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1

FDA Approves First Once-Monthly Injectable Buprenorphine for Opioid Use Disorder

Sublocade (Indivdor Inc.)
tx of OUD in adults who have initiated treatment with a transmucosal (absorbed through mucus membrane) buprenorphine-containing product
indicated for patients who have been on a stable dose of buprenorphine treatment for a minimum of 7 days

2

Sublocade SEs

constipation, nausea, vomiting, headache, drowsiness, injection site pain, itching (pruritus) at the injection site, and abnormal liver function tests.
not studied in patients under 17 years or over age of 65.

3

Sublocade boxed warning

dangers of administering the drug IV instead of subQ- forms a solid mass upon contact with body fluids and may cause occlusion, local tissue damage, and thrombo-embolic events, including threatening pulmonary emboli

4

As many as a third (32.2%) of all patients with ? may go on to develop schizophrenia or bipolar disorder within five years

substance use-induced psychosis
the highest risk of conversion was for patients who experienced cannabis-induced psychosis, which had a conversion rate of 47.4%
highest risk of conversion to schizophrenia for those 16 to 25 years

5

Long-Term SSRI Treatment May Delay Progression From Mild Cognitive Impairment to Alzheimer’s Dementia

a significantly decreased probability of conversion to Alzheimer’s dementia in MCI patients with a history of depression and long-term SSRI treatment [>1,610 days] compared with all other groups,

6

Cannabidiol May Be Effective Adjunct to Antipsychotic Treatment for Schizophrenia Patient

Patients with schizophrenia who are prescribed cannabidiol (CBD) in addition to antipsychotics may experience lower levels of positive psychotic symptoms compared with those taking antipsychotics alone, may also improve cognitive performance and overall functioning.

7

Adjunctive Ketamine Appears to Reduce Suicidal Thoughts in Depressed Patients for Up to Six Weeks

Within 24 hours of IV ketamine (0.5 mg/kg in 100 mL saline) or midazolam (0.02 mg/kg in 100 mL saline) infused over 40 minutes, patients in the ketamine group experienced a greater reduction in SSI score : 55% for the ketamine group and 30% for the midazolam group

8

Catatonia Often Goes Undiagnosed, Untreated in General Hospitals

-often reversible when treated with lorazepam and/or electroconvulsive therapy (ECT)
-failure to recognize may lead to improper treatment with antipsychotics, which can increase the risk for developing malignant catatonic features or NMS
-presence of grimacing, agitation, or echolalia symptoms was associated with a 4 to 6 times greater likelihood that the catatonia would go undiagnosed

9

First Non-Opioid Medication Approved to Reduce Opioid Withdrawal Symptoms in Adults

Lucemyra—an oral, selective alpha 2-adrenergic receptor agonist—is approved for treatment up to 14 days.
can reduce anxiety, agitation, drug craving, muscle aches, sleep problems, stomach cramps, and more

10

what can reduce symptoms and improve quality of life for patients recently diagnosed with psychosis

early intervention programs or coordinated specialty care (CSC) program
- experienced significant improvements in health, function, and education/employment within months,

11

medication May Decrease Symptoms Of Moderate And Severe PPD

brexanolone, an intravenous (IV) formulation of allopregnanolone, neuroactive steroid
-administered as a single, continuous IV infusion for 60 hours
-benefit of treatment persisted at the 30-day follow-up assessment

12

regimen for PPD

antidepressant:
paroxetine (paxil) or sertraline (zoloft)- low levels found in infants exposed to breast milk
Escitalopram, fluoxetine, and fluvoxamine are used less often
plus add-on treatment with drugs such as second-generation antipsychotics, lithium, or triiodothyronine.

13

resistant PPD

switch antidepressants rather than augmentation with a second drug: another SSRI, a serotonin-norepinephrine reuptake inhibitor (eg, desvenlafaxine, duloxetine, or venlafaxine), an atypical antidepressant (bupropion or mirtazapine), or a tricyclic (eg, nortriptyline)

14

partial response to PPD treatment

add on 2nd drug rather than switch:
second-generation antipsychotics (eg, aripiprazole, risperidone, or olanzapine), lithium, and triiodothyronine

15

hormonal tx in PPD

-progestin (single norethisterone 200 mg injection) and placebo were comparable
-estrogen (transdermal 17 beta-estrogen 200 mg/day plus cyclical dydrogesterone) with placebo; improvement was greater with estrogen than placebo.

