Journal of Clinical Psychopharmacology最新文献

Purpose/background: Vesicular monoamine transporter 2 inhibitors (VMAT2-Is), valbenazine and deutetrabenazine, are the only FDA-approved medications for tardive dyskinesia (TD); tetrabenazine is used off-label. TD diagnosis and VMAT2-I use data remain limited. This study characterizes trends in TD diagnosis and VMAT2-I use among adults (aged 18 to 65 years) with mental health diagnoses receiving antipsychotics.

Methods/procedures: We analyzed 2017-2022 MarketScan data. TD and mental health diagnoses were identified using ICD-10 codes, and VMAT2-I use from prescription claims. Mental health diagnoses were hierarchically categorized as schizophrenia, bipolar disorder (BPD), major depressive disorder (MDD), or other. Descriptive analyses summarized trends, and multivariable logistic regression assessed predictors of VMAT2-I use.

Findings/results: Among a cohort of 729,262 adults, TD diagnosis increased from 0.45% (N=849) in 2017 to 0.57% (N=1194) in 2022. VMAT2-I use increased from 0.05% (N=100) to 0.22% (N=454). Predictors of VMAT2-I use included first-generation antipsychotic use versus second-generation use only [adjusted odds ratio (aOR): 2.06, 95% CI: 1.59-2.67], schizophrenia (aOR: 8.40, 95% CI: 6.57-10.74) or BPD (aOR: 3.18, 95% CI: 2.62-3.86), versus other mental health diagnoses, female versus male sex (aOR: 1.32, 95% CI: 1.14-1.51), age 51 to 65 versus age 18 to 34 years (aOR: 5.57, 95% CI: 4.63-6.71), and calendar year (aOR: 1.42 95% CI: 1.36-1.48). Among patients with TD, schizophrenia (aOR: 1.80; 95% CI: 1.26-2.57), BPD (aOR: 1.85; 95% CI: 1.39-2.46), and age [aOR: 3.55; 95% CI: 2.70-3.84 (51 to 65 vs. 18 to 34 y)] were predictors of VMAT2-I use.

Implications/conclusions: TD remains underdiagnosed, with treatment rates low, highlighting the need for improved TD recognition and VMAT2-I access.

Purpose: The reproductive safety profiles of quetiapine (QTP) during pregnancy are not fully understood. This review primarily assesses perinatal outcomes and major malformations following exposure to quetiapine.

Methods: ‎A comprehensive literature search identified 33 studies published through February 2025. Outcomes were synthesized for QTP using random-effects models and benchmarked against population surveillance and psychiatric controls when available.

Results: ‎Among 13,090 pregnancies exposed to QTP with malformation outcomes, the major malformation rate was 4.1%, which is comparable to background rates. Perinatal outcomes were similar to those of the controls for QTP. Several high-quality studies have shown a dose-response relationship between higher QTP doses and the risk of gestational diabetes.

Implications/conclusions: QTP is not associated with an increased risk of major malformations and does not significantly raise adverse perinatal outcomes compared with controls. The dose-related metabolic risks of QTP underscore the importance of minimizing dosage and closely monitoring metabolism during pregnancy.

Purpose/background: Cognitive impairment severely disrupts functioning and recovery in schizophrenia. Methylphenidate extended-release (ER) shows promise for cognition in attention-deficit/hyperactivity disorder but has limited, inconsistent evidence in schizophrenia. This study investigates low-dose methylphenidate ER's effects on cognitive and functional outcomes in schizophrenia, addressing a critical therapeutic gap.

Methods/procedures: In an 8-week, open-label, randomized crossover trial, 24 stable adults with Diagnostic and Statistical Manual of Mental Disorders, 5th edition, diagnosis of schizophrenia spectrum disorder received 4 weeks of methylphenidate ER or treatment-as-usual (TAU), with crossover at week 4, and follow-up at week 12. The primary outcome was improvement in functional capacity, measured by the Virtual Reality Functional Capacity Assessment Tool (VRFCAT), while secondary outcomes included cognitive performance, assessed by the Brief Assessment of Cognition in Schizophrenia (BACS), and symptom severity evaluated by Positive and Negative Symptoms Scale (PANSS).

Findings/results: VRFCAT scores improved significantly over time; in the first period (baseline to week 4), the medication-first arm showed improvement versus the TAU-first arm, with overall gains from baseline to week 8 of 303.47 seconds and 159.91 seconds , respectively, sustained post medication. BACS showed significant improvements in the TAU-first arm during the medication phase for Symbol Coding and Tower of London. PANSS-6 improved significantly while on study medication, notably in delusions and social withdrawal, without psychosis exacerbation. At 2-month follow-up, 75% resumed methylphenidate ER.

Implications/conclusions: While results are interpreted cautiously due to the open-label design and small sample size, this trial suggests low-dose methylphenidate ER may enhance functional capacity, specific cognitive domains, and symptoms in schizophrenia without exacerbating psychosis.

Background: Methylphenidate is a central nervous system stimulant commonly used in the treatment of attention deficit hyperactivity disorder (ADHD). While it is known to improve sustained attention, its effects on individuals without clinical conditions remain controversial. This integrative review investigates the impact of MPH in nontherapeutic settings, with a focus on cognitive and behavioral outcomes and potential side effects.

Methods: A systematic search was conducted across multiple electronic databases, including PubMed, EMBASE, Scopus, Web of Science, and PsycINFO, covering studies published from 2010 to 2021, according to a previously published protocol.

Results: A total of 33 studies were included. While findings indicate that a single dose of methylphenidate may improve attention and readiness in cognitive tasks and may enhance the efficiency of visual and motor processing, the literature about its effects on working memory, inhibitory response, food consumption, and subjective mood alteration remains controversial. Also, methylphenidate shows some increase in heart rate and blood pressure.

Conclusion: This review highlights robust evidence regarding the effects of methylphenidate on attention and readiness, in addition to minimal overall cardiovascular impact. Also, it reveals a significant lack of research on the chronic effects of the medication and lack of standardization in the methods used to measure the stimulant's effects. Limitations include the lack of a meta-analysis and a potentially restrictive search strategy, which may have reduced the number of studies analyzed.