The edition · Psychiatry
Psychodynamic therapy improved functioning in schizophrenia over three years
A Berlin trial found a manualised psychodynamic therapy added to usual care improved psychosocial functioning at 24 and 36 months. Also: what rapid relapse after stopping an antipsychotic does and does not mean, antidopaminergic drugs in Huntington disease, and a generic clozapine supplement.
The edition in brief
A single-centre, assessor-blinded trial in Berlin randomised 130 outpatients with schizophrenia or schizoaffective disorder to modified psychodynamic psychotherapy (at least 30 sessions) plus usual care, or usual care alone. Psychosocial functioning improved more with therapy: adjusted Mini-ICF-APP differences of −3.45 (95% CI −5.51 to −1.40) at 24 months and −4.07 (−6.19 to −1.94) at 36 months, with similar adverse event rates. An individual participant data analysis of five paliperidone discontinuation trials found two relapse patterns, rapid and delayed; rapid relapse was not more common after stopping the drug than during continued treatment, and was linked to higher baseline severity. A post hoc analysis of the placebo arm of PROOF-HD found adults with Huntington disease taking antipsychotics or VMAT2 inhibitors declined faster on function and composite scores, an association that may reflect disease severity. The FDA recorded a supplement to a generic clozapine application, an administrative action. The pearl covers restarting clozapine after missed doses.
Rapid relapse after stopping paliperidone did not look like a withdrawal effect
When planning antipsychotic reduction, stratify by baseline severity and monitor closely, rather than assuming a fast relapse means the taper was simply too quick.
Antipsychotics and VMAT2 inhibitors linked to faster decline in Huntington disease
In Huntington disease, keep antidopaminergic drugs at the lowest effective dose and review them regularly, without stopping treatment that is controlling symptoms.
FDA records a supplement to a generic clozapine application
No action needed: this is an administrative supplement to a generic clozapine application.
Clozapine missed for more than 48 hours: re-titrate
After more than 48 hours off clozapine, restart at a low dose and titrate up again rather than resuming the old dose.
Psychodynamic therapy added to usual care improved functioning in schizophrenia
Consider structured psychotherapy, including psychodynamic approaches where available, to improve functioning in stable schizophrenia alongside medication.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for psychiatry, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free