Douglas L. Noordsy, MD, is Clinical Professor and Associate Chair of Clinical Integration & Coordination, Director of Sports Psychiatry, and psychiatrist on the INSPIRE Early Psychosis Clinic in the Department of Psychiatry & Behavioral Sciences at Stanford University School of Medicine. Dr. Noordsy was previously Professor of Psychiatry, Director of Psychosis Services and Investigator in the Psychopharmacology Research Group at the Geisel School of Medicine at Dartmouth. His research interests include medication and lifestyle interventions for individuals with psychotic disorders; methods to facilitate recovery and promote achievement of optimal outcomes for people with schizophrenia and bipolar disorder; and methods to prevent progression of early psychotic disorders. He is particularly interested in the role of physical exercise for prevention of progression of early psychosis and for potentiating learning in CBTp and supported employment and education. Dr. Noordsy is a member of the Schizophrenia International Research Society, the International Early Psychosis Association, and is a fellow of the American Psychiatric Association. He is a member of the editorial boards for Community Mental Health Journal, Clinical Schizophrenia & Related Psychosis, and Schizophrenia Bulletin. Dr. Noordsy was recognized with the Exemplary Psychiatrist Award from the National Alliance on Mental Illness in 2001, and the Excellence in Leadership Award from the Department of Psychiatry & Behavioral Sciences at Stanford in 2018.
- Early psychosis
- Sports Psychiatry
- Lifestyle medicine
Clinical Professor, Psychiatry and Behavioral Sciences
Associate Chair of Clinical Integration and Coordination, Psychiatry & Behavioral Sciences (2016 - Present)
Director of Sports Psychiatry, Psychiatry & Behavioral Sciences (2015 - Present)
Medical Education:Washington University School Of Medicine Registrar (1985) MO
Board Certification: Psychiatry, American Board of Psychiatry and Neurology (1990)
Residency:Darmouth-Hitchcock Medical Center (1989) NH
M.D., Washington University School of Medicine, Medicine (1985)
B.S. magna cum laude, St. Lawrence University, Chemistry (1981)
Consumer and Family Perspectives on Reducing the Duration of Untreated Psychosis
WILEY. 2018: 62
View details for Web of Science ID 000444798900176
Clozapine Titration for People in Early Psychosis A Chart Review and Treatment Guideline
JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY
2018; 38 (3): 234–38
The use of clozapine, particularly in young people, is often limited by early treatment-emergent adverse effects including drowsiness and lethargy. Concerns about adverse effects, medication adherence, and the need for blood monitoring often impede the use of clozapine in this population, leading to repeated trials of less effective medications. Current clozapine dosing recommendations are based on people further in the course of their illness and thus reflect different responsiveness and sensitivities to antipsychotic medication. As such, there is a need for evidence-based guidelines for titration and dosing of clozapine among people in early psychosis.We performed a chart review of 14 people treated with clozapine within our early psychosis team. Data regarding dose titration, response, time to discontinuation, symptom severity, weight gain, and other adverse effects were gathered at clozapine initiation, 3 months, and last available visit on clozapine.People treated with slow titration within their first year of psychosis onset achieved sustained response at very low maintenance doses (mean dose = 81 mg/d, mean duration of treatment = 200 weeks) compared with slow titration with longer duration of illness (mean dose = 350 mg/d, mean duration of treatment = 68 weeks) or standard dose titration in early psychosis (mean dose = 112 mg/d, mean duration of treatment = 38 weeks). The most common adverse effects in all groups were weight gain and sedation, with the groups requiring higher mean doses reporting a broader range of adverse effects. There was no apparent difference in the clinical global impression for severity or improvement between the slow titration and standard titration groups in people with early psychosis. These observations are synthesized into a proposed treatment guideline for use of clozapine among people in early psychosis.We describe development of a slow titration approach to initiating clozapine among people in early psychosis. This approach resulted in clinical response at remarkably low maintenance doses of clozapine among people within their first year of illness, but not in those with longer duration of symptoms. Slow titration also led to good tolerability and acceptance of clozapine treatment for some patients.
