Latuda® (lurasidone HCl) Nurse Practitioner Central | HCP Resources

Nurse Practitioner Central

Resources to help identify, manage, and treat your patients with bipolar depression

Latuda® (lurasidone HCl) Nurse Practitioner Central
Latuda® (lurasidone HCl) Nurse Practitioner Central

We understand the challenges you face as a nurse practitioner who treats adults and pediatric patients (10 to 17 years) with bipolar depression. That’s why we’ve created an online resource for nurse practitioners just like you. Welcome to Nurse Practitioner Central.

This is your online resource to download and print tools to share with your patients and their caregivers.

It's also where you can watch educational videos developed for health care professionals about LATUDA and bipolar depression and get answers to the most frequently asked questions.

See a nurse practitioner discuss the challenges of diagnosing and managing bipolar depression in adults

Is it Bipolar Disorder? Insights from an NP – Tammy LeBlanc video


Nurse Practitioner Perspectives

Get the clinical facts behind each patient’s story with a nurse practitioner’s perspective. Learn to recognize the signs that differentiate bipolar depression from other types of depression, as well as identifying the types of patients who may be appropriate for LATUDA.

Click on the patient's photo below to review their medical profile and access a nurse practitioner's commentaryon the case.

Patient Profile: Jane’s Journey*

A 10-year journey to a bipolar depression diagnosis 

Case commentary by Diane Snow,
PhD, APRN, PMHNP-BC, FAANP, FIAAN

Clinical Professor and Director, PM-HNP Program
University of Texas at Arlington College of Nursing and Health Innovation Arlington, Texas

Diane Snow is a paid consultant of Sunovion Pharmaceuticals Inc.


Unfortunately, it is not uncommon for individuals with bipolar disorder to go undiagnosed or misdiagnosed for long periods of time. When Jane* presents to her psychiatric NP, her primary complaint is her depression, and we know that she is tired of trying one antidepressant after another. This account of failed antidepressant therapy is a red flag that the patient may have bipolar disorder. She has not expressed any symptoms other than those of a depressive nature thus far, which can mask the need to investigate further into her history. In fact, I would urge primary care and psychiatric providers to rule out bipolar disorder in any patient who presents with depressive symptoms to help prevent a misdiagnosis and possible inappropriate treatment. A straightforward way to do that is via screening tools, such as the MDQ, which screens for a lifetime history of mania. This tool can provide feedback to the patient, who may start to recognize his or her symptoms through the screening tools. Following a positive screen, assessment of mood symptoms using the DSM-5 criteria and asking about sudden switches in mood over time is important. It is also helpful to ask the patient to cite any previous diagnoses, as patients are not always sure of their diagnostic history. Asking specifically about a family history of bipolar disorder in first- and second-degree relatives may help to confirm a diagnosis of heritable bipolar disorder.

Jane’s denial of feeling “unusually good” in the past is not as much a denial as it is a lack of self-awareness and insight. To gain insight from an outside source, the psychiatric NP speaks with Jane’s husband. If Jane had not been willing to include her husband in the conversation, the psychiatric NP could have asked Jane, “Has your family ever mentioned that you were acting out of character?” An account of family members’ responses could provide additional clues into Jane’s own bipolar symptoms.

Once Jane is diagnosed with bipolar I disorder, she begins therapy with a mood stabilizer. It is important to follow up—even by phone—to make sure her depression does not get any worse. As with any medication, if there is no improvement, a change in dose or treatment may be warranted. In this case, after 6 weeks, the psychiatric NP adds LATUDA to the mood stabilizer to treat Jane’s bipolar depression.

References:

  1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613.
  2. Hirschfeld RM, Williams JB, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry. 2000;157(11):1873-1875.

Patient Profile: Jeanette’s Journey*

Her first diagnostic workup

Case commentary by Diane Snow,
PhD, APRN, PMHNP-BC, FAANP, FIAAN
Clinical Professor and Director, PM-HNP Program
University of Texas at Arlington College of Nursing and Health Innovation Arlington, Texas

Diane Snow is a paid consultant of Sunovion Pharmaceuticals Inc.


