Antipsychotics

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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Long-Acting Injectable Antipsychotics: A Practical Guide for Prescribers

Author: Flavio Guzman, MD Competing interests: none This article summarizes the most clinically relevant features of long-acting injectable antipsychotics (LAIs, previously known as depot antipsychotics). We discuss general concepts as well as key prescribing facts of individual agents. The guide also includes two new formulations: aripiprazole lauroxil (Aristada) and 3-month paliperidone palmitate (Invega Trinza). Advantages and disadvantages of long-acting antipsychotics…

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Summary of Newly Approved Antipsychotics

By Flavio Guzman, MD Two new second-generation antipsychotics were approved in 2015: brexpiprazole (Rexulti) and cariprazine (Vraylar). Like aripiprazole (Abilify), they are both D2 partial agonists and are associated with risk of akathisia. Aripiprazole, brexpiprazole and cariprazine are FDA-approved for the treatment of schizophrenia. Aripiprazole and cariprazine are approved for the treatment of manic episodes in…

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Reviewing Antipsychotic Adverse Effects with Prof. Mark Taylor

Professor Mark Taylor is a consultant psychiatrist at the NHS in the UK. He is also Associate Professor at the University of Queensland in Brisbane Australia. He is the coauthor of a paper published in the Journal of Psychopharmacology: “First do no harm.” A systematic review of the prevalence and management of antipsychotic adverse effects”.…

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Aripiprazole Lauroxil Extended-Release Injectable (ARISTADA)

By Flavio Guzman, MD Prescribing information highlights To be administered by intramuscular injection in the deltoid (441 mg dose only) or gluteal (441 mg, 662 mg or 882 mg) muscle by a healthcare professional. For patients naïve to aripiprazole, establish tolerability with oral aripiprazole prior to initiating treatment with ARISTADA. ARISTADA can be initiated at…

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Pharmacotherapy of Treatment-Resistant OCD: Augmentation Strategies

Treatment of obsessive compulsive disorder is often challenging. Treatment resistance is quite common, between 40 to 60% of patients do not show and adequate response to first-line treatments. We invited Dr. David Veale to comment on his meta-analysis published in BMC Psychiatry : “Atypical antipsychotic augmentation in SSRI treatment refractory obsessive-compulsive disorder: a systematic review…

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FDA Warning: Ziprasidone Associated with DRESS Syndrome

The FDA has issued a warning (December 11, 2014) that the second generation antipsychotic ziprasidone (Geodon and others) is associated with a rare but serious skin condition known as Drug Reaction with Eosinophilia (DRESS)and Systemic Symptoms . Excerpts from the FDA website: A new warning has been added to the Geodon drug label to describe…

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Ziprasidone Adverse Effects

Source: Drug labeling information submitted to the Food and Drug Administration (FDA), updated by the National Library of Medicine (NLM). Commonly observed adverse reactions (incidence ≥5% and at least twice the incidence for placebo) were: Schizophrenia: Somnolence, respiratory tract infection. Manic and Mixed Episodes Associated with Bipolar Disorder: Somnolence, extrapyramidal symptoms, dizziness, akathisia, abnormal vision,…

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