Brooke Gessner, Michelle Carter, Alberto Almeida, Colleen Borralho, Kiana Rahnama, Tamara Mihic, Joan C. Y. Ng, J. Puyat, A. Russolillo, Katelyn Halpape
Clozapine is the most effective antipsychotic in the management of treatment-resistant schizophrenia; however, its use is challenging due to the risk of severe adverse effects. Despite the risks associated with clozapine, there is no mandatory monitoring in Canada beyond hematologic testing for agranulocytosis surveillance. This study focuses on the development, implementation, and evaluation of a clozapine clinical toolkit (CTK) targeted at optimizing inpatient clozapine use. A comprehensive literature review was conducted to identify clozapine best practices, experts were consulted, and a comprehensive clozapine CTK was developed and implemented at a large Canadian tertiary hospital in December 2018. To evaluate the CTK, a retrospective chart review was conducted to assess for change in guideline-concordant monitoring pre- and post- CTK implementation. Patients were included if they were > 18 years of age and received clozapine during inpatient admission. Results were analyzed using descriptive and inferential statistics. Among the charts reviewed, 185 and 113 admissions met the pre- and post-CTK inclusion criteria, respectively. Staff used the CTK in the care of 96% of clozapine patients post implementation, and its use resulted in improvements in guideline-concordant monitoring for agranulocytosis and myocarditis. Implementation of the clozapine CTK increased the concordance of clozapine monitoring with best practice recommendations. Future research is necessary to assess the impact of the CTK on clinical outcomes and patient satisfaction.
{"title":"Clozapine clinical toolkit optimizes inpatient clozapine monitoring","authors":"Brooke Gessner, Michelle Carter, Alberto Almeida, Colleen Borralho, Kiana Rahnama, Tamara Mihic, Joan C. Y. Ng, J. Puyat, A. Russolillo, Katelyn Halpape","doi":"10.9740/mhc.2024.04.085","DOIUrl":"https://doi.org/10.9740/mhc.2024.04.085","url":null,"abstract":"\u0000 \u0000 \u0000 Clozapine is the most effective antipsychotic in the management of treatment-resistant schizophrenia; however, its use is challenging due to the risk of severe adverse effects. Despite the risks associated with clozapine, there is no mandatory monitoring in Canada beyond hematologic testing for agranulocytosis surveillance. This study focuses on the development, implementation, and evaluation of a clozapine clinical toolkit (CTK) targeted at optimizing inpatient clozapine use.\u0000 \u0000 \u0000 \u0000 A comprehensive literature review was conducted to identify clozapine best practices, experts were consulted, and a comprehensive clozapine CTK was developed and implemented at a large Canadian tertiary hospital in December 2018. To evaluate the CTK, a retrospective chart review was conducted to assess for change in guideline-concordant monitoring pre- and post- CTK implementation. Patients were included if they were > 18 years of age and received clozapine during inpatient admission. Results were analyzed using descriptive and inferential statistics.\u0000 \u0000 \u0000 \u0000 Among the charts reviewed, 185 and 113 admissions met the pre- and post-CTK inclusion criteria, respectively. Staff used the CTK in the care of 96% of clozapine patients post implementation, and its use resulted in improvements in guideline-concordant monitoring for agranulocytosis and myocarditis.\u0000 \u0000 \u0000 \u0000 Implementation of the clozapine CTK increased the concordance of clozapine monitoring with best practice recommendations. Future research is necessary to assess the impact of the CTK on clinical outcomes and patient satisfaction.\u0000","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"76 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140794325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In June of 2022, the State of Maryland Board of Pharmacy issued regulations permitting pharmacist administration of maintenance injectable medications. Subsequently, the University of Maryland School of Pharmacy created a laboratory to train student pharmacists based on these regulations on administering long-acting maintenance injections. This training included a review of regulations, reconstitution and administration of medications, and education for patients and caregivers on long-acting injectable medications. This is the first training the authors are aware of incorporating both reconstitution and administration of these medications. The objective of this paper is to describe the laboratory details and future directions of the training course. The first training laboratory trained 94 student pharmacists in the administration technique of long-acting injectable medications. The program has been adapted for practicing pharmacists and other healthcare providers. Thus far, more than 300 practitioners have participated in the learning lab.