View details for DOI 10.1097/JCP.0000000000000860
View details for Web of Science ID 000431001500012
View details for PubMedID 29659460
Therapeutic Potential of Physical Exercise in Early Psychosis.
The American journal of psychiatry
2018; 175 (3): 209–14
View details for PubMedID 29490501
Factors motivating spontaneous exercise in individuals with schizophrenia-spectrum disorders.
View details for PubMedID 29656908
Impact of age of onset of psychosis and engagement in higher education on duration of untreated psychosis
JOURNAL OF MENTAL HEALTH
2018; 27 (3): 257–62
The average age of onset of psychosis coincides with the age of college enrollment. Little is known about the impact of educational engagement on DUP in a college-aged population.To determine DUP, and the impact of educational engagement, for college-aged participants of the RAISE study (n = 404).We conducted secondary data analyses on the publicly available RAISE dataset. Subsamples were analyzed to determine the impact of age and educational engagement on DUP.DUP was significantly shorter (p < 0.02) for participants who were college-aged (18-22 years, n = 44) and engaged in post-secondary education (median = 12 weeks, mean = 29 weeks) compared with participants who were college-aged and not engaged in higher education (n = 92, median = 29 weeks, mean = 44 weeks).Educational engagement appears to be associated with a shorter DUP. This may be partially explained by the presence of on-site wellness centers in college settings. However, even among young people who engaged in post-secondary education DUP was still at, or beyond, the upper limit of WHO recommendations in this group. Future research exploring how colleges could improve their capacity to detect and refer at risk students for treatment at an earlier stage is recommended.
View details for PubMedID 29707996
An RCT Evaluating the Effects of Skills Training and Medication Type on Work Outcomes Among Patients With Schizophrenia
2017; 68 (3): 271-277
Although supported employment increases job acquisition for people with serious mental illness, data on participants' job tenure have been variable. This study evaluated the effects of a standardized work skills training program (the Workplace Fundamentals Module [WPFM]) on job tenure and other work outcomes among individuals receiving individual placement and support (IPS). The effects of two atypical antipsychotic medications on side effects were also tested. The primary hypothesis tested was that participants in IPS plus WPFM would have increased job tenure compared with those enrolled in IPS only, and the secondary hypothesis was that different antipsychotic medications would yield unique side effects.A 2×2 randomized controlled trial compared work outcomes, including job tenure, of participants receiving IPS with or without WPFM for up to two years after obtaining a job. Participants were also randomly assigned to olanzapine or risperidone. Measures of work outcomes, clinical status, and medication side effects were collected.Among 107 participants, 63% obtained at least one job. WPFM did not increase job tenure (51.53 and 41.37 total weeks worked for IPS only and IPS plus WPFM, respectively) or affect other work outcomes. Participants on olanzapine experienced increased body mass index, whereas those on risperidone lost weight, but medications did not differentially affect clinical or job outcomes.Clinic-based skills training did not improve work outcomes accruing from IPS. Risperidone, compared with olanzapine, may reduce body mass but has no differential effect on other work or clinical outcomes.
