Podcasts about risperidone

These are some horror stories of people who took Risperidone...

Send us a textDr. Richard Scranton, M.D., M.P.H., is the President of Global Product Development and the Chief Medical Officer of Lyndra Therapeutics ( https://lyndra.com/ ), a company pioneering long-acting oral therapies, designed to deliver medicine for up to a week or longer in an oral form. Dr. Scranton is responsible for advancing the company's proprietary LYNX™ drug delivery platform ( https://lyndra.com/platform/ ) and evolving and overseeing portfolio strategy, current and future product development from preclinical through commercialization, and external partnerships and alliances. Dr. Scranton has 20+ years of expertise in pharmaco-epidemiologic research, clinical epidemiology, health services research and clinical trials research.Prior to joining Lyndra, Dr. Scranton held roles with increasing responsibility at Pacira Pharmaceuticals, including Chief Medical Officer, where he led the global development and advancement of their non-opioid long-lasting injectable local anesthetic. Dr. Scranton also served as Chief Medical Officer at VeroScience, where his responsibilities included all aspects of clinical development, regulatory and pharmacovigilance of their investigational drugs in the metabolic disease and immunological domains. Dr. Scranton also has served as instructor in medicine at Harvard Medical School and associate physician in the division of aging at Brigham and Women's Hospital, associate medical director and research consultant for Phase V Technologies, assistant clinical professor of medicine at the Uniformed Services University of the Health Sciences and a senior research fellow at the Massachusetts Veterans Administration Epidemiology, Research and Information Center (MAVERIC).Dr. Scranton earned a Bachelor of Arts from the University of Tennessee and a Doctor of Medicine from the Quillen College of Medicine at Eastern Tennessee State University. He completed his internship and residency in internal medicine at the Naval Medical Center in Portsmouth, Va, and served as chief resident. He completed his Harvard General Medicine Fellowship and received a Master of Public Health from the Harvard School of Public Health. #RichardScranton #LyndraTherapeutics #LongActing #OralTherapies #Risperidone #Pharmacoepidemiology #MedicationAdherence #RobertLanger #BiochemicalEngineering #Schizophrenia #OpioidUseDisorder #PregnancyPrevention #Pharmacokinetics #ProgressPotentialAndPossibilities #IraPastor #Podcast #Podcaster #ViralPodcast  #STEM #Innovation #Technology #Science #ResearchSupport the show

In this episode, we explore the use of risperidone in treating anorexia nervosa in children and adolescents. We discuss a groundbreaking study examining its efficacy and tolerability. Can atypical antipsychotics like risperidone offer hope for young anorexia patients, or are we still searching for effective pharmacological treatments? Faculty: David Rosenberg, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.5 CME: CAP Smart Takes Vol. 18 Efficacy of Risperidone as Treatment for Anorexia Nervosa

Join us as we discuss a second generation antipsychotic, Risperidone (Risperdal). We will also cover some the long-acting injectable formulations such as Consta, Uzedy and Perseris. Answer to Poll Question Below (SPOILER) ----------------------------------------------------------------- Answer: D (Low-dose Aripiprazole)

