This case of a 10-year-old girl herein presented is one of the earliest to report safe and effective use of cariprazine, a metabolic-friendly agent, targeting the behavioral facets in ASD. This might open new treatment venues in such complicated clinical scenarios.
Eugeroics are a distinct, yet heterogeneous group of psychotropic agents that differ from classical stimulants, are less activating, of less abuse potential, sorely clinically underutilized, and have an attractive pharmacological portfolio speaking to the idea of pluripotent molecules of an expanded therapeutic potential. Herein, authors would touch briefly on the current available literature on eugeroics as germane to psychiatric practice whilst examining the extant evidence.
Background:Traumatic brain injury (TBI) is associated with a range of neuropsychiatric sequelae, including secondary psychotic disorders. Delusional syndromes are a prominent and clinically significant manifestation, often classified as Psychotic Disorder Due to Another Medical Condition.1,2. Methods:This narrative synthesis reviews case series, cohort studies, retrospective analyses, and conceptual literature published between 1998 and 2025, focusing on epidemiology, clinical features, pathophysiology, diagnosis, and psychopharmacologic management of post-TBI delusional syndromes. Results:Delusions-commonly persecutory or misidentification types-frequently emerge after a latency of months to years and are more prevalent than schizophrenia-like presentations.1,2,6 Risk factors include moderate-to-severe injury, frontal or temporal lesions (particularly right-sided), post-traumatic epilepsy, and genetic vulnerability.3-6 Compared to primary psychotic disorders, negative symptoms are typically less prominent, though cognitive impairment is nearly universal.6,7,12 Low-dose atypical antipsychotics demonstrate favorable response rates, but tolerability concerns-including sedation, extrapyramidal symptoms, and seizure risk-necessitate cautious use.8,9 Adjunctive anticonvulsants may be beneficial, particularly in patients with comorbid epilepsy.10,15. Conclusions:Post-TBI delusional syndromes highlight the role of structural brain injury in the development of psychosis. Careful diagnostic evaluation and individualized, low-dose psychopharmacologic strategies are essential. Further research is needed to guide evidence-based treatment in this population.
Aims:To compare the efficacy and safety of electroconvulsive therapy (ECT) and ketamine infusion (KET-IFU) in routine care for patients with bipolar I or II depression (BPD). Methods:Electronic medical records of patients who received ECT and/or KET-IFU were used to identify patients with BPD who received both ECT and KET-IFU treatments. The change in the 16-item Quick Inventory of Depressive Symptomatology Self-Report (QIDS-16-SR) total score was used as an efficacy outcome. Self-reported side effects and Montreal Cognitive Assessment (MoCA) were used as safety measures. Results:Six patients with BPD received both ECT and KET-IFU treatments. All patients received ECT first. Five patients received KET-IFU due to subjective memory concerns from ECT although their MoCA scores were within normal range. One patient with multiple previous ECT series received two KET-IFU series followed by an ECT series. Four patients responded to acute ECT treatments well with ⩾ 50% improvement in QIDS-16-SR total scores. Two of them also responded to KET-IFU well with ⩾ 50% improvement but the onset of antidepressant effect differed. One patient did not respond to ECT or KET-IFU. The patient who had two series of KET-IFU responded well during the first KET-IFU series but had limited benefit from the second KET-IFU series. No patient discontinued KET-IFU due to an adverse event. Conclusion:Most patients responded to ECT well and half of them had similar benefit from KET-IFU as from ECT. Randomized, head-to-head comparison studies of ECT versus KET-IFU in BPD are warranted to confirm or refute these findings.
Background:Approximately 30% of patients treated for major depressive disorder develop treatment-resistant depression (TRD). The STAR*D study demonstrated remission rates decline progressively with each antidepressant failure (37%, 31%, 14%, and 13%, respectively). A single-day individualized dosing regimen of GH001 (synthetic mebufotenin for inhalation) produced rapid, large improvements in depressive symptoms versus placebo in patients with TRD in a Phase 2b trial (least-squares mean difference, -15.5; effect size, -2.0; 57.5% remission at Day 8 versus 0% placebo). The current post hoc analysis examines whether GH001 efficacy varies by number of prior lifetime antidepressant treatment failures. Methods:This analysis included all 40 patients who received GH001 in the double-blind part of a Phase 2b trial. Spearman rank correlations between number of prior lifetime antidepressant failures and change from baseline in Montgomery-Åsberg Depression Rating Scale (MADRS) scores were calculated at Day 8 and among 6-month open-label extension completers. Remission rates (MADRS ⩽10) were examined by subgroup (2, 3, 4, or ⩾5 prior lifetime failures). Results:No meaningful correlation was observed between prior lifetime treatment failures and MADRS improvement at Day 8 (r = -0.13; P = 0.44) or 6-month OLE completers (r = -0.10; P = 0.60). Remission rates at Day 8 likewise were similar across subgroups (range, 53.9%-63.6%) and were maintained at end of treatment visit/Month 6 (range, 61.5%-85.7%). Secondary endpoints were not associated with treatment history. Conclusions:The efficacy of GH001 in patients with TRD appears largely independent of number of prior lifetime antidepressant treatments, and further research in patients with extensive treatment histories will be conducted in subsequent development stages.
