Dr Sanil Rege FRANZCP | MRCPsych
@sanilrege
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Psychiatrist / Co-Founder Psych Scene / Founder Vita Healthcare / Founder of 🎓 Academy by Psych Scene / #MedicalEducator
Melbourne, Victoria
Joined January 2011
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Since 5-HT is all the rage - Here are some antidepressants that do not act via SERT blockade. Antidepressants are not a homogeneous group. Most commonly those that put them under one umbrella have a anti-med agenda. So let's get started 👇
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Borderline Personality Disorder is best conceptualised as a Chronic Pain Syndrome 🚨
The Difference - Psychological vs Physical Pain ✅
Neurobiologically however they involve the same circuits.
🚨The Pain Triggers? - Interpersonal Relationships 🚨
This conceptualisation is
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First Post-Mortem Insights on ECT's Impact on the Human Brain 🧠🔬
"The first post-mortem observations suggest that ECT has no damaging effects but may rather have induced neuroplasticity in the DG (dentate gyrus) of depressed patients."
Examination of the post-mortem
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Neuroinflammation in Depression: 10 Key Points for Psychiatrists 🚨
Recognising an inflammatory subtype can make a significant difference to treatment✅
History, examination and investigations reveal clues pointing to inflammatory subtypes
Key points : ( Not exhaustive)
1.
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Antidepressant Mechanisms of Exercise 🏃🏾🚀
1. Enhances Dopamine Transmission and Neural Reward Circuitry
2. Augments Effort Exertion and Mitigates Anhedonia
3. Improves Cognitive Control
Enhances attention, memory, and executive function.
4. Anti-Inflammatory Effects
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Catatonia - Where Psychiatry and Neurology meet 🚀🧠
“Mostly it is grief and worry and generally depressive moods and affections turned against oneself that give rise to catatonia. … Not infrequently, hypochondria and moods directed against the outside world, anger,
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Treating Antipsychotic-Induced Akathisia: A Systematic Review and Network Meta-Analysis 📚🔍
Key Findings:
Effective Treatments: ✅
👉Mirtazapine
👉Biperiden
👉Vitamin B6
showed the greatest efficacy against placebo 💊.
Alternative Options: ✅
👉Trazodone
👉Mianserin
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Borderline Personality Disorder (BPD) continues to offer insights into biological underpinnings serving as a unique intersection where the biological, psychological, and social domains converge. 📚
Below are some biological aspects in BPD 👇
1️⃣Genetics and epigenetics - overlap
While it is often alleged that borderline personality disorder is a psychoanalytic concept, its identification and study proved fundamental to the rise of biological psychiatry. Early theorists believed that the riddle of schizophrenia's genetic transmission might be solved by
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You shouldn’t be allowed to make comments like this until you’ve tried understanding causality in psychiatry for at least a year.
You shouldn’t be allowed SSRIs until you’ve tried going to the gym twice a week.
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Sleep first’ should be the foundation of all psychiatric management 🚀✅
Understanding sleep is crucial across psychiatry and beyond – it's a transdiagnostic indicator that influences mood, cognition, emotion and overall well-being.
"Sleep that relieves the weary labourer and
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ADHD is psychiatry’s greatest mimic !
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Long-Term Outcomes in First-Episode Psychosis: Clinical Recovery and Treatment Resistance After 10 Years 🚨
A 10-year follow-up study of FEP patients revealed three distinct outcome groups:
1. Clinical Recovery (29%)
2. Treatment Resistance (31%)
3. Partial Recovery (40%).
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🚨Clozapine and Constipation
This is the one side effect that easily flies under the radar BUT is associated with the highest risk of mortality. ( High case fatality - 28%! )
I have to constantly remind myself and remind the patient about the seriousness of this SE.
While
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“The psychiatrist must be first and foremost and all the time a physician… In fact, psychiatry is neurology without physical signs, and calls for diagnostic virtuosity of the highest order…
The psychiatrist should not only first be a physician but ideally a superlative
@lynne_drummond
Psychiatry can't be practiced in isolation from the rest of medicine. Working on a blog post about that right now.