Contributor: Taylor Lynch, MD Educational Pearls: What is NMS? Neuroleptic Malignant Syndrome Caused by anti-dopamine medication or rapid withdrawal of pro-dopamenergic medications Mechanism is poorly understood Life threatening What medications can cause it? Typical antipsychotics Haloperidol, chlorpromazine, prochlorperazine, fluphenazine, trifluoperazine Atypical antipsychotics Less risk Risperidone, clozapine, quetiapine, olanzapine, aripiprazole, ziprasidone Anti-emetic agents with anti dopamine activity Metoclopramide, promethazine, haloperidol Not ondansetron Abrupt withdrawal of levodopa How does it present? Slowly over 1-3 days (unlike serotonin syndrome which has a more acute onset) Altered mental status, 82% of patients, typically agitated delirium with confusion Peripheral muscle rigidity and decreased reflexes. AKA lead pipe rigidity. (As opposed to clonus and hyperreflexia in serotonin syndrome) Hyperthermia (>38C seen in 87% of patients) Can also have tachycardia, labile blood pressures, tachypnea, and tremor How is it diagnosed? Clinical diagnosis, focus on the timing of symptoms No confirmatory lab test but can see possible elevated CK levels and WBC of 10-40k with a left shift What else might be on the differential? Sepsis CNS infections Heat stroke Agitated delirium Status eptilepticus Drug induced extrapyramidal symptoms Serotonin syndrome Malignant hyperthermia What is the treatment? Start with ABC's Stop all anti-dopaminergic meds and restart pro-dopamine meds if recently stopped Maintain urine output with IV fluids if needed to avoid rhabdomyolysis Active or passive cooling if needed Benzodiazapines, such as lorazepam 1-2 mg IV q 4hrs What are active medical therapies? Controversial treatments Bromocriptine, dopamine agonist Dantrolene, classically used for malignant hyperthermia Amantadine, increases dopamine release Use as a last resort Dispo? Mortality is around 10% if not recognized and treated Most patients recover in 2-14 days Must wait 2 weeks before restarting any medications References Oruch, R., Pryme, I. F., Engelsen, B. A., & Lund, A. (2017). Neuroleptic malignant syndrome: an easily overlooked neurologic emergency. Neuropsychiatric disease and treatment, 13, 161–175. https://doi.org/10.2147/NDT.S118438 Tormoehlen, L. M., & Rusyniak, D. E. (2018). Neuroleptic malignant syndrome and serotonin syndrome. Handbook of clinical neurology, 157, 663–675. https://doi.org/10.1016/B978-0-444-64074-1.00039-2 Velamoor, V. R., Norman, R. M., Caroff, S. N., Mann, S. C., Sullivan, K. A., & Antelo, R. E. (1994). Progression of symptoms in neuroleptic malignant syndrome. The Journal of nervous and mental disease, 182(3), 168–173. https://doi.org/10.1097/00005053-199403000-00007 Ware, M. R., Feller, D. B., & Hall, K. L. (2018). Neuroleptic Malignant Syndrome: Diagnosis and Management. The primary care companion for CNS disorders, 20(1), 17r02185. https://doi.org/10.4088/PCC.17r02185 Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSIII  

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This woman was wrongfully prescribed Risperidone. Now she is dealing with the horrible side effects years later.

When should women begin receiving biennial screening for breast cancer? Find out about this and more in today's PeerDirect Medical News Podcast.

