More Study Needed on Effects of Cognitive-Enhancing Drugs on Healthy Individuals

????????From Psychiatric News Alert: The use of cognitive-enhancing drugs—ordinarily prescribed to control attention-deficit/hyperactivity disorder (ADHD), slow memory loss in Alzheimer’s patients, or promote wakefulness—appears to be growing among healthy individuals and the phenomenon deserves closer attention from researchers, clinicians, regulators, and the pharmaceutical industry, said neuroscientists Barbara Sahakian, Ph.D., of the Department of Psychiatry at the University of Cambridge; and Sharon Morein-Zamir, Ph.D., of the Department of Psychology at the University of Cambridge.

“The main uses of pharmacological cognitive enhancers by healthy individuals seem to be for achievement of a competitive advantage at school, university, or work; to maintain levels of attention and performance when sleep deprived or jet-lagged; and to improve task-related motivation.”

Researchers noted the effects of these drugs (sometimes referred to as “smart drugs”) on healthy individuals are actually quite small, but too little is known about who uses them, under what circumstances, whether they are used acutely or chronically, or what effects they could have on the developing brains of young users.

“We conclude that more immediate action is needed to establish the long-term risks and benefits of pharmacological cognitive enhancers for healthy people and to continue to develop novel, more effective pharmacological cognitive enhancers for people with impairments associated with brain injury or neuropsychiatric disorders,” they said.

To read more about the need for research into cognition, see the Psychiatric News article “IOM Tackles Standards on Cognition in Depression.

Photo Credit: magraphics.eu | DPC

New Drug “ITI-007” Shows Promise for Schizophrenia

????????????????????????????????????????????????????A new medication, now in phase 3 clinical development for the treatment of schizophrenia, is showing great promise, according to its manufacturer and developer, Intra-Cellular Therapies Inc., as presented at the end of March at the 15th International Congress on Schizophrenia Research (ICOSR) in Colorado Springs and this week at the 4th Biennial Schizophrenia International Research Society (SIRS) Conference in Florence, Italy.

“This drug has a different pharmacological profile than any of the other antipsychotics. We believe the unique serotonergic-dopaminergic-glutamatergic pharmacological profile represents a new approach to the treatment of schizophrenia in a single stand-alone therapy.”

According to Intra-Cellular Therapies:

“Our lead product candidate, ITI-007, possesses a mechanism of action targeting multiple brain systems and may allow a physician to fine tune the drug’s action in the brain by simple dose adjustments. At the lowest doses, ITI-007 has been demonstrated to act primarily as a potent 5-HT2A serotonin receptor antagonist. As the dose is increased, additional benefits are derived from the engagement of additional drug targets, including modest dopamine receptor modulation and modest inhibition of serotonin transporters. We believe that combined interactions at these receptors may provide additional benefits above and beyond selective 5-HT2A antagonism for treating agitation, aggression and sleep disturbances in diseases that include dementia, Alzheimer’s disease and autism spectrum disorders, while avoiding many of the side effects associated with more robust dopamine receptor antagonism. As the dose of ITI-007 is further increased, leading to moderate dopamine receptor modulation, inhibition of serotonin transporters, and indirect glutamate modulation, these actions complement the complete blockade of 5-HT2A serotonin receptors. In this dose range, we believe that ITI-007 will be useful in treating the symptoms associated with schizophrenia, bipolar disorder, major depressive disorder and other neuropsychiatric diseases.”

 

 

Study Finds Treatment-Resistant BPD Responds Better to ECT Than Medication

Bipolar Disorder. Image Credit: xpixel | shutterstock

Bipolar Disorder. Image Credit: xpixel | shutterstock

From Psychiatric News Alert: Electroconvulsive therapy (ECT) for treatment-resistant bipolar disorder appears to be more effective than an algorithm-based pharmacologic treatment in terms of symptom improvement, says the report “Treatment-Resistant Bipolar Depression: A Randomized Controlled Trial of Electroconvulsive Therapy Versus Algorithm-Based Pharmacological Treatment” in the January American Journal of Psychiatry. But remission rates did not differ between the two groups and remained modest regardless of treatment choice for this challenging clinical condition.