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Aripiprazole and Hyperprolactinemia: A Real-World Study in Acute Schizophrenia 🚨
Key Messages:
👉Aripiprazole significantly lowered elevated prolactin levels after 8 weeks of treatment in patients with acute schizophrenia.
👉 In patients with normal baseline prolactin,
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The latest 🚀- Pharmacological treatments for psychotic depression: a systematic review and network meta-analysis 🚀
Results :
👉The combination of fluoxetine and olanzapine showed significantly higher treatment response rates compared to placebo
👉SSRIs combined with
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Patient - “sertraline 50 mg reduced my irritability & improved my mood”
Me -Why was it ⬆️ to 200 mg.
Pt -Because I was still anxious & depressed
Me-Did it improve with the ⬆️?
Pt -“No I felt more disconnected. Like I was going through the motions. I feel nothing’. 1/ 🧵
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🚨 Elevated Prolactin with Antipsychotics CANNOT be Overlooked
Here are some findings that should motivate psychiatrists to proactively treat ⬆️ Prolactin
1️⃣Females have a much higher risks of hyperprolactinemia related adverse effects
2️⃣Prolactin related effects are strongly
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Memantine: An Underutilised Agent in Psychiatry 🚀💊
Find out why 👇
MOA 👉reducing NMDA excitotoxicity due to glutamatergic over-activation 🧠
NMDA receptors' locations: 🧠
1. DLPFC: Influences executive function
2. Ventral Tegmental Area: Houses dopaminergic neurons,
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🚨Antipsychotics Change Brain Networks in FEP
FOR THE BETTER ✅
🧠 Key Findings in First Episode Psychosis ( FEP) :
1. Antipsychotic treatment significantly alleviates alterations in brain network Functional Connectivity (FC).
Interestingly, the degree of FC normalisation
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C-PTSD or PTSD or BPD ✅
Tips for clinical practice :
Instead of purely focusing on labels,
consider all 3 diagnoses within the context of
1. Trauma
2. Attachment disruptions
3. Intergenerational trauma
and its impact on neurobiology, psychosocial- cultural domains
Trastorno de estrés postraumático complejo y modelo biopsicosocial del trastorno límite de la personalidad
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In psychiatry a key formulatory statement in relation to visual hallucinations ( significant, as part of psychiatric illness) is 👇
“Visual hallucinations indicate organicity unless proven otherwise.”
What does a meta-analysis tell us?
1. “Visual hallucinations were strongly
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Lithium - What Levels and What Effects? 🚀
Latest review critically examines the clinical evidence supporting the 0.6 mEq/L threshold.📚
Key Points:
👉Lithium's clinical effects for mood stabilisation occur at concentrations above 0.6 mEq/L.
👉Lower levels may suffice for
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Akiskal on BPD 💭
"Borderline personality disorder is at best a confusing concept, and at worst, a counter-transference diagnosis which robs the patient of the opportunity of much needed treatment."
"An illustration of the diagnostic confusion that could result from competing
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ECT vs Ketamine - Systematic Review and Meta Analysis
1. ECT was superior to ketamine (overall pooled SMD for posttreatment depression ratings)
2. ECT was superior to ketamine for study-defined response and remission rates
"The findings of this systematic review and
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Freud was onto something - and w current advances have integrated neuroscience & pharmacotherapy to a greater extent.
The uncanny similarities b/w
1. The id, ego, superego & the tripartite network (DMN, SN, ECN)
2. Ego overwhelm & Corticolimbic dysfxn
1/
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'It's not ADHD; It's Trauma ❌'.
This dichotomy oversimplifies complex neurodevelopmental realities.
Trauma's impact on the neurodevelopment of fronto-striatolimbic circuits, central to ADHD and ASD domains, cannot be overlooked.
