Abstract Pain is highly prevalent, costly, and disabling in later life, especially when undertreated. In this article, we aim to describe the risks and benefits of non-opioid medication options for the management of pain in adults aged 65 years and older in order to provide additional options in a practitioner's tool box when designing a pain management regimen for an older adult. Non-opiate pharmacologic therapies, such as acetaminophen, nonsteroidal anti-inflammatory drugs, topicals, and antidepressants have an important role in pain management of older adults. When designing a pain regimen, taking an individualized approach that considers the patient's functional status, comorbidities, and treatment goals will maximize pain management.
{"title":"Non-opiate pharmacotherapy options for the management of pain in older adults","authors":"Nakia Duncan, Rebecca J. Mahan, S. J. Turner","doi":"10.9740/MHC.2015.05.091","DOIUrl":"https://doi.org/10.9740/MHC.2015.05.091","url":null,"abstract":"Abstract Pain is highly prevalent, costly, and disabling in later life, especially when undertreated. In this article, we aim to describe the risks and benefits of non-opioid medication options for the management of pain in adults aged 65 years and older in order to provide additional options in a practitioner's tool box when designing a pain management regimen for an older adult. Non-opiate pharmacologic therapies, such as acetaminophen, nonsteroidal anti-inflammatory drugs, topicals, and antidepressants have an important role in pain management of older adults. When designing a pain regimen, taking an individualized approach that considers the patient's functional status, comorbidities, and treatment goals will maximize pain management.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"1 1","pages":"91-101"},"PeriodicalIF":0.0,"publicationDate":"2015-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89247965","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 Opioid-induced hyperalgesia (OIH) is a relatively new paradigm that has added to the already growing uncertainty surrounding long-term opioid treatment. OIH is the oversensitization to sti...
{"title":"Known unknowns: A review of opioid-induced hyperalgesia","authors":"Dan McGraw","doi":"10.9740/MHC.2015.05.138","DOIUrl":"https://doi.org/10.9740/MHC.2015.05.138","url":null,"abstract":"Abstract Opioid-induced hyperalgesia (OIH) is a relatively new paradigm that has added to the already growing uncertainty surrounding long-term opioid treatment. OIH is the oversensitization to sti...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"49 1","pages":"138-143"},"PeriodicalIF":0.0,"publicationDate":"2015-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72921432","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, Whitney M. Buterbaugh, B. Martin, Christopher J Thomas
Abstract Introduction: Neuropathy is a pathological pain disorder characterized by burning, stabbing, and cramping sensations. There are multiple etiologies for this pain such as diabetes, vascular disorders, and chemotherapy treatment. Neurotransmitters, such as norepinephrine and serotonin, are thought to play a part in the modulation of this pain. The objective of this review is to summarize the current literature to support the efficacy and impact of adverse events of the various classes of antidepressants utilized in the treatment of neuropathic pain. Methods: A Medline/Pubmed search was conducted to identify randomized clinical trials within the last 12 years examining the efficacy and safety of antidepressants for the treatment of neuropathy. Systematic reviews and meta-analyses were also included. Results: Antidepressants are commonly used in the treatment of neuropathy, with meta-analyses supporting the use of tricyclic antidepressants and selective norepinephrine serotonin reuptake inhibitors. T...
{"title":"Review of antidepressants in the treatment of neuropathic pain","authors":"Elizabeth P. Baltenberger, Whitney M. Buterbaugh, B. Martin, Christopher J Thomas","doi":"10.9740/MHC.2015.05.123","DOIUrl":"https://doi.org/10.9740/MHC.2015.05.123","url":null,"abstract":"Abstract Introduction: Neuropathy is a pathological pain disorder characterized by burning, stabbing, and cramping sensations. There are multiple etiologies for this pain such as diabetes, vascular disorders, and chemotherapy treatment. Neurotransmitters, such as norepinephrine and serotonin, are thought to play a part in the modulation of this pain. The objective of this review is to summarize the current literature to support the efficacy and impact of adverse events of the various classes of antidepressants utilized in the treatment of neuropathic pain. Methods: A Medline/Pubmed search was conducted to identify randomized clinical trials within the last 12 years examining the efficacy and safety of antidepressants for the treatment of neuropathy. Systematic reviews and meta-analyses were also included. Results: Antidepressants are commonly used in the treatment of neuropathy, with meta-analyses supporting the use of tricyclic antidepressants and selective norepinephrine serotonin reuptake inhibitors. T...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"7 1","pages":"123-133"},"PeriodicalIF":0.0,"publicationDate":"2015-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77490927","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 Treatment refractory schizophrenia is a serious issue affecting at least 30% of all patients with schizophrenia despite the continued emergence of new agents aimed at treating this disease...
