The Week in Review: January 20-24

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This week, Psychiatric Times discussed a wide variety of psychiatric issues and industry updates, including and US Food and Drug Administration approval and Real Psychiatry conference coverage.

Optimize, Augment, or Switch: Best Practices for Prescribing ADHD Medication

During the Real Psychiatry conference in Scottsdale, AZ, Psychiatric Times caught up with Michael Asbach, DMSc, PA-C, Psych-CAQ. Asbach spoke about the best time to switch attention-deficit/hyperactivity disorder (ADHD) medications and psychiatric treatments.

“If a patient is not demonstrating adequate response to a medication, it is our duty as a provider to be the adult in the room and say, ‘We need to move on,’ even if it is scary or uncomfortable,” Asbach said.

With a lack of response, it may be time to (1) optimize the dose, (2) augment treatment, or (3) switch altogether. Continue reading.

Treating Alcohol Use Disorder: Whole-Patient Approach and Evidence-Based Strategies

In a 5-part interview with Psychiatric Times, Joseph Volpicelli, MD, PhD, discussed how he approaches treating patients with alcohol use disorder (AUD). He said it is important to understand how alcohol is impacting your patient’s life and how they feel about their addiction.

“You get a sense of what the person’s needs are and what their goals are, why they want to get better,” Volpicelli said.

Knowing the different kinds of evidence-based treatments is important when treating AUD. Naltrexone is the gold standard for medical treatment, but psychosocial support for patients in treatment can help them engage in treatment. Continue reading.

Esketamine CIII Nasal Spray: First and Only Monotherapy for Treatment-Resistant Depression

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The Us Food and Drug Administration (FDA) has approved the new Johnson & Johnson supplemental New Drug Application (sNDA) esketamine (Spravato) CIII nasal spray. This is the first and only monotherapy for adults with treatment-resistant depression. This approval is based on a study demonstrating significant improvement in depression scores compared to placebo, with a consistent safety profile. Esketamine provides rapid symptom relief within 24 hours by antagonizing NMDA receptors, which enhances synaptogenesis and neuroplasticity. Due to potential risks such as sedation and dissociation, Spravato is available through a Risk Evaluation and Mitigation Strategy (REMS) program. Continue reading.

It's Time it Reconcile With Medication Reconciliation

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In this Special Report, Sara Robinson, DNP, RN, PMHNP-BC, shares how regular medication reconciliation is crucial in psychiatric practice to prevent drug interactions and ensure effective treatment. Patients with psychiatric conditions often experience polypharmacy, increasing the risk of adverse events. Clinicians should routinely review all medications, including over-the-counter drugs and supplements, to identify potential interactions and duplications. Utilizing evidence-based tools, such as the Medications at Transitions and Clinical Handoffs Toolkit, can aid in maintaining accurate medication lists and enhancing patient safety. Consistent medication reconciliation helps address unexpected adverse effects or suboptimal therapeutic responses, contributing to improved patient outcomes. Continue reading.

Best Practices for Polypharmacy in Traumatic Brain Injury

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In managing traumatic brain injury (TBI), polypharmacy is often overlooked. In this special report, Matthew Ashley, MD, JD, discusses the polypharmaceutical approach to treating TBI. Common inhibitors to patient improvement include sedating medications, antiepileptics, and anticoagulants. Regular evaluation of medication necessity is crucial as TBI is increasingly recognized as a chronic condition. As patients improve, medications for secondary complications and acute care should be reassessed and potentially discontinued. Continue reading.