Episódios
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Dr. Julia Ann Koretski, a psychiatrist and Digital Editor of Journal of Clinical Psychopharmacology (JCP), discusses the editorial “Psychopharmacologic Laziness” with its author, Dr. Anthony Rothschild, who is Editor-in-Chief of JCP. He contends that psychotropic medications with well-established efficacy for the treatment of various psychiatric conditions are underprescribed due in part to what he provocatively refers to as prescriber "laziness." Under discussion are lithium, clozapine, and long-acting injectable second-generation antipsychotics. Dr. Rothschild notes that there seems to be a reluctance to treat patients with medications that entail taking blood levels or dosage monitoring, extra patient education, attentiveness to interactions and side effects, or a step outside a comfort zone. The podcast concludes with suggestions of medication-specific fixes and a rethinking of a psychiatric resident’s training to include proficiency in treating with remedies that have a strong evidence base but are viewed as extra work. The editorial is published in the November-December 2024 issue of the Journal of Clinical Psychopharmacology.
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According to the US Centers for Disease Control and Prevention, products containing psychoactive compounds such as cannabis or mushroom extracts are increasing in availability though they may have undisclosed ingredients, contaminants, and adulterants. Elisa Nguyen, and Drs. Abraham Qavi and Minh-Ha Tran, authors of the letter to the editor “Health Alert: Microdose Products Leading to Acute Illness and Hospitalizations Across the United States” offer general information on personal use availability of Schedule 1 controlled substances such as psilocybin, cannabis, and lysergic acid diethylamide. The letter details recent occurrences of illness, hospitalization, and deaths. Outside of the confines of carefully conducted clinical trials, consumers place themselves at risk of adverse effects through consumption of unregulated products available in nearly half of the United States. The letter to the editor is published in the November-December 2024 issue of the Journal of Clinical Psychopharmacology.
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This podcast features Dr. Chadi Calarge, a child psychiatrist at Baylor College of Medicine and, for over 20 years, a researcher focused on long-term psychiatric medication safety with regard to height growth and metabolic abnormalities. He gives an overview of past and forward-looking research questions related to growth, growth hormones, and such drugs as selective serotonin reuptake inhibitors and stimulants. He discusses the journal article, “Fluoxetine and Sertraline Inhibit Height Growth and Growth Hormone Signaling During Puberty,” which was written with 10 co-authors and is published in the November-December 2024 issue of the Journal of Clinical Psychopharmacology.
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Ketamine and esketamine represent significant advancements for patients with treatment-resistant depression. Their rapid action provides much needed relief for patients who do not respond to traditional antidepressants. Their use, however, introduces challenges that necessitate ongoing research and careful consideration to maximize their potential, which Dr. Balwinder Singh, MD, MS, details in this podcast. Important challenges include unregulated or poorly monitored use of these potentially addictive products and risks related to the creation of compounded ketamine options.
Dr. Singh is an assistant professor of psychiatry at the Mayo Clinic in Rochester, Minnesota, and the medical director of the mood program at the Mayo Clinic Depression Center. His guest editorial, titled “Ketamine and Esketamine for Depression in Daily Practice: Opportunities and Challenges,” is published in the September-October 2024 issue of the Journal of Clinical Psychopharmacology.
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The symptoms of irritability associated with autism spectrum disorder (ASD) include aggression, tantrums, self-injury, and disruption. Propranolol, a beta-blocker, has accumulated much anecdotal evidence as a promising option for symptoms of these disorders, but well-designed studies are rare.
Dr. Eric London is the lead author of the article “High-dose propranolol for severe and chronic aggression in autism spectrum disorder: A pilot, double-blind, placebo-controlled, randomized crossover study,” which is published in the September-October 2024 issue of the Journal of Clinical Psychopharmacology. The article describes its effectiveness in decreasing aggression in individuals with ASD. As this was a small study, a larger clinical trial is needed.
Dr. London is director of Autism Treatment Research at the New York State Institute for Basic Research. In this podcast, he offers extensive background on treatment challenges and the difficult core symptoms of ASD.
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It has been hypothesized that alterations in the gut microbiota may play a part in the pathophysiology of schizophrenia, including immune system dysfunction. Preliminary evidence suggests that people with schizophrenia have decreased relative abundance of butyrate-producing bacteria in the gut microbiota. Butyrate plays a critical role in maintaining the integrity of the gut-blood barrier and has anti-inflammatory effects.
