Dr. Mark Zimmerman, professor of psychiatry and human behavior at Brown University, speaks about depression efficacy trials and their clinical implications.
This interview is part of a series covering the 2018 ASCP Annual Meeting.
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.
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.
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,…Read More
James Phelps, MD Director Mood Disorders Program Samaritan Mental Health, Corvallis, OR. Dr. Phelps has no conflicts of interest to disclose. Lamotrigine has a reputation for being slow because of its long titration period. Lamotrigine was just as fast as the olanzapine/fluoxetine combination (OFC) in a trial sponsored by the manufacturer of OFC, Eli Lilly.…Read More
James Phelps, MD Director Mood Disorders Program Samaritan Mental Health, Corvallis, OR. There are two drug interactions with lamotrigine that must be managed with special care. When lamotrigine is added to divalproex and when lamotrigine is used with carbamazepine. If the patient is already on divalproex and you are adding lamotrigine, cut lamotrigine dose…Read More
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,…Read More
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…Read More
Sandra A. Jacobson, M.D. Research Associate Professor University of Arizona College of Medicine-Phoenix This presentation discusses selected concepts on the use of mood stabilizers in the elderly. Lithium serum levels are kept low (0.4 and 0.8 mEq/L), even for the treatment of mania in elders. Lithium should be dosed on a once nightly basis with…Read More
Prof. Philip Cowen Professor of Psychopharmacology Department of Psychiatry University of Oxford, UK This presentation compares advantages and disadvantages of using quetiapine vs. aripiprazole as augmentation for treatment-resistant depression. It also addresses the common question of when to augment (antidepressant + SGA) vs. when to switch (prescribing a different antidepressant). Combination and Augmentation: Clarifying Concepts…Read More