The Mental Health Clinician最新文献

{"title":"Treatment of concurrent etizolam and tianeptine withdrawal following accidental overdose.","authors":"Marija Markovic,&nbsp;Dania Niwash","doi":"10.9740/mhc.2022.12.356","DOIUrl":"https://doi.org/10.9740/mhc.2022.12.356","url":null,"abstract":"<p><strong>Background: </strong>The availability of nonapproved psychoactive substances with addiction potential from internet sources poses a significant threat to public health. Polysubstance abuse or inadvertent contamination of preparations may result in clinically challenging intoxication and withdrawal syndromes.</p><p><strong>Case report: </strong>We report a case of a 32-year-old male with an approximate 2-year history of taking internet-obtained etizolam and tianeptine who presented to the hospital following an overdose. He experienced subsequent withdrawal symptoms consistent with benzodiazepine and opioid withdrawal. Initial attempts at managing symptoms with chlordiazepoxide 25 mg every 6 hours did not relieve his symptoms. On day 3 of admission, addiction medicine was consulted and his regimen was changed to diazepam 80 mg daily with additional as-needed diazepam based on etizolam equivalence. He also received a 5-day methadone taper with plans to transition to buprenorphine in the outpatient setting. Upon discharge he was referred to an addiction medicine specialist who was willing to continue a slow diazepam taper and initiate medications for opioid use disorder to manage both substance use disorders.</p><p><strong>Discussion: </strong>This case report demonstrates the effectiveness of diazepam in managing benzodiazepine withdrawal from etizolam while concurrently using methadone to manage opioid withdrawal symptoms from tianeptine in a hospitalized patient following overdose. We highlight the importance of a warm handoff in considering the outpatient discharge plan.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":"12 6","pages":"356-359"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/43/92/i2168-9709-12-6-356.PMC9819137.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10590113","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":"Severe olanzapine-induced liver function test elevation.","authors":"Ericka Crouse,&nbsp;Rose Woessner","doi":"10.9740/mhc.2022.12.360","DOIUrl":"https://doi.org/10.9740/mhc.2022.12.360","url":null,"abstract":"We read with great interest the case report on identifying olanzapine-induced liver injury in the setting of acute hepatitis C. We wanted to bring to the attention of the Mental Health Clinician readers our similar case report entitled ‘‘Olanzapine-induced elevated liver function tests in an older person with antidepressant-induced mania’’, who similarly experienced significant liver function test (LFT) elevation thought to be related to olanzapine that was published in The Senior Care Pharmacist in September 2022.","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":"12 6","pages":"360"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3f/e5/i2168-9709-12-6-360.PMC9819136.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10536111","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":"Patient-reported perceptions of brexanolone in the treatment of postpartum depression: A qualitative analysis.","authors":"Aaron Salwan,&nbsp;Megan Maroney,&nbsp;Lisa Tremayne","doi":"10.9740/mhc.2022.12.342","DOIUrl":"https://doi.org/10.9740/mhc.2022.12.342","url":null,"abstract":"<p><strong>Introduction: </strong>Brexanolone demonstrates short-term efficacy for the treatment of postpartum depression (PPD). Postpartum depression is linked to infanticide and maternal suicide, and current treatment often fails to adequately control depressive symptoms. The purpose of this analysis is to further understand the experience(s) of women who have received brexanolone for the treatment of PPD.</p><p><strong>Methods: </strong>Semistructured interviews modeled after the theory of planned behavior (TPB) were conducted to assess women's perceptions of treatment for PPD with brexanolone. Women who received treatment with brexanolone at this inpatient facility were eligible to participate in this study. The TPB is often used to predict intention to perform health-related behaviors. Semistructured interviews were recorded and transcribed, and thematic analysis was conducted to identify common ideas across all interviews. Follow-up assessment of depressive and anxious symptoms was also conducted using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively.