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Antipsychotic discontinuation linked to greater risk of symptom recurrence
Discontinuation of antipsychotic treatment after functional recovery from a single psychotic episode was associated with a high rate of symptom recurrence in an open‐label, nonrandomized study. Resumption of antipsychotic treatment in these patients was associated with clinical remission and a lack of further relapses, the study found. (Source: The Brown University Psychopharmacology Update)
Source: The Brown University Psychopharmacology Update - March 21, 2016 Category: Psychiatry Tags: What's New in Research Source Type: research

Angioedema caused by ritonavir and risperidone
Many patients with HIV are likely to be prescribed antipsychotics, antidepressants, or anxiolytics to manage psychiatric symptoms. Some of the protease inhibitors used in the treatment of HIV are modulators of various metabolic enzymes, but limited information is available regarding the potential for drug interaction between protease inhibitors and psychotropic agents. The following report describes three cases of angioedema that could be related to a potential interaction between risperidone and ritonavir. (Source: The Brown University Psychopharmacology Update)
Source: The Brown University Psychopharmacology Update - March 21, 2016 Category: Psychiatry Authors: Y. W. Francis Lam Tags: Drug ‐Drug Interactions Source Type: research

Lamotrigine improves bipolar depression, but folic acid counteracts effects
A 12‐week study of patients with bipolar disorder has found that a combination treatment of quetiapine and lamotrigine led to greater improvement in depressive symptoms than quetiapine alone, but use of folic acid during the study period acted to nullify lamotrigine's effects. These findings, coupled with data from an earlier study, appear to confirm lamotrigine's effectiveness in the treatment of bipolar depression. Study results were published online Dec. 10, 2015, in Lancet Psychiatry. (Source: The Brown University Psychopharmacology Update)
Source: The Brown University Psychopharmacology Update - March 21, 2016 Category: Psychiatry Tags: Bipolar Disorder Treatment Source Type: research

Higher doses of SSRIs linked to better outcomes, more side effects
A review and meta‐analysis encompassing 40 randomized trials has concluded that higher doses of selective serotonin reuptake inhibitors (SSRIs) appear to result in slightly more improved outcomes in treating major depressive disorder. The meta‐analysis also found, however, that higher doses generated more treatment dropouts due to side effects, which means that the decision to increase dosage requires a balancing of these factors. Results were published online Nov. 10, 2015 in the American Journal of Psychiatry. (Source: The Brown University Psychopharmacology Update)
Source: The Brown University Psychopharmacology Update - February 23, 2016 Category: Psychiatry Tags: Depression Treatment Source Type: research

Research Roundup
Clozapine compares favorably with standard antipsychotics Study links prescription stimulants to incidence of PTSD in military Use of stimulants in youths leads to sleep difficulties Suicide risk with antidepressants not higher than with no treatment Bright light treatment promising for nonseasonal depression Adjunctive raloxifene improves schizophrenia symptoms in women (Source: The Brown University Psychopharmacology Update)
Source: The Brown University Psychopharmacology Update - February 23, 2016 Category: Psychiatry Tags: Research Roundup Source Type: research

Adjunctive antipsychotic after mania remission effective over 24 weeks
Twenty‐four weeks of adjunctive therapy with risperidone or olanzapine after remission of acute mania was effective in reducing relapse to a mood episode, but a longer 52‐week duration of adjunctive antipsychotic treatment showed no additional benefit and increased the risk of adverse effects, a new study has found. (Source: The Brown University Psychopharmacology Update)
Source: The Brown University Psychopharmacology Update - February 23, 2016 Category: Psychiatry Tags: What's New in Research Source Type: research

Lurasidone effective in treating depression with mixed features
In what is believed to be the first placebo‐controlled trial of a medication treatment for patients with depression and subthreshold hypomanic symptoms, researchers have found that the atypical antipsychotic lurasidone was safe and effective over a 6‐week treatment period. Lurasidone demonstrated efficacy across a range of core mood symptoms associated with the disorder, the researchers reported. (Source: The Brown University Psychopharmacology Update)
Source: The Brown University Psychopharmacology Update - February 23, 2016 Category: Psychiatry Tags: What's New in Research Source Type: research

Valproate, risperidone, and antibiotic levels
The antiepileptic drug valproate is frequently used in the treatment of manic episodes, either as monotherapy or combined with lithium, carbamazepine, or antipsychotics. Drug interaction with valproate secondary to its ability to inhibit drug elimination, as well as induction of its metabolism by concurrently administered drugs, is commonly reported. In particular, the carbapenem antibiotics have been reported to interact with valproate, resulting in lower valproic acid concentrations and loss of seizure control.1 (Source: The Brown University Psychopharmacology Update)
Source: The Brown University Psychopharmacology Update - February 23, 2016 Category: Psychiatry Authors: Y. W. Francis Lam Tags: Drug ‐Drug Interactions Source Type: research

