For Schizophrenia Patients, Some Drug Combos Work Better Than Others

https://psychcentral.com/news/2019/02/21/for-schizophrenia-patients-some-drug-combos-work-better-than-others/143080.html

Most patients with schizophrenia take more than one type of psychiatric medication for their symptoms, but a new study published in the journal JAMA Psychiatry suggests that some combinations may be more effective than others.

Antipsychotic drugs are the first line of treatment for psychosis, but these drugs can fail to control schizophrenia symptoms on their own. Doctors often prescribe additional psychiatric medications, such as another antipsychotic, an antidepressant, a benzodiazepine, or a mood stabilizer.

“Antipsychotic medications are used to treat psychotic symptoms such as delusions and hallucinations but there is little guidance on what to do for other types of symptoms like depression, anxiety or excitement,” said lead author T. Scott Stroup, M.D., M.P.H., professor of psychiatry at Columbia University Vagelos College of Physicians and Surgeons in New York.

“Additional medications are often prescribed, but we know little about how different psychiatric drug combinations affect people with schizophrenia. Until now we have known virtually nothing about how these strategies compare to each other.”

For the study, the research team analyzed the Medicaid records of 81,921 adults with schizophrenia who had been taking only an antipsychotic drug for at least 3 months before starting either an antidepressant, benzodiazepine, mood stabilizer, or another antipsychotic drug.

The findings show that schizophrenia patients who added an antidepressant were less likely to end up in the emergency room or hospital for a mental health issue compared to patients who started another antipsychotic or a benzodiazepine.

In fact, antidepressants lowered the risk of hospitalization by 16 percent compared to antipsychotics and by 22 percent compared to benzodiazepines. For emergency room visits, antidepressants reduced the risk by 8 percent compared to antipsychotics and by 18 percent compared to benzodiazepines.

“Our study adds more evidence that benzodiazepine use should be limited and that combining antidepressants with antipsychotic drugs for individuals with schizophrenia may have benefits,” Stroup said. “We still need to know more about when to use antidepressants, which may be useful for conditions other than depression.”

Combining medications is often referred to as polypharmacy. “The results of our study should promote rational polypharmacy,” Stroup said. He believes that clinicians will find the results believable and hopes that they will lead to practice changes and improved patient outcomes.

Around 1 percent of the global population is diagnosed with schizophrenia, and approximately 1.2 percent of Americans (3.2 million) have the disorder.

Source: Columbia University Irving Medical Center

 

Read More...

Gene that keeps PTSD-like behavior at bay in female mice

https://www.sciencedaily.com/releases/2019/03/190312170807.htm

More than 30 decades ago, scientists discovered that mad cow and Creutzfeldt-Jakob ailments are caused by prions. But in the last few years, Nobel laureate Eric Kandel, M.D., demonstrated in mice that many prions are advantageous and serve important roles in the brain and body. And now, new research from Dr. Kandel describes how one such prion-like protein assists the mind stay fearful memories from check. With no, female mice demonstrate that the tell-tale indicators of post-traumatic stress disorder, or PTSD.

Read More...

Book Review: Mental Illness Is an Asshole: And Other Observations

https://psychcentral.com/lib/book-review-mental-illness-is-an-asshole-and-other-observations/

Howard writes,”First we need to discuss that emotional illness — or ‘crazy’ — is based on a spectrum, just as bodily illness does. Someone with stage four cancer and also a individual with a headache could be described as physically ill, but there is a world of difference between them both.”

Maybe due to this societal reception individuals with bipolar frequently get, they generally feel as though they are supposed to blame because of their illness and seek citizenship — a premise Howard rejects completely.

In his new novel, Emotional Illness is an Asshole – And Other Observations, Howard offers a straightforward, nothing held back look in mental illness.

While past indiscretions cannot be changed, focusing upon the present — the things which are going well and the achievements and goals you’re working toward — improves your outlook today and helps form the future you would like.
For coping with the holidays, Howard provides tips for everything from living the holidays when you have panic and anxiety to making the vacations gloomy and keeping New Years’ resolutions.

Howard goes on to explain that the public does not truly understand the depths of mental illness or how it can impact a person. “A person living with depression depression depression, mania, rage, or some other undesirable result and those near us are not easy to blame the person instead of the disease ,” writes Howard.

“In a world where friends are assholes, parents are assholes, even cute, small three-year-olds are assholes, there’s no reason that psychological ailments receive a pass,” writes Gabe Howard.
Howard also provides practical advice for caregivers and clinicians, including the idea that bipolar is present on a spectrum with typical moods and it is vital watch for telltale mania behaviors like insomnia, racing thoughts, and doing things in surplus.
He writes,”We no longer need forgiveness for a disease than we do to our own hair colour.”
Encouraging, informative, and personal, Howard’s novel reads like a letter from the best buddy — just this best friend was there and knows just how.
Howard’s following bit of advice is equally as important to an individual with mental illness as it is to anybody taking on a worthwhile challenge. He writes,”There isn’t enough money, understanding or education to change the minds of an whole society overnight. Brace yourself; this is going to take a little while.”

But, Howard thinks it’s the bipolar person ’s obligation to have up to their actions throughout a depressive episode, even though with the disease itself is unjust. “Recall bipolar is an explanation for what happened, not a justification,” he writes.

He writes,”daily, depressed or not, make any small, positive step ahead and you’ll be better off. Small changes lead to gigantic victories.”
One interesting tip he gives is to stop listening to the press. He writes,”The press can play an important role in how we see the holidays. Pop culture enjoys to emphasize images which have large families lovingly gathered around a flame, feast, along with other holiday festivity. Don’t compare your real life together with all the ‘picture perfect’ version of this holiday season.”

To the end, Howard offers an abundance of tips and steps individuals with mental illness may take. For example, he indicates encouraging physical health through movement, watching what you eat, and keeping a stable sleep schedule.
As it turns out, it’s the wrong question.

Howard, that hosts The Psych Central Show tradition and writes for Psych Central on the subjects of bipolar and mental disorder, is famous for his fun, enjoyable and eminently valuable observations about mental disorder.
But, misconceptions and misunderstandings about mental disorder color our ability to treat it appropriately. Howard reflects his own experience, stating,”My ignorance on the topic was so good that my failure to act on behalf of individual’s dwelling with mental illness almost forced me a casualty. Two hours prior to visiting the emergency area for suicidal ideation, delusions, along with crippling depression, I firmly stood my ground and announced,’I don’t need to attend a hospital. I’m not sick. Only sick people go to hospitals. ”’
He writes,”Because of all of the misinformation out there, I honed my ability to describe to folks what living with mental illness actually means, replacing their fear of details. ”

Read More...

[Articles] Clinical and cost-effectiveness of the Managing Agitation and Raising Quality of Life (MARQUE) intervention for agitation in people with dementia in care homes: a single-blind, cluster-randomised controlled trial

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30045-8/fulltext?rss=yes

The MARQUE intervention was not efficacious for agitation although feasible and cost-effective concerning wellbeing. Addressing agitation in care homes may need resourcing for shipping by professional staff of a more intensive intervention, executing social and activity times, and also a longer time to execute change.

Read More...