Medscape InDiscussion: Schizophrenia Medscape

Drs John M. Kane and Jonathan Meyer discuss treatment-resistant schizophrenia, how common it is, how to detect and manage it, and how delays in the initiation of treatment negatively affect patients.
Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984480). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.
Resources
The Clozapine Handbook: Stahl's Handbooks (Stahl's Essential Psychopharmacology Handbooks) https://www.amazon.com/Clozapine-Handbook-Handbooks-Essential-Psychopharmacology/dp/1108447465
Treatment Resistant Schizophrenia: Clinical, Biological, and Therapeutic Perspectives https://pubmed.ncbi.nlm.nih.gov/30170114/
Predictors of Treatment-Resistant and Clozapine-Resistant Schizophrenia: A 12-Year Follow-up Study of First-Episode Schizophrenia-Spectrum Disorders https://pubmed.ncbi.nlm.nih.gov/33043960/
Mortality in People With Schizophrenia: A Systematic Review and Meta-analysis of Relative Risk and Aggravating or Attenuating Factors https://pubmed.ncbi.nlm.nih.gov/35524619/
Pharmacological Interventions for Clozapine-Induced Hypersalivation https://pubmed.ncbi.nlm.nih.gov/18646130/
The Effect of Clozapine on Premature Mortality: An Assessment of Clinical Monitoring and Other Potential Confounders https://pubmed.ncbi.nlm.nih.gov/25154620/
Antipsychotic Plasma Levels in the Assessment of Poor Treatment Response in Schizophrenia https://pubmed.ncbi.nlm.nih.gov/29072776/
Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology https://pubmed.ncbi.nlm.nih.gov/27919182/
An International Adult Guideline for Making Clozapine Titration Safer by Using Six Ancestry-Based Personalized Dosing Titrations, CRP, and Clozapine Levels https://pubmed.ncbi.nlm.nih.gov/34911124/
FDA Strengthens Warning That Untreated Constipation Caused by Schizophrenia Medicine Clozapine (Clozaril) Can Lead to Serious Bowel Problems https://www.fda.gov/drugs/drug-safety-and-availability/fda-strengthens-warning-untreated-constipation-caused-schizophrenia-medicine-clozapine-clozaril-can
Cariprazine https://reference.medscape.com/drug/vraylar-cariprazine-999874
Lumateperone https://reference.medscape.com/drug/caplyta-lumateperone-1000316
Lurasidone https://reference.medscape.com/drug/latuda-lurasidone-999605

Drs John M. Kane and Jose Rubio-Lorente discuss the value of long-acting injectable formulations in reducing the risk for relapse and rehospitalization for patients diagnosed with schizophrenia.
Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984482). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.
Resources
Schizophrenia https://emedicine.medscape.com/article/288259-overview
The Nature of Relapse in Schizophrenia https://pubmed.ncbi.nlm.nih.gov/23394123/
What Is the Risk-Benefit Ratio of Long-term Antipsychotic Treatment in People With Schizophrenia? https://pubmed.ncbi.nlm.nih.gov/29856543/
Long-Acting Antipsychotic Therapies for Patients With Schizophrenia https://reference.medscape.com/recap/949130
Long-term Continuity of Antipsychotic Treatment for Schizophrenia: A Nationwide Study https://pubmed.ncbi.nlm.nih.gov/34129663/
Predictors for Initiation of Atypical Long-Acting Injectable Antipsychotic Agents in a Commercial Claims Cohort of Individuals With Early-Phase Schizophrenia https://pubmed.ncbi.nlm.nih.gov/36791360/
Long-Acting Injectable Versus Oral Antipsychotics in Schizophrenia: A Systematic Review and Meta-analysis of Mirror-Image Studies https://pubmed.ncbi.nlm.nih.gov/24229745/
Antipsychotic Use Among Persons With Schizophrenia in Sweden and Finland, Trends and Differences https://pubmed.ncbi.nlm.nih.gov/33331804/
Predictors of Lack of Relapse After Random Discontinuation of Oral and Long-Acting Injectable Antipsychotics in Clinically Stabilized Patients With Schizophrenia: A Re-analysis of Individual Participant Data https://pubmed.ncbi.nlm.nih.gov/34355232/

