iiinova — where your digital self keeps evolving

Aleksi Hamina @aleksihamina.bsky.social · 21/09/2026

Very creative and impressive work!

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The Mental Elf @thementalelf.bsky.social · 02/07/2026

Clozapine is the gold-standard for treatment-resistant schizophrenia. 💊 A Nordic registry of 500,000+ people asks if its benefits reach other disorders too. buff.ly/f0XQBpd #Clozapine #Schizophrenia

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Addiction journal @addictionjournal.bsky.social · 17/03/2026

Cost-effectiveness of contingency management for methamphetamine use disorder: A model-based analysis

buff.ly

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Aleksi Hamina @aleksihamina.bsky.social · 12/03/2026

New @jamapsychiatry.com RCT indicates clozapine could be it already after the first failed antipsychotic: better efficacy, no difference in 1-year discontinuation due to adverse effects. dx.doi.org/10.1001/jama... Similar result from our group previously: dx.doi.org/10.1016/S221... #medsky 🧠🧪🩺

Kaplan-Meier curves showing the proportion without treatment discontinuation due to insuffient efficacy and adverse effects. Difference between clozapine vs. efficacy highly significant for efficacy; no differences in adverse effects.

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Aleksi Hamina @aleksihamina.bsky.social · 05/03/2026

More observational evidence on GLP-1 agonists and SUD outcomes. Promising, but I'm still worried about healthy user bias, something that this design can't get rid of.

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Aleksi Hamina @aleksihamina.bsky.social · 15/01/2026

New publication in World Psychiatry! We applied standard RCT excludion criteria to adults with MDD on maintenance antidepressants in Finland (n=73,720) and Sweden (n=135,092). >33% were RCT‑ineligible and had ≈2.5× higher risk of main outcome. #medsky 🧪🧠🩺 Open access! www.doi.org/10.1002/wps.70013

Graphical abstract of the study.

Same information in the written abstract: We determined the proportion of individuals with major depressive disorder (MDD) receiving maintenance antidepressant treatment in routine care who would be ineligible for RCTs, and compared their outcomes with those who were eligible. Utilizing specialized health care registers in Finland (2004-2018) and Sweden (2006-2021), we identified adults diagnosed with non-psychotic MDD (ICD-10: F32, F33) who were stabilized on maintenance antidepressant monotherapy. Through multidisciplinary expert consensus on latest meta-analytic evidence, we derived a standardized list of RCT inclusion and exclusion criteria. These criteria were systematically applied to classify individuals as RCT-eligible or RCT-ineligible. We then used Cox proportional models to derive hazard ratios (HRs) of a composite primary outcome of hospitalization due to any psychiatric reason or suicide attempt, and all-cause mortality, during a 6-month follow-up. Secondary outcomes were treatment changes (i.e., discontinuation, switch or augmentation) and psychiatric sick leave ≥2 weeks. A total of 73,720 individuals in Finland and 135,092 in Sweden were included. More than one third of patients with MDD (33.5% in Finland and 35.3% in Sweden) were found to be ineligible for RCTs. The most common reasons for ineligibility were comorbidities (serious somatic disease, other psychiatric disorders, or substance use disorder). RCT-ineligible individuals had more than twice the risk of the composite primary outcome compared to eligible individuals (HR=2.44, 95% CI: 2.15-2.76 in Finland; HR=2.61, 95% CI: 2.37-2.87 in Sweden)

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Altmetric @altmetric.com · 08/01/2026

Since Jan 1 2025, which feels like four trillion years ago, research has been shared on here 5 million whole-ass times. Bluesky recently passed 2 billion posts IN TOTAL. So 0.25% of the entire site's traffic was citations to research. That is actually massively high. Is it? Yes. Here's why.

Altmetric Explorer screenshot: Showing 5,011,088 mentions (from 4,918,333 individual posts) of research outputs from the results of your search query.

