The edition · Psychiatry
Injectables in bipolar disorder linked to fewer manic admissions, with early EPS to watch
Hong Kong records link long-acting antipsychotics with about half the manic admissions of oral periods in the same patients. Sensory loss tracks with late-life depression, and clinician-supported online therapy holds up against face-to-face care.
The edition in brief
A self-controlled case series of 2,086 people with bipolar disorder in Hong Kong compared periods on long-acting injectable antipsychotics with oral periods in the same individuals. Injectable periods were associated with fewer psychiatric admissions (aIRR 0.67), manic admissions (aIRR 0.51) and mixed-episode admissions (aIRR 0.31), with no difference for depressive admissions. Extrapyramidal symptoms were about three times as frequent in the first 90 days, then no longer differed. Across three ageing cohorts (19,310 people in China, the US and England), self-reported combined hearing and vision loss was associated with higher odds of depressive symptoms (pooled OR 1.73), partly through reduced social engagement and cognitive decline. An analysis of three Australian government-funded digital services, reaching more than 282,000 people, found clinician-supported online treatment produced large symptom improvements (Cohen d 0.95 to 1.42), close to face-to-face comparators, though heterogeneity was high. The FDA recorded a supplement to an existing generic clozapine application on 29 September; it is an administrative action, not a new indication or a safety finding. The pearl covers why smoking changes matter for anyone on clozapine.
Hearing and vision loss together track with late-life depression
In an older patient with depression, ask about hearing and vision, and treat the loss as part of the care plan.
Clinician-supported online therapy rivals face-to-face care in Australia
Clinician-supported online therapy is a reasonable first step for mild to moderate anxiety and depression when face-to-face therapy is not available.
FDA records a supplement to a generic clozapine application
This is an administrative supplement to a generic clozapine licence; nothing in prescribing or monitoring changes.
Smoking changes clozapine levels more than most doses do
Any change in smoking in a patient on clozapine is a reason to recheck the level and the dose.
Long-acting antipsychotics in bipolar disorder: linked to half the manic admissions
For bipolar disorder with manic relapses and patchy adherence, offer a long-acting injectable and watch closely for EPS in the first three months.
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