Wednesday, 3:00 – 4:30, F2 What's New in Psychopharmacology Joel M. Sanchez, MD [email protected] Objectives: Identify advances in clinical assessment and management of selected healthcare issues related to persons with developmental disabilities Notes: 4/7/2016 What’s New in Nuedexta Psychopharmacology • A new medication for pseudobulbar affect (PBA) • Pseudobulbar Affect: Joel M. Sanchez, M.D. • Frequent, uncontrollable outbursts of crying or laughing in people with certain neurologic conditions or brain injuries Diplomate of the American Board of Psychiatry and Neurology, Psychiatry • Episodes may occur several times per day and can last seconds to minutes Diplomate of the American Board of Psychiatry and Neurology, Child/Adolescent Psychiatry • “emotional incontinence” • “pathological laughing and crying” The Right Door for Hope, Recovery and Wellness Wedgwood Christian Services Turning Leaf Behavioral Health Services Community Mental Health Authority - CEI ADHD Medications Antidepressants • Stimulants • SSRIs • Adzenys XR-ODT (amphetamine extended release oral dissolving tablet) • Brintellix (vortioxetine) • Quillivant XR (methylphenidate extended release liquid) • Viibryd (vilazodone) • Daytrana (methylphenidate transdermal) • SNRIs • Non-Stimulants • Fetzima (levomilnacipran) • Clonidine (Catapres / Kapvay) • Pristiq (desvenlafaxine) • Guanfacine (Tenex / Intuniv) • Strattera (atomoxetine) Antipsychotics Blood Pressure Medications • Abilify Maintena & Aristada (aripiprazole) • What’s Old is New • Every 4 weeks or Every 4-6 weeks • Propranolol (Inderal) • Invega Sustenna & Invega Trinza (paliperidone) • Communication in ASD • Every 4 weeks or Every 3 months • Prazosin (Minipress) • Rexulti (brexpiprazole) • Reduction of trauma-related nightmares 1 4/7/2016 Back to Something New CNS-LS for PBA • Nuedexta for pseudobulbar affect (PBA) • 7 Item Questionnaire • (dextromethorphan/quinidine) • Validated for ALS and MS • 7 Items scored 1,2,3,4,5 • Originally developed with goal of treating ASL • 1 – Applies Never • 2 – Applies Rarely • Center for Neurologic Study – Lability Scale (CNS-LS) • 3 – Applies Occasionally for pseudobulbar affect (PBA) • 4 – Applies Frequently • 5 – Applies Most of the Time • Range is 7 to 35 with >13 suggesting PBA CNS-LS for PBA CNS-LS for PBA • 1 - There are times when I feel fine 1 minute, and then I’ll become • 2 – Others have told me that I seem to become amused very easily or tearful the next over something small or for no reason at all. that I seem to become amused about things that are really aren’t funny. • 1 – Applies Never • 2 – Applies Rarely • 1 – Applies Never • 3 – Applies Occasionally • 2 – Applies Rarely • 4 – Applies Frequently • 3 – Applies Occasionally • 5 – Applies Most of the Time • 4 – Applies Frequently • 5 – Applies Most of the Time CNS-LS for PBA CNS-LS for PBA • 3 – I find myself crying very easily. • 4 – I find that even when I try to control my laughter, I am often unable to do so. • 1 – Applies Never • 2 – Applies Rarely • 1 – Applies Never • 3 – Applies Occasionally • 2 – Applies Rarely • 4 – Applies Frequently • 3 – Applies Occasionally • 5 – Applies Most of the Time • 4 – Applies Frequently • 5 – Applies Most of the Time 2 4/7/2016 CNS-LS for PBA CNS-LS for PBA • 5 – There are times when I won’t be thinking of anything happy or • 6 – I find that even when I try to control my crying, I am often unable funny at all, but then I’ll suddenly be overcome by funny or happy to do so. thoughts. • 1 – Applies Never • 1 – Applies Never • 2 – Applies Rarely • 2 – Applies Rarely • 3 – Applies Occasionally • 3 – Applies Occasionally • 4 – Applies Frequently • 4 – Applies Frequently • 5 – Applies Most of the Time • 5 – Applies Most of the Time CNS-LS for PBA PBA • 7 – I find that I am easily overcome by laughter. • PBA: A condition to consider • 1 – Applies Never • Nuedexta: A medication to consider • 2 – Applies Rarely • 3 – Applies Occasionally • 4 – Applies Frequently • 5 – Applies Most of the Time References • Pioro EP, Rix Brooks B, Cummings J, et al. Dextromethorphan Plus Ultra Low-Dose Quinidine Reduces Pseudobulbar Affect. Annals of Neurology 2010;68(5):693-702 • Moore SR, Gresham LS, Bromberg MB et al. A self report measure of affective lability. Journal of Neurology, Neurosurgery, and Psychiatry 1997;63(1):89-93 • https://www.nuedexta.com/do-i-have-pba-assessment 3.