{"title":"A review of the clinical utility of serum clozapine and norclozapine levels","authors":"J. Ellison, R. Dufresne","doi":"10.9740/MHC.2015.03.068","DOIUrl":"https://doi.org/10.9740/MHC.2015.03.068","url":null,"abstract":"Abstract Treatment refractory schizophrenia is a serious issue affecting at least 30% of all patients with schizophrenia despite the continued emergence of new agents aimed at treating this disease...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"3 1","pages":"68-73"},"PeriodicalIF":0.0,"publicationDate":"2015-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78434047","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: Lamotrigine's packaging contains a boxed warning for serious skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis. The purpose of this review is to summarize literature pertaining to HLA genetic polymorphisms that may increase susceptibility to serious skin reactions induced by lamotrigine. Methods: A literature search of PubMed/MEDLINE and Ovid IPA was conducted using the following search terms: lamotrigine, genetic polymorphism, pharmacogenetics, pharmacogenomics, predictive genetic testing, anticonvulsants, hypersensitivity, and HLA-B. Results: Three case-control studies were identified focusing on genetic polymorphisms that can cause direct susceptibility to serious skin reactions, such as HLA-B*1502. Other factors were also taken into consideration, such as age, concomitant medications, ethnicity, and smoking status. Most results were not statistically significant but rather hypothesis generating and were limited by small sample size and study desig...
{"title":"Pharmacogenomics of lamotrigine: a possible link to serious cutaneous adverse reactions","authors":"Rebecca H Campbell, J. Beall","doi":"10.9740/MHC.2015.03.078","DOIUrl":"https://doi.org/10.9740/MHC.2015.03.078","url":null,"abstract":"Abstract Introduction: Lamotrigine's packaging contains a boxed warning for serious skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis. The purpose of this review is to summarize literature pertaining to HLA genetic polymorphisms that may increase susceptibility to serious skin reactions induced by lamotrigine. Methods: A literature search of PubMed/MEDLINE and Ovid IPA was conducted using the following search terms: lamotrigine, genetic polymorphism, pharmacogenetics, pharmacogenomics, predictive genetic testing, anticonvulsants, hypersensitivity, and HLA-B. Results: Three case-control studies were identified focusing on genetic polymorphisms that can cause direct susceptibility to serious skin reactions, such as HLA-B*1502. Other factors were also taken into consideration, such as age, concomitant medications, ethnicity, and smoking status. Most results were not statistically significant but rather hypothesis generating and were limited by small sample size and study desig...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"120 1","pages":"78-81"},"PeriodicalIF":0.0,"publicationDate":"2015-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80141337","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 Neuroleptic malignant syndrome (NMS) is a potential life-threatening adverse effect of antipsychotics. Characteristic signs and symptoms of NMS include hyperthermia, muscle rigidity, alter...
{"title":"Successful clozapine rechallenge following clozapine-induced neuroleptic malignant syndrome","authors":"C. Ross","doi":"10.9740/MHC.2015.03.088","DOIUrl":"https://doi.org/10.9740/MHC.2015.03.088","url":null,"abstract":"Abstract Neuroleptic malignant syndrome (NMS) is a potential life-threatening adverse effect of antipsychotics. Characteristic signs and symptoms of NMS include hyperthermia, muscle rigidity, alter...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"6 1","pages":"88-90"},"PeriodicalIF":0.0,"publicationDate":"2015-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72834646","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 Background: Myocarditis, or inflammation of the heart muscle, is a black box warning associated with the use of clozapine. Although the incidence of clozapine-induced myocarditis is only 0.015% to 1.2%, recent retrospective studies have found that up to 66% of clozapine patients develop nonspecific symptoms consistent with myocarditis. Because of the difficulty in distinguishing these symptoms (including fever, tachycardia, and fatigue) from clozapine dose titration, myocarditis may be difficult to recognize. If left undetected, the condition could be fatal. Patient Case: A 25-year-old Filipino male with a history of schizoaffective disorder, bipolar type, continued to endorse persistent and distressing command auditory and visual hallucinations despite therapy with olanzapine, 40 mg daily. Clozapine was initiated for refractory psychosis and titrated up to 125 mg over 17 days. On day 14, the patient reported “feeling sick,” having chills, a nonproductive cough, and fatigue; he was febrile and ta...
