Section - Quick Takes

04. Effect of Long-Acting Injectable Antipsychotics vs Usual Care on Time to First Hospitalization in Early-Phase Schizophrenia: A Randomized Clinical Trial

Published on January 1, 2021 Expired on April 1, 2024

James Phelps, M.D.

Research Editor - Psychopharmacology Institute

Key Points

A variation of cognitive–behavioral therapy explicitly developed for first-episode psychosis, with an emphasis on treatment engagement, was equally effective—as per a measure of psychosocial function—whether accompanied by an antipsychotic or not.
For comparison, training clinics to use a long-acting injectable antipsychotic in first-episode psychosis was associated with a lower rate of subsequent hospitalization compared with clinics offering treatment as usual.
The psychosocial intervention study is limited by the relatively tight inclusion criteria, whereas the long-acting injectable study is limited by the evident and extensive involvement of the pharmaceutical company that funded the study and most of the investigators.

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Is an antipsychotic required in the treatment of first-episode psychosis? Or a more direct question would be, can you imagine managing a young person with psychotic symptoms without using an antipsychotic? Conversely, can you imagine going straight to a long-acting injectable for that young person?

Hi! Jim Phelps here for the Psychopharmacology Institute. Let’s compare 2 recent studies in first-episode psychosis. First, we’ll look at a randomized trial of an intensive psychosocial intervention with or without an antipsychotic. Second, we’ll compare a multicenter randomized trial using long-acting injectable antipsychotics vs treatment as usual. Both of these studies support their respective interventions. In the first one, when patients received systematic nonmedication treatment, adding an antipsychotic didn’t improve the outcome. On the other hand, compared to usual care, a long-acting injectable rather than an oral antipsychotic reduced later hospitalizations.

Now, I realize this could make your job harder the next time you

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05. Effectiveness of Sequential Psychological and Medication Therapies for Insomnia Disorder: A Randomized Clinical Trial

Learning Objectives:

After completing this activity, the learner will be able to:

Assess the efficacy of pharmacologic treatments of borderline personality disorder: Antidepressants, antipsychotics, anticonvulsants, and lithium.
Compare the evidence of benefit from several pharmacologic approaches to insomnia in PTSD, including a recent randomized trial of eszopiclone, the nonbenzodiazepine hypnotic.
Consider the link between metformin use and Alzheimer’s disease: Is it positive, negative, or no relationship?
Compare features of 2 randomized trials of first-episode psychosis: That of an intensive psychosocial intervention, with and without an antipsychotic, and that of a program to train clinics to use a long-acting injectable antipsychotic more frequently.
Reexamine the research basis for the current guidelines for the treatment of insomnia: Behavioral therapy first, before medications.

Original Release Date: 01/01/2021

Review Date: 03/01/2024

Expiration Date: 04/01/2024

Relevant Financial Disclosures:

The following planners, faculty, and reviewers have the following relevant financial relationships with commercial interests to disclose:

Dr. Phelps has disclosed the following relationships:

McGraw-Hill: book on bipolar disorder
W.W. Norton & Co.: books on bipolar disorder

All of the relevant financial relationships listed for these individuals have been mitigated.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

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Follow these steps to earn CME credit:

View the required educational content provided on this course page.
Complete the Post Activity Evaluation for providing the necessary feedback for continuing accreditation purposes and for the development of future activities. NOTE: Completing the Post Activity Evaluation after the quiz is required to receive the earned credit.
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