View details for DOI 10.1176/appi.ps.201500171
View details for Web of Science ID 000397093300012
GENETIC CORRELATION ANALYSIS OF SCHIZOPHRENIA MIRRORS KNOWN EPIDEMIOLOGICAL RELATIONSHIPS AND SUGGESTS NOVEL ASSOCIATIONS
OXFORD UNIV PRESS. 2017: S73
View details for Web of Science ID 000397126200196
Risperidone versus olanzapine among patients with schizophrenia participating in supported employment: Eighteen-month outcomes
Journal of Psychiatric Research
This study compares the efficacy and tolerability of olanzapine versus risperidone among patients with schizophrenia who are established in outpatient psychiatric care and entering supported employment. A multicenter, randomized, double-blind trial was conducted among 107 outpatients with schizophrenia, who were cross-titrated to flexible dose risperidone or olanzapine over 2 weeks. Clinical endpoints included time to hospitalization and persistence on assigned medication. Weight, laboratory tests, psychopathology, neurologic side effects, social adjustment and role functioning were assessed at 3-6 month intervals. Data were analyzed first by randomized treatment, and then reassessed controlling for prior medication treatment. The proportion of patients on assigned medication at 18 months was 30.9% for risperidone and 37.3% for olanzapine. Mean doses were 6.4 ± 3.2 mg daily for risperidone, and 17.0 ± 5.0 mg daily for olanzapine. The groups did not differ significantly in time to medication discontinuation, first hospitalization or first employment. There were few differences in psychopathology, laboratory, or neurological assessments between groups at 18 months. Patients randomized to olanzapine gained modestly more weight. Controlling for pre-randomization medication suggested improvement in some aspects of psychopathology from switching medications; however, switching from olanzapine to risperidone was associated with more hospitalizations. Risperidone and olanzapine have similar efficacy and tolerability in patients with schizophrenia who are participating in supported employment. Randomization to olanzapine was associated with more weight gain, but randomization from olanzapine to risperidone appeared to be associated with a greater likelihood of hospitalization. Careful monitoring of metabolic effects and participation in supported employment may have contributed to minimal weight gain and metabolic effects.
View details for DOI 10.1016/j.jpsychires.2017.09.008
View details for PubMedCentralID PMC5653420
Genetic Correlation Profile of Schizophrenia Mirrors Epidemiological Results and Suggests Link Between Polygenic and Rare Variant (22q11.2) Cases of Schizophrenia.
New methods in genetics research, such as linkage disequilibrium score regression (LDSR), quantify overlap in the common genetic variants that influence diverse phenotypes. It is becoming clear that genetic effects often cut across traditional diagnostic boundaries. Here, we introduce genetic correlation analysis (using LDSR) to a nongeneticist audience and report transdisciplinary discoveries about schizophrenia. This analytical study design used publically available genome wide association study (GWAS) data from approximately 1.5 million individuals. Genetic correlations between schizophrenia and 172 medical, psychiatric, personality, and metabolomic phenotypes were calculated using LDSR, as implemented in LDHub in order to identify known and new genetic correlations. Consistent with previous research, the strongest genetic correlation was with bipolar disorder. Positive genetic correlations were also found between schizophrenia and all other psychiatric phenotypes tested, the personality traits of neuroticism and openness to experience, and cigarette smoking. Novel results were found with medical phenotypes: schizophrenia was negatively genetically correlated with serum citrate, positively correlated with inflammatory bowel disease, and negatively correlated with BMI, hip, and waist circumference. The serum citrate finding provides a potential link between rare cases of schizophrenia (strongly influenced by 22q11.2 deletions) and more typical cases of schizophrenia (with polygenic influences). Overall, these genetic correlation findings match epidemiological findings, suggesting that common variant genetic effects are part of the scaffolding underlying phenotypic comorbidity. The "genetic correlation profile" is a succinct report of shared genetic effects, is easily updated with new information (eg, from future GWAS), and should become part of basic disease knowledge about schizophrenia.