The Frontier Psychiatrist's newsletter? It is what you are reading. It's a health-themed publication written by Owen Scott Muir, M.D. This is a brief detour from my recent series on medications, many of which have a critical slant. Those include Risperidone, Depakote, Geodon, Ambien, Prozac, Xanax, Klonopin, Lurasidone, Olanzapine, Zulranolone, Benzos, Caffeine, Semeglutide, Lamotrigine, Cocaine, Xylazine, Lithium, dextromethorphan/bupropion and Adderall, etc. I write this all by myself every day. Consider subscribing. (the paywall starts 5 weeks back, and there are 360something articles back there). It makes a horrible or awesome gift, depending on your friend circle. I also get paid more money by Amazon if my readers buy stuff now, like, for example, my favorite book about mental illness—or this tea I drink daily. I also encourage you to send me this coffee maker— or, more realistically, to anyone else.Today, I address what happens when schizophrenia is not treated, even if it is. It has high morbidity and mortality, a problem that medications address. Effectively. Not without costs, but the best data suggests treatment is better than no treatment for most people.I'm going to cut to the chase briefly, and if you or a family member want to read a great book on treatment with antipsychotic medicine, I'd recommend this one. Jeff Leiberman, M.D., has been …controversial… of late. However, there is no denying his role in understanding schizophrenia and its treatment, and his book on the topic is worth a read or listen, called a Malady of the Mind.Psychotic. We use the word commonly in chit-chat to denote something is bad. Unreasonable. Wrong. Deranged. Nothing is beguiling about the word. It is a thing to deny in oneself— “I am not psychotic!”Understanding PsychosisSome people don't get that luxury. Some people are honest-to-goodness psychotic. Most of us do not know what that means. Some of us do, and some smaller portions are blessed with the ability to spend time on both sides of that psychotic equation. I will define the term:Psychosis refers to a collection of symptoms that affect the mind, where there has been some loss of contact with reality. During an episode of psychosis, a person's thoughts and perceptions are disrupted and they may have difficulty recognizing what is real and what is not. The most common illness we associate with psychosis is schizophrenia. Psychosis can occur with depression, bipolar disorder, and other maladies. Depression and mania are mood states; we refer to these mixed with psychotic symptoms as affective disorders in psychiatry. A brief grammar note, brought to you by Grammarly, a tool I use and—sadly—am not paid to promote:Is affective just another word for effective? Are the two words similar and entangled in the way the verbs affect and effect are? No, affective is not just another word for effective. And affective and effective are not derived from the verbs affect and effect. They come from the nouns affect and effect.There is a difference in the literature—and in the lives of patients—when it comes to illnesses that have affective psychosis and non-affective psychosis. Much of the anti-psychiatry crowd focuses on affective disorders and argues about the side effects of those treatments. Less attention is paid to non-affective psychosis because It's not as compelling an argument. These are challenging illnesses either way and are associated with significant morbidity—impairments in life—and mortality—early death.“Uncured of Worse”: 1937.As far back as 1937, authors noted the grim prospects in the long-term course of schizophrenia (in this context, I'm referring to largely “non-affective psychosis” —where the delusions or hallucinations are not tied to mood episodes):Of the 100 cases, 66% were uncured or worse after the lapse of 6-10 years, with persisting process symptoms or in a defective state after the course had run; 13% were improved, 4% were cured with defects, and 17% were completely cured. “The Prognosis is Poor”: 2010By 2010, with decades of more data, the conclusion was much the same—schizophrenia sucks, even compared to other admittedly bad illnesses:Our 26-year longitudinal study and other longitudinal studies confirm older views that outcome for schizophrenia, while showing some variation for different schizophrenia patients, is still significantly poorer than that for other psychiatric disorders.A large NIMH follow-up study with 2 to 10 years of time following patients from a first episode that required hospitalization demonstrated:The sample showed substantial functional impairment and levels of symptoms, with only about 20% of the sample demonstrating a good outcome…The “not-good” outcomes looked like this:78% of the sample suffered a relapse, 38% attempted suicide and 24% had episodes of major affective illness.Beyond Psychiatric Problems?We tend to focus on the role of bad psychiatric outcomes as psychiatrists. Still, the medical outcomes are similarly troubling, including high smoking rates, metabolic syndrome, heart disease, HIV, Hepatitis C, and other medical illnesses. Overall, this leads to an extremely disheartening finding: having schizophrenia is an illness that takes a tremendous toll on the individual and their family and leads to early death and disability at unacceptably high rates:Persons with schizophrenia have an exceptionally short life expectancy. High mortality is found in all age groups, resulting in a life expectancy of approximately 20 years below that of the general population. Evidence suggests that persons with schizophrenia may not have seen the same improvement in life expectancy as the general population during the past decades. Thus, the mortality gap not only persists but may actually have increased.Comparisons are useful, and if we look at HIV after the introduction of HAART (Highly Active Anti-Retroviral Therapy), we find:HIV-related mortality decreased from 6.5 to 1.3 per 100,000 population (80% decrease, p = 0.0115). New HIV diagnoses declined from 702 to 238 cases (66% decrease; p = 0.0004) with a consequent estimated decline in HIV incident cases from 632 to 368 cases per year (42% decrease; p = 0.0003).And if we compare that to schizophrenia, in the largest meta-analysis I could find, we find:The mortality risk for patients with schizophrenia was 1249 per 100 000 … (95% CI, 1029-1469)Psychosis is Bad Compared to Other Bad ThingsThe mortality from schizophrenia is 19,215% higher than from pre-HAART HIV infection and 96,076% higher than from HIV with HAART treatment. If you had to choose between HIV and schizophrenia, HIV is safer—with or without treatment.To make the point even more clearly, even having a car crash only has a 0.77% fatality rate, or 770/100,000.If you had to choose between a car crash and schizophrenia, the car crash is safer.Those outcomes are not good enough. Schizophrenia is impairing and dangerous to your life, especially if untreated. Other psychiatric illnesses are also. Psychiatric medications can modify this risk to your life in the right direction, even with those risks. Tapering them, as we saw in the RADAR trial (lead-authored by a critical psychiatrist, published in the Lancet just this week), doesn't make it better:At 2-year follow-up, a gradual, supported process of antipsychotic dose reduction had no effect on social functioning.And, further, made it worse:here were 93 serious adverse events in the reduction group affecting 49 individuals, mainly comprising admission for a mental health relapse, and 64 in the maintenance group, relating to 29 individuals.It includes twice as many deaths. In a research study, this is a huge deal. The way to look at this is the probability of relapsing is bad, and it's statistically more likely and with more than double likelihood if you were randomized to a taper protocol.Antipsychotic Medication Saves Lives. It has Burdens. These Choices are Difficult. We need to do better, but the haters are incorrect. We have done better than nothing, even with imperfect tools, even when examined by those who have an axe to grind with those very tools. Treatment of schizophrenia saves lives.Stay Humble,Faced with Suffering, and Carry On—Owen Scott Muir, M.D. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