It is not unusual for a patient with bipolar I disorder to present with confounding symptoms. In this case, Jeannette* demonstrates performance anxiety, preventing her from functioning in her career as a musician. Clinicians must be prudent in assessing all symptoms, but recognizing that patients with bipolar disorder can indeed present with one or more psychiatric comorbidities, such as anxiety disorders, as reported in STEP-BD.4 The clinician uses the GAD-7, the PHQ-9, and the MDQ to screen for anxiety, depression, and a history of mania. Although very helpful as screening tools, these screeners do not replace the clinical interview in making a diagnosis. A comprehensive interview is required.

Jeannette reveals in the interview that she has had a history of episodes that appear to be mania. She is currently depressed (specifically, experiencing at least 2 weeks of depressed mood along with other criteria from the Diagnostic and Statistical Manual of Mental Disorders. 5th ed. [DSM-5]).5 If the psychiatric NP had not determined that Jeannette had a manic episode with at least 7 days of elevated mood, racing thoughts, decreased need for sleep, and/or other symptoms, such as distractibility, excess energy, and inflated self-esteem, it is very possible that Jeannette would have been treated with an antidepressant. Antidepressants are not first-line treatment for bipolar depression; they can often precipitate a switch to mania.6

In addition, the clinician needs to confirm the extent of Jeannette’s drinking. Alcohol and drugs can affect mood and impulsivity, challenging the clinician to sort through intoxication and withdrawal symptoms to establish a clearer clinical picture.

Finally, this patient has a supportive friend who can be a valuable asset for monitoring symptoms and being alert to changes in mood and anxiety. This advocacy role can provide tremendous benefit to the clinician. Furthermore, Jeannette may benefit from psychotherapy to improve coping skills in handling stress and to ensure she maintains a normal daily routine.

References:

  1. Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives Intern Med. 2006;166(10):1092-1097. 
  2. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613.
  3. Hirschfeld RM, Williams JB, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry. 2000;157(11):1873-1875.
  4. Simon NM, Otto MW, Weiss RD, et al. Pharmacotherapy for bipolar disorder and comorbid conditions: baseline data from STEP-BD. J Clin Psychopharmacol. 2004;24(5):512-520.
  5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Publishing; 2013.
  6. Valenti M, Pacchiarotti I, Bonnín CM, et al. Risk factors for antidepressant-related switch to mania. J Clin Psychiatry. 2012;73(2):e271-e276.

Patient Profile: Dave's Journey*

A new treatment plan for persistent symptoms  

Case commentary by Diane Snow,
PhD, APRN, PMHNP-BC, FAANP, FIAAN

Clinical Professor and Director, PM-HNP Program
University of Texas at Arlington College of Nursing and Health Innovation Arlington, Texas

Diane Snow is a paid consultant of Sunovion Pharmaceuticals Inc.


The first step in a comprehensive follow-up by the primary care clinician would be to run a standard lab workup to assess a new baseline of values, including, but not limited to: thyroid, cholesterol, and triglycerides. These values can provide a point of reference for ongoing appointments. Next, the clinician should delve into the patient’s sleep habits, which could be affecting his motivation and energy levels. If Dave’s sleep habits do require further investigation, the clinician may take this opportunity to refer Dave to a sleep laboratory or another health care professional. To address Dave’s physical health, the psychiatric NP or primary care clinician should discuss basic lifestyle modifications (ie, dietary change, increase in exercise) with Dave and his wife.

Keeping family members active in the discussion and treatment plan can be valuable, as they can provide support and serve as another perspective on a patient’s health status and overall functioning. Collaboration should continue between the psychiatric NP and primary care clinician as these health care providers track Dave’s progress in regards to his depressive symptoms and results from his periodic physical exams. Improvements of any kind—no matter how big or small—can help the patient, so working with Dave while incorporating changes agreed upon by him and his wife can be a good start toward improving overall health practice.

References:

  1. Vancampfort D, Vansteelandt K, Correll CU, et al. Metabolic syndrome and metabolic abnormalities in bipolar disorder: a meta-analysis of prevalence rates and moderators. Am J Psychiatry. 2013;170(3):265-274. 
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IMPORTANT SAFETY INFORMATION AND INDICATIONS FOR LATUDA

INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS; and SUICIDAL THOUGHTS AND BEHAVIORS

Increased Mortality in Elderly Patients with Dementia-Related Psychosis
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. LATUDA is not approved for the treatment of patients with dementia-related psychosis.

