Engage

The Psychiatry Resident Community will host a small group discussion for residents to share lessons learned during their residencies to better prepare individuals as they transition to new practitioners. 

Anti-N-methyl-D-aspartate receptor encephalitis (NMDARE) is an autoimmune disorder that attacks NMDA receptors causing neuropsychiatric symptoms, seizures, movement disorders and cognitive impairment.1 The condition can be treated with intravenous immunoglobulin, corticosteroids or rituximab.2 The initial clinical picture is often complicated, as the neuropsychiatric symptoms may include hallucinations, paranoia, aggression, depression, mania, or grandiosity.2,3 Female patients may also have a teratoma which should be removed as part of treatment. Patients may initially be evaluated by psychiatrists, and antipsychotic medication will be started with a lack of response.3 Misdiagnosis of schizophrenia or bipolar disorder may lead to lack of proper treatment which could lead to death as the condition continues. As the syndrome progresses, autonomic instability is the primary cause of death in patients with NMDARE.3 A case study published in 2007, was one of the first to describe NMDARE in a patient with a teratoma.4

1. Zhang L, Wu MQ, et. al. Clinical characteristics, treatments, and outcomes of patients with anti-N-methyl-D-aspartate receptor encephalitis: A systematic review of reported cases. Epilepsy Behav. 2017; 68:57-65. 
2. Howard CM, Kass JS, et al. Challenges in providing critical care for patients with anti-N-methyl-D-aspartate receptor encephalitis. Chest. 2014;145(5):1143-1147. 
3. Mann AP, Grebenciucova E, et al. Anti-N-methyl-D-aspartate-receptor encephalitis: diagnosis, optimal management, and challenges. Ther Clin Risk Manag. 2014;10:517-25. 
4. Dalmau J, Tuzun E, et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007;61(1):25-36. 

Stigma is a public health concern that leads people to avoid living, socializing, employing, or working with individuals with mental illness. Researchers have suggested that stigma also exists among health care professionals, including pharmacists independent of how knowledgeable they are about treatments for mental illnesses. Pharmacists may have more stigmatizing views and a higher level of discomfort in interacting with people with mental illness than those with a cardiovascular disease. This may lead to patients avoiding treatment and not receiving the support and care they need to recover. Mental health professionals, including pharmacists, have a crucial role in improving patient health outcomes by increasing mental health literacy and reducing stigma. Through this interactive discussion den, we will briefly provide information to inspire thinking about recognizing forms of stigma, including internal stigma, and its impact on patients. Participants will work in small groups to brainstorm ideas and approaches to create a stigma-free culture and reduce stigmatizing language and behaviors in their community, workplace, and pharmacy schools. Small group ideas will be then be shared with the larger group to foster further discussion. The goal is for participants to learn strategies and best practices from others to improve stigma and promote a supportive culture.

With the current opioid epidemic the US is facing, it is vital to help patients receive effective treatment for opioid use disorder to help save and extend-lives.  Buprenorphine and extended-release naltrexone are widely available treatment options.  Comparative efficacy trials of buprenorphine versus extended-release naltrexone have recently been published.  Although naltrexone is an option for treatment of opioid use disorder, a barrier to inpatient initiation of naltrexone after detox has been needed for the opioid-free period before initiation.  The aim of this session will include sharing of best practices amongst CPNP members around key topics surrounding the use of buprenorphine versus extended-release naltrexone, including discussion of the application of the findings from the comparative studies to current practice, sharing of patient-specific characteristics in treatment selection and different naltrexone initiation strategies.

The goals of this session are to discuss techniques and strategies for conducting more effective medication groups in both the inpatient and outpatient settings, to explain the importance of patient medication education group documentation and how to complete this task in any practice setting, and to consider ways to link outcome tracking with documentation. Dr. Williams will briefly discuss the logistics of his eight different PMEGs, and how he has improved the quality of his groups over time. Dr. Crouse will then discuss documentation and how this task can be linked to practice outcomes.

The RPD community will meet and discuss the hot topics currently on going in PGY2 Psychiatric Pharmacy. This will include but not be limited to: update on recruitment and status report on the match, review of first year with the new competencies, goals and objectives and how to address/get residents the help needed when they face a personal mental health crisis.

This session will follow-up on topics discussed during 2017-18 teaching community webinars and in the 2017 Teaching Community discussion den. The layered learning model will be discussed as a way to enhance quality IPPEs and APPEs in psychiatry and neurology. Resident teaching roles will be discussed.  Residency program directors and preceptors will have the opportunity to share ideas for enhancing resident teaching and documenting resident teaching in PharmAcademic. Ideas for incorporating knowledge and skills in psychiatry and neurology as part of entrustable professional activities will be shared. 

While many of us know that psychiatric pharmacists are ideally positioned to support individuals with mental illness across the continuum of care, the role of psychiatric pharmacists has traditionally been associated with inpatient hospital settings. However, as the healthcare environment continues to change and with the majority of mental disorders being treated in primary care, there is a growing need to integrate psychiatric pharmacy services into such settings. Not only would this improve access to mental health services, but it would also allow psychiatric pharmacists to expand their expertise to the management of a variety of primary care conditions. Participants will engage in guided discussions regarding the current state of mental services in ambulatory care, steps needed to implement psychiatric pharmacy services into primary care settings, strategies for demonstrating value, and methods of supporting program sustainability. Residents and new practitioners are welcome!