My favorite opening line of an academic article (this week) follows:Mental illnesses are prevalent, cause great suffering, and are burdensome to society.Welcome to the Frontier Psychiatrists. It's a newsletter that I write all by myself. I'm doing a series on medications, largely (but not entirely) in psychiatry. I'm a child and adult psychiatrist, and I still see patients. I've also been a patient since I was 16 years old. Please consider subscribing and sharing widely.The first antipsychotic introduced after clozapine would be a big deal—especially if it didn't cause life-threatening side effects. Risperidone was first developed by the Johnson & Johnson subsidiary Janssen-Cilag between 1988 and 1992 and was first approved by the FDA in 1994. It's one of the very few drugs with data for bipolar disorder that I, personally, have never been prescribed.Risperidone—Risperdal as a trade name—was ready to be a huge hit.It was presented as very atypical—this was the post-clozapine branding of choice. The “second generation” label was added years later. I have a confession to make. After residency, when the attending doctors told me, as a trainee, what to prescribe, I never prescribed risperidone ever again. I think this compound—and paliperidone, the metabolite— still has an important role in managing schizophrenia and bipolar disorder. There are more formulations of long-acting injectable risperidone and related compounds than I can remember. I think those are going to be useful drugs for a long time. Oral risperidone? Nope.Clozapine was an exciting drug. No horrible motor side effects? (Plausibly) More effective? It was better than every drug that came before. It had this pesky adverse effect that could lead to death called agranulocytosis, which I addressed in my first research paper in 2011. We needed more drugs that were this atypical!We—the field of psychiatry, at least— needed things that were not gonna kill you abruptly, in a terrifying manner, like clozapine had the rare potential to do. But we didn't want more of the same old antipsychotics. After Psychiatry got a taste of not having to explain permanent tardive dyskinesia as a likely side effect of antipsychotic medication, we wanted to keep doing that. Editors note: It is still a side effect of all non-clozapine antipsychotics, and we should never have let our guard down.Risperidone was the first antipsychotic that came to market after clozapine rocked the world of psychiatry by being better. Risperidone is similar, and they even use the accidental branding of clozapine— “atypical”—for this medication. The Food and Drug Administration (FDA)-approved indications for oral risperidone (tablets, oral solution, and M-TABs) include the treatment of:* schizophrenia (in adults and children aged 13 and up), * bipolar I acute manic or mixed episodes as monotherapy (in adults and children aged 10 and up), * bipolar I acute manic or mixed episodes adjunctive with lithium or valproate (in adults)* autism-associated irritability (in children aged 5 and up). Also, the long-acting risperidone injection has been approved for the use of schizophrenia and maintenance of bipolar disorder (as monotherapy or adjunctive to valproate or lithium) in adults.The “mechanism of action” of all of the drugs that have efficacy in psychosis was presumed to be dopamine D2 receptor blockade, a mechanism shared with all of the prior medication from Thorazine (chlorpromazine) through Haldol (haloperidol). The assumption—which clozapine disproved—was motor side effects were required for the drug's efficacy in psychosis. This primacy of the D2 blockade as a mechanism of action has since been disproven. This is the mechanism that leads to gynecomastia, leading to a bevy of lawsuits from men who developed breasts. It also causes related side effects like galactorrhea—breast milk from breasts that can be on men or women who are not nursing— and erectile dysfunction. Dopamine—it does a lot of work in the brain, not just pleasure.This motor side effect profile was not true with clozapine. It had various additional receptors, particularly in the serotonergic family (5HT-2a, for example), and alpha-adrenergic, histaminic, and other receptor sites throughout the brain. This broad profile of different receptors explains the wide range of side effects. But more importantly, these are complex, “messy,” and hard-to-predict outcomes given the complexity of the brain. The complex pharmacology allowed psychiatrists like me to think—hard!—about which particular witches brew of receptors we would choose to tickle (agonize) or antagonize. It's very satisfying. I also suspect this is a story we tell ourselves that is not as closely moored to truth as we'd like. We enjoy thinking about science-ish stuff. Receptor binding profiles are seductive— because they are knowable. Our patient's heart, hope, dreams, and heartbreak? Less so.The most important feature of risperidone today—and its 1st order metabolite, paliperidone—is that is deliverable as pills, rapid-acting dissolvable tablets, and long-acting injectable formulations, lasting between 2 weeks and 6 months between doses. A psychiatric treatment that isn't an oral once-daily pill? One you have to take twice a year? Medicine that is intended for people who often—like many—feel conflicted about taking a daily pill? That is a big enough deal. That is a real innovation— it considers human frailty, ambivalence, and common failures of mind. Not because it's a magic drug. Rather, long-acting medicine that doesn't make crippling relapse easy —thanks to good design— is exactly the kind of medicine that works. My second research effort was on the acceptability of such medicines in youth. It's responsible for my presence at the academic conference where I met my now wife.Oral medicines were popular because they were easy to sell. Novel medicines and technologies will be easy to take. The story of my fascination with the risks and benefits of these medicines doesn't end there, though.I still research these medicines and their adverse effects— funded by NIMH— for identifying Tardive Dyskinesia with Machine Learning and closed-loop Internet of Things physical medication compliance tech with my team at iRxReminder and colleagues at Videra. We are enrolling in a study at Fermata in New York and other sites. Thanks for reading.This article is another in my series about one drug or another. Prior installments include Depakote, Geodon, Ambien, Prozac, Xanax, Klonopin, Lurasidone, Olanzapine, Zulranolone, Benzos, Caffeine, Semeglutide, Lamotrigine, Cocaine, Xylazine, Lithium, dextromethorphan/bupropion and Adderall, etc.Sponsored Content!One way of supporting this publication is buying stuff from Amazon, like a nifty box from Apogee that I used to record the voice-over: the BOOM. In fairness, it's just the A/D. I am also using the API 512c mic pre, plugged into an AnaMod 660 500 series compressor, nestled in a reliable RND R6 Lunchbox, and all of that plugs into the Boom into my Mac. It's a Microtech Geffel mic. Most of the audio post-processing is done with Izotope RX 10. I get money if you purchase any of these things— not a trivial amount since they upped my affiliate rewards.In case anyone was wondering if I was an audio nerd… This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

