Bibliography

BackgroundAcceptability is crucial for treatment efficacy, and the World Health Organization emphasizes its impact on patient compliance. Taste plays a significant role in acceptability, with bitter taste often leading to treatment discontinuation. Clozapine, an effective drug for treatment-resistant schizophrenia, faces acceptability challenges that have been connected to its poor taste.ObjectivesThe aim of this study was...

Clozapine is licenced for treatment‐resistant schizophrenia and psychosis in Parkinson's disease. In the United Kingdom, there is a mandatory requirement for absolute neutrophil count (ANC) and white blood cell count (WBC) monitoring to safeguard against agranulocytosis. Some people have naturally low ANCs without increased infection risk, caused by a homozygous T > C variant in ACKR1, commonly...

Background and Hypothesis Clozapine treatment carries a risk of blood dyscrasias (BD) and requires indefinite monitoring in many jurisdictions, a major factor in its under-utilization. Although previous studies suggest BD risk is highest early in treatment, BD events have also been reported after many years. This study compares early vs late (>6 months) suspected blood dyscrasias...

AimsOlanzapine long-acting injection (OLAI) is prescribed as maintenance antipsychotic treatment within small established clinics in Southwark and Lambeth. Despite the association between long-acting antipsychotics use and reductions in the number of relapses and hospital admissions, and oral olanzapine being the most commonly prescribed antipsychotic, OLAI is the least commonly prescribed LAI. This is due to...

AimsIn a community mental health setting, we studied real-world relapse rates in patients with a history of psychosis, before and after switching from oral antipsychotics to a long-acting injectable antipsychotic (LAIA). We also aimed to evaluate the relevance of metabolic/demographic factors in relapse rate.MethodsTwenty-five individuals with a past history of psychosis and variable medication concordance...

Cariprazine is effective in a number of conditions and has shown efficacy in the treatment of negative symptoms. Data on its use as an adjunct to other antipsychotics is growing. To evaluate the effectiveness of add-on cariprazine in patients with predominant negative symptoms, we assessed a series of patients prescribed adjunctive cariprazine using the Schedule...

Relapse following antipsychotic discontinuation is consistently associated with reduction in dopamine D2 receptor occupancy, but available evidence does not support the view that relapse risk is determined by the speed of receptor-occupancy decline. Meta-analytic findings indicate that, within discontinuation studies, abrupt and gradual discontinuation do not significantly differ in relative relapse risk. Apparent advantages of...

BackgroundNaturalistic studies examining paliperidone palmitate 3-monthly (PP3M) long-acting injection have proven PP3M to be a safe and effective maintenance treatment for patients with schizophrenia.ObjectivesThe aim of this study is to explore patients’ views and experiences with PP3M.DesignThis was a cross-sectional, non-interventional, one-time questionnaire which was designed by pharmacists in collaboration with clinicians experienced in the...

BackgroundClozapine is contraindicated in patients with a history of neutropenia suspected to be clozapine-induced agranulocytosis. Under exceptional circumstances, patients may be rechallenged with clozapine under an off-licence agreement. The evidence regarding clozapine rechallenge after suspected clozapine-induced neutropenia remains sparse and conflicting. In this observational study, we aimed to review the outcomes of patients rechallenged with...

We wish to congratulate Gangadin and colleagues on the completion of a landmark trial answering a key question regarding stopping antipsychotics after a first episode of psychosis. 1 Their data show that more than half of patients with their first episode of psychosis (FEP) can stop antipsychotics without relapsing within 18 months of follow-up after...

Clozapine is the only antipsychotic with established efficacy for treatment-resistant schizophrenia and remains recommended in the UK and the USA for this indication. For many patients, it is not simply the best option but the only antipsychotic with established efficacy in treatment-resistant schizophrenia, often conferring the greatest likelihood of clinically meaningful recovery, though response remains...

To the Editor The Handling Antipsychotic Medication Long-Term Evaluation of Targeted Treatment (HAMLETT) randomized clinical trial by Sommer et al1 is an ambitious endeavor to find optimal antipsychotic treatment of patients after first psychotic episode remission. This is an important issue because long-term maintenance antipsychotic treatment (MT) compared with dose reduction/discontinuation (DRD) may have drawbacks...

In the United Kingdom (UK), the Medicines and Healthcare products Regulatory Agency (MHRA) 1 serves as the principal medicines regulatory authority, operating under the Human Medicines Regulations 2012. 2 Its key role is to ensure that medicines are effective, safe and manufactured to consistently high standards.A pharmaceutical company seeking to bring a new drug to...

Many guidelines recommend deprescribing benzodiazepines and z-drugs in most long-term users. Due to physical dependence in those using medication as prescribed (distinct from addiction), discontinuation can be difficult and is often unsuccessful, as withdrawal symptoms can be severe and long-lasting, especially after long-term use. There is a lack of clarity on how to taper patients...

Clozapine is the only effective treatment for treatment-resistant schizophrenia, but concerns over blood dyscrasia and need for monitoring limit its use. Evidence suggests many hematological abnormalities may result from surveillance bias, with agranulocytosis being the primary adverse effect directly induced by clozapine. This systematic review (PROSPERO: CRD42024487199) investigates non-genetic risk factors associated with blood dyscrasia...

Methods: A systematic search was performed, using MEDLINE, EMBASE, PsycINFO, the National Clinical Trial (NCT) and the US Food and Drug Administration (FDA) databases from inception until April 2025. Single-or double-blinded randomised controlled trials (RCTs) were eligible if they compared any of 30 antidepressants, in head-to-head or placebo-controlled trials, for acute monotherapy in psychiatric disorders....

Methods: Public annual data on primary care prescribing for England for anxiolytics, hypnotics and anti-depressant agents taken as tablets or capsules was extracted from years 2010-2023. Medications that were on repeat prescriptions and those with episodic patterns were included. Annual data included medication agent, tablet size in milligrams, number of prescriptions and quantity of tablets.Anti-depressants:...

Xanomeline is a novel M1 and M4 muscarinic receptor agonist (Bodick et al., 1997). To date, there have been three double-blind randomised controlled trials (RCTs) of xanomeline-trospium (XT) combination in schizophrenia (Brannan et al., 2021; Kaul et al., 2024a; Kaul et al., 2024b). These placebo-controlled trials suggest a welcome but unanticipated large effect size-a measure...

Despite its superior effectiveness for treatment-resistant schizophrenia, clozapine has a high burden of adverse drug reactions (ADRs), which require monitoring and treatment. This global Delphi study has established consensus guidelines for absolute neutrophil count (ANC) thresholds for consideration of clozapine cessation and provided monitoring protocols for ADR management. Recommendations include lowering ANC thresholds for consideration...

More than 70 years after the first use of chlorpromazine in psychosis, there remain widely different views on the prescribing of antipsychotic drugs in schizophrenia and schizoaffective disorder. While most practitioners recognise the need for longterm treatment, there is an incomplete consensus on the optimal duration of treatment, although most people with schizophrenialike psychoses are...