The mental health clinician最新文献

{"title":"Antipsychotics in child and adolescent patients with major depressive disorder: A retrospective analysis of prescribing patterns.","authors":"Danielle Dauchot, Suzanne Rettey, Brittany L Melton, Karen E Moeller","doi":"10.9740/mhc.2024.02.010","DOIUrl":"10.9740/mhc.2024.02.010","url":null,"abstract":"<p><strong>Introduction: </strong>Depression rates in children/adolescents in the United States have increased in the last 10 years. Fluoxetine and escitalopram are the only 2 antidepressants approved for the treatment of major depression disorder (MDD) in children/adolescents. In adults, some antipsychotics are approved for augmented treatment of MDD. However, there is limited research on antipsychotic augmentation in child/adolescent MDD.</p><p><strong>Methods: </strong>This retrospective chart review evaluated antipsychotic prescribing for MDD in hospitalized patients aged 4 to 17 years to determine the frequency of prescribing antipsychotics for MDD and what factors influence the addition of an antipsychotic. For inclusion, patients were diagnosed with MDD and not on an antidepressant or antipsychotic before admission. Binomial logistic regression was used to analyze variables with prescribed antipsychotics as the dependent variable.</p><p><strong>Results: </strong>There were 6.8% of patients prescribed an antipsychotic. Binomial logistic regression analysis found that increased age (odds ratio [OR] 1.28; 95% CI = 1.045, 1.568; <i>P</i> = .017) and multiple admissions within 1 year (OR 3.277; 95% CI = 2.283, 4.705; <i>P</i> < .001) were associated with the use of antipsychotics in patients with MDD. Posttraumatic stress disorder and disruptive mood dysregulation disorder were also associated with the use of antipsychotics.</p><p><strong>Discussion: </strong>Careful consideration should be taken when using off-label antipsychotics in children due to limited studies on efficacy. Future research is warranted to assess the efficacy and safety of these agents in children and adolescents.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"14 1","pages":"10-16"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10836566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139682272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of early direct-contact experiences on reducing mental health stigma among student pharmacists: A pilot study.","authors":"Amber R Tran, Saumyaa A Patel, Lindsey J Loera, Tawny Smith, Samantha Catanzano","doi":"10.9740/mhc.2024.02.073","DOIUrl":"10.9740/mhc.2024.02.073","url":null,"abstract":"<p><strong>Introduction: </strong>Mental health-related stigma is a barrier to treatment and recovery for serious mental illnesses (SMIs). Educational training programs demonstrate positive changes in health professional students' attitudes and stigma toward SMI; however, student pharmacists have minimal opportunity to directly engage with the SMI population. This study aims to assess and compare student pharmacists' stigma related to SMI before and after participating in a pilot series of direct-contact workshop experiences.</p><p><strong>Methods: </strong>The 15-item Opening Minds Scale for Healthcare Providers survey was administered to student pharmacists before and after the workshop experiences to measure stigma toward SMI. Five 2-hour workshops were provided to members of a local nonprofit organization serving people with SMI by student pharmacist volunteers detailing a health and wellness topic. The postworkshop survey included free text responses to obtain student feedback.</p><p><strong>Results: </strong>Twenty-four complete preworkshop surveys were obtained, and most of them had positive attitudes and beliefs at baseline. Thirteen postworkshop surveys were obtained from student pharmacists who participated in a workshop event, and 9 were completed by student pharmacists who did not participate in a workshop event, which were used as a comparator group. Stigma decreased after participating in a workshop event, and those who participated demonstrated a lower degree of stigma versus the comparator group.</p><p><strong>Discussion: </strong>Direct-contact experiences allow student pharmacists to interact with people with SMI earlier in their training and help reduce stigma toward those with psychiatric disorders. Future research is needed to identify large-scale changes in pharmacy student stigma.