Management of Bipolar I Depression: Clinical Utility of Lurasidone

Lurasidone is a benzisothiazol derivative second-generation antipsychotic. It has been approved in the United States and Europe for treatment of acute schizophrenia and bipolar depression. In type I bipolar subjects, treatment with lurasidone monotherapy of adjunctive therapy to lithium or valproic acid with doses of 20 to 120 mg once daily with food, results in statistically and clinically significant reduction of depressive symptoms. Patients experience relatively few side effects, which include somnolence, akathisia, nausea, and other gastrointestinal upset. Dopamine related side effects, such as Parkinsonism and elevated prolactin, are rare and mild. Longer term safety data obtained in 6 months long, open continuation observation periods, suggest that metabolic related elevations in weight, glucose, and lipids are absent or minimal. The mechanism of action of lurasidone is not known, but the data are compatible with antagonism of the serotonin 7 receptor. Lurasidone is a new option for the treatment of bipolar depression with relatively few side effects

Update on Schizophrenia and Bipolar Disorder: Focus on Cariprazine

Schizophrenia and bipolar disorder are severe psychiatric disorders that are frequently associated with persistent symptoms and significant dysfunction. While there are a multitude of psychopharmacologic agents are available for treatment of these illnesses, suboptimal response and significant adverse consequences limit their utility. Cariprazine is a new, novel antipsychotic medication with dopamine D2 and D3 partial agonist effects. Its safety and efficacy have been investigated in acute psychosis of schizophrenia, bipolar mania, bipolar depression, and unipolar depression. Efficacy has been demonstrated in schizophrenia and mania. It is unclear if cariprazine is effective in depression associated with unipolar or bipolar illness. Adverse consequences include extrapyramidal symptoms including akathisia, and various gastrointestinal symptoms. The US Food and Drug Administration (FDA) has recently approved cariprazine. This review will provide clinicians with basic information regarding the research program of cariprazine

The Effect of Acute and Chronic Ethanol on Dopamine Turnover in the Caudate Nucleus of the Rat

It is generally believed that acute and chronic ethanol (EtOH) administration alters the activity of catecholamines in the brain, however, the specific effects of EtOH on the dopaminergic system are disputed (I). Acute EtOH administration has been variously reported to decrease (2,3), increase (4,5), and cause no change (6 ,7) in dopamine (DA) synthesis and turnover. Likewise, chronic EtOH treatments have been reported to decrease (2,8) and increase (9, 10) DA synthesis and turnover. Many of these apparently conflicting results are explained by the use of different animal models (rat (2, 3,6,7,10), rabbit (6), and mouse (4,5,9)), different methods of EtOH administration (intraperitoneal (3 ,4,6,7), oral (2,5) , and inhalation (9)), and no assurance of alcoholic dependence with chronic exposure (2, I0). Further, the majority of these studies were carried out prior to the development of a very sensitive high performance liquid chromatography (HPLC) technique which can detect minute amounts of DA, dihyroxyphenylalanine (DO PA), and dihydroxyphenylacetic acid (DOPAC) (11 ,12)

Strategies to Improve Medication Adherence in Patients with Schizophrenia: The Role of Support Services

The purpose of this review is to describe research over the past 10 years on the role of support services in promoting medication adherence in mental health consumers diagnosed with schizophrenia. A literature search was conducted using the terms medication adherence, schizophrenia, and support services, using Medline, PubMed, and CINAHL. Reference lists from published studies were also reviewed to identify additional research studies. Twenty-two articles focused on support-service intervention studies, and these were selected for review. Available support-service interventions include adherence therapy, electronic reminders via text messages and telephones, cognitive-behavioral and motivational strategies, and financial incentives. Support-service intervention strategies need to be tailored to the specific needs of mental health consumers with schizophrenia. More research is needed to investigate effective support services to enhance long-term adherence and adherence to medications for medical illnesses in this population

The curious case of the missing face: Death of California sea lion by Dungeness crab trap

