Patient Centered Care Approach to Medication Therapy Management for Caregivers of Children with Attention Deficit Hyperactivity Disorder (ADHD)
Evidence suggests that medication management of Attention Deficit Hyperactivity Disorder (ADHD) is highly efficacious. However, both uptake of treatment and long-term adherence have presented a formidable task in clinical practice. Caregivers and practitioners may have different interpretations of the benefits and improvements of ADHD medication. Furthermore, it is likely that caregivers’ views impact adherence to treatment. Therefore, understanding caregivers’ assessments of treatment options and perceptions of improvement have tremendous implications for enhancing the uptake and ongoing use of mental health services.
IMPACT OF CLOZAPINE VERSUS OLANZAPINE ON THE USE OF HEALTH CARE BY MEDICAID PATIENTS WITH SCHIZOPHRENIA
Olanzapine was FDA-approved for schizophrenia in late 1996, seven years after Clozapine. The California Medicaid Program (Medi-Cal) established open access to atypical antipsychotics in October 1997. Clozapine and olanzapine are considered to be two of the most effective antipsychotics, but clinicians often resist initiating clozapine due to the burden of complete blood count monitoring during therapy. Several studies and clinician experiences suggest clozapine has superior efficacy compared to olanzapine. Therefore it is relevant to compare health care use between treatment episodes of clozapine versus olanzapine in Medi-Cal patients with schizophrenia.
Despite guideline recommendations for alternative agents, benzodiazepines are still widely prescribed for anxiety and related disorders. Patient specific factors including older age, concomitant disease states, and concurrent medications can lead to increased risk for adverse events such as central nervous system depression and subsequent injury including falls.
Tallahassee Memorial Healthcare NeuroScience Center is a multidisciplinary clinical initiative that provides services to patients with neurological disorders. The NeuroScience Center houses a Memory Disorder Clinic, Parkinson 's Center, and Multiple Sclerosis Clinic. It also provides supportive services for patients with seizures, traumatic brain injury, and other neurological disorders. Pharmacists work with neurologists, social workers, neuropsychologists, speech therapists, and nurses to individually and collectively assess patients with these disorders. Practice faculty from Florida A&M University College of Pharmacy provide comprehensive medication reviews and other services such as patient and caregiver education.
Clozapine is an atypical antipsychotic with proven efficacy in a psychiatric patient population with treatment-resistant schizophrenia. The prescribing of clozapine in this population is limited in part by its side effect profile, which includes the risk of agranulocytosis and other adverse hematological outcomes. Since successful clozapine therapy requires the maintenance of specific blood counts, care must be taken to avoid confounding factors that may precipitate reductions in WBC or ANC. It is known that the resolution of an infection produces an accompanying decrease in antibody production and WBC/ANC. Antibiotics have been implicated as a confounding factor of decreased blood cell counts when administered concomitantly with clozapine. However, these drops in the WBC and ANC have been noted to be related to the resolution of infection and not to a drug induced dyscrasia.
SECOND GENERATION ANTIPSYCHOTIC PRESCRIBING PATTERNS FOR VETERANS WITH POSTTRAUMATIC STRESS DISORDER OVER A TEN-YEAR PERIOD
Selective serotonin reuptake inhibitors (SSRIs) are FDA-approved, first-line treatments for posttraumatic stress disorder (PTSD). However, many PTSD patients fail to respond fully to SSRI treatment. Increasingly, second generation antipsychotics (SGAs) are being used adjunctively. This study examined the pattern of use of SGAs in veterans with PTSD over a 10-year period.