RSS 1.0Medicines Management
Recent Submissions
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Practical Guidance on the Use of Lurasidone for the Treatment of Adults with SchizophreniaIntroduction: Lurasidone is an atypical antipsychotic that was approved in Europe in 2014 for the treatment of schizophrenia in adults aged ≥ 18 years. Clinical experience with lurasidone in Europe is currently limited, and there is therefore a need to provide practical guidance on using lurasidone for the treatment of adults with schizophrenia. Methods: A panel of European psychiatrists with extensive experience of prescribing lurasidone was convened to provide recommendations on using lurasidone to treat adults with schizophrenia. Results: Extensive evidence from clinical trials and the panel's clinical experience suggest that lurasidone is as effective as other atypical agents, with the possible exception of clozapine. Lurasidone is associated with a lower propensity for metabolic side effects (in particular, weight gain) and hyperprolactinaemia than most other atypical antipsychotics and has a relatively benign neurocognitive side effect profile. Patients switching to lurasidone from another antipsychotic may experience weight reduction and/or improvements in the ability to focus/concentrate. Most side effects with lurasidone (such as somnolence) are transitory, easily managed and/or ameliorated by dose adjustment. Akathisia and extrapyramidal symptoms may occur in a minority of patients, but these can be managed effectively with dose adjustment, adjunctive therapy and/or psychosocial intervention. Conclusions: Given the crucial importance of addressing the physical as well as mental healthcare needs of patients, lurasidone is a rational therapeutic choice for adults with schizophrenia, both in the acute setting and over the long term.
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Clozapine induced neutropenia, onset after 6 years of treatment: a case reportNo abstract available.
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Can orexin receptor antagonist offer a future option in pharmacological management of insomnia in older adults?Insomnia is a sleep condition in the general population including older adults. Pharmacological treatments may have limited efficacy and unacceptable side effects profile for the older population. Daridorexant, a dual orexin receptor antagonist has shown promise in improving some sleep parameters. We discuss its clinical application and efficacy in this article. Methods: We searched databases including PubMed and Science Direct and checked clinical trials that determined its efficacy using parameters such as wake time after sleep onset (WASO), latency to persistent sleep (LPS) and total sleep time (TST), at different doses. Results: Small doses such as 5 and 10 mg did not show clinical efficacy, while 25mg and 50mg were superior in improving the efficacy outcomes with mild adverse reactions. Daridorexant reduced wake time after sleep onset (WASO), latency to persistent sleep (LPS), whilst increasing total sleep time (sTST). It was associated with a mild risk of headache and fatigue but did not cause other adverse associated with traditional therapies, such as withdrawal or rebound insomnia. This review supports clinicians such as psychiatrists, physicians and pharmacists in choosing the best treatment options taking into consideration patients’ conditions and preferences. The authors do not recommend prescribing before more longitudinal and larger studies.
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A visual antiretroviral regimen based tool to support cost-effective prescribing in treatment-naive individuals : defining the baselinePoster abstract P146 from the 23rd Annual Conference of the British HIV Association (BHIVA), Liverpool, UK, 4–7 April 2017.
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The importance of clinical observation: A case of subtle tardive dyskinesia with paliperidone palmitateNo abstract is available.
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Neuroleptic Malignant Syndrome: The Value of Diagnostic CriteriaNeuroleptic malignant syndrome (NMS) is a rare but potentially serious reaction to antipsychotic medications. The incidence of NMS is around 0.9%,1 with an estimated mortality of 5.6%–12%.2,3 Early recognition is key and a low index of suspicion is required as the presentation shares symptoms with other disorders,1,4,5 which is further compounded by a lack of definitive diagnostic criteria.
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Phelan-McDermid syndrome, bipolar disorder and treatment with lithiumBackground Phelan-McDermid syndrome is caused by a deletion at chromosome 22q13.3, and results in a phenotype characterised by intellectual disability, features of autism, physical and mental health conditions. It is becoming increasingly recognised that bipolar disorder represents part of this phenotype. Materials and methods This case study describes 2 patients with Phelan-McDermid syndrome presenting with bipolar mania at inpatient unit for adults with intellectual disability. Both patients presented with severe disturbance of their behaviour, at times exhibiting aggression, disinhibition and hypersexuality. Results Despite treatment with a number of atypical antipsychotics and anticonvulsant mood stabilising agents, both patients showed the greatest improvement when started on lithium, and were successfully treated with this medication. Conclusions This adds further support to the growing evidence of bipolar disorder contributing to the phenotype of Phelan-McDermid syndrome, and clinicians should have a low threshold for considering the use of lithium in these patients.