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"14 1","pages":"73-78"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10836568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139682277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Valproate, risperidone, and paliperidone: A case of valproate-induced hyperammonemic encephalopathy.","authors":"Kyle Wesselman, Vincent Cavaliere, Rakesh Goyal, Eric Anderson","doi":"10.9740/mhc.2024.02.028","DOIUrl":"10.9740/mhc.2024.02.028","url":null,"abstract":"<p><p>Hyperammonemia is a well-known adverse effect of valproate that can progress to a potentially fatal condition known as valproate-induced hyperammonemic encephalopathy (VHE). VHE is more common when valproate is used in combination therapy with other antiepileptic medications. A growing number of case reports have pointed to a possible interaction with the antipsychotic risperidone leading to an increased risk of VHE. We present a case of VHE in which a 20-year-old male patient with bipolar affective disorder developed VHE when on concomitant valproate, risperidone, and paliperidone palmitate. On the seventh day of treatment with oral risperidone, oral divalproex sodium was added. Intramuscular paliperidone palmitate was initiated on day 13, and oral risperidone was discontinued after the second loading dose on day 16. The following day, the patient displayed worsening psychomotor retardation, swaying gait, drowsiness, and vomiting. The patient was found to have hyperammonemia and transferred to the emergency department for treatment of suspected VHE.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"14 1","pages":"28-32"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10836567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139682278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical pharmacist intervention to ensure safe stimulant prescribing practices at a Veterans Affairs facility.","authors":"Bailey B Bass, Lacey J Vann","doi":"10.9740/mhc.2024.02.017","DOIUrl":"10.9740/mhc.2024.02.017","url":null,"abstract":"<p><strong>Introduction: </strong>The Psychotropic Drug Safety Initiative (PDSI) is a national Veterans Affairs program that recommends obtaining cardiovascular vital signs semiannually and urine toxicology screening annually for veterans prescribed stimulants. The PDSI also recommends a risk review of concurrent central nervous system (CNS) depressants to ensure the benefits of coadministration with stimulants outweigh the risks. This project's purpose was to evaluate the occurrence of coprescriptions for CNS depressants and stimulants and encourage compliance with the PDSI recommendations to increase safe and appropriate management of veterans prescribed the combination. This study aimed to evaluate the occurrence of coprescriptions for CNS depressants and stimulants, evaluate compliance with stimulant monitoring recommendations, and measure the proportion of pharmacist recommendations implemented by the prescriber.</p><p><strong>Methods: </strong>This quality improvement project identified veterans with an outpatient prescription for a stimulant and any coprescription(s) for benzodiazepines, sedative-hypnotics, and/or opioids. A pharmacy intervention note was generated to request a risk review, provide recommendations for de-escalation, and notify the stimulant prescriber of overdue monitoring parameters. Impact was measured 60 days after intervention. Descriptive statistics and a McNemar test were used to compare preintervention and postintervention data.</p><p><strong>Results: </strong>From the 61 patients included, there were 67 unique prescriptions for benzodiazepines (49.3%), sedative-hypnotics (34.3%), and opioids (16.4%) in combination with a stimulant. Pharmacist intervention resulted in de-escalation of coprescribing for 9 patients (16.1%) and was associated with statistically significant improvement in compliance to stimulant monitoring recommendations.</p><p><strong>Discussion: </strong>Clinical pharmacists can assist in ensuring safe and appropriate monitoring and management of veterans prescribed stimulants.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"14 1","pages":"17-22"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10836565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139682273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic literature review of the impact of psychiatric pharmacists.","authors":"Jessica L Ho, Jenna Roberts, Gregory H Payne, Dorothy N Holzum, Hannah Wilkoff, Tran Tran, Carla D Cobb, Tera D Moore, Kelly C Lee","doi":"10.9740/mhc.2024.02.033","DOIUrl":"10.9740/mhc.2024.02.033","url":null,"abstract":"<p><strong>Introduction: </strong>Pharmacists focusing on psychotropic medication management and practicing across a wide variety of healthcare settings have significantly improved patient-level outcomes. The Systematic Literature Review Committee of the American Association of Psychiatric Pharmacists was tasked with compiling a comprehensive database of primary literature highlighting the impact of psychiatric pharmacists on patient-level outcomes.</p><p><strong>Methods: </strong>A systematic search of literature published from January 1, 1961, to December 31, 2022, was conducted using PubMed and search terms based on a prior American Association of Psychiatric Pharmacists literature review. Publications describing patient-level outcome results associated with pharmacist provision of care in psychiatric/neurologic settings and/or in relation to psychotropic medications were included. The search excluded articles for which there was no pharmacist intervention, no psychiatric disorder treatment, no clinical outcomes, no original research, no access to full text, and/or no English-language version.