The British journal of clinical practice
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We review advances in the treatment of schizophrenia. We begin with an overview of antipsychotic drug development, focusing on the in vitro and in vivo binding profiles of clozapine and a new generation of D2:5HT antagonists. ⋯ Within this framework, we review the mechanisms of action and clinical uses of the 'atypical' antipsychotic drugs. We also show how a variety of psychosocial interventions, particularly those that incorporate cognitive techniques, can be used in combination with pharmacotherapy to overcome the same clinical hurdles.
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The recent European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET) have clearly defined a population who benefit from carotid artery endarterectomy (CAE). However these trials used different criteria to identify > 70% stenosis of the internal carotid artery (ICA). The role of CAE in asymptomatic ICA stenosis has been investigated by the Carotid Artery Stenosis with Asymptomatic Narrowing Operation Versus Aspirin (CASANOVA) study, the Veterans Administration Asymptomatic Carotid Study (VAACS) and the Asymptomatic Carotid Artery Stenosis (ACAS) trials, all of which have design limitations. The Asymptomatic Carotid Stenosis Trial (ACST) is still recruiting patients but until the natural history of asymptomatic ICA disease is understood, the role of surgical intervention will continue to be controversial.
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Chronic non-malignant pain is often treated inadequately because of opiophobia. There is no scientific justification for this fear. ⋯ There is no scientific evidence that patients with chronic non-malignant pain are more prone to addiction or tolerance. It is also pertinent to consider that the endpoint of chronic pain treatment is not just freedom from pain but global wellbeing.
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Drugs affecting the leukotriene pathway are emerging as a new class of asthma treatment--the first for more than 20 years. Development of these leukotriene antagonists should lead to greater understanding of the underlying processes in asthma and may result in a safe, oral, anti-asthmatic drug to benefit particular groups of asthmatic patients.
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The information gained when abnormalities are detected by pre-operative investigations is of interest to the anaesthetist as it may change the anaesthetic technique and anaesthetic drugs used. Tests should not be routinely used in all patients, but only in those over the age of 50 or in those with an increased chance of abnormalities being detected.