Objective: Benzodiazepine receptor agonists (BZRAs) are still prescribed for insomnia to many patients in clinical practice, even though dual orexin receptor antagonists (DORAs) are an effective insomnia pharmacotherapy. It is important to establish appropriate methods of switching from BZRAs to DORAs for insomnia treatment. Methods: We performed a secondary analysis of our prior retrospective study of the rate of DORA (suvorexant or lemborexant) continuance at 3 months after the introduction of these agents in 210 patients under long-term BZRA treatment.We investigated the effects of the classes of BZRAs (which are based on half-life lengths) on the DORA continuation rate and the decreased BZRA ratio. Results: Our analyses revealed a significantly lower rate of failure of switching to a DORA in the patients who were being treated with ultra-short/short-acting BZRAs. Two logistic regression analyses of successful switching to DORAs identified the following as predictors of a 3-month continuation of a DORA: (i) a higher-dose BZRA at baseline (Exp(B):1.570, 95% CI: 1.090−2.262), (ii) shorter-term BZRA use (Exp(B): 0.991, 95% CI: 0.985−0.997), and (iii) BZRA with ultra-short/short half-lives (Exp(B): 7.335, 95% CI: 2.054−26.188). The analyses identified higher BZRA dose at baseline (Exp(B): 1.801, 95% CI: 1.008−3.216) as a predictor of both DORA continuation and BZRA tapering. Conclusion These findings suggest that in efforts to switch a patient’s insomnia medication to a DORA, the tapering of ultra-short/short-acting BZRAs can lead to the successful switch to a DORA among patients under high-dose BZRA treatment, whereas careful switching is necessary for patients under long-term BZRA treatment.

Dopamine supersensitivity psychosis (DSP) is an unstable clinical condition observed in individuals with schizophrenia who have been treated with an antipsychotic medication at a high dosage and/or for a long period. An up-regulation of dopamine D2 receptors (DRD2) is thought to be involved in the essential pathology of DSP. An antipsychotic agent with both tight binding to DRD2 and a long half-life is generally effective for treating DSP, but a patient who meets the criteria of treatment-resistant schizophrenia sometimes needs treatment with clozapine. We report the case details of two patients whose DSP was not controlled with several antipsychotics but was successfully controlled with asenapine.Asenapine binds to a broad range of dopamine receptors and serotonin receptors, and it is thus distinct from other atypical antipsychotics. The unique profile of asenapine may contribute to the control of severe DSP symptoms in individuals with schizophrenia.

Dopamine supersensitivity psychosis (DSP) is a type of acute exacerbation of recurrent psychosis caused by long-term treatment with antipsychotics in schizophrenic patients. Although DSP is exceedingly troublesome for clinicians, effective treatment has not yet been established. Based on clinical research and our animal study, we hypothesize that aripiprazole, an atypical anti-psychotic, may reduce the exacerbation of recurrent psychotic episodes. We report the case of a 46-year-old female who suffered from schizophrenia with DSP. In this case, sustained treatment with a high dose of aripiprazole gradually reduced the severity of her recurrent psychotic episodes. In conclusion, sustained treatment with aripiprazole may reduce the exacerbation of recurrent psychotic episodes in schizophrenic patients with DSP, and may be an effective treatment of DSP.
Animals ; Antipsychotic Agents ; Aripiprazole* ; Disease Progression ; Dopamine* ; Female ; Humans ; Middle Aged ; Psychotic Disorders ; Receptors, Dopamine D2 ; Recurrence ; Schizophrenia

OBJECTIVE: Schizophrenia is a mental disorder characterized by severe cognitive impairment. Accumulating evidence suggests a role for oxidative stress in the pathophysiology of schizophrenia. Sulforaphane (SFN) extracted from broccoli sprout is an agent with potent anti-oxidant and anti-inflammatory activity. In this study, we attempted to evaluate the effect of SFN on cognitive impairment in medicated patients with schizophrenia. METHODS: We recruited a total of 10 outpatients with schizophrenia, all of whom gave informed consent. Participants took 3 tablets of SFN, consisting of 30 mg of SFN-glucosinolate per day, for 8 weeks. Clinical symptoms using the Positive and Negative Syndrome Scale (PANSS) and cognitive function using the Japanese version of CogState battery were evaluated at the beginning of the study and at week 8. RESULTS: A total of 7 patients completed the trial. The mean score in the Accuracy component of the One Card Learning Task increased significantly after the trial. However, we detected no other significant changes in participants. CONCLUSION: This result suggests that SFN has the potential to improve cognitive function in patients with schizophrenia.
Asian Continental Ancestry Group ; Brassica* ; Executive Function ; Humans ; Informed Consent ; Learning ; Mental Disorders ; Outpatients ; Oxidative Stress ; Schizophrenia* ; Tablets