Michael D. Teehan

Effects of oxazepam and lorazepam on implicit and explicit memory: evidence for possible influences of time course

Abstract The effects of oxazepam (30 mg), lorazepam (2 mg), and placebo on implicit and explicit memory were studied in two testing cycles, 100 and 170 min after drug administration. Thirty healthy volunteers were randomly assigned to one of three groups (placebo, oxazepam, or lorazepam) in a double-blind, independent groups design. Drug groups were equivalent prior to drug administration on a variety of cognitive measures. Following drug administration, both oxazepam and lorazepam equally impaired performance on a cued-recall explicit memory task relative to placebo, at both testing cycles. Relative to placebo, lorazepam markedly impaired priming on a word-stem completion implicit memory task, at both testing cycles. Consistent with previous work, oxazepam failed to produce impairments in priming on the word-stem completion task at 100 min post-drug administration. However, oxazepam was found significantly to impair priming on this latter task relative to placebo, at close to theoretical peak plasma concentration (i.e., 170 min post-drug administration). Explanations for the observed detrimental effect of oxazepam on implicit memory task performance are considered, including: possible time-dependent effects related to the relative rate of absorption of these two benzodiazepines (BZs); and potential contamination of the implicit memory task by explicit memory strategies during the second testing cycle.

Long-acting injectable antipsychotics: recommendations for clinicians.

A major source of limitation to the real effectiveness of antipsychotics is the high rate of patient nonadherence or, more frequently, partial adherence. using long-acting injectable (LAI) formulations is likely to reduce the impact of such adherence problems. Conversely, the use of LAIs in Canada remains low relative to many other jurisdictions. Based on effectiveness data from randomized control trials and other, less rigorous, studies, as well as our 2 qualitative studies exploring numerous issues around the use of LAIs, including their low use, we put forward 10 different recommendations for consideration by clinicians. These are also based on the experience of many clinicians and clinician scientists. These recommendations address mostly clinical challenges associated with the use of LAIs. Their application in clinical settings is illustrated in our report through several case examples highlighting the large variation across patients and different phases of illness. It is recommended that LAIs should be considered as a treatment option for psychotic disorders across all phases, including the first 2 to 5 critical years.

Guidelines for the Pharmacotherapy of Schizophrenia in Adults.

Objective: The present guidelines address the pharmacotherapy of schizophrenia in adults across different stages, phases, and symptom domains. Method: Guidelines were developed using the ADAPTE process, which takes advantage of existing guidelines. Six guidelines were identified for adaptation, with recommendations extracted from each. For those specific to the pharmacotherapy of schizophrenia in adults, a working group selected between guidelines and recommendations to create an adapted guideline. Results: Recommendations can be categorized into 6 areas that include 1) first-episode schizophrenia, 2) acute exacerbation, 3) relapse prevention and maintenance treatment, 4) treatment-resistant schizophrenia, 5) clozapine-resistant schizophrenia, and 6) specific symptom domains. For each category, recommendations are made based on the available evidence, which is discussed and linked to other established guidelines. Conclusions: In most cases, evidence-based recommendations are made that can be used to guide current clinical treatment and decision making. Notably, however, there is a paucity of established evidence to guide treatment decision making in the case of clozapine-resistant schizophrenia, a subsample that represents a sizable proportion of those with schizophrenia.

Physical Health and Drug Safety in Individuals with Schizophrenia

Background: While antipsychotic medications are the mainstay of therapy for individuals with schizophrenia and psychotic disorders, their use is associated with adverse effects on physical health that require the attention and care of prescribers. Methods: We used the ADAPTE process to adapt existing guideline recommendations from the National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) guidelines on the dosing of antipsychotics and antipsychotic polypharmacy, screening for adverse effects of antipsychotics, and management of metabolic and extrapyramidal side effects to the Canadian context. Results: Prescribers are encouraged to use the lowest effective dose and to avoid the routine use of multiple antipsychotics. Scheduled monitoring of body mass index, waist circumference, blood pressure, glucose, lipids, prolactin, electrocardiograms, and extrapyramidal symptoms is recommended. Lifestyle interventions are recommended to mitigate antipsychotic-induced weight gain. Prescribers should follow Canadian guidelines on the treatment of obesity, dyslipidemia, and diabetes. Recommendations on antipsychotic drug choice are made for users particularly concerned about extrapyramidal symptoms. Conclusion: Careful monitoring and attention by prescribers may mitigate adverse effects associated with antipsychotic medications.

University Students’ Perceptions of Links Between Substance Use and Mental Health: A Qualitative Focus Group Study

There is a consensus among addictions researchers and clinicians that mental health concerns and substance use problems are often interrelated. It is less clear to what extent the general public, and university students in particular, understand connections between substance use and mental health. The current study aimed to understand university students’ perceived links between substance use and mental health by conducting three semistructured focus groups (N = 24 participants, 67% female). Thematic analysis of the data yielded five themes: (1) Students use substances to cope with mental health issues, (2) substance use can lead to mental health problems, (3) links between mental health and substance use are cyclical, (4) substance use is an aspect/indicator of mental health, and (5) substance use and mental health are not always linked. Findings provide insight into the understudied area of perceived links between substance use and mental health and have implications for campus programming.

Issues of choice in second-generation antipsychotic agents

Objectives: To identify and describe the most significant issues in optimal clinical use of the second-generation antipsychotics. Methods: A case report of an elderly female with treatment-refractory psychosis, negative symptoms, and tardive dyskinesia is used to focus the discussion of the clinical decisions. The rationale for switching, the choice of an appropriate compound, and the practical issues of transition from her present treatment are addressed. Conclusions: The case illustrates a common clinical scenario, focusing on the practical clinical issues in changing treatments. It draws attention to the need to carefully monitor the switch from traditional to second-generation antipsychotics. This is particularly important in patients with severe symptoms, so as not to confuse withdrawal effects from present medications with apparent failure of the new treatments.