College of Psychiatric and Neurologic Pharmacists

This presentation will provide participants an overview of the medico-legal considerations regarding treatment of neuropsychiatric symptoms in patients with dementia. Read more about this session.

Since the development and introduction of the long-acting antipsychotic medications in the 1960’s, clinical debates have occurred among health-care providers as to when these medications are appropriate to use.  The impact of poor medication adherence among patients with psychiatric disorders has a great impact on their clinical outcomes.  Long-acting injectable antipsychotics have been shown to reduce hospitalizations and to improve medication adherence.  The clinical pharmacologic properties, safety and tolerability profiles of these medications vary between agents. Read more about this session.

The safety and efficacy of antidepressants for patients with bipolar disorder continues to remain a source of tremendous controversy.  Initial reports of antidepressant-induced mania or hypomania led to marked concern among practitioners that antidepressants were highly likely to destabilize mood and worsen the course of illness in most people with bipolar disorder.  More recent investigations indicate that the potential for antidepressants to cause mania or hypomania is a rarer phenomenon than originally thought, occurring in about 10-15% of bipolar disorder patients.  Moreover, studies from the past two decades identify patient-specific risk factors for the emergence of antidepressant-associated mania or hypomania, suggesting its potential significance as an illness endophenotype.  Clinical studies suggest that the risk for mood destabilization from antidepressants appears higher in individuals with bipolar I (rather than bipolar II) disorder, as well as those with concomitant manic/hypomanic symptoms during depressive illness phases, recent manic or hypomanic episodes, comorbid alcohol or drug abuse, and past histories of antidepressant-induced mood destabilization.  Furthermore, risk may be somewhat higher with noradrenergic antidepressants (such as tricyclics or serotonin/norepinephrine reuptake inhibitors) than with purely serotonergic or primarily dopaminergic agents.  Co-therapy with antimanic drugs such as lithium may not reliably mitigate the risk for antidepressant-induced mania or hypomania. Read more about this session.