The edition · Psychiatry
After a first psychotic mania, mood-stabiliser regimens were linked to fewer readmissions than an antipsychotic alone
A target trial emulation in 371 young adults favours a mood stabiliser, alone or combined, for continuation treatment. Plus antipsychotics compared by sex, CYP2D6 status and venlafaxine failure, a generic olanzapine supplement, and which drugs actually shift antipsychotic weight.
The edition in brief
In 371 people aged 16 or over treated after a first manic episode with psychotic features, an emulated target trial using linked records from North America, Chile and Spain found a two-year risk of psychiatric hospitalisation or emergency visit of 49.5% on second-generation antipsychotic monotherapy, against 42.3% on a mood stabiliser alone and 42.2% on the combination (risk ratio 0.82 for each). The design is observational and the authors call for randomised confirmation. An individual participant data meta-analysis of 18 fixed-dose schizophrenia trials (7,062 people) found no sex difference in antipsychotic efficacy or dose-response, but a larger prolactin rise in women. In Norwegian and UK Biobank cohorts, CYP2D6 poor metabolisers were more likely to switch away from venlafaxine within a year (OR 2.05 and 1.58). The FDA recorded a supplement to a generic olanzapine application on 16 September, an administrative action. A network meta-analysis of 95 trials ranked semaglutide, liraglutide, topiramate, metformin and exenatide as the drugs with moderate-certainty evidence for reducing antipsychotic-associated weight, with metformin backed by 16 trials. The pearl covers the metabolic baseline before an antipsychotic is started.
First psychotic mania: a mood stabiliser, alone or combined, was linked to fewer readmissions than an antipsychotic alone
After a first psychotic mania, consider continuing with a mood stabiliser, alone or with the antipsychotic, rather than an antipsychotic alone.
Antipsychotics worked equally in women and men, but raised prolactin more in women
Dose antipsychotics the same way in women and men, but ask women specifically about prolactin-related side-effects.
CYP2D6 poor metabolisers were more likely to switch away from venlafaxine
Consider CYP2D6 genotype and interacting drugs when venlafaxine fails or is poorly tolerated at ordinary doses.
FDA records a supplement to a generic olanzapine application
This is an administrative FDA action on a generic olanzapine; it does not change how you prescribe it.
Weigh, measure and test before the first antipsychotic dose
Record a metabolic baseline before starting an antipsychotic, and weigh early and often.
Antipsychotic weight gain: five drugs with moderate-certainty evidence, metformin the best studied
When weight climbs on an antipsychotic, consider metformin first, and a GLP-1 receptor agonist for marked gain where cost allows.
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