Journal of Clinical Psychopharmacology最新文献

{"title":"Hepatic Safety of Ketamine and Esketamine for Treatment-Resistant Depression: A Real-World Cohort Study.","authors":"Balwinder Singh, Jonathan G Leung, Vanessa K Pazdernik, Simon Kung, Jennifer L Vande Voort","doi":"10.1097/JCP.0000000000002228","DOIUrl":"10.1097/JCP.0000000000002228","url":null,"abstract":"<p><strong>Background: </strong>Ketamine and esketamine are increasingly used for treatment-resistant depression (TRD), yet their hepatic safety profile with repeated or long-term use remains poorly characterized. Chronic recreational ketamine abuse has been linked to cholestasis and cholangiopathy, raising concern that therapeutic use may carry similar risks. No systematic data exist on liver enzyme trajectories or biliary injury at subanesthetic doses used for depression.</p><p><strong>Methods: </strong>This historical cohort study included adults with TRD receiving IV ketamine or intranasal (IN) esketamine at the Mayo Clinic Ketamine Clinic (2017 to 2024). Patients were eligible if they had at least one liver enzyme value (AST, ALT, ALP, or bilirubin) within 12 months before through 3 months after treatment. Longitudinal enzyme trajectories were modeled using generalized linear-mixed models with a Gamma distribution. Clinically significant elevation was defined as ≥2× the upper limit of normal (ULN). Wilcoxon signed-rank tests compared pretreatment and post-treatment paired values.</p><p><strong>Results: </strong>Of 104 enrolled patients, 74 had liver enzyme data available; 51 had post-initiation data. Median age was 51.5 years; 72% were female. Most (78.4%) received IV ketamine. No clinically meaningful changes in enzyme trajectories were observed. Three patients (5.9%) had elevations ≥2× ULN, all attributable to alcohol use, myalgias, or pre-existing hepatic steatosis rather than (es)ketamine.</p><p><strong>Conclusions: </strong>Subanesthetic IV ketamine (0.5 mg/kg) and FDA-approved IN esketamine doses were not associated with clinically significant liver enzyme elevations in this real-world TRD cohort. Current evidence does not support routine hepatic monitoring for asymptomatic patients, although prospective, larger-scale studies are needed to confirm these findings.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148603414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vortioxetine Related Hypertriglyceridemia in a Young Male.","authors":"Yun-Chih Yeh, Chih-Chung Huang, Chun-Yen Chen, Shin-Chang Kuo, Chia-Ling Chen, Dawei Zhao, Yi-Wei Yeh","doi":"10.1097/JCP.0000000000002243","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002243","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591950","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":"Rapid Reinitiation of Clozapine After Recent Discontinuation: Report of 2 Cases and Review of Literature.","authors":"Sandeep Grover, Kagan Temur","doi":"10.1097/JCP.0000000000002242","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002242","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592024","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":"Predicting Metabolic Adverse Effects of Lithium in Bipolar Disorder.","authors":"Betül Bakay","doi":"10.1097/JCP.0000000000002235","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002235","url":null,"abstract":"<p><strong>Purpose: </strong>Patients with bipolar disorder (BD) are at an increased metabolic risk due to chronic inflammation, metabolic vulnerability, and psychotropic medication exposure. Although lithium is a cornerstone of BD treatment, its metabolic safety profiles are heterogeneous. The reason why some patients tolerate lithium metabolically while others develop early metabolic adverse effects remains unclear. The Prognostic Nutritional Index (PNI), which reflects the inflammatory-nutritional reserve, may identify individuals vulnerable to lithium-related metabolic stress.</p><p><strong>Methods: </strong>Euthymic patients with BD (n=152) were evaluated at baseline and after 3 months of lithium therapy. Changes in lipid parameters and the Castelli Risk Index (CRI) were assessed. Multiple regression analysis was used to identify the predictors of post-treatment CRI. Albumin values reported in g/L were converted to g/dL for the PNI calculation.</p><p><strong>Results: </strong>Triglyceride levels increased (P<0.001), HDL cholesterol levels decreased (P=0.001), and CRI increased (P=0.001) after lithium therapy. A lower baseline PNI independently predicted a higher post-treatment CRI (P=0.023), although the baseline CRI remained the strongest predictor (P<0.001). Age, sex, smoking status, atypical antipsychotic use, illness duration, and serum lithium levels were not significant predictors.</p><p><strong>Conclusions: </strong>A reduced baseline inflammatory-nutritional reserve predicts early atherogenic worsening during lithium treatment. Early metabolic worsening during lithium treatment may be associated with individual biological vulnerability rather than occurring uniformly across patients. Incorporating a simple, routinely available biomarker into pretreatment evaluations may support early risk stratification and closer lipid monitoring, although these findings require confirmation in studies with broader metabolic assessment and longer follow-up.