Pain Management and Opioid Addiction: Interview with Nora Volkow, MD, Director of National Institute on Drug Abuse
In this engaging interview, we ask Dr. Nora Volkow what common misconceptions exist that can influence the way clinicians treat pain and manage opioid addiction. We also ask her what risk factors are associated with opioid addiction and what early warning signs exist that a patient is becoming addicted. She also shares with us the most effective pain biomarkers available today and in development, so that we may be able to more effectively manage pain and avoid some of the risk associated with opioid treatment for pain. To hear the full interview, subscribe to the NEI podcast.
Future of Psychiatry: Treating Mental Health in the Digital Age: Interview with Arshya Vahabzadeh, MD, Chief Medical Officer, Brain Power
The 2017 APA annual meeting featured the debut of the Mental Health Innovation Zone, at which attendees could learn about and test out a variety of technologies that are being applied to mental health practice. One such technology is virtual reality, which is being explored for disorders ranging from posttraumatic stress disorder to autism. We interviewed Dr. Arshya Vahabzadeh about his role as chief medical officer at Brain Power and the exciting projects that they are developing to help patients with autism; the use of digital information, apps, and devices to help accurately predict suicide risk; and a sneak peak of what lies on the horizon for mental health in the digital age. To hear the full interview, subscribe to the NEI podcast.
Violence and Aggression: Interview with Katherine Warburton, DO, Medical Director of California Department State Hospitals
At the 2017 APA annual meeting, Dr. Katherine Warburton presented on the pharmacological management of persistent violence in psychiatric inpatients. In this interview, we ask her about the development and impact of the CAL-VAT guidelines, which were released in 2014 through the combined efforts of the California Department of State Hospitals (DSH), the Neuroscience Education Institute (NEI), and a panel of mental health experts. We also discuss different classifications of violence, risk factors associated with violence, and treatment interventions based on classification and drivers of violence and aggression. To hear the full interview, subscribe to the NEI podcast.
New Drug Developments
Clinical trial results for medications in development as well as for new indications or formulations of existing medications were presented during the poster sessions. Highlights include:
Dasotraline for the Treatment of Moderate to Severe Binge Eating Disorder in Adults: Results from a Randomized, Double-Blind, Placebo-Controlled Study. Navia B et al., P7-084. Dasotraline is a potent dopamine and norepinephrine reuptake inhibitor that has a long half-life and is slowly absorbed, allowing for once daily dosing. In this Phase 3, 12-week, flexible-dose study in adults with moderate to severe binge eating disorder, dasotraline was associated with statistically significant improvements in binge eating symptoms compared to placebo; the most common adverse events were insomnia, dry mouth, and decreased appetite.
PLACID: A Randomized Trial of Inhaled Loxapine Versus IM Aripiprazole in Acutely Agitated Patients With Schizophrenia or Bipolar Disorder. San L et al (P5-060) presented the first head-to-head comparison of an inhaled antipsychotic formulation with an intramuscular (IM) formulation. The study was open-label, rater blind, and randomized, and took place across multiple centers in Europe. Primary endpoint was time to response (CGI-I score of 1 or 2). Patients were randomly assigned to either 10 mg inhaled loxapine (n=179) or 9.75 mg aripiprazole IM (n=178); the maximum number of allowed doses was 2. Median time to response was significantly shorter in the inhaled loxapine group; the most common adverse events were dysguyesia and somnolence in the inhaled loxapine group and dizziness and somnolence in the aripiprazole IM group.
Single-Dose Pharmacokinetics of HLD200, a Delayed-Release and Extended-Release Methylphenidate,
in Adults and in Adolescents and Children with ADHD. HLD200 is in development as a novel methylphenidate formulation for attention deficit hyperactivity disorder. Its unique pharmacokinetic profile means that it can be dosed in the evening, with delayed initial release of methylphenidate of 8- to 10-hours, followed by extended release that should lead to lasting effects throughout the day. Childress A et al. (P7-048) presented results showing that HLD200 had the intended release profile and was well tolerated in healthy adults and in children and adolescents with ADHD, with similar body-weight adjusted pharmacokinetics between the three groups.
A Phase I, Open-Label, Single Dose Pharmacokinetic Study in Stabilized Patients With Schizophrenia Following Risperidone Implant; A Phase I, 6-Month Open-Label, Dose-Ranging Pharmacokinetic Study in Stabilized Patients With Schizophrenia Following Risperidone Implant. An implantable formulation of risperidone is currently is Phase 1 trials, with results presented on the single-dose pharmacokinetics (Dammerman R et al., P5-027) as well as for a 6-month, open-label dose-ranging study in stabilized patients with schizophrenia (Dammerman R et al., P5-030). In the dose-ranging study, patients stabilized on 4, 6, or 8 mg/day of oral risperidone received a 480-mg risperidone implant, a 480-mg plus a 240-mg implant, or two 480-mg implants, respectively. The implant was inserted subcutaneously in the upper nondominant arm. Plasma concentrations of the active moiety reached therapeutic levels within 2 days following implantation. Mean peak plasma concentrations of risperidone plus 9-OH-risperidone (active metabolite) were lower with the implant than with oral risperidone, while steady state levels for the implant were similar to trough values for the oral formulation. The implant demonstrated a constant concentration over 6 months.
The Dark Web and the Future of Addiction
The dark web is an increasingly common way for individuals to easily and anonymously obtain illegal drugs. Smith et al. (P6-012) presented a poster on their investigation into the dark web, which stemmed from a patient's discovery and use of it. They found that the dark web contains numerous illegal substances, including untested synthetic formulations of opioids, stimulants, hallucinogens, and marijuana, all of which can be obtained through online auctions utilizing bitcoin as currency.
On May 21, 2017, NEI held its first ever live concert featuring our greatest hits from our signature Focuser videos--scientific song parodies that provide an entertaining and educational look at a variety of mental health topics. The live performance featured the Decades Band, with NEI's own senior medical writer, Dr. Debbi Ann Morrissette, on lead vocals. We certainly look forward to repeating this event in the future!