Psychopharmacology bulletin最新文献

Since its first inception by Kahlbaum in relation to schizophrenia, Catatonia syndrome is currently believed to cut across many neuropsychiatric diagnoses. In this focussed review, authors touch briefly on prevalence of catatonia in psychiatric presentations, discuss clinical diagnosis, neurobiology, typology, and conclude with a psychopharmacological algorithm to treatment.

Introduction: Alcoholic hallucinosis (AH) is one of the severe complications of chronic alcoholism, characterized by psychotic symptoms such as auditory hallucinations and delusions. Haloperidol is widely used to treat AH; however, its therapy is often complicated by side effects. A personalized approach using pharmacogenetic testing (particularly the CYP2D6 polymorphism) allows individualization of haloperidol dosage, improving both safety and efficacy of therapy.

Materials and methods: The study included 100 men diagnosed with "psychotic disorder induced by alcohol use." Patients were randomized into two groups: the main group (45 patients) received haloperidol based on the results of pharmacogenetic testing, while the control group (55 patients) received standard dosing. Genotyping was conducted for the CYP2D6 1846G > A polymorphism. The effectiveness was assessed using the PANSS, UKU, and SAS scales.

Results: Genotyping showed an even distribution of CYP2D6 polymorphisms in both groups. The main group demonstrated a significant reduction in side effects and improvement in psychotic symptoms compared to the control group. Differences on the UKU, SAS, and PANSS scales reached statistical significance on days 3-5 of treatment.

Conclusion: Using pharmacogenetic testing to adjust haloperidol dosage improves therapy tolerability and accelerates the resolution of psychotic symptoms in patients with alcoholic hallucinosis, confirming the feasibility of a personalized approach in psychopharmacotherapy.

Bipolar disorder is a chronic disease that imposes a lifelong burden on those that suffer from it. Lithium is still considered both gold standard treatment and first-line maintenance treatment, and access to treatment with lithium is paramount to improving patient outcomes. However, access to adequate treatment is not only contingent on symptom recognition, accurate diagnosis, and individualization of treatment, but also affected by racial and ethnic disparities at each stage of patient experience. Individuals of African Ancestry with bipolar disorder are more frequently misdiagnosed with non-affective psychoses, less likely to receive minimally adequate treatment or be prescribed lithium, and more likely to be prescribed antipsychotics. To compare prescription patterns in the treatment of bipolar disorder between individuals of African and European Ancestry, we conducted a pooled meta-analysis of four cohorts spanning different clinical settings, recruitment periods, and ascertainment methods, followed by sex-stratified analyses. We found that, overall, individuals of African Ancestry with bipolar disorder were significantly less likely to be prescribed lithium, and more likely to be prescribed first and second-generation antipsychotics during their lifetime, than those of European Ancestry. Furthermore, both men and women of African Ancestry were independently less likely to be prescribed lithium and more likely to be prescribed second generation antipsychotics than men and women of European Ancestry. However, women appeared to be more burdened by the significantly increased likelihood of first-generation antipsychotic prescription than men, for whom the association was marginally non-significant. This continued underutilization of lithium likely stems from the complex interaction of multiple biases.

Gabapentin and pregabalin are widely used in the management of neuropathic pain though their prescribing patterns, effectiveness, and safety profiles remain topics of ongoing research. This retrospective chart review analyzed the prevalence of gabapentinoid use in a chronic pain clinic over a one-year period from May 1, 2023, to April 30, 2024. The study examined patient records from four pain management physicians, focusing on those prescribed gabapentin or pregabalin. Of the 2,395 patients reviewed, 478 (19.96%) were prescribed gabapentin, while 236 (9.85%) received pregabalin. Combined, 714 patients (29.81%) were managed with either medication, highlighting the significant role gabapentinoids play in chronic pain treatment. The study found that gabapentin was prescribed more frequently than pregabalin. Although both medications are effective for neuropathic pain, their use comes with notable side effects, including dizziness, somnolence, and, in some cases, an increased risk of suicidal ideation. This review underscores the importance of careful patient monitoring and individualized treatment approaches when prescribing gabapentinoids. Future research across multiple sites and further stratification of patient demographics would enhance understanding of gabapentinoid use in clinical practice.

