After first psychotic mania, mood stabiliser regimens linked to fewer readmissions

The edition in brief

In 371 people with a first manic episode with psychotic features, followed for up to two years in first-episode clinics in North America, Chile and Spain, starting a mood stabiliser, alone or with a second-generation antipsychotic, was associated with a lower two-year risk of psychiatric hospitalisation or emergency visit than antipsychotic monotherapy (about 42% vs 49.5%; risk ratio 0.82). This is a target trial emulation using observational data, so it supports but does not prove that mood stabilisers should anchor early maintenance. An individual participant data meta-analysis of 18 fixed-dose trials (7,062 adults with acute schizophrenia) found no sex difference in antipsychotic efficacy or in dose-response, which plateaued at 3-5 mg risperidone equivalents; prolactin rose more in women. In two cohorts from Norway and the UK, CYP2D6 poor metabolisers had about twice the odds of switching away from venlafaxine within a year (OR 2.05 in Norway, 1.58 in UK Biobank). On the regulatory side, the FDA recorded a supplement to a generic olanzapine application held by Macleods; this is an administrative change to an existing generic, not new safety or efficacy information.