</p><p><strong>Results: </strong>Five of the 10 women who received treatment with brexanolone at this facility were interviewed, and common themes related to the TPB were analyzed. Attitudes toward brexanolone were favorable, and having a strong support system was a motivating factor in receiving treatment for PPD. Insurance approval, need for childcare, and poor understanding of symptoms of PPD were barriers to receiving treatment with brexanolone. Symptoms of depression and anxiety were rated as low at the time of the follow-up interview as measured by the PHQ-9 (mean 1.6, range 1 to 3) and GAD-7 (mean 2.8, range 2 to 4), respectively.</p><p><strong>Discussion: </strong>Brexanolone rapidly and sustainably reduced symptoms of PPD and was well-received by patients. Despite significant barriers to use, women who received treatment with brexanolone advocated for its availability as well as increased awareness of PPD.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":"12 6","pages":"342-349"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/14/35/i2168-9709-12-6-342.PMC9819138.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10536110","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":"Publication rates and characteristics of PGY2 psychiatric pharmacy resident research projects.","authors":"Dayton L Antley,&nbsp;Leigh Anne Nelson,&nbsp;Carrie R Kriz,&nbsp;Courtney A Iuppa,&nbsp;Shelby E Lang,&nbsp;Nicole A Gramlich,&nbsp;Ellie S R Elliott,&nbsp;Roger W Sommi","doi":"10.9740/mhc.2022.12.350","DOIUrl":"https://doi.org/10.9740/mhc.2022.12.350","url":null,"abstract":"<p><strong>Introduction: </strong>To describe the publication rates and characteristics of PGY2 psychiatric pharmacy residency projects presented as a poster presentation at the annual meetings of the College of Psychiatric and Neurologic Pharmacists (CPNP) from 2002 to 2018. (As of 2022 the organization is under the name, American Association of Psychiatric Pharmacists.).</p><p><strong>Methods: </strong>CPNP abstracts from even years were strategically searched in PubMed, Ovid MEDLINE, and Google Scholar. If a publication was identified, additional data were collected for characterization, including study information, journal information, author information, institutional affiliation, publication year, and time to publication.</p><p><strong>Results: </strong>A total of 348 abstracts were evaluated. Publication in a journal was achieved for 60 projects (17.2%), with publication rates decreasing from 2012 to 2018. The mean time to publication was 17.3 months after completion of the residency, with most projects published at 8 months. More than half (51.7%) of these projects were published in a psychiatric pharmacy journal affiliated with CPNP. Study designs were predominantly retrospective, observational, cohort studies with a focus on evaluation of a drug therapy outcome. The PGY2 resident was the first author in 90% of the publications. Forty percent included other health care professionals outside of pharmacy as a coauthor. PGY2 residencies affiliated with academic institutions had overall higher publications rates.</p><p><strong>Discussion: </strong>Publication rates for PGY2 psychiatric pharmacy residency projects are low and are decreasing over time despite an increasing number of PGY2 psychiatric pharmacy residency programs. This publication rate is lower than that reported in the literature for PGY2 critical care residency programs. The downward trend of publication rates for PGY2 psychiatric pharmacy residency projects is concerning.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":"12 6","pages":"350-355"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cb/65/i2168-9709-12-6-350.PMC9819139.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10536115","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":"Comparison of clozapine doses and tolerability in patients with and without concurrent valproic acid.","authors":"Ranel Troy Santos,&nbsp;Sandra Mullen,&nbsp;Ericka L Crouse,&nbsp;Katie S Adams","doi":"10.9740/mhc.2022.12.336","DOIUrl":"https://doi.org/10.9740/mhc.2022.12.336","url":null,"abstract":"<p><strong>Introduction: </strong>Valproic acid (VPA) and its various formulations can be given in conjunction with clozapine for seizure prophylaxis or for augmentation in schizophrenia. There is conflicting literature on how VPA affects clozapine metabolism and the incidence of clozapine-related side effects. The purpose of this study is to compare the effects of VPA when given concurrently with clozapine to patients on clozapine monotherapy.