Suicidal Thoughts and Behaviors
Antidepressants increased the risk of suicidal thoughts and behavior in pediatric and young adults in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening, and for emergence of suicidal thoughts and behaviors.

 

CONTRAINDICATIONS: LATUDA is contraindicated in the following:

Cerebrovascular Adverse Reactions, Including Stroke: In clinical trials, elderly subjects with dementia randomized to risperidone, aripiprazole, and olanzapine had a higher incidence of stroke and transient ischemic attack, including fatal stroke. LATUDA is not approved for the treatment of patients with dementia-related psychosis.

Neuroleptic Malignant Syndrome (NMS): NMS is a potentially fatal symptom complex reported with administration of antipsychotic drugs. Clinical signs of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability. Additional signs may include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure. Manage NMS with immediate discontinuation of antipsychotic drugs, including LATUDA, intensive symptomatic treatment and monitoring.

Tardive Dyskinesia (TD): The risk of developing TD (a syndrome of abnormal involuntary movements) and the potential for it to become irreversible are believed to increase as the duration of treatment and total cumulative dose of antipsychotic increase. The syndrome can develop, although much less commonly, after relatively brief treatment periods at low doses or may even arise after discontinuation of treatment. The syndrome may remit, partially or completely, if antipsychotic treatment is withdrawn.

Metabolic Changes Atypical antipsychotic drugs have caused metabolic changes including:

Hyperglycemia and Diabetes Mellitus: Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics. Patients with diabetes should be regularly monitored for worsening of glucose control; those with risk factors for diabetes should undergo fasting blood glucose testing at the beginning of and periodically during treatment. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia, including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia should undergo fasting blood glucose testing. In some cases, hyperglycemia has resolved when the atypical antipsychotic was discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the suspect drug.

Dyslipidemia: Undesirable alterations in lipids have been observed in patients treated with atypical antipsychotics.

Weight Gain: Weight gain has been observed with atypical antipsychotic use. Clinical monitoring of weight is recommended.

Hyperprolactinemia: As with other drugs that antagonize dopamine D2 receptors, LATUDA elevates prolactin levels. Galactorrhea, amenorrhea, gynecomastia, and impotence have been reported in patients receiving prolactin-elevating compounds.

Leukopenia, Neutropenia, and Agranulocytosis: Leukopenia/neutropenia has been reported with antipsychotics. Agranulocytosis (including fatal cases) has been reported with other agents in the class. Monitor complete blood count in patients with a pre-existing low white blood cell count (WBC)/absolute neutrophil count (ANC) or history of drug-induced leukopenia/neutropenia. Discontinue LATUDA at the first sign of a decline in WBC in the absence of other causative factors.

Orthostatic Hypotension and Syncope: Atypical antipsychotics cause orthostatic hypotension and syncope. Generally, the risk is greatest at the beginning of treatment and when increasing the dose. Monitor patients vulnerable to hypotension and those with cardiovascular and cerebrovascular disease.

Falls: Antipsychotics may cause somnolence, postural hypotension, or motor and sensory instability, which may lead to falls, causing fractures or other injuries. For patients with disease, conditions, or medications that could exacerbate these effects, complete fall risk assessments when initiating treatment and recurrently during therapy.

Seizures: LATUDA should be used cautiously in patients with a history of seizures or with conditions that lower seizure threshold.

Potential for Cognitive and Motor Impairment: Patients should be cautioned about operating hazardous machinery, including motor vehicles, until they are reasonably certain that therapy with LATUDA does not affect them adversely.

Body Temperature Regulation: Use LATUDA with caution in patients who may experience conditions that increase body temperature (e.g., exercising strenuously, exposure to extreme heat, concomitant medication with anticholinergic activity, or being subject to dehydration).

Dysphagia: Antipsychotics, including LATUDA, have been associated with esophageal dysmotility and aspiration, and should be used with caution in patients at risk for aspiration pneumonia.

Most Commonly Observed Adverse Reactions: Commonly observed adverse reactions (≥5% incidence and at least twice the rate of placebo) for LATUDA:

To report SUSPECTED ADVERSE REACTIONS, contact Sunovion Pharmaceuticals Inc. at 877-737-7226 or FDA at 1-800-FDA-1088 (www.fda.gov/medwatch).

Indications

LATUDA is indicated for:

Before prescribing LATUDA, please read the full Prescribing Information, including Boxed Warning.