After first psychotic mania, a mood stabiliser may hold better than an antipsychotic alone

The edition in brief

A target trial emulation in 371 young adults with a first manic episode with psychotic features found the two-year risk of psychiatric hospitalisation or emergency visit was about 42% with a mood stabiliser alone or in combination, against about 50% with a second-generation antipsychotic alone (risk ratio 0.82 for both comparisons). It is observational and the authors call for randomised confirmation. An individual participant data meta-analysis of 18 fixed-dose trials (7,062 people with acute schizophrenia) found no sex difference in antipsychotic efficacy or dose-response, which plateaued at 3–5 mg risperidone equivalents; women had a greater prolactin rise and a larger reduction in dropout. A two-cohort study from Norway and the UK Biobank found CYP2D6 poor metabolisers had higher odds of switching away from venlafaxine (OR 2.05 and 1.58), with the highest odds in people who were poor metabolisers for both CYP2D6 and CYP2C19. FDA recorded a supplement to a generic risperidone application, an administrative action rather than a safety finding. The pearl covers checking for prolactin-related symptoms on antipsychotics.