Psychopharmacology bulletin最新文献

{"title":"Antipsychotics-<i>Therapeutic Salve or Iatrogenic Thorn?</i>","authors":"Ahmed Naguy, Saxby Pridmore, Mohamed Y Abuzeid, Bibi Alamiri","doi":"10.64719/pb.16602","DOIUrl":"10.64719/pb.16602","url":null,"abstract":"<p><p>Antipsychotics might be thought of as pleuripotent broad-spectrum psychotropics, given the versatile pharmacological portfolio, with a multitude of uses on clinical grounds, albeit off-label. Herein, authors would touch briefly on the general pharmacology and therapeutic potential of antipsychotics. Nonetheless, It should be borne in mind, that the level of evidence supporting the use of antipsychotics in many of these unlicensed indications remain, at large, flimsy, and other agents with solid evidence-base should be explored first.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 2","pages":"163-169"},"PeriodicalIF":0.0,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12976953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Management of Evolving Neuropsychiatric Symptoms in a Female with Fragile X Syndrome: A Case Report.","authors":"Anvitha R Metpally, Anuradha Reddy","doi":"10.64719/pb.16620","DOIUrl":"10.64719/pb.16620","url":null,"abstract":"<p><p>Fragile X syndrome (FXS) is a genetic neurodevelopmental disorder characterized by cognitive impairment, behavioral dysregulation, and emotional lability. While it is primarily known as a leading cause of inherited intellectual disability, patients with FXS may also present with complex neuropsychiatric symptoms including attention-deficit/hyperactivity disorder (ADHD), anxiety, autistic features, irritability, and self-injurious behaviors as they progress through childhood and adolescence. As such, these patients require close monitoring and routine adjustment of behavioral and pharmacologic treatment. Although pharmacologic sensitivity and fluctuating clinical needs are well-documented in FXS, longitudinal management remains a clinical challenge and further complicated by variable treatment responses and frequent comorbidities such as autism spectrum disorder (ASD) and ADHD. We present longitudinal management of a genetically confirmed female with FXS who was followed from childhood into young adulthood. Her course was characterized by early emerging ASD features, severe ADHD, anxiety, episodic irritability, skin-picking, and comorbid epilepsy. Over time, stimulant medication, adjunctive clonidine, intermittent low-dose antipsychotic use, selective serotonin reuptake inhibitors, and antiseizure medications formed the core of treatment. Behavioral therapy, school-based supports, and caregiver training were consistently emphasized. Medication choices and dosing shifted in response to developmental stage, psychiatric symptom emergence, metabolic side-effects, neurologic comorbidity, and family preference. This case illustrates the need for continuous reassessment, metabolic and neurologic monitoring, and flexible, interdisciplinary management in patients with FXS and evolving psychiatric symptoms.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 2","pages":"199-202"},"PeriodicalIF":0.0,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12976948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Valproate Induced Hyperammonaemic Encephalopathy in a Psychiatric Inpatient.","authors":"Alice Cockill, Clare Stephenson","doi":"10.64719/pb.16617","DOIUrl":"10.64719/pb.16617","url":null,"abstract":"<p><p>We present the case of a young gentleman admitted to an inpatient psychiatric ward with a diagnosis of Bipolar Affective Disorder who developed Valproate-induced Hyperammonaemic Encephalopathy (VHE) alongside infection with COVID-19. His condition had exhibited a relapsing and remitting course, relapses being associated with non-compliance with prescribed medication and substance misuse. He had previously been successfully treated with a combination of antipsychotic (haloperidol) and semi-sodium valproate which were re-prescribed following the index admission to hospital. On this occasion however both his mental and physical health began to deteriorate, with evidence of irritability and over-sedation, disorientation, and significantly impaired cognition. On examination, reduction in visual fields was noted, and after bloods, MRI scanning and a review by neurology, he was diagnosed with hyperammonaemic encephalopathy. This was suspected to be an adverse effect of the Depakote. Following transfer back to the psychiatric hospital, he was