After a first psychotic mania, mood stabiliser strategies were linked to fewer relapses

The edition in brief

A BD-CAUSAL target trial emulation of 371 young people after a first manic episode with psychotic features found that starting a mood stabiliser, alone or with an antipsychotic, was associated with a lower two-year risk of psychiatric admission or emergency visit than antipsychotic monotherapy (about 42% vs 50%, RR 0.82). It is observational and the authors call for a randomised trial. An individual participant data meta-analysis of 18 fixed-dose trials (7,062 people) found no sex difference in antipsychotic efficacy or dose-response in acute schizophrenia, but a larger prolactin rise and a greater fall in dropout in women. In Norwegian and UK cohorts, CYP2D6 poor metabolisers had higher odds of switching off venlafaxine within a year (OR 2.05 and 1.58). FDA approved a manufacturing supplement to an existing generic risperidone application, which is administrative. The pearl covers what to check before calling an antidepressant a failure.