Journal of Clinical Psychopharmacology最新文献

{"title":"Comparative Effectiveness of Pharmacogenomics for Treatment of Depression.","authors":"Andrew A Nierenberg, Masoud Kamali, Dustin J Rabideau, Jonathan E Alpert, Warren D Taylor, Samantha Pegg, Audrey R Stromberg, Kedie Pintro, Zainab O Soetan, Nur Akpolat, Saee Chitale, Amrutha Garimella, Ingrid R Hsu, Hadi Kobaissi, Louisa G Sylvia","doi":"10.1097/JCP.0000000000002175","DOIUrl":"10.1097/JCP.0000000000002175","url":null,"abstract":"<p><strong>Purpose/background: </strong>Pharmacogenomics (PGx), or the use of genetic information to assess drug-gene interactions, is an important step toward precision medicine. It is unclear if clinician use of PGx yields better outcomes for their patients. This study compared the effectiveness of combinatorial PGx-guided plus guideline-informed treatment (PGx+GIT) with guideline-informed treatment (GIT) alone to improve well-being in individuals with major depressive disorder.</p><p><strong>Methods/procedures: </strong>Eligible participants (N=201) were randomized to PGx+GIT or GIT alone. PGx was measured with the proprietary GeneSight combinatorial test. PGx+GIT participant clinicians received test results within 2 business days to inform decisions about medication changes. Participants completed the World Health Organization Well-Being Index (WHO-5), Patient Health Questionnaire (PHQ-9), and PROMIS Profile physical functioning and social roles and activity domains every 2 weeks for 2 months and then every 2 months for the remaining 10 months. Monthly medication changes operationalized as necessary clinical adjustments were tracked with the medication recommendation tracking form.</p><p><strong>Findings/results: </strong>Both groups improved average well-being over the 12-month study period (model-based change in WHO-5 per log (week) [95% CI]: 4.1 [3.3, 5.0] PGx+GIT and 4.8 [4.0, 5.5] GIT). PGx+GIT did not result in superior improvement in well-being (model-based difference [95% CI]: -0.6 [-1.8, 0.5], P =0.270), or any secondary outcomes. The effect of randomized treatment on well-being was not moderated by depression severity, number of previous failed medications for major depressive disorder, or presence of a comorbid condition.</p><p><strong>Implications/conclusions: </strong>These data suggest PGx+GIT was not superior to GIT alone, possibly due to a ceiling effect of GIT, or PGx did not yield better results.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"571-583"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701479","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":"Therapeutic Interventions and Clinical Outcomes Following Breakthrough Psychosis on Antipsychotic Maintenance Medication (BAMM): A Retrospective Chart Review.","authors":"Fuminari Misawa, Hiroyoshi Takeuchi","doi":"10.1097/JCP.0000000000002196","DOIUrl":"10.1097/JCP.0000000000002196","url":null,"abstract":"<p><strong>Background: </strong>Despite consistently good adherence to antipsychotic treatment, some patients experience relapse, known as breakthrough psychosis on antipsychotic maintenance medication (BAMM). This study aimed to clarify the therapeutic interventions and outcomes following BAMM.</p><p><strong>Methods: </strong>This retrospective chart review included patients who experienced BAMM, defined as hospitalization during adherent long-acting injectable antipsychotic (LAI) treatment at Yamanashi Prefectural Kita Hospital. Clinical and demographic data were collected, including therapeutic interventions during the index hospitalization and maintenance treatment failure (psychiatric rehospitalization or treatment discontinuation) following BAMM. Kaplan-Meier survival analysis was conducted to estimate time to maintenance treatment failure within 3 years after the index discharge, and a Cox proportional hazards model was used to identify factors associated with maintenance treatment failure.</p><p><strong>Results: </strong>Fifty-nine patients were included. Therapeutic interventions after BAMM varied substantially. While most patients continued the same LAI treatment during hospitalization, some discontinued or required dose adjustments. Clozapine was initiated in nearly 20% of patients, mostly after maintenance treatment failure following BAMM. Maintenance treatment failure was common: over 50% of patients experienced it within 1 year, and ~70% within 3 years. A longer time from LAI initiation to BAMM was significantly associated with a reduced risk of maintenance treatment failure.</p><p><strong>Conclusions: </strong>Clinical outcomes following BAMM are often unfavorable. Further research is warranted to identify optimal approaches for preventing and managing BAMM.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"608-611"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148030926","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":"Question: Why Is My Patient With Breast Cancer Advised That She Can Take Clozapine and Tamoxifen Together Despite Possible Interactions Between the Two?","authors":"Richard I Shader, David J Greenblatt","doi":"10.1097/JCP.0000000000002209","DOIUrl":"10.1097/JCP.0000000000002209","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"657-658"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163408","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":"Contemporary Clinicians and Researchers Need to Recognize Akathisia.","authors":"Steven D Targum, Stephen R Marder","doi":"10.1097/JCP.0000000000002224","DOIUrl":"10.1097/JCP.0000000000002224","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"652-654"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470902","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":"Partial Dopamine Agonists and Gambling Disorder: A Comprehensive Review and Clinical Implications.","authors":"Filippo Besana, Gursharan Johal, Stefano Pasquariello, Henrietta Bowden-Jones, Steve Sharman","doi":"10.1097/JCP.0000000000002230","DOIUrl":"10.1097/JCP.0000000000002230","url":null,"abstract":"<p><strong>Purpose: </strong>Aripiprazole, cariprazine, and brexpiprazole are third-generation antipsychotics indicated for the treatment of various mental health conditions. Several cases of gambling-related harms and various impulse control problems related to aripiprazole have been reported. The objective of our study was to conduct a comprehensive review focusing on case reports about gambling disorder induced by partial dopamine agonist therapy.