In this newsletter, we include information about the outcomes of prenatal exposure to antipsychotics. We also share practical tips on the management of tobacco use disorder, key points from a presentation on the use of psychotropic drugs in lactation, and our practical research summaries (Quick Takes).
Prenatal Exposure to Antipsychotics
- Background
- The safety of antipsychotic use during pregnancy remains unclear. There are limited studies about the association between the use of antipsychotics in pregnancy and the risk of neurodevelopmental disorders in children.
- Study
- A Hong Kong study with a population-based cohort assessed the association between prenatal antipsychotic exposure and the risk of birth and neurodevelopmental problems, including preterm birth, small for gestational age, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD).
- This study was published in JAMA Internal Medicine on August 16, 2021. You can read more here.
- Findings
- Researchers found that of 411,251 mother–child pairs, there was no increased risk for any of the birth and neurodevelopmental problems studied.
- However, among pregnant women who were never exposed to antipsychotics but had a psychiatric disorder, children did have a higher risk of ASD and ADHD.
- Clinical recommendations
- These findings do not support a recommendation for women to discontinue their regular antipsychotic treatment during pregnancy. If a pregnant woman is left untreated, her chronic condition could affect both the mother and the unborn child.
If you do not have enough expertise in managing medications in pregnancy, you could benefit from the following video lectures:
- Clinical Management of Bipolar Disorder in Pregnancy
- Perinatal Psychopharmacology: Helping Patients Make Decisions in Pregnancy
The Clinical Guide on Tobacco Use Disorder With Joji Suzuki, M.D.
In this interview, Dr. Joji Suzuki reviews current evidence and practical insights for the management of tobacco use disorder. He explains the advantages of motivational interviewing techniques in enhancing quit rate success and shares practical considerations for selecting and initiating pharmacologic treatments for tobacco use disorder.
Interview highlights include the following:
- In addressing tobacco use disorder, clinicians should be mindful of the importance of motivational interviewing approaches. This includes a nonjudgmental, curious listening style and a desire to support each patient’s reasons for quitting nicotine.
- Although many treatment options are available for the treatment of tobacco use disorder, the best choice will usually be the one that the patient feels most comfortable in trying.
Learn more and earn 0.5 CME credits here.
Understanding the Use of Psychotropic Drugs in Lactation
In this presentation, Dr. Lauren Osborne addresses the use of psychotropic drugs in lactation. The presentation includes tools to determine the infant’s exposure to drugs, considerations during breastfeeding, and the possible adverse effects for the baby. Finally, she discusses the risks of using different classes of medications while breastfeeding.
Antidepressants During Breastfeeding
- SSRIs have low passage into the breastmilk and are considered compatible with breastfeeding.
- There is no reason to stop fluoxetine for breastfeeding if it works well for the patient.
- Older drugs have more data.
- Sertraline has the lowest passage into breastmilk.
- Choose the drug that works for the patient.
- Other classes of antidepressants are also considered compatible with breastfeeding.
Learn more and earn 1.0 CME credit here.
Quick Takes: Informing Your Practice
A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse
- When tapering antipsychotics, conceptualize the process as “finding a new minimum effective dose.” This could take months, likely years.
- Lower the dose very slowly at the end, asymptotically approaching zero. Dose examples are given. Learn more.
Marine Omega-3 Fatty Acid Supplementation for Borderline Personality Disorder: A Meta-Analysis
- In this meta-analysis of fish oil for borderline personality disorder, across 4 randomized trials, the effect size relative to placebo was 0.54 (substantial) and for affective dysregulation, 0.74 (clinically very relevant). Learn more.
Listen to or read the full volume, and earn 0.5 CME credits here.
References
Wang, Z., Chan, A. Y., Coghill, D., Ip, P., Lau, W. C., Simonoff, E., Brauer, R., Wei, L., Wong, I. C., & Man, K. K. (2021). Association between prenatal exposure to antipsychotics and attention-deficit/Hyperactivity disorder, autism spectrum disorder, preterm birth, and small for gestational age. JAMA Internal Medicine.