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Art Walaszek, MD @walaszek.art · 05/12/2025

Weight gain, increased blood sugar & elevated blood sugar can be major problems in people with #schizophrenia taking antipsychotics. This small RCT found that weekly semaglutide injections improved hemoglobin A1c in people taking olanzapine or clozapine. #medsky jamanetwork.com/journals/jam...

jamanetwork.com

Semaglutide in Schizophrenia Spectrum Disorders

This randomized clinical trial investigates the effects of semaglutide on glycemic control and weight outcomes in individuals with early-stage prediabetes or diabetes and schizophrenia spectrum disord...

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Reposted by Aleksi Hamina

The Lancet Psychiatry @thelancetpsych.bsky.social · 03/11/2025

"clozapine is more effective than other oral antipsychotics in reducing psychiatric hospitalisations and several secondary outcomes in schizophrenia-spectrum disorders, bipolar disorder, inpatient-treated major depressive disorder, & psychotic depression" Article: www.thelancet.com/journals/lan...

thelancet.com

Transdiagnostic effectiveness and safety of clozapine in individuals with psychotic, affective, and personality disorders: nationwide and meta-analytic comparisons with other antipsychotics

These findings support the transdiagnostic effectiveness and safety of clozapine, particularly in schizophrenia-spectrum disorders, bipolar disorder, and severe depression. Given the overall consisten...

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Aleksi Hamina @aleksihamina.bsky.social · 03/11/2025

New study out in @thelancetpsych.bsky.social! Clozapine was associated with reduced psychiatric hospitalisations compared with other oral antipsychotics across several psychotic and affective disorders, but not borderline personality disorder. Free access! authors.elsevier.com/c/1m2747tf1d...

A forest plot figure of the risk of the primary outcome, hospitalisation for any psychiatric reason, in people with schizophrenia, schizoaffective disorder, bipolar disorder, depression, psychotic depression, delusional disorder, and borderline personality disorder in the Finnish and Swedish cohorts and meta-analysis of these cohorts.

Figure shows decreased risk for clozapine compared to other oral antipsychotics as a group for all other studied disorders, but not for borderline personality disorder.

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Reposted by Aleksi Hamina

The Mental Elf @thementalelf.bsky.social · 22/10/2025

🧪 Weighing the risks: new review ranks antidepressants by their physical health side effects Antidepressants help many, but how do they affect heart health, weight, blood pressure, or glucose? New Lancet review (out today!) compared 30 meds across 58k ppl. 🧵 THREAD #Antidepressants #SideEffects

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The Mental Elf @thementalelf.bsky.social · 06/10/2025

🧠 Treating ADHD in psychosis: What does the evidence say about safety? New research tracked over 9,000 people with schizophrenia spectrum disorders over 9 years. What happened when they were prescribed ADHD medication? 🧵 #ADHD #Psychosis #MentalHealthResearch #Schizophrenia

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Tapio Määttä @tapiomaatta.bsky.social · 02/10/2025

Olisiko hyvä idea, jos yliopistolla aloittava uusi professori saisi miljoonan euron aloituspaketin voidakseen rakentaa omaa tutkimusryhmäänsä? Jos hyvällä aloituspaketilla tuettu professuuri Itä-Suomen yliopistossa kiinnostaa, ks. toimintaohjeet uutisestamme. www.uef.fi/fi/artikkeli...

uef.fi

Itä-Suomen yliopistolta 4 miljoonaa euroa kansainvälisten huippuprofessoreiden rekrytointeihin

Itä-Suomen yliopisto tavoittelee korkean kansainvälisen tason tutkijoita vakituisiin ja kokoaikaisiin professuureihin uusilla ja mittavilla rekrytointipaketeilla.

