There is a modest collection of literature describing the pharmacokinetic and clinical differences between the extended-release form of divalproex sodium (Depakote ER ® ) and the delayed-release form (Depakote ® ). Published articles are quick to espouse the extended-release formulation, especially in the setting of seizure control. Reasons commonly cited include a longer dosing interval, improved patient compliance, a more consistent pharmacokinetic profile, and fewer side effects. There are fewer articles discussing these differences in the context of treating mental illnesses, namely bipolar affective disorder. This article aims to compare these two formulations of divalproex with a special focus on their pharmacokinetic profiles, uses in psychiatric illness, and the role of therapeutic drug monitoring. The patient case that follows will describe a scenario in which a patient was prescribed each formulation during an acute hospitalization.
{"title":"Therapeutic drug monitoring with valproate-Why product selection is an important factor","authors":"Dan McGraw","doi":"10.9740/MHC.N186966","DOIUrl":"https://doi.org/10.9740/MHC.N186966","url":null,"abstract":"There is a modest collection of literature describing the pharmacokinetic and clinical differences between the extended-release form of divalproex sodium (Depakote ER ® ) and the delayed-release form (Depakote ® ). Published articles are quick to espouse the extended-release formulation, especially in the setting of seizure control. Reasons commonly cited include a longer dosing interval, improved patient compliance, a more consistent pharmacokinetic profile, and fewer side effects. There are fewer articles discussing these differences in the context of treating mental illnesses, namely bipolar affective disorder. This article aims to compare these two formulations of divalproex with a special focus on their pharmacokinetic profiles, uses in psychiatric illness, and the role of therapeutic drug monitoring. The patient case that follows will describe a scenario in which a patient was prescribed each formulation during an acute hospitalization.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"19 1","pages":"31-34"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75026947","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}
When ‘new’ psychotropic medications are released on the market, it can be difficult to discern the differences between the newer agents and their similar predecessors. Since head to head clinical trials are rarely available, it is important to learn what can be gleaned from the package inserts and the Food and Drug Administration (FDA) website. These sources are a wealth of information and were used as the primary resources for the comparative tables that follow.
{"title":"What is the difference? Within class comparisons of psychotropic agents with new products","authors":"A. Vandenberg","doi":"10.9740/MHC.N186968","DOIUrl":"https://doi.org/10.9740/MHC.N186968","url":null,"abstract":"When ‘new’ psychotropic medications are released on the market, it can be difficult to discern the differences between the newer agents and their similar predecessors. Since head to head clinical trials are rarely available, it is important to learn what can be gleaned from the package inserts and the Food and Drug Administration (FDA) website. These sources are a wealth of information and were used as the primary resources for the comparative tables that follow.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"19 1","pages":"2-7"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76905895","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}
Morgan C. Snyder, Lisa Mican, Tawny L Smith, J. Barner
Background: The Beers Criteria and STOPP Criteria were developed to identify potentially inappropriate medications (PIMs) in the geriatric population. Utilization of STOPP Criteria PIMs have shown a significant association with presence of avoidable adverse drug events (ADEs) as compared to utilization of Beers Criteria PIMs. Objectives: The purpose of this study was to utilize STOPP and Beers Criteria to identify PIMs in geriatric patients at an inpatient psychiatric facility, with the goal of implementing a formal process for assessing medication regimens. This process would be expected to decrease adverse outcomes. Methods: Both criteria were used by the pharmacist to identify PIMs and recommendations were made to address the PIMs. A retrospective chart review evaluated whether utilization of the two criteria led to a significant change in number of PIMs and associated adverse outcomes. The primary outcome was the change in number of PIMs for the Beers Criteria versus the STOPP Criteria. Secondary outc...
