Psychopharmacology bulletin最新文献

Objective: This prospective 12-week randomized controlled trial tested an adherence promotion approach called Customized Adherence Enhancement in schizophrenia (CAE-S) vs. Enhanced Treatment as Usual (eTAU) in 36 poorly adherent individuals.

Methods: Patients were randomized to either CAE-S or eTAU at baseline and were assessed at 12-week follow-up. Primary outcomes were program attendance, patient satisfaction and change in schizophrenia symptoms as measured by the Positive and Negative Syndrome Scale (PANSS). Additional evaluations were adherence measured by the Tablets Routine Questionnaire (TRQ), Clinical Global Impression (CGI), Short Form Health Survey (SF-12), Global Assessment of Functioning (GAF), and Strauss-Carpenter Level of Functioning Scale (SCLFS).

Results: Mean age was 44.9 (Standard deviation/SD 12) years. 12-week attrition was 19.4%. At screening, mean past 7-day TRQ (proportion of days with missed dose) was 29.7% (SD 23.8) for CAE and 41.7% (SD 26.5) for eTAU. By baseline, mean TRQ improved to 11.3% (SD 15.8) in CAE-S, and to 19.3% (SD 25.7) in eTAU. Mean session attendance (out of a maximum of 6) was 4.89 (SD 1.9) for CAE and 3.88 (SD 2.5) for ETAU. CAE and ETAU satisfaction were both high. From baseline to 12 weeks, mean PANSS improved significantly in both CAE-S (p < .05) and eTAU (p < .01) with no difference between arms. There was no significant change in TRQ, while CGI and GAF improved significantly in both arms with no significant difference between arms. Mean SCLFS improved in both arms, with results favoring CAE (p < .001).

Conclusion: Telehealth CAE-S is feasible and acceptable among poorly adherent patients with schizophrenia. Adherence improved rapidly with monitoring, which could explain improvement in schizophrenia symptoms and largely similar outcomes across intervention arms.

Lamotrigine-induced DRESS syndrome is a potentially fatal drug reaction with variable clinical presentation and complications requiring early recognition and rapid response.

Background: Opioid prescribing practices have come under increased scrutiny due to the ongoing opioid crisis, with efforts focusing on harm reduction strategies such as co-prescription of opioid antagonists. This study analyzes opioid prescribing trends and the frequency of opioid-antagonist co-prescription over the course of 2024.

Methods: A retrospective analysis was performed using electronic medical record data to identify all opioid prescriptions issued between January 1, 2024, and December 31, 2024. Each opioid prescription was cross-referenced with any concurrent prescription for an opioid antagonist. The analysis did not differentiate opioid type, duration of therapy, or prescribing indication.

Results: A total of 68,212 opioid prescriptions were issued in 2024. Quarterly totals were: Q1: 16,574; Q2: 16,882; Q3: 16,922; and Q4: 17,834. Among these, 7,586 (11.1%) were co-prescribed with an opioid antagonist, while 60,626 (88.9%) were not. The distribution across quarters was:Q1: 16,574 prescriptionsQ2: 16,882 prescriptionsQ3: 16,922 prescriptionsQ4: 17,834 prescriptionsOf these, 7,586 (11.1%) were co-prescribed with an opioid antagonist, while 60,626 (88.9%) were prescribed without one. The quarterly breakdown of opioid-antagonist co-prescription was:Q1: 1,874 prescriptions with an antagonist, 14,700 withoutQ2: 1,867 prescriptions with an antagonist, 15,015 withoutQ3: 1,945 prescriptions with an antagonist, 14,977 withoutQ4: 1,900 prescriptions with an antagonist, 15,934 without.

Conclusion: Despite ongoing recommendations to increase opioid-antagonist co-prescription, a large majority (88.9%) of opioid prescriptions in 2024 were issued without an antagonist. While there was a modest increase in overall opioid prescriptions over the year, opioid-antagonist co-prescription rates remained relatively stable. These findings highlight the need for further investigation into barriers preventing wider adoption of opioid-antagonist co-prescription and the potential impact on patient safety.

Background: Tramadol is a widely used analgesic with a unique dual mechanism of action, combining weak μ-opioid receptor agonism with inhibition of norepinephrine and serotonin reuptake. It is frequently prescribed for various acute and chronic pain conditions. Evaluating prescribing trends can provide valuable insight into clinical practice patterns and inform institutional pain management strategies and policy development.