Drs John M. Kane and Christoph U. Correll discuss the importance of ongoing assessment of psychiatric comorbidities in patients with schizophrenia and its impact on outcomes and treatment decisions.
Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984483). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.
Resources
Schizophrenia https://www.medscape.com/resource/schizophrenia
What Are the Major Metabolic and Neurologic Risks Associated With Antipsychotic Medications? https://www.medscape.com/viewarticle/969525
Trauma and Posttraumatic Stress Disorder (PTSD) in Patients With Schizophrenia or Schizoaffective Disorder https://pubmed.ncbi.nlm.nih.gov/19777347/
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) https://www.psychiatry.org/psychiatrists/practice/dsm
Relationship Between Obsessive Compulsive Symptomatology and Severity of Psychotic Symptoms in Schizophrenia: Meta-analysis and Meta-Regression Analysis https://pubmed.ncbi.nlm.nih.gov/36549240/
Clozapine-Induced Obsessive-Compulsive Symptoms: Mechanisms and Treatment https://pubmed.ncbi.nlm.nih.gov/30565908/
The Specific Phenotype of Depression in Recent Onset Schizophrenia Spectrum Disorders: A Symptom Profile and Network Comparison to Recent Onset Major Depressive Disorder Without Psychotic Features https://pubmed.ncbi.nlm.nih.gov/34942537/
Schizophrenia Comorbid With Panic Disorder: Evidence for Distinct Cognitive Profiles https://pubmed.ncbi.nlm.nih.gov/22417926/
Obsessive-Compulsive Disorder Comorbid With Schizophrenia and Bipolar Disorder https://pubmed.ncbi.nlm.nih.gov/30745688/
Depressive Symptoms in Schizophrenic Patients https://pubmed.ncbi.nlm.nih.gov/22112362/
Post-Psychotic Depression: An Updated Review of the Term and Clinical Implications https://pubmed.ncbi.nlm.nih.gov/35220306/
Mortality in People With Schizophrenia: A Systematic Review and Meta-analysis of Relative Risk and Aggravating or Attenuating Factors https://pubmed.ncbi.nlm.nih.gov/35524619/
Comorbid Major Depressive Disorder in Schizophrenia: A Systematic Review and Meta-Analysis https://pubmed.ncbi.nlm.nih.gov/33252130/
The RAISE Early Treatment Program for First-Episode Psychosis: Background, Rationale, and Study Design https://pubmed.ncbi.nlm.nih.gov/25830446/
First Episode Psychosis With and Without the Use of Cannabis and Synthetic Cannabinoids: Psychopathology, Global Functioning and Suicidal Ideation and Antipsychotic Effectiveness https://pubmed.ncbi.nlm.nih.gov/36682093/
Cannabis Use Among Patients With Psychotic Disorders https://pubmed.ncbi.nlm.nih.gov/35348056/
Methamphetamine Psychosis: Epidemiology and Management https://pubmed.ncbi.nlm.nih.gov/25373627/
Demographic and Clinical Correlates of Substance Use Disorders in First Episode Psychosis https://pubmed.ncbi.nlm.nih.gov/28697856/
Why Do Patients With Schizophrenia Smoke? https://pubmed.ncbi.nlm.nih.gov/20051860

Drs John M. Kane and Scott W. Woods discuss clinical high-risk syndrome and schizophrenia, including assessment methods, interventions, and risk indicators for future psychosis.
Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984484). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.
Resources
Schizophrenia https://emedicine.medscape.com/article/288259-overview
Schizophrenia and Clinical High Risk https://www.ampscz.org/about/schizophrenia-chr/
PRIME Psychosis Prodrome Research Clinic https://medicine.yale.edu/psychiatry/research/programs/clinical_people/prodome/?locationId=460
Conversion to Psychosis in Adolescents and Adults: Similar Proportions, Different Predictors https://pubmed.ncbi.nlm.nih.gov/32248862/
Clinical Validity of DSM-5 Attenuated Psychosis Syndrome: Advances in Diagnosis, Prognosis, and Treatment https://pubmed.ncbi.nlm.nih.gov/31746950/
Prevalence of Individuals at Clinical High-risk of Psychosis in the General Population and Clinical Samples: Systematic Review and Meta-analysis https://pubmed.ncbi.nlm.nih.gov/34827543/
Stability of Mental Disorder Prevalence Estimates Among School-aged Children and Adolescents: Findings From the Community-based Project to Learn About Youth-mental Health (PLAY-MH) and Replication-PLAY-MH (Re-PLAY-MH), 2014-2017 https://pubmed.ncbi.nlm.nih.gov/35661706/
The Clinician's Illusion https://pubmed.ncbi.nlm.nih.gov/6334503/
What Causes the Onset of Psychosis in Individuals at Clinical High Risk? A Meta-analysis of Risk and Protective Factors https://pubmed.ncbi.nlm.nih.gov/31219164/
Association of Neurocognition With Transition to Psychosis: Baseline Functioning in the Second Phase of the North American Prodrome Longitudinal Study https://pubmed.ncbi.nlm.nih.gov/27806157/
Accelerated Cortical Thinning Precedes and Predicts Conversion to Psychosis: The NAPLS3 Longitudinal Study of Youth at Clinical High-risk https://pubmed.ncbi.nlm.nih.gov/36434057/
Treatment Outcomes for Young People at Clinical High Risk for Psychosis: Data From a Specialized Clinic https://pubmed.ncbi.nlm.nih.gov/34309198/
Real-world Effectiveness of Antipsychotic Treatment in Psychosis Prevention in a 3-year Cohort of 517 Individuals at Clinical High Risk From the SHARP (ShangHai at Risk for Psychosis) https://pubmed.ncbi.nlm.nih.gov/32436725/
The PRIME North America Randomized Double-blind Clinical Trial of Olanzapine Versus Placebo in Patients at Risk of Being Prodromally Symptomatic for Psychosis: I. Study Rationale and Design https://pubmed.ncbi.nlm.nih.gov/12648731/
Accelerating Medicines Partnership® Program - Schizophrenia (AMP® SCZ) https://www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/accelerating-medicines-partnershipr-program-schizophrenia-ampr-scz#:~:text=The%20Accelerating%20Medicines%20Partnership%C2%AE,multiple%20public%20and%20private%20organizations.

