We close our top 10 research updates with a new med combo for alcohol use disorder, a surprise result for antipsychotics in schizophrenia and guidance on stimulants in ADHD.

Welcome to the Carlet Psychiatry Podcast, keeping psychiatry honest since 2003. I'm Chris Sagan, the editor-in-chief of the Carlatte Psychiatry podcast, keeping psychiatry honest since 2003.

I'm Chris Agen, the editor-in-chief of the Carlat Psychiatry Report.

But I'm Kelly Newsom, a psychiatric MP, and a dedicated reader of every issue.

Our first study answers a long-standing debate in schizophrenia.

While antipsychotics treat acute psychotic episodes, they don't relieve negative symptoms,

and some believe they even worsen cognition in this illness.

So over the past decade, a few trials have tested whether functioning improves when the dose is

lowered or even stopped, when they aren't in a psychotic episode.

Some trials say yes, and some say no, but it's hard to conduct the long-term investigations

needed to answer this vaccine question.

So enter this large two-year study from 19 centers in England.

The patients had stable schizophrenia, and they were randomized to either

have their dose reduced gradually or to stay on the same antipsychotic dose. The dose reduction

here was very gradual. The antipsychotic was cut by 67% over the first year, and then lowered by another 33% after the second year.

The results were not as expected. There was no difference on the main outcome, social functioning,

in either group, so dose reduction did not help functioning here.

And instead, it came with a major risk.

There were more hospitalizations with dose reduction, a lot more, 39% versus 16%.

But before we write off the dose reduction strategy, I'm going to mention a few limitations

of this study.

First, it only went for two years. And that seems like a long time, but the earlier study that found

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