</p><p><strong>Procedures: </strong>A multistep literature search in different databases was carried out. Articles were screened by title and then by abstract for inclusion in data extraction. Articles were included if they were: (1) providing data about gambling behaviour induced by a partial dopamine agonist, (2) case reports or case series, and (3) written in English.</p><p><strong>Findings: </strong>Seventeen articles were eligible for data extraction, for a total of 36 patients. All the case reports were related to aripiprazole, while no case studies reporting gambling induced by brexpiprazole and cariprazine were found. The mean age of the total sample was 35.1 years (range: 17 to 64). The main psychiatric comorbidities were schizophrenia (N = 15, 41.6%), followed by bipolar disorder (N = 7, 19.4%). In most of the cases, it was necessary to suspend aripiprazole, with a good outcome on gambling disorder (N = 24, 66.6%).</p><p><strong>Implications: </strong>The data presented suggest a clear relationship between aripiprazole and gambling behaviour, although more research is needed on this topic. Clinicians should be aware of the risk of gambling associated with partial dopamine agonists, and should therefore monitor the occurrence of gambling behaviour when introducing this drug, because patients may be reluctant to disclose it voluntarily.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722804","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":"Atomoxetine in a Patient With Gilbert's Syndrome: Hepatic Monitoring and Pharmacogenomic Considerations.","authors":"Süleyman Dönmezler","doi":"10.1097/JCP.0000000000002245","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002245","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712574","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":"Unintentional Lithium Toxicity in Patients With Bipolar Disorder: A Literature Review of Case Reports.","authors":"Luana Almeida de Souza Silva, Luciana de Andrade Agostinho","doi":"10.1097/JCP.0000000000002236","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002236","url":null,"abstract":"<p><strong>Objective: </strong>Unintentional lithium toxicity is a clinically relevant and potentially underrecognized complication in patients with bipolar disorder receiving long-term maintenance therapy. This literature review aimed to synthesize published case reports of unintentional lithium toxicity in bipolar disorder, focusing on recurrent clinical manifestations, contributing risk factors, and the relationship between clinical toxicity and serum lithium concentrations.</p><p><strong>Methods: </strong>Case reports published between 2009 and 2024 were identified through PubMed and the Virtual Health Library using the terms lithium, intoxication, and bipolar disorder. Adult patients with bipolar disorder experiencing unintentional lithium toxicity were included. Demographic data, clinical presentation, serum lithium concentrations, renal function, comorbidities, duration of lithium therapy, and concomitant medications were extracted and descriptively analyzed.</p><p><strong>Results: </strong>Twenty-one case reports were included. Most patients were female (76.2%), with a mean age of 61 years. Neurological manifestations predominated, with tremor being the most frequent symptom (61.9%), followed by altered mental status (42.9%), decreased level of consciousness (38.1%), and gait disturbance or ataxia (38.1%). Speech disturbances, myoclonus, and gastrointestinal symptoms (nausea, vomiting, or diarrhea) were also commonly reported. Serum lithium concentrations exceeded 1.5 mmol/L in 81.0% of cases, with most classified as severe intoxication; however, clinically significant toxicity also occurred at therapeutic or near-therapeutic levels. Renal dysfunction was frequent, with elevated serum creatinine reported in approximately two-thirds of patients. Polypharmacy was common, particularly involving antipsychotics, diuretics, and antihypertensive agents. The most frequent lithium dose was 600 mg/day, and prolonged exposure (>10 years) occurred in nearly one-third of cases.</p><p><strong>Conclusion: </strong>Unintentional lithium toxicity presents with heterogeneous and predominantly neurological manifestations and may occur despite therapeutic serum lithium concentrations. Comprehensive clinical assessment, including neurological examination, renal function evaluation, and medication review, is essential to ensure safer long-term lithium use.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712623","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":"An Open-Label, Randomized, Active Controlled Trial Evaluating Sublingual Dexmedetomidine for Moderate to Severe Agitation in Inpatients With Schizophrenia or Bipolar Disorder.","authors":"Justin Faden, Sandra Veigne, Daohai Yu, Leslie Citrome","doi":"10.1097/JCP.0000000000002232","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002232","url":null,"abstract":"<p><strong>Purpose: </strong>Agitation can occur in patients with schizophrenia, schizoaffective disorder, and bipolar disorder. This study evaluated the efficacy of sublingual dexmedetomidine, a selective alpha-2 adrenergic receptor agonist, for the treatment of acute agitation in \"real-world\" psychiatric inpatients.