Neurobiology including developmental
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The Rise in ADHD Diagnoses - A Neurobiological ( and analytical) Understanding 🚀🧠
👉For decades, the focus in psychiatry was on subcortical and limbic domains, leading to an exploration and a focus on diagnoses like bipolar disorder, ‘neuroses’, schizophrenia etc.
🧠The
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Akathisia 👇
Some important points
1. Akathisia should be differentiated from hyperarousal , agitation and RLS.
The treatments for all 4 differ significantly
2. Akathisia can occur as part of drug withdrawal
3. The mechanism of akathisia is more than just D2 antagonism -
Why as a clinician you should be aware of the symptoms of akathisia…
For accredited learning and more in-depth information about akathisia, check out the Psychopharmacology Masterclass Series on The Academy. Link below:
#Psychiatry
#Akathisia
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Restless Legs Syndrome - Findings from Systemic Review and Network Meta-Analysis 📚
Number 4 may be a surprise!
1. Cabergoline is the most effective in reducing IRLS scores among all drugs.
2. Pramipexole demonstrates superiority over ropinirole in alleviating RLS symptoms.
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Today discharged my patient with ADHD after 4 appts to GP. Gp prescribing dexamfetamine, clonidine & lamotrigine in collaboration - now will be managed only in primary care with me involved if needed. How it started 2020 - unemployed with distress. Now-manager of dairy farm.
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One day, psychiatry will recognise the pivotal role of addressing sleep effectively ( not sedation) in treating psychiatric conditions.
RESTORING SLEEP ARCHITECTURE could prove to be one of the most effective interventions across the spectrum. 💤🌙
#SleepMatters
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Neuroinflammation: An Important Missing Piece in Cardiac Disease Management 🫀🧠🔍
The 🫀- 🧠 Axis and Why Psychiatrists ( and others) can make a difference 🚀
As a consultation-liaison psychiatrist when seeing patients on the cardiology ward an intriguing aspect often emerges
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BPD is best conceptualised as a Interpersonal Pain Syndrome 🚨
👉There are many converging models Biological and Psychological that explain the range of features in BPD
Some include
1. Interpersonal tone is mediated by opiodergic pathways ( see diagram for the self harm -
Why do
#borderline
patients appear "better" when they are single or involved only in casual relationships? It is because the interpersonal symptoms of
#BPD
are largely a function of the proximity of their relationships, i.e., the closer someone gets, the more fearful and
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Is it ADHD or BPD ( Borderline Personality Disorder) ? ¿Por Qué No Los Dos? 🤷🏽♂️
There are 4 possible explanations for the frequent co-occurrence of ADHD and BPD 👇
1️⃣Attention-Deficit/Hyperactivity Disorder (ADHD) may function as a developmental antecedent to Borderline
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Antidepressants Trending: Time for a Refresh 🚀
💊The term "antidepressants" itself is misleading.
It made sense once upon a time, but now?
The term fails to encompass the broad spectrum of their pharmacological effects.
These medications are multifaceted in their
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Is there a role for Naltrexone in Self Harm and Self injurious behaviour? 🚀
👉Some Self harm behaviours can be conceptualised along an addiction model with salience ( compulsion) and an altered pain threshold.
👉“Naltrexone produces a clinically significant reduction in the
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Females with ADHD 🚨👇
How many times have you found these buzz words in females with ADHD? ( not all exhaustive but look closely and you’ll see common patterns and constellations)
1. ASD /ASD ( delayed diagnoses)
2. PCOS
3. Migraine
4. Borderline Personality Disorder
5.
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Efficacy of Lamotrigine in Bipolar Disorder: A Systematic Review and Meta-Analysis 🚀
Key Findings:
Studies were categorised into three groups:
1. Acute treatment of depression
2. Acute treatment of mania and hypomania
3. Maintenance treatment
1. Acute Treatment of
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It's not ADHD; It's Trauma ❌'.
Avoid Double Jeopardy 🚨
This dichotomy oversimplifies complex neurodevelopmental realities.