In this episode, you'll discover the preferred second-generation antipsychotics for augmenting treatment for obsessive-compulsive disorder: Risperidone and aripiprazole. We discuss their effectiveness and important considerations when choosing between them. What factors should clinicians weigh when deciding on an augmentation strategy? Faculty: David Osser, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CME: Algorithm for the Pharmacotherapy of Obsessive-Compulsive Disorder Node 4: SSRI Augmentation With SGA

On this episode, I discuss risperidone pharmacology, adverse effects, monitoring, and common indications. There are numerous drug interactions that I discuss in this podcast episode. CYP2D6 inhibitors may increase drug concentrations. Risperidone increases prolactin more than most 2nd generation antipsychotics. This can lead to sexual adverse effects. QTC prolongation is a concern with all antipsychotics like risperidone. We can monitor EKG to monitor for this risk.

This is the 15th podcast episode for the Psychiatric Medication Podcast Series. Series Description: Current literature indicates that podcasts can be an effective educational format to reach health professionals across the continuum of medical education, addressing a myriad of topics pertinent to providers. This episode serves as an overview of Risperidone/Risperdal & Paliperidone/Invega. This podcast season is the second released by East Carolina University's Office of Continuing Medical Education and may be beneficial for physicians, residents, fellows, nurse practitioners, physician assistants, and nurses. This podcast season is comprised of approximately 30 episodes, each focusing on different psychiatric medications for the non-psychiatric provider. Those tuning into the podcast's second season will receive a primer on the "bread and butter" behavioral health medications for primary care: antidepressants, antipsychotics, and mood stabilizers. Episodes will be released weekly on Wednesdays.Jennifer B. Stanley, MD & Maxwell Miller, DO

