The Brown University Psychopharmacology Update最新文献

A case-control study involving patients with a psychiatric hospitalization has found increased odds of psychosis and mania in individuals with past-month use of prescription amphetamines. Risk of psychosis and mania was substantially higher in patients receiving higher doses of amphetamines, the investigators reported. Study results were published online Sept. 12, 2024, in the American Journal of Psychiatry.

Divalproex sodium, valproic acid, valproate (generic) — Depakote, Depakene (brand)

The atypical antipsychotic clozapine is considered the primary agent for patients with treatment-resistant schizophrenia, and is also used at times in the treatment of other treatment-resistant psychotic disorders. Despite its efficacy, use of clozapine is often limited by the occurrence of significant adverse effects, smoking-induced increased metabolism, and drug-drug interactions due to co-administered medications to treat concurrent medical and psychiatric conditions.

As many as two-thirds of individuals with autism spectrum disorder (ASD) experience challenging symptoms of irritability, including aggression and self-injury. The antipsychotics risperidone and aripiprazole are approved for the treatment of irritability associated with ASD; however, their adverse effects can compromise long-term use in many patients. Based on longstanding case reports showing promising results for the beta-blocker propranolol in reducing challenging symptoms in ASD, investigators conducted a randomized, double-blind, placebo-controlled crossover trial to evaluate the feasibility of high-dose propranolol for treating aggression in patients with ASD. The investigators recruited youths and young adults aged 12 to 30 with ASD and a history of severe and chronic aggression, self-injury, and disruptive behaviors that interfere with daily activities. Participants were required to have had an inadequate trial of at least two psychotropic medications, including at least one antipsychotic. Dosing of propranolol started at 10 mg three times a day and could be increased until adequate therapeutic response was achieved, to a maximum dose of 200 mg three times a day. Most study visits were conducted via telehealth in order to minimize patient schedule disruption. The primary outcomes were change in scores on the Clinical Global Impression-Improvement (CGI-I) and Aberrant Behavior Checklist-Community (ABC-C) scales from baseline to study endpoint. Six participants with a mean age of 16 years were enrolled. The investigators found that propranolol resulted in mean reductions of 50% in scores on the CGI-I and 37% in scores on the ABC-C. Effect sizes were large for both measures: –0.74 for the CGI-I and –0.64 for the ABC-C. “As this was a feasibility pilot study, we had a small sample that limits the generalization of our results to a wider population, and therefore, until a placebo-controlled, double-blind study with an adequate number of subjects is conducted, the clinical value of this report is limited,” the study's authors wrote. [London, E., et al. (2024). J Clin Psychopharmacol. https://doi.org/10.1097/JCP.0000000000001895]

An 8-week study involving patients with treatment-resistant depression has found that repetitive transcranial magnetic stimulation (rTMS) was significantly more effective than a change in antidepressant regimen in reducing depressive symptoms. The researchers found rTMS was also more effective in reducing symptoms of anxiety and anhedonia. Study results were published online Aug. 7, 2024, in the American Journal of Psychiatry.

Use of antidepressants in elderly patients has raised concerns over the risk of impaired cognition and development of dementia. The research data evaluating this potential association are conflicting, however, with little information on the effects of long-term exposure or potential differences among the various classes of antidepressants (Wang et al., 2018).

A cohort study has found comparable neonatal and maternal outcomes for women receiving the combination of buprenorphine and naloxone in the first trimester of pregnancy and women receiving buprenorphine alone. The results suggest that both formulations of buprenorphine appear to be a safe choice for pregnant women with opioid use disorder (OUD).