Trauma's impact on the neurodevelopment of fronto-striatolimbic circuits, central to ADHD and ASD domains, cannot be overlooked.
Neurobiology
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One of the most common tests I use in clinical practice.
Examination of fronto-striatal circuits.
In Psychiatry we have clinical examination markers that provide us with diagnostic, treatment and prognostic information for a formulation.
Here are some of the aspects about
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ADHD and Comorbid Conditions: Key Findings from a systematic review and meta analysis 🔍🚨
Among 76 health outcomes, ADHD shows significant associations with 39 comorbid conditions, impacting neurological, psychiatric, sleep, metabolic, musculoskeletal, oral, allergic, visual
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Borderline Personality Disorder (BPD) is built on a Paradox. 🚨
This paradox emerges across various dimensions-pain (both physical and psychological), communication, behaviour, emotional responses, etc.
Why?
Let me explain 👇
To truly understand this, we must look at the
Patients with borderline personality disorder respond paradoxically to positive evaluation by others. This is believed to be due to an unconscious association between positive evaluation and fear of abandonment.
.
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The purpose of Suicide risk assessment is not to ‘predict’ a rare event.
It is to formulate a tailored plan to address a patient's needs, factoring in known probabilistic factors linked to suicide.
It says it in the title - Suicide Risk assessment NOT Suicide prediction.
"In 1954, Dr. Albert Rosen performed an elegant statistical analysis and predicted that, considering the low base rate of suicide, suicide risk assessments are 'of no practical value, for it would be impossible to treat the prodigious number of false positives.' It seems that...
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Trazodone in the Management of Major Depression Among Elderly Patients with Dementia 💊
Trazodone has a dual mechanism of action :
1️⃣Serotonin transporter (SERT) inhibition
2️⃣5-HT2A and 5-HT2C receptor antagonism
Additional mechanisms:
1️⃣α1- and α2-adrenergic receptor
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MDMA
86.5 % achieved a measurable reduction in severity of symptoms.
71 % no longer met the criteria for a PTSD diagnosis.
Placebo
69 % improved
48 % no longer qualified for a PTSD diagnosis.
Can we start using the placebo in the mean time?
.
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🚨 Neuroscience of addiction
3 stages
1.Binge & Intoxication:
Reward circuit ( NAc, VTA & Caudate)
2.Withdrawal & Negative affect : OFC, DLPFC & amygdala
3. Anticipation & Craving:
Insula & prefrontal lobes
Addiction sets in via dorsal shift (⬇️cognitive control)
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Vitamin D supplementation in Depression - Meta Analysis ✅
Results :
✅Vitamin D supplementation has a benefit on improving depressive symptoms in adults with primary depression and 25(OH)D levels higher than 50 nmol/L
❌No effect on improving depressive symptoms in adults
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What anti-psychiatrists see 👇
“Chemical imbalance”
“Big pharma”
“Serotonin umbrella”
What else?
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REM sleep behaviour disorder is important for psychiatrists as it provides important clues for diagnosis & management 👇
1. DA Plays an important role in REM atonia hence the association with parkinson’s disease
2. SSRIs & SNRIs can unmask RBD
3. Clonazepam can be a very
Did you know during REM sleep behavioral disorder your muscles are supposed to be completely quiet? In neurodegenerative diseases like Parkinson's when you recorded during sleep studies the movements may be purposeful and in many cases may set the person up for an injury during
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💊The term "antidepressants" itself is misleading and highlights the lack of understanding of pharmacology.
The term fails to encompass the broad spectrum of their pharmacological effects.
Like Metformin, GLP-1 agonists, SGLT2 inhibitors, etc, we've moved away from
This was probably the most important slide I showed in my talk at RCPsych congress yesterday
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Summary of Emerging Horizons in Psychopharmacology: Innovations in 2023-4 and Future Directions
New Antidepressants:
1. Auvelity: Bupropion and dextromethorphan - faster antidepressant response with improved tolerability.
2. Zuranolone (Zurzuvae): An oral analogue of IV
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Schizophrenia and Nicotine 🚬
Really important topic
Summary 👇
Learn more:
1. Schizophrenia and Nicotine Dependence: Neurobiology and Treatment:
2. Prof David Castle's Lecture on Smoking and Schizophrenia:
#Smoking
Up to 80% of people with schizophrenia smoke cigarettes. Why?
