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Novel Schizophrenia Treatments

CE / CME

Strategic Steps in Schizophrenia: Mastering Modern Muscarinic Management

Psychologists: 0.50 APA CE Credit

Social Workers: 0.50 ASWB ACE CE Credit

Physician Assistants/Physician Associates: 0.50 AAPA Category 1 CME credit

Nurse Practitioners/Nurses: 0.50 Nursing contact hour

Pharmacists: 0.50 contact hour (0.05 CEUs)

Physicians: maximum of 0.50 AMA PRA Category 1 Credit

Released: July 24, 2025

Expiration: July 23, 2026

Activity

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Course Completed

  1. Owen M, et al. Genomic findings in schizophrenia and their implications. Mol Psychiatry 2023; 28:3638-3647.
  2. American Psychiatric Association, DSM-5 Task Force. Diagnostic and statistical manual of mental disorders, Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Publishing, Inc. 2024.
  3. Weittenhiller LP. What gets in the way of social engagement in schizophrenia? World J Psychiatry 2021:11:13-26.
  4. Giraldo-Chica M, et al. Prefrontal-thalamic anatomical connectivity and executive cognitive function in schizophrenia. Biol. Psychiatry. 2018;83:509-517.
  5. Ferrarelli, F. Sleep disturbances in schizophrenia and psychosis. Schizophr Res. 2020;221:1-3.
  6. Bernardo M, et al. Real-world data on the adverse metabolic effects of second-generation antipsychotics and their potential determinants in adult patients: A systematic review of population-based studies. Adv Ther. 2021;38:2491-2512.
  7. Haloperidol. [prescribing information]. Titusville, NJ: Janssen Pharmaceuticals; 2005.
  8. Benztropine. [prescribing information]. Deerfield, IL: Lundbeck; 2013.
  9. Lorazepam. [prescribing information]. Philadelphia, PA: Wyeth Pharmaceuticals; 2007.
  10. Masroor A., et al. Unraveling the association between schizophrenia and substance use disorder-predictors, mechanisms and treatment modifications: A systematic review. Cureus. 2021;13: e16722.
  11. Propranolol [prescribing information]. Wilmington, DE: AstraZeneca US; 2010.
  12. Xanomeline-trospium. [prescribing information]. Princeton, NJ: Bristol-Myers Squibb; 2024.
  13. Montani C, et al. The M1/M4 preferring muscarinic agonist xanomeline modulates functional connectivity and NMDAR antagonist-induced changes in the mouse brain. Neuropsychopharmacol. 2021;46:1194-1206.
  14. Jakubík J, et al. Differences in kinetics of xanomeline binding and selectivity of activation of G proteins at M(1) and M(2) muscarinic acetylcholine receptors. Mol. Pharmacol. 2006;70:656-66.
  15. Broadley KJ, et al. Muscarinic receptor agonists and antagonists. Molecules 2001;6:142-93.
  16. Pak RW, et al. Trospium chloride: a quaternary amine with unique pharmacologic properties. Curr Urol Rep. 2003;4:436-440.
  17. Brannan SK, et al. Muscarinic cholinergic receptor agonist and peripheral antagonist for schizophrenia. N Engl J Med. 2021;384:717-726.
  18. Fabiano N, et al. Efficacy, tolerability, and safety of xanomeline-trospium chloride for schizophrenia: A systematic review and meta-analysis. Eur Neuropsychopharmacol. 2025;92:62-73.
  19. Citrome L, et al. Xanomeline and trospium chloride versus placebo for the treatment of schizophrenia: A post hoc analysis of number needed to treat, number needed to harm, and likelihood to be helped or harmed. Neuropsychiatr Dis Treat. 2025;21:761-773.
  20. Chiappini S, et al. Misuse of anticholinergic medications: A systematic review. Biomedicines. 2022;10:355.
  21. Ondansetron [prescribing information]. Research Triangle Park, NC: GlaxoSmithKline; 2016.
  22. Olanzapine [prescribing information]. Indianapolis, IN: Lilly; 2009.
  23. Murray RM, et al. Why is clozapine uniquely effective in treatment resistant schizophrenia? Biol. Psychiatry. 2025;S0006-3223:01270-3.
  24. Nicholas F, et al. Switching to a muscarinic agonist to alleviate antipsychotic-induced metabolic and neuromotor adverse effects in a person living with schizophrenia. J Psychiatry Neurosci. 2025;50:E200-E201.
  25. Beach SR, et al. Intravenous haloperidol: A systematic review of side effects and recommendations for clinical use. Gen Hosp Psychiatry. 2020;67:42-50.
  26. Baandrup L, et al. Pharmacological interventions for benzodiazepine discontinuation in chronic benzodiazepine users. Cochrane Database Syst Rev. 2018;3(3):CD011481.
  27. Gollan JK, et al. What are the clinical implications of new onset or worsening anxiety during the first two weeks of SSRI treatment for depression? Depress Anxiety. 2012;2994-101.
  28. World Health Organization. Schizophrenia. who.int/news-room/fact-sheets/detail/schizophrenia. Accessed July 18, 2025.
  29. Seeman MV. History of the dopamine hypothesis of antipsychotic action. World J Psychiatry 2021;11:355-364.
  30. Stahl SM. Beyond the dopamine hypothesis of schizophrenia to three neural networks of psychosis: dopamine, serotonin, and glutamate. CNS Spectrums. 2018;23:187-191.
  31. Maroney M. Management of cognitive and negative symptoms in schizophrenia. Ment Health Clin. 2022;12:282-299.
  32. Mortimer KRH, et al. Second-generation antipsychotics and metabolic syndrome: A role for mitochondria. Front Psychiatry 2023;14:1257460.
  33. Meyer JM, et al. From theory to therapy: unlocking the potential of muscarinic receptor activation in schizophrenia with the dual M1/M4 muscarinic receptor agonist xanomeline and trospium chloride and insights from clinical trials. Int J Neuropsychopharmacol. 2025;28:pyaf015.
  34. Kaul I, et al. Long-term safety and efficacy of xanomeline and trospium chloride in schizophrenia: results from the 52-week, open-label EMERGENT-4 trial. Presented at: American Association of Psychiatric Pharmacists. April 28, 2025.
  35. Kaul I, et al. Efficacy and safety of xanomeline-trospium chloride in schizophrenia: A randomized clinical trial. JAMA Psychiatry. 2024;81:749-756.