Antipsychotics Carlat Reports | Carlat Publishing

Research Update

Establishing a Dose-Response Relationship for Lurasidone in Acute Schizophrenia

From The Carlat Psychiatry Report, Bipolar Disorder

Topics: Antipsychotics | Dose Response | Dosing | Lurasidone | Schizophrenia

REVIEW OF: Srisurapanont M et al, Sci Rep 2021:11(1):5571 STUDY TYPE: Network meta-analysis Lurasidone is FDA approved in schizophrenia, but we lack good evidence to guide its dosage. This study compared the efficacy, safety, and acceptability of lurasidone at different doses to establish a dose-response relationship for its therapeutic and adverse ef

Research Update

Sleepwalking on Antipsychotics and Lithium

From The Carlat Psychiatry Report, Bipolar Disorder

REVIEW OF: Gouverneur A et al, Br J Clin Pharmacol 2021;87:3971–3977 STUDY TYPE: Retrospective analysis Sleepwalking and sleep-eating are common parasomnias, also known as somnambulism and sleep-related eating disorder. Both can be side effects of benzos, z-hypnotics, and—rarely—antidepressants. This review looked at parasomnias’ association w

Expert Q&A

The Schizophrenia-OCD Overlap

From The Carlat Psychiatry Report, Mood Disorders

TCPR: What is schizo-obsessive disorder?Dr. Poyurovsky: Schizo-obsessive disorder (schizo-OCD) is not a DSM diagnosis. The term is used to refer to patients with schizophrenic disorders that have comorbid features of OCD. We see these obsessive-compulsive symptoms in schizophrenia more often than would be expected by chance. About one in four patients h

In Brief

In Brief: Lamotrigine Gets a New Warning

From The Carlat Psychiatry Report, Problems with Generics

Topics: Antipsychotics | Carbamazepine | Lamotrigine

A new warning now sits beneath the list of life-threatening allergic reactions that can happen with lamotrigine. The anticonvulsant is suspected of causing cardiac arrhythmias in susceptible patients by slowing ventricular conduction and widening the QRS. A similar warning has long been in effect with carbamazepine, and both drugs are thought to exert t

Research Update

Antipsychotic Use Associated With Increased Risk of Mortality

From The Carlat Psychiatry Report, Stopping Psych Meds Part 2

Topics: Antidepressant Augmentation | Antipsychotics | Aripiprazole | Mortality

REVIEW OF: Gerhard T et al, PLoS One 2020;15(9):e0239206 TYPE OF STUDY: Population-based comparator cohort study We know that atypical antipsychotics increase mortality in elderly patients with dementia—the FDA has long required a black box warning to that effect. But are these medications also dangerous when prescribed to younger people with de

Research Update

How to Switch Antipsychotics

From The Carlat Psychiatry Report, Stopping Psych Meds Part 1

Review of: Takeuchi H and Remington G, J Psychopharmacol 2020;34(8):914–919 Type of study: Meta-analysis of randomized controlled trials Antipsychotic switching is a routine part of schizophrenia care, but what’s the best way to go from one medication to another? This article compared three strategies: 1) abruptly stopping the old antipsychotic an

Brief Clinical Update

Metformin ER Recalled Due to Cancer Risk

From The Carlat Psychiatry Report, Practical Psychotherapy

Topics: Antipsychotics | Generics | Metformin | Weight gain | Weight Loss Medications

Metformin is often prescribed to our patients to prevent weight gain on antipsychotics, but recently the FDA discovered that large batches of various metformin ER formulations may be contaminated with a carcinogen. Voluntary recalls of metformin ER began in May 2020 and have continued to the present. The result is drug shortages, fear, and an unanswered

Research Update

Mood Stabilizers: What You Don’t Know Can Hurt Them

From The Carlat Psychiatry Report, Mood and Menopause

Topics: | | | | | | | | | | | | | | | | | | | | | | | | Antipsychotics Aripiprazole Asenapine Bipolar Depression Bipolar Disorder Bipolar II Cariprazine Lithium Lurasidone Mania Medication adherence Mood Stabilizers olanzapine Oxcarbazepine Pharmacology Pharmacology Tips Psychopharmacology Psychopharmacology Tips Quetiapine Research Research Update Risperidone safety Saphris Side Effects

Review of: Bai Y et al, J Clin Psychopharmacol 2020;40(2):167–179 STUDY TYPE: Combined meta-analysis and literature review of placebo-controlled trials Medication adherence is an ongoing struggle in bipolar disorder, and it’s compounded by the fact that our patients often don’t advertise their non-adherence. While numbers vary, reviews general

Clinical Update

Modern Challenges of Delusional Disorder

From The Carlat Psychiatry Report, When to Use Lithium

Topics: Antipsychotics | Delusional Disorder | Pimozide | Psychosis | Psychotic Depression

While positive symptoms like hallucinations and delusions are among the more treatment-responsive symptoms of schizophrenia, the treatment of delusional disorder often proves much more vexing. Delusional disorder is often a diagnosis of exclusion requiring that you rule out other causes like schizophrenia, primary mood disorder, or substance-induced ps

