The Week in Review: May 13-17

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This week, Psychiatric Times® discussed a wide variety of psychiatric issues and industry updates, from DBS for treatment-resistant schizophrenia to communication in patients with BPD.

Rolling Submission for Subcutaneous Lecanemab

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Eisai and Biogen announced they have initiated a rolling submission for the subcutaneous (SC) version of the Alzheimer disease (AD) therapy lecanemab-irmb (US brand name: Leqembi®) for weekly maintenance dosing. Leqembi is indicated for the treatment of AD in patients with mild cognitive impairment or mild dementia stage of disease. The newly initiated rolling submission is backed by data from the phase III Clarity AD study.

The FDA’s fast-track designation for the approved intravenous (IV) Leqembi did not extend to the new SC formulation, pushing back plans. The rolling submission, originally scheduled for March, was delayed after the FDA requested additional 3-month immunogenicity data on the SC formulation proposed maintenance dose of 360 mg weekly. Continue Reading

DBS: A Solution to Treatment-Resistant Schizophrenia

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Despite advances in psychotropic agents, treatment-resistant psychotic symptoms remain surprisingly prevalent in schizophrenia spectrum disorders. Deep brain stimulation (DBS) could be an attractive option in terms of effectiveness, although more studies are needed. As with all psychosurgery intervention choices, DBS is underutilized, and ethical issues—as well as knowledge, cost, and acceptability issues—represent barriers to its usability.

Case Vignette

“Dora” is a 35-year-old woman who was diagnosed with schizophrenia 8 years ago. She first presented to the emergency department when she was brought from the airport, where she was trying to get through security without a ticket. Dora reported paranoia, persecutory delusions that the FBI was spying on her through air-conditioning vents, and command auditory hallucinations to run to the top of the mountains so she could see those following her. Continue Reading

Examining a Case of Psychiatric Polypharmacy-Related Agranulocytosis

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A recent study examined the association between psychiatric polypharmacy and agranulocytosis, with a particular emphasis on the potential risks and adverse effects of polypharmacy in patients with complex psychiatric conditions. The study’s investigators explored this association through a case study of a 20-year-old female with a history of multiple psychiatric conditions.

The patient, who had been residing in a psychiatric facility, presented to the hospital with weakness, dizziness, myalgia, and fever, prompting evaluation for medication management. Her extensive psychiatric history included major depressive disorder, borderline personality disorder, posttraumatic stress disorder, anxiety disorder, and a history of suicide attempts. She also had a medical history of ulcerative colitis and hypothyroidism. Continue Reading

A Double Bind: Communication in Patients With Borderline Personality Disorder

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Borderline personality disorder (BPD) is a severe mental disorder characterized, in part, by paradoxical and self-defeating behavior, particularly in the realm of interpersonal relationships. I have described BPD as fundamentally a disorder of self-contradiction; via the process of cyclical psychodynamics, first described by Paul Wachtel, PhD, the patient with BPD inadvertently elicits precisely what they most fear.

An underappreciated aspect of BPD is the patient’s characteristic methods of communication. Although several classic theorists, such as Eric Berne, MD, and Thomas Szasz, MD, have attempted to apply game-theoretical concepts to the understanding of psychopathology, relatively little attention has been paid specifically to the communicative patterns of patients with BPD. Continue Reading

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