I’ve always had a soft spot for the self-medication hypothesis. Nicotine improves cognition (vital in schizophrenia) and reduces side effects from antipsychotics.
That pesky increased mortality from cigs sucks tho.
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I think as psychiatrists at times we are too polite in calling out BS.
What else would one call this?
Antipsychiatry should be added as one of the risk factors for a range of poor outcomes.
The below is not critical psychiatry.
Exhibit 1:
J. Moncrieff - “If something is
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Do you know of ADHD - SOM? 🤔
“Based on the close link between ADHD and sleep dysregulation, some authors have proposed a diagnostic subtype, ADHD-SOM (from ‘Somnus’, Latin for sleep), where sleep disorders significantly contribute to ADHD
symptomatology. [Bijlenga et al.,
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New article 👉The Neuroscience of Addiction - Application to Clinical Practice 🚀
Addiction is best conceptualised as a phenomenon where a ‘stimulus’ / object often an external ‘substance’ becomes all consuming.
In this context the neuroscientific principles highlight how the
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Two partial D2 agonists with different profiles - Aripiprazole vs Brexpiprazole
1. Aripiprazole 👉Dopamine system stabiliser (DSS)
2. Brexpiprazole 👉Serotonin- Dopamine Activity Modulator (SDAM)
Why does it matter ?
1. Aripiprazole has a > Partial agonist action >
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RSD vs BPD bs ADHD 🤔
I’ll weigh in - either way - it’s Twitter 😊
Labels can often create more confusion than clarity, especially when we talk about conditions like Borderline Personality Disorder (BPD) - broader construct and Rejection Sensitive Dysphoria (RSD) - which is a
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Impact of ADHD Medication on Mortality Risk: A Nationwide Cohort Study in Sweden 🚨
Attention-deficit/hyperactivity disorder (ADHD) is associated with increased risks of adverse health outcomes including premature death. 🚨
Main Outcomes and Measures:
👉The study assessed
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🚨In autoimmune disorders (e.g Sjogren’s, NPSLE) neuropsychiatric symptoms can occur before the onset of physical symptoms - a point that is often overlooked by rheumatologists leading to patients with neuropsychiatric issues being sometimes dismissed.
👉Titres do not correlate
@neuropsychSjo
Wow I didn’t know that neurological features start before the classical dry eyes and mouth. Which neuro symptoms should people watch out for?
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ADHD and ASD Distinct or Overlapping entities? 📚
👉ADHD presents in 30–80% of individuals with ASD, and ASD presents in 20–50% of individuals with ADHD.
👉ADHD and ASD show a shared aetiology in multiple neurobiological aspects.
Read our review on ADHD and Autism Comorbidity:
AuDHD, the co-occurrence of autism and ADHD, brings unique challenges and traits. Once thought incompatible, these conditions overlap more than you might expect.
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Conceptualising the Multiple Dimensions of Fear and Anxiety 🧠🚨
1. Threat as a Common Antecedent:
👉Fear, anxiety, and related states are a mechanism to alert the organism to potential dangers.
2. Arousal and Negativity:
👉Fear and anxiety are inherently arousing and
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Dosing of Antipsychotics and Mood Stabilisers in Bipolar Disorder - Relapse Risk and Safety
Finnish Cohort Study 🚀
Key Findings:
1. Higher doses of antipsychotics or mood stabilisers were not associated with better treatment outcomes.
2. Standard doses of lithium and
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Weighing into the the ongoing debate on the existence of ADHD. Strange to me. Labels can always be debated and disproven but the underlying neuroscience ( may be incomplete) but not so easily disproved. So let's get back to neuroscience to understand
#ADHD
. 🧵👇
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PCOS in Psychiatry 👉
1. Endophenotype of Bipolar disorder (clinical Sx are likely to have a mixed feature profile - > emotional arousal)
2. Due to the above : caution w SSRI & SEs
3. Valproate and PCOS association
4. PCOS is an inflammatory condition & hence in psychiatry
2023 international evidence-based guidelines on Polycystic Ovary Syndrome.