cross titrated off Depakote and on to Lithium, and the cognitive disturbance remitted. This case adds to the existing literature on the potential challenges in diagnosing this rare but potentially fatal reaction to valproate, in a psychiatric inpatient population for which data on VHE is limited. Psychiatrists should keep a high index of suspicion for VHE in those taking Valproate who show new signs of a deterioration in mental status. Early diagnosis and withdrawal of valproate are key in manifesting a prompt and complete recovery. While neurologists are familiar with this complication we believe this is not well known among psychiatrists and therefore worthy of adding this case report to the existing literature.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 2","pages":"191-198"},"PeriodicalIF":0.0,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12976959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective 12-week Randomized Controlled Trial of Remotely-Delivered Customized Adherence Enhancement for Poorly Adherent Individuals with Schizophrenia vs Enhanced Treatment as Usual.","authors":"Martha Sajatovic, Jennifer B Levin, Gracie Howard-Griggs, Jessica Surdam, Jacqueline Krehel-Montgomery, Sakshi Priya, Nicole Fiorelli, Farren Briggs","doi":"10.64719/pb.15412","DOIUrl":"10.64719/pb.15412","url":null,"abstract":"<p><strong>Objective: </strong>This prospective 12-week randomized controlled trial tested an adherence promotion approach called Customized Adherence Enhancement in schizophrenia (CAE-S) vs. Enhanced Treatment as Usual (eTAU) in 36 poorly adherent individuals.</p><p><strong>Methods: </strong>Patients were randomized to either CAE-S or eTAU at baseline and were assessed at 12-week follow-up. Primary outcomes were program attendance, patient satisfaction and change in schizophrenia symptoms as measured by the Positive and Negative Syndrome Scale (PANSS). Additional evaluations were adherence measured by the Tablets Routine Questionnaire (TRQ), Clinical Global Impression (CGI), Short Form Health Survey (SF-12), Global Assessment of Functioning (GAF), and Strauss-Carpenter Level of Functioning Scale (SCLFS).</p><p><strong>Results: </strong>Mean age was 44.9 (Standard deviation/SD 12) years. 12-week attrition was 19.4%. At screening, mean past 7-day TRQ (proportion of days with missed dose) was 29.7% (SD 23.8) for CAE and 41.7% (SD 26.5) for eTAU. By baseline, mean TRQ improved to 11.3% (SD 15.8) in CAE-S, and to 19.3% (SD 25.7) in eTAU. Mean session attendance (out of a maximum of 6) was 4.89 (SD 1.9) for CAE and 3.88 (SD 2.5) for ETAU. CAE and ETAU satisfaction were both high. From baseline to 12 weeks, mean PANSS improved significantly in both CAE-S (p < .05) and eTAU (p < .01) with no difference between arms. There was no significant change in TRQ, while CGI and GAF improved significantly in both arms with no significant difference between arms. Mean SCLFS improved in both arms, with results favoring CAE (p < .001).</p><p><strong>Conclusion: </strong>Telehealth CAE-S is feasible and acceptable among poorly adherent patients with schizophrenia. Adherence improved rapidly with monitoring, which could explain improvement in schizophrenia symptoms and largely similar outcomes across intervention arms.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 1","pages":"8-27"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Opioid Prescribing and Co-Prescription of Opioid Antagonists: A Retrospective Analysis over a 12-Month Period.","authors":"Jamal Hasoon, Ahmed Abdalla, Giuliano Lo Bianco, Christopher L Robinson","doi":"10.64719/pb.15418","DOIUrl":"10.64719/pb.15418","url":null,"abstract":"<p><strong>Background: </strong>Opioid prescribing practices have come under increased scrutiny due to the ongoing opioid crisis, with efforts focusing on harm reduction strategies such as co-prescription of opioid antagonists. This study analyzes opioid prescribing trends and the frequency of opioid-antagonist co-prescription over the course of 2024.</p><p><strong>Methods: </strong>A retrospective analysis was performed using electronic medical record data to identify all opioid prescriptions issued between January 1, 2024, and December 31, 2024. Each opioid prescription was cross-referenced with any concurrent prescription for an opioid antagonist. The analysis did not differentiate opioid type, duration of therapy, or prescribing indication.