{"title":"Application of STOPP Criteria and Beers Criteria in an inpatient psychiatric facility and impact on utilization of potentially inappropriate medications and adverse outcomes","authors":"Morgan C. Snyder, Lisa Mican, Tawny L Smith, J. Barner","doi":"10.9740/MHC.N204529","DOIUrl":"https://doi.org/10.9740/MHC.N204529","url":null,"abstract":"Background: The Beers Criteria and STOPP Criteria were developed to identify potentially inappropriate medications (PIMs) in the geriatric population. Utilization of STOPP Criteria PIMs have shown a significant association with presence of avoidable adverse drug events (ADEs) as compared to utilization of Beers Criteria PIMs. Objectives: The purpose of this study was to utilize STOPP and Beers Criteria to identify PIMs in geriatric patients at an inpatient psychiatric facility, with the goal of implementing a formal process for assessing medication regimens. This process would be expected to decrease adverse outcomes. Methods: Both criteria were used by the pharmacist to identify PIMs and recommendations were made to address the PIMs. A retrospective chart review evaluated whether utilization of the two criteria led to a significant change in number of PIMs and associated adverse outcomes. The primary outcome was the change in number of PIMs for the Beers Criteria versus the STOPP Criteria. Secondary outc...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"6 1","pages":"201-206"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79073779","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}
CASE BF is a 42 year-old Caucasian male who reported his onset of depression began four years ago after he was involved in a car accident that fractured his hip. He was not treated for depression until he overdosed on approximately 50 aspirin 325 mg tablets and 750 ml of whiskey (seven months following the accident). After being medically cleared from the emergency room and acute inpatient unit, he was transferred to inpatient psychiatry for evaluation of depression. Upon admission to the inpatient psychiatric unit, his labs were found to be within normal limits (WNL) except a slight elevation in gamma-glutamyl transferace (GGT) at 51 U/L, likely from his acute alcohol ingestion. His thyroid panel was also WNL. He denied any other illness or taking any other medications.
{"title":"Treatment refractory mood disorders: Case report","authors":"S. Leckband","doi":"10.9740/MHC.N207190","DOIUrl":"https://doi.org/10.9740/MHC.N207190","url":null,"abstract":"CASE BF is a 42 year-old Caucasian male who reported his onset of depression began four years ago after he was involved in a car accident that fractured his hip. He was not treated for depression until he overdosed on approximately 50 aspirin 325 mg tablets and 750 ml of whiskey (seven months following the accident). After being medically cleared from the emergency room and acute inpatient unit, he was transferred to inpatient psychiatry for evaluation of depression. Upon admission to the inpatient psychiatric unit, his labs were found to be within normal limits (WNL) except a slight elevation in gamma-glutamyl transferace (GGT) at 51 U/L, likely from his acute alcohol ingestion. His thyroid panel was also WNL. He denied any other illness or taking any other medications.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"75 1","pages":"219-220"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79732851","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}
Objective: To review current practice guidelines in the treatment of asthma and chronic obstructive pulmonary disease (COPD), review therapeutic options for smoking cessation, and apply current evidence to management of these conditions in the psychiatric population. Background: Chronic respiratory illnesses and nicotine dependence are frequently encountered conditions in the psychiatric population. Psychiatric illness itself may contribute to or be affected by these conditions; medication therapy may additionally be linked to alterations in mental status. However, it is well established that when left untreated or improperly managed, chronic respiratory illness and tobacco use can negatively affect patients' quality of life and lead to increased healthcare utilization. Methods: Current practice guidelines, literature reviews, and primary data pertaining to management of patients with asthma, COPD, and nicotine dependence were examined. Additional data regarding patients with psychiatric illness was revie...
{"title":"Clearing the air: Chronic respiratory illnesses and smoking cessation in the adult psychiatric population","authors":"E. Palmer, Emily Frederick","doi":"10.9740/MHC.N199354","DOIUrl":"https://doi.org/10.9740/MHC.N199354","url":null,"abstract":"Objective: To review current practice guidelines in the treatment of asthma and chronic obstructive pulmonary disease (COPD), review therapeutic options for smoking cessation, and apply current evidence to management of these conditions in the psychiatric population. Background: Chronic respiratory illnesses and nicotine dependence are frequently encountered conditions in the psychiatric population. Psychiatric illness itself may contribute to or be affected by these conditions; medication therapy may additionally be linked to alterations in mental status. However, it is well established that when left untreated or improperly managed, chronic respiratory illness and tobacco use can negatively affect patients' quality of life and lead to increased healthcare utilization. Methods: Current practice guidelines, literature reviews, and primary data pertaining to management of patients with asthma, COPD, and nicotine dependence were examined. Additional data regarding patients with psychiatric illness was revie...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"10 1","pages":"153-161"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87644356","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}
Elizabeth P. Baltenberger, G. Schmitt, Christopher J Thomas
Depression is the most common psychological condition in patients with cancer. These patients often have worse outcomes, such as decreased adherence to treatment and increased suicide rates. Since depression is common and often under recognized in this patient population, guidelines recommend screening every patient with cancer for depression. Both psychotherapy and pharmacotherapy are shown to be effective to treat depression in patients with cancer. Psychotherapy, specifically cognitive behavioral therapy, is preferred in patients with more mild depressive symptoms, while pharmacotherapy is used for more severe depression. Dignity therapy and supportive-expressive therapy are also recommended for patients near the end of life. Pharmacotherapeutic options for treatment include antidepressants and psychostimulants. Guidelines recommend SSRIs, SNRIs, or mirtazapine as first line treatment, with TCAs often avoided due to side effects. Psychostimulants, such as modafinil and methylphenidate, can be used as w...
