Psilocybin is classified as a serotonergic psychedelic and a prodrug of psilocin (4-hydroxy-dimethyltryptamine), which converts to the active form once ingested.¹ The theoretical mechanism of action involves binding to serotonin_2A (5-HT_2a) predominantly in the amygdala, thalamus, and prefrontal cortex. The psychopharmacologic profile of psilocybin was examined in the 1960s. It was proposed that oral administration of approximately 10 mg was needed to induce psychological effects, with more potent effects developing with increasing doses.^2-4 Psilocybin’s psychological effects were comparable to those of lysergic acid diethylamide, but thought to be more vividly visual, less emotionally intense, more euphoric, and less likely to cause panic attacks or paranoia.⁴ Clinical studies suggest psilocybin produces an antidepressant benefit in patients with treatment-resistant depression.⁵ This impact is believed to be connected to its affinity for the serotonergic pathway in the brain, which is essential in controlling mood.⁵

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and safety data of iloperidone for the treatment of schizophrenia. DATA SOURCES: Data were selected by searching Pre-MEDLINE, MEDLINE, and International Pharmaceutical Abstracts (1966-January 2010). Abstracts, scientific posters, and unpublished data provided by the manufacturer in the English language were also assessed. STUDY SELECTION AND DATA EXTRACTION: All published data including pharmacologic, pharmacokinetic, pharmacodynamic, and clinical studies related to iloperidone were considered for inclusion. Selected studies included randomized controlled trials, abstracts, and posters presented at national scientific meetings providing pertinent data. data synthesis: Iloperidone is a benzisoxazole phenylethanone with a higher affinity for serotonin-2a than dopamine-2 receptors. The recommended therapeutic total daily dose is 12-24 mg divided in 2 doses titrated over 1 week to avoid orthostasis. Acute, 6-week, randomized, placebo-controlled, and active-controlled studies demonstrated iloperidone's efficacy in reducing psychotic symptoms according to changes in the total positive and negative symptom scale (PANSS-T) score from baseline. A long-term maintenance trial demonstrated similar efficacy with haloperidol in preventing time to relapse. Pharmacogenomic studies reported possible single nucleotide polymorphisms related to QT interval prolongation and efficacy with iloperidone. Common adverse effects included dizziness, dry mouth, and sustained orthostasis occurring more frequently with higher doses. Weight gain is possible at any dose. Additionally, studies showed that QTc interval prolongation may be dose related. The incidence of extrapyramidal symptoms appears to be low across all dosage ranges; however, akathisia may be more frequent with higher doses. CONCLUSIONS: Iloperidone demonstrated efficacy in acute exacerbations and long-term maintenance in adults with schizophrenia. Caution may be warranted in elderly patients and patients with cardiac disease, due to orthostasis. Further studies regarding pharmacogenomic testing related to the drug's efficacy and tolerability are needed to justify its routine use in practice.

Purpose: Approximately 25–40% of patients with Alzheimer's disease (AD) may develop depression. Antidepressants are typically used to treat depression in this population. However, their effect on cognition has been rarely studied and the results are conflicting. In addition, the long‐term effects of antidepressants on cognition have not been studied. Therefore, the objective of the study was to evaluate the effects on cognition in patients with AD treated with antidepressants for at least 9 months. Methods: Data on antidepressant use over a minimum period of 9 months were retrospectively collected for patients with AD receiving cholinesterase inhibitors. Data on cognition were analyzed to compare those taking antidepressant therapy and those not receiving antidepressants. Results: Ninety‐nine of 210 patients met our inclusion criteria. Fifty‐eight patients were prescribed an antidepressant (e.g. selective serotonin reuptake inhibitors (SSRIs), newer generation antidepressants). Sertraline (mean dose: 82 mg/day) and citalopram (mean dose: 35 mg/day) were the most commonly prescribed antidepressants. The baseline mean Mini Mental State Examination (MMSE) score was 16·32 with an average annual rate of cognitive decline of 2·55 for patients receiving antidepressants compared with 16·59 (P = NS) and 2·27 (P = NS) for those not taking antidepressants. Conclusions: Our small sample data indicate no differences in baseline MMSE scores and cognitive decline between the two groups, suggesting antidepressants did not contribute significantly to cognitive decline over a utilization period of at least 9 months.