Diagnosis
A/Prof Carolyn Ee
@drcarolynee
#WONCASydney2023
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Update: 5HT-3 Antagonist Augmentation of SSRIs in Moderate to severe OCD🚀
"Augmentation of 5-HT3 antagonists with SSRIs can be beneficial in treating moderate to severe OCD.
They are safe and efficient and can be used when the first-line treatment fails to achieve acceptable
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How long should I continue Antidepressants ? 💊
What is the Critical Minimum Duration of Treatment to Prevent a Relapse? 🤔👇
Duration of Antidepressant Treatment: Balancing Efficacy and Relapse Risk in Major Depressive Disorder - Meta Analysis 🚨
Key findings 👇
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The domains of ADHD and the 3 levels
Level 1- Domains
1. Cognition
2, Activity
3. Reward sensitivity
4. Behavioural inhibition
5. Behavioural activation
6. Fight and flight
Level 2- formulatory factors
Then comes the bio-psycho-socio-cultural - diet- lifestyle
@adultADHDindia
@thewaitinghours
@psycheureka
No. That's not what ADHD is.
The concept of ‘ADHD ‘ goes beyond just executive function.
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Obsessive–compulsive symptoms (OCS) in Treatment Resistant Schizophrenia - Relationship to Psychosis vs Clozapine 🚨
196 clozapine-treated individuals
👉High incidence of significant OCS observed in 37.9% of the patients, with checking behaviors being the most common.
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ADHD Management 🚨
Not sure who needs to hear it but here goes 👇
1. ADHD management is not just about prescribing stimulant medications
2. The FRAME of ADHD treatment is > ADHD pharmacological treatment
👉ADHD is a lifespan condition, so treatments should focus on
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PTSD vs C-PTSD vs BPD - A Hyper-Visual
The following is a summary based on published evidence.
However, we know things are never as clear cut - nonetheless, it's a useful visual tool!
To learn more about C-PTSD, PTSD and the differences
👇
5+ hours of Courses on
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Antipsychotic Use and Risk of Breast Cancer in Women With Severe Mental Illness 🚨
Study Design
👉Nested case–control study.
👉 women aged 18–85 years with schizophrenia/schizoaffective/other nonaffective psychotic disorder/bipolar disorder
Main Findings :
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"Lithium was the only treatment associated with decreased risk of both psychiatric and somatic admissions". 🚀
Real-world effectiveness of pharmacological treatments for bipolar disorder: register-based national cohort study | The British Journal of Psychiatry | Cambridge Core
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Antipsychotics were protective against all-cause mortality versus no antipsychotic with largest effects in order of risk reduction
1. SGA-LAIs
2. Clozapine
3. LAI
4.Any SGA
Hopefully in TRS we will consider point 2 more. Evidence of critical period 👉
Huge meta-analysis shows mortality in people with schizophrenia is greater than those in the general population but pharmacotherapy (most notably clozapine) can significantly shrink the mortality gap.
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Impact of Clozapine on Anti-Glutamate Receptor Antibody Levels in Treatment-Resistant Schizophrenia 🚀🧠
👉Treatment-resistant schizophrenia (TRS) has been linked to glutamatergic function abnormalities and immune processes, including higher levels of antineuronal antibodies.
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Catatonia 🧠- article releasing 30th July🚀
👉Is it a movement disorder?
👉Is it an affective disorder?
👉Is it a psychomotor disorder?
👉Is it a medical condition?
👉Is it an autoimmune condition?
👉Is it a cognitive-behavioural disorder?