{"title":"Training student pharmacists to administer long-acting injectable medications","authors":"M. Ehret, Raymond C. Love, Bethany DiPaula","doi":"10.9740/mhc.2024.04.107","DOIUrl":"https://doi.org/10.9740/mhc.2024.04.107","url":null,"abstract":"\u0000 \u0000 \u0000 In June of 2022, the State of Maryland Board of Pharmacy issued regulations permitting pharmacist administration of maintenance injectable medications. Subsequently, the University of Maryland School of Pharmacy created a laboratory to train student pharmacists based on these regulations on administering long-acting maintenance injections. This training included a review of regulations, reconstitution and administration of medications, and education for patients and caregivers on long-acting injectable medications. This is the first training the authors are aware of incorporating both reconstitution and administration of these medications. The objective of this paper is to describe the laboratory details and future directions of the training course.\u0000 \u0000 \u0000 \u0000 The first training laboratory trained 94 student pharmacists in the administration technique of long-acting injectable medications. The program has been adapted for practicing pharmacists and other healthcare providers. Thus far, more than 300 practitioners have participated in the learning lab.\u0000","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"168 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140777941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pharmacologic treatment of bipolar disorder and comorbid adult attention-deficit/hyperactivity disorder","authors":"Anuja Vallabh","doi":"10.9740/mhc.2024.04.082","DOIUrl":"https://doi.org/10.9740/mhc.2024.04.082","url":null,"abstract":"","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"431 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140776170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-28eCollection Date: 2023-06-01DOI: 10.9740/mhc.2023.06.152
Erica A K Davis
Background: Several different formulations of valproic acid derivatives are available in the United States. Although these formulations have different absorption characteristics, they are believed to be interchangeable, with the exception of the extended-release product.
Case report: A 31-year-old African American man with schizoaffective disorder was started on fluphenazine concentrate and valproate oral solution on admission to an inpatient unit. A 12-hour steady-state concentration, drawn on 1000 mg/day, resulted in 40.8 mg/L, and the dose continued to be titrated. Despite increasing doses, confirmed medication adherence, and accurate lab sampling, his concentrations remained low: 60.3 and 60.1 mg/L on 1500 mg/day, and 65.6 mg/L on 1750 mg/day. He was switched to divalproex delayed-release tablets, and his dose was increased to 2000 mg/day. Follow-up 12-hour steady-state concentrations were significantly higher, at 126.6 and 113.8 mg/L. It is theorized that the formulation of divalproex/valproic acid is what contributed to these differences in concentrations.
Discussion: Valproic acid formulations are considered to be interchangeable, and several studies have demonstrated that chronic psychiatric inpatients stabilized on delayed-release divalproex may be safely switched to valproate oral solution without changes in psychiatric stability. This case demonstrates a significant difference in serum drug concentrations when switching from valproate oral solution to divalproex delayed-release tablets.
{"title":"Differences in serum concentration with valproate oral solution versus delayed-release divalproex in an adherent patient.","authors":"Erica A K Davis","doi":"10.9740/mhc.2023.06.152","DOIUrl":"10.9740/mhc.2023.06.152","url":null,"abstract":"<p><strong>Background: </strong>Several different formulations of valproic acid derivatives are available in the United States. Although these formulations have different absorption characteristics, they are believed to be interchangeable, with the exception of the extended-release product.</p><p><strong>Case report: </strong>A 31-year-old African American man with schizoaffective disorder was started on fluphenazine concentrate and valproate oral solution on admission to an inpatient unit. A 12-hour steady-state concentration, drawn on 1000 mg/day, resulted in 40.8 mg/L, and the dose continued to be titrated. Despite increasing doses, confirmed medication adherence, and accurate lab sampling, his concentrations remained low: 60.3 and 60.1 mg/L on 1500 mg/day, and 65.6 mg/L on 1750 mg/day. He was switched to divalproex delayed-release tablets, and his dose was increased to 2000 mg/day. Follow-up 12-hour steady-state concentrations were significantly higher, at 126.6 and 113.8 mg/L. It is theorized that the formulation of divalproex/valproic acid is what contributed to these differences in concentrations.</p><p><strong>Discussion: </strong>Valproic acid formulations are considered to be interchangeable, and several studies have demonstrated that chronic psychiatric inpatients stabilized on delayed-release divalproex may be safely switched to valproate oral solution without changes in psychiatric stability. This case demonstrates a significant difference in serum drug concentrations when switching from valproate oral solution to divalproex delayed-release tablets.</p>","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"5 1","pages":"152-154"},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10945732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87928255","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}
Abstract Introduction: Duloxetine, a serotonin-norepinephrine reuptake inhibitor, has been used successfully for adults for the management of neuropathic pain syndromes. Pediatric data are needed because inadequate neuropathic pain management in children and adolescents results in lower psychosocial functioning, delayed development, and decreased quality of life. We aim to describe a case series on the use of duloxetine for the management of symptoms associated with chronic neuropathic pain syndromes in a pediatric population. Methods: Data were collected in a naturalistic, consecutive, case report format, from a pediatric pain management clinic for children prescribed duloxetine for analgesia for a variety of neuropathic-type pain conditions. Follow-up data, including self-report of pain, and type and frequency of adverse reactions, were collected to describe the efficacy and safety of duloxetine. Results: Duloxetine was prescribed for the management of self-reported average pain scores of greater than 5...
