Drs John Kane and Christoph U. Correll discuss the major metabolic and neurologic risks associated with antipsychotic medications for patients diagnosed with schizophrenia.

Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/969525). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals.

Resources

Schizophrenia https://www.medscape.com/resource/schizophrenia

Understanding the Effects of Antipsychotics on Appetite Control https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8762106/

Food and Drug Administration's Obesity Drug Guidance Document https://www.ahajournals.org/doi/10.1161/circulationaha.111.028381

Risk of Weight Gain for Specific Antipsychotic Drugs: A Meta-analysis https://www.nature.com/articles/s41537-018-0053-9

Diabetes and Schizophrenia https://link.springer.com/article/10.1007/s11892-015-0704-4

Brain Insulin Action: Implications for the Treatment of Schizophrenia https://www.sciencedirect.com/science/article/abs/pii/S0028390819301960?via%3Dihub

Obesity as a Risk Factor for Accelerated Brain Ageing in First-Episode Psychosis -- A Longitudinal Study https://academic.oup.com/schizophreniabulletin/article-abstract/47/6/1772/6291438

Body Mass Index Identified as an Independent Predictor of Psychiatric Readmission https://pubmed.ncbi.nlm.nih.gov/25004198/#:~:text=Conclusions%3A%20Body%20mass%20index%20was,be%20explored%20in%20prospective%20studies

Metabolic Syndrome and Illness Severity Predict Relapse at 1-Year Follow-Up in Schizophrenia: The FACE-SZ Cohort https://pubmed.ncbi.nlm.nih.gov/30257079/

Incidence and Severity of Tardive Dyskinesia Increase With Age https://jamanetwork.com/journals/jamapsychiatry/article-abstract/492775

Extrapyramidal Symptoms With Atypical Antipsychotics: Incidence, Prevention and Management https://reference.medscape.com/medline/abstract/15733025

Drs John Kane and Stefan Leucht discuss the effectiveness and optimal dosing of antipsychotic medications in the treatment of schizophrenia.

Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/969527). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals.

Resources

Toward a Phenomenological Psychotherapy for Schizophrenia https://www.karger.com/Article/FullText/500163

APA Releases New Practice Guideline on Treatment of Patients with Schizophrenia https://www.psychiatry.org/newsroom/news-releases/apa-releases-new-practice-guideline-on-treatment-of-patients-with-schizophrenia

Pharmacological Treatments for First-Episode Schizophrenia https://academic.oup.com/schizophreniabulletin/article/31/3/705/1894509?login=false

Putting the Efficacy of Psychiatric and General Medicine Medication Into Perspective: Review of Meta-analyses https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/putting-the-efficacy-of-psychiatric-and-general-medicine-medication-into-perspective-review-of-metaanalyses/39C15F3428BDD1F8A4C152B67C06A5A6

The Nature of Relapse in Schizophrenia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599855

20-Year Nationwide Follow-Up Study on Discontinuation of Antipsychotic Treatment in First-Episode Schizophrenia https://pubmed.ncbi.nlm.nih.gov/29621900/

Amisulpride and Olanzapine Followed by Open-Label Treatment With Clozapine in First-Episode Schizophrenia and Schizophreniform Disorder (OPTiMiSE): A Three-Phase Switching Study https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30252-9/fulltext

Clozapine https://reference.medscape.com/drug/clozaril-versacloz-clozapine-342972

Lurasidone Dose Escalation in Early Nonresponding Patients With Schizophrenia: A Randomized, Placebo-Controlled Study https://www.psychiatrist.com/jcp/schizophrenia/lurasidone-in-early-nonresponding-schizophrenia/

Dose-Response Meta-Analysis of Antipsychotic Drugs for Acute Schizophrenia https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19010034

Examination of Dosing of Antipsychotic Drugs for Relapse Prevention in Patients With Stable Schizophrenia: A Meta-analysis https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2783296

Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2725088

Drs John Kane and Jonathan M. Meyer discuss what new antipsychotic drugs are available for schizophrenia. What drugs are under development? And what do they potentially offer?

Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/969528). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals.

Resources

The Clozapine Handbook: Stahl's Handbooks (Stahl's Essential Psychopharmacology Handbooks) New Edition https://www.amazon.com/Clozapine-Handbook-Handbooks-Essential-Psychopharmacology/dp/1108447465

The Clinical Use of Antipsychotic Plasma Levels: Stahl's Handbooks (Stahl's Essential Psychopharmacology Handbooks) Kindle Edition https://www.amazon.com/Clinical-Antipsychotic-Plasma-Levels-Psychopharmacology-ebook-dp-B09B3VMM8N/dp/B09B3VMM8N

Clinical Use of Reserpine in Psychiatry: Comparison With Chlorpromazine https://nyaspubs.onlinelibrary.wiley.com/doi/epdf/10.1111/j.1749-6632.1955.tb42463.x

Arvid Carlsson https://www.nobelprize.org/prizes/medicine/2000/carlsson/facts/

Clozapine: Guidelines for Clinical Management https://pubmed.ncbi.nlm.nih.gov/2670914/

Clozapine: Medscape Drugs & Diseases https://reference.medscape.com/drug/clozaril-versacloz-clozapine-342972

Tardive Dyskinesia Prevalence in the Period of Second-Generation Antipsychotic Use: A Meta-analysis https://www.psychiatrist.com/jcp/movement-disorder/tardive-dyskinesia-prevalence/

Efficacy and Safety of Lumateperone for Treatment of Schizophrenia — A Randomized Clinical Trial https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2758022

Trace Amine-Associated Receptor 1 (TAAR1): Molecular and Clinical Insights for the Treatment of Schizophrenia and Related Comorbidities https://pubs.acs.org/doi/10.1021/acsptsci.2c00016

Trace Amine-Associated Receptor 1 Modulates Dopaminergic Activity https://jpet.aspetjournals.org/content/324/3/948.long

A Non-D2-Receptor-Binding Drug for the Treatment of Schizophrenia https://www.nejm.org/doi/10.1056/NEJMoa1911772

A Clinical Study to Evaluate the Long-term Safety and Tolerability of an Investigational Drug in People With Schizophrenia https://clinicaltrials.gov/ct2/show/NCT04109950

A Study to Assess the Effects of RO6889450 (Ralmitaront) in Participants With Schizophrenia or Schizoaffective Disorder and Negative Symptoms https://clinicaltrials.gov/ct2/show/NCT03669640

Emerging Schizophrenia Drugs Target Negative Symptoms https://www.medscape.com/viewarticle/953336

Selective Muscarinic Receptor Agonist Xanomeline as a Novel Treatment Approach for Schizophrenia https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2008.06091591

Muscarinic Cholinergic Receptor Agonist and Peripheral Antagonist for Schizophrenia https://www.nejm.org/doi/10.1056/NEJMoa2017015

Risperidone, 2 mg/day vs. 4 mg/day, in First-Episode, Acutely Psychotic Patients: Treatment Efficacy and Effects on Fine Motor Functioning https://www.psychiatrist.com/jcp/schizophrenia/risperidone-mgday-vs-mgday-episode-acutely-psychotic/

Drs John Kane and Philip D. Harvey discuss how physicians can assess cognitive functioning in patients with schizophrenia and how to utilize rehabilitation and technology to address it.

Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/969529). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals.

