Journal of psychiatric practice
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This series of columns has 3 main goals: (1) to explain class warnings as used by the United States Food and Drug Administration, (2) to increase awareness of movement disorders that may occur in patients treated with antipsychotic medications, and (3) to understand why clinicians should refrain from immediately assuming a diagnosis of tardive dyskinesia/dystonia (TD) in patients who develop abnormal movements during treatment with antipsychotics. The first column in the series presented a patient who developed abnormal movements while being treated with aripiprazole as an augmentation strategy for major depressive disorder (MDD) and reviewed data concerning the historical background, incidence, prevalence, and risk factors for tardive and spontaneous dyskinesias, the clinical presentations of which closely resemble each other. The second column in the series reviewed the unique mechanism of action of aripiprazole and preclinical studies and an early-phase human translational study that suggest a low, if not absent, risk of TD with aripiprazole. ⋯ The confidence intervals for all of these potential incidence rates overlap with zero. The next column in this 5-part series reviews 37 case reports that reported TD in association with aripiprazole treatment and 27 case reports that suggested an improvement in preexisting TD with aripiprazole treatment. The fifth and final column in this series will discuss the types of prohibitively expensive and logistically difficult studies that would be needed to determine whether a definitive causal relationship between aripiprazole and TD exists.
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Prescription drug abuse is a serious health concern and is considered a nationwide epidemic. Patients often fail or refuse to disclose the use of controlled substances, leaving prescribers and pharmacies unaware of the potential for harmful drug interactions and risk of overdose. Psychiatric patients are especially vulnerable to controlled substance misuse. ⋯ Reviewing PDMP databases before prescribing controlled substances should be considered a standard prescribing practice to prevent abuse, diversion, and adverse medical outcomes.
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Although benzodiazepines (BZDs) are commonly used in the treatment of posttraumatic stress disorder (PTSD), no systematic review or meta-analysis has specifically examined this treatment. The goal of this study was to analyze and summarize evidence concerning the efficacy of BZDs in treating PTSD. ⋯ The results of this systematic review suggest that BZDs should be considered relatively contraindicated for patients with PTSD or recent trauma. Evidence-based treatments for PTSD should be favored over BZDs.
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Randomized Controlled Trial
Effect of pregabalin augmentation in treatment of patients with combat-related chronic posttraumatic stress disorder: a randomized controlled trial.
It has been suggested that the anticonvulsant drug pregabalin may be useful in some anxiety disorders. The goal of this study was to evaluate the effectiveness of pregabalin augmentation of standard treatment (selective serotonin reuptake inhibitors and sodium valproate) for patients with chronic posttraumatic stress disorder (PTSD). ⋯ Pregabalin effectively reduced the severity of PTSD symptoms but it was not effective in improving the severity of depression, anxiety, and quality of life. Further investigations are required to confirm or refute these findings.
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With 23 states and the District of Columbia having enacted medical marijuana laws as of August 2014, it is important that psychiatrists be able to address questions about medical marijuana from patients, families, and other health care professionals. The author discusses the medical literature on synthetic cannabinoids and medical marijuana. The synthetic cannabinoids dronabinol and nabilone are approved by the United States Food and Drug Administration for nausea and vomiting associated with cancer chemotherapy and appetite stimulation in patients with wasting diseases such as acquired immunodeficiency syndrome (AIDS). ⋯ Facilitating a thorough substance abuse consultation is one of most positive ways that psychiatrists, especially addiction psychiatrists, can make an impact as medical marijuana becomes increasingly common. A careful review of the prospective medical marijuana user's substance use history, co-occurring medical and psychiatric conditions, family history, and psychosocial stressors is essential in evaluating the potential risks of medical marijuana for these patients. The author concludes that psychiatrists can have a significant impact by increasing the likelihood that medical marijuana will be used in a safe and responsible way.