{"title":"Off-label use of duloxetine for pediatric neuropathic pain","authors":"K. Burghardt, S. Thomas, V. Tutag-Lehr","doi":"10.9740/MHC.2015.11.277","DOIUrl":"https://doi.org/10.9740/MHC.2015.11.277","url":null,"abstract":"Abstract Introduction: Duloxetine, a serotonin-norepinephrine reuptake inhibitor, has been used successfully for adults for the management of neuropathic pain syndromes. Pediatric data are needed because inadequate neuropathic pain management in children and adolescents results in lower psychosocial functioning, delayed development, and decreased quality of life. We aim to describe a case series on the use of duloxetine for the management of symptoms associated with chronic neuropathic pain syndromes in a pediatric population. Methods: Data were collected in a naturalistic, consecutive, case report format, from a pediatric pain management clinic for children prescribed duloxetine for analgesia for a variety of neuropathic-type pain conditions. Follow-up data, including self-report of pain, and type and frequency of adverse reactions, were collected to describe the efficacy and safety of duloxetine. Results: Duloxetine was prescribed for the management of self-reported average pain scores of greater than 5...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"40 1","pages":"277-283"},"PeriodicalIF":0.0,"publicationDate":"2015-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82820944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction: This article will review the pharmacologic and clinical evidence supporting the use of selective norepinephrine reuptake inhibitors, most notably atomoxetine, for the treatment of neuropathic pain states. Many medications initially marketed for psychiatric indications have gained widespread use for their analgesic properties after additional research. Methods: In search of alternative treatments for neuropathic pain, current guidelines, published reviews, and primary literature, including both rodent and human trials, were reviewed. Results and Discussion: The first group of medications to gain widespread use in pain management was the tricyclic antidepressants. As further research was completed and serotonin norepinephrine reuptake inhibitors began to be utilized for their analgesic properties, a growing body of evidence began to indicate that the analgesic properties of these medications were primarily due to the blockade of norepinephrine reuptake with serotonin playing only a mi...
{"title":"Pharmacologic basis for the use of selective norepinephrine reuptake inhibitors for the treatment of neuropathic pain conditions","authors":"M. Webster","doi":"10.9740/MHC.2015.11.284","DOIUrl":"https://doi.org/10.9740/MHC.2015.11.284","url":null,"abstract":"Abstract Introduction: This article will review the pharmacologic and clinical evidence supporting the use of selective norepinephrine reuptake inhibitors, most notably atomoxetine, for the treatment of neuropathic pain states. Many medications initially marketed for psychiatric indications have gained widespread use for their analgesic properties after additional research. Methods: In search of alternative treatments for neuropathic pain, current guidelines, published reviews, and primary literature, including both rodent and human trials, were reviewed. Results and Discussion: The first group of medications to gain widespread use in pain management was the tricyclic antidepressants. As further research was completed and serotonin norepinephrine reuptake inhibitors began to be utilized for their analgesic properties, a growing body of evidence began to indicate that the analgesic properties of these medications were primarily due to the blockade of norepinephrine reuptake with serotonin playing only a mi...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"12 1","pages":"284-288"},"PeriodicalIF":0.0,"publicationDate":"2015-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87600821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction: Some of the most bothersome symptoms associated with menopause are the vasomotor symptoms (VMS), characterized by transient elevations in body temperature associated with a narrowing of the thermoneutral zone and an abnormal firing rate of thermosensitive neurons in the hypothalamus. These VMS have traditionally been treated with hormone replacement therapy (HRT); however, after a trial suggesting an association between HRT and a number of serious adverse events, alternative therapies for VMS are being studied. The purpose of this review is to evaluate the available literature regarding the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) for the alleviation of VMS associated with menopause. Methods: PubMed and Ovid/MEDLINE keyword searches were conducted. Literature was reviewed for inclusion if it included any SSRI or SNRI for menopausal symptoms published prior to August 31, 2014. Results: Seven studies were included ...
