Objective. To analyze the cost avoidance resulting from clinical interventions made by pharmacy students completing an advanced pharmacy practice experience (APPE) at a psychiatric hospital. Methods. A retrospective database review of documented clinical interventions by pharmacy students was conducted to classify interventions by type and significance. Interventions were assigned a cost avoidance value determined by an evaluation of the literature. Results. Three hundred-twenty interventions were documented by 15 pharmacy students during the 1-year study period. The majority of interventions were related to psychiatric medication classes and most (n 5 197; 61.6%) were classified as being of moderate significance. The most common interventions included patient education (13.1%), order clarification (11.6%), therapeutic dosing adjustments (10.9%), and laboratory order monitoring (8.8%). The estimated cost avoidance from all interventions made by pharmacy students was approximately $23,000. Conclusions. Pharmacy students completing APPEs at a psychiatric hospital contributed to a variety of significant clinical interventions and provided considerable cost avoidance value to the institution.
There is limited literature addressing the safety of administering electroconvulsive therapy (ECT) to patients concomitantly receiving bupropion monotherapy or in combination with other drugs that may alter the seizure threshold. We describe a prolonged seizure occurring during the first treatment of a course of ECT in an adult patient receiving long-term bupropion therapy, lithium, and venlafaxine.
Objective:
The emphasis on reducing the duration of untreated psychosis (DUP) has highlighted complex barriers to accessing appropriate services. Internet and social media use by individuals with first-episode psychosis (FEP) was examined to explore how these platforms might be used to facilitate treatment initiation.
Methods:
Participants ages 15–35 were interviewed with the Pathways to Care for Psychosis Questionnaire, an 81-item instrument designed to explore online activity during symptom emergence.
Results:
Of 112 participants, 90% used the Internet and social media daily. The Internet was listed as the most used resource (62%) for information while symptoms were emerging. A minority (19%) shared concerns via social media, and 76% responded favorably to the possibility of receiving online mental health support.
Conclusions:
The Internet and social media were part of daily life for participants with FEP. Activity continued throughout the DUP, offering the prospect of earlier intervention. Participants expressed positive attitudes toward Internet-based outreach and engagement efforts.
A detailed qualitative analysis revealed that PGY2 psychiatric pharmacy residents' interventions were largely accepted, focused on medication adjustments for psychiatric conditions, and were of moderate significance at two state psychiatric facilities. Antipsychotics were associated with the greatest cost avoidance and total number of interventions.
ADRs were most commonly associated with mood stabilizers and antipsychotics, and pADRs were common. There is an opportunity to provide education to medical staff on therapeutic drug monitoring and drug-drug interactions for these classes, particularly lithium.
There is a paucity of data evaluating the use of melatonin in TD. Both of the controlled studies evaluating its use are limited by methodologic issues. Although the most recent trial did report a statistically significant improvement in TD with melatonin, these results are not considered to be clinically significant. There are inadequate data at the present time to support the use of melatonin in patients with TD.
*Objective: To compare antihyperglycemic medication adherence and glycemic control between individuals with schizophrenia and related psychotic disorders and a nonpsychiatric comparison group. Methods: This was a retrospective medical record review. A total of 124 subjects with diabetes (62 patients with schizophrenia or a related psychotic disorder and 62 randomly selected, age-matched patients without a psychiatric illness) receiving their medical and psychiatric care exclusively through the Kansas City Veterans Affairs healthcare system during 2008 were included in the study. Adherence to antihyperglycemic and antipsychotic medication was determined by refill records obtained through the computerized patient record system to calculate the cumulative mean gap ratio. Hemoglobin A1C values were utilized to compare glycemic control between groups and compared to glycemic goals established by diabetes treatment guidelines. Results: Antihyperglycemic medication adherence was poor for both groups as approximately 60% of the psychotic disorder group and 75% of the nonpsychiatric comparison group were without antihyperglycemic medication for greater than 30 days during the 12-month period but adherence did not differ between the groups (p=0.182). Antipsychotic adherent subjects (≥80% adherent) were more likely to be adherent to their antihyperglycemic medication (p=0.0003). There were no significant differences between groups in glycemic control.
Conclusion
CUMPLIMIENTO DE LA MEDICACIÓN Y CONTROL GLUCÉMICO EN PACIENTES CON DESORDENES PSICÓTICOS EN EL SISTEMA DE SALUD DE LA OFICINA DE VETERANOS RESUMENObjetivo: Comparar la adherencia a la medicación antihiperglucémica y el control glucémico entre individuos con esquizofrenia y desordenes psicóticos relacionados y un grupo de comparación no psiquiátrico. Métodos: Esto fue una revisión retrospectiva de historiales clínicos. Se incluyeron en el estudio a un total de 124 individuos con diabetes (62 pacientes con esquizofrenia o desordenes psicóticos relacionados y 62 pacientes sin enfermedad psiquiátrica aleatoriamente seleccionados y emparejados por edades) que recibían su medicación y sus cuidados psiquiátricos exclusivamente a través del sistema sanitario de la Oficina de Veteranos de Kansas City durante 2008. La adherencia a la medicación antihiperglicemica y antipsicótica se determinó de los registros de recogida de medicación a través del sistema informático para calcular el porcentaje de discordancia medio acumulativo. Se utilizaron los valores de hemoglobina A1C para comparar el control glucémico entre los grupos y comparar con los objetivos glucémicos establecidos en las guias de tratamiento. Resultados: La adherencia a la medicación antihiperglucémica fue pobre en ambos grupos, ya que aproximadamente el 60% del grupo de desordenes psicóticos y el 75% del grupo de comparación no psiquiátrico estuvieron sin medicación antihiperglucémica durante más de 30 días en el periodo de 12 meses pero la adherencia no fue diferente entre los grupos (p=0,182). Los ind...
Cautious treatment initiation, patient education, and close follow-up, monitoring for mood and behavior changes during therapy are recommended, especially in the psychiatric setting.
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