According to the research, ECT treatment was significantly more effective than the pharmacological treatment. For more details of the research, see the Psychiatric News article. There were possible limitations noted by Mauricio Tohen, M.D., Dr.P.H., and Christopher Abbott, M.D., M.S., additionally stating:

“In spite of the above limitations, this report adds major value to the evidence-based data on the use of ECT as a treatment option for bipolar depression.”

For more research on the use of ECT in depressive disorders, see the Psychiatric News article, “Ketamine Outperforms ECT in Depression Study.”

Advantages of Long-Acting Injectable Antipsychotics

With studies showing schizophrenia to be treatment refractory in one-fifth of those affected, psychiatrists are exploring other options to the delivery of effective treatment. At APA’s Institute on Psychiatric Services in San Francisco, some of the leading experts in psychopharmacology led a research symposium on the benefits of long-acting injectable (LAI) antipsychotic medications.Said Steven Potkin, M.D., director of clinical research at the University of California, Irvine:

“Psychiatrists who were trained during my time of training, think that long-acting injectable antipsychotics should be used for the most refractory, noncompliant, and difficult to treat patients. However, there is accumulating evidence that very early in the course of illness that this should be offered as an option, since half of the patients with first-episode psychosis discontinue medication after they are discharged from a hospital.”

Research on part of the “accumulating evidence” on long-acting injectable antipsychotics was presented by Keith Nuechterlein, Ph.D., a distinguished professor of psychiatry at the University of California, Los Angeles, who led a randomized study comparing LAI risperidone with oral rispiderone in 83 individuals who had a first psychotic episode within the two years prior to the study. The results showed that after one year of treatment, participants who received the daily oral form of risperidone had a 33%relapse rate, compared with 5% in those treated weekly with LAI risperidone. In addition, individuals in the oral risperidone cohort were four times more likely to be hospitalized than those taking the LAI version.

“We were struck that these were among the most dramatic results that have occurred for long-acting injectables—and it was in first-episode patients,” said Nuechterlein, adding that not only did patients experience advantages regarding outcomes associated with LAIs, but the patients accepted LAI medication quite readily. (The study was funded by the National Institutes of Health and Janssen Pharmaceuticals.)

“This symposium was an invitation for psychiatrists to rethink when is it appropriate to offer patients long-acting injectable medication. Should it be reserved only for refractory patients, or should it be offered to people earlier in the course [of illness]… or at any stage of illness? Of course, LAIs are not for everyone, but our patients should definitely be given options.”

New Depression Medication: Brintellix

The U.S. Food and Drug Administration (FDA) approved a new medication to treat clinical depression in Adults. A total of six clinical studies were conducted to garner FDA’s drug approval. The new drug is called Brintellix by Takeda Pharmaceutical & H. Lundbeck. Brintellix will be available in 5 mg, 10 mg, 15 mg, and 20 mg tablets. Nausea appears to be a side effect reported by some patients.

The manufacturer reports that the new drug is an inhibitor of serotonin (5-HT) reuptake, and also acts as an agonist at 5-HT1A receptors, a partial agonist at 5-HT1B receptors and an antagonist at 5-HT3, 5-HT1D and 5-HT7 receptors.

Since medications affect everyone differently, it is important to have a variety of treatment options for depression.

Short Hospitalizations Found to Be Risk Factor for Readmission of Schizophrenia Patients

From Psychiatric News Alert. Short hospital stays for patients with schizophrenia are associated with risk of early readmission, possibly because the person is insufficiently stabilized, according to a report in Psychiatric Services in Advance. Researchers at the University of South Florida and other institutions used Medicaid and service-use data to identify adults with schizophrenia discharged from hospitals and crisis units who were taking anti-psychotics. Data were extracted on demographic characteristics, service use before admission, psychopharmacologic treatment after discharge, and readmission to acute behavioral health care.

Study subjects had 6,633 inpatient episodes. Readmission occurred for 84 percent of the episodes, 23 percent of them within 30 days after initial discharge. Variables associated with an increased readmission risk in the first 30 days were shorter hospital stay, shorter time on medication before discharge, greater prehospitalization use of acute care, serious general medical comorbidity, and prior substance abuse treatment.

“This finding suggests that some patients may have been discharged before they were sufficiently stabilized,” the researchers said. “Patients with shorter stays and those not sufficiently stabilized on their medication should receive more vigorous discharge planning and follow-up care to ensure smoother transition to treatment in the community.”