Almost 40% of cases of first-episode psychosis treated in community mental health clinics are not being medicated according to guidelines, finds a recent report published on the website of the American Journal of Psychiatry.
The 2009 schizophrenia patient outcome research team (PORT) psychopharmacological treatment recommendations were the result of a comprehensive five-year study of clinical research on treating schizophrenia. Most of the recommendations related to full-blown schizophrenia, but there were some clear guidelines on patients experiencing their first episode of psychosis.
These include using antipsychotics—with the exception of clozapine and olanzapine—as the first-line treatment. The guidelines state that these medications should be prescribed at lower doses than those used for multi-episode schizophrenia, since first-episode patients have been found to be both more responsive to treatment and more sensitive to side effects.
Nevertheless, the recent research found that 39.4% of patients examined in community mental health clinics were not prescribed medication according to recommendations. Among these patients, more than 36% were prescribed an antidepressant along with antipsychotic without a clear reason, 32% were prescribed olanzapine, often at a high dose, 23% were prescribed more than one antipsychotic, and 10% were not prescribed an antipsychotic at all.
This research is some of the first reported as part of the NIMH’s RAISE project (Recovery After an Initial Schizophrenia Episode). This research program is aimed at early intervention for psychosis with the ultimate goal of changing the long-term outcomes for these patients. More on RAISE can be found on the NIMH website at www.nimh.nih.gov/health/topics/schizophrenia/raise/index.shtml.
Alzheimer’s Drug May Treat Binge Eating
Memantine (Namenda), one of the few medications FDA-approved to treat memory loss and mental changes due to Alzheimer’s disease, may have a future as a treatment for binge eating disorder.
Researchers from Boston University recently studied the effect of the medication on food-related behavior in male rats. In this study, memantine was infused directly into the brain area associated with binge eating.
They found that the medication had a dose-dependent effect on “binge-like” eating behavior and completely eliminated food seeking behavior and compulsive eating in rats fed a special diet of highly palatable sugary food, but not in those fed regular food.
A small open-label study in 2008 found similar results. Patients given memantine 5 to 20 mg/day for 12 weeks showed significant reductions in the frequency of episodes of binge-eating, disinhibition, and disability.
The BU study was published in the journal Neuropsychopharmacology.
FDA Standardizes Drug Labeling for Pregnancy and Lactation Risk
In early December, the FDA finalized a labeling rule that will make it easier for prescribers to assess medications’ safety in pregnancy and lactation.
The new labeling does away with the A, B, C, D, & X pregnancy risk classification that has been in use for 35 years. Instead, each drug label will contain three sections on (1) pregnancy, (2) lactation, and (3) females and males of reproductive potential. Within these categories, there will be subsections that include a risk summary, clinical considerations, and data. These sections will have details of clinical research and any specific pregnancy-related side effects.
This new labeling rule is part of a broad effort by the FDA to improve the content and format of prescription drug labeling, according to a press release from the agency. The aim is to make risk/benefit judgments easier and more focused on real-life than the letter classification.
This new labeling rule will go into effect for all new drugs by June 30, 2015. Previously approved medications will have a phase-in period.
For more information, see the FDA website.
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