</p><p><strong>Results: </strong>A total of 68,212 opioid prescriptions were issued in 2024. Quarterly totals were: Q1: 16,574; Q2: 16,882; Q3: 16,922; and Q4: 17,834. Among these, 7,586 (11.1%) were co-prescribed with an opioid antagonist, while 60,626 (88.9%) were not. The distribution across quarters was:Q1: 16,574 prescriptionsQ2: 16,882 prescriptionsQ3: 16,922 prescriptionsQ4: 17,834 prescriptionsOf these, 7,586 (11.1%) were co-prescribed with an opioid antagonist, while 60,626 (88.9%) were prescribed without one. The quarterly breakdown of opioid-antagonist co-prescription was:Q1: 1,874 prescriptions with an antagonist, 14,700 withoutQ2: 1,867 prescriptions with an antagonist, 15,015 withoutQ3: 1,945 prescriptions with an antagonist, 14,977 withoutQ4: 1,900 prescriptions with an antagonist, 15,934 without.</p><p><strong>Conclusion: </strong>Despite ongoing recommendations to increase opioid-antagonist co-prescription, a large majority (88.9%) of opioid prescriptions in 2024 were issued without an antagonist. While there was a modest increase in overall opioid prescriptions over the year, opioid-antagonist co-prescription rates remained relatively stable. These findings highlight the need for further investigation into barriers preventing wider adoption of opioid-antagonist co-prescription and the potential impact on patient safety.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 1","pages":"39-47"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lamotrigine-Induced DRESS Syndrome with Myelosuppression in a Patient with Bipolar Disorder: Case Report.","authors":"Marlene Kelbrick, Feras Ali Mustafa, Helen Wilson, Lynn Nyadzayo, David Ibrahim, Gabriela Paduret","doi":"10.64719/pb.15433","DOIUrl":"10.64719/pb.15433","url":null,"abstract":"<p><p>Lamotrigine-induced DRESS syndrome is a potentially fatal drug reaction with variable clinical presentation and complications requiring early recognition and rapid response.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 1","pages":"126-130"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tramadol Utilization Patterns: A One-Year Retrospective Review.","authors":"Jamal Hasoon, Anvinh Nguyen, Ivan Urits, Omar Viswanath","doi":"10.64719/pb.15421","DOIUrl":"10.64719/pb.15421","url":null,"abstract":"<p><strong>Background: </strong>Tramadol is a widely used analgesic with a unique dual mechanism of action, combining weak μ-opioid receptor agonism with inhibition of norepinephrine and serotonin reuptake. It is frequently prescribed for various acute and chronic pain conditions. Evaluating prescribing trends can provide valuable insight into clinical practice patterns and inform institutional pain management strategies and policy development.</p><p><strong>Objective: </strong>To assess tramadol prescribing patterns over a one-year period in a university-based health system and compare them to overall opioid prescribing.</p><p><strong>Methods: </strong>A retrospective review was conducted using electronic medical record (EMR) data from January 1, 2024, to December 31, 2024. The number of tramadol prescriptions was quantified quarterly and compared to the total number of opioid prescriptions (including tramadol) during the same period. No identifiable patient information was collected.</p><p><strong>Results: </strong>A total of 17,660 tramadol prescriptions were written in 2024. Quarterly breakdowns were: Q1 - 4,347; Q2 - 4,382; Q3 - 4,369; Q4 - 4,562. Overall, tramadol prescriptions accounted for 25.9% of the 68,212 total opioid prescriptions written during the year.</p><p><strong>Conclusion: </strong>Tramadol constituted over one-quarter of all opioid prescriptions in this academic medical center. Prescribing remained stable across all quarters, with a slight increase observed in Q4. These findings highlight tramadol's significant role in opioid prescribing practices for acute and chronic pain management.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 1","pages":"64-70"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Intersection of Gender Dysphoria (GD) and Autism Spectrum Disorder (ASD): A Case Series.","authors":"Trishna Sharma, Anuradha Reddy","doi":"10.64719/pb.15439","DOIUrl":"10.64719/pb.15439","url":null,"abstract":"<p><p>Over the past two decades, there has been a growing interest in the co-occurrence of gender dysphoria (GD) and autism spectrum disorder (ASD). This case series will examine five patients from our clinic population who present with both diagnoses. We will analyze differences and similarities among the cases, summarizing each patient's presentation trajectory. This will include the age of onset for both diagnoses, the clinical symptoms that led to the diagnosis, and current treatment responses. Our objective is to contribute to the existing literature on the intersection of these diagnoses.