Mental Health Clinician Volume 1: Issue 11

The use of antipsychotics in the treatment of neuropsychiatric symptoms (NPS) in the geropsychiatric population is a controversial topic. Clinicians must be aware of current guidelines and best practices regarding antipsychotic use in long term care populations due to an associated risk of mortality. This article discusses and compares the guidelines regarding treatment of NPS published by the American College of Neuropsychopharmacology and the World Federation of Societies of Biological Psychiatry, and reviews the guidelines regarding gradual dose reduction in this population.

The acetylcholinesterase inhibitor donepezil has been in clinical use for the treatment of Alzheimer's disease since 1996. The patent on the medication expired in November 2010, and at approximately the same time, a new dosage form of donepezil was FDA approved for moderate to severe Alzheimer's disease. This article discusses the benefits and risks of the new 23 mg sustained-release dosage form compared with donepezil 10 mg, based on the clinical trial data.

It is estimated that more than half of elderly patients with dementia will develop some degree of behavioral and psychological symptoms of dementia (BPSD). BPSD is associated with significant morbidity, rapid functional decline, and psychiatric hospitalization, and there are currently no medications approved by the Food and Drug Administration (FDA) for its treatment. One treatment option that has been evaluated is the antiepileptic drug valproate. This retrospective medical record review evaluated the tolerability of valproate in elderly patients with dementia. A total of 62 patients met inclusion criteria for this review, which sought to determine whether there was an association either between the initial valproate dose and discontinuation or dose reduction (DCDR) or the maximum valproate dose achieved and DCDR. Both the total daily dose and total daily dose in mg/kg were assessed. For both the maximum daily dose (OR 1.0; 95% CI 0.99, 1.01) and maximum daily mg/kg dose (OR =1.15; 95% CI 0.92, 1.49) there was also no association with DCDR. There was no associated risk of DCDR when evaluating initial daily doses (OR: 1.0; 95% CI: 0.99 – 1.01). However, an association between DCDR and initial daily mg/kg dose was found (OR: 1.92; 95% CI: 1.11–4.02). For both the initial dose and initial mg/kg dose model, African Americans were associated with the need for DCDR (OR 20.75; 95% CI: 1.77–660). Results from this study suggest that higher initial starting doses based on weight may lead to higher rates of side effects necessitating a discontinuation or dose reduction; however, large trials are needed to confirm these results.

CPNP members maintain a suggested reading list to provide information on peer recommended resources and convenient access to the highest quality neuropsychopharmacology publications. A reminder that if you shop with CPNP, by following the links below to Amazon, a small commission will be paid to CPNP which helps to financially support our mission to improve the minds and lives of individuals with psychiatric and/or neurologic disorders.

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Book: Clinical Handbook of Psychotropic Drugs, 19^th revised edition

PRODUCT DESCRIPTION:

Fully updated and expanded,

A potential case of refeeding syndrome in a patient with severe mental illness

Amber R. DouglassPharmD, BCPS, BCPP, FAAPP,

Eliana SpeyBS, and

Kimberly A. EhrhardPharmD, BCPP

Geropsychiatry: A word from the editor

Antipsychotics in the treatment of neuropsychiatric symptoms in dementia

Donepezil 23 mg: Is it more advantageous compared to the original?

Dosing of valproate in an elderly population with dementia: Evaluation of discontinuations and dose reductions

Spotlight on a geriatric, long-term care practice

Describe your geriatric clinic/long-term care setting and your day-to-day activities. What is your time commitment to the practice or clinic?

Spotlight on a consultant pharmacist practice

Describe your geriatric clinic/long-term care setting and your day-to-day activities. What is your time commitment to the practice or clinic?

The “Improving Antipsychotic Appropriateness in Dementia Patients” clinical tools and training program

Ginkgo biloba and vitamin E for Alzheimer's disease

Psychopharmacology concerns in older individuals

Book Review: Clinical handbook of psychotropic drugs, 19th revised edition

PRODUCT DESCRIPTION:

Movie Review of Take Shelter

Annual Meeting energizes and educates

CPNP Announcements

HOW TO PREVENT ADVERSE DRUG EVENTS: ENHANCED AWARENESS, VIGILANT MONITORING CAN REDUCE MORBIDITY AND MORTALITY

A potential case of refeeding syndrome in a patient with severe mental illness

A case of Alice in Wonderland Syndrome associated with topiramate in a patient with vestibular migraine

Implementation of mMINDS monitoring for alcohol withdrawal at an inpatient academic psychiatric facility

A primary care psychiatric pharmacist clinic for addressing hypertension and mental health disparities in black patients

Re: Hernandez Bustamante et al. “Pharmacist administration of long-acting injectable medications for substance use disorders”

CPNP Announcements

The annual state of CPNP report

CPNP Announcements

Pursuing provider status

Book Review: Get the residency: ASHP's guide to residency interviews and preparation