Cariprazine shows encouraging results in treatment of bipolar depression
A double‐blind, placebo‐controlled Phase II study of the atypical antipsychotic cariprazine for the treatment of bipolar depression has found the most highly effective outcomes with a dose of 1.5 mg/day. A dose of 3 mg/day resulted in improvement in depressive symptoms, but results were not significant when adjusted for potential confounding factors. A dose of 0.75 mg/day did not result in improvement over placebo. Results were published online Nov. 6, 2015, in the American Journal of Psychiatry. (Source: The Brown University Psychopharmacology Update)
Source: The Brown University Psychopharmacology Update - February 23, 2016 Category: Psychiatry Tags: Bipolar Disorder Treatment Source Type: research

Study finds no link between lithium and increased end‐stage kidney disease
Results of a population‐based study conducted in Denmark suggest that lithium can be used in patients with bipolar disorder without exacerbating the risk of end‐stage chronic kidney disease. The study also found that long‐term use of anticonvulsants for bipolar disorder was associated with an increased risk of end‐stage chronic kidney disease. Results were published online Nov. 4, 2015, in JAMA Psychiatry. (Source: The Brown University Psychopharmacology Update)
Source: The Brown University Psychopharmacology Update - January 26, 2016 Category: Psychiatry Tags: Bipolar Disorder Treatment Source Type: research

Research Roundup
Study of infant functioning warns of risks of maternal polypharmacy Examination of antipsychotic response offers promise for genotype‐guided care Lithium reduces manic symptoms in pediatric bipolar study Dose of beta‐blocker prevents return of fear after exposure therapy Analysis concludes antidepressants not overprescribed for mild depression Study: Off‐label uses linked to adverse events (Source: The Brown University Psychopharmacology Update)
Source: The Brown University Psychopharmacology Update - January 25, 2016 Category: Psychiatry Tags: Research Roundup Source Type: research

Psychotherapy after acute pharmacotherapy reduces relapse in depression
A meta‐analysis encompassing 13 studies has found that administration of psychotherapy following successful acute‐phase pharmacotherapy constitutes a viable strategy for preventing relapse in major depressive disorder. Outcomes in the studies were generally encouraging whether psychotherapy was administered with or without continuation treatment with an antidepressant. (Source: The Brown University Psychopharmacology Update)
Source: The Brown University Psychopharmacology Update - January 25, 2016 Category: Psychiatry Tags: What's New in Research Source Type: research

Psychological therapy for ADHD works better with methylphenidate
Psychological interventions yielded better outcomes in adult patients with attention‐deficit hyperactivity disorder (ADHD) when they were combined with methylphenidate as opposed to placebo, a study comparing four treatment conditions has found. The study also found that an easily implemented individual clinical management intervention fared no worse than a more structured group psychotherapy protocol. (Source: The Brown University Psychopharmacology Update)
Source: The Brown University Psychopharmacology Update - January 25, 2016 Category: Psychiatry Tags: What's New in Research Source Type: research

Immunoglobulin M deficiency in clozapine‐treated patients
The atypical antipsychotic clozapine has demonstrated effectiveness in managing patients with treatment‐resistant schizophrenia. However, the drug also affects levels of antibody‐producing cytokines and possesses immunosuppressive activity, and therefore could affect humoral immunity.1 A recent report investigated the relationship between long‐term clozapine treatment and the occurrence of selective immunoglobulin M deficiency, a rare dysgammaglobulinemia that occurs in the setting of normal T‐cell number.2 (Source: The Brown University Psychopharmacology Update)
Source: The Brown University Psychopharmacology Update - January 25, 2016 Category: Psychiatry Authors: Y. W. Francis Lam Tags: Drug ‐Drug Interactions Source Type: research

Methylphenidate effective on range of symptoms in PTSD, brain injury
A placebo‐controlled trial of the stimulant methylphenidate or the cholinesterase inhibitor galantamine for cognitive and emotional symptoms in patients with post‐traumatic stress disorder (PTSD) and/or traumatic brain injury (TBI) found a broad range of positive outcomes associated with methylphenidate. This included the surprising finding of improvement in PTSD symptoms. Effects were not as pronounced for galantamine, although patients receiving that drug did show improvement on a measure of episodic memory. Results were published online Oct. 28, 2015, in Neuropsychopharmacology. (Source: The Brown University Psychopharmacology Update)
Source: The Brown University Psychopharmacology Update - January 25, 2016 Category: Psychiatry Tags: Cognitive Treatments Source Type: research