CPNP abstracts are printed in the Journal of Pharmacy Practice each spring.
Schizophrenia has similar prevalence rates among ethnic groups, yet little is known about the relationships between patients’ ethnicities and their treatment outcomes.
In recent years, partial recovery and remission have become increasingly prominent targets for treatment outcomes of people with schizophrenia. This is due in part to new understanding of the etiology and course of schizophrenia, new treatments, and increased interest in improving outcomes among patients, families, advocates and professionals. The current lack of clear, clinically relevant outcomes for comparing treatment modalities has helped to drive recent interest in this area. The Schizophrenia Working Group developed expert consensus criteria to define remission in schizophrenia
Stability, remission, and recovery are important concepts in chronic disease management, but no widely accepted definitions exist for these concepts in schizophrenia. Research criteria for remission, suggested by a working group (Andreasen et al, 2005), were applied to a database of once-monthly long-acting injectable antipsychotic paliperidone palmitate (PP) in subjects with schizophrenia.
Treatments that reduce healthcare resource use in patients with schizophrenia have the potential to reduce healthcare costs substantially. From a societal perspective, such treatments could also reduce indirect costs by allowing patients to return to their normal life sooner, and by reducing the care time of caregivers or family members.
In 2005, McEvoy, et. al. reported baseline CATIE results that subjects had a 2-3 times greater odds of developing metabolic syndrome compared to matched NHANES III subjects. Despite this data, patients treated with antipsychotics are not consistently monitored because fasting glucose and lipid samples are difficult to obtain. Alternatively, weight, waist circumference and blood pressure measurements are easily obtained in office settings. Furthermore, waist and blood pressure measurements have been linked with increased prevalence of metabolic syndrome.
The purpose of the study is to describe use of point-of-care glucose testing
and a “real-life” metabolic screening checklist model to quantify baseline metabolic risk
of outpatients treated with antipsychotics.
Long acting injectable (LAI) antipsychotics may have certain advantages over oral (PO) antipsychotics, such as decreased non-adherence and maximized pharmacokinetic coverage. As needed (PRN) psychiatric medications are used when patients are agitated or aggressive during acute stress. A study conducted, in 2012, found that 79% of the population which required PRNs was on PO-only antipsychotics compared to patients receiving LAIs. The objective of our research was to conduct a mirror-image analysis to determine if there was a significant reduction in PRN psychiatric medication use when patients were receiving LAI versus PO antipsychotics.
Currently there is limited data available supporting the use of extended-release (ER) divalproex in the mentally ill. We recently published the results of a four-week conversion study of ten patients from delayed (DR) to ER-divalproex. We found no significant changes in psychiatric status, but found better tolerability with fewer gastrointestinal complaints, decreased tremor, and less sedation. In addition, significant decreases were observed in serum potassium and LDL cholesterol. This study reviews the results of patients who have taken ER-divalproex for up to one year, some of who were converted from DR-divalproex.
Patients with psychiatric disorders have been shown to have higher rates of smoking compared to the general population. Additionally the leading cause of death in psychiatric patients is cardiovascular disease. To help improve the health of its patients, the Avera Behavioral Health Center implemented a tobacco-free campus on October 1, 2008. Other behavioral health facilities have previously reported their experiences with implementing a tobacco-free campus. One thing that has not been supported by literature is the long-term effectiveness of smoking cessation interventions in psychiatric patients. Also, there is some concern that the implementation of a tobacco-free campus will cause patients with certain diagnoses to avoid hospitalization because they will no longer be permitted to use tobacco products.
Medication adherence has always been a problem with drug therapy regimens, especially in the psychiatric population. Antipsychotics have a variety of undesirable side effects and are more prone to non-adherence. Along with antipsychotic medications, many patients with mental illness take numerous other psychotropics such as mood stabilizers, benzodiazepines, and antidepressants. Unfortunately, there are only a few long acting injectable (LAI) antipsychotics available in the United States, among which are haloperidol and risperidone.