In this podcast episode, Leslie Citrome, MD, MPH, and Adam Lowy, MD, share a wealth of knowledge about long-acting injectable (LAI) antipsychotics. Their conversation begins with an overview of the pharmacokinetic profiles of LAI antipsychotics and how they differ from their oral counterparts, as well as injection intervals available with current formulations. The experts also discuss the clinical utility of LAI antipsychotics in psychiatry practice, highlighting their role in assuring medication adherence and their application in both first- and later-episode psychosis. Finally, Drs Citrome and Lowy hit on practical aspects of incorporating LAI antipsychotics into patient care: communicating with patients to dispel myths and stigma surrounding injectable medications, identifying injection resources in your medical community, and strategies to navigate insurance barriers.Throughout the podcast, Drs Citrome and Lowy reference several links to outside sources that can provide valuable education on LAI antipsychotics. Those links are listed below for your convenience.Administering LAI Into Dorsal Gluteal Site: https://bit.ly/3XjSm5aAdministering LAI Into Deltoid Site: https://bit.ly/3Xlyq1LAdministering LAI Into Abdominal Site: https://bit.ly/3wgGJ2ZPresenters:Leslie Citrome, MD, MPHClinical ProfessorDepartment of Psychiatry and Behavioral SciencesNew York Medical CollegeValhalla, New YorkAdam Lowy, MDStaff PsychiatristEllenhornLos Angeles, CaliforniaThis activity is supported by educational funding provided byOtsuka America Pharmaceutical, Inc. and Lundbeck.For additional activities in this program, visit:https://bit.ly/3iM0HiP

The use of the combination of stimulants and antipsychotic medications is increasing in pediatric patients who suffer from Attention Hyperactivity Disorder (ADHD). In this podcast, Dr. Mohamed Mohamoud discusses how this combination may result in acute hyperkinetic movement disorder in children. Using the FDA Adverse Event Reporting System database, Dr. Mohamoud and his colleagues conducted a case series analysis and identified 36 instances where a pharmacodynamic drug-drug interaction may have resulted in the disorder. Their report is published in the May/June 2022 issue of the Journal of Clinical Psychopharmacology. Prescribing information has recently been updated and this podcast discusses the data upon which that information was changed. Dr. Mohamoud is being interviewed by FDA press officer Charlie Kohler.

Here is the subreddit used in this podcast: https://www.reddit.com/r/schizophrenia/ Don't forget you can check out all things casual at: https://linktr.ee/Casual_Empire Also you can email me at: mentalhealthcasual@gmail.com In this podcast, we talk about the effectiveness of Risperidone as well as the problems with auditory hallucinations.

Can biologics lower COVID-19 hospitalization risk in patients with psoriasis? Find out about this and more in today's PV Roundup podcast.