Research Update

A New Antipsychotic for Bipolar Depression

From The Carlat Psychiatry Report, Traumatic Brain Injury

Lumateperone (Caplyta) just hit the pharmacy shelves with FDA approval in schizophrenia (see TCPR March 2020), and its manufacturer is pursuing further approval for bipolar depression. So far they’ve completed two phase III trials—one negative and one positive—and the positive one was presented in poster form by Suresh Durgam and colleagues at the

Clinical Update

How to Choose an Antipsychotic in Schizophrenia

From The Carlat Psychiatry Report, Psychopharmacology Algorithms

It’s been over a decade since the CATIE trial changed the way we look at antipsychotic drugs. Since then, the number of second-generation antipsychotics has about doubled, and the number of clinical trials has risen even more. Antipsychotics are not all the same, though, and when it comes to schizophrenia, a few stand out in ways that can help you fin

Expert Q&A

The Psychopharmacology Algorithm Project

From The Carlat Psychiatry Report, Psychopharmacology Algorithms

TCPR: What would be the biggest change in practice if psychiatrists followed your algorithms?Dr. Osser: One area is bipolar depression. This is a disorder where there is an exceptionally large deviation between what the evidence says and what people are doing, especially when it comes to antidepressants. They are still being used rampantly, even in pati

News of Note

Lumateperone and lemborexant

From The Carlat Psychiatry Report, Bipolar II

Two new psychiatric medications were approved in the final days of 2019. One is the first of its kind, an antipsychotic with minimal dopaminergic blockade: lumateperone (Caplyta). The other is lemborexant (Dayvigo), a variation on the hypnotic suvorexant (Belsomra). Lumateperone (Caplyta)Though classified as an atypical antipsychotic, lumateperone is u

Research Update

An Answer for Psychotic Depression

From The Carlat Psychiatry Report, Inflammation and Depression

REVIEW OF: Flint AJ et al, JAMA 2019;322(7):622–631 TYPE OF STUDY: Randomized, placebo-controlled trial Psychotic features in depression indicate a more severe form of the disease, with a higher risk of hospitalization and double the rate of disability compared with non-psychotic depression. A combination of an antipsychotic and an antidepressant is

Research Update

Olanzapine for Anorexia Nervosa

From The Carlat Psychiatry Report, Adult ADHD

Review of: Attia E et al, Am J Psychiatry 2019;176(6):449–456 Type of study: Randomized, double-blind, placebo-controlled trial Antipsychotics have been tried in anorexia since 1960, but their success has been mixed and often outweighed by their risks. Seven controlled trials have tested atypical antipsychotics in anorexia, and although most were p

News of Note

A New Treatment for Bipolar Depression

From The Carlat Psychiatry Report, Side Effects Part II

On May 28, 2019, cariprazine (Vraylar) became the fourth atypical antipsychotic to receive FDA approval for bipolar depression. The approval was based on two randomized controlled trials involving 1,051 patients and lasting 6–8 weeks. These studies grouped patients into fixed doses from 0.75–3 mg/day. The sweet spot seems to be 1.5 mg/day, which was

Article

Evaluating the Mortality Risks of Antipsychotics in Children and Youths

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

Topics: Antipsychotics | Psychopharmacology | Schizophrenia

There are reports of increased mortality from antipsychotics in older adults. Now, we have a paper showing increased mortality in children, adolescents, and young adults aged 5–24 years. Given the frequent use, both on- and off-label, of antipsychotics, does this change how we use them? And if so, how? What we already know In 2005, the FDA added a

Article

Ask the Editor: Which Antipsychotic Is Best When Patients Complain of Akathisia?

From The Carlat Psychiatry Report, Drug Metabolism

Topics: Antipsychotics

Each month, Editor-in-Chief Chris Aiken, MD, gives advice on a different practice challenge. If you have a question you’d like Dr. Aiken to answer, please send an email to AskTheEditor@thecarlatreport.com. Dr. Aiken won’t be able to answer all questions received, but he will pick one each month that is of general interest. Which Antipsychot

Research Update

Is Clozapine the Next Step After a Single Failed Antipsychotic Trial?

From The Carlat Psychiatry Report, Drug Metabolism

Topics: Antipsychotics | Research Update

Review of: Khan RS et al, Lancet Psychiatry, published online 8/13/2018 Type of study: Sequential trial with open-label and randomized, double-blind comparison phases Clozapine is often used as a last resort in schizophrenia, even though practice guidelines recommend a trial of this medication after failing 2 antipsychotics. The current study set

Research Update

Dose Maintenance, Reduction With Antipsychotics

From The Carlat Psychiatry Report, Neurobiology

Topics: Antipsychotics | Research Update

Review of: Zhou Y et al, Journal of Psychopharmacology 2018. doi:10.1177/0269881118756062 Once patients with schizophrenia are stabilized on an antipsychotic in the acute phase of their treatment, guidelines are unclear on how to continue dosing. Some guidelines recommend lowering the dose, others recommend maintaining the dose, and others give no fi