Because standard antipsychotics don’t do much for the negative symptoms of schizophrenia (such as affective flattening and paucity of speech), there has been a fair amount of interest in the so-called “hypoglutaminergic hypothesis” of schizophrenia.

In 2005, the FDA issued a health advisory saying that antipsychotics appear to increase the risk of death in elderly patients with dementia. That advisory was based on data from placebo-controlled trials of antipsychotics conducted by industry. Now, a new study based on a completely different, and much larger, dataset, appears to confirm these dangers.

One of the final major questions that the NIMH-funded CATIE trials promised to answer was whether atypical antipsychotics are better at improving cognition in schizophrenia than conventional agents, as some smaller studies implied.

Why don’t we start with the issue of agitation? The question in many psychiatrists’ minds is how seriously we should take the FDA advisory about the dangers of atypical antipsychotics?

We’ve known for some time now that clozapine and Zyprexa (olanzapine) cause the most weight gain of any antipsychotic, but we didn’t know the actual mechanism – until now.

Janssen’s marketing team apparently missed the fact that the word in the English language that sounds most like “Invega” is “inveigle,” meaning “to entice, lure, or ensnare by flattery or artful talk or inducements” (www.dictionary.com). You may have already heard some “artful talk” from your Janssen reps, who are keen to have you convert your patients from Risperdal to Invega.

In this article, guest author Dr. Shalom Feinberg, takes a hard look at the most recent data on the effectiveness of SGAs for depression in its various guises, including treatment-resistant depression (TRD) and bipolar depression (BD).

Dr. Carpenter, as Editor-in-Chief of Schizophrenia Bulletin and a long-time researcher in the field, I’m sure you’ve seen trends come and go. Lately, we’ve been hearing a lot about how the older, conventional antipsychotics may be just as good as the newer atypicals. What’s your take?

We often see teenagers with co-occurring bipolar disorder and aggressive/impulsive behaviors. While Depakote is often effective, we also often prescribe atypical antipsychotics. A new post-hoc analysis provides some
evidence to bolster that practice.

Atypical antipsychotics can cause significant weight gain in adolescents. In this study, 39 kids between 10 and 18 years of age were randomized to receive either the antidiabetic drug Glucophage (metformin) or a matched placebo; each was added to their primary antipsychotic medication (Risperdal, Seroquel, or Zyprexa) for 16 weeks.