A proof-of-concept study published in the Journal of Clinical Psychopharmacology was designed to assess whether treatment with an oligofructose-enriched inulin prebiotic could increase the production of butyrate. The study demonstrated that the treatment selectively increased the level of plasma butyrate in people with schizophrenia. The article, titled “Prebiotic Treatment in People with Schizophrenia,” appears in the September-October 2024 issue of the journal.
The podcast provides a “somewhat more detailed background rationale for the study” than in the article, according to Dr. Robert W. Buchanan, professor of psychiatry at the Maryland Psychiatric Research Center in Baltimore, first author of the paper, who discusses the results of this study and ongoing research in a larger cohort.
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Psychotic bipolar depression (PBD) is a prevalent yet understudied psychiatric illness with no specific guidelines or Food and Drug Administration-approved medications for its treatment. Recent studies suggest that some antipsychotics and mood stabilizers may be effective in managing bipolar depression; however, their effectiveness for PBD remains unclear. With an urgent need for more focused research for managing PBD, several authors conducted a literature review to piece together existing literature on the topic.
In this podcast, Dr. Julia Ann Koretski, Digital Editor of the Journal of Clinical Psychopharmacology (JCP), discusses the review with two of its authors, Dr. Maité Cintrón Pastrana and Dr. Anthony Rothschild, who is Editor-in-Chief of the Journal of Clinical Psychopharmacology. Both authors are from the University of Massachusetts Chan Medical School. A third author, Jessica C. Irizarry Flores, is from the Ponce Health Science University Medical School in Puerto Rico.
The article appears in the July/August 2024 issue of the journal.
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There are two distinct and unrelated definitions of the word “floxing.” In this podcast, the author of an editorial in the July-August 2024 issue of the Journal of Clinical Psychopharmacology discusses both, while providing an interesting lesson about potential drug-drug interactions that psychiatrists should be mindful of.
The author is Dr. Richard Shader, who is Founding Editor-in-Chief Emeritus of the Journal of Clinical Psychopharmacology. Dr. Shader describes the two definitions in a conversation with Dr. Julia Ann Koretski, a psychiatrist at Mass General Brigham Newton-Wellesley Hospital and Digital Editor of Journal of Clinical Psychopharmacology,
In recent decades in genetics and biology, floxing has meant to insert or sandwich a specific DNA sequence in a targeted gene. The current lay or street language term is, however, the topic of the podcast. Here, floxing refers to serious side effects attributed to the use of fluoroquinolone antibiotics. The Food and Drug Administration (FDA) refers to these effects as fluoroquinolone-associated disability or FQAD. The podcast focuses on those disabilities and the need for prescribers to guard against drug-drug interactions of the widely used antibiotic ciprofloxacin with widely prescribed psychotropic medications including clozapine, duloxetine, and fluvoxamine. Dr. Shader calls for case studies to demonstrate toxicity and to ferret out causality. Clinicians should direct instances of interaction to FDA’s reporting portal www.fda.gov/medwatch.
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Tachyphylaxis is a phenomenon described as the loss of response to a medication that was previously effective at an established dose. In a case report letter to the editors, Stefanie Cavalcanti, MD, Olga A. Lopez, MD, Simon Kung, MD, Jennifer L. Vande Voort, MD, Kristin Somers, MD, Mark A. Frye, MD, and Balwinder Singh, MD, MS, from the department of psychiatry and psychology at the Mayo Clinic, in Rochester, Minnesota, discuss “A Case of Tachyphylaxis After Long-Term Intravenous Racemic Ketamine for Treatment-Resistant Depression” in the May/June 2024 issue of the Journal of Clinical Psychopharmacology.
In this podcast about the case report, two co-authors, Dr. Singh and Dr. Cavalcanti, discuss the compelling history of one 56-year-old woman with treatment-resistant recurrent major depressive disorder. Her depression, ongoing for 10 years, featured prominent symptoms of depressed mood, social isolation, low energy, decreased appetite, and anhedonia. Past medication trials included selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, mood stabilizers, antipsychotics, benzodiazepines, and bitemporal electroconvulsive therapy with limited benefit. Ketamine, which is used increasingly for treatment-resistant depression (TRD), and other psychiatric disorders, was tried next. Sustained clinical response was observed for the first 2 years of intravenous ketamine treatment despite ongoing life stressors. In the following years, a gradual reduction of response to subsequent ketamine infusions was observed in the patient, who required more frequent infusions to obtain the same response.
