderly, E Y Sliwo, consultant physician, Department of Care of the Elderly, Huddersfield Royal Infirmary, Huddersfield HD3 3EA

Getting people to cough while you're taking blood from them is a neat little trick that acts as a good pain reliever. In 20 healthy male volunteers taking part in a randomised crossover study the reported intensity of pain they experienced was significantly lower when they coughed, whereas other variables such as hand withdrawal, palm sweating, blood pressure, heart rate, and serum glucose concentrations changed insignificantly. The mechanism is unknown (Anesthesia and Analgesia 2004;98: 343-5).

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