July 2023 Newsletter: Evidence-Based Mental Health Apps, Updates on Geriatric Psychopharmacology, and Clozapine Management and Challenges

This newsletter presents a selection of evidence-based apps tailored for various psychiatric disorders to enhance conventional therapies and inspire patients to assume control of their mental health outside of clinical settings.

We also discuss updates on geriatric psychopharmacology, key points from a presentation on clozapine, and our practical research summaries of adult, child, and adolescent psychiatry (Quick Takes and CAP Smart Takes).

Evidence-Based Mental Health Apps

In the field of mental health, technology has become essential. Below is a list of evidence-based apps that can complement pharmacotherapy and psychotherapy, which you can recommend to your patients. Although these apps do not replace the role of psychiatrists, they offer valuable support for patients in actively managing their mental health.

Anxiety and Stress

A popular meditation app that has been shown in research to help reduce stress and improve focus and attention.

This app offers a wide variety of mindfulness and meditation exercises. Some research has shown that it can help manage stress and improve sleep.

Mood Disorders

This app is designed to help users track, monitor, and understand their emotional health. It has been clinically validated to screen for symptoms of depression.

Sanvello offers clinical validation in various studies, demonstrating its efficacy in reducing symptoms of stress, anxiety, and depression. It utilizes CBT, mindfulness meditation, and behavioral health coaching within the app.

This is a mood tracking app developed specifically for people with bipolar disorder.
The app allows users to track their daily mood, sleep, medication, and other symptoms related to bipolar disorder.
The data collected can be shared with healthcare professionals for better diagnosis and treatment.

Insomnia

This app is based on the therapy manual CBT for Insomnia in Veterans and was developed by the U.S. Department of Veterans Affairs. It uses cognitive–behavioral therapy to help individuals develop healthy sleep habits.

This app is an online sleep improvement program featuring cognitive–behavioral therapy techniques for insomnia. Many clinical trials have shown Sleepio to be effective in improving sleep.

Substance Use Disorders

reSET and reSET-O are the first-ever FDA-approved mobile medical applications for substance use disorders and opioid use disorder, respectively.
These apps provide CBT and contingency management strategies and have shown clinical effectiveness with standard outpatient treatment.

This app can help people recover from alcoholism, drug addiction, or any form of substance abuse.
It helps build new habits and provides ongoing motivation by connecting patients to a vast network of people, all striving to stay sober.

Suicide Prevention

This app uses a variety of tools, such as games, coping cards, and guided meditations, to help users cope with stress and suicidal thoughts. It can also be used to store a variety of multimedia reminders of reasons for living.

This app is packed with useful information to help users stay safe. It includes safety plan templates, customizable reasons for living, and quick access to crisis resources.

Posttraumatic Stress Disorder (PTSD)

This app offers self-help strategies, education about PTSD, opportunities to find support, and information on professional care. It is highly recommended for veterans but can also be used by the general population.

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

This period tracker and ovulation app predicts the next period, PMS, and ovulation dates. It also tracks mood changes, which can be beneficial for PMDD management.

This app is specifically designed for PMDD management. It allows symptom tracking and cycle tracking and includes resources for coping and treatment strategies.

Attention-Deficit/Hyperactivity Disorder (ADHD)

This app is designed based on the principles of CBT and contains a series of exercises aimed at improving attention, concentration, and memory.

This is an app designed to help users stay focused, manage their time effectively, and build productive habits.
The app concept is centered around planting virtual trees that grow over time as long as the user remains focused on their task.

Medication Adherence

This app sends users reminders to take their medication, renew prescriptions, and track medication adherence. It can also share this information with healthcare providers.

This app helps patients manage medication and doctor instructions. It provides reminders for taking pills and receiving prescription refills.
It also provides motivational progress reports, including adherence statistics over time.

Children and Adolescents

This is a mindfulness app that has programs for different age groups, including children. It has been used in schools and has shown promising results.

This is a bilingual (English and Spanish) research-based app that uses Sesame Street characters to help teach skills, such as problem-solving, self-control, planning, and task persistence.

Updates on Geriatric Psychopharmacology, With Lauren Gerlach, D.O.

In this interview, Dr. Lauren Gerlach reviews essential clinical principles in the assessment and management of older adults with psychiatric conditions. She presents dosing strategies and additional therapeutic options, particularly for patients who may have specific concerns, such as sexual dysfunction, postural hypotension, gastrointestinal adverse effects, and renal impairment.

Interview highlights include the following:

Mirtazapine and bupropion both show fewer sexual side effects compared with SSRIs and may be preferred in certain patients.
Mirtazapine is preferred over SSRIs for geriatric patients with significant GI upset.
For patients with renal impairment, dose adjustment is advised when prescribing mirtazapine, duloxetine, and gabapentin.

Learn more and earn 0.5 CME credits here.

Clozapine: Management and Challenges

In this video lecture, Dr. Brian Miller examines clozapine prescribing and the associated management challenges. He explores the approved and off-label indications of clozapine and the pretreatment screenings mandated for beginning a treatment trial. Furthermore, Dr. Miller expounds on the potential side effects of clozapine and how to handle them competently. Finally, he gives helpful clinical insight through a clinical vignette.

Initiating and Optimizing Clozapine

The guiding principle of clozapine titration is to start low and go slow.
The average target dose of clozapine is 400 mg/day.
Blood levels can help guide clozapine titration.
Do not taper the pre-clozapine antipsychotic until clozapine is 100 mg–200 mg/day.

Learn more and earn 1.25 CME credits here.

Quick Takes: Research, Digested

Olanzapine–Samidorphan in Young Adults With Schizophrenia, Schizophreniform Disorder, or Bipolar I Disorder Who Are Early in Their Illness

A randomized trial comparing olanzapine alone and olanzapine–samidorphan combination showed that the latter resulted in 1.3 kg less weight gain in 12 weeks, but patients still gained a significant amount of weight.
The olanzapine–samidorphan combination was found to have similar adverse effects on lipids as olanzapine alone and is much more expensive than generic olanzapine ($1500 vs $9 in one quick check). Learn more.

Listen to or read the full volume, and earn 0.5 CME credits here.

CAP Smart Takes: Research, Digested

Safety and Tolerability of Cariprazine in Pediatric Patients

Cariprazine was safe and well-tolerated in pediatric patients with schizophrenia and bipolar I disorder and may be associated with favorable effects regarding prolactin and metabolic levels.
The sustained improvement with cariprazine observed in adults may also be seen in pediatric patients, but controlled studies are needed to confirm these findings. Learn more.