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The edition · Psychiatry

Depot antipsychotics in bipolar disorder were linked to about half the rate of manic admissions

A Hong Kong self-controlled study compared the same patients on and off long-acting injectables. Plus the symptoms that outlast NMDA receptor encephalitis, gut signals and relapse in anorexia, a serum marker in early psychosis, and exercise for depression in lung cancer.

The edition in brief

In 2,086 people with bipolar disorder in Hong Kong who had periods on both long-acting injectable and oral antipsychotics, injectable periods were associated with fewer psychiatric admissions (aIRR 0.67) and manic admissions (aIRR 0.51), with no rise in cardiovascular admissions. Extrapyramidal symptoms were about three times as likely in the first 90 days. A Berlin study of 70 patients after NMDA receptor encephalitis found two-thirds still had symptoms a median 22 months on, mostly memory problems, and psychiatric features shifted from psychosis to mood. In 62 weight-restored women with anorexia nervosa, measures of how accurately they sensed gut signals predicted relapse at six months, in a small experimental study. Serum and CSF ACE protein was lower in 122 young people with early psychosis than in controls, and lower again in treatment-resistant cases, a cross-sectional research finding. A meta-analysis of 15 trials suggested exercise may lower depressive symptoms in lung cancer, with very low certainty.

In this edition
01
Clinical update

Two-thirds still have symptoms after NMDA receptor encephalitis

Follow patients after NMDA receptor encephalitis for mood and memory problems long after the neurology team calls them recovered.

2 min · The lancet. PsychiatryRead →
Primary outcome
Residual symptoms, cognition and cortical morphological complexity
Effect
67% had residual symptoms: memory 61%, psychiatric 36%; mRS median 5 at peak vs 1 later
02Research

How women with anorexia sense their gut predicted relapse

Ask about gut discomfort and hunger signals after weight restoration in anorexia, and treat them as part of relapse risk.

2 min · JAMA psychiatryRead →
03Research

Lower ACE protein in early psychosis, lower still in treatment resistance

Note ACE protein as a candidate marker of treatment-resistant psychosis, but do not order it.

1 min · JAMA psychiatryRead →
04Research

Exercise may ease depressive symptoms in lung cancer, with low certainty

Consider structured exercise as supportive care for low mood in lung cancer, alongside standard depression treatment.

1 min · Medicina (Kaunas, Lithuania)Read →
05Pearl

Establish oral tolerability before the first depot

Confirm oral tolerability of the same drug before giving a depot, and look for extrapyramidal symptoms at every early visit.

1 minRead →
06
Practice changer

Long-acting injectables linked to fewer manic admissions in bipolar disorder

Consider offering a long-acting injectable earlier to patients with bipolar disorder whose relapses are mainly manic, with close early monitoring for extrapyramidal symptoms.

2 min · The American journal of psychiatryRead →
Primary outcome
Healthcare use, relapse admissions and safety
Effect
Psychiatric admission aIRR 0.67 (0.61–0.74); manic 0.51 (0.44–0.59); EPS early 2.95 (1.40–6.22)

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