Resources

Schizophrenia https://www.medscape.com/resource/schizophrenia

Schizophrenia Practice Essentials https://emedicine.medscape.com/article/288259-overview

The Schizophrenia Cognition Rating Scale: An Interview-Based Assessment and Its Relationship to Cognition, Real-World Functioning, and Functional Capacity https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.163.3.426

Comprehensive Review of the Research Employing the Schizophrenia Cognition Rating Scale (SCoRS) https://www.sciencedirect.com/science/article/pii/S0920996419302178

Using a Meta-cognitive Wisconsin Card Sorting Test to Measure Introspective Accuracy and Biases in Schizophrenia and Bipolar Disorder https://www.sciencedirect.com/science/article/abs/pii/S0022395621003903

Developing a Cognitive Training Strategy for First-Episode Schizophrenia: Integrating Bottom-Up and Top-Down Approaches https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4256669/

Brain HQ https://www.brainhq.com/

Training Engagement, Baseline Cognitive Functioning, and Cognitive Gains With Computerized Cognitive Training: A Cross-Diagnostic Study https://europepmc.org/article/pmc/pmc6889599

Efficacy and Safety of the Novel Glycine Transporter Inhibitor BI 425809 Once Daily in Patients With Schizophrenia: A Double-Blind, Randomised, Placebo-Controlled Phase 2 Study https://linkinghub.elsevier.com/retrieve/pii/S2215-0366(20)30513-7

A Study to Test Long-term Safety of BI 425809 in People With Schizophrenia Who Took Part in a Previous CONNEX Study https://clinicaltrials.gov/ct2/show/NCT05211947

Evaluation of the Efficacy of BI 425809 Pharmacotherapy in Patients With Schizophrenia Receiving Computerized Cognitive Training: Methodology for a Double-blind, Randomized, Parallel-group Trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7105423/

Karunatx.com. KarXT https://karunatx.com/pipeline-programs/karxt/

F46. The Potential of M1 Agonists to Treat Cognitive Impairment: Evidence From a Phase 2 Study of KarXT in Schizophrenia (EMERGENT-1) https://pmg.joynadmin.org/documents/1007/6247485871767404791c9d14.pdf

Cognitive Training and Supported Employment for Persons With Severe Mental Illness: One-Year Results From a Randomized Controlled Trial https://academic.oup.com/schizophreniabulletin/article/31/4/898/1877695

Long-Acting Antipsychotic Therapies for Patients With Schizophrenia https://reference.medscape.com/recap/949130

Why Treating Early, Treating Well, and Treating for Life Is Important in Schizophrenia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991981/

Progressive Brain Change in Schizophrenia: A Prospective Longitudinal Study of First-Episode Schizophrenia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3496792/

P515. Genomic Analyses of Schizophrenia and Bipolar Disorder Patients With Very Poor Outcomes https://www.researchgate.net/publication/360255195_P515_Genomic_Analyses_of_Schizophrenia_and_Bipolar_Disorder_Patients_With_Very_Poor_Outcomes

Challenges in Assessment of Daytime Sleepiness in Cognitively Impaired Populations Can Be Bypassed Through Use of Ecological Momentary Assessment https://scholarship.miami.edu/esploro/outputs/report/Challenges-in-Assessment-of-Daytime-Sleepiness/991031600661502976

Evidence for Avolition in Bipolar Disorder? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141033/

Drs John Kane and Anil Malhotra discuss neuroimaging and connectivity between various regions of the brain in patients with schizophrenia and how it impacts the pathophysiology and treatment response.

Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/969530). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals.

Resources

Schizophrenia https://www.medscape.com/resource/schizophrenia

Diffusion Tensor Imaging Measures of White Matter Compared to Myelin Basic Protein Immunofluorescence in Tissue Cleared Intact Brains https://www.sciencedirect.com/science/article/pii/S235234091630779X?via%3Dihub

Baseline Striatal Functional Connectivity as a Predictor of Response to Antipsychotic Drug Treatment https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845897/

Dissecting Heterogeneity of Treatment Response of First Episode Schizophrenia https://grantome.com/grant/NIH/P50-MH080173-05

The M1/M4 Preferring Muscarinic Agonist Xanomeline Modulates Functional Connectivity and NMDAR Antagonist-Induced Changes in the Mouse Brain https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115158/

