Antipsychotics can be used in the short term to manage dementia-related psychosis, but serious adverse effects can outweigh benefits. Novel antipsychotics or other agents may offer superior efficacy and safety. Explore the evidence in this CME activity.
Lockdown measures have helped contain the spread of COVID-19, but how do they affect mental health? This report describes a patient who developed a paranoid delusion caused by isolation, uncertainty, anxiety, and fear related to lockdown.
Clozapine has been associated with pneumonia, but what about other agents? This study compared pneumonia hospitalization rates for patients with a psychotic or bipolar disorder prescribed 1 of 4 second-generation antipsychotics prior to admission.
Pharmacokinetics of antipsychotics are generally slower centrally than peripherally. This review examined the possible dissociation between central D2 receptor occupancy with antipsychotics and their peripheral blood concentrations.
Stress-induced changes in pharmacokinetics can alter plasma levels of drugs like clozapine. This brief report describes the case of a man with schizoaffective disorder who showed sustained elevation in clozapine levels 3 days after discontinuation.
In addition to psychosis, depressive symptoms can occur in patients with anti-NMDAR encephalopathy (ANMDARE). ANMDARE should be considered in patients presenting with psychotic or atypical depressive illnesses. Early recognition of ANMDARE could lead to better management of this potentially life-threatening autoimmune disorder.
The COVID-19 pandemic has caused various manifestations of psychosis to surface in otherwise healthy individuals. This case series describes paranoid delusions about COVID-19 resulting in the patients' first inpatient psychiatric hospitalizations.
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.”