5 Minutes with Dr. Leslie Citrome, MD. MPH
What’s the most remarkable treatment advance of mental disorders in 2024?...and more!
Happy holidays from all of us at Medscape! We spend some time this month to round out the year with one of the thought leaders and faithful faculty for the upcoming 2025 Psychiatry Update meeting, co-chair, Leslie Citrome, MD, MPH. Dr. Citrome has always his given time and effort to make this e-newsletter a valuable read for all of you, and this month we tap in to him on new agents in the psychiatrist’s armamentarium, both challenges and wins of 2024, and his recent appearance on Medscape’s YouTube event, Navigating Schizophrenia: Path to Stability: Long-Acting Injectable Therapy.
Read on for Dr. Citrome’s opinions and experience on many topics germane to today’s practicing psychiatrist! Also, scroll down for the Psychiatry Resource Section, in which you will find multiple articles on some of the very topics covered in this month’s exchange.
Thank you to Dr. Goldberg for his time and effort, especially during the holiday season. Please contact me at colleen@cmhadvisors.com with any comments. –Colleen Hutchinson
5 Minutes with… Dr. Leslie Citrome
What is an issue in psychiatry that needs more attention to solutions?
Dr. Citrome: Our diagnostic framework is based on phenomenology and not pathophysiology. This makes it difficult to treat patients who appear to have the same illness by symptoms alone (i.e., schizophrenia) but for which a different mechanism of action of a medication may be necessary to treat them.
You recently appeared as faculty via YouTube on Medscape’s education event, Navigating Schizophrenia: Path to Stability: Long-Acting Injectable Therapy. What were some takeaways that you feel are critical to the practicing psychiatrist?
Dr. Citrome: We should be offering long-acting injectable (LAI) formulations of antipsychotics routinely to our patients, including those early on in their illness. It is our best "shot" at reducing the risk of relapse!
Hosted online here, the event covered 4 areas on use of LAIs. What are 4 takeaways?
Dr. Citrome:
- Rationale and benefits for using LAls versus oral antipsychotic treatments: LAIs beat oral antipsychotics in reducing the risk of relapse and hospitalization, as well as reducing mortality.
- Factors to consider when selecting an LAI: The molecules available are quite different—match up the right molecule to the right patient. Once the molecule is selected, choose the formulation that is the most convenient as well as most preferred by your patient.
- Which patients are candidates: All patients should be offered the choice. The very best candidate is the first-episode patient—they have the most to gain and the most to lose!
- How to present an LAl to a patient: "How would you like to take your medicine once a month or once every two months instead of every day?"
Do you think glycine transport inhibitor is going to be the breakthrough for the long-awaited treatment for cognitive deficits in schizophrenia?
Dr. Citrome: Clinical trials are underway to test this. Because almost all patients with schizophrenia have at least some degree of cognitive impairment, everyone will want to try adding this agent if approved by the FDA for this indication.
What was something you have recently LEARNED from other faculty/conference proceedings that was practical for you to take back to practice and utilize?
Dr. Citrome: Older medications are often overlooked. This is unfortunate because a lot of patients can be helped by medications such as lithium or monoamine oxidase inhibitors.
What is the most remarkable advance in the treatment of mental disorders in 2024?
Dr. Citrome: The most remarkable advance in the treatment of mental disorders in 2024 has been the FDA approval of the first truly novel medication to treat schizophrenia in 70 years - a muscarinic agonist. Although muscarinic receptor agonism has been recognized as a potential path to decrease psychosis as far back as the 1950s, it took a long time to "rediscover" this approach and for medicinal chemists to develop a reasonably tolerable drug.
Muscarinic agonism appears more selective than the traditional means of managing the positive symptoms of schizophrenia via direct blockade of postsynaptic dopamine receptors in the striatum, thus avoiding drug-induced movement disorders or alterations in prolactin levels. This new medication, a combination of xanomeline and trospium, is also free of sedation or the deleterious metabolic effects that have hampered the use of older agents.
Time will tell how well we can manage the potential of gastrointestinal adverse effects, but patients who have trouble tolerating the side effects of traditional schizophrenia medications may benefit most from xanomeline-trospium combination, and a different mechanism of action holds hope for those who have not responded adequately to existing treatments.
Need CME?—Don’t Miss This!
2025 Psychiatry Update
Chicago, IL | MARCH 20—22, 2025
The Chicago Marriott Downtown Magnificent Mile
Earn up to 16 CME/CE Credits and get the latest updates in the advancements of psychiatry. You won’t want to miss a moment of this innovative event as you network with your colleagues!
Psychiatry Resource Section
Medscape Article: Psychologists and Psychotropic Prescribing: An Old Debate Heats Up
JAMA Psychiatry Viewpoint— An Architecture for Transformation in Child Mental Health
New England Journal of Medicine Perspective: Tethered
Medscape Medical News Article: Infographic: How Well Are Medical Residents Managing Life?
Psychiatric News: Special Report: Precise, Personalized, and Preventive Psychiatry
MD Edge: APA Updates Guidance on Borderline Personality Disorder
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