16

the FDA has approved the first generic version of Suboxone

(buprenorphine and naloxone) “film strip that dissolves under the tongue"

17

serious efforts are under way to identify genes and other determinants that might guide more precise prescribing for patients with depression with the goal to identify biological substrates of major depression and their roles in response to antidepressant medications
these include the following studies:

-International Study to Predict Optimized Treatment in Depression (iSPOT-D)
-Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care for Depression (EMBARC)
-Predicting Remission in Depression to Individual and Combined Treatment (PREDICT) studies

18

insufficient data to support widespread use of pharmacogenomic tests in clinical practice to guide antidepressant treatment at this time

GeneSight, GeneCept, IDgenetix, and CNSDose

GeneSight testing, produced by AssureRx Health, has the “most substantial evidence” of the four tests examined

19

requent use of digital media by adolescents may be associated with an increased risk for attention-deficit/hyperactivity disorder

prioritize activities that promote adolescent executive functioning and well-being, including sleep, physical activity, distraction-free homework, and positive interactions with family and friends

20

Patterns of Potentially Unsafe Use of Zolpidem

recommended dose of zolpidem for women should be lowered from 10 mg to 5 mg for immediate-release products (Ambien, Edluar, and Zolpimist) and from 12.5 mg to 6.25 mg for extended-release products (Ambien CR)
-to reduce the risks of next-day impairment, abnormal behavioral changes, and dependency
-efficacy declines substantially after 14 days of continuous administration, however most zolpidem patients reported sustained use, with increased risk of dependence, given that zolpidem is a class IV-controlled substance

21

Mobile Apps Offering Advice On Mental Health Management May Encourage Overdiagnosis Of Certain Conditions

may ‘medicalize’ normal ups and downs and encourage the overdiagnosis of certain conditions

22

survival times following the diagnosis of dementia was similar for “patients of all ages,” but “varied depending on the type of dementia:
7/22/18

6.4 years for frontotemporal lobe degeneration; 6.2 years for Alzheimer’s disease; 5.7 years for vascular dementia; 5.1 years for dementia with Lewy bodies; and 3.6 years for rarer causes of dementia.

23

Low-Dose Ketamine (≤0.5 mg/kg) Offers Effective Alternative to Opioids in Treatment of Acute Pain, Meta-Analysis Suggests
17 July 2018

no statistical difference in pain scale reduction between morphine and ketamine

24

trauma endured early in life can ripple directly into a child’s molecular structure and distort their DNA
7/19/18

genetic changes “leave them biologically more vulnerable in later life to psychiatric afflictions like depression, anxiety, mood disorders and high-risk behavior like drug abuse, the researchers found.”

25

College Athletes With AD/HD And Concussion May Be At Higher Risk Of Depression And Anxiety
7/12/18

researchers found that college athletes with attention-deficit/hyperactivity disorder (AD/HD) “may have greater risks of depression and anxiety after concussion.

26

Safety Planning Intervention With Suicidal Patients After ED Discharge Associated With Reduced Risk Of Future Suicide Attempts

following a suicide attempt, a simple intervention conducted by staff in ED can reduce the risk of future suicide attempts research indicates. This intervention involves creating a safety plan for each patient and f/u with phone calls after d/c.
Adults who received the intervention plus f/u were less likely to engage in suicidal behavior compared with those who received usual care during six-month f/u

27

FDA Approves Aristada Initio to Allow Immediate Initiation of the Long-Acting Atypical Antipsychotic
7/2/18

Aristada Initio (aripiprazole lauroxil)
in combination with a single 30 mg dose of oral aripiprazole, along with their first dose of Aristada (441 mg, 662 mg, or 882 mg monthly; 882 mg once every six weeks; and 1064 mg once every two months) in a single day.
approved in 2015, with dosages for use every 4-6 weeks
in June 2017, the agency approved a two-month dose of the medication

28

Consuming Alcohol While Breastfeeding May Lead to Cognitive Problems in Children
8/1/18

The study revealed that children aged 6 to 7 whose mothers reported consuming alcohol while breastfeeding had lower scores on the reasoning test than children whose mothers did not report consuming alcohol while breastfeeding—a relationship the authors noted was not observed in children who were not breastfed as infants.
(not observed with cigarettes)

29

People With Depression Appear To Have Low Levels Of Acetyl-L-Carnitine
7/31/18

(helps the body produce energy)
“blood samples from 116 participants, 71 with depression and 45 without.” The study also found that “patients with very low LAC levels were more likely to have more serious depressive symptoms and to have developed depression earlier in life.” Additionally, there was “a higher chance they had experienced childhood trauma and were resistant to treatments for depression.”

