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July 2010

Omega-3 Fatty Acids and Exercise for Psychosis?
Omega-3 fatty acid supplementation and exercise are relatively benign interventions that might prevent symptoms and improve outcome in patients with or at high risk of developing chronic psychotic disorders.

Long-Acting Injectable Risperidone Often Discontinued
In a study of patients with schizophrenia in the US Department of Veterans Affairs health care system, clozapine (Clozaril and others) had the highest continuation rate over 1 to 2 years, while long-acting injectable risperidone (Risperdal Consta) was discontinued by over half of patients for whom it was prescribed.

Can Molindone Help with Weight Loss?
Molindone (Moban) may produce modest benefits for weight loss in patients taking antipsychotics but carries the risk of long-term movement disorders and is no longer available in the United States.

In Brief
Depression Care Initiative Reduces Suicide Rate to Zero; Ecstasy Decreases Serotonin Transporter Binding in Brain Regions Associated with Memory

Adjunctive Aspirin Reduces Schizophrenia Symptoms
Preliminary data suggest aspirin might reduce schizophrenia symptoms through its anti-inflammatory properties.

Torsade de Pointes and Ziprasidone
The second case of torsade de pointes following ziprasidone (Geodon) overdose reported in the medical literature involved multiple risk factors for triggering the life-threatening ventricular arrhythmia.

Can Molindone Help with Weight Loss?

July 2010

Molindone (Moban) is a first-generation antipsychotic. It never received much attention and, with the advent of the second generation, fell into relative disuse. In 1977, Gardos and Cole wrote of weight reduction associated with molindone treatment in patients with schizophrenia,1 but this possible beneficial effect garnered little notice and virtually no additional research. Weight gain associated with antipsychotics, however, is a problem that won't go away. Recently, McCue and others described positive effects of molindone in three patients who were severely obese and suffering from psychosis.2

The patients were two women and a man, aged 50 and 51 years. Two carried diagnoses of schizophrenia; the third, major depressive disorder with psychosis. On hospital admission, the patients weighed between 321 and 350 pounds, with body mass indices from 41.1 to 53.6. Doctors tapered and discontinued previous antipsychotic drugs and substituted molindone, 75 to 200 mg daily. The patients lost between 6.2 and 20.4 pounds, and all experienced marked improvement in psychotic symptoms. Two of the three developed extrapyramidal reactions, which were controlled with anti-Parkinson medicines.

The authors acknowledge that in this uncontrolled small series, the hospital diet or other variables may have caused the modest weight loss they observed during brief hospitalizations. In addition, they are unaware of whether the patients maintained or extended their weight loss during outpatient follow-up.

Qualifications notwithstanding, these are interesting observations, which are consistent with an earlier literature and clinical impressions about molindone. For patients who need antipsychotic therapy but have difficulty maintaining healthy body weight, this first-generation agent might be considered. Clinicians must bear in mind, however, the risk of short-term extrapyramidal effects associated with molindone, as well as the risk of long-term and potentially irreversible disorders, such as tardive dyskinesia and dystonia.

Postscript: Molindone was discontinued by its sole supplier, Endo Pharmaceuticals, on January 13, 2010.3

1Gardos G, Cole JO: Weight reduction in schizophrenics by molindone. Am J Psychiatry 1977;134:302-304.

2McCue RE, Unuigbe FE, Charles RA, Orendain GC, Waheed R: Treatment of morbidly obese psychotic patients with molindone: Three case reports. J Clin Psychiatry 2009;70:1606-1607.

3US Department of Health and Human Services. US Food and Drug Administration. Drugs to Be Discontinued. Accessed May 28, 2010. Available at http://www.fda.gov/Drugs/DrugSafety/DrugShortages/ucm050794.htm