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591927","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 Orally Disintegrating Tablets Result in Less Weight Gain Compared With Olanzapine Standard Oral Tablets: A Systematic Review and Meta-analysis.","authors":"Maarten Bak, Django Wolters, Bea Campforts, Georgios Schoretsanitis, Lieuwe de Haan, Marjan Drukker","doi":"10.1097/JCP.0000000000002238","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002238","url":null,"abstract":"<p><strong>Background: </strong>Antipsychotic-induced weight gain may result in obesity. Olanzapine is associated with substantial weight gain. Several studies evaluated whether olanzapine orally disintegrating tablets (OODT) resulted in less weight gain or weight loss compared with treatment with standard olanzapine tablets (SOT).</p><p><strong>Methods: </strong>Following PRISMA guidelines, we performed a meta-analysis of randomized controlled trials (RCTs) and observational studies that evaluated treatment with OODTs, regardless of psychiatric diagnosis. PubMed and Embase, databases were searched. The primary outcome measure was the change in body weight.</p><p><strong>Results: </strong>Only 10 studies could be included in the meta-analyses. Five were RCT's. Three studies included antipsychotic (AP) naïve patients and 7 studies included an intervention group with patients who switched from SOT or another AP to OODT (AP-switch studies). In all included studies the control group used SOT. In AP-naïve patients, SOT was associated with clinically relevant weight gain and significantly more than OODT (difference of 2.13 kg). Although OODT showed substantial weight gain (3.10 kg) as well. In the switch studies OODT showed some weight loss (-0.61 kg) compared with those who remained on SOT with statistical significant difference (1.97 kg).</p><p><strong>Conclusions: </strong>We found evidence that starting OODT results in less weight gain compared with SOT, although for both weight gain is substantial. Moreover, switch to OODT may result in weight loss in those who suffer from weight gain by SOT. Although the effects are small, treatment with OODT may be considered as an option for antipsychotic-naïve patients or switch strategy for reaching weight loss.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591930","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":"Semaglutide and Other GLP-1 Agonists for Antipsychotic-Associated Metabolic Dysfunction in Schizophrenia: A Systematic Review and Meta-Analysis.","authors":"Nouraiz Abbas, Adil Ahmed Memon, Rumaisa Zulfiqar, Aqsa Zahoor Noon, Syed Mohamin Abbas Shah, Khadija Panhwar, Zehra Sadia, Muhammad Saad Khan, Muhammad Bilal Akbar, Sana Iftikhar, Iftikhar Hayat","doi":"10.1097/JCP.0000000000002234","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002234","url":null,"abstract":"<p><strong>Background: </strong>Individuals with schizophrenia spectrum disorders experience a high burden of metabolic abnormalities, which are further exacerbated by antipsychotic treatment and contribute to increased cardiovascular morbidity and premature mortality. Glucagon-like peptide-1 (GLP-1) receptor agonists have demonstrated metabolic benefits in the general population; however, their effectiveness and safety in individuals with schizophrenia remain uncertain.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of randomized controlled trials evaluating the effects of semaglutide and other GLP-1 receptor agonists on metabolic outcomes in adults with schizophrenia spectrum disorders receiving antipsychotic treatment. The review was conducted in accordance with PRISMA 2020 guidelines, with the protocol prospectively registered in PROSPERO (CRD420251248437). Electronic databases were searched from inception to the final search date. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using the GRADE approach. Random-effects meta-analyses were performed.</p><p><strong>Results: </strong>Seven randomized controlled trials involving 446 participants were included. GLP-1 receptor agonist therapy was associated with a statistically significant reduction in body weight compared with control (-6.10 [95% CI: -12.10 to -0.10], P=0.05) although heterogeneity was substantial (I²=99%). Significant reductions were also observed in body mass index, waist circumference, and fasting plasma glucose. Effects on lipid parameters, insulin-related outcomes, and blood pressure were inconsistent and generally not statistically significant. Serious adverse events were less frequent in the intervention group. The certainty of evidence ranged from low to moderate, primarily due to heterogeneity and imprecision.</p><p><strong>Conclusions: </strong>GLP-1 receptor agonists are associated with statistically significant improvements in body weight and selected glycemic parameters among adults with schizophrenia spectrum disorders treated with antipsychotics. However, substantial heterogeneity, shorter study population, and low certainty of evidence restrict the strength of these conclusions. Larger, well-designed randomized controlled trials with longer follow-up and standardized outcome reporting are needed to better define the efficacy and safety of GLP-1 receptor agonists in this population.