Health literacy is a critically important skill that helps people become active participants in their health care. Multiple studies in the United States and across the world have documented the association of health literacy with multiple health outcomes. In particular, the elderly and many members of minority groups have been shown to have low levels of health literacy; the same groups are disproportionately affected by chronic illnesses. These twin burdens affect the people most in need of the skills and knowledge required for coping with chronic illnesses. Chronic disease self-management (CDSM) is a logical target for a general health literacy intervention. In an approach that spans across specific diseases, CDSM targets problems and skills needed to cope with issues such as fatigue, pain, stress, depression, sleep disturbance, and treatment adherence. In a previous study, we showed that a computer-delivered tailored information intervention targeting health literacy could improve treatment and adherence and be cost effective, but it is not clear that this same strategy will be effective in persons with low health literacy and multiple chronic conditions. The purpose of this study is to develop a computer-delivered mobile intervention that will provide individuals with chronic conditions the necessary information to cope with their conditions. In this project, we will complete a qualitative study on the status and needs of individuals with more than one chronic condition. Results of this study will be used to develop a mobile tailored information app that will address self-management challenges in the areas of pain, sleep, fatigue, depression, anger, stress, memory problems, and treatment adherence. The impact of the intervention on patient quality of life, patient-provider relationships, health literacy, and patient activation will be assessed. We will also explore the extent to which health literacy mediates important outcomes, such as health-related quality of life and health service utilization. We are currently completing the preliminary qualitative and usability studies that will inform the content and design of the intervention. We anticipate that the intervention will be complete in 2017, and the clinical trial of its efficacy will also commence in 2017. Results will provide evidence on the usefulness of a mobile tailored information app for improving health literacy, patient activation, health-related quality of life, and self-reported health in patients with multiple chronic conditions. Clinicaltrials.gov NCT02922439; https://clinicaltrials.gov/ct2/show/NCT02922439 (Archived by WebCite at http://www.webcitation.org/6pTiqDAyN).

The purpose of this study was to evaluate the effects of a mobile app designed to improve chronic disease self-management in patients aged 40 years and older with low health literacy and who had at least one chronic health condition, and to assess the impact of delivering information at different levels of reading difficulty. A randomized controlled trial was completed at two sites. Individuals aged 40 years and older screened for low health literacy who had at least one chronic health condition were randomly assigned to a tailored information multimedia app with text at one of three grade levels. Four primary outcomes were assessed: patient activation, chronic disease self-efficacy, health-related quality of life, and medication adherence. All groups showed overall increases in activation, self-efficacy, and health-related quality of life, but no change in medication adherence. No between-group differences were observed. The mobile app may have been effective in increasing participants’ levels of several psychosocial variables, but this interpretation can only be advanced tentatively in light of the lack of control-experimental group differences. Reading difficulty level was not significantly related to outcomes.

Objective: The primary objective was to develop a computerized culturally adapted health literacy intervention for older Hispanics with type 2 diabetes (T2D). Secondary objectives were to assess the usability and acceptability of the intervention by older Hispanics with T2D and clinical pharmacists providing comprehensive medication management (CMM). Materials and methods: The study occurred in three phases. During phase I, an integration approach (i.e., quantitative assessments, qualitative interviews) was used to develop the intervention and ensure cultural suitability. In phase II, the intervention was translated to Spanish and modified based on data obtained in phase I. During phase III, the intervention was tested for usability/acceptability. Results: Thirty participants (25 older Hispanics with T2D, 5 clinical pharmacists) were included in the study. Five major themes emerged from qualitative interviews and were included in the intervention: 1) financial considerations, 2) polypharmacy, 3) social/family support, 4) access to medication/information, and 5) loneliness/sadness. Participants felt the computerized intervention developed was easy to use, culturally appropriate, and relevant to their needs. Pharmacists agreed the computerized intervention streamlined patient counseling, offered a tailored approach when conducting CMM, and could save them time. Conclusion: The ability to offer individualized patient counseling based on information gathered from the computerized intervention allows for precision counseling. Future studies are needed to determine the effectiveness of the developed computerized intervention on adherence and health outcomes.