👉Is it a disorder of autonomic
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Conceptualising Catatonia from different lenses 🔎
1. Psychiatry
Movement - Dorsal Striatum (Goal directed & Habit)
Dopamine D1 vs D2 striatal dysregulation
2. NeuroPsychoanalysis 👉The striatum is also the home of implicit memories ‘the unconscious’
The unconscious
Jung held that movement allowed access to material that is unconscious.
In one case, he saw a woman with psychosis who had such severe stereotypic hand-rubbing that she had developed calluses. It transpired that the movements had started as sewing and polishing movements.
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Antipsychotic Medication - To Continue OR Taper and Discontinue 🚨🚨- The Latest
Patients With Schizophrenia and Other Nonaffective Psychotic Disorders 📚
Findings :
👉Many RCTs have abrupt dose changes, predisposing them to intervention failure.
👉Individualised Dose
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New algorithm for treating GAD in older adults. 🚀
First-line treatment:
👉SSRIs (sertraline or escitalopram preferred).
👉Consider buspirone if avoiding sexual side effects is important.
Second-line treatment:
👉If the response to the first SSRI is inadequate, switch to a
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I think there is a significant misunderstanding of what functional neurological disorder means 🚨
This needs more discussion as it affects patients
1. FND does not mean ‘psychiatric’ or a predominant ‘psychological formulation ‘ in the traditional sense- Far from it.
2.
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Borderline Personality Disorder is best conceptualised as a Chronic Pain Syndrome 🚨
Endogenous opioid system (EOS) plays a distinctive role in the core symptoms of BPD ( Gescher,2024)
Covered in a previous tweet 👇
The Difference - Psychological vs Physical Pain ✅
In this study by Joel Paris's group at McGill, 89% of borderline personality disorder patients reported current pain and 65% met criteria for a DSM-IV lifetime pain disorder diagnosis. Thirty percent of chronic pain patients have BPD.
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Comparative Risk of Hyponatremia Across Antidepressant Classes: A Comprehensive Meta-Analysis 🚨
Study : 📚
A meta-analysis, analysing data from 39 studies involving over 8 million adults.
Key Findings: 👇
👉Exposure to antidepressants was associated with significantly
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Cariprazine Augmentation of Clozapine in Treatment-Resistant Schizophrenia 🚀
Study : Retrospective Chart Review
12 individuals who received a combination of cariprazine and clozapine for 3-60 weeks (median 32 weeks)
Findings:
👉A treatment response was observed in 75% of
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Formulation time! 🚀
"The MRI shows scattered T2/FLAIR white matter hyperintensities in the subcortical areas".
Significant or non-significant? You'll commonly hear they aren't diagnostic, or they are non-specific, etc.
You decide if it's relevant or not -based on the
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The Tragic Case of Dr. Osheroff: A Cautionary Tale of Antipsychiatry's Dangerous ‘Anti-medication’ Ideology 🚨
Antipsychiatry or anti-’biomedical’ anti-medication stances are not new, and while they periodically gain attention, they often falter due to their opposition to
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🚀Breakthrough ! Zuranolone (Zurzuvae) now FDA approved for postpartum depression. First oral neurosteroid in PPD. Next - MDD ?
This is likely one of the important developments in psychiatry - the field of neurosteroids. Multiple applications likely across disorders. Will have more on the 🎓 in the women’s mental health series later this year. 👉
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DORAs - The Efficacy of Dual Orexin Receptor Antagonists (DORAs) in the Treatment of Insomnia: Meta Analysis 📚
Mechanisms of Action:🧠
👉Orexin, a neuropeptide integral to wakefulness, interacts with orexin receptor 1 (OxR1) and orexin receptor 2 (OxR2), both G-protein coupled
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Clozapine and Olanzapine most effective in real world data.
