The Week in Review: October 16-20

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This week, Psychiatric Times® discussed a wide variety of psychiatric issues and industry updates, from long-acting injectable antipsychotics for managing schizophrenia to mental health responses to the recent conflict in Israel. Here are some highlights from the week.

The Earlier, the Better: Long-Acting Injectable Antipsychotics for Managing Schizophrenia

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Medication discontinuation is very common in schizophrenia, leading to relapse, treatment resistance, and poor outcomes. Long-acting injectable (LAI) antipsychotics offer a solution to poor adherence, explained Sanjai Rao, MD, at the 2023 Annual Psychiatric Times™ World CME Conference.

“By some estimates, up to half our patients will discontinue medications within the first 6 months of treatment, and perhaps up to 75% will discontinue medications within a year and a half of treatment. When this happens, even if it is after just a single psychotic episode, this can lead to relapse. The more often this happens to your patient, the more often they relapse and the longer it is going to take to get them back to something resembling remission,” said Rao, who is clinical professor of psychiatry and associate residency training director at the University of California, San Diego; site director of residency training at the VA San Diego Healthcare System in San Diego, CA. Continue Reading

Mental Health Responses to the Recent Conflict in Israel

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The war between Israel and Hamas that broke out on Saturday, October 7, has had a profound impact on Israel, affecting not only the general population but also psychiatric patients and the professionals who treat them. This article describes the response to this challenging situation.

Psychiatric In-Patient Treatment

Israel's severe psychiatric patients are primarily served by a network of standalone psychiatric hospitals positioned across the country, with a total of approximately 3300 beds. Although some of these facilities are partially fortified against missile attacks, most remain vulnerable. Hospitals situated near the borders face potential casualties from missile attacks, as they lack protection against bombs; a missile landed in one of them with no casualties. Approximately 160 psychiatric patients have been evacuated from one of these hospitals near the border to hospitals situated more centrally. Continue Reading

Concurrent Treatment of Eating Disorders and PTSD Leads to Long-Term Recovery

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Research shows an undeniable connection between posttraumatic stress disorder (PTSD) and eating disorders (EDs). Individuals with significant traumatic histories and/or PTSD have more severe ED symptoms, more suicidality, and more anxiety and depressive symptoms. Studying the intersection between these 2 mental health illnesses helps us understand how to treat them together moving forward, specifically in higher levels of care, including residential ED treatment programs.

Groundbreaking research published in the Journal of Eating Disorders shows the effectiveness of integrating trauma treatment with evidenced-based ED treatment in residential programs. The conventional thinking in psychiatry had been that it was best to refrain from trauma work while in intensive treatment settings, deferring this to later outpatient treatment. Continue Reading

Orexin: The New Kid on the Insomnia Block

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Dual orexin receptor antagonists (DORAs), the newest kid on the insomnia treatment block, do not adversely effect sleep architecture, explained Paul P. Doghramji, MD, at the 2023 Annual Psychiatric Times™ World CME Conference. He also explained DORAs do not have rebound insomnia, tolerance issues, or withdrawal symptoms. Doghramji, Senior Family Physician at Collegeville Family Practice, told attendees how orexins work, and then reviewed the currently available DORAs.

Suvorexant was the first DORA on the market, approved in 2014 for difficulties with sleep onset and/or maintenance, he said. Available in 5, 10, 15, and 20 mg doses, Doghramji finds most patients do best at the 20 mg dose but suggested starting with the 10 mg dose. It has a half-life of 15 hours and a Tmax of 2 hours. The most common adverse effects in trials were somnolence, headache, abnormal dreams, dry mouth, cough, and upper respiratory infection. Continue Reading

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