Psychopharmacology and Psychiatry Updates

In this engaging discussion, Oliver Freudenreich, a psychopharmacology expert, explores the revolutionary antipsychotic KarXT, which targets the cholinergic system instead of dopamine pathways. He shares insights from promising Phase 3 trial results, indicating KarXT's potential to treat schizophrenia with fewer motor-related side effects. This innovative approach not only showcases the drug's clinical efficacy but also discusses its potential FDA approval and implications for transforming how schizophrenia is managed.

In a thought-provoking discussion, Scott Zeller, Vice President for Acute Psychiatry at Vituity and former president of the American Association for Emergency Psychiatry, challenges traditional views on managing agitation. He emphasizes the importance of involving patients in medication decisions, even in crises. The conversation addresses the stigma of 'chemical restraints' and promotes respectful, patient-centered approaches that prioritize calming strategies. Zeller advocates for innovative methods blending medication with verbal de-escalation to enhance outcomes in emergency settings.

Scott Beach, an expert in psychopharmacology, shares groundbreaking research on famotidine, a common heartburn medication, and its potential to treat post-COVID brain fog. The discussion highlights the cognitive challenges faced by recovering patients and how this unlikely candidate could alleviate mental haziness. Beach dives into the mechanisms behind famotidine’s effects and presents compelling evidence from clinical assessments. The conversation underscores the urgent need for effective treatments for those grappling with lingering cognitive impairment.

Dr. Scott Zeller, an expert in emergency psychiatry and past president of the American Association for Emergency Psychiatry, reveals transformative insights on managing agitation. He emphasizes the significant drawbacks of using physical restraints, which can extend emergency department stays by four hours. Dr. Zeller introduces essential verbal de-escalation techniques, stressing the power of calm communication and the '10 de-escalation commandments' to improve outcomes. His evidence-based approach aims to enhance patient safety and care in crisis situations.

In this episode, we explore the RADAR trial's findings on antipsychotic dose reduction in schizophrenia. Can patients with chronic schizophrenia safely reduce or discontinue their antipsychotic medications without increasing relapse risk? The trial's results challenge common assumptions about medication reduction and provide crucial guidance for clinical practice. Faculty: Oliver Freudenreich, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.5 CME: Quick Take Vol. 62 Antipsychotic Dose Reduction in Schizophrenia: Insights From the RADAR Trial  

In this episode, we explore the challenges of diagnosing and managing agitation in emergency settings, focusing on mood disorders and substance use. Dr. Scott Zeller shares insights on differentiating acute mania from substance-induced psychosis. How can clinicians navigate the complex interplay between psychiatric symptoms and substance effects in emergencies? Faculty: Scott Zeller, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CME: The Psychopharmacology of Agitation: Managing Behavioral Emergencies Other Psychiatric Diagnoses in Agitated Patients: Mood and Substance Use Disorders

Oliver Freudenreich, a Boston-based psychiatrist and expert at the Psychopharmacology Institute, dives into the intriguing world of high-dose olanzapine as a potential alternative for treatment-resistant schizophrenia. The conversation highlights the challenges and risks associated with doses exceeding FDA limits. Oliver compares high-dose olanzapine to clozapine, discussing its efficacy based on a systematic review of various studies. They stress the necessity for patient-centered care, emphasizing informed discussions about long-term side effects like metabolism and weight gain.

David Mintz, Director of Psychiatric Education at the Austin Riggs Center, shares his expertise on fusing psychodynamic principles with pharmacotherapy. He discusses how understanding a patient's emotional landscape can dramatically influence their treatment outcomes. The conversation highlights the importance of recognizing patients' fantasies about their illness and the role of medications as transitional objects. Mintz emphasizes the need for a strong therapeutic alliance to tackle treatment-resistant depression effectively, enhancing both adherence and overall health.

Guest Paul Zarkowski, a faculty member at the Psychopharmacology Institute, discusses a groundbreaking Israeli study on tapering benzodiazepines in elderly hospital patients. He highlights the significant risks associated with prolonged use, including falls and cognitive decline. The study's two interventions show modest success in encouraging medication discontinuation. Zarkowski emphasizes the importance of patient education, proper tapering protocols, and communication between physicians to improve long-term outcomes and care continuity for this vulnerable population.

In this episode, we explore the critical role of therapeutic alliance in psychopharmacology. We discuss how factors like empathy, communication, and shared decision-making can significantly impact treatment outcomes. Did you know that a doctor's warm voice can increase appointment adherence by 162%? Faculty: David Mintz, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1 CME: Psychodynamic Psychopharmacology: Alliance, Communication, and Psychotherapy Skills Pharmacotherapy Alliance, Treatment Preferences, and Communication