Mental Health Clinician Volume 13: Issue 1

The Mental Health Clinician (MHC) continues to be a valuable resource for psychiatric practitioners and researchers with nearly 1 million article views in 2022. MHC is now indexed in PubMed, Scopus, and DOAJ which reflects the quality of our authors, reviewers, and editorial board. The editorial board is very appreciative of everyone who submitted a manuscript or authored a peer review in 2022 and would like to acknowledge those whose contributions have been exceptionally significant.

MHC Editors' Choice Award

The MHC Editors' Choice Award for Outstanding Articles identifies those manuscripts that received a great deal of attention in 2022.

Abstract

Introduction

Cocaine use disorder (CUD) is a disabling disease associated with high rates of relapse and intense cravings. Patients with CUD struggle to adhere to treatment, which contributes to relapse and frequent readmissions to residential rehab (RR) facilities. Preliminary studies suggest that N-acetylcysteine (NAC) attenuates cocaine-induced neuroplasticity and, therefore, may assist with cocaine abstinence and adherence to treatment.

Methods

This retrospective cohort study obtained data from 20 RR facilities across Western New York. Eligible subjects were 18 or older, diagnosed with CUD, and were divided based on their exposure to 1200 mg NAC twice daily during RR. The primary outcome was treatment adherence measured by outpatient treatment attendance rates (OTA). Secondary outcomes included length of stay (LOS) in RR and craving severity on a 1 to 100 visual analog scale.

Results

One hundred eighty-eight (N = 188) patients were included in this investigation: NAC, n = 90; control, n = 98. NAC did not significantly impact OTA (% appointments attended), NAC 68%; control 69%, (P = .89) or craving severity NAC 34 ± 26; control 30 ± 27, (P = .38). Subjects treated with NAC had a significantly longer average LOS in RR compared with controls, NAC 86 ± 30; control 78 ± 26, (P = .04).

Discussion

In this study, NAC did not impact treatment adherence but was associated with a significantly longer LOS in RR for patients with CUD. Owing to limitations, these results may not be applicable to the general population. More rigorous studies examining NAC's impact on treatment adherence in CUD are warranted.

Abstract

Introduction

Psychotropic drug-drug interactions (DDIs) contribute to adverse drug events, but many go undetected or unmanaged. Thorough documentation of potential DDIs can improve patient safety. The primary objective of this study is to determine the quality of and factors associated with documentation of DDIs in an adult psychiatric clinic run by postgraduate year 3 psychiatry residents (PGY3s).

Methods

A list of high-alert psychotropic medications was identified by consulting primary literature on DDIs and clinic records. Charts of patients prescribed these medications by PGY3 residents from July 2021 to March 2022 were reviewed to detect potential DDIs and assess documentation. Chart documentation of DDIs was noted as none, partial, or complete.

Results

Chart review identified 146 DDIs among 129 patients. Among the 146 DDIs, 65% were not documented, 24% were partially documented, and 11% had complete documentation. The percentage of pharmacodynamic interactions documented was 68.6% with 35.3% of pharmacokinetic interactions documented. Factors associated with partial or complete documentation included diagnosis of psychotic disorder (p = .003), treatment with clozapine (p = .02), treatment with benzodiazepine-receptor agonist (p < .01), and assumption of care during July (p = .04). Factors associated with no documentation include diagnosis of “other (primarily impulse control disorder)” (p < .01) and taking an enzyme-inhibiting antidepressant (p < .01).

Discussion

Investigators propose best practices for psychotropic DDI documentation: (1) description and potential outcome of DDI, (2) monitoring and management, (3) Patient education on DDI, and (4) patient response to DDI education. Strategies to improve DDI documentation quality include targeted provider education, incentives, and electronic medical record “DDI smart phrases.”

Abstract

Introduction

Diabetes and depression may present concurrently, and clinical pharmacists are well equipped to manage these conditions. Clinical pharmacists were grant funded to implement a diabetes-focused randomized controlled trial in a Federally Qualified Health Center. The objective of this analysis is to evaluate if glycemic control and depressive symptoms improve for patients with diabetes and depression with additional management from clinical pharmacists compared with those receiving the standard of care.

Methods

This is a post hoc subgroup analysis of a diabetes-focused randomized controlled trial. Pharmacists enrolled patients with type 2 diabetes mellitus (T2DM) and a glycated hemoglobin (A1C) greater than 8% and randomly assigned them to 1 of 2 cohorts, one managed by the primary care provider alone and one with additional care from the pharmacist. Pharmacists completed encounters with patients who have T2DM with or without depression to comprehensively optimize pharmacotherapy while tracking glycemic and depressive outcomes throughout the study.

Results

A1C improved from baseline to 6 months in patients with depressive symptoms who received additional care from pharmacists by −2.4 percentage points (SD, 2.41) compared with a −0.1 percentage point (SD, 1.78) reduction in the control arm (P .0081), and there was no change in depressive symptoms.

Discussion

Patients with T2DM and depressive symptoms experienced better diabetes outcomes with additional pharmacist management compared with a similar cohