Antipsychotics Carlat Reports | Carlat Publishing

Clinical Update

Treatment of Antipsychotic-Induced Weight Gain

From The Carlat Psychiatry Report, College Mental Health

Topics: Antipsychotics | Bupropion | Dosing | Lithium | Schizophrenia

Antipsychotic-induced weight gain can decrease medication adherence, with a domino effect of negative consequences on the psychiatric illness. Recently the FDA approved the first therapy to address this problem: Lybalvi, a combination of olanzapine and samidorphan. In this article, I’ll look at how it compares with other treatments for antipsychotic-i

Clinical Update

Psychiatric Medication–Induced Hyperprolactinemia

From The Carlat Hospital Psychiatry Report, Minimizing Use of Restraints

Topics: Antipsychotics | endocrinological side effects | Prolactin

A 26-year-old female patient with schizophrenia tells you she is certain she is pregnant. You run a pregnancy test, which comes back negative, but she continues to insist that she is pregnant “because I haven’t had a period in three months.” She began risperidone 2 mg twice daily about four months earlier. You check her prolactin level, and it is

Clinical Update

Quetiapine Reconsidered

From The Carlat Psychiatry Report, Psychotic Depression

It is the best of drugs; it is the worst of drugs. Quetiapine (Seroquel) has benefits in some disorders that are unmatched by other medications, but it is also one of the most difficult antipsychotics to tolerate. In this article, I’ll look at where this medication fits and whether its numerous off-label uses are justifiable, including PTSD, generaliz

Expert Q&A

Psychosis During Depression

From The Carlat Psychiatry Report, Psychotic Depression

Topics: Antipsychotics | Depression | Psychosis

TCPR: Is psychotic depression difficult to diagnose? Dr. Swartz: Psychotic depression is often missed and often misdiagnosed. A study of hospital units at four academic medical centers found that one in three cases of psychotic depression were missed (Rothschild AJ et al, J Clin Psychiatry 2008;69(8):1293–1296). This is important because these pati

Clinical Update

Deprescribing Anti-Anxiety Medications in Older Adults

From The Carlat Geriatric Psychiatry Report, Anxiety

Our inclination may be to “not rock the boat” when a patient is stable and not misusing prescribed medication. However, tapering anti-anxiety medications in older adults is often a good idea when considering the risks of falls, sedation, and accidents. Which meds to taper? The risks of anti-anxiety medications increase with age. Here are some of t

Expert Q&A

Treating Agitation in Patients with Dementia

From The Carlat Hospital Psychiatry Report, Agitation

CHPR: Can you tell us about yourself and your background? Dr. Metzger: I’m the medical director of psychiatry at Hebrew SeniorLife and an assistant professor of psychiatry at Harvard Medical School. My work also includes training residents and geriatric medicine fellows who rotate through our facility. CHPR: You participated in the psychopharmacol

Clinical Update

Medications to Rapidly Treat Psychotic Agitation

From The Carlat Hospital Psychiatry Report, Agitation

Topics: | | | | | | | | | | | | | | | | | | Agitation Antipsychotics Aripiprazole Benzodiazepines Chlorpromazine De-escalation Diphenhydramine Droperidol Emergency Haloperidol Hydroxyzine olanzapine Pharmacotherapy Promethazine Psychosis Quetiapine Risperidone Violence Ziprasidone

If you work in an emergency department (ED) or psychiatric inpatient unit, you’ve encountered agitated and even violent patients. We can help many patients settle down by listening empathically, validating their emotions, and offering oral medications, but even with our best efforts, these interventions do not always work. Medications help reduce agit

In Brief

IM Olanzapine Plus Benzodiazepines: Safe or Unsafe?

From The Carlat Hospital Psychiatry Report, Agitation

Topics: Antipsychotics | Benzodiazepines | olanzapine | Psychotic Agitation | Side Effects

The Eli Lilly warning followed reports of 160 adverse events, including 29 fatalities, linked to IM olanzapine/IM benzodiazepine combinations from January 2004 to September 2005 (Marder SR et al, J Clin Psychiatry 2010;71(4):433–441). Looking closely at these cases, it is unclear that this medication combination actually caused the fatalities. Many of

Clinical Update

Finally, Effective Treatments for Tardive Dyskinesia

From The Carlat Hospital Psychiatry Report, Capacity Assessments

Antipsychotics, especially first-generation antipsychotics, can cause tardive dyskinesia (TD) or abnormal involuntary movements of different areas of the body. For years, we have dreaded seeing our patients develop TD because there was little we could do about these symptoms. In 2017, the FDA approved two agents to treat TD, valbenazine (Ingrezza) and d

Research Update

Antipsychotic Dosing: How High?

From The Carlat Hospital Psychiatry Report, Psychiatric Emergencies

Topics: Antipsychotics | Free Articles | Research Update

Review of: Leucht S et al, Am J Psychiatry 2020;177(4):342–353 (published correction appears in Am J Psychiatry 2020;177(3):272) How high should we go when dosing antipsychotics in schizophrenia? Surprisingly little is known about optimal doses. During drug development, dosing is estimated from animal studies, but more detailed studies in humans ar

Research Update

Which Medications Have the Lowest Risk of Side Effects?

From The Carlat Child Psychiatry Report, Mood Disorders in Children and Adolescents

REVIEW OF: Solmi M et al, World Psychiatry 2020;19(2):214–232 Adverse effects are important considerations when choosing psychotropic medications, especially in children and adolescents. This study pooled available research to compare the safety profiles of various psychotropics used in the pediatric population. The authors screened thousands of st

Clinical Update

Exploring the Potential Neurotoxicity of Antipsychotics in Younger Populations

From The Carlat Child Psychiatry Report, Autism in Children and Adolescents

Topics: Antipsychotics | Autism | Autism Spectrum Disorder | Neurotoxicity

At Carlat, we bang the drum of caution about antipsychotic use in children and adolescents. In this article, we pair rising concerns about antipsychotic neurotoxicity with the lack of efficacy evidence for off-label usage. Labeled use It is important to treat psychosis. A recent review by Goff and colleagues shows better outcomes for people who rece

Research Update

Weight Gain From Aripiprazole Same as Risperidone

From The Carlat Child Psychiatry Report, Autism in Children and Adolescents

Review of: Schoemakers RJ et al, J Child Adolesc Psychopharm 2019;29(3):192–196 Many providers prefer aripiprazole over risperidone for young patients due to observed lower incidence of weight gain. This is supported in studies with follow-up of less than 3 months. However, does aripiprazole fare better with long-term use? Researchers reviewed r

Expert Q&A

Philip G. Janicak, M.D. On Using Atypical Antipsychotics

From The Carlat Psychiatry Report, Atypical Antipsychotics 2005

Topics: Antipsychotics

TCR: Dr. Janicak, you've had a long career in research and academia, and I was hoping you could help shed some light on the various contentious issues surrounding the use of atypical antipsychotics, including the issue of whether there is clearly a difference in metabolic profile among the different medications. Dr. Janicak: At least two different cons

Article

Antipsychotic Updates

From The Carlat Psychiatry Report, Battle of the Atypicals

Topics: Antipsychotics

Tired of industry-funded antipsychotic trials? The NIMH comes to the rescue with the "CATIE" project (Clinical Antipsychotic Trials of Intervention Effectiveness). Blissfully un-industry-funded researchers have enrolled 1500 schizophrenic patients at 50 different sites, and have randomly assigned them to Zyprexa, Seroquel, Risperdal, Geodon, or Trilafon

Ask the Editor

Ask the Editor: Can Antipsychotics Enhance Cognition?

From The Carlat Psychiatry Report, Depression

Topics: Antipsychotics | Cognition

Dear Dr. Aiken: The article on Trintellix and cognition (TCPR, February 2019) reminded me of another industry claim: that atypical antipsychotics improve cognition. Any truth to that one? Dr. Aiken: I’ve also heard this whispering campaign, and there is reason to doubt it. The logic goes like this: Unlike the typical antipsychotics, atypi

Article

Antipsychotic Maintenance: How Long is Enough?

From The Carlat Psychiatry Report, Esketamine

Your 58-year-old patient started risperidone to augment lithium 2 years ago. It got her out of a severe mania, and she has stayed well since then. Now she’s worried about long-term risks and wondering if it’s time to come off. Augmentation with an atypical antipsychotic may offer rapid relief from mania and depression, but antipsychotics’ potenti

Research Update

Vitamin B6 Lowers Prolactin on Antipsychotics

From The Carlat Psychiatry Report, Living With Mental Illness

REVIEW OF: Zhuo C et al, Front Psychiatry 2021;12:681418 STUDY TYPE: Randomized, double-blind trial with an active control Hyperprolactinemia, a common problem on antipsychotics, can cause multiple issues, including sexual dysfunction and gynecomastia. It is a particular problem in treatment-resistant schizophrenia (TRS), as these patients often need

In Brief

Lybalvi: The Diet Olanzapine

From The Carlat Psychiatry Report, Schizophrenia

Lybalvi is a new combo pill that aims to overcome the dreaded metabolic effects of olanzapine by pairing it with the opioid antagonist samidorphan. Patients still gain weight on Lybalvi, though not as much as they do on olanzapine. In the three controlled trials that compared the two drugs, the weight gain on Lybalvi was 5 lb less at six months, 3 lb le

Research Update

Quetiapine in Bipolar With OCD

From The Carlat Psychiatry Report, The Difficult Patient

REVIEW OF: Sahraian A et al, CNS Spectr 2021;1–5 TYPE OF STUDY: Randomized, double-blind, placebo-controlled clinical trial SSRIs are first-line meds for obsessive-compulsive disorder (OCD), but they may pose risks of mania and rapid cycling when the patient also has bipolar disorder (BD). These conditions overlap more often than expected by chance,