USC has secured funding to initiate its first clinical trial evaluating psilocybin for mental health conditions, marking a step in the ongoing research into psychedelic pharmacotherapy.
A randomized controlled trial published in Nature demonstrates that spironolactone, repurposed to antagonize the NRG1-ERBB4 signaling pathway, is a viable treatment for schizophrenia.
This podcast episode outlines the American Society of Clinical Psychopharmacology's consensus framework on deprescribing psychotropics, offering practical guidance on managing polypharmacy, addressing pseudotreatment resistance via long-acting injectables, and navigating the psychological aspects of medication discontinuation.
Monash University has launched Australia's first randomized clinical trial to evaluate psilocybin-assisted therapy for persistent post-concussion symptoms, targeting neuroinflammation and neural plasticity.
A proof-of-concept trial found that spironolactone did not significantly improve working memory in schizophrenia compared to placebo, though post-hoc analyses suggest potential benefit warranting further study.
Clinical Pearls
Bite-sized clinical takeaways from today's literature (sources from Jun 14 – Jun 16)
- Consider repurposing prucalopride for patients with depression who present with prominent cognitive fog, given early-phase evidence of cognitive improvement via 5-HT4 agonism.
- Utilize subcutaneous extended-release risperidone (Uzedy) for patients requiring long-acting injectable coverage, as it maintains therapeutic plasma levels for up to 56 days without new safety signals.
- Counsel patients on cannabis use that psychiatric adverse events are the most common serious side effects and include risks of hospitalization or death.
- Apply the ASCP consensus framework to identify pseudotreatment resistance in polypharmacy cases, potentially resolving it by switching to long-acting injectables rather than adding more oral agents.
- Monitor for significant psychiatric adverse reactions when prescribing spironolactone off-label for schizophrenia, as recent proof-of-concept trials showed no significant benefit on working memory compared to placebo.
- Exercise caution with high-dose dextromethorphan (300-400 mg) due to dose-dependent hallucinatory effects, as current evidence is insufficient to define safe therapeutic parameters for psychiatric use.
- Refer patients with opioid use disorder to hospital-based addiction consultation services like START, which have been shown to improve clinical outcomes at low cost.
- Anticipate that spironolactone may still hold potential for specific schizophrenia subtypes based on post-hoc analyses suggesting benefit in working memory, warranting further targeted study.
Drug Development 2
HMNC Brain Health raised $50M in Series B funding to advance its two depression drug candidates into mid-stage clinical trials.
A Phase 1 study confirms the safety and pharmacokinetic profile of TV-46000 (Uzedy), a subcutaneous extended-release risperidone formulation, demonstrating therapeutic plasma levels maintained for up to 56 days with no new safety signals.
Substance Use 2
A hospital-based addiction consultation service (START) for opioid use disorder improves clinical outcomes at low cost.
A global pharmacovigilance analysis of nearly 10,000 cannabis-related adverse drug reaction reports reveals that psychiatric and nervous system disorders are the most frequent suspected side effects, with a high proportion of serious outcomes including hospitalization and death.
Diagnosis & Treatment 1
A clinical trial is being conducted to evaluate the efficacy of psilocybin administered within a group therapy setting for the treatment of PTSD.
Mechanism of Action 1
This systematic review characterizes the dose-dependent psychedelic effects of dextromethorphan, noting hallucinatory phenomena at 300-400 mg, but concludes evidence is insufficient to define therapeutic parameters for psychiatric use.