Long-Term Efficacy and Safety of Brexpiprazole in Elderly Japanese Patients with Schizophrenia: A Subgroup Analysis of an Open-Label Study

Steroid-induced Obsessive-compulsive Disorder Associated With Oral Budesonide: Case Report and Literature Review

While psychiatric adverse effects to corticosteroids have been widely reported in the literature, only 6 reports of new-onset, steroid-induced obsessive-compulsive disorder (OCD) have been published. This article discusses what, to our knowledge, is the first reported case of oral budesonide-associated steroid-induced OCD. The patient was a 73-year-old female with a psychiatric history of bipolar disorder who developed pedophilic obsessive-compulsive symptoms as part of a constellation of psychiatric symptoms 14 days after starting oral budesonide 9 mg/d for the maintenance treatment of lymphocytic colitis. Following treatment recommendations for general psychiatric adverse effects to steroids, the patient was restarted on her original medications, tapered off budesonide over 14 days, and started on brexpiprazole 2 mg/d. The patient's symptoms fully resolved within 14 days of starting treatment. While this case demonstrates many risk factors for the general psychiatric adverse effects of steroids, there are notable differences between the characteristics shared by the reviewed cases of steroid-induced OCD and this case. This finding suggests that risk factors for steroid-induced OCD may vary from the general risk factors for psychiatric adverse effects and should be further researched. Despite some differences, both this case and previous cases in the literature demonstrated a resolution of OCD symptoms following discontinuation of the corticosteroid, adding evidence to current recommendations of discontinuing the corticosteroid, when possible, to treat steroid-induced psychiatric symptoms. Finally, despite a warning on the drug label concerning compulsive behaviors, augmentation with brexpiprazole was associated with a resolution of symptoms in this case. Brexpiprazole should be further researched for possible uses in both steroid-induced OCD and primary OCD.

Brexpiprazole—Pharmacologic Properties and Use in Schizophrenia and Mood Disorders

In 2002, the first III generation antipsychotic drug was registered—aripiprazole. Its partial dopaminergic agonism underlies its unique mechanism of action and the potentially beneficial influence on the positive, negative, or cognitive symptoms. Due to its relatively high intrinsic activity, the drug could often cause agitation, anxiety, or akathisia. For this reason, efforts were made to develop a drug which would retain the positive favorable actions of aripiprazole but present a more advantageous clinical profile. This turned out to be brexpiprazole, which was registered in 2015. Its pharmacodynamic and pharmacokinetic profile (similarly to the other most recent antipsychotics, i.e., lurasidone or cariprazine) shows promise of increasing the effectiveness of schizophrenia treatment in the dimensions in which the previous antipsychotics were not sufficiently effective, including negative, depressive, or cognitive symptoms. Like other new antipsychotics, it can also be useful in the treatment of mood disorders, for instance drug-resistant depression. Previous reviews focused on the use of brexpiprazole in specific diagnostic groups. The aim of this article is to provide the readers with an overview of data on the mechanism of action, clinical effectiveness in all studied diagnostic groups, as well as potential drug–food interactions, and the safety of brexpiprazole.

New Antipsychotic Medications in the Last Decade

PURPOSE OF REVIEW

Over the last ten years, the treatment of psychosis has seen a near explosion of creative development in both novel agents and new delivery modalities. The current review summarizes these developments over the past decade (2011-2020). We performed a systematic review utilizing PubMed and PsychInfo with the aim of identifying all the RCT and related analyses in adults with psychosis (schizophrenia and mania).

RECENT FINDINGS

We identified 11 significant developments: the introduction of new antipsychotics cariprazine, brexpiprazole, lumateperone, and pimavanserin; introduction of new delivery methods: subcutaneous long-acting risperidone, aripiprazole lauroxil, transdermal asenapine, and inhaled loxapine; and the introduction of new approaches such as olanzapine/samidorphan for olanzapine-associated weight gain, examination of the TAAR1 agonist SEP 363,856 as a test of concept, and the combination of Xanomeline/Trospium, an M₁ and M₄ muscarinic receptor agonist in conjunction with a peripheral anticholinergic. Last decade has seen a tremendous development in second-generation antipsychotics which provides unprecedented treatment options for clinicians in treating psychosis.

Ageing with schizophrenia: an update

PURPOSE OF REVIEW

The aim of this review was to summarize the recent literature on the clinical symptoms, functioning, outcomes and treatments for older adults with chronic schizophrenia.

RECENT FINDINGS

The number and proportion of older adults with schizophrenia is rapidly increasing. Schizophrenia is a heterogeneous disorder and older adults with schizophrenia display significant variability in symptom severity, quality of life and overall outcomes. Many achieve stable disease remission, some display persistent nonremission and others experience fluctuating symptoms. Depression is commonly reported, and although rates of suicide are higher when compared with age-matched peers, the excess mortality seen in this population is mainly attributed to natural causes of death. Cognitive decline and reduced illness awareness have important implications for functional status and quality of life. Antipsychotics remain essential in the treatment regimen, although elderly patients with chronic disease may be good candidates for gradual dose reduction. Interdisciplinary treatment approaches as well as nonpharmacologic psychosocial interventions play a critical adjunctive role in the treatment of older adults with schizophrenia.

SUMMARY

Research focusing on schizophrenia in late life is sparse. Too often, older patients are eliminated from research studies or averaged in with all age groups. Thus, there continues to be gaps in our understanding of modifiable predictors of remission and recovery, and the most efficacious and safest treatment approaches for this age group.