Objective: To assess tramadol prescribing patterns over a one-year period in a university-based health system and compare them to overall opioid prescribing.

Methods: A retrospective review was conducted using electronic medical record (EMR) data from January 1, 2024, to December 31, 2024. The number of tramadol prescriptions was quantified quarterly and compared to the total number of opioid prescriptions (including tramadol) during the same period. No identifiable patient information was collected.

Results: A total of 17,660 tramadol prescriptions were written in 2024. Quarterly breakdowns were: Q1 - 4,347; Q2 - 4,382; Q3 - 4,369; Q4 - 4,562. Overall, tramadol prescriptions accounted for 25.9% of the 68,212 total opioid prescriptions written during the year.

Conclusion: Tramadol constituted over one-quarter of all opioid prescriptions in this academic medical center. Prescribing remained stable across all quarters, with a slight increase observed in Q4. These findings highlight tramadol's significant role in opioid prescribing practices for acute and chronic pain management.

Kleine-Levin Syndrome (KLS) is a rare, neurological disorder characterized by episodes of hypersomnia, cognitive impairment, and behavioral abnormalities. The etiology of KLS remains unclear, and treatment responses are highly variable. This report describes a 22-year longitudinal experience with a 40-year-old male diagnosed with KLS at 15 years of age. Treatment trials of all standard KLS medications (lithium, valproic acid, selective serotonin reuptake inhibitors, modafinil) yielded no benefit in attenuating or preventing episodes. Following the onset of overlapping an acute KLS exacerbation and catatonia-like symptoms, the patient's episode was shortened after a trial of intravenous (IV) lorazepam. This response was consistently reproduced, with episodes resolving after approximately 5-7 days of IV lorazepam administration. Notably, the frequency of episodes increased after the patient contracted COVID-19 despite the continued efficacy of IV lorazepam in reducing episode duration. This case highlights the potential utility of IV lorazepam in terminating acute KLS episodes. While short-term outcomes were favorable, the observed increase in episode frequency underscores the need to assess the risks of chronic benzodiazepine exposure, including receptor downregulation and tolerance. These findings support the use of lorazepam in acute KLS management but emphasize caution regarding long-term reliance and encourage further mechanistic and therapeutic research into episodic hypersomnia and benzodiazepine responsiveness.

Over the past two decades, there has been a growing interest in the co-occurrence of gender dysphoria (GD) and autism spectrum disorder (ASD). This case series will examine five patients from our clinic population who present with both diagnoses. We will analyze differences and similarities among the cases, summarizing each patient's presentation trajectory. This will include the age of onset for both diagnoses, the clinical symptoms that led to the diagnosis, and current treatment responses. Our objective is to contribute to the existing literature on the intersection of these diagnoses.

Objective: Posttraumatic Stress Disorder (PTSD) is a common condition with few effective medication treatments. Glecaprevir/Pibrentasvir (GLE/PIB), a treatment for hepatitis C virus (HCV) infection, demonstrated possible evidence of effectiveness for PTSD in an epidemiological study. We sought to determine if GLE/PIB decreases the symptoms of PTSD and modulates inflammation.

Methods: An uncontrolled open trial was conducted at the Veterans Affairs Medical Center in White River Junction Vermont. Participants were veterans with PTSD and no HCV infection. Ten participants received Glecaprevir 100 mg/Pibrentasvir 40 mg, three tablets daily for 8 weeks. Symptoms were measured at baseline, mid-treatment, post-treatment, as well as at three- and six-months post-treatment. The primary outcome was PTSD symptoms as measured by the Clinician Administered PTSD Scale for DSM 5 (CAPS-5). Exploratory analyses were conducted to assess serum inflammatory biomarkers at baseline and post-treatment.

Results: The mean baseline CAPS-5 score was 33.6 (SD = 3.3). Six-month post-treatment effects were large (CAPS-5: d = 1.6, p < 0.01). By the end of the study, eight patients met the criteria for response, including eight who met the criteria for loss of PTSD diagnosis and six who met the criteria for total remission of PTSD (CAPS-5 score of less than 12). Lower interleukin (IL)-27 levels prior to treatment were predictive of treatment response. Eight-week IL-9 levels changes with treatment were associated with symptom improvement.

Conclusions: GLE/PIB may be an effective treatment for PTSD. Furthermore, treatment may modulate inflammatory responses in PTSD. Future studies are required to confirm these findings regarding GLE/PIB, PTSD, and inflammation.

