Treatment of Antipsychotic-Induced Weight Gain

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

Quetiapine Reconsidered

Topics: Antipsychotics | Anxiety | Bipolar Depression | Depression | Dosing | Psychopharmacology | Psychopharmacology Tips | PTSD | Quetiapine | Schizophrenia

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

Topiramate Improves Weight in Schizophrenia in South Asians

Topics: Metabolic syndrome | Schizophrenia | Special populations | Topiramate | Weight gain

REVIEW OF: Chandradasa M et al, Asian J Psychiatr 2022;68:102963 STUDY TYPE: Randomized placebo-controlled trial People with schizophrenia have higher rates of cardiometabolic mortality. There is meta-analytic evidence that adjunctive topiramate reduces weight and improves psychiatric symptoms in schizophrenia. However, there are few studies of th

Assessing and Treating Catatonia

Topics: Amantadine | Ativan Challenge Test | Benzodiazepines | Bush-Francis Scale | Catatonia | lorazepam taper | mood disorders | neuroleptic malignant syndrome | retarded vs excited catatonia | Schizophrenia

CHPR: Welcome, Dr. Heckers. You recently published a review of the management of catatonia (Heckers S and Walther S, JAMA Psychiatry 2021;78(5):560–561). What is catatonia and how do you diagnose it? Dr. Heckers: Catatonia is a psychomotor syndrome. Some patients cannot move or respond normally. Patients often stare blankly, remain motionless for lon

Clozapine for Conduct Disorder in Schizophrenia

Topics: Clozapine | Conduct Disorder | Schizophrenia | Violence

REVIEW OF: Krakowski M et al, Am J Psychiatry 2021;178(3):266–274 STUDY TYPE: Randomized controlled trial We often struggle to find effective interventions for aggressive behavior in patients with schizophrenia. For patients with a history of conduct disorder, the task is even more challenging. Patients with schizophrenia will often have shown s

New Combination Treatment Mitigates Antipsychotic-Induced Weight Gain

Topics: Metabolic syndrome | olanzapine | Opioid antagonist | Samidorphan | Schizophrenia | Weight gain

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

Combination Treatment for Schizophrenia

Topics: Adjunct treatment | Antidepressant | Antipsychotic | Benzodiazepine | CATIE | Combination treatment | Free Articles | Mood stabilizer | Outcomes | Psychopharmacology | Schizoaffective disorder | Schizophrenia | Substance Use Disorder

CHPR: You recently published a study on the use of adjunctive medications in patients with schizophrenia (Stroup TS et al, JAMA Psychiatry 2019;76(5):508–515). Your findings were provocative as you found that adjunctive medications often help improve patients’ outcomes, yet many clinicians avoid polypharmacy because of concern that patients will exp

A Potentially Lethal Side Effect You Probably Never Heard Of

Topics: Clozapine | FDA Warnings | Free Articles | Management | Psychosis | Schizophrenia

In January 2020, the FDA issued a strong warning about constipation on clozapine. With a fatality rate of 1 in 1000, this is not just a nuisance side effect, and it can happen with other antipsychotics and psychotropics as well. This type of constipation is caused by slowing of the gut, or gastric hypomotility, and it requires a unique approach. Fiber s

Anticholinergic-Associated Cognitive Impairment in Schizophrenia

Topics: Cognition | Negative symptoms of schizophrenia | Schizophrenia | Side Effects

REVIEW OF: Joshi YB et al, Am J Psychiatry 2021;178(9):838–847 STUDY TYPE: Cross-sectional study Schizophrenia is associated with impaired cognition. Medications with anticholinergic properties, including antipsychotics, benztropine (Cogentin), and antidepressants, can worsen this problem and may confer increased risk of dementia. What we don’t kn

Vitamin B6 Lowers Prolactin on Antipsychotics

Topics: Antipsychotics | double blind | Prolactin | Randomized controlled trial | RCT | Schizophrenia | Vitamin B6

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

Raising the Bar in Schizophrenia Treatment

Topics: Clozapine | Negative Symptoms | Psychosis | Schizophrenia | Second Generation Antipsychotics (SGAs)

TCPR: Antipsychotics are the standard of care in schizophrenia, but what can we do beyond that? Dr. Miller: Several things come to mind. Therapeutic alliance, addressing the full symptom picture, and greater use of clozapine in treatment-resistant cases. TCPR: Let’s start with therapeutic alliance. Dr. Miller: Nonadherence with medications is the

Establishing a Dose-Response Relationship for Lurasidone in Acute Schizophrenia

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

The Schizophrenia-OCD Overlap

Topics: Antipsychotics | Aripiprazole | Clozapine | Comorbidity | Diagnosis | Lamictal | Lamotrigine | Obsessive Compulsive Disorder | OCD | olanzapine | Pharmacology Tips | polypharmacy | Quetiapine | Risperidone | Schizoaffective disorder | Schizophrenia

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

Are SSRIs Associated With Increased Rates of Violence?

Topics: Deprescribing | Mania on Antidepressants | Medication adherence | polypharmacy | Psychosis | Psychotic Depression | Schizophrenia | Tags | Tardive dyskinesia | Withdrawal

REVIEW OF: Lagerberg et al, Eur Neuropsychopharm 2020;26:1–9 TYPE OF STUDY: Analysis of Swedish national registries Soon after the introduction of SSRIs in 1988, case reports began to emerge suggesting that they might trigger violence in a small subset of patients. At the time, such reports were mostly dismissed and attributed to the fact that p

How to Switch Antipsychotics

Topics: Antipsychotics | Deprescribing | Pharmacology | Pharmacology Tips | Psychopharmacology | Psychopharmacology Tips | Psychosis | Research Update | Schizophrenia

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

How to Choose an Antipsychotic in Schizophrenia

Topics: Antipsychotics | Aripiprazole | Cariprazine | Clozapine | Negative Symptoms | olanzapine | Psychopharmacology | Psychopharmacology Tips | Psychosis | Risperidone | Schizophrenia

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

Polypharmacy in Schizophrenia

Topics: Research Updates | Schizophrenia

REVIEW OF: Tiihonen J et al, JAMA Psychiatry 2019;76(5):499–507 and Stroup T et al, JAMA Psychiatry 2019;76(5):508–515 TYPE OF STUDY: Retrospective non-randomized controlled trials Antipsychotic polypharmacy is discouraged in guidelines but common in practice. Up to 30% of patients with schizophrenia are prescribed multiple antipsychotics, and com

Highlights From This Issue

Topics: ADHD | Adult ADHD | Micronutrients | Narcolepsy | Schizophrenia

Micronutrients are vitamins and minerals that play an essential role in human physiology. They have promising studies in a host of psychiatric disorders, and Dr. Rucklidge explains why. Adult-onset ADHD has been proposed as a new diagnosis, but the data supporting it point in a different direction. Light therapy is one of few natural treatments with

Evaluating the Mortality Risks of Antipsychotics in Children and Youths

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

Cannabidiol for Schizophrenia

Topics: Cannabidiol | Research Update | Schizophrenia

Review of: McGuire P et al, Am J Psychiatry 2017;175(315). doi:10.1176/appi.ajp.2017.17030325 Type of study: Double-blind, randomized controlled trial Traditional antipsychotic medications leave much to be desired. Their therapeutic response rate for schizophrenia is low, and their side effects are troubling and lead to high rates of noncompliance