I'm back in Maryland, but I am still thinking about all that I learned at the MGH course. Let me see what else I can add of interest. Let me put in a plug for the course: It was an excellent catch-up class on practical aspects of psychopharm. Highly recommended, and I'll go again in a couple of years.
Dr. Bianchi on sleep disorders, mainly insomnia
~Medicines of all types change sleep architecture and reduce REM sleep. There's no evidence that these changes have meaningful clinical correlates.
~Melatonin -- start at 0.5mg and go up, take 3 hours before sleep, and it's contraindicated for patients on coumadin.
~People's perceptions of their sleep is not accurate. Ambien increases total sleep time by 40 minutes; people estimate they've slept two hours longer.
~Trazodone doesn't work. (I'm just the messenger here)
~Suvorexant (Belsomra) -- the first orexin antagonist. There were safety concerns at the higher dose and efficacy concerns at the lower dose which was FDA approved.
~You can try herbals and lavendar drops on your pillowcase
~20-50% of insomniacs have sleep apnea. Even if they are skinny and don't snore. Who knew?
~CBT! Try an online course, but if you need to know, there are 8 clinics in Boston that offer CBT specifically for insomnia.
Dr. Freudenreich on First-Episode Psychosis
~The average time from onset of psychotic symptoms to starting treatment is 74 weeks
~In one study, giving patients with a psychotic prodrome 12 weeks of fish oil dramatically decreased the number who went on to be diagnosed with schizophrenia.
~Adding metformin to the regimen may improve metabolic parameters
~New stuff: Brexipiparzole (Rexulti) and Invega Trinza (a long acting injectible that can be given once every 3 months).
~Best antipsychotic is still Clozapine.
~While medications prevent relapse of psychotic symptoms, they are not comprehensive treatment for schizophrenia.