</p><p><strong>Methods: </strong>A retrospective medical record review was completed to identify patients admitted to the inpatient psychiatry unit at an academic medical center with an order for clozapine with and without concurrent VPA from August 7, 2010 to August 7, 2020. The primary outcome was the difference in clozapine doses in patients on clozapine as monotherapy versus dual therapy with VPA. Secondary outcomes include the difference in incidence of adverse effects in monotherapy versus dual therapy, as well as clozapine and norclozapine concentrations in both treatment groups.</p><p><strong>Results: </strong>During the study period, 73 patients were included in the monotherapy group and 35 patients were included in the dual therapy group. The average clozapine dose in the dual therapy group was 250 mg (95% CI = 194.7, 305.4) which was significantly higher than the average monotherapy dose of 175.9 mg (95% CI = 134.0, 208.7; <i>P</i> = .016). However, there was no significant difference in the average clozapine concentration between the dual therapy group (392.5 ng/mL; 95% CI = 252.8, 532.2) and monotherapy group (365.9 ng/mL; 95% CI = 260.5, 471.3; <i>P</i> = .756). There were higher rates of tachycardia (45.7% vs 17.8%; <i>P</i> = .002), sedation (51.4% vs 8.2%; <i>P</i> < .001), and constipation (42.8% vs 9.5%; <i>P</i> < .001) in the dual therapy group compared to the monotherapy group, respectively.</p><p><strong>Discussion: </strong>Patients on concurrent clozapine and VPA received higher doses of clozapine and experienced a higher incidence of tachycardia, sedation, and constipation.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":"12 6","pages":"336-341"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cd/c8/i2168-9709-12-6-336.PMC9819135.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10590112","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 clinical utility of newer antidepressant agents: Understanding the role in management of MDD.","authors":"Kristin Waters","doi":"10.9740/mhc.2022.10.309","DOIUrl":"10.9740/mhc.2022.10.309","url":null,"abstract":"<p><p>Whereas MDD is characterized in part by changes in mood, other symptoms can also cause significant impairment, including sexual dysfunction, cognitive impairment, and fatigue. Newer antidepressants are explored with the goal of more optimally treating these non-mood-related symptoms of MDD. The 3 oral antidepressants that have been FDA-approved most recently include vortioxetine, vilazodone, and levomilnacipran. Unique features of these antidepressants are explored through 3 patient cases.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":"12 5","pages":"309-319"},"PeriodicalIF":0.0,"publicationDate":"2022-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8d/ec/i2168-9709-12-5-309.PMC9645287.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9912512","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":"A Veterans Affairs' perspective in response to Best Practice Model Subcommittee attribute statements for outpatient psychiatric pharmacists.","authors":"Jonathan F Lister,&nbsp;Dana Chiulli,&nbsp;Sarah E Ward,&nbsp;Erica Frazier","doi":"10.9740/mhc.2022.10.327","DOIUrl":"https://doi.org/10.9740/mhc.2022.10.327","url":null,"abstract":"Dear Editor: We applaud the work published by Lee et al and the best practice model subcommittee in their attribute statements for defining the optimal recommendations for outpatient psychiatric pharmacy practice. This serves as an excellent foundation in standardizing the expectations for clinical pharmacist practitioners (CPP) within outpatient mental health (MH) settings and our group believes these defined statements are being applied at the Department of Veterans Affairs (VA). Measurement-based care, suicide assessment, and comprehensive medication management (CMM) are all standards of care for VA outpatient MH CPP. The goal of our letter is to highlight the VA MH CPP model and the advancements in access, quality impact, and standardization.","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":" ","pages":"327-328"},"PeriodicalIF":0.0,"publicationDate":"2022-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/64/31/i2168-9709-12-5-327.PMC9645291.