The authors emphasize that “the extension of ketamine’s antidepressant effect with an increased dosage remains uncertain. … Ketamine has an addiction potential; thus, it is important to be mindful that increasing the ketamine dosage to address ketamine tachyphylaxis may enhance the potential for undesired consequences. Urgent studies investigating strategies to prolong ketamine’s efficacy in adults with TRD are required.”
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The glucagon-like peptide 1 (GLP-1)–based diabetes and obesity drug semaglutide, with trade names Ozempic and Wegovy, will become the second best-selling drug in 2024, with estimated worldwide Ozempic sales of US ~$16 billion. Finally, the pharmacological treatment of obesity seems to have a breakthrough after decades of setbacks, with previous weight-loss medications withdrawn from the market because of serious side effects.
In this podcast, the co-author of a guest editorial, “Glucagon-Like Peptide 1 Receptor Agonists in Psychiatry,” Hubertus Himmerich, MD, reviews the implications of GLP-1 drugs for psychiatry and healthcare globally. The article is published in the May/June 2024 issue of the Journal of Clinical Psychopharmacology. Dr. Himmerich, who is from the department of psychological medicine, Institute of Psychiatry, Psychology & Neuroscience at King's College in London, authored the editorial with Dr. Susan L. McElroy, of the Lindner Center of HOPE, Mason, OH, and the Department of Psychiatry and Behavioral Neuroscience at the University of Cincinnati College of Medicine.
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Among most prescribers, bupropion is considered a substance of low misuse potential, with some studies showing lesser misuse potential than caffeine. However, several case reports exist of recreational bupropion misuse and diversion. This podcast, a discussion by authors of their bupropion systematic review, reports that snorting and intravenous injection of bupropion occur almost exclusively in patients with a substance use disorder history, with a preponderance of patients with stimulant use disorder or multiple substance use disorders. Users who divert bupropion from prescribed use describe a brief cocaine-like high of approximately 30 seconds to 5 minutes. The systematic review highlights the bupropion misuse potential in certain patient populations and serves to increase awareness among clinicians of unhealthy results of abuse. Additional patient screening, monitoring and follow-up, surveillance, and further research are needed to investigate and prevent bupropion misuse in at-risk patient populations.
Sahil Munjal, MD, moderates a discussion conducted with his systematic review co-authors Greg Noe, BS, Kaushal Shah, MD, MPH, and Samantha Ongchuan, MD, on bupropion misuse. The article appears in the May/June 2024 issue of the Journal of Clinical Psychopharmacology. The authors are from Wake Forest University School of Medicine, the Department of Psychiatry at Atrium Wake Forest Baptist Health, and the Department of Psychiatry at Wake Forest University in Winston-Salem, NC.
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In a guest editorial in the Journal of Clinical Psychopharmacology, authors Eric G. Smith and Kushani M. Patel discuss how case series and case reports can contribute to psychiatric treatment decisions. Their article in the March-Apil 2024 issue is titled “The Role of Case Series and Case Reports in Evidence-Based Medicine.” Dr. Smith is from the VA Bedford Healthcare System and the UMass Chan Medical School. Dr. Patel is from the Boston University Chobanian & Avedisian School of Medicine.
Case reports and case series are justifiably far down in the hierarchy of evidence-based medicine, but there are specific clinical situations in which referring to case reports or case series can be of value. In this podcast, Dr. Smith discusses some of these circumstances, such as when there is no FDA-approved treatment for a disorder or when treating patients who have declined treatment with medications supported by higher levels of evidence such as randomized controlled trials. Additionally, case reports can assist in evaluating questions of safety.
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“Rapid cycling” in bipolar disorder is defined by the occurrence of at least 4 episodes of mania, hypomania, depression, or mixed states during the preceding 12 months. Episodes are demarcated by partial or full remission for at least 2 months or a switch to an episode of opposite polarity.