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Chris Aiken, MD @chrisaikenmd.bsky.social · 19/09/2025

Should we start meds for #opioid use disorder like buprenorphine in jail? Yes. Associated with 50% lower overdose risk and lower risk of reincarnation: www.ncbi.nlm.nih.gov/pubmed/40929... Evidence grade: Moderate (5/10) chrisaikenmd.com/ebm/ ▪ 13% of US jails provide it Art: Van Gogh

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Chris Aiken, MD @chrisaikenmd.bsky.social · 05/09/2025

New APA delirium guideline says NO to antipsychotics unless severe danger/distress. They failed in large trials: www.psychiatry.org/getmedia/51e... Use non-pharm approaches (and address underlying cause) in all patients, such as table 9: pmc.ncbi.nlm.nih.gov/articles/PMC...

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Art Walaszek, MD @walaszek.art · 12/07/2025

1- Stopping an antidepressant causes, on average one more discontinuation symptom than not stopping it, according to a systematic review and meta-analysis of 50 studies involving 17,282 participants. #medsky #psychsky jamanetwork.com/journals/jam...

Table 1. Incidence of Individual Symptoms in the First 2 Weeks Following Discontinuation in Placebo-Controlled Studies

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Aleksi Hamina @aleksihamina.bsky.social · 05/07/2025

Interesting new analysis of ADHD meds in schizophrenia-spectrum disorders: reduced risk of psychosis with atomoxetine and reduced risk for somatic hospitalizations with lisdexamphetamine. Higher somatic hospitalization with polytherapy, no other negative safety signals. #psychiatry #medsky

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Chris Aiken, MD @chrisaikenmd.bsky.social · 04/07/2025

Pramipexole lifted treatment-resistant #depression with large effect size (0.87) in 48-wk, placebo-controlled augmentation trial of 150 pubmed.ncbi.nlm.nih.gov/40602411 Used 2.5mg as high dose works better in TRD (vs 1.5mg) but more side effects How to use: www.thecarlatreport.com/articles/308...

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Olúfẹ́mi O. Táíwò @olufemiotaiwo.bsky.social · 30/06/2025

I gotta say I find a lot of AI discourse around higher ed very confusing. "if ChatGPT can write your essays is college even worth it?" did people think math teachers were assigning problem sets because *they* couldn't figure out the answers?

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Reposted by Aleksi Hamina

Chris Aiken, MD @chrisaikenmd.bsky.social · 12/06/2025

People with #schizophrenia lived longer on #clozapine than other antipsychotics in this 11-year study of 41,695 from Hong Kong, confirming earlier findings: www.ncbi.nlm.nih.gov/pubmed/40412... Long-acting injectables (LAIs) also had an edge, particularly paliperidone. #psychiatry #pmhnp

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Aleksi Hamina @aleksihamina.bsky.social · 12/06/2025

Small (N=31) but important phase 2 trial in @thelancetpsych.bsky.social indicates semaglutide is safe and effective in people with schizophrenia on clozapine: 13.9% mean weight loss in 3 years with no difference in PANSS scores or clozapine levels. doi.org/10.1016/S221... #medsky #psychiatry

Percentage weight change in participants up to 36 weeks. A line chart showing significant weight loss in the semaglutide group and no change in the placebo group.

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Aleksi Hamina @aleksihamina.bsky.social · 12/06/2025

Extremely interesting narrative review on lithium's potential as a disease-modifying drug in bipolar disorder published in @thelancetpsych.bsky.social #medsky #psychiatry

Abstract of the article "Lithium as a disease-modifying drug for bipolar disorder":
Lithium is a classic, primary treatment for bipolar disorder that has paradoxically been used less over time, especially
in North America, which goes against the accumulating evidence for its efficacy. Bipolar disorder is increasingly
conceptualised as a chronic, potentially progressive condition worsened and accelerated by each mood episode, which
might resemble multiple sclerosis or rheumatoid arthritis as a condition that requires disease-modifying treatments
to change illness trajectory. In this Personal View, we argue that lithium acts like a disease-modifying drug in bipolar
disorder. Although the pathophysiology of bipolar disorder remains unclear, many of the mechanisms implicated in
bipolar disorder, and the surrogate markers associated with this condition, are uniquely affected by lithium treatment
from the DNA and cellular levels to the structure and function of the brain and other body systems. Clinical trial and
cohort study evidence shows that lithium is effective and probably superior to other medications used to treat bipolar
disorder, and that long-term outcomes are better with lithium than non-lithium regimens. Conceptualisation of
lithium as a disease-modifying agent might help to increase clinical use by doctors, especially early in the disease
course to better serve our patients.