</p><p><strong>Results: </strong>A total of 4270 articles were reviewed via PubMed, with 4072 articles excluded based on title, abstract, and/or full text in the initial pass and 208 articles selected for inclusion. A secondary full-text review excluded 11 additional articles, and 5 excluded articles were ultimately included based on a secondary review, for a final total of 202 articles meeting the inclusion criteria. A comprehensive database of these articles was compiled, including details on their study designs and outcomes.</p><p><strong>Discussion: </strong>The articles included in the final database had a wide range of heterogeneity. While the overall impact of psychiatric pharmacists was positive, the study variability highlights the need for future publications to have more consistent, standardized outcomes with stronger study designs.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"14 1","pages":"33-67"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10836561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139682276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethnopsychopharmacology: Clinical and scientific writing pearls.","authors":"Jonathan G Leung","doi":"10.9740/mhc.2023.12.276","DOIUrl":"10.9740/mhc.2023.12.276","url":null,"abstract":"<p><p>The concept of ethnopsychopharmacology aims to predict or explain the pharmacologic response to psychiatric medications based on the influence of biologic and nonbiologic factors. Interactions involving these factors are complex and influence patient outcomes in health care. Pharmacists and other clinicians working in patient care environments, research, or medical education should engage in lifelong learning to enhance ethnopsychopharmacologic knowledge gaps, which ultimately may improve and individualize care across diverse populations. Through two cases, this paper provides pearls on how biogeographical ancestry and cytochrome P450 status may influence pharmacotherapy selection, dosing, or response. A third scenario highlights a publication, like many other published works, with deficiencies in how data on ancestry, race, and ethnicity are collected or reported. Current recommendations on the use of inclusive language in scientific writing are reviewed, with attention to specific examples.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"13 6","pages":"276-288"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10696167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antidepressant prescribing in transgender and nonbinary individuals diagnosed with gender dysphoria and mood or anxiety disorders.","authors":"Casey M Tiefenthaler, Kelly C Lee","doi":"10.9740/mhc.2023.12.298","DOIUrl":"10.9740/mhc.2023.12.298","url":null,"abstract":"<p><strong>Introduction: </strong>Transgender and nonbinary (TGNB) individuals are highly stigmatized members of society and are significantly at higher risk of having mood or anxiety-related disorders compared to non-TGNB individuals.</p><p><strong>Methods: </strong>In this retrospective cohort study, antidepressant prescribing data were collected from TGNB adults diagnosed with gender dysphoria (GD) and mood or anxiety-related disorder between January 2005 and October 2021. The primary outcome was to compare the number of active outpatient antidepressant prescriptions at the time of GD diagnosis between gender identities. The secondary outcomes were to compare antidepressant class utilization between gender identities as well as the prevalence of concurrent mood or anxiety-related disorder diagnoses between gender identities.</p><p><strong>Results: </strong>Of 131 patients who met inclusion criteria, there was no significant difference in number of active antidepressant prescriptions between gender identities at the time of the GD diagnosis (<i>p</i> = .357). However, transgender females were prescribed bupropion at significantly higher rates than other gender identities (<i>p</i> = .046). Approximately 38% of patients did not have an active antidepressant prescription at the time of GD diagnosis despite concurrent mood or anxiety-related diagnoses. The prevalence of generalized anxiety disorder was significantly greater among transgender males (<i>p</i> = .044).</p><p><strong>Discussion: </strong>Although the number of active antidepressant prescriptions between gender identities were similar in this study, we found 38% of patients were not prescribed any antidepressants at time of GD and mood or anxiety-related disorders. This serendipitous finding elucidates a potential gap in mental health care among transgender adults.