This week features unexpected help for patients on antipsychotics, a compelling case study of new-onset psychosis, and new insight into mood disorders.
Metformin Boosts Antipsychotic Adherence
A common diabetes drug might offer a surprisingly practical solution to one of psychiatry’s most annoyingly persistent problems – patients quitting second-generation antipsychotics because of weight gain.
In a new study in The Journal of Clinical Psychiatry, University of Houston researchers analyzed insurance claims from nearly 7,700 adults taking antipsychotics between 2017 and 2019. None had diabetes. Some received metformin. Others didn’t.
The effect was substantial. At the six-month mark, adherence hovered around 80% for those on metformin versus 68% for those on antipsychotics alone. Patients on combination therapy also stayed on their medications roughly a month longer before discontinuing.
Perhaps most importantly, the timing didn’t seem to matter. Patients who started metformin within 30 days of beginning antipsychotics (proactively) saw benefits. So did those who added metformin later. That pattern suggests metformin could prevent and mitigate antipsychotic-related weight increases, a huge adherence threat.
It’s no secret that antipsychotics typically lead to weight gain. One meta-analysis found an average weight increase of more than 3 kg per patient. Consequently, poor adherence drives up relapse and hospitalization risks.
While the study couldn’t directly measure weight change or illness severity, its consistent findings across populations point to a simple, low-cost strategy that could help patients stay on life-saving treatment.
IN OTHER PSYCHIATRY AND NEUROLOGY NEWS
- The Primary Care Companion of CNS Disorders has a case study this week that discusses a 16-year-old boy who developed new-onset psychosis of religious preoccupation and delusions.
- Original JCP research shows suicidal young people with mood disorders have distinct, widespread brain connectivity disruptions .
- Another PCC case report details a patient with treatment-resistant schizophrenia developed persistent catatonia after sudden cessation of clozapine.
- In a letter to JCP, readers write in support of exposure and response prevention, which remains the safest and most effective first-line psychotherapy for perinatal OCD.
- And, finally, there’s a new episode of “The JCP Podcast,” which features a chat with JCP deputy editor-in-chief Joseph Goldberg, MD.
