Journal of Clinical Psychopharmacology最新文献

{"title":"Resolution of Catatonia With Cariprazine-A Case Report.","authors":"Alexandra Rockett, Andrew Stoner, Catherine Ironbar, Joseph Chien","doi":"10.1097/JCP.0000000000001993","DOIUrl":"10.1097/JCP.0000000000001993","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"291-293"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors and Correlates of Psychiatric Polypharmacy Among Child and Adolescent Psychiatric Inpatients: A Retrospective Study.","authors":"Sean Lynch, Timothy Becker, Parul Shanker, Dalton Martin, Paige Staudenmaier, Alicia Leong, Timothy Rice","doi":"10.1097/JCP.0000000000001981","DOIUrl":"10.1097/JCP.0000000000001981","url":null,"abstract":"<p><strong>Purpose/background: </strong>Rates of prescriptions of psychotropic medications to youth have increased, a significant proportion of which are recipients of psychiatric polypharmacy. Polypharmacy can increase the risk of multiple negative outcomes. Prior studies attempting to identify predictors/correlates of polypharmacy have been heterogeneous. This study aimed to examine factors associated with polypharmacy among psychiatrically hospitalized youth, and measure changes in polypharmacy over time throughout the COVID-19 pandemic.</p><p><strong>Methods/procedures: </strong>The medical records of 1101 patients were reviewed. Sociodemographic and clinical information was collected and analyzed using SPSS.</p><p><strong>Findings/results: </strong>About one-third of patients received psychotropic polypharmacy; this group contained a higher percentage of males, White patients, and fewer Asian/South Asian patients. They had on average more hospitalizations, a longer hospitalization period, and were more likely to be diagnosed with an impulsive/behavioral disorder, developmental disorder, or bipolar spectrum disorder. They were twice as likely to receive medication for agitation while hospitalized. A regression model identified positive predictors of polypharmacy as having a history of violence and a higher number of psychiatric hospitalizations. Negative predictors included non-White race. The rate of polypharmacy was relatively stable throughout the study time period, and no impact of the COVID-19 pandemic was found.</p><p><strong>Implications/conclusions: </strong>Pediatric psychiatric polypharmacy is relatively common and may be associated with poorer outcomes. Certain sociodemographic and clinical characteristics may aid clinicians in predicting which youth may be at risk for polypharmacy. Longitudinal studies are indicated to examine outcomes of polypharmacy so that providers can effectively implement judicious prescribing practices in the community.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"243-250"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Methylphenidate and Aripiprazole in the Treatment of Emotion Dysregulation in Children With ADHD.","authors":"Pei-Yin Pan, Chin-Bin Yeh","doi":"10.1097/JCP.0000000000002002","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002002","url":null,"abstract":"<p><strong>Purpose: </strong>In this study, we examined the effectiveness of methylphenidate on emotion dysregulation among children with attention-deficit/hyperactivity disorder (ADHD), and the strategy of switching to or adding aripiprazole for nonresponders.</p><p><strong>Methods: </strong>We conducted a 3-step, 10-week, open-label trial including children (6-18 years old) with ADHD and emotion dysregulation, defined according to the Child Behavior Checklist-Dysregulation Profile. In step 1, patients received methylphenidate treatment for 4 weeks. In step 2, nonresponders were started on aripiprazole treatment for 4 weeks. Nonresponders in step 2 entered step 3, receiving a combination of methylphenidate and aripiprazole for 2 weeks. The primary outcome was the change from baseline in emotion dysregulation, assessed using the irritability subscale of the Aberrant Behavior Checklist. Secondary outcomes included the change from baseline in ADHD symptoms, cross-domain-associated symptoms, adaptive functioning, and neurocognitive profiles.</p><p><strong>Results: </strong>Among the 30 enrolled patients, 22 (73.3%) responded to methylphenidate (group MR), while 8 entered step 2 (aripiprazole treatment for methylphenidate nonresponders; group MN). In step 2, 5 patients responded to aripiprazole, while 2 patients entered step 3 and received methylphenidate plus aripiprazole. Patients who responded to methylphenidate or aripiprazole exhibited significant improvements in emotion dysregulation (Hedges' g: 2.62 and 1.30, respectively) and school adaptation. Emotion dysregulation severity was correlated with oppositional defiant disorder symptoms, but not with core symptoms of ADHD.</p><p><strong>Conclusions: </strong>The nature of emotion dysregulation in ADHD is heterogeneous regarding the response to methylphenidate. For most patients, methylphenidate significantly improved emotion dysregulation. Aripiprazole could be effective and safe for methylphenidate nonresponders.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Impact of Pharmacogenomic Testing on Medication Use and Healthcare Resource Utilization in Patients With Major Depressive Disorder.","authors":"Andria L Del Tredici, Holly L Johnson, Brady DeHart, Alexander Gutin, Pamela Morin, Chelsea R Kasten, Laura Becker, Katherine Johansen Taber, Devika Chawla, Andrew A Nierenberg","doi":"10.1097/JCP.0000000000001999","DOIUrl":"https://doi.org/10.1097/JCP.0000000000001999","url":null,"abstract":"<p><strong>Background: </strong>Pharmacogenomic (PGx) testing can help improve response and remission rates for patients with major depressive disorder (MDD) and at least one treatment failure. To investigate real-world outcomes, we examined 1) significant gene-drug interactions (GDIs) and 2) healthcare resource utilization (HRU) in a large US insurance claims dataset.