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"13 6","pages":"298-302"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10696168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of traditional versus nontraditional initiation dosing schedule of paliperidone palmitate on 30-day readmission and safety.","authors":"Erika Kim, Andrew Williams, Justin Chang, Niyati Butala, Matthew Firek","doi":"10.9740/mhc.2023.12.311","DOIUrl":"10.9740/mhc.2023.12.311","url":null,"abstract":"<p><strong>Introduction: </strong>Paliperidone palmitate (PP), a second-generation long-acting injectable antipsychotic, requires 2 injections upon initiation. Due to the fast-paced nature of the inpatient setting, the second dose may be administered earlier than recommended by labeled use despite the lack of evidence that evaluates this practice.</p><p><strong>Methods: </strong>This was a retrospective chart review that investigated the outcomes associated with the timing of the second PP initiation dose with the aim of comparing patients who received the second PP dose fewer than 3 days after the first injection with those who received it between 3 and 11 days after the first injection. The primary outcomes included 30-day psychiatric readmission, index hospitalization length of stay, and time until the next psychiatric hospitalization. Secondary outcomes included 6-month readmission and the percentage of patients who experienced an adverse event after the second injection.</p><p><strong>Results: </strong>No statistically significant differences were observed between groups for 30-day readmission. There was a statistically significant shortened index length of hospitalization (median, 2 vs 4 days; <i>P</i> < 0.001) and a non-statistically significant trend for time until the next psychiatric hospitalization (median, 25 vs 47 days) when comparing those who received the nontraditional loading regimen to those who received the traditional labeled loading regimen. No differences were observed in the secondary outcomes or safety/tolerability.</p><p><strong>Discussion: </strong>The results of the study indicate that there are no significant differences in readmission rates and adverse drug reactions in those who received the second PP dose earlier than recommended per labeled use. Larger, controlled studies are needed to further investigate clinical and safety outcomes.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"13 6","pages":"311-316"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10696170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of OFF condition in Parkinson disease.","authors":"Jessa Koch","doi":"10.9740/mhc.2023.12.289","DOIUrl":"10.9740/mhc.2023.12.289","url":null,"abstract":"<p><p>Parkinson disease (PD) impacts nearly 1 million individuals in the United States. Nearly every patient with PD will require therapy with dopamine in the form of levodopa as the disease progresses. In more advanced stages of the disease, patients will experience motor fluctuations and require adjustment to their medication regimens to maintain good control of their symptoms. During the last 10 years, several new therapeutic treatment options have come to the market to treat motor fluctuations and improve patient quality of life. Some of these agents represent additional options to previously available drug classes, such as the catechol-<i>O</i>-methyl transferase (COMT) inhibitor, opicapone, and monoamine-oxidase B-inhibitor (MAO-B inhibitor), safinamide, as well as new dosage forms for available therapeutics. One new agent, istradefylline, has a novel mechanism in the treatment of PD. The place in therapy for these newer therapeutic options will be explored through a series of patient cases. This article focuses on evidence-based recommendations for the use of these newer options in the management of patients experiencing OFF episodes.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"13 6","pages":"289-297"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10696172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concepts for selection and utilization of psychiatric medications in pregnancy.","authors":"P Brittany Vickery","doi":"10.9740/mhc.2023.12.255","DOIUrl":"10.9740/mhc.2023.12.255","url":null,"abstract":"<p><p>Psychiatric illness may develop or relapse during pregnancy, and understanding best practices is paramount. In 2017, the British Association for Psychopharmacology (BAP) consensus guidance on the use of psychotropic medication preconception, in pregnancy, and postpartum was released. The BAP guidelines provide concise evidence and additional insight and flexibility for use of psychiatric medication. Key takeaways of these guidelines are highlighted serving as a concise reference for practitioners. Additionally, practice points, such as recommendations for rapid tranquilization and the role of long-acting injectable antipsychotic medications as well as additional insights to the growing body of literature associated with psychiatric medications in pregnancy since 2017 are summarized. Providers are strongly encouraged to stay up to date to provide optimal care for pregnant patients and their babies.</p>","PeriodicalId":101313,"journal":{"name":"The mental health clinician","volume":"13 6","pages":"255-267"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10696173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}