Therapeutic Potential of TAAR1 Agonists in Schizophrenia: Evidence From Preclinical Models and Clinical Studies https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8704992/

ECT and Other Procedures for Schizophrenia https://www.webmd.com/schizophrenia/electroconvulsive-therapy

Electroconvulsive Therapy Augmentation in Clozapine-Resistant Schizophrenia: A Prospective, Randomized Study https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2014.13060787

Long-Acting Antipsychotic Therapies for Patients With Schizophrenia https://reference.medscape.com/recap/949130

Psychosis Relapse During Treatment With Long-Acting Injectable Antipsychotics in Individuals With Schizophrenia-Spectrum Disorders: An Individual Participant Data Meta-analysis https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30264-9/fulltext

North American Prodrome Longitudinal Study https://napls.ucsf.edu/

Association Between Residential Instability at Individual and Area Levels and Future Psychosis in Adolescents at Clinical High Risk From the North American Prodrome Longitudinal Study (NAPLS) Consortium https://www.sciencedirect.com/science/article/abs/pii/S0920996421003959?via%3Dihub

Clinical, Brain, and Multilevel Clustering in Early Psychosis and Affective Stages https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2792519

Brain Disease and Psychiatric Illness: When Should a Psychiatrist Order a CAT Scan? https://ajp.psychiatryonline.org/doi/10.1176/ajp.141.12.1521

Transcranial Magnetic Stimulation for Positive Symptoms in Schizophrenia: A Systematic Review https://www.karger.com/Article/FullText/502148

Drs John Kane and Jose Rubio-Lorente discuss relapse in schizophrenia — why it occurs, how often it occurs, and what we can do about it.

Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/969531). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals.

Resources

Schizophrenia https://www.medscape.com/resource/schizophrenia

Schizophrenia Clinical Presentation https://emedicine.medscape.com/article/288259-clinical

Natural Course of Schizophrenic Disorders: A 15-Year Follow-up of a Dutch Incidence Cohort https://academic.oup.com/schizophreniabulletin/article/24/1/75/1878027

Predictors of Relapse Following Response From a First Episode of Schizophrenia or Schizoaffective Disorder https://jamanetwork.com/journals/jamapsychiatry/fullarticle/204795

Five-Fold Increased Risk of Relapse Following Breaks in Antipsychotic Treatment of First Episode Psychosis https://www.sciencedirect.com/science/article/abs/pii/S0920996416304376?via%3Dihub

Long-term Continuity of Antipsychotic Treatment for Schizophrenia: A Nationwide Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8530382/

Real-World Effectiveness of Antipsychotic Treatments in a Nationwide Cohort of 29,823 Patients With Schizophrenia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710250

Long-Acting Injectable Versus Oral Antipsychotics for the Maintenance Treatment of Schizophrenia: A Systematic Review and Comparative Meta-analysis of Randomised, Cohort, and Pre-Post Studies https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00039-0/fulltext

Effect of Long-Acting Injectable Antipsychotics vs Usual Care on Time to First Hospitalization in Early-Phase Schizophrenia: A Randomized Clinical Trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364341/

Psychosis Relapse During Treatment With Long-Acting Injectable Antipsychotics in Individuals With Schizophrenia-Spectrum Disorders: An Individual Participant Data Meta-analysis https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30264-9/fulltext

The Pharmacological Treatment of Schizophrenia: How Far Have We Come? https://onlinelibrary.wiley.com/doi/full/10.1002/pcn5.13

Striatal Functional Connectivity in Psychosis Relapse: A Hypothesis Generating Study https://www.sciencedirect.com/science/article/pii/S092099642100222X?via%3Dihub

Drs John M. Kane and Jonathan Meyer discuss treatment-resistant schizophrenia, how common it is, how to detect and manage it, and how delays in the initiation of treatment negatively affect patients.

Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984480). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.