</p><p><strong>Methods: </strong>Weighted multigene PGx testing results in adult patients with MDD were linked with deidentified US claims data. The PGx test report organized medications as congruent (no known or moderate GDI) or incongruent (significant GDI). Medication claims data before and after PGx testing was used to categorize patients as no change in congruency, incongruent-to-congruent, or congruent-to-incongruent. HRU (hospitalizations and emergency department visits) was compared in the 180 days before and after PGx testing.</p><p><strong>Results: </strong>A total of 20,933 patients met inclusion criteria; 16,965 of whom filled medication prescriptions before and after PGx testing. After PGx testing, the proportion of patients filling prescriptions with significant GDIs was reduced (26.1% pretesting vs 15.9% posttesting). All HRU was significantly reduced (P < 0.001) after PGx testing except for nonpsychiatric hospitalizations (P > 0.05). Psychiatric hospitalizations were significantly reduced after PGx testing in the incongruent-to-congruent and no change in congruency categories (P < 0.001), but not in the congruent-to-incongruent category. Conversely, emergency department visits were significantly reduced after PGx testing in all congruency categories (P < 0.005) and did not differ when compared across congruency categories.</p><p><strong>Conclusions: </strong>After PGx testing, patients with MDD had decreased prescribing of medications with significant GDI and reduced HRU. PGx testing may have influenced these outcomes, but the retrospective study design limits clarity on its impact.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awake Bruxism Onset and Exacerbation Associated With Lisdexamfetamine Dimesylate Intake: Insights from 2 Case Reports.","authors":"Matheus Herreira-Ferreira, Tatiana Prosini da Fonte, Carolina Ortigosa Cunha, Leonardo Rigoldi Bonjardim, Paulo César Rodrigues Conti, Juliana Stuginski-Barbosa","doi":"10.1097/JCP.0000000000002012","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002012","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma Clozapine in Treatment Refractory Schizophrenia: What Is the Target Range?","authors":"Robert James Flanagan, Stephen John Obee, Alice Hyun Min Kim, Susanna Every-Palmer, Paula Liren Valbuena Sanchez, Lauren Evans, Jonathan Rogers, Suzanne Reeves","doi":"10.1097/JCP.0000000000002007","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002007","url":null,"abstract":"<p><strong>Background: </strong>In treatment-refractory schizophrenia (TRS), a predose plasma concentration of 0.35 mg L-1 is suggested to ensure an adequate trial of clozapine, but the target range may differ between smokers and nonsmokers.</p><p><strong>Method: </strong>We studied data from a clozapine therapeutic drug monitoring service, 1993-2017, with respect to age, sex, smoking status, clozapine dose, estimated clozapine treatment duration, plasma clozapine and norclozapine concentrations, and reason for the request.</p><p><strong>Results: </strong>There were 35,147 and 88,279 samples from 8882 women and 20,378 men, respectively, for which reasons for the request were specified (26,572 samples, 2 reasons; 6421, 3 or more reasons). More samples were sent for analysis due to suspected adverse drug reactions (ADRs) from women (5.3 vs 4.7%, P < 0.001). The median minimum duration of clozapine treatment before the suspected reaction was 156 days shorter in nonsmokers than smokers of either sex (P < 0.001) and shorter in female than male nonsmokers (189 vs 334 d; P < 0.01). The differences in median plasma clozapine concentrations between suspected ADR (1869/4149 samples from women/men, respectively), and control (10,627/25,848 samples from women/men, respectively) groups were small, averaging 0.03 mg L-1 (P < 0.01), but the median plasma clozapine in the ADR and baseline groups was 0.15 mg L-1 lower in smokers than nonsmokers (P < 0.001).</p><p><strong>Implications: </strong>The target ranges associated with response to clozapine and minimal ADRs in TRS may be 0.35-0.45 and 0.50-0.60 mg L-1 in smokers and in nonsmokers, respectively. ADRs may occur earlier in treatment in nonsmokers, particularly in women, who in general have higher predose plasma clozapine concentrations than men.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weekly Changes in the Clozapine Concentration-to-Dose Ratio During Clozapine Titration in Japanese Patients With Schizophrenia.","authors":"Yuki Kikuchi, Mutsumi Sakata, Kazuro Ikawa, Daisuke Kume, Naoki Horikawa, Hiroshi Komatsu, Hiroaki Tomita","doi":"10.1097/JCP.0000000000002003","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002003","url":null,"abstract":"<p><strong>Background: </strong>To prevent inflammatory side effects early in the titration phase of clozapine, international guidelines recommend measuring clozapine blood levels weekly. However, data on such measurements are lacking.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of all patients with schizophrenia who were treated with clozapine for the first time and whose clozapine blood levels were measured for at least 2 consecutive weeks from clozapine initiation at our institution from 2020 to 2024. Patients were divided into 2 groups based on whether they had a fever during the first 6 weeks of clozapine treatment. The clozapine concentration-to-dose (C/D) ratios were compared weekly within 6 weeks after starting clozapine.