{"title":"Clozapine-induced myocarditis may warrant cardiac monitoring protocol","authors":"L. J. Miller, Rachel Grande","doi":"10.9740/MHC.2015.03.082","DOIUrl":"https://doi.org/10.9740/MHC.2015.03.082","url":null,"abstract":"Abstract Background: Myocarditis, or inflammation of the heart muscle, is a black box warning associated with the use of clozapine. Although the incidence of clozapine-induced myocarditis is only 0.015% to 1.2%, recent retrospective studies have found that up to 66% of clozapine patients develop nonspecific symptoms consistent with myocarditis. Because of the difficulty in distinguishing these symptoms (including fever, tachycardia, and fatigue) from clozapine dose titration, myocarditis may be difficult to recognize. If left undetected, the condition could be fatal. Patient Case: A 25-year-old Filipino male with a history of schizoaffective disorder, bipolar type, continued to endorse persistent and distressing command auditory and visual hallucinations despite therapy with olanzapine, 40 mg daily. Clozapine was initiated for refractory psychosis and titrated up to 125 mg over 17 days. On day 14, the patient reported “feeling sick,” having chills, a nonproductive cough, and fatigue; he was febrile and ta...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"34 1","pages":"82-87"},"PeriodicalIF":0.0,"publicationDate":"2015-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76524067","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}
Robert J. Stanton, Chris Paxos, W. Geldenhuys, B. Pharm., Jessica L. Boss, M. Munetz, A. Darvesh, M. Pharm
Abstract It has been shown that up to one third of patients with schizophrenia do not respond to antipsychotic therapy. Thus, treatment-resistant schizophrenia (TRS) remains a major mental health care challenge. Clozapine has been shown to provide superior therapeutic benefits and is approved as first-line therapy for TRS. These benefits include improvement in both positive and negative symptoms, and reduction of suicidal behavior in patients with schizophrenia. Clozapine, however, remains significantly underused for TRS. A major reason for clozapine's underuse is its substantial adverse effect profile, mainly the risk of life-threatening agranulocytosis which necessitates regular hematologic monitoring. Another factor contributing to reduced clozapine prescribing is the increased use of other second-generation antipsychotics. In TRS patients, there is often a considerable delay in clozapine use, which is prescribed only after other unsuccessful second-generation antipsychotic trials. To combat this trend...
{"title":"Clozapine underutilization in treatment-resistant schizophrenia","authors":"Robert J. Stanton, Chris Paxos, W. Geldenhuys, B. Pharm., Jessica L. Boss, M. Munetz, A. Darvesh, M. Pharm","doi":"10.9740/MHC.2015.03.063","DOIUrl":"https://doi.org/10.9740/MHC.2015.03.063","url":null,"abstract":"Abstract It has been shown that up to one third of patients with schizophrenia do not respond to antipsychotic therapy. Thus, treatment-resistant schizophrenia (TRS) remains a major mental health care challenge. Clozapine has been shown to provide superior therapeutic benefits and is approved as first-line therapy for TRS. These benefits include improvement in both positive and negative symptoms, and reduction of suicidal behavior in patients with schizophrenia. Clozapine, however, remains significantly underused for TRS. A major reason for clozapine's underuse is its substantial adverse effect profile, mainly the risk of life-threatening agranulocytosis which necessitates regular hematologic monitoring. Another factor contributing to reduced clozapine prescribing is the increased use of other second-generation antipsychotics. In TRS patients, there is often a considerable delay in clozapine use, which is prescribed only after other unsuccessful second-generation antipsychotic trials. To combat this trend...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"42 1","pages":"63-67"},"PeriodicalIF":0.0,"publicationDate":"2015-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88835298","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 Since its initial landmark trial against chlorpromazine in 1988, clozapine has been the drug of choice for the treatment of refractory schizophrenia. However, variability in clinical response to clozapine treatment is unequivocal. In an effort to preselect patients who are most likely to benefit from clozapine, a number of patient and disease variables and select genetic differences have been studied for their association with positive treatment response to clozapine. Because of small trial sizes and the heterogeneity of study design, findings have resulted in no generalizable conclusion. Future pharmacogenetic studies hold the promise of antipsychotic treatment personalization.
{"title":"Indicators of response to clozapine treatment","authors":"Dongmi Kim","doi":"10.9740/MHC.2015.03.074","DOIUrl":"https://doi.org/10.9740/MHC.2015.03.074","url":null,"abstract":"Abstract Since its initial landmark trial against chlorpromazine in 1988, clozapine has been the drug of choice for the treatment of refractory schizophrenia. However, variability in clinical response to clozapine treatment is unequivocal. In an effort to preselect patients who are most likely to benefit from clozapine, a number of patient and disease variables and select genetic differences have been studied for their association with positive treatment response to clozapine. Because of small trial sizes and the heterogeneity of study design, findings have resulted in no generalizable conclusion. Future pharmacogenetic studies hold the promise of antipsychotic treatment personalization.","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"21 1","pages":"74-77"},"PeriodicalIF":0.0,"publicationDate":"2015-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88884694","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}
Introduction: Studies examining educational interventions led by pharmacists to minimize negative outcomes associated with elevated and potentially harmful lithium levels in inpatient psychiatric f...
{"title":"Minimizing negative outcomes associated with potentially harmful lithium levels by means of pharmacist-led educational interventions in an inpatient psychiatric facility","authors":"Erika E Tillery","doi":"10.9740/MHC.2015.01.029","DOIUrl":"https://doi.org/10.9740/MHC.2015.01.029","url":null,"abstract":"Introduction: Studies examining educational interventions led by pharmacists to minimize negative outcomes associated with elevated and potentially harmful lithium levels in inpatient psychiatric f...","PeriodicalId":18691,"journal":{"name":"Mental Health Clinician","volume":"19 1","pages":"29-34"},"PeriodicalIF":0.0,"publicationDate":"2015-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81403368","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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