Sanjay Gupta, MD, conducts a Masterclass on treating geriatric patients with symptoms of dementia, particularly amid the restrictions tied to COVID-19. Dr. Gupta is chief medical officer at BryLin Hospital in Buffalo, N.Y. He is also is a clinical professor in the department of psychiatry at the State University of New York, Syracuse, and is affiliated with SUNY at Buffalo. Dr. Gupta attends at 8-10 nursing homes. He disclosed serving on the speakers’ bureaus of AbbVie, Acadia, Alkermes, Intra-Cellular Therapies, Janssen, and Otsuka. Take-home points Common neuropsychiatric symptoms in patients with dementia include agitation, aggression, delusions, insomnia, anxiety, and depression. One-third of community-dwelling elders and between 60%-80% of nursing facility patients have these neuropsychiatric symptoms. The most common medication class Dr. Gupta uses is antipsychotics. The use of these medications in individuals with dementia is off label. The Food and Drug Administration maintains a black-box warning on the use of antipsychotics for geriatric patients because of the increased risk of sudden death. Risperidone is supported by the most data, then olanzapine, then aripiprazole, and finally quetiapine. Quetiapine has very limited data to support its efficacy. Most antipsychotics have modest efficacy data for their use in this population. The riskiest adverse effects are cardiovascular adverse events, which are higher in risperidone. Dr. Gupta starts risperidone at a low dose of 0.25 mg taken by mouth b.i.d. and titrates to a maximum dose of 2 mg/24 hours. The starting dose for olanzapine is 2.5 mg up to a maximum dose of 10 mg. The starting dose of aripiprazole is 1 mg, and maximum dose 5 mg or less. Selective serotonin reuptake inhibitors (most commonly sertraline or citalopram), the atypical antidepressant mirtazapine, and anticonvulsants (valproic acid) are also used for agitation in dementia but there is limited evidence for their efficacy. Melatonin and trazodone have a positive effect on sleep that can have downstream improvement on aggressive behaviors. Summary To choose an effective treatment, it’s essential to obtain a detailed history of the symptoms from patients and collateral, such as relatives and staff members from the facility. Staff members can be educated about what information is most important to the clinician, or they may provide vague information, such as “the patient is confused.” Specific symptoms that can be used guide treatment include the presence of disorganized thoughts, delusions and paranoia, or visual and/or auditory hallucinations; the timing of the behavior (day vs. night); and patterns of aggressive behaviors. Dr. Gupta emphasizes that it’s important to rule out delirium as the cause of agitation by evaluating underlying medical issues with laboratory evaluations, and when possible, a physical exam. Antipsychotics work best in the context of aggression driven by paranoia and/or delusions of persecution. Antipsychotics seem to work less well for general agitation that may be driven by triggers that need to be uncovered through investigation of the history and environment. Reasons for agitation and aggression might include sensory or activity deprivation, difficulty emptying bladder or bowels, or depression and loneliness, both of which are prevalent during the pandemic. Adverse effects of antipsychotics will be greater in older adults, and include sedation, gait problems that increase the risk of falls, and extrapyramidal or Parkinsonian symptoms. In a geriatric patient, tardive dyskinesia can occur with as little as 1 month of exposure to an antipsychotic, compared with 3 months in younger adults. Before starting an antipsychotic, the clinician must obtain informed consent from the health-care proxy and inform them that using antipsychotics in a patient with dementia is a non–FDA-approved treatment with a black-box warning. Gradual dose reduction, a Medicare policy about the use of psychotropic medications within nursing homes, is defined as “stepwise tapering of a dose to determine if symptoms, conditions, or risks can be managed by a lower dose or if the dose or medication can be discontinued.” Dr. Gupta addresses this policy by assessing which medications are essential and often stopping some medications once the patient is started on antipsychotics. References Steinberg M, Lyketsos CG. Am J Psychiatry. 2012 Sep;169(9):900-6. Maher AR et al. JAMA. 2011 Sep 28;306(12):1359-69. Schneider LS et al. JAMA. 2005 Oct 19;294(15):1934-43. Seitz DP et al. Cochrane Database Sys Rev. 2001 Feb 16;(12):CD0089. Ballard C et al. Cochrane Database Sys Rev. 2006 Jan 25. doi: 10.1002/14651858. Ballard C, Waite J. Cochrane Database Sys Rev. 2006 Jan 25;(1):CD003476. Department of Health & Human Services. State Operations Manual Surveyor Guidance Revisions Related to Psychosocial Harm in Nursing Homes. CMS.gov. 2016 Mar 25. *  *  * Show notes by Jacqueline Posada, MD, associate producer of the Psychcast; assistant clinical professor in the department of psychiatry and behavioral sciences at George Washington University, Washington; and staff physician at George Washington Medical Faculty Associates, also in Washington. Dr. Posada has no conflicts of interest. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com

Thank you Ray Kwong, OMS III for developing the topic and finding the great articles! Thank you Brandon Trujillo OMS IV and Natalie Pratt, OMS IV for participating. This podcast is of minimal shelf exam benefit. It does address the key issues of recognition of Tourette's Syndrome and treatment that may show up on practice tests and shelf exams. This article by Kevin Black describes the ongoing research into tics and a great summary of current information about the condition. It is freely available through Pubmed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316401/ Aripiprazole and Haloperidol have FDA indications for treatment of Tourette's, but not Risperidone. The correct pronunciation of Premonitory (very different than how we were saying it)! https://www.youtube.com/watch?v=2kaGcByXeDE ed 8/25/2020 to include correct pronunciation of "Premonitory"

Says it all in the title.

