Abstract

There are now 9 available FDA-approved second-generation long-acting injectable antipsychotics including aripiprazole (3), olanzapine (1), paliperidone (3), and risperidone (2). These high-cost medications are commonly used with the goal of improving adherence and patient outcomes. With almost 2 decades of use, key aspects have been well studied, including population pharmacokinetics, CYP interactions and various clinical and economic outcomes. However, there are still unknowns with these medications. Issues including adherence, transition from oral antipsychotics, renal dosing, pharmacogenomics, and managing missed doses will be addressed in the context of 4 patient cases.

Abstract

Currently available antipsychotics provide only modest benefit in managing the cognitive and negative symptoms of schizophrenia even though these symptoms are often the most impairing in patients' daily lives. Certain antipsychotics may have slight benefits over others, and several nonpharmacologic and pharmacologic adjunctive treatments have been evaluated in recent clinical trials. Recently published meta-analyses and clinical studies of such treatments are reviewed. Potential strategies to manage cognitive and negative symptoms, including deprescribing of medications that may exacerbate these symptoms, are described using theoretical case examples.

Abstract

OCD is characterized by obsessions and compulsions that cause distress, are time-consuming, and interfere with a patient's social, occupational, or other areas of functioning. SSRIs are first-line pharmacologic treatment options and produce response rates of up to 60% in patients with OCD. Several potential strategies have been evaluated for enhancing patient response, including high-dose SSRI therapy, antipsychotic augmentation, and memantine augmentation. Three patient cases are used to explore treatment guidelines, evaluate existing literature, and provide pharmacotherapy recommendations for the management of patients with OCD when first-line therapy fails.

Dear Editor:

We applaud the work published by Lee et al¹ and the best practice model subcommittee in their attribute statements for defining the optimal recommendations for outpatient psychiatric pharmacy practice. This serves as an excellent foundation in standardizing the expectations for clinical pharmacist practitioners (CPP) within outpatient mental health (MH) settings and our group believes these defined statements are being applied at the Department of Veterans Affairs (VA).² Measurement-based care, suicide assessment, and comprehensive medication management (CMM) are all standards of care for VA outpatient MH CPP.³ The goal of our letter is

Pharmacist administration of long-acting injectable medications for substance use disorders: A scoping review

Pamela Hernandez BustamanteBS, PharmD,

Amanda CharlesPharmD, BCPS,

Marissa SniderPharmD, MPH, and

Samantha CatanzanoPharmD, BCPP

A model for timely dissemination of critical information: Clozapine toxicity during the COVID pandemic

Jessica GannonMD,

K. N. Roy ChengappaMD,

Robert O. CotesMD,

Jonathan G. LeungPharmD, BCPS, BCPP,

Patrick FraileyMD,

Mariel PiechowiczMD,

Elizabeth KistlerMD,

Vernon NathanielMD,

Cynthia EldredgeRN,

Jade AlessandroBS,

Kimberly ClinebellMD,

Melanie YabsPharmD, MS, BCPP,

Dale AdairMD, DLFAPA, and

Joseph ZimmermanMSN, RN, CNL, CPPS

An update on recently approved long-acting injectable second-generation antipsychotics: Knowns and unknowns regarding their use

Abstract

Management of cognitive and negative symptoms in schizophrenia

Abstract

Moving beyond first-line treatment options for OCD

Abstract

The clinical utility of newer antidepressant agents: Understanding the role in management of MDD

Abstract

Stewardship applied to antipsychotics: Development of an antipsychotic stewardship program in inpatient settings for monitoring and optimizing outcomes

Abstract

A Veterans Affairs' perspective in response to Best Practice Model Subcommittee attribute statements for outpatient psychiatric pharmacists

Dear Editor:

Pharmacist administration of long-acting injectable medications for substance use disorders: A scoping review

Transitions of care: Assessment of adherence to long-acting injectable antipsychotic treatment following discharge from inpatient psychiatry

Use of atypical antipsychotics in individuals with anorexia nervosa

Potential changes impacting psychiatric pharmacy by 2030

A model for timely dissemination of critical information: Clozapine toxicity during the COVID pandemic