In this podcast, Dr. Ross J. Baldessarini of McLean Hospital and Harvard Medical School discusses the prevalence of rapid cycling and the challenges in its treatment. Rapid cycling is more common in women and is associated with an elevated risk of suicide. Dr. Baldessarini's comments are informed by recent efforts he and his colleagues undertook to synthesize reviews and meta-analyses on prevalence rates and response rates to treatment, as well as on their recently research on a cohort of 1261 bipolar disorder patients with or without rapid cycling who were followed up for at least 1 year.The March-April 2024 issue of the Journal of Clinical Psychopharmacology includes a commentary from Dr. Baldessarini, Dr. Alessandro Miola, Dr. Mark A. Frye, and Dr. Leonardo Tondo titled “Current Status and Treatment of Rapid Cycling Bipolar Disorder.”
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Two articles in the March-April 2024 issue of the Journal of Clinical Psychopharmacology present research on glucagon-like peptide-1 receptor agonists (GLP-1 RAs), a class of medications that has drawn considerable media attention in recent months for their ability to promote significant weight loss.
The articles in JCP consider their use in specific populations of patients: individuals with bipolar disorder or eating disorders (in this case, atypical anorexia nervosa). This podcast features a discussion of the articles by authors Susan L. McElroy, MD; Anna Ward, ARPN; and Dr. Anna Guerdjikova, PhD, LISW, from the Lindner Center of HOPE in Mason, OH, and the University of Cincinnati.The first article, Liraglutide in Obese or Overweight Individuals With Stable Bipolar Disorder, reports on a placebo-controlled double-blind trial, which showed that compared with placebo, liraglutide was associated with greater reductions in percent change in body weight, and reductions in weight, body mass index, binge eating and hunger. Obesity is common among individuals with bipolar disorder, possibly contributing to their well-documented higher risk of cardiovascular-related mortality.
The second article is titled Semaglutide Misuse in Atypical Anorexia Nervosa – A Case Report. The report presents the case of a patient with a history of an eating disorder who intentionally misused the GLP-1 semaglutide and lost more than 40 pounds in 9 months. The case report is designed to alert clinicians of the importance of reviewing patients’ medical and psychiatric histories, being attuned to patient histories of weight fluctuations, and screening for eating dysregulation when prescribing weight-loss approved medications.
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In 1954, Dr Heinz Lehmann published the first clinical article on the use of chlorpromazine. Chlorpromazine was the first synthetic drug used to control states of mania and psychomotor excitement, marking the birth of modern psychopharmacology.
Seventy years later, the Journal of Clinical Psychopharmacology is highlighting the anniversary of Dr Lehmann’s publication. The January-February 2024 issue of the journal includes a guest editorial that offers a brief history lesson on Dr Lehmann’s contributions.
The authors of the editorial are Drs. Pablo Dutra, Richard Balon, and Antonio E. Nardi.In this podcast, the authors of the editorial are joined by a distinguished group of JCP Editorial Board members to discuss Dr. Lehmann’s research and the many profound ways the research environment has changed in the past 70 years. Along with the authors, the podcast participants are Drs. Carl Salzman, Alan Schatzberg, Leslie Citrome, Matthew Byerly, John Davis, and Anthony Rothschild. Dr Julia Koretski, Digital Editor for JCP, leads the discussion.
The guest editorial is published in the January-February 2024 issue of the Journal of Clinical Psychopharmacology, in an article titled "Celebrating 70 Years of the First Publication on Antipsychotic Treatment in North America by Heinz E. Lehmann and Gorman E. Hanrahan: Would Their Methodology Still Be Conceivable?"
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We have all seen the television commercials imploring viewers to “ask your doctor” about Drug X, Y, or Z. The authors of a study in the Journal of Clinical Psychopharmacology were interested in finding out how such advertising might affect the prescribing of psychotropic medicines. In this podcast, the authors discuss their research with Dr. Julia A. Koretski, Digital Editor for JCP.
The authors of the study are Drs. Bennett Wechsler, Richard Balon, Richard Shader; and Anthony Rothschild. Dr. Balon is an Associate Editor of JCP and Dr. Rothschild is Editor-in-Chief. Dr. Shader is the Founding Editor-in-Chief Emeritus.
The researchers surveyed psychiatrists to ask how challenging it was for them to convince patients that a medication was not needed, despite what the advertising might suggest. The results of their survey showed that psychiatrists who were newer to their profession (less than 10 years since they completed training) had a more challenging time than those who were more experienced in changing patients’ minds.