Tales of good and bad experiences with psychiatric medication, Lithium, Lamotrigine, Pregabalin, Abilify, Latuda, Risperidone,...

Podcast summary of articles from the October 2017 edition of Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include trauma patients on anticoagulation, terrorist stabbings, anticholinergic syndrome, risperidone use in intoxicated patients, chest pain admissions, and board review on cellulitis.  Guest speakers include Dr. Michael Weinstock from the Ohio State University and Dr. Tona Rios-Alba from the Cleveland Clinic Emergency Services Institute.

Risperidone, a drug used to reduce irritability in people with autism, was not as effective as estrogens in correcting autism-like behavior in a study on zebrafish. Matthew State of the University of California, San Francisco and a team of international scientists introduced a gene known to cause autism in humans into these fish. They found that estrogens completely stopped their nighttime hyperactivity, which is a symptom of autism. Risperidone also prevented this behavior, but it made the fish less active during the day. "It doesn't explain why risperidone works. What it did do, was say, that of the medications that we know are FDA-approved for autism, they also will correct some of the abnormalities that are a consequence of these mutations in zebrafish. What we’re hoping for is that if we find a point of biological convergence, that will help narrow in on really the critical aspect of biology that is potentially, a target for therapeutics."

Interview with John H. Krystal, MD, author of Adjunctive Risperidone Treatment for Antidepressant-Resistant Symptoms of Chronic Military Service-Related PTSD

Background: As schizophrenia patients are typically suspicious of, or are hostile to changes they may be reluctant to accept generic substitution, possibly affecting compliance. This may counteract drug costs savings due to less symptom control and increased hospitalization risk. Although compliance losses following generic substitution have not been quantified so far, one can estimate the possible health-economic consequences. The current study aims to do so by considering the case of risperidone in Germany. Methods: An existing DES model was adapted to compare staying on branded risperidone with generic substitution. Differences include the probability of non-compliance and medication costs. Incremental probability of non-compliance after generic substitution was varied between 2.5% and 10%, while generic medication costs were assumed to be 40% lower. Effect of medication price was assessed as well as the effect of applying compliance losses to all treatment settings. The probability of staying on branded risperidone being cost-effective was calculated for various outcomes of a hypothetical study that would investigate non-compliance following generic substitution of risperidone. Results: If the incremental probability of non-compliance after generic substitution is 2.5%, 5.0%, 7.5% and 10% respectively, incremental effects of staying on branded risperidone are 0.004, 0.007, 0.011 and 0.015 Quality Adjusted Life Years (QALYs). Incremental costs are (sic)757, (sic)343, -(sic)123 and -(sic)554 respectively. Benefits of staying on branded risperidone include improved symptom control and fewer hospitalizations. If generic substitution results in a 5.2% higher probability of non-compliance, the model predicts staying on branded risperidone to be cost-effective (NICE threshold of 30,000 per QALY gained). Compliance losses of more than 6.9% makes branded risperidone the dominant alternative. Results are sensitive to the locations at which compliance loss is applied and the price of generic risperidone. The probability that staying on branded risperidone is cost-effective would increase with larger compliance differences and more patients included in the hypothetical study. Conclusion: The model predicts that it is cost-effective to keep a patient with schizophrenia in Germany on branded risperidone instead of switching him/her to generic risperidone (assuming a 40% reduction in medication costs), if the incremental probability of becoming non-compliant after generic substitution exceeds 5.2%..

The aim of this investigation was to compare the degree of striatal dopamine-(D2) receptor blockade by two atypical antipsychotic drugs, risperidone and olanzapine. The percentage of D2 receptor occupancy during treatment was calculated by comparing the results of 123I-iodobenzamide SPECT with those from healthy control subjects. Twenty inpatients suffering from schizophrenia or schizoaffective psychosis according to DSM IV/ICD-10 criteria were treated with clinically recommended doses of risperidone and compared with 13 inpatients treated with up to 20 mg olanzapine. Neuroleptic dose and D2 receptor blockade correlated strongly for both risperidone (Pearson r = –0.86, p = 0.0001) and olanzapine (Pearson r = –0.77, p = 0.002). There was no significant difference between the D2 receptor occupancy of the two substances when given in the clinically recommended dose range (unpaired t-test, t= –0.112, p=0.911).