In this newsletter, we summarize a few pharmacotherapy recommendations from the updated guideline for the treatment of schizophrenia from the APA, share clinical tips for diagnosing and managing bipolar disorder in later life, and address a few clinical pearls on managing body dysmorphic disorder. We also comment on bipolar disorder in later life, as well as on 2 article reviews for our Quick Takes: One on the pharmacotherapy of borderline personality disorder and 1 on the psychological and medication therapies for insomnia disorder.
New Schizophrenia Guideline by the American Psychiatric Association
The document is an update to the 2011 guidelines. It emphasizes the use of clozapine.
Some of the suggestions are:
- For patients who have akathisia associated with antipsychotic therapy, APA suggests the following options:
- Lowering the dosage of the antipsychotic medication.
- Switching to another antipsychotic.
- Adding a benzodiazepine.
- Adding a beta-adrenergic blocking agent.
- APA suggests treating patients with clozapine if the risk for aggressive behavior remains substantial despite other treatments.
- APA suggests treating patients with a long-acting injectable antipsychotic medication if they prefer such treatment or if they have a history of poor or uncertain adherence.
- APA recommends that patients who have moderate-to-severe or disabling tardive dyskinesia associated with antipsychotic therapy be treated with a reversible inhibitor of the vesicular monoamine transporter 2 (VMAT2).
You can download the APA guideline here.
Bipolar Disorder in Later Life, With Martha Sajatovic, M.D.
In this interview, Dr. Sajatovic discusses late-onset bipolar disorder and explains how it differs from early-onset bipolar disorder. She also evaluates the available pharmacotherapeutic options.
Interview Highlights:
- When considering bipolar disorder in later life, it is crucial to rule out some other conditions. History, physical exam, laboratory testing, and neuroimaging are thus of utmost importance.
- Antipsychotics and mood stabilizers should be used at lower doses to minimize potential side effects and be titrated more slowly.
Learn more and earn 0.5 CME credits here.
Obsessive-Compulsive and Related Disorders
Obsessive-compulsive and related disorders include hoarding disorder, BFRBs, and body dysmorphic disorder. These disorders need to be recognized, assessed, and treated with SSRIs, augmentation strategies, and/or CBT.
Body Dysmorphic Disorder: Medications, CBT, and Exposure Response Prevention Therapy
- SSRIs are the first-line medication treatment choice for BDD.
- Antipsychotics are not helpful with BDD, even in patients with delusional insight.
- Clomipramine can be used if a patient fails an SSRI. Learn more.
You can earn 1.5 CME credits here.
Quick Takes: Informing Your Practice
Pharmacotherapy for Borderline Personality Disorder
- The prevalent use of medications in borderline personality disorder is still not reflected or supported by the current evidence. However, quetiapine may provide significant benefits but with some costs, including weight gain. Learn more.
Effectiveness of Sequential Psychological and Medication Therapies for Insomnia Disorder
- It is best to start with behavioral therapy, and if that doesn’t work well enough, add cognitive therapy or zolpidem. Learn more.
Listen to or read the full volume, and earn 0.5 CME credits here.
Reference
- Keepers, G. A., Fochtmann, L. J., Anzia, J. M., Benjamin, S., Lyness, J. M., Mojtabai, R., Servis, M., Walaszek, A., Buckley, P., Lenzenweger, M. F., Young, A. S., Degenhardt, A., Hong, S. H., & (Systematic Review) (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. The American Journal of Psychiatry, 177(9), 868–872.
