Treating Psychiatric Symptoms in Persistent Postural Perceptual Dizziness.

Persistent postural perceptual dizziness (PPPD) is a functional neurological disorder characterized by troublesome feelings of dizziness and might be precipitated by vestibular events, postural changes, psychopathologies, and/or a person's perceptual experiences. The diagnosis is confirmed by assessing a patient's history. A variety of psychiatric symptoms are associated with PPPD; anxiety and depression are the most common. Psychotherapy and pharmacotherapy can be clinically helpful in reducing psychiatric symptoms and dizziness. Early intervention improves prognosis.

Managing Psychiatric Symptoms in Patients with Complex Regional Pain Syndrome.

Complex regional pain syndrome (CRPS) is a rare but debilitating chronic pain condition of the extremities, which often develops after an injury. Its multifactorial pathophysiology includes the immune and nervous systems and, potentially, autoimmune, genetic, and psychological factors. Psychiatric illnesses can be comorbid with CRPS, including mood disorders, anxiety disorders, insomnia, substance use disorder, personality disorders, and somatic symptom disorder. This article discusses these psychiatric symptoms and offers treatment guidance.

Postpartum Depression in Men.

Postpartum depression (PPD) is often defined as an episode of major depressive disorder (MDD) occurring soon after the birth of a child. It is frequently reported in mothers but can also occur in fathers. There are no established criteria for PPD in men, although it could present over the course of a year, with symptoms of irritability restricted emotions, and depression. Risk factors include a history of depression in either parent, poverty, and hormonal changes. It might be associated with anxiety disorders and can adversely affect the father, family unit, and developing child. Treatment includes psychotherapy and pharmacotherapy. Clinicians are encouraged to screen for depression in men during the first year postpartum and to offer treatment or treatment referral if depression is present.

Use of Brexanolone for Postpartum Depression.

Postpartum depression (PPD) in women is common and adversely affects the mother, infant, and family unit. Treatments include psychotherapy and pharmacotherapy, but not all women experience response or remission, and response might be delayed. A precipitous decrease in allopregnanolone levels and failure of GABAA receptors to adapt to this change might contribute to PPD. Administered intravenously, brexanolone (BRX) is a solution of allopregnanolone that modulates the GABAA receptor and restores third-trimester levels, thus allowing for receptor adaptation and symptom improvement. In clinical studies, patients receiving BRX experienced a rapid reduction or remission of depression. Due to the risk for sedation or syncope, it is only available through a national registry, and administration and monitoring must occur in a supervised medical setting. Further studies are needed to explore its long-term efficacy.

Valbenazine and Deutetrabenazine for Tardive Dyskinesia.

Tardive dyskinesia (TD) is a medication-induced permanent movement disorder with no United States Food and Drug Administration (FDA)-approved treatments prior to 2017. Although TD is medication-induced, patients who have responded well to antipsychotics might not be candidates for dose reduction or discontinuation due to a risk of psychiatric decompensation. Valbenazine and deutetrabenazine were recently approved by the FDA for the treatment of TD. They offer a unique mechanism of action by inhibiting vesicular monoamine transporter type 2. The objective of this review is to discuss the efficacy, tolerability, dosing, drug interactions, and precautions for valbenazine and deutetrabenazine.

Liothyronine for Depression: A Review and Guidance for Safety Monitoring.

Objective: The objective of this review is to discuss triiodothyronine's (T3, liothyronine) mechanism of action, efficacy in enhancement and augmentation trials, and dosing and safety considerations for the treatment of depression. Method: A literature search of PubMed was performed using search terms depression, augmentation, antidepressant, and liothyronine. Only English-language studies of subjects with unipolar depression were included from the past 50 years. Results: Most studies have shown that liothyronine is an efficacious enhancement and augmentation strategy for depression in combination with antidepressants, primarily tricyclic antidepressants and selective serotonin reuptake inhibitors. Conclusion: With appropriate baseline and follow-up safety monitoring, liothyronine augmentation can be a safe and effective treatment for unipolar depression. Larger studies of longer duration assessing liothyronine efficacy with serotonin norepinephrine reuptake inhibitors and multimodal antidepressants are needed.

