The Week in Review: January 8-12

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This week, Psychiatric Times® discussed a wide variety of psychiatric issues and industry updates, from substance use disorders in physicians to new research on the efficacy of MDMA-assisted therapy for PTSD.

Landmark Study Highlights Efficacy of MDMA-Assisted Therapy for PTSD

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In the first of its kind, Bessel van der Kolk, MD, and colleagues found 3,4-methylenedioxymethamphetamine (MDMA)-assisted performed better in improving emotional coping skills in adults with severe posttraumatic stress disorder as compared to therapy plus placebo. The results were published in PLOS ONE.

The results were derived from the MDMA-Assisted Psychotherapy for PTSD (MAPP1) (NCT03537014). The phase 3 randomized, double-blind, placebo-controlled trial was conducted across multiple sites and compared the safety and efficacy of MDMA-assisted therapy with therapy with placebo in individuals who met DSM-5 criteria for severe PTSD, with a Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) total severity score of 35 or greater. Continue Reading

Long-Term Antipsychotic Treatment Tapered in 2-Year Trial

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Tapering the dosage of long-term antipsychotic medication treatment for schizophrenia or recurrent psychosis was more likely to result in relapse of symptoms than maintaining the dose in a 2-year trial, despite individualized and gradual reduction over several months.

In the open, parallel-group, randomized Research into Antipsychotic Discontinuation and Reduction (RADAR) trial, investigators had anticipated that social functioning would improve with reduced or discontinued antipsychotic medication. They were also hopeful that the very gradual dose reduction, along with continued consultation with the treating psychiatrist and the option of psychological therapy as clinically indicated, would mitigate against relapse. Continue Reading

Addressing Substance Use Disorders in Physicians to Sustain Wellness

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Clinicians are having a difficult time addressing the unreasonable demands of an increasingly broken health care system. Even before the COVID-19 pandemic, our rates of burnout were steadily rising to the point that more than half of physicians were reported to have at least 1 symptom of burnout. Physicians have one of the highest suicide rates of any profession, with female physicians being particularly vulnerable. A quarter to one-third of our students and trainees are reported to be suffering from clinical depression.

The pandemic exacerbated all these stressors, causing many doctors to quit, cut down, or “quietly quit,” yet this process has been gaining momentum for decades. Physician shortages are looming. As corporations buy up primary care practices, and as hospitals increasingly act just like avaricious corporations, doctors are increasingly feeling like cogs in someone else’s machine. Continue Reading

Medication Pipeline: Schizophrenia and PTSD

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As 2024 begins, the pipeline for novel agents for the treatment of psychiatric disorders remains strong. There is no paucity of unmet need for novel treatments for all psychiatric disorders. The prototypes for the mechanisms of action of all the current US Food & Drug Administration (FDA)-approved antipsychotics go back to the 1950s. Drugs targeting central muscarinic cholinergic receptors to treat schizophrenia are on the horizon and may provide the first novel drug mechanism to treat this challenging disorder beyond blocking dopamine-2 receptors.

Despite cognitive and negative symptoms significantly contributing to functional impairment in patients with schizophrenia, we have no FDA-approved drugs targeting these symptoms. Researchers around the world continue to painstakingly search out and develop new medications in the hope of developing treatments to address this huge unmet need. Continue Reading

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