olanzapine Carlat Reports | Carlat Publishing

Clinical Update

From The Carlat Psychiatry Report, ADHD

Every day we are faced with prescribing dilemmas that don’t have ready answers. Instant or extended release? Brand or generic? With food or without? How should we adjust dosing to account for drug interactions, age, gender, ethnicity, or genetic testing results? Our new textbook Prescribing Psychotropics: From Drug Interactions to Pharmacogenetics is

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

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

From The Carlat Hospital Psychiatry Report, Metabolic Side Effects

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

Expert Q&A

Weight Gain and Metabolic Side Effects

From The Carlat Hospital Psychiatry Report, Metabolic Side Effects

CHPR: Dr. Marder, can you please tell us about your work? Dr. Marder: Sure. My work has focused on pharmacologic and nonpharmacologic approaches to improving the outcomes of serious mental illnesses, particularly schizophrenia. I’m very interested in ways to combine psychosocial interventions with pharmacological approaches and to reduce adverse side

Research Update

New Combination Treatment Mitigates Antipsychotic-Induced Weight Gain

From The Carlat Hospital Psychiatry Report, Metabolic Side Effects

Review of: Correll CU et al, Am J Psychiatry 2020;177(12):1168–1178 To date, we have had no FDA-approved medications to mitigate antipsychotic-associated weight gain (AIWG). This will soon change, thanks to recent research showing that samidorphan, an opioid receptor antagonist, appears to significantly lessen weight gain associated with the use

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

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

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

Research Update

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

From The Carlat Psychiatry Report, Mood and Menopause

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

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

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