Salt is found in nearly every kitchen across the world; however, it is not typically thought of to be a means for suicide. Depending on the age and size of the person, anywhere from 2 to 4 tablespoons of salt consumed rapidly can be lethal. To put that in perspective, the average person in the United States consumes approximately 0.5 tablespoons of salt over the course of the day, which is still above what is recommended. Most cases discussing salt overdose or salt poisoning happen accidentally, however there are case studies and reviews discussing intentional salt overdoses that mostly occur either as exorcism rituals in adults or parents poisoning their young children in cases of factitious disorder imposed on another (formally Munchausen's by proxy). Adolescents using salt as a suicide method, especially in the United States, is either very rare or not well documented due to the lack of available case reports. Here we present a case of an adolescent female who consumed approximately 4 dessertspoons of kosher salt (equivalent to 2-3 tablespoons) to kill herself after reportedly seeing the idea on social media. Although this patient had a favorable outcome with no signs of neurological damage, our goal is to bring awareness to the dangers of salt overdose and warn about a potential rise in cases due to circulating videos on popular apps social media apps.

Herein, authors report on an ASD child with comorbid ADHD, ID, metabolic syndrome and nocturnal enuresis that failed multiple trials of psychotropic agents for behavioural dyscontrol. Viloxazine adjuventia brought about remarkable improvement spanning different domains. Purported pharmacodynamic mechanisms are briefly discussed. This case represents one of the earliest reports of viloxazine use in ASD.

Background: Immunologic measures have been studied as predictors of who will respond to standard antidepressants. Two previous, small studies of pretreatment leukocyte mRNA expression levels of the cytokines macrophage migration inhibitory factor (MIF) and interleukin 1-beta (IL1-β) identified antidepressant treatment responders.

Methods: We tested these findings in 1,299 patients from the PRIME Care study, a multi-center pharmacogenetic depression treatment trial. Patients underwent 5 depression-symptom assessments over 24 weeks. mRNA was extracted from peripheral blood, purified, and assayed with TaqMan gene expression assays and a known copy number calibrator to yield relative quantification and copy numbers for each sample. In generalized estimating equations models, we regressed the repeated depression measures and a binary treatment response measure on the baseline MIF and IL-1β measures and relevant covariates.

Results: Participants' depression scores decreased monotonically during treatment, with the treatment response percentage increasing concomitantly. We found no significant associations of the cytokine concentrations with either the change in depression scores or the likelihood of a treatment response. A secondary analysis limited to a subsample of 126 participants selected to remove the potential for confounding also showed no significant associations.

Limitations: Despite efforts to control for sample and assay method differences, these could have contributed to the lack of replication of prior research.

Conclusions: We did not replicate prior findings that pre-treatment expression levels for two cytokines predicted antidepressant treatment response. This raises questions about the clinical utility of using these biomarkers in treating depression.

Narcolepsy with cataplexy (NT1) is a sleep disorder very rarely associated with early-onset psychosis. The incidence of this association is unknown but appears to be more common in children and adolescents. This combination of diagnoses presents a diagnostic and therapeutic challenge. This case report discusses an adolescent female with first-episode psychosis who was being treated for NT1 and had no prior psychiatric history. After ruling out other possible medical causes, she was given an initial diagnosis of a brief psychotic episode and treated with Risperidone while continuing treatment for NT1 with Modafinil and Venlafaxine. Following partial response to Risperidone, her psychosis improved with Chlorpromazine, one of the first documented cases of successful use of this medication for first-episode psychosis with NT1.

There is little evidence for psychopharmacotherapy in pica. A few studies reported some benefit from the use of SSRIs, atypical antipsychotics and methylphenidate. That said, evidence to deploy these agents remains, at large, flimsy. Here, despite scarcity, we review available literature and draw some generalities that can inform decision-making on clinical grounds.