{"title":"Treatment of depressive symptoms in patients with cancer","authors":"Elizabeth P. Baltenberger, G. Schmitt, Christopher J Thomas","doi":"10.9740/MHC.N194575","DOIUrl":"https://doi.org/10.9740/MHC.N194575","url":null,"abstract":"Depression is the most common psychological condition in patients with cancer. These patients often have worse outcomes, such as decreased adherence to treatment and increased suicide rates. Since depression is common and often under recognized in this patient population, guidelines recommend screening every patient with cancer for depression. Both psychotherapy and pharmacotherapy are shown to be effective to treat depression in patients with cancer. Psychotherapy, specifically cognitive behavioral therapy, is preferred in patients with more mild depressive symptoms, while pharmacotherapy is used for more severe depression. Dignity therapy and supportive-expressive therapy are also recommended for patients near the end of life. Pharmacotherapeutic options for treatment include antidepressants and psychostimulants. Guidelines recommend SSRIs, SNRIs, or mirtazapine as first line treatment, with TCAs often avoided due to side effects. Psychostimulants, such as modafinil and methylphenidate, can be used as w...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"11 1","pages":"114-117"},"PeriodicalIF":0.0,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84483268","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}
Rosana Oliveira, Troy A Moore, C. Mascareñas, Carrie E Rogers
Background: Post-Traumatic Stress Disorder (PTSD) is a syndrome that can emerge after exposure to a traumatic event. In the veteran population, the strongest predictor of developing PTSD is frequency and intensity of direct combat exposure. The 2010 Veterans Affairs (VA)/Department of Defense (DoD) guidelines for the treatment of PTSD published in 2010 recommend psychotherapy techniques and/or pharmacotherapy (selective serotonin reuptake inhibitor or venlafaxine) as initial management. Objective: This study aimed to determine whether Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans received treatment for PTSD in concordance with VA/DoD guidelines. Methods: A retrospective chart review was conducted for 400 patients at the South Texas Veterans Health Care System (STVHCS) with OEF/OIF service who had a PTSD-related encounter between September 1, 2011 and August 31, 2012. The primary outcome was the percentage of OEF/OIF veterans with PTSD who received treatment in concordance wit...
{"title":"Post-traumatic stress disorder in veterans of Operation Enduring Freedom/Operation Iraqi Freedom: Retrospective review of treatment received compared to evidence-based practice guidelines","authors":"Rosana Oliveira, Troy A Moore, C. Mascareñas, Carrie E Rogers","doi":"10.9740/MHC.N224783","DOIUrl":"https://doi.org/10.9740/MHC.N224783","url":null,"abstract":"Background: Post-Traumatic Stress Disorder (PTSD) is a syndrome that can emerge after exposure to a traumatic event. In the veteran population, the strongest predictor of developing PTSD is frequency and intensity of direct combat exposure. The 2010 Veterans Affairs (VA)/Department of Defense (DoD) guidelines for the treatment of PTSD published in 2010 recommend psychotherapy techniques and/or pharmacotherapy (selective serotonin reuptake inhibitor or venlafaxine) as initial management. Objective: This study aimed to determine whether Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans received treatment for PTSD in concordance with VA/DoD guidelines. Methods: A retrospective chart review was conducted for 400 patients at the South Texas Veterans Health Care System (STVHCS) with OEF/OIF service who had a PTSD-related encounter between September 1, 2011 and August 31, 2012. The primary outcome was the percentage of OEF/OIF veterans with PTSD who received treatment in concordance wit...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"23 1","pages":"301-308"},"PeriodicalIF":0.0,"publicationDate":"2014-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90518968","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}
Mental health is intrinsically linked to general medical health. People with severe and persistent mental illnesses (SPMIs) have been reported to have higher rates of infectious diseases, type 2 diabetes, respiratory illnesses, and cardiovascular disease. They also have 1.5 to 2 times the prevalence of dyslipidemia, hypertension, and obesity than the general population. Healthcare Homes (HCHs) are an integrated treatment approach allowing for psychiatric and medical conditions to be addressed collaboratively. The HCH model promotes open communication among healthcare providers, wellness education, and preventative care. Physicians and nurses are mandatory providers within the HCH. Pharmacists are not routine members of this new approach to care. This article will describe an example of how psychiatric pharmacy services have been incorporated into a HCH. It also calls for advocacy within the specialty of psychiatric pharmacy in an effort to encourage state and government policy changes that mandate the add...