Drs John M. Kane and Delbert G. Robinson discuss psychoeducation, treatment options, and possible side effects of medication for patients experiencing their first episode of schizophrenia.
Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984489). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.
Resources
Schizophrenia https://emedicine.medscape.com/article/288259-overview
First-Episode Schizophrenia https://pubmed.ncbi.nlm.nih.gov/21141653/
Comprehensive Versus Usual Community Care for First Episode Psychosis: Two-Year Outcomes From the NIMH RAISE Early Treatment Program https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981493/
Schizophrenia Treatment & Management https://emedicine.medscape.com/article/288259-treatment#d9
Akinesia https://pubmed.ncbi.nlm.nih.gov/32965848/
Clozapine (Rx) https://reference.medscape.com/drug/clozaril-versacloz-clozapine-342972
20-year Nationwide Follow-up Study on Discontinuation of Antipsychotic Treatment in First-Episode Schizophrenia https://pubmed.ncbi.nlm.nih.gov/29621900/
A Randomized, Controlled Trial of Omega-3 Fatty Acids Plus an Antioxidant for Relapse Prevention After Antipsychotic Discontinuation in First-Episode Schizophrenia https://pubmed.ncbi.nlm.nih.gov/24996507/
Beneficial Effects of Omega-3 Fatty Acid Supplementation in Schizophrenia: Possible Mechanisms https://pubmed.ncbi.nlm.nih.gov/32620164/
An Overview of Coordinated Specialty Care (CSC) for Persons With First Episode Psychosis https://www.nasmhpd.org/content/presentation/overview-coordinated-specialty-care-csc-persons-first-episode-psychosis

Drs John M. Kane and Mitchell Arnovitz discuss assessment of patients for negative symptoms of schizophrenia and the potential of MDMA in alleviating these symptoms in supervised treatment settings.
Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984490). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.
Resources
Schizophrenia https://emedicine.medscape.com/article/288259-overview
MDMA for the Treatment of Negative Symptoms in Schizophrenia https://pubmed.ncbi.nlm.nih.gov/35743326/
MDMA (Ecstasy/Molly) https://nida.nih.gov/publications/drugfacts/mdma-ecstasymolly
The NIMH-MATRICS Consensus Statement on Negative Symptoms https://pubmed.ncbi.nlm.nih.gov/16481659/
The Current Conceptualization of Negative Symptoms in Schizophrenia https://pubmed.ncbi.nlm.nih.gov/28127915/
Akinesia https://www.ncbi.nlm.nih.gov/books/NBK562177/
An Assessment of Five (PANSS, SAPS, SANS, NSA-16, CGI-SCH) Commonly Used Symptoms Rating Scales in Schizophrenia and Comparison to Newer Scales (CAINS, BNSS) https://pubmed.ncbi.nlm.nih.gov/29430333/
Ecological Momentary Assessment https://pubmed.ncbi.nlm.nih.gov/18509902/
Schizophrenia Medication https://emedicine.medscape.com/article/288259-medication#2
Cariprazine, a Broad-Spectrum Antipsychotic for the Treatment of Schizophrenia: Pharmacology, Efficacy, and Safety https://pubmed.ncbi.nlm.nih.gov/34091867/
DRD3 Dopamine Receptor D3 [Homo sapiens (human)] https://www.ncbi.nlm.nih.gov/gene/1814
MDA https://dictionary.apa.org/mda
Transcranial Magnetic Stimulation: A Review of Its Evolution and Current Applications https://pubmed.ncbi.nlm.nih.gov/31359968/
Memantine https://www.ncbi.nlm.nih.gov/books/NBK500025/
Making MDMA a Medicine (II) (Re)scheduling for Schedule I Substances https://maps.org/news/bulletin/making-mdma-a-medicine-ii-rescheduling-for-schedule-1-substances/
Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors https://www.ncbi.nlm.nih.gov/books/NBK548187/
Metaplasticity: Tuning Synapses and Networks for Plasticity https://pubmed.ncbi.nlm.nih.gov/18401345/
MDMA-Assisted Psychotherapy for Treatment of Posttraumatic Stress Disorder: A Systematic Review With Meta-Analysis https://pubmed.ncbi.nlm.nih.gov/34708874/
Reduction in Social Anxiety After MDMA-Assisted Psychotherapy With Autistic Adults: A Randomized, Double-Blind, Placebo-Controlled Pilot Study https://pubmed.ncbi.nlm.nih.gov/30196397/
Prefrontal Cortex-Nucleus Accumbens Interaction: In Vivo Modulation by Dopamine and Glutamate in the Prefrontal Cortex https://pubmed.ncbi.nlm.nih.gov/18508116/
Serotonin Syndrome https://emedicine.medscape.com/article/2500075-overview