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 1","pages":"142-161"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Lorazepam for Acute Episodes in a Patient with Kleine-Levin Syndrome: A Longitudinal Case Report.","authors":"Michael Hamper, Michael Rancurello","doi":"10.64719/pb.15441","DOIUrl":"10.64719/pb.15441","url":null,"abstract":"<p><p>Kleine-Levin Syndrome (KLS) is a rare, neurological disorder characterized by episodes of hypersomnia, cognitive impairment, and behavioral abnormalities. The etiology of KLS remains unclear, and treatment responses are highly variable. This report describes a 22-year longitudinal experience with a 40-year-old male diagnosed with KLS at 15 years of age. Treatment trials of all standard KLS medications (lithium, valproic acid, selective serotonin reuptake inhibitors, modafinil) yielded no benefit in attenuating or preventing episodes. Following the onset of overlapping an acute KLS exacerbation and catatonia-like symptoms, the patient's episode was shortened after a trial of intravenous (IV) lorazepam. This response was consistently reproduced, with episodes resolving after approximately 5-7 days of IV lorazepam administration. Notably, the frequency of episodes increased after the patient contracted COVID-19 despite the continued efficacy of IV lorazepam in reducing episode duration. This case highlights the potential utility of IV lorazepam in terminating acute KLS episodes. While short-term outcomes were favorable, the observed increase in episode frequency underscores the need to assess the risks of chronic benzodiazepine exposure, including receptor downregulation and tolerance. These findings support the use of lorazepam in acute KLS management but emphasize caution regarding long-term reliance and encourage further mechanistic and therapeutic research into episodic hypersomnia and benzodiazepine responsiveness.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 1","pages":"162-169"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glecaprevir/Pibrentasvir for Post Traumatic Stress Disorder.","authors":"Bradley V Watts, Jessica E Hoyt, Krista D Disano, Crystal M Noller, Luke Rozema, Danielle M Foster, Matthew Vincenti, Brian Shiner","doi":"10.64719/pb.15419","DOIUrl":"10.64719/pb.15419","url":null,"abstract":"<p><strong>Objective: </strong>Posttraumatic Stress Disorder (PTSD) is a common condition with few effective medication treatments. Glecaprevir/Pibrentasvir (GLE/PIB), a treatment for hepatitis C virus (HCV) infection, demonstrated possible evidence of effectiveness for PTSD in an epidemiological study. We sought to determine if GLE/PIB decreases the symptoms of PTSD and modulates inflammation.</p><p><strong>Methods: </strong>An uncontrolled open trial was conducted at the Veterans Affairs Medical Center in White River Junction Vermont. Participants were veterans with PTSD and no HCV infection. Ten participants received Glecaprevir 100 mg/Pibrentasvir 40 mg, three tablets daily for 8 weeks. Symptoms were measured at baseline, mid-treatment, post-treatment, as well as at three- and six-months post-treatment. The primary outcome was PTSD symptoms as measured by the Clinician Administered PTSD Scale for DSM 5 (CAPS-5). Exploratory analyses were conducted to assess serum inflammatory biomarkers at baseline and post-treatment.</p><p><strong>Results: </strong>The mean baseline CAPS-5 score was 33.6 (SD = 3.3). Six-month post-treatment effects were large (CAPS-5: d = 1.6, p < 0.01). By the end of the study, eight patients met the criteria for response, including eight who met the criteria for loss of PTSD diagnosis and six who met the criteria for total remission of PTSD (CAPS-5 score of less than 12). Lower interleukin (IL)-27 levels prior to treatment were predictive of treatment response. Eight-week IL-9 levels changes with treatment were associated with symptom improvement.</p><p><strong>Conclusions: </strong>GLE/PIB may be an effective treatment for PTSD. Furthermore, treatment may modulate inflammatory responses in PTSD. Future studies are required to confirm these findings regarding GLE/PIB, PTSD, and inflammation.</p>","PeriodicalId":94351,"journal":{"name":"Psychopharmacology bulletin","volume":"56 1","pages":"28-38"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}