In this newsletter, we include information about a recent study of fluvoxamine for preventing hospitalization in COVID-19.
We also share practical tips for treating ADHD in adults, key points from a presentation on assessment and management of first episode of psychosis, and our practical research summaries (Quick Takes).
Early Treatment With Fluvoxamine Among Patients With COVID-19
A recent study published on October 27, 2021, assessed the potential therapeutic role of fluvoxamine for COVID-19 in preventing hospitalization. You can read more here.
- Why was fluvoxamine studied as a therapeutic for COVID-19?
- Fluvoxamine is an SSRI and a σ-1 receptor (S1R) agonist, which confers anti-inflammatory effects, modulating innate and adaptive immune responses.
- How was this trial conducted?
- Researchers recruited 1,497 Brazilian adults who were positive for SARS-CoV-2 with a known risk factor for progression to severe disease.
- What was the intervention?
- Patients received either 100 mg of fluvoxamine or placebo pills twice a day for 10 days and were monitored for another 28 days.
- What was the primary outcome?
- A composite endpoint of medical admission to a hospital setting due to COVID-19 with participants:
- Remaining under observation for more than 6 hours.
- Referred to further hospitalization due to progression of COVID-19.
- A composite endpoint of medical admission to a hospital setting due to COVID-19 with participants:
- What were the main findings?
- Treatment with fluvoxamine among high-risk outpatients with early diagnosed COVID-19 reduced the need for hospitalization.
- In the placebo group, 16 % developed complications requiring hospitalization vs 11 % in the fluvoxamine group. Also, fluvoxamine cut severe complications by 66% and reduced mortality by 91%.
- What are the limitations of this trial?
- The outcomes were subjective, and metrics could easily be affected by patient and physician behavior.
- Deaths were too rare an event to provide enough statistical power to detect differences between treatment and placebo.
- Patients were recruited from community health facilities. These were COVID-19 emergency centers that were set up due to hospitals being overloaded; thus, they were similar to being at a hospital.
- Should we start using fluvoxamine in patients with COVID-19?
- Although these results are promising, it is necessary to determine whether they can be replicated under different research conditions.
The Clinical Guide to Adult ADHD, With Oscar Bukstein, M.D.
In this interview, Dr. Oscar Bukstein discusses management strategies for adult ADHD. He explores the neurobiological underpinnings and clinical presentations of adult ADHD. He also discusses treatment considerations, including dosing strategies and management options for patients with comorbid disorders.
Interview highlights include the following:
- Adult ADHD is both underdiagnosed and undertreated, often due to the lack of insight or the ability of patients to perform compensatory mechanisms.
- Patients with adult ADHD may have comorbid conditions, such as bipolar disorder and substance use disorders. However, these conditions should not limit clinicians from treating their ADHD and prescribing stimulant medications if necessary.
- The abuse potential of stimulants may be associated with their speed of onset and metabolism rather than their specific mechanisms of action.
Learn more and earn 0.5 CME credits here.
Assessment and Management of First Episode of Psychosis
In this presentation, Dr. Stephen Marder reviews evidence on the assessment and management of the first episode of psychosis. He discusses the long-term impact of high-risk, prodromal, and first-episode psychosis on patients. Finally, he presents strategies for antipsychotic use and special considerations regarding pharmacotherapy.
Long-Term Treatment of FEP
- Long-term treatment should include the lowest effective dose of antipsychotics.
- Patients and clinicians should discuss the risks and benefits of discontinuing and lowering antipsychotics.
Learn more and earn 0.75 CME credits here.
Quick Takes: Informing Your Practice
Clozapine-Induced Myocarditis: Electronic Health Register Analysis of Incidence, Timing, Clinical Markers, and Diagnostic Accuracy
- What might be myocarditis in a patient taking clozapine turns out not to be myocarditis about 80% of the time in this large retrospective study.
- Making the diagnosis is tricky because symptoms like chest pain and tachycardia are shared by other diagnoses in the differential. Learn more.
Suicidality and Self-Injury With SSRIs in Youth: Occurrence, Predictors, and Timing
- In this retrospective analysis of 365 cases, antidepressant initiation in young people with depression or anxiety was associated with a substantial reduction in suicidal ideation.
- Prior studies have shown an increase in suicidal ideation in a small fraction of young patients starting an antidepressant. Learn more.
Listen to or read the full volume, and earn 0.5 CME credits here.
Listen to Our Podcast: Psychopharm Updates
Don’t miss out on the latest updates in psychopharmacology! Each episode of our podcast showcases one of our products on a regular basis: Video lectures, Quick Takes, and Expert Consultations. We update our feed every 5 days.
References
Reis, G., Dos Santos Moreira-Silva, E. A., Silva, D. C., Thabane, L., Milagres, A. C., Ferreira, T. S., Dos Santos, C. V., De Souza Campos, V. H., Nogueira, A. M., De Almeida, A. P., Callegari, E. D., De Figueiredo Neto, A. D., Savassi, L. C., Simplicio, M. I., Ribeiro, L. B., Oliveira, R., Harari, O., Forrest, J. I., Ruton, H., … Mills, E. J. (2021). Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: The together randomised, platform clinical trial. The Lancet Global Health.
