Managing drug-induced psychosis

The use of community treatment orders in people with substance induced psychosis

The community treatment order (CTO) is a legally mandated approach to community based psychiatric care that has been in existence for over 20 years in the Canadian province of Saskatchewan. Changes to legislation of CTOs implemented in 2015, has resulted in bolstered use of this approach to treat substance induced psychosis (SIP). Treatment plans implemented with the use of CTOs in the present study include pharmacotherapy, in the form of long-acting injectable antipsychotics (LAI-AP). The purpose of this retrospective, observational study was to determine whether there is a benefit for the use of a CTO with LAI-AP to mandate treatment for individuals diagnosed with SIP, and rates of both readmission to hospital, and presentation to emergency departments. We observed that individuals diagnosed with SIP and assigned a CTO that included a LAI-AP demonstrated a significantly lower rate of presentations to emergency departments and a lower rate of readmissions to hospital in the first one year following diagnosis, compared to those diagnosed with SIP and not assigned a CTO. Our results suggest that use of legally mandated treatment in this diagnostic group may ease both fiscal and human resource burdens on the healthcare system. Our finding may also assist when planning treatment pathways and services for people with a diagnosis of SIP.

Corticosteroid-Induced Psychiatric Disorders: Mechanisms, Outcomes, and Clinical Implications

Corticosteroids are extensively used in medicine for their powerful anti-inflammatory and immunosuppressive effects. However, their psychiatric side effects-such as mood disturbances, anxiety, and psychosis-are significant yet often underappreciated. This review provides a comprehensive exploration of corticosteroid-induced psychiatric disorders, with a focus on their underlying mechanisms and clinical implications. We examine how corticosteroids influence the hypothalamic-pituitary-adrenal (HPA) axis, leading to the dysregulation of stress responses and alterations in neurotransmitter levels, particularly dopamine, serotonin, and glutamate. These changes are linked to structural abnormalities in key brain areas such as the hippocampus and amygdala, which are implicated in mood and anxiety disorders, psychosis, and conditions like post-traumatic stress disorder (PTSD) and eating disorders. This review highlights the need for healthcare providers to be vigilant in recognizing and managing corticosteroid-induced psychiatric symptoms, especially in vulnerable populations with pre-existing mental health conditions. The complex relationship between corticosteroid type, dose, duration, and mental health outcomes is explored, emphasizing the importance of personalized treatment approaches to mitigate psychiatric risks. Given the widespread use of corticosteroids, there is an urgent need for more focused research on their psychiatric side effects. This review underscores the importance of patient education and careful monitoring to ensure optimal therapeutic outcomes while minimizing mental health risks associated with corticosteroid therapy.

Adverse event signal mining and severe adverse event influencing factor analysis of Lumateperone based on FAERS database

Background

Lumateperone has been approved by the Food and Drug Administration (FDA) for the treatment of schizophrenia in adults since 2019, however, there is still a lack of data report on adverse reactions in real-world settings. Conducting data mining on adverse events (AEs) associated with Lumateperone and investigating the risk factors for serious AEs can provide valuable insights for its clinical practice.

Methods

AE reports in the FDA Adverse Event Reporting System (FAERS) from 2019 Q4 (FDA approval of Lumateperone) to 2024 Q1 were collected and analyzed. Disproportionality in Lumateperone-associated AEs was evaluated using the following parameters: Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinker (MGPS). Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for Lumateperone-induced severe AEs.

Results

A total of 2,644 reports defined Lumateperone as the primary suspected drug was collected, including 739 reports classified as severe AEs and 1905 reports as non-severe AEs. The analysis revealed that 130 preferred terms (PTs) with significant disproportionality were based on the four algorithms, 67 (51.53%) of which were not included in the product labeling, affecting 6 systems and organs. In addition, dizziness (81 cases) was the most reported Lumateperone-associated severe AEs, and tardive dyskinesia showed the strongest signal (ROR = 186.24). Logistic regression analysis indicated that gender, bipolar II disorder, and concomitant drug use are independent risk factors for Lumateperone-associated severe AEs. Specifically, female patients had a 1.811-fold increased risk compared with male patients (OR = 1.811 [1.302, 2.519], p = 0.000), while patients with bipolar II disorder had a 1.695-fold increased risk compared with patients diagnosed with bipolar disorder (OR = 1.695 [1.320, 2.178], p = 0.000). Conversely, concomitant use of CYP3A4 inhibitors or drugs metabolized by CYP3A4 was associated with a decreased risk of severe AEs (OR = 0.524 [0.434, 0.633], P = 0.000).

Conclusion

Collectively, this study provides critical insights into the safety profile of Lumateperone. It highlights the need for cautious use in high-risk populations, such as females and individuals with bipolar II disorder, and emphasizes the importance of monitoring for AEs, including dizziness and tardive dyskinesia. Healthcare also should remain alert to potential AEs not listed in the prescribing information to ensure medical safety.

Perceived advantages and disadvantages of substance use in a dual diagnosis population with severe mental disorders and severe substance use disorder. Considering the self-medication hypothesis

AIM

Based on a large cohort of dual diagnosis patients, the aim of this study was to quantify the patient-perceived problems and advantages of their substance use and relate the quantity of problems to the substance type and psychiatric diagnosis.

MATERIAL

Data comes from a naturalistic cohort admitted to an in-patient facility in Denmark specialized in integrated dual diagnosis treatment. We included 1076 patients at their first admission to the facility from 2010 to 2017. Participants completed 607 DrugCheck and 130 DUDIT-E questionnaires.

METHOD

we analyzed the questionnaires and included admission diagnosis by use of t-test and ANOVA to depict the patterns in substance use in relation to psychiatric diagnosis.

RESULTS

The three most common substance related problems according to the DrugCheck questionnaire were: feeling depressed, financial problems, and losing interest in daily activities. From DUDIT-E, the highest-ranking negative substance related effects were financial ruin, deterioration of health, and problems at work. Effects on social life relationships were also evident with more than 40% of participants. The top three positive substance related effects reported were relaxation, improved sleep, and control over negative emotions. The number of problems listed varied significantly with the type of preferred substance. Patients using pain medication, sedatives, central stimulants, and alcohol reported most problems. Diagnosis did not differentiate the problems experienced. Results partially support the broad self-medication hypothesis for patients with severe mental illness, but also points out that patients are well aware of negative effects.