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Sertraline for anxiety in adults with a diagnosis of autism (STRATA): study protocol for a pragmatic, multicentre, double-blind, placebo-controlled randomised controlled trialBackground: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to manage anxiety in adults with an autism diagnosis. However, their effectiveness and adverse effect profile in the autistic population are not well known. This trial aims to determine the effectiveness and cost-effectiveness of the SSRI sertraline in reducing symptoms of anxiety and improving quality of life in adults with a diagnosis of autism compared with placebo and to quantify any adverse effects. Methods: STRATA is a two-parallel group, multi-centre, pragmatic, double-blind, randomised placebo-controlled trial with allocation at the level of the individual. It will be delivered through recruiting sites with autism services in 4 regional centres in the United Kingdom (UK) and 1 in Australia. Adults with an autism diagnosis and a Generalised Anxiety Disorder Assessment (GAD-7) score ≥ 10 at screening will be randomised 1:1 to either 25 mg sertraline or placebo, with subsequent flexible dose titration up to 200 mg. The primary outcome is GAD-7 scores at 16 weeks post-randomisation. Secondary outcomes include adverse effects, proportionate change in GAD-7 scores including 50% reduction, social anxiety, obsessive-compulsive symptoms, panic attacks, repetitive behaviours, meltdowns, depressive symptoms, composite depression and anxiety, functioning and disability and quality of life. Carer burden will be assessed in a linked carer sub-study. Outcome data will be collected using online/paper methods via video call, face-to-face or telephone according to participant preference at 16, 24 and 52 weeks post-randomisation, with brief safety checks and data collection at 1-2, 4, 8, 12 and 36 weeks. An economic evaluation to study the cost-effectiveness of sertraline vs placebo and a QuinteT Recruitment Intervention (QRI) to optimise recruitment and informed consent are embedded within the trial. Qualitative interviews at various times during the study will explore experiences of participating and taking the trial medication. Discussion: Results from this study should help autistic adults and their clinicians make evidence-based decisions on the use of sertraline for managing anxiety in this population.
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Cariprazine as a treatment for negative psychotic symptoms in first-episode psychosis: case series.Negative psychotic symptoms are among the most disabling features of schizophrenia, and are strongly associated with relatively poor clinical and functional outcomes. However, there are no effective treatments for negative symptoms, and this represents a major unmet clinical need. Recent research has shown that negative symptoms are already present in many patients at illness onset. There is evidence that cariprazine may improve negative symptoms in patients with chronic schizophrenia. However, its utility in treating negative symptoms in the early stage of the disorder is unclear. Here, we report six cases of patients with first-episode psychosis who were treated with cariprazine.
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The neuropsychiatric effects of nitrous oxide and low vitamin B12This narrative review article aims to update knowledge on the neuropsychiatric complications of nitrous oxide use and low vitamin B12. We consider common forms and uses of nitrous oxide (N2O) and review its mechanism of action, and then explore the potential impacts of use. In particular, neuropsychiatric effects mediated by low vitamin B12 are considered and the correct interpretation of laboratory results explored. This is of particular importance as where vitamin B12 is inactivated by chronic nitrous oxide use, blood test levels of vitamin B12 may not reflect the quantity of functional B12 in patients.
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Prescribing antipsychotic medication for adults with intellectual disability: shared responsibilities between mental health services and primary careAims and method We conducted a secondary analysis of data from a Prescribing Observatory for Mental Health audit to assess the quality of requests from intellectual disability services to primary care for repeat prescriptions of antipsychotic medication. Results Forty-six National Health Service Trusts submitted treatment data on 977 adults with intellectual disability, receiving antipsychotic medication for more than a year, for whom prescribing responsibility had been transferred to primary care. Therapeutic effects had been monitored in the past 6 months in 80% of cases with a documented communication indicating which service was responsible for this and 72% of those with no such communication. The respective proportions were 69% and 42% for side-effect monitoring, and 79% and 30% for considering reducing/stopping antipsychotic medication. Clinical implications Where continuing antipsychotic medication is prescribed in primary care for people with intellectual disability, lack of guidance from secondary care regarding responsibilities for monitoring its effectiveness may be associated with inadequate review.