{"title":"Integration of a clinical pharmacist into the healthcare home (HCH)","authors":"Kelly Gable","doi":"10.9740/MHC.N207649","DOIUrl":"https://doi.org/10.9740/MHC.N207649","url":null,"abstract":"Mental health is intrinsically linked to general medical health. People with severe and persistent mental illnesses (SPMIs) have been reported to have higher rates of infectious diseases, type 2 diabetes, respiratory illnesses, and cardiovascular disease. They also have 1.5 to 2 times the prevalence of dyslipidemia, hypertension, and obesity than the general population. Healthcare Homes (HCHs) are an integrated treatment approach allowing for psychiatric and medical conditions to be addressed collaboratively. The HCH model promotes open communication among healthcare providers, wellness education, and preventative care. Physicians and nurses are mandatory providers within the HCH. Pharmacists are not routine members of this new approach to care. This article will describe an example of how psychiatric pharmacy services have been incorporated into a HCH. It also calls for advocacy within the specialty of psychiatric pharmacy in an effort to encourage state and government policy changes that mandate the add...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"9 1","pages":"292-295"},"PeriodicalIF":0.0,"publicationDate":"2014-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82009053","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}
Treatment of mental illnesses has slowly shifted to primary care settings over the past decade. As more patients are identified as needing treatment for a mental illness, the availability of behavioral health (BH) practitioners has become more strained, leading to this shift towards primary care treatment. With more patients receiving psychiatric health care from their primary care providers (PCP), a need for dedicated BH practitioners within the primary care setting was developed. This article describes a novel program where a clinical psychiatric pharmacist is utilized as the primary psychiatric provider within an integrated BH program of a busy primary care clinic in a major metropolitan area. Working under a collaborative practice agreement to prescribe, the pharmacist acts as the initial BH contact for the clinic, as well as a liaison between primary care and BH. Patients referred to the pharmacist from primary care are then evaluated and appropriate medication prescribed for their illness. Most pati...
{"title":"Utilization of a psychiatric clinical pharmacist in an integrated behavioral health program of a community health center","authors":"R. Silvia","doi":"10.9740/MHC.N207386","DOIUrl":"https://doi.org/10.9740/MHC.N207386","url":null,"abstract":"Treatment of mental illnesses has slowly shifted to primary care settings over the past decade. As more patients are identified as needing treatment for a mental illness, the availability of behavioral health (BH) practitioners has become more strained, leading to this shift towards primary care treatment. With more patients receiving psychiatric health care from their primary care providers (PCP), a need for dedicated BH practitioners within the primary care setting was developed. This article describes a novel program where a clinical psychiatric pharmacist is utilized as the primary psychiatric provider within an integrated BH program of a busy primary care clinic in a major metropolitan area. Working under a collaborative practice agreement to prescribe, the pharmacist acts as the initial BH contact for the clinic, as well as a liaison between primary care and BH. Patients referred to the pharmacist from primary care are then evaluated and appropriate medication prescribed for their illness. Most pati...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"50 1","pages":"287-291"},"PeriodicalIF":0.0,"publicationDate":"2014-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73800330","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}
With the rapid growth of medication information and increased demands on healthcare practitioners, efficiently finding answers to clinical questions is of great importance. Working for a medical information services and publishing company is a unique pharmacy practice setting that aims to help improve global healthcare outcomes by efficiently delivering answers to clinical questions during a healthcare practitioner's normal work-flow. This practice setting is well-suited for pharmacists with strong interests in medical writing, research, evidence-based medicine, and informatics.
{"title":"Enhancing patient outcomes globally by providing answers to clinical questions: Developing pharmacy information services and publishing tools and resources","authors":"Katie A. Carls","doi":"10.9740/MHC.N207251","DOIUrl":"https://doi.org/10.9740/MHC.N207251","url":null,"abstract":"With the rapid growth of medication information and increased demands on healthcare practitioners, efficiently finding answers to clinical questions is of great importance. Working for a medical information services and publishing company is a unique pharmacy practice setting that aims to help improve global healthcare outcomes by efficiently delivering answers to clinical questions during a healthcare practitioner's normal work-flow. This practice setting is well-suited for pharmacists with strong interests in medical writing, research, evidence-based medicine, and informatics.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"21 1","pages":"276-278"},"PeriodicalIF":0.0,"publicationDate":"2014-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81304152","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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