{"title":"Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors for menopausal vasomotor symptoms","authors":"K. Holt, A. Thompson","doi":"10.9740/MHC.2015.11.260","DOIUrl":"https://doi.org/10.9740/MHC.2015.11.260","url":null,"abstract":"Abstract Introduction: Some of the most bothersome symptoms associated with menopause are the vasomotor symptoms (VMS), characterized by transient elevations in body temperature associated with a narrowing of the thermoneutral zone and an abnormal firing rate of thermosensitive neurons in the hypothalamus. These VMS have traditionally been treated with hormone replacement therapy (HRT); however, after a trial suggesting an association between HRT and a number of serious adverse events, alternative therapies for VMS are being studied. The purpose of this review is to evaluate the available literature regarding the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) for the alleviation of VMS associated with menopause. Methods: PubMed and Ovid/MEDLINE keyword searches were conducted. Literature was reviewed for inclusion if it included any SSRI or SNRI for menopausal symptoms published prior to August 31, 2014. Results: Seven studies were included ...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"135 1","pages":"260-264"},"PeriodicalIF":0.0,"publicationDate":"2015-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87912506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction: The use of thyroid hormones to enhance the effects of antidepressants is based on evidence supporting a link between thyroid function and Major Depressive Disorder. Thyroid abnormalities have been found in patients with Major Depressive Disorder and have been correlated with depression severity. Symptoms associated with clinical hypothyroidism include mood disturbances, primarily depression. In addition, an increase in antidepressant treatment resistance has been associated with thyroid abnormalities. This article reviews the existing data regarding triiodothyronine (T3) supplementation of antidepressants in the treatment of major depressive disorder. Methods: Medline and EMBASE were searched from 1996 to November 2014 using the key terms triiodothyronine, T3, and treatment-resistant depression. Results: T3 may increase serotonergic neurotransmission and has been studied as an add-on agent in patients with unipolar depression with and without thyroid dysfunction to accelerate, enhan...
{"title":"Triiodothyronine (T3) supplementation in major depressive disorder","authors":"Anna K. Morin","doi":"10.9740/MHC.2015.11.253","DOIUrl":"https://doi.org/10.9740/MHC.2015.11.253","url":null,"abstract":"Abstract Introduction: The use of thyroid hormones to enhance the effects of antidepressants is based on evidence supporting a link between thyroid function and Major Depressive Disorder. Thyroid abnormalities have been found in patients with Major Depressive Disorder and have been correlated with depression severity. Symptoms associated with clinical hypothyroidism include mood disturbances, primarily depression. In addition, an increase in antidepressant treatment resistance has been associated with thyroid abnormalities. This article reviews the existing data regarding triiodothyronine (T3) supplementation of antidepressants in the treatment of major depressive disorder. Methods: Medline and EMBASE were searched from 1996 to November 2014 using the key terms triiodothyronine, T3, and treatment-resistant depression. Results: T3 may increase serotonergic neurotransmission and has been studied as an add-on agent in patients with unipolar depression with and without thyroid dysfunction to accelerate, enhan...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"42 1","pages":"253-259"},"PeriodicalIF":0.0,"publicationDate":"2015-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91198055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction: Peripheral neuropathy is a painful condition that can lead to a reduction in quality of life. The pain, which stems from damaged, hyperexcitable neurons, does not respond to traditional analgesics. However, due to the underlying mechanism of pain, some antidepressants are effective in managing peripheral neuropathy. The purpose of this review is to evaluate the available literature on serotonin-norepinephrine reuptake inhibitors for the management of peripheral neuropathy and outline clinical considerations for choosing an agent. Methods: PubMed, Ovid/MEDLINE, and Scopus queries were conducted for relevant literature. Search types were limited to keyword searches and articles were limited to those published prior to March 31, 2015. Results: There were 19 randomized controlled trials included in this review. No articles were found investigating the use of desvenlafaxine, milnacipran, or levomilnacipran for treatment of neuropathy. Both duloxetine and venlafaxine improved pain severit...
{"title":"Evidence and clinical considerations for the use of serotonin and norepinephrine reuptake inhibitors for the treatment of painful neuropathy","authors":"M. Sigler, A. Vandenberg, A. Thompson","doi":"10.9740/MHC.2015.11.289","DOIUrl":"https://doi.org/10.9740/MHC.2015.11.289","url":null,"abstract":"Abstract Introduction: Peripheral neuropathy is a painful condition that can lead to a reduction in quality of life. The pain, which stems from damaged, hyperexcitable neurons, does not respond to traditional analgesics. However, due to the underlying mechanism of pain, some antidepressants are effective in managing peripheral neuropathy. The purpose of this review is to evaluate the available literature on serotonin-norepinephrine reuptake inhibitors for the management of peripheral neuropathy and outline clinical considerations for choosing an agent. Methods: PubMed, Ovid/MEDLINE, and Scopus queries were conducted for relevant literature. Search types were limited to keyword searches and articles were limited to those published prior to March 31, 2015. Results: There were 19 randomized controlled trials included in this review. No articles were found investigating the use of desvenlafaxine, milnacipran, or levomilnacipran for treatment of neuropathy. Both duloxetine and venlafaxine improved pain severit...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"18 1","pages":"289-295"},"PeriodicalIF":0.0,"publicationDate":"2015-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73012754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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