</p><p><strong>Results: </strong>A total of 28 patients were included in the study, of whom 6 developed a fever and 22 did not. The median C/D ratios in weeks 1 and 2 were significantly higher in patients with a fever than in those without (week 1: 2.12 vs 1.31, P = 0.0217; week 2: 3.48 vs 1.23, P = 0.01). There was no significant difference in C/D ratios between the groups from week 3 to week 6. During the first 6 weeks of treatment, C/D ratios increased markedly and showed peaks in patients with fever but remained stable in patients without fever.</p><p><strong>Conclusions: </strong>Measuring clozapine blood levels early in the titration phase helps estimate the metabolic capacity of patients. Furthermore, it is essential to pay attention to inflammation, which may increase clozapine C/D ratios.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clozapine Use Among Individuals With Schizophrenia Occurring on the Background of Intellectual Disability and Rare Genetic Variation: A Retrospective Chart Review.","authors":"Mark A Colijn","doi":"10.1097/JCP.0000000000002000","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002000","url":null,"abstract":"<p><strong>Background: </strong>Treatment resistance in schizophrenia is associated with both intellectual disability and rare genetic variation. Information pertaining to the use of clozapine in this context has primarily come from case reports and small case series. Given the frequent occurrence of comorbid medical issues in various genetic disorders and the heightened sensitivity to antipsychotic medications among intellectually disabled individuals, additional information regarding the effectiveness and tolerability of clozapine in this population is needed, particularly in light of its unique side effect profile.</p><p><strong>Methods: </strong>This retrospective review of 1200 charts, which took place at a subspecialty psychiatry clinic, sought to characterize the use of clozapine in individuals with schizophrenia (or psychotic symptoms, generally speaking) and intellectual disability occurring on the background of rare genetic variation, a difficult to study and underserved patient population.</p><p><strong>Results: </strong>Twelve hundred charts were reviewed and 10 eligible individuals were identified, all of whom had been prescribed clozapine and carried a diagnosis of schizophrenia on the background of intellectual disability and rare genetic variation. Six of these 10 individuals harbored presumed pathogenic variants.</p><p><strong>Implications: </strong>This study affirms what is known about clozapine treatment in 22q11.2 deletion syndrome, adds to the scarce literature on Usher syndrome in this context, and provides the first accounts of clozapine use in 22q11.2 microduplication syndrome and DCX variant-related heterotopia.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Addictive Potential of Tranylcypromine: A Case Report.","authors":"Livia Beraldo de Lima, Laura Fernandes Berto, Victor Hugo Spitz, João P De Aquino, Rodolfo Furlan Damiano","doi":"10.1097/JCP.0000000000001998","DOIUrl":"https://doi.org/10.1097/JCP.0000000000001998","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antidepressant non-refill as a Proxy Measure for Medication Acceptability in Electronic Health Records.","authors":"Jorge A Sanchez-Ruiz, Melissa Solares-Bravo, Gregory D Jenkins, Nicolas A Nuñez, Nicole I Leibman, Ahmed T Ahmed, Suzette J Bielinski, Richard M Weinshilboum, Liewei Wang, Mark A Frye, Joanna M Biernacka, Aysegul Ozerdem","doi":"10.1097/JCP.0000000000002001","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002001","url":null,"abstract":"<p><strong>Background: </strong>Pharmacogenomic studies on antidepressant treatment outcomes could be conducted using previously collected data from electronic health record (EHR)-linked biobanks. However, absence of EHR based outcome measures is an unmet need in designing such studies We aimed to define EHR-derived antidepressant outcome measures and explore their utility in showing associations between treatment outcomes and Cytochrome P450 (CYP) metabolizer phenotypes in a proof-of-concept study.</p><p><strong>Methods: </strong>Using data from the EHR-linked cohort, Right Drug, Right Dose, Right Time: Using Genomic Data to Individualize Treatment (RIGHT 10K) Study, we collected prescription data and patient health questionnaire 9 (PHQ-9) scores to compute 3 proxy measures for antidepressant response, efficacy, and acceptability: change in PHQ-9 scores, longest treatment interval with a single antidepressant, and antidepressant non-refill. Subsequently, we tested the association of both prescription-based outcomes with DNA-predicted CYP metabolizer phenotypes in European-ancestry participants.</p><p><strong>Results: </strong>We identified 3920 RIGHT 10K participants with at least 1 antidepressant prescription and European-ancestry. Participants had a mean age of 61 years and 72% were women. Implementation of the PHQ-9 outcome was not feasible because of missingness. Of both prescription-based outcomes, antidepressant non-refill reproduced several known antidepressant-CYP interactions. However, the pilot was limited by small subgroups of participants with non-normal metabolizer phenotypes.</p><p><strong>Conclusions: </strong>Derived from structured data, antidepressant non-refill is a promising outcome measure for EHR-linked biobanks that partially reproduced antidepressant-CYP interactions. However, testing on larger datasets is necessary to understand whether it would be a useful for pharmacogenomic research.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}