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592008","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":"Tirzepatide-Induced Weight Loss and Exacerbation of Bipolar Disorder With Clozapine Treatment: A Case Report.","authors":"Rebekka Rantanen, Christopher Olson, Chirag Raval","doi":"10.1097/JCP.0000000000002241","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002241","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148578740","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":"Antibiotic-Associated Psychosis in Children and Adolescents: A Systematic Review.","authors":"Brian J Miller, Dale Peeples","doi":"10.1097/JCP.0000000000002233","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002233","url":null,"abstract":"<p><strong>Background: </strong>There are case reports of antibiotic-induced psychosis in children and adolescents in the literature, which have not been extensively reviewed. We performed a systematic review of cases of antibiotic-induced acute psychosis in children and adolescents and evaluated the strength of the association for each case.</p><p><strong>Methods: </strong>We identified cases by searching PubMed, PsycInfo, and Web of Knowledge, and the reference lists of identified reports. We systematically evaluated the quality of the causal relationship between antibiotic treatment for infection and psychosis. Sixteen articles (describing 18 different cases) met the inclusion criteria.</p><p><strong>Results: </strong>The primary findings were: (1) 16 of the reported cases (89%) were \"highly suggestive\" of a potential causal relationship between antibiotic treatment and psychosis, including 3 cases with a recurrence of psychosis following rechallenge with the same antibiotic, (2) 5 different classes of antibiotics were implicated in this association (fluroquinolones, isoniazid, macrolides, penicillins, and trimethoprim-sulfamethoxazole), (3) for the majority of reported cases, both the onset and resolution of psychosis occurred within 1 week of initiation and discontinuation of the antibiotic, respectively, (4) almost three-quarters of cases (72%) did not require treatment with antipsychotics, and (5) the average age was 10, and 56% of cases were males.</p><p><strong>Conclusions: </strong>Our findings suggest that acute psychosis is a potential adverse effect of antibiotic treatment in children and adolescents. The mechanism(s) underlying this association remain unclear.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562111","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":"Early Discontinuation of Antidepressants in Mood and Anxiety Disorders: A Narrative Review of Factors and Strategies to Improve Adherence.","authors":"Md Abdul Aziz, Abdullah Al Maruf, James M Bolton, Kaarina Kowalec, Sherif Eltonsy, Christine Leong","doi":"10.1097/JCP.0000000000002217","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002217","url":null,"abstract":"<p><strong>Purpose: </strong>Early discontinuation of antidepressants continues to be a major challenge in treating mood and anxiety disorders, despite strong evidence supporting ongoing pharmacotherapy to prevent relapse and enhance long-term outcomes. This narrative review aimed to identify potential patient-level, medication-level, prescriber-level, and system-level factors of early discontinuation and to highlight strategies to improve long-term adherence.</p><p><strong>Methods: </strong>First, guideline recommendations from Canada, the United States, the United Kingdom, Europe, and international bodies were reviewed to contextualize recommended treatment durations. Then, a literature search was performed, including studies published from 2000 to 2025. We used PubMed, Google Scholar, PsycINFO, and Web of Science databases. Findings from observational studies, clinical guidelines, and qualitative research were synthesized to identify key factors contributing to early discontinuation and to outline strategies to improve adherence.</p><p><strong>Results: </strong>Early antidepressant discontinuation was often associated with low socioeconomic status, immigrant background, older age, prior substance use, comorbid psychiatric conditions, and misconceptions about treatment, although findings varied depending on the operational definition and study settings. Medication‑related contributors included adverse effect burden, initiation on tricyclic antidepressants, and cost‑related non-adherence. Prescriber‑level and system‑level contributors included limited follow‑up, high workload, variability in prescribing practices, and communication barriers. Several strategies to improve adherence can be adopted, including patient-centered communication, culturally competent care, selecting well‑tolerated first‑line agents, structured follow‑up, pharmacist‑led support, and digital/telehealth‑based interventions.</p><p><strong>Conclusions: </strong>Early antidepressant discontinuation is common and influenced by intersecting social, clinical, and structural factors, including equity-related determinants. Multifaceted, coordinated approaches, including effective communication, appropriate medication selection, and strengthened follow‑up processes, are needed to improve adherence.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549248","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":"Aripiprazole-Associated Hypomania in a Patient With Major Depressive Disorder.","authors":"Yasemin Arıkoğlu","doi":"10.1097/JCP.0000000000002227","DOIUrl":"https://doi.org/10.1097/JCP.0000000000002227","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549281","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}