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JAMA @jama.com · 04/06/2025

Varenicline, combined with behavioral counseling, increased vaping abstinence in youth who vape nicotine and do not regularly smoke tobacco. ja.ma/4jvML5W

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Reposted by Aleksi Hamina

Art Walaszek, MD @walaszek.art · 23/05/2025

1- New international guidelines for algorithmic treatment (INTEGRATE) of #schizophrenia were just published: #medsky www.thelancet.com/journals/lan... (paywall, unfortunately)

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Aleksi Hamina @aleksihamina.bsky.social · 16/05/2025

Our new study, published in PAIN, analyzed age-standardized mortality in 116,006 non-cancer long-term users of opioids. Multifold risk of mortality vs the general population, especially due to suicide, accidents, and accidental poisoning. www.doi.org/10.1097/j.pain.0000000000003653 #medsky 🧪 #episky

Table on Standardized Mortality Ratios for all-cause and cause-specific mortality in noncancer patients with long-term prescription opioid use. Results show multifold risk for unnatural causes of death, especially suicide, accidents, and accidental poisoning.

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Aleksi Hamina @aleksihamina.bsky.social · 13/05/2025

New study on 3357 Canadian hypertension patients (followed on median 4.6 years) showed no difference between morning vs. bedtime dosing for CV outcomes, casting further doubt on the dramatic results of the MAPEC and Hygia trials. www.doi.org/10.1001/jama.2025.4390 #medsky 🧪

Graphical abstract of the study, explaining randomization of 1677 patients to bedtime, 1680 patients to morning dosing. Findings were 2.3 cardiovascular events per 100 py with bedtime dosing and 2.4 with morning dosing (adjusted hazard ratio 0.96, 95% CI 0.77-1.19), ie, no difference.

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Aleksi Hamina @aleksihamina.bsky.social · 07/05/2025

New study from our group! In a Swedish cohort of 1772 individuals with cannabis-induced psychosis, antipsychotics and especially LAIs, were effective in preventing re-hospitalization. Open access! Published in the British Journal of Psychiatry www.doi.org/10.1192/bjp.2025.72

A forest plot graph on the association of antipsychotic use with hospital admission caused by psychotic relapse, compared to periods of non-use. Graph shows lowered adjusted hazard ratios for any antipsychotic, but also especially for long-acting injectable antipsychotics (LAIs).

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Reposted by Aleksi Hamina

Art Walaszek, MD @walaszek.art · 05/05/2025

The average longest duration between ANC checks was 88 days, consistent with a 2020 consensus guideline recommending quarterly in patients with continuous clozapine treatment for > 1 year who never had an ANC < 2000/μL. www.jpn.ca/content/45/3...

jpn.ca

Consensus statement on the use of clozapine during the COVID-19 pandemic

With the ongoing coronavirus disease 2019 (COVID-19) pandemic, psychiatrists find themselves in the clinical situation of being asked by patients, family members and patient advocacy societies to help...

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Aleksi Hamina @aleksihamina.bsky.social · 30/04/2025

Super interesting (but preliminary) study published in Neuron, indicating: -Transplanting gut microbiota from women with fibromyalgia into mice induces pain -Replacing fibromyalgia microbiota with healthy microbiota alleviated pain both in mice and humans doi.org/10.1016/j.ne... #medsky 🧪

$The results of an open-label pilot study to investigate the effects of fecal microbiota transplantation from healthy female donors on fibromyalgia symptoms in 14 women with severe, refractory fibromyalgia. Figure showing statistically significant (positive) effects on pain intensity, Fibromyalgia Impact Questionnaire results, anxiety, depression, sleep disturance, and physical quality of life.$

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Aleksi Hamina @aleksihamina.bsky.social · 15/04/2025

Study in BC 🇨🇦 sees no change in opioid or stimulant harms 1 year after decriminalization. "The findings do not support decriminalization in isolation as an effective policy at reducing drug overdose harms." Keep an eye on that opioid hospitalization trend, though www.doi.org/10.1001/jama.2025.3006

Changes in opioid and stimulant deaths and hospitalizations two years before and one year after decriminalization in British Columbia.

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Aleksi Hamina @aleksihamina.bsky.social · 09/04/2025

New short report in the American Journal of Psychiatry indicates that self-reported non-medical use of prescription stimulants, opioids, and benzodiazepines in adolescents decreased notably between 2009 and 2022 in US adolescents: www.doi.org/10.1176/appi.ajp.20240674 🧪

Trend lines (2009-2022) of nonmedical use of prescription benzodiazepines, opioids, and stimulants showing decreases in past-year nonmedical use, lifetime medical use and adolescents reporting these drugs are "very easy to get. Simultaneously increases in adolescents reporting that these drugs are "probably impossible to get".

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The Mental Elf @thementalelf.bsky.social · 03/04/2025

Lithium is best at decreasing the risk of depression-related hospitalisation in bipolar disorder, according to new cohort study buff.ly/bHzIaxb #BipolarDisorder #BipolarDepression #Lithium #MoodStabilisers 🧵 THREAD

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NEJM.org @nejm.org · 29/03/2025

SOUL phase 3b trial: Among participants with type 2 diabetes & cardiovascular disease, chronic kidney disease, or both, oral semaglutide was associated with a lower risk of cardiovascular events than placebo after 4 years of follow-up. nej.md/4hHII5M #ACC25 @accintouch.bsky.social

A graph showing major adverse cardiovascular events

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Helena Klara Jambor @helenajambor.bsky.social · 26/03/2025

H/T @yan-holtz.bsky.social -- all OurWorldInData Datasets available in an R package - fantastic! 🧪📊

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Aleksi Hamina @aleksihamina.bsky.social · 25/03/2025

New meta-analysis finds co-occurring psychotic disorders are negatively associated with OAT retention, but no evidence of association between co-occurring psychotic disorders and illicit drug use (in OAT). doi.org/10.1007/s404...

Forest plot of comparison: patients with psychotic versus patients with non-psychotic OUD receiving opioid agonist therapy, outcome: treatment retention. Pooled OR 0.65 (95% CI: 0.57–0.74; P < 0.05), suggesting significantly poorer OAT retention among patients with OUD and psychotic disorders.

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Reposted by Aleksi Hamina

The Mental Elf @thementalelf.bsky.social · 19/03/2025

Quetiapine may pip lithium to the augmentation post in 'treatment resistant depression': results from the LQD study buff.ly/Y7jCajZ #LQDstudy #Quetiapine #Lithium #Depression #RCT 🧵 THREAD

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Art Walaszek, MD @walaszek.art · 14/03/2025

Clozapine is a life-saving medication for people with schizophrenia. The clozapine REMS was a barrier to effective to mental healthcare. The REMS is now gone. I recommend adopting these evidence-based monitoring guidelines proposed by this task force: pmc.ncbi.nlm.nih.gov/articles/PMC... #medsky

The time has come for revising the rules of clozapine blood monitoring in Europe. A joint expert statement from the European Clozapine Task Force.

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Art Walaszek, MD @walaszek.art · 08/03/2025

Insightful editorial raising questions about the role of esketamine in the treatment of depression, including "marginal effect sizes after the first week, the lack of controlled long-term efficacy data, and negligible evidence for efficacy against suicidality." psychiatryonline.org/doi/10.1176/...

psychiatryonline.org

Six Years After Approval of Esketamine Nasal Spray for Serious Depression: Clinical Conundrums and Unanswered Questions | American Journal of Psychiatry

PsychiatryOnline.org is the platform for all American Psychiatric Association Publishing journals, DSM, and bestselling textbooks, as well as APA Practice Guidelines, and continuing medical education.

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Addiction journal @addictionjournal.bsky.social · 03/03/2025

Relapse in substance-induced psychosis and associated risk factors. A Nationwide register-linkage study from Sweden by Venla Ellilä @utu.fi and colleagues buff.ly/3D0TmGv

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Art Walaszek, MD @walaszek.art · 26/02/2025

The end of the clozapine REMS ... sort of. The FDA no longer expects prescribers/pharmacies/patients to participate in REMS but "still recommends that prescribers monitor patients’ ANC according to the monitoring frequencies described in the prescribing information." www.fda.gov/drugs/postma...

fda.gov

Information on Clozapine

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Art Walaszek, MD @walaszek.art · 21/02/2025

What is the effect of ketamine on suicidal ideation (SI) in people with major depressive disorder (MDD)? A large cohort study using aggregated EHR data (N=515,000 pts w/ recurrent MDD) found that ketamine over time reduced SI more than antidepressants. pmc.ncbi.nlm.nih.gov/articles/PMC...

Comparison between ketamine and other antidepressants outcome w/r/t suicidal ideation. HR < 1 (favoring ketamine) for ketamine vs antidepressants at all follow-up periods (7, 30, 90, 180, 270 days).

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Aleksi Hamina @aleksihamina.bsky.social · 20/02/2025

New study! Despite continuous use of LAI D2 blockers, 45% of first-episode schizophrenia patients relapsed in 10 years, suggesting non-dopaminergic pathophysiology. Risk of breakthrough psychosis decreased over time, opposing dopamine supersensitivity theory. dx.doi.org/10.1176/appi.ajp.20240321

Kaplan-Meier graphs of cumulative probability of relapse among patients on continuous long-acting injectable (LAI) antipsychotic treatment (N=305) and all other patients during the first year and across 10 years (N=4,483). The figures show lower risk with LAI, but progressively cumulating relapses over time.

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Aleksi Hamina @aleksihamina.bsky.social · 13/02/2025

New evidence for treating AUD with semaglutide: phase 2 RCT including 48 participants showed a decrease in laboratory alcohol self-administration (and some self-measured outcomes). www.doi.org/10.1001/jamapsychiatry.2024.4789

Visual abstract of the RCT "Once-weekly semaglutide in adults with alcohol use disorder".

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Aleksi Hamina @aleksihamina.bsky.social · 07/02/2025

New Lancet Psychiatry study on 105,495 individuals with bipolar disorder in Sweden: lithium reduces the risk of hospitalisation for depression (aHR 0·75, 95% CI 0·67–0·85) mania (0·61, 0·54–0·68), and somatic hospitalisation (0·86, 0·80–0·93), unlike any other drug. doi.org/10.1016/S221...

Risk of depression-related hospitalisation associated with drugs for bipolar disease in a within-individual model compared to non-use. Only lithium is associated with a decreased risk (aHR 0.75, 95% CI 0.67-0.85).

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Addiction journal @addictionjournal.bsky.social · 05/02/2025

There does not appear to be an overall increased risk of overdose for individuals co-prescribed a stimulant medication with opioid agonist therapy. Open access research by Samantha Young and colleagues buff.ly/412Kl8I

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Aleksi Hamina @aleksihamina.bsky.social · 22/01/2025

New research from our team, published in Lancet Psychiatry! Switching to clozapine after a first psychosis relapse significantly reduces the risk of a second relapse compared to non-clozapine treatments. Open access: doi.org/10.1016/S221... 🧪 #medsky #episky #psychiatry #schizophrenia

doi.org

Redirecting

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Addiction journal @addictionjournal.bsky.social · 16/01/2025

Lisdexamfetamine appears to reduce methamphetamine use over a 12-week treatment period. Read the open access research by Nadine Ezard and colleagues buff.ly/4gRwNmb

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