Orthorexia Nervosa: An Obsession With Healthy Eating.

Despite a focus on eating, orthorexia nervosa may lead to malnourishment, loss of relationships, and poor quality of life.

Cariprazine for Schizophrenia and Bipolar Disorder.

Schizophrenia and bipolar disorder are associated with significant morbidity and mortality. Although atypical antipsychotics reduce positive and negative symptoms of schizophrenia as well as manic or mixed episodes of bipolar disorder, they are associated with varying degrees of metabolic adverse effects. This necessitates continued development of efficacious yet metabolically favorable treatments. Cariprazine was recently approved to treat adult patients with schizophrenia and manic or mixed episodes. It was well-tolerated and adverse reactions included akathisia, extrapyramidal symptoms, nausea, or constipation. Cariprazine is taken once daily without regard to food. The dose should be adjusted in patients who receive CYP450 inhibitors, and it should not be given to patients with severe hepatic or renal disease. This article reviews mechanisms of action, efficacy, tolerability (including adverse effects), dosing, and contraindications of cariprazine.

Brexpiprazole: A New Treatment Option for Schizophrenia.

Schizophrenia occurs in approximately 0.3 to 0.7 percent of the world's population and is associated with significant morbidity and mortality. Although atypical antipsychotics reduce positive and negative symptoms, they are associated with varying degrees of metabolic adverse effects. This necessitates continued development of efficacious yet metabolically favorable treatments. This article reviews brexpiprazole, a medication recently approved to treat patients with schizophrenia. Brexpiprazole was well-tolerated, and adverse reactions were statistically insignificant. They included nausea; insomnia; headache; agitation; akathisia; and weight gain or changes in lipid, creatine phosphokinase, glucose, or prolactin levels. Brexpiprazole is taken once daily without regard to food, and the dose should be adjusted in patients who receive moderate or strong CYP450 inhibitors or inducers and in patients with hepatic or renal disease.

Lurasidone: a new treatment option for bipolar depression-a review.

Depressive episodes in bipolar disorder contribute to significant morbidity and mortality. Until recently, only quetiapine and an olanzapine-fluoxetine combination were approved to treat bipolar depression. Recently, lurasidone was approved to treat bipolar depression either as monotherapy or adjunctively with lithium or valproate. Lurasidone was well- tolerated, and commonly observed adverse reactions (incidence ≥5% and at least twice the rate for placebo) were akathisia, extrapyramidal symptoms, and somnolence. There were no significant metabolic or electrocardiogram abnormalities. It is taken with food to ensure maximal absorption, and dose should be adjusted in patients who receive moderate CYP450 inhibitors or inducers and in patients with renal disease.

A Review of Psychostimulants for Adults With Depression.

A survey of medical literature suggests that for patients with depression who have not responded to other augmentation strategies, psychostimulants may offer improvements in mood, energy, and concentration.

Antipsychotic drugs and safety concerns for breast-feeding infants.

Antipsychotic drugs prescribed to treat psychiatric symptoms during the postpartum period are secreted into breast milk. Because breast-feeding is crucial to infant development, it is important to select a medication that poses the fewest adverse consequences. Aripiprazole, haloperidol, perphenazine, and trifluoperazine demonstrate no known developmental dangers. Olanzapine, quetiapine, and risperidone are cited as safe, although monitoring is recommended. Chlorpromazine and clozapine may induce developmental concerns. There are limited safety data for asenapine, fluphenazine, iloperidone, loxapine, lurasidone, paliperidone, pimozide, thioridazine, thiothixene, and ziprasidone. Clinicians should choose medications considered to be the safest and prescribe them at the lowest effective doses.