Marine mammals frequently interact with human detritus due to their proximity to shores and shared target foods. Sea lions have been known to attempt to obtain bait inside crab traps. A case is described in which the pattern of decomposition of a California Sea Lion, Zalophus californianus, suggests that it likely became entangled and drowned while attempting to get Dungeness crab trap bait. This represents the first case of California Sea Lion death related to interaction with a crab trap

Suicide and Homicide More Common with Limited Urban Tree Canopy Cover

Distribution of urban tree canopies is generally not uniform. Multiple variables have been shown to be associated with tree canopy cover, including violence, health, and general well-being. Herein we examine the relationship of tree cover with intentional deaths. Suicide, homicide, and tree cover data were examined by ZIP code for Louisville, a mid-sized city in Kentucky. Relationship between intentional death (suicide and homicide) and tree cover was examined with Poisson regression analysis. In both univariate and multivariate models, suicides (P \u3c 0.0001 and P = 0.0005), homicides (P \u3c 0.0001 and P = 0.03), and combination (P = 0.0541) were negatively associated with tree cover. In this exploratory study we have found that sparse canopy cover is associated with higher rates of intentional human death (both suicides and homicides). Given that suicides and homicides are relatively rare occurrences, these data suggest that larger samples be examined to confirm the relationship between intentional death and canopy cover

Role of eslicarbazepine in the treatment of epilepsy in adult patients with partial-onset seizures

Eslicarbazepine is a new dibenzazepine antiepileptic agent. It is a high affinity antagonist of the voltage-gated sodium channel. It is closely related to both carbamazepine and oxcarbazepine. Eslicarbazepine has similar affinity to inactivated sodium channels (channels in just activated neurons) as carbamazepine, and greater efficacy in animal models of seizure than oxcarbazepine. In human placebo-controlled trials of a single daily dose of eslicarbazepine added to other anti-epileptic agents, significant seizure reductions occurred with 800 and 1200 mg daily, with nearly half of the patients experiencing a greater than 50% reduction in seizure frequency. Adverse events (AEs) occurred in over 50% of patients receiving therapeutic doses of eslicarbazepine (compared to 31.4%–44.7% of placebo-treated subjects), but were generally mild or moderate. Eight to 19.6% of eslicarbazepine treated patients discontinued due to AEs (compared to 3.9%–8.5% of placebo-treated subjects). In these patients receiving combination anticonvulsant therapy, the most common AEs were dizziness, nausea and vomiting, somnolence, and diplopia. Eslicarbazepine is an effective and reasonably well-tolerated adjunct in patients with suboptimal control of their partial seizures

Neurotropic Manifestations as a Potential Risk Factor for Schizophrenia Following in utero Exposure to SARS-CoV-2

Background: COVID-19 infection is associated with neurologic and psychiatric morbidity that suggests a direct effect of the virus or secondary effect of an inflammatory process. These neuropsychiatric consequences may increase the likelihood of schizophrenia in the offspring of women who become infected with COVID-19 during their pregnancy. Methods: We performed a directed narrative review of the literature focusing on the proposed pathophysiological processes that lead to schizophrenia and known pathological consequences of COVID-19 infection. Results: Schizophrenia in adult offspring has been associated with maternal infections during pregnancy by a wide range of respiratory and neurotropic pathogens. Spikes in the incidence of schizophrenia approximately 20 years after several influenza pandemics have been documented. There are multiple lines of evidence suggesting that a similar pattern may be seen due to the recent COVID-19 pandemic. These include the nonspecific consequences of acute illness and hyperpyrexia, as well as more specific derangements of brain development related to direct effects of the virus or secondary effects of the inflammatory response on the developing brain. There is the potential to prospectively test this hypothesis by following the offspring of women who are known to have developed COVID-19 during their pregnancy. Conclusion: The COVID-19 pandemic is likely associated with a range of future neuropsychiatric consequences in people whose mothers suffered the infection during their fetal development. It is important to try to follow these offspring to determine the full range of consequences of COVID-19 infection