View details for PubMedID 29294133
Ethical Issues in the Care of People with Schizophrenia
Focus: The Journal of Lifelong Learning in Psychiatry
2016; 14 (3): 349-353
View details for DOI 10.1176/appi.focus.20160011
Long-Acting Injectable vs Oral Risperidone for Schizophrenia and Co-Occurring Alcohol Use Disorder: A Randomized Trial
JOURNAL OF CLINICAL PSYCHIATRY
2015; 76 (10): 1359-1365
Alcohol use disorders worsen the course of schizophrenia. Although the atypical antipsychotic clozapine appears to decrease alcohol use in schizophrenia, risperidone does not. We have proposed that risperidone's relatively potent dopamine D2 receptor blockade may partly underlie its lack of effect on alcohol use. Since long-acting injectable (LAI) risperidone both results in lower average steady-state plasma concentrations than oral risperidone (with lower D2 receptor occupancy) and encourages adherence, it may be more likely to decrease heavy alcohol use (days per week of drinking 5 or more drinks per day) than oral risperidone.Ninety-five patients with DSM-IV-TR diagnoses of schizophrenia and alcohol use disorder were randomized to 6 months of oral or LAI risperidone between 2005 and 2008. Explanatory (efficacy) analyses were carried out to evaluate the potential benefits of LAI under suitably controlled conditions (in contrast to real-world settings), with intent-to-treat analyses being secondary.Explanatory analyses showed that heavy drinking in the oral group worsened over time (P = .024) and that there was a statistical trend toward significance in the difference between the changes in heavy drinking days in the oral and LAI groups (P = .054). Furthermore, the 2 groups differed in the mean number of drinking days per week (P = .035). The intent-to-treat analyses showed no difference in heavy drinking but did show a difference in average drinking days per week similar to that obtained from the explanatory analyses (P = .018). Neither explanatory nor intent-to-treat analyses showed any between-group differences in alcohol use as measured by intensity or the Alcohol Use Scale. The plasma concentrations of the active metabolite 9-hydroxyrisperidone were significantly lower in patients taking LAI (P < .05), despite their significantly (overall) better treatment adherence (P < .005).For the population considered here, schizophrenia patients with alcohol use disorder appear to continue drinking some alcohol while taking either form of risperidone. Nonetheless, our data suggest that injectable risperidone may be a better choice than the oral form for these dual diagnosis patients.ClinicalTrials.gov identifier: NCT00130923.
View details for DOI 10.4088/JCP.13m08838
View details for Web of Science ID 000368347900022
View details for PubMedID 26302441
Low-Dose Quetiapine Induced or Worsened Mania in the Context of Possible Undertreatment
JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE
2015; 28 (1): 154-158
Bipolar disorder is a mental illness with a lifetime prevalence of 2% and has a dramatic impact on quality of life. Mania is a distinct period of abnormal and sustained elevated, expansive, or irritable mood and increase in goal-directed activity or energy that lasts at least 1 week and is present for most of each day. Quetiapine is an atypical antipsychotic approved for the treatment of bipolar depression and mania. For the treatment of acute mania, a dose of 600 to 800 mg/day is recommended. There has been concern of potential induction or worsening of hypomanic or manic symptoms at low doses via the ratio of 5HT2A/D2 receptor antagonism, which at lower doses favors greater 5HT2A receptor blockade and thus increases dopamine concentrations. This article describes a case report of hypomania worsening to mania with psychotic features in a drug-naïve patient who was started on low-dose quetiapine. This case adds to the existing literature of case reports indicating that low-dose quetiapine may be associated with induction or worsening of hypomanic/manic symptoms, while acknowledging the difficulty of suggesting a causal relationship.
View details for DOI 10.3122/jabfm.2015.01.140105
View details for Web of Science ID 000347880900024
View details for PubMedID 25567837
Pharmacotherapy of Co-Occurring Schizophrenia and Substance Use Disorders.
Current addiction reports
2014; 1 (4): 251-260
Substance use disorders, common in patients with schizophrenia, can lead to poor outcomes. Here we review the literature on the use of antipsychotics in patients with co-occurring schizophrenia and substance use disorder as well as evidence for the use of adjunctive pharmacological treatments targeting substance use in these patients. We also discuss a neurobiological formulation suggesting that the cooccurrence of these disorders may be related to a dysfunction in the dopamine mediated brain reward circuitry. Typical antipsychotics do not appear to decrease substance use in this population. Randomized, controlled trials provide some support for use of the atypical antipsychotic clozapine for co-occurring cannabis use disorder, naltrexone and disulfiram for alcohol use disorder, and also nicotine replacement therapy, sustained-release bupropion and varenicline for tobacco use disorder. Nonetheless, data regarding treatment in patients with these co-occurring disorders are still limited, and many studies reported to date have been either underpowered or did not include a control condition. Further research is needed to evaluate optimal pharmacotherapeutic strategies for this population.
