Latuda for Psychosis?

[ryerica22]

Hi all,
So I'm inherting a patient from another center who has a guy with Bipolar with psychotic features on Latuda 120 mg and Lamictal xR 200 mg. He is complaining of feeling depressed and having hallucinations all the time. There hasn't been any substance use for 3 months. The previous provider wants to cross taper with Ziprasidone and lower the dose of Latuda due to lack of effectiveness. I think it's better to increase it to the maximum dose before changing it all together since he's been on it for a few years? Is my chain of thought, alright? This is the same person who is giving xanax out like candy, which i'm trying to taper which the patient does not want to be on Klonopin for. Ugh, frustrations.

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[NickNaylor]

You're saying he's not having a response at 120 mg total daily, but you expect a miracle to happen at 160 mg total daily? I mean, worth a shot I guess just to say that you tried the maximum dose, but I doubt that such a minimal increase will result in dramatic response if the patient remains symptomatic at an already solid dose.

 

[thoffen]

You're saying he's not having a response at 120 mg total daily, but you expect a miracle to happen at 160 mg total daily? I mean, worth a shot I guess just to say that you tried the maximum dose, but I doubt that such a minimal increase will result in dramatic response if the patient remains symptomatic at an already solid dose.

Yep. But if it's otherwise been an efficacious medicine for them it doesn't necessarily mean the next treatment step is changing the antipsychotic just because the patient has an episode with psychosis. Plenty of other treatment options for the depressive episode. And opportunity to rethink diagnosis if in doubt.

 

[NickNaylor]

Yep. But if it's otherwise been an efficacious medicine for them it doesn't necessarily mean the next treatment step is changing the antipsychotic just because the patient has an episode with psychosis. Plenty of other treatment options for the depressive episode. And opportunity to rethink diagnosis if in doubt.

Perhaps I misunderstood the case - it sounded to me that the mood and psychotic symptoms were not new, but chronic. I wouldn't consider that particularly efficacious treatment. I would agree with you if these were new symptoms and the patient was otherwise stable and doing well at the lower dose. If that were the case, I'd be a little more optimistic about the possibility of a response with a dose increase. And sure, you could augment - again, I think a reasonable next step if there was previously good symptomatic control at the lower dose.

And if there's a history of extensive substance abuse, then all bets are off because that's going to be difficult to manage irrespective of the medication.

 

[abcxyz0123]

make sure they are taking it with 350+ calorie meal otherwise it may not be fully absorbed

 

[J ROD]

I found Latuda works well for Borderlines....lol

 

[Dharma]

I'd be curious as to if this gentleman is actually experiencing hallucinations. Are we working with an accurate diagnosis? Time to reconceptualize the case? If you are suspicious of the previous provider's recommended regimen I'd be questioning his diagnostic skills as well. Just throwing that out there.

 

[st2205]

I'd be curious as to if this gentleman is actually experiencing hallucinations. Are we working with an accurate diagnosis? Time to reconceptualize the case? If you are suspicious of the previous provider's recommended regimen I'd be questioning his diagnostic skills as well. Just throwing that out there.

My thoughts.

Not all reports of hearing voices are hallucinations. In fact, most aren’t.

 

[psyguru]

Maybe max out latuda and augment with a few mg of haldol.

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[clausewitz2]

As a side note, what is the treatment goal? Titrating neuroleptics to complete abolition of auditory hallucinations in someone with a chronic psychotic disorder is not a great idea, as they are way more effective in reducing the urgency/distress associated with these hallucinations than in actually ridding people of them. There is probably a dose at which this gentleman will no longer hear voices, but this may be significantly higher than the dose at which he can still function and participate in goal-directed activity beyond sleeping and eating.

 

[whopper]

I've put perhaps about 15 people on Latuda for Bipolar-depression and only about 1 person said they felt improvement with depression on it. Otherwise I agree with comments above. At close to the maximum dosage unless there's already some response it's likely the highest dose won't do better.