In this podcast, the authors discuss how their study came about and the thorny issues raised by the commercial promotion of psychiatric medications.
The article titled “Direct-to-Consumer Advertising Survey of Psychiatrists in Massachusetts and Michigan” is published in the January-February 2024 issue of the Journal of Clinical Psychopharmacology.
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Replacement therapy is a key tool in the treatment of individuals who abuse opioids. The idea is to replace heroin or morphine with less euphoric and longer-acting substances, such as methadone, under a medication management protocol. The goals of medical-assisted replacement treatment include reducing an individual's craving for abused opioids, preventing medical complications, decreasing criminal behavior and its consequences, and utimately, hopefully, helping the individual become opioid-free.
In this podcast, Dr. Richard Balon discusses the potential for replacement therapy for abuse of other types of substances, including cocaine and methamphetamines. In the podcast and in an editorial in the Journal of Clinical Psychopharmacology (JCP), he notes promising but preliminary studies of lisdexamfetamine as a possible replacement agent.
Dr. Balon is an Associate Editor of JCP and Professor of Psychiatry at Wayne State University School of Medicine in Detroit, Michigan. In this podcast, he is interviewed by Dr. Julia Koretski, Digital Editor for JCP and a psychiatrist at Mass General Brigham Newton Wellesley Hospital in Newton, Massachusetts.
Dr. Balon’s editorial is published in the November–December 2023 issue of the Journal of Clinical Psychopharmacology, in an article titled “The Need for Examining the Role of Psychostimulants in Treatment of Methamphetamine Use/Dependence.” -
Clozapine is an important drug in the treatment of schizophrenia, and adherence is generally thought to be as good as, if not better than, other antipsychotics. Nonadherence, however, is difficult to detect and potentially dangerous. Tolerance to the cardiovascular effects of the drug is easily lost; restarting at a “normal” dose can prove fatal after a period of abstinence. Nonadherence also increases the risk of self-harm.
In this podcast, Dr. Robert Flanagan, a now-retired clinical scientist at Kings College Hospital in London, discusses his study of nonadherence, as measured by plasma levels of clozapine, in samples submitted to a clozapine therapeutic drug monitoring service from 1993–2017. In thousands of submitted samples, nonadherence was 1.1% for men and 1% for women.
Dr. Flanagan discusses both the implications of his research as well its limits.
The research is published in the September–October 2023 issue of the Journal of Clinical Psychopharmacology, in an article titled “Assessing Adherence to Clozapine: Practical Considerations.” Dr. Flanagan’s coauthors are Samora Hunter and Stephen J. Obee, also of Kings College Hospital.
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Much has been written in recent months regarding the growing use of artificial intelligence (AI) in medicine and the potential benefits and risks of its use. In this podcast, Anthony J. Rothschild, MD, Editor-in-Chief of the Journal of Clinical Psychopharmacology, highlights a paper in the journal by Drs. Jose de Leon and Carlos De Las Cuevas that reports their experiment to see how ChatGPT3 would respond to various questions about clozapine metabolism. The generated text proved to be profoundly unreliable.
Dr. Rothschild also discusses his editorial about the journal’s policies regarding use of generative AI by authors and reviewers. Authors must disclose any such use; peer reviewers are prohibited from using AI in conducting their reviews.Dr. Rothschild’s editorial and the commentary by Drs. De Leon and de Las Cuevas both appear in the September–October 2023 issue of the Journal of Clinical Psychopharmacology.
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The COVID-19 pandemic and associated public health measures shifted the way people access health care. In this podcast, Dr. Christine Leong, Associate Professor at the University of Manitoba College of Pharmacy, discusses the research she and her colleagues conducted to study the effects of the pandemic on psychotropic medication adherence. The data were drawn from a claims repository that contains information on health service and medication use for almost all Manitoba residents.
The study showed improved adherence to most psychotropic medications in the 9 months after public health restrictions were enacted. Patients who were already adherent to their psychotropic medications were less likely to discontinue them during the pandemic. Findings in this study highlight that, although there were concerns about public health measures restricting access to in-person care, access to medications in Manitoba did not seem to be restricted.
The article “Adherence to Psychotropic Medication Before and During COVID-19: A Population-Wide Retrospective Observational Study” is published in the July-August 2023 issue of the Journal of Clinical Psychopharmacology.
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