But why? It's interesting when psychopharmacology translates to the real world
🧬 Key Factor: The Optimal D1 and D2 Ratio
See the image ( Clozapine and Olanzapine has an almost equal D1 :D2 occupancy ratio followed
Efficacy and Effectiveness of Antipsychotics - Network Meta - Analysis combining Trial and Real World Data 🚀
🔑 Key Findings 👇
1. APs more effective in RCT-eligible vs. ineligible individuals.
2. Efficacy vs. Effectiveness: Efficacy in RCTs (vs placebo) greater than
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Cognitive improvement in late-life depression treated with Vortioxetine and Duloxetine 🧠 - RCT 📚
Impact of Age at Depression Onset
Key Messages:
👉Vortioxetine and Duloxetine improved cognitive performance of elderly depressed patients with first onset after 50.
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Can Metformin improve outcomes in Treatment-Resistant Bipolar Disorder (TRBD) 🚀
Study: RCT
45 Bipolar Disorder patients
Metformin vs Placebo
👉After 14 weeks or more, a significant number of patients treated with metformin no longer met the criteria for insulin resistance
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Antipsychotic induced metabolic effects via action on the trafficking and biosynthesis of sterols and lipids. 💊🩸
The study assessed, the aetiopathogenic mechanisms of olanzapine, risperidone and ziprasidone ( high, medium, low metabolic risk in patients)
Key Points : ✅
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Sharing with permission - One of the best descriptions of emotional blunting I've read 🚨👇
"After being on Sertraline (SSRI) for many years following PTSD I was quite content to be 'Comfortably Numb' as Pink Floyd would say, it's like being in a protective cocoon, unaffected
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ECT and Neuronal Injury - no evidence 🧠🚨👇
Following last years study showing neuroplastic effects in dentate gyrus - the latest study just published 👇
“In summary, we found transient increased levels of GFAP suggesting astrocytic reactivity in ECT, but no evidence of
First Post-Mortem Insights on ECT's Impact on the Human Brain 🧠🔬
"The first post-mortem observations suggest that ECT has no damaging effects but may rather have induced neuroplasticity in the DG (dentate gyrus) of depressed patients."
Examination of the post-mortem
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Naturalistic effectiveness study of maintenance therapies for the bipolar disorders 💊
Key findings 👇
1️⃣Lithium and lamotrigine were found to be the most commonly prescribed mood stabilisers (MSTs).
2️⃣Both lithium and lamotrigine were effective at mood stabilisation, with a
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The Answer Could Save Lives: Understanding the Hierarchy of Pathological Thoughts 🚀
Phenomenology in psychiatry is like reading ECG patterns or interpreting biomarkers.
Recognising thought patterns can genuinely be life-saving!
So let’s understand the thought hierarchy 👇
What features do people use to distinguish rumimation from obsession? Interested to hear different approaches.
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Antidepressants and Suicide Prevention Evidence - You be the Judge 👇Systematic Review 📚
👉”Antidepressants reduced suicidal ideation in nine of 12 studies that reported effects on suicidal ideation”
👉”Meta-analyses of both randomized controlled trials and
@Matt36518076622
@TotalCytopath
@Rozewicz
@WeCareAboutMH
Leon is wrong. FDA meta-analysis shows antidepressants have no effect on suicide in adults, increased it <25, slight decrease >65.
More recent analysis suggests increased risk or no risk for adults
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Cognitive dysfunction is a transdiagnostic entity. 🧠
In Depression - Cognition is a core symptom (a biotype highlights the need to recognise the importance of cognition but does not mean we can carve at the joints i.e cognitive vs non cognitive) ❌
✅ The importance of
“Cognitive”
#depression
proposed in 2023 trial:
1) Slow processing
2) Insomnia
3) Low functioning
4) Impaired cognitive control circuits on fMRI
Poorer response to antidepressants; research is exploring guanfacine/TMS
#psychiatry
#mentalhealth
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Beware of one-sided deprescribing experts! 🚨💊
I don’t know who needs to hear this but here goes. 👇
Prescribing and deprescribing are intricately intertwined as they operate on a continuum.
Both need a thorough understanding of pharmacology which can only be developed
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