Resources

The Clozapine Handbook: Stahl's Handbooks (Stahl's Essential Psychopharmacology Handbooks) https://www.amazon.com/Clozapine-Handbook-Handbooks-Essential-Psychopharmacology/dp/1108447465

Treatment Resistant Schizophrenia: Clinical, Biological, and Therapeutic Perspectives https://pubmed.ncbi.nlm.nih.gov/30170114/

Predictors of Treatment-Resistant and Clozapine-Resistant Schizophrenia: A 12-Year Follow-up Study of First-Episode Schizophrenia-Spectrum Disorders https://pubmed.ncbi.nlm.nih.gov/33043960/

Mortality in People With Schizophrenia: A Systematic Review and Meta-analysis of Relative Risk and Aggravating or Attenuating Factors https://pubmed.ncbi.nlm.nih.gov/35524619/

Pharmacological Interventions for Clozapine-Induced Hypersalivation https://pubmed.ncbi.nlm.nih.gov/18646130/

The Effect of Clozapine on Premature Mortality: An Assessment of Clinical Monitoring and Other Potential Confounders https://pubmed.ncbi.nlm.nih.gov/25154620/

Antipsychotic Plasma Levels in the Assessment of Poor Treatment Response in Schizophrenia https://pubmed.ncbi.nlm.nih.gov/29072776/

Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology https://pubmed.ncbi.nlm.nih.gov/27919182/

An International Adult Guideline for Making Clozapine Titration Safer by Using Six Ancestry-Based Personalized Dosing Titrations, CRP, and Clozapine Levels https://pubmed.ncbi.nlm.nih.gov/34911124/

FDA Strengthens Warning That Untreated Constipation Caused by Schizophrenia Medicine Clozapine (Clozaril) Can Lead to Serious Bowel Problems https://www.fda.gov/drugs/drug-safety-and-availability/fda-strengthens-warning-untreated-constipation-caused-schizophrenia-medicine-clozapine-clozaril-can

Cariprazine https://reference.medscape.com/drug/vraylar-cariprazine-999874

Lumateperone https://reference.medscape.com/drug/caplyta-lumateperone-1000316

Lurasidone https://reference.medscape.com/drug/latuda-lurasidone-999605

Drs John M. Kane and Jose Rubio-Lorente discuss the value of long-acting injectable formulations in reducing the risk for relapse and rehospitalization for patients diagnosed with schizophrenia.

Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984482). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.

Resources

Schizophrenia https://emedicine.medscape.com/article/288259-overview

The Nature of Relapse in Schizophrenia https://pubmed.ncbi.nlm.nih.gov/23394123/

What Is the Risk-Benefit Ratio of Long-term Antipsychotic Treatment in People With Schizophrenia? https://pubmed.ncbi.nlm.nih.gov/29856543/

Long-Acting Antipsychotic Therapies for Patients With Schizophrenia https://reference.medscape.com/recap/949130

Long-term Continuity of Antipsychotic Treatment for Schizophrenia: A Nationwide Study https://pubmed.ncbi.nlm.nih.gov/34129663/

Predictors for Initiation of Atypical Long-Acting Injectable Antipsychotic Agents in a Commercial Claims Cohort of Individuals With Early-Phase Schizophrenia https://pubmed.ncbi.nlm.nih.gov/36791360/

Long-Acting Injectable Versus Oral Antipsychotics in Schizophrenia: A Systematic Review and Meta-analysis of Mirror-Image Studies https://pubmed.ncbi.nlm.nih.gov/24229745/

Antipsychotic Use Among Persons With Schizophrenia in Sweden and Finland, Trends and Differences https://pubmed.ncbi.nlm.nih.gov/33331804/

Predictors of Lack of Relapse After Random Discontinuation of Oral and Long-Acting Injectable Antipsychotics in Clinically Stabilized Patients With Schizophrenia: A Re-analysis of Individual Participant Data https://pubmed.ncbi.nlm.nih.gov/34355232/