30

Children of mothers who experienced depression and/or anxiety during pregnancy are more likely to have behavioral difficulties throughout childhood
7/27/18

higher in economically disadvantaged families.

odds of having children with behavioral difficulties were almost 1.5 to 2 times greater than those not experiencing prenatal depression or anxiety

31

Cognitive deficits may identify youth most likely to develop psychosis
7/26/18

five cognitive components from principal components analysis – social cognition, attention, verbal fluency, general cognitive function and perception

32

Treating patients who have depression following a recent heart attack or unstable angina with escitalopram may reduce their risk of future cardiac events
7/26/18

escitalopram may positively affect common mediators of ACS and depression including brain-derived neurotrophic factor and proinflammatory cytokines and may normalize autonomic and platelet dysfunction, which have adverse effects on cardiac outcomes

33

Both Abstainers And Those Who Drink Over 14 Glasses Of Wine Weekly Have Higher Risk Of Dementia
8/1/18

Alcohol in moderation may be beneficial in improving blood circulation by influencing blood-clotting factors that can cause blockages in the heart as well as the brain; good blood flow can keep neurons healthy and able to communicate in their complex networks.

Excessive alcohol, however, can start to negatively affect healthy tissues, building up in toxic amounts that can compromise nerve function, for example.

34

more on etOH

Alcohol in moderation can lower the risk of heart disease for some people, reduce the risk of type 2 diabetes and gallstones.
excessive drinking linked to several types of cancer, including breast, colon, pharynx, larynx and esophageal

35

Some Medications for Alcohol, Opioid Use Disorders May Reduce Suicidality, Criminal Behavior
August 3, 2018

Naltrexone: less likely to accidentally overdose (hazard ratio=0.82). However, the medication was not associated with a significant reduction in suicidality or arrests
Buprenorphine: reduction in accidental overdoses (hazard ratio=0.75) and arrests in all crime categories (violent, nonviolent, and substance-related).
Methadone: significant reductions in the rate of suicidal behaviors (hazard ratio=0.60) and overall arrests However, there was an increased risk for accidental overdoses (hazard ratio=1.25).
Acamprosate: no significant differences in suicidal behavior, accidental overdoses, overall arrests, and arrests for violent crime

36

Methylphenidate (Ritalin) may be a first-choice attention-deficit/hyperactivity disorder (ADHD) medication for kids, while amphetamines may be preferred for adults, a large-scale meta-analysis affirmed
8/7/18

kids: modafinil (provigil) also preferred
Among children and adolescents, the odds of dropping out over adverse events was higher for both amphetamines and guanfacine
Among adults, amphetamines were also less tolerable than placebo by the same measure despite their high efficacy. Drop out due to side effects was also more common with atomoxetine, methylphenidate, and modafinil

37

ADHD meds + brand names

lisdexamphetamine: Vyvanse
dexmethylphenidate: Focalin
Clonidine (Catapres)
Guanfacine (Intuniv)
Modafinil (Provigil)

38

Ketamine infusion well-tolerated in small sample with mood disorders
8/7/18

Controversy remains about whether ketamine should be used outside of research protocols due to concerns regarding potential negative clinical outcomes for repeated use, including impaired cognition, delusions and interstitial cystitis
however, no evidence of cognitive decline, increased inclination for delusions or emerging symptoms consistent with cystitis.

39

Adjunctive Aripiprazole May Reduce Prolactin-Related Side Effects of Antipsychotics in Women
August 2018

almost 80% of women having resolution of this side effect at the end of the 16 weeks compared with 33% in the placebo group

hyperprolactinemia may cause irregular menstrual periods or no menstrual periods (amenorrhea), milky discharge from the breasts (galactorrhea) when not pregnant or breast-feeding, and/or painful intercourse due to vaginal dryness.

40

FDA Approves Bedtime ADHD Medication
Wednesday, August 15, 2018

Jornay PM (extended-release methylphenidate capsules)
if taken at at night results in lower ADHD symptoms in the early morning and throughout the day
20 mg, 40 mg, 60 mg, 80 mg, and 100 mg doses