Management of Psychogenic Polydipsia

Topics: diabetes insipidus | fluid restriction | Hyponatremia | low sodium | Naltrexone | Osmolality | SIADH | sodium supplementation | water intoxication | water restriction

  Your new patient came from jail and has a history of schizophrenia. In jail, he was prescribed chlorpromazine and was observed to drink water compulsively, even from his cell toilet. On interview, he seems confused and disoriented, and he urinates on himself. The nurses tell you he has been complaining of thirst and needs to urinate frequently

Battle of the Bulge: Obesity and Antipsychotic-Induced Weight Gain

Topics: Aripiprazole | Benzphetamine | Bupropion | Diabetes | Diethylpropion | Exercise | Insulin resistance | Liraglutide | Metabolic syndrome | Metformin | Naltrexone | olanzapine | Phendimetrazine | Phentermine | Samidorphan | Semaglutide | Side Effects | Topiramate | Waist circumference | Weight gain | Ziprasidone

Many psychiatric medications cause weight gain, including mood stabilizers, antidepressants, and especially antipsychotics. Most weight gain secondary to antipsychotic use occurs in the first 6 months of therapy, so it’s important to monitor weight closely and intervene early in a patient’s treatment. We counsel patients at every visit about healthy

Oral vs Extended-Release Naltrexone for Opioid Use Disorder

Topics: Addiction Treatment | Naltrexone | Opioid Use Disorder | Research Update

Review of: Sullivan MA et al, Am J Psychiatry 2017;174(5):459–467 Extended-release (XR) naltrexone (Vivitrol) is FDA approved for opioid use disorder and has shown efficacy in several trials. It works best for patients who have already successfully detoxed from opioids and who are highly motivated to abstain. But what about oral naltrexone? While i

Does Extended-Release Naltrexone Worsen Psychiatric Symptoms?

Topics: Naltrexone | Opioids | Research Update

Review of: Latif Z et al, JAMA Psychiatry 2019;76(2):127–134 Extended-release (XR) naltrexone (Vivitrol) is an injectable version of naltrexone that lasts for 4 weeks and is FDA approved for opioid use disorder (OUD). Although effective, there is some concern that XR naltrexone may cause or worsen psychiatric symptoms because of its opioid blockade

The COMBINE Study: A Core Paper in the Treatment of AUD

Topics: Acamprosate | Addiction | Addiction Treatment | Alcohol | Alcohol Use | Alcohol use disorder | Alcoholism | Medication | Naltrexone | Pharmacology | Psychotherapy | Research | Research Update | Substance Use | Substance use disorders | Therapy during medication appointment | Therapy with Med Management

Review of: Anton RF et al, JAMA 2006;295(17):2003–2017 Conducted from 2001 to 2004 and published in 2006, the COMBINE study was the largest pharmacotherapy study that assessed the treatment of alcohol use disorder (AUD). Although there were significant data on the use of naltrexone and acamprosate (both had been FDA approved), widespread use had no

Meds for Alcohol Use Disorders

Topics: Alcohol use disorder | Naltrexone | observational study | Psychopharmacology

REVIEW OF: Heikkinen M et al, Addiction 2021;116(8):1990–1998 STUDY TYPE: Cohort study In the US, only 9% of patients diagnosed with alcohol use disorder (AUD) are prescribed AUD medication (Kranzler HR and Soyka M, JAMA 2018;320(8):815–824). A Swedish study provides evidence that further illuminates the potential harms from this lack of treat

Suboxone vs. Vivitrol for Opioid Use Disorder: How Do you Choose?

Topics: Addiction Treatment | Buprenorphine | Medication for Opioid Use Disorder | Naltrexone | Opioid Use Disorder

REVIEW OF: Nunes EV Jr et al, Am J Psychiatry 2021;178(7):660–671 For decades, methadone and buprenorphine (Bup) have been upheld as the gold standard of opioid use disorder (OUD) treatments, with naltrexone largely considered second line. However, a pair of landmark studies challenged that wisdom by showing the non-inferiority of long-acting injec

Treating Alcohol Use Disorder

Topics: Addiction Treatment | Alcohol | Alcohol use disorder | Alcoholism | Medication | Naltrexone | Substance Use Disorder | Therapy with Med Management

CATR: Can you tell us about the role of medications for alcohol use disorder (AUD)? Dr. Arias: Medications are a very important part of AUD treatment. They can and should be used as a first-line treatment in any reasonable medical setting—primary care or psychiatry, or a specialty addiction setting. Unfortunately, very few patients ever receive them.

Treating Addiction in Patients Transitioning to/from Incarceration

Topics: Addiction | Addiction Treatment | Buprenorphine | Clinical practice | Incarceration | Methadone | Naltrexone | Opioid epidemic | Opioid Use Disorder | Opioids | Overdose | Prison | Substance use disorders

CATR: Could you tell us a bit about your background in working with people with addiction in the criminal justice system? Dr. Cropsey: I am a clinical psychologist and professor in the Department of Psychiatry at the University of Alabama at Birmingham. I conduct research and provide clinical care to patients with addiction within the criminal justice

Switching from Buprenorphine to Extended-Release Naltrexone: Does it Work?

Topics: Buprenorphine | Naltrexone | Opioids | Research Update | Substance Use

Review of: Solli KK et al, Addiction 2018;113(10):1840-1849 Extended-release naltrexone (Vivitrol) has had some good data, yet getting patients on it remains a challenge, because an opioid-free period is required before starting it. Understandably, practitioners get nervous when patients stabilized on buprenorphine ask to be transitioned to extended-