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IN THIS ISSUE:
June 2007

An NSAID for Schizophrenia?
Adjunctive celecoxib (Celebrex) may be beneficial for treating schizophrenia.

Psychotropics and Fracture Risk
Patients (especially elderly ones) taking psychiatric medications are at increased risk for fractures.

Riluzole Augmentation for Depression
Preliminary evidence suggests riluzole (Rilutek) may be helpful in treating mood and anxiety disorders.

CBT Beats Zopiclone for Insomnia in Elderly
Cognitive behavioral therapy (CBT) was superior to zopiclone (Ambien) for chronic primary insomnia.

Alternative Medicines Are Commonly Used
Surveys show alternative medicines used by more than half of US population.

Hyponatremia with Antidepressants
Hyponatremia reported in patients treated with escitalopram (Lexapro) or duloxetine (Cymbalta).

In Brief
Dosing Strategies for Risperidone Long-Acting Injection; Deaths Associated with Methadone Treatment for Pain

Prolactin Levels and Associated Side Effects with Risperidone
Initial elevation of prolactin levels with risperidone (Risperdal) returns to normal with long-term treatment.

Mifepristone for Psychotic Depression?
Treatment with mifepristone (Mifeprex) improves psychosis but not depression in patients with psychotic depression.

rTMS: Inferior to ECT?
Repetitive transcranial magnetic stimulation (rTMS) is not as efficacious as electroconvulsive therapy (ECT) in patients referred for ECT.

In Brief

June 2007

Last month, we discussed two studies of risperidone long-acting injection (RLAI; Risperdal Consta) and an editorial by Dr Taylor, in which he stated that 25 mg every 2 weeks, the initial RLAI dose recommended by expert consensus guidelines, might be subtherapeutic for most patients with schizophrenia (BTP 2007;30:19-20). Taylor suggested a conversion factor of 2 mg of oral risperidone equating to 25 mg RLAI every 2 weeks. A new study by Bai et al suggests a slight modification to this plan (J Clin Psychiatry, in press). These authors studied 50 asymptomatic, stable hospitalized patients with schizophrenia who were randomly assigned to receive either daily oral risperidone or one of three dosages of RLAI every 2 weeks, with a 1-year follow-up to assess symptom recurrence. There were no significant differences in Positive and Negative Syndrome Scale (PANSS) scores between subjects taking oral risperidone and the group receiving RLAI. But the patients taking RLAI had reduced scores on the UKU Side Effect Rating Scale and the Simpson-Angus Scale, and reduced prolactin levels, which the authors attribute to more stable serum metabolite concentrations. Of patients receiving RLAI, those getting 25-mg or 37.5-mg injections every 2 weeks had increased PANSS scores, decreased serum metabolite concentrations, and an increased tendency to relapse compared with those receiving 50-mg injections. For converting from oral risperidone, they recommend a 25-mg injection for patients who had been taking up to 3 mg/day orally, 37.5 mg for between 3 and 5 mg/day, and 50 mg for over 5 mg/day orally. Their study was small, and the authors call for further long-term and large-scale studies to investigate the stability and benefits of maintenance treatment with RLAI.

As we noted in April (BTP 2007;30:15), the US Food and Drug Administration (FDA) issued a public health advisory in 2006 about deaths and serious adverse events occurring in patients being treated with methadone for pain. A recent update in JAMA reveals that between 1999 and 2004, annual deaths related to methadone poisoning increased by 390%, much faster than the 54% increase in deaths from other kinds of poisoning (2007;297:799). The Substance Abuse and Mental Health Services Administration issued a report in 2004 concluding that this rapid growth in methadone-related deaths was most likely due to the increased prescription of methadone as an analgesic rather than as a treatment for opioid addiction.

Heather S. Hopkins

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