</p><p><strong>Methods: </strong>This was a pragmatic, randomized, open-label, active-controlled study, conducted at Temple University Episcopal Hospital in Philadelphia, PA. Participants were inpatients with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder, and were randomized in a 1:1 manner to receive sublingual dexmedetomidine or oral lorazepam. Participants received sublingual dexmedetomidine 180 mcg (n = 7), sublingual dexmedetomidine 120 mcg (n = 5), or oral lorazepam 2 mg (n = 12) during an episode of agitation. The primary efficacy end point was absolute change from baseline in Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) total score at 2 hours after medication administration. There were no restrictions on concurrent substance use disorders, suicidal ideations, or psychiatric comorbidities.</p><p><strong>Results: </strong>Twenty-four participants self-administered study medication. Diagnoses included schizophrenia 8/24 (33%), schizoaffective disorder 5/24 (21%), and bipolar disorder 11/24 (46%). At 2 hours post-dose, the PANSS-EC total change from baseline was [median (IQR)] -13.0 (-17.0, -10.0) for sublingual dexmedetomidine and -14.0 (-19.0, -12.0) for oral lorazepam. There were no spontaneously reported adverse effects in either group.</p><p><strong>Conclusions: </strong>At 2 hours post-dose, sublingual dexmedetomidine was effective at reducing acute agitation in \"real-world\" psychiatric inpatients with schizophrenia, schizoaffective disorder, and bipolar disorder, who may have had psychiatric comorbidities. There were no spontaneously reported adverse effects. The study was not powered to detect differences between treatment groups.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701340","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":"Olanzapine/Samidorphan-Associated Opioid Withdrawal Reported to US Poison Centers.","authors":"James B Leonard, Sheila Mohebbi","doi":"10.1097/JCP.0000000000002244","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002244","url":null,"abstract":"<p><strong>Purpose/background: </strong>Olanzapine/samidorphan is a combination medication indicated for the treatment of mood and psychotic symptoms with limited weight gain. Samidorphan is a mu-opioid receptor antagonist that is contraindicated in patients actively using opioids.</p><p><strong>Methods/procedures: </strong>Retrospective evaluation of olanzapine/samidorphan cases reported to the National Poison Data System between May 1, 2021, and June 30, 2025. We reviewed coded data to identify those possibly describing a patient who experienced opioid withdrawal. Case notes were requested from individual poison centers, and clinical factors were extracted from the notes.</p><p><strong>Findings/results: </strong>There were 426 cases reported to the National Poison Data System, of which 31 were patients experiencing opioid withdrawal. About half were male, and the median age was 45 years. Buprenorphine and methadone were the most common opioids that patients were previously taking. Opioid withdrawal lasted about 24 hours for most patients. Seven patients were intubated in the course of their withdrawal management.</p><p><strong>Implications/conclusions: </strong>Precipitated opioid withdrawal is a known concern when initiating olanzapine/samidorphan in patients using opioids. Withdrawal may last about 24 hours and require inpatient treatment. Careful screening for opioid use may reduce the risk.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148669992","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":"Efficacy and Safety of Alpha-Lipoic Acid as an Adjunctive Therapy in Schizophrenia: A Systematic Review and Meta-Analysis.","authors":"Gabriel Caruso Novaes Tudella, Maria Antônia Oliveira Machado Pereira, Augusto Utida Klostermann, João Victor Pereira Gonzalez, Ocílio Ribeiro Gonçalves, Kenzo Ogasawara Donato, Luiz Arthur de Oliveira Nantes, Anderson Matheus Pereira da Silva, Ana Rízzia Cunha Cordeiro Forte, Marianna Letícia Vasconcelos Patrocínio, Tatiana de Queiroz Oliveira, Silvânia Maria Mendes Vasconcelos","doi":"10.1097/JCP.0000000000002231","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002231","url":null,"abstract":"<p><strong>Background: </strong>Alpha-lipoic acid (ALA) is an antioxidant proposed to mitigate metabolic burden and psychopathology in schizophrenia. We systematically reviewed the efficacy and safety of ALA as an adjunct to antipsychotics.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, and the Cochrane Library from inception to September 2025 for human studies evaluating ALA in individuals with schizophrenia. Random-effects meta-analyses pooled mean differences (MDs) with 95% CIs for continuous outcomes and pooled proportions for adverse events and discontinuation.</p><p><strong>Results: </strong>Eight studies (n = 165) were included. In single-arm analyses, ALA showed no significant improvements in PANSS scores in pooled estimates, despite isolated findings in small subsets. A reduction in BMI was observed in the RCT subgroup but not in the overall analysis. No significant effects were found for HbA1c, waist circumference, or lipid profile. In ALA versus placebo comparisons, no significant differences were observed for PANSS scores, BMI, adverse events, or discontinuation. ALA was generally well tolerated, though findings were limited by small sample sizes and imprecision.</p><p><strong>Conclusions: </strong>Current evidence suggests adjunctive ALA may modestly influence selected PANSS subscales but does not improve metabolic outcomes. Larger, well-designed trials with standardized dosing and longer follow-up are needed to clarify clinical relevance and safety.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630577","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}