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40715533","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":"An update on recently approved long-acting injectable second-generation antipsychotics: Knowns and unknowns regarding their use.","authors":"Amy M VandenBerg","doi":"10.9740/mhc.2022.10.270","DOIUrl":"https://doi.org/10.9740/mhc.2022.10.270","url":null,"abstract":"<p><p>There are now 9 available FDA-approved second-generation long-acting injectable antipsychotics including aripiprazole (3), olanzapine (1), paliperidone (3), and risperidone (2). These high-cost medications are commonly used with the goal of improving adherence and patient outcomes. With almost 2 decades of use, key aspects have been well studied, including population pharmacokinetics, CYP interactions and various clinical and economic outcomes. However, there are still unknowns with these medications. Issues including adherence, transition from oral antipsychotics, renal dosing, pharmacogenomics, and managing missed doses will be addressed in the context of 4 patient cases.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":" ","pages":"270-281"},"PeriodicalIF":0.0,"publicationDate":"2022-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/16/5b/i2168-9709-12-5-270.PMC9645288.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40715530","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 cognitive and negative symptoms in schizophrenia.","authors":"Megan Maroney","doi":"10.9740/mhc.2022.10.282","DOIUrl":"https://doi.org/10.9740/mhc.2022.10.282","url":null,"abstract":"<p><p>Currently available antipsychotics provide only modest benefit in managing the cognitive and negative symptoms of schizophrenia even though these symptoms are often the most impairing in patients' daily lives. Certain antipsychotics may have slight benefits over others, and several nonpharmacologic and pharmacologic adjunctive treatments have been evaluated in recent clinical trials. Recently published meta-analyses and clinical studies of such treatments are reviewed. Potential strategies to manage cognitive and negative symptoms, including deprescribing of medications that may exacerbate these symptoms, are described using theoretical case examples.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":" ","pages":"282-299"},"PeriodicalIF":0.0,"publicationDate":"2022-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/77/5d/i2168-9709-12-5-282.PMC9645289.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40715534","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":"Stewardship applied to antipsychotics: Development of an antipsychotic stewardship program in inpatient settings for monitoring and optimizing outcomes.","authors":"Gillian Gonzales,&nbsp;Kari Tornes,&nbsp;Stephen R Saklad","doi":"10.9740/mhc.2022.10.320","DOIUrl":"https://doi.org/10.9740/mhc.2022.10.320","url":null,"abstract":"<p><p>Antipsychotic (AP) medications are prescribed for various psychiatric diagnoses that require routine monitoring to ensure optimal use, effectiveness, adherence, and for potentially severe adverse effects. There is currently no comprehensive protocol for institutional supervision of prescribing and monitoring AP. Antibiotics (ABX) are commonly associated with stewardship programs aimed at optimizing use and mitigating harm. These programs have proven to result in positive outcomes in both safety and efficacy parameters for numerous institutions. Given that AP are also associated with significant adverse effects and often misused, the concept of stewardship can be applied to this class of agents to optimize their use and improve overall patient outcomes. The objective of this paper is to provide guidance for the implementation of antipsychotic stewardship programs (APSP) in the inpatient setting. The development of this APSP was designed based on ABX stewardship programs and the Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, and the American Psychiatric Association practice guidelines on the treatment of patients with schizophrenia. In conclusion, APSPs have the potential to enhance and standardize institutional supervision of prescribing and monitoring practices of AP, leading to improved clinical outcomes and the reduction of adverse effects. APSP teams should be multidisciplinary, consisting of clinicians and administrators, working in conjunction with patients and patient advocates to design individualized recovery plans that consider the individual patient's history and desired outcomes. Monitoring, stewardship interventions, and outcomes should be documented on both an individual and deidentified institutional basis, analyzed, and summarized periodically as measures for quality improvement.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":" ","pages":"320-326"},"PeriodicalIF":0.0,"publicationDate":"2022-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/34/54/i2168-9709-12-5-320.PMC9645292.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40715531","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}