View details for PubMedID 27226947
View details for PubMedCentralID PMC4877030
- Neuroleptic Malignant Syndrome During Multiple Antipsychotic Therapy COMMUNITY MENTAL HEALTH JOURNAL 2013; 49 (1): 45-46
A Randomized Trial of Clozapine Versus Other Antipsychotics for Cannabis Use Disorder in Patients With Schizophrenia
JOURNAL OF DUAL DIAGNOSIS
2011; 7 (1-2): 50-63
Cannabis use disorder is the most common co-occurring drug use disorder in people with schizophrenia and is associated with poor outcomes. We launched a randomized controlled trial to assess the impact of clozapine compared with treatment as usual on cannabis use in patients with schizophrenia and co-occurring cannabis use disorder.Thirty-one patients with schizophrenia and co-occurring cannabis use disorder were randomly assigned to switch to clozapine or to stay on their current antipsychotic and were then followed weekly for 12 weeks. Blinded raters assessed participants weekly with the Timeline Follow-back for substance use and the expanded Brief Psychiatric Rating Scale for symptoms. Longitudinal random effects models were used to investigate the time-varying differences in cannabis use and other outcomes between the treatment as usual and clozapine groups.The two groups differed in average intensity of cannabis use by approximately 4.5 joints/week, with lesser use in the clozapine group (t = -1.77; df = 28.5; p=.086; effect size ~ 0.6). Symptoms and functioning were not different between the two groups.Clozapine may reduce cannabis use among patients with schizophrenia and co-occurring cannabis use disorder. Further controlled trials are warranted.
View details for DOI 10.1080/15504263.2011.570118
View details for Web of Science ID 000290671900006
View details for PubMedID 25914610
View details for PubMedCentralID PMC4407140
- Treatment of catatonic schizophrenia with lorazepam and aripiprazole SCHIZOPHRENIA RESEARCH 2009; 112 (1-3): 194-195
Six-month outcomes for patients who switched to olanzapine treatment
2001; 52 (4): 501-507
This study evaluated the outcomes of patients in a community mental health center who switched from treatment with another antipsychotic to olanzapine treatment. It also sought to determine whether simultaneous access to case management and psychosocial rehabilitation and olanzapine leads to enhanced functional improvement.Six-month outcomes for a consecutive series of 104 patients who switched from a conventional antipsychotic medication to olanzapine were evaluated. Forty-nine patients in the same treatment program who continued to take conventional antipsychotics were also monitored as a reference group. Outcomes of the group receiving olanzapine were compared with their own baseline status and with outcomes of the reference group.At six months, patients in the olanzapine group demonstrated significant improvement over baseline across multiple measures of symptoms and psychosocial function. Compared with the reference group, the olanzapine group was more symptomatic at baseline and demonstrated significantly greater improvement at follow-up on the Brief Psychiatric Rating Scale and all subscales; Mini Psychiatric Rating Scale negative symptom, disorganization, anxiety, depression, and medication side effects items; and Clinical Global Improvement scale and Case Manager's Rating Scale-Plus illness factors. There was a trend toward superior improvement in psychosocial functioning among patients in the olanzapine group that achieved significance when patients in acute relapse at baseline were excluded.Olanzapine is effective in managing markedly to severely ill patients with psychotic disorders in a community mental health center. Simultaneous treatment with olanzapine, case management, and psychosocial rehabilitation leads to enhanced functional improvement among nonrelapsing patients.
View details for Web of Science ID 000167877100014
View details for PubMedID 11274497