This case report describes the successful use of zolpidem to treat severe refractory insomnia in a critically ill patient with delirium, challenging the general avoidance of Z-drugs in this population when sleep disruption perpetuates cognitive decline.
A randomized controlled trial found pioglitazone ineffective for reducing alcohol use or craving in adults with AUD overall, though a subgroup with elevated baseline inflammation showed benefit.
This meta-analysis identifies clinical and sociodemographic correlates of poor medication adherence in bipolar disorder, highlighting that younger age, lower education, psychotic features, substance use disorders, and comorbid anxiety or personality disorders are associated with non-adherence.
This large observational study identifies patient demographics and specific medication choices (e.g., topiramate vs. naltrexone) as significant predictors of early discontinuation of FDA-approved medications for alcohol use disorder, highlighting a critical adherence gap in clinical practice.
This case report highlights postpartum delirious mania in a bipolar patient, demonstrating that while valproate and olanzapine are used for maintenance, electroconvulsive therapy (ECT) is critical for rapid symptom resolution when pharmacotherapy fails.
Clinical Pearls
Bite-sized clinical takeaways from today's literature (sources from Jun 03 – Jun 11)
- Consider electroconvulsive therapy (ECT) as a critical intervention for rapid symptom resolution in postpartum delirious mania when pharmacotherapy fails.
- Evaluate baseline inflammatory markers in patients with alcohol use disorder, as those with elevated inflammation may derive specific benefit from pioglitazone treatment.
- Anticipate higher early discontinuation rates for topiramate compared to naltrexone in alcohol use disorder and proactively address adherence barriers related to these medication choices.
- Utilize zolpidem cautiously but effectively for severe refractory insomnia in critically ill delirious patients when sleep disruption is perpetuating cognitive decline.
- Screen for predictors of poor medication adherence in bipolar disorder, specifically noting risks associated with younger age, psychotic features, and comorbid substance use or anxiety disorders.
- Monitor the regulatory landscape for new ADHD pharmacotherapies like CTx-1301, as development hurdles may impact future prescribing options.
- Address the critical adherence gap in FDA-approved alcohol use disorder medications by tailoring patient education to specific demographic and clinical correlates of non-adherence.
- Recognize that while pioglitazone lacks efficacy for AUD in the general population, it remains a viable option for the subgroup with elevated baseline inflammation.
Policy & Regulation 1
The FDA issued a complete response letter for Cingulate's once-daily ADHD drug CTx-1301, indicating regulatory hurdles in its development pathway.