Objective: To estimate the association between tobacco use and the prevalence of psychotropic medication use and prescribed dosage among inpatients and outpatients with severe mental disorders treated at a neuropsychiatric hospital.

Methods: Observational, cross-sectional, analytical study conducted on May 3, 2023. Smoking status and prescribed psychotropic medications were recorded for all hospitalized patients and community-based outpatients. Dosages were reported in mg/day, defined daily doses (DDD), and for antipsychotics as chlorpromazine equivalents (CPZeq). Bivariate and multivariate analyses were performed.

Results: Tobacco use data were collected from 325 out of 425 total patients (71.7% male, mean age [SD]: 51.4 [14.4] years, 56% inpatients, 70.2% with schizophrenia and related psychosis). The prevalence of smoking was 72.3%, with differences by gender (78.1% in males vs. 57.8% in females, p < 0.001), and decreased with age (18-39 years: 86.1%; 40-59 years: 71.7%; ⩾ 60 years: 63.2%; p = 0.01). Mean dosages of antipsychotics, clozapine, and olanzapine measured in CPZeq were higher in smokers than in non-smokers by 35.4%, 37.1%, and 33.3%, respectively. After adjusting for confounding factors, smoking was associated with a 21.8% higher dosage of antipsychotics (95% CI: 0.4%-43.2%; p = 0.046), equivalent to an additional 132.2 mg/day (24.2-240.1; p = 0.017) of clozapine and 5.4 mg/day (1.2-9.6; p = 0.012) of olanzapine. The average dosage of sedatives/hypnotics was 45.5% higher among smokers (13.6%-89.5%; p = 0.008).

Conclusion: A high prevalence of smoking was found among patients with severe mental disorders, associated with higher average dosages of sedatives/hypnotics and antipsychotics, particularly clozapine and olanzapine.

Objective: To analyze patterns of pro re nata (PRN) medication utilization during the seven-day periods preceding and following aggressive incidents in a forensic setting, including both psychotropic and somatic agents, to identify trends in use surrounding aggression.

Methods: This was a retrospective chart review at a long-term state forensic psychiatric facility. Patients housed on units associated with the New Outlook Program (NOP) within a six-month period who received PRN medications were included.

Results: Out of 106 patients evaluated, 42 were included. The mean age for study participants was 37 years old, with 83% being male. Out of 322 aggressive incidents, the overall PRN utilization rate was higher than the baseline in 38.8% of events (N = 125). For the overall seven-day period preceding and following an aggressive incident, there was no significant difference between psychotropic and somatic PRNs (β = -0.16, p = 0.74), and neither type showed a meaningful deviation from baseline (Intercept = -0.25, p = 0.46). Additionally, there was no significant difference in PRN utilization when separately assessing the seven-day period preceding or following an aggressive incident.

Conclusion: No consistent group-level trends in PRN utilization were identified in relation to aggression. However, some patient-level variation was observed post-incident, suggesting individualized patterns compared to group-level trends. These findings support the clinical value of monitoring individuals' PRN utilization patterns to inform treatment planning.

Background: Diphenhydramine, an over-the-counter antihistamine, is increasingly misused by adolescents for its sedative and hallucinogenic effects. Despite its accessibility and perceived safety, chronic misuse poses serious risks, including neurologic, psychiatric, and gastrointestinal complications, especially in vulnerable youth with preexisting trauma or psychiatric illness.

Case: We present a case of a teenage female with a history of traumatic brain injury, major depressive disorder, and restrictive eating disorder who was admitted following a diphenhydramine overdose. Her suicide attempt was preceded by a two-year history of undisclosed daily diphenhydramine misuse, initially for mood regulation and later escalating to dependency. Multisystem symptoms including seizures, disordered eating, and behavioral changes were retrospectively linked to her chronic use. Her TBI and initial seizure also coincided with a period of increased diphenhydramine ingestion, raising concern for misattributed or missed diagnoses.

Discussion: This case highlights the diagnostic challenges posed by diphenhydramine misuse in adolescents. Chronic use can mimic or exacerbate psychiatric and neurologic conditions, delay appropriate intervention, and contribute to unnecessary polypharmacy or healthcare utilization. Her improvement with structured psychiatric care and medication discontinuation supports the role of early identification and trauma-informed management in preventing further harm.

Conclusion: Diphenhydramine misuse should be considered in adolescents with overlapping psychiatric, neurologic, and gastrointestinal complaints. Routine psychosocial screening and awareness of non-traditional substances of abuse are essential for timely diagnosis and intervention.