How can you discriminate between behavioral variant frontotemporal dementia and psychiatric disorders with similar behavioral changes, such as apathy, disinhibition, reduced empathy, or compulsions? Which neuropsychological tests are useful?
Review highlights from 2 experts' presentations on identifying and treating tardive dyskinesia. Quotes from actual patients illustrate the embarrassment that they feel and show why even mild movements should be treated if patients are distressed by them.
If your patient is having myoclonic jerks, consider the combination of drugs being administered and how they may work on similar receptors. Learning the pharmacokinetic genetics of your patient, eg, an intermediate metabolizer of CYP2D6, is also helpful.
Meaningful benefits can be derived from the evaluation of cognition in older adults when there is possible cognitive impairment and dementia. Here, experts explain how brief cognitive assessment tools and neuropsychological evaluations can aid diagnosis and inform a management plan.
Disclosing a diagnosis of dementia can be one of the most challenging aspects of care for clinicians. However difficult the diagnosis is to give, disclosing the diagnosis in a timely fashion, accompanied by psychoeducation and care planning, is beneficial to patients and their care partners. Disclosure provided as early as possible increases the likelihood for patients to be involved in decision-making and planning for their future and allows care options to be implemented sooner. In this CME activity, learn about using patient-centered communication and following a structured process to disclose the diagnosis.
Extrapyramidal side effects have been identified as frequent side effects of antipsychotics in RCTs with highly selected subjects, but how common are they in nonselected samples? This national multicenter study of outpatients with schizophrenia was conducted to determine the prevalence and correlates of EPS in real-world settings.
Could valbenazine help your patients who experience antipsychotic-induced abnormal movements? This follow-up analysis of a phase 3 study provides further insights into the efficacy of valbenazine for tardive dyskinesia by extending the analysis to include odds ratios and number-needed-to-treat statistics.
Tamsulosin, used to treat benign prostatic hyperplasia, was associated in a recent study with an increase in the risk of incident dementia. In this installment of his column, Dr Andrade uses that study as a point of departure to show ways in which readers can think more critically about study methodology when interpreting results.
Pediatric acute-onset neuropsychiatric disorder (PANS) is characterized by abrupt onset of obsessive-compulsive disorder and/or food restriction with 2 or more similarly debilitating neuropsychiatric symptoms. Read this article to learn about caregiver burden with this disorder and how it may change over time.
Baclofen, a French Exception, Seriously Harms Alcohol Use Disorder Patients Without Benefit
To the Editor: Dr Andrade’s analysis of the Bacloville trial in a recent Clinical and Practical Psychopharmacology column, in which he concluded that “individualized treatment with high-dose baclofen (30-300 mg/d) may be a useful second-line approach in heavy drinkers” and that “baclofen may be particularly useful in patients with liver disease,” deserves comment.1
First, Andrade failed to recall that the first pivotal trial of baclofen, ALPADIR (NCT01738282; 320 patients, as with Bacloville), was negative (see Braillon et al2).
Second, Dr Andrade should have warned readers that Bacloville’s results are most questionable, lacking robustness. Although he cited us,3 he overlooked the evidence we provided indicating that the Bacloville article4 was published without acknowledging major changes to the initial protocol, affecting the primary outcome. Coincidentally (although as skeptics, we do not believe in coincidence), the initial statistical team was changed when data were sold to the French pharmaceutical company applying for the marketing authorization in France. As Ronald H. Coase warned, “If you torture the data long enough, it will confess.”