Opparounds

Pharmacological Interventions for Weight Reduction in Patients With Schizophrenia Treated With Antipsychotics: A Systematic Review and Network Meta-Analysis

Nicolette Stogios, Sri Mahavir Agarwal, Kateryna Maksyutynska, et al. · JAMA Psychiatry · July 2026

This systematic review and network meta-analysis pooled 95 randomized trials (pooled N = 5,898) testing 39 pharmacological strategies for reducing weight already gained on antipsychotics in patients with schizophrenia spectrum disorders. Using a frequentist random-effects network meta-analysis with CINeMA-graded certainty, the authors ranked each add-on agent by mean weight change versus placebo on top of ongoing antipsychotic treatment.

Semaglutide produced by far the largest effect (−10.98 kg), followed by liraglutide (−5.43 kg), topiramate (−3.95 kg), metformin (−3.86 kg), and exenatide (−2.97 kg) — all moderate-certainty evidence. Familiar options like metformin and topiramate still moved the needle, just far less than the GLP-1 agonists.

Read the paper →  doi:10.1001/jamapsychiatry.2026.1814

Selective Serotonin Reuptake Inhibitors and Bleeding Risk in Patients Undergoing PCI on Dual Antiplatelet Therapy: A Retrospective Cohort Study

Ishmum Chowdhury, Kuan-Yu Chi, Yu Chang, et al. · European Heart Journal – Cardiovascular Pharmacotherapy · May 2026

This propensity-matched retrospective cohort study used the TriNetX global network to compare one-year bleeding outcomes in patients on 12-month dual antiplatelet therapy (DAPT) after PCI who were or weren't taking a concurrent SSRI. Of nearly 30,000 PCI patients on DAPT, 3,847 SSRI users were matched 1:1 with non-users.

Major bleeding occurred more often with concurrent SSRI use (14.0% vs 11.3%; HR 1.28), driven specifically by intracranial hemorrhage (HR 1.73) and GI bleeding (HR 1.34), with no offsetting reduction in ischemic events. The excess risk was most pronounced in older patients and those with chronic kidney disease or concurrent NSAID use.

Read the paper →  doi:10.1093/ehjcvp/pvag034

Olanzapine Pamoate's Three-Hour Hold Is Timed to a Pharmacokinetic Accident

Olanzapine long-acting injection (Zyprexa Relprevv) carries a black-box warning and a REMS program most other depot antipsychotics don't need: every patient is observed for three hours after each injection at a certified facility. The reason is post-injection delirium/sedation syndrome (PDSS) — heavy sedation, occasionally coma, occurring in roughly 1.4% of patients over the drug's lifetime, almost always from a single injection rather than a recurring pattern. This isn't an allergic or idiosyncratic reaction. The pamoate salt is only slightly soluble in blood; if a needle nicks a vessel during injection, that solubility barrier disappears and a large fraction of the depot dissolves rapidly into circulation, producing a transient spike measured above 600 ng/mL — roughly ten times the usual therapeutic range — before falling back to baseline over 24 to 72 hours. Median symptom onset is 25 minutes post-injection, with a tail out to 3–5 hours, which is exactly why the observation window sits where it does. Every reported patient has recovered; the three hours exist so someone is there when it happens.

Therapeutic Neutrality Was Never the Absence of a Relationship

Technical neutrality is routinely misheard as emotional blankness — the therapist as mirror, giving nothing of themselves away. That isn't what the term meant even in Anna Freud's original formulation: neutrality is equidistance from a patient's id impulses, defending ego functions, and superego demands, not distance from the patient as a person. Running alongside it is a separate track Greenson called the real relationship — the ordinary, undistorted rapport of two people in a room, which coexists with transference rather than contaminating it. A therapist who refuses every human moment in the name of neutrality isn't protecting the frame; they're enacting a withholding pattern of their own, often mistaken for rigor. The technical question is never disclose-or-don't — it's which track a given moment belongs to, and whether responding as a real person serves the treatment or quietly serves the therapist's own discomfort at being seen.