Antipsychotics

How to Manage an Agitated Patient?

In this episode, we venture into the psychopharmacology of agitation, with a special focus on psychotic agitation. Dr. Michael Jibson (University of Michigan) and Dr. David Osser (Harvard Medical School) shared clinical pearls to treat this challenging situation.

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When to Discontinue Antipsychotics? Reviewing the Evidence

When is the right time to discontinue an antipsychotic in the treatment of schizophrenia? We reviewed the evidence as well as consulting Dr. Ira Glick to help us answer this question.

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Are Drug Interaction Warnings Influenced by Drug Company Promotion? An Interview with Dr. Jeffrey Mattes

Dr. Jeffrey Mattes, psychiatrist in Princeton, New Jersey speaks about drug interaction warnings that appear during electronic prescribing and how these warnings may be influenced by drug company promotion.
This interview is part of a series covering the 2018 ASCP Annual Meeting.

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Clozapine-Induced Sialorrhea: Why Is It Important and How Should You Manage It?

Clozapine-induced sialorrhea increases the risk for aspiration pneumonia and is probably linked to norclozapine’s M1 agonism. In terms of treatment, first-line options are orally applied anticholinergics (atropine drops, ipratropium spray).

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Managing Clozapine-Induced Constipation: Practical Advice

Routine management of constipation is a critical part of clozapine treatment. There are case reports of fatal ileus related to clozapine therapy.

-The first step is to minimize the use of systemic anticholinergics.
-Docusate should be used routinely.  Bulk agents can make constipation worse and should be avoided.
-After docusate, the next agent to add is PEG 3350.
-Lubiprostone, a more expensive agent, can also be tried. It can be used if the combination of docusate + PEG-3350 + a stimulant is not effective.

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Clozapine Augmentation for Treatment-Resistant Schizophrenia: What Does the Evidence Say?

Up to 30% of patients with treatment-resistant schizophrenia treated with clozapine have residual positive symptoms. Clozapine augmentation is a common approach, but the evidence supporting this practice is limited.
According to the latest evidence, risperidone, lamotrigine, topiramate, or ECT are potential augmenting options.

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Choosing Among Long-Acting Injectable Antipsychotics: Practical Aspects

David N. Osser, MD Associate Professor of Psychiatry Harvard Medical School Brockton Division of the VA Boston Healthcare System   First-generation LAIs (haloperidol, fluphenazine) have higher rates of acute extrapyramidal symptoms, tardive dyskinesia and hyperprolactinemia symptoms compared to most second-generation antipsychotics. However, they have lower costs. Most second-generation antipsychotics cost more than $1000 a month,…

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Antipsychotic-Induced Dystonia: Diagnosis and Management

Michael D. Jibson, MD, PhD Professor of Psychiatry Director of Residency Education University of Michigan   Acute dystonic reactions are associated with antipsychotic use, especially with high-potency first-generation antipsychotics. About 90% of these reactions occur either in the first four days of treatment or after an increase in dose. Risk factors include large muscle mass,…

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Antipsychotics for Agitation: Differences Between Tablets, Orally Disintegrating Tablets and Sublingual Formulations

Michael D. Jibson, MD, PhD Professor of Psychiatry Director of Residency Education University of Michigan This presentation discusses how to prescribe oral antipsychotics for acute agitation (standard tablets, orally disintegrating tablets, and a sublingual formulation). Orally disintegrating antipsychotics (Abilify Discmelt, Zyprexa Zydis, Risperdal M-Tab) are not absorbed transmucosally, they have to be swallowed. Orally disintegrating…

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Bipolar Disorder Treatment Guidelines: A 2018 Update

By Flavio Guzman, MD Editor Psychopharmacology Institute This page offers direct links to the most recent guidelines for the treatment of bipolar disorder. You may notice that we have not included the guidelines published by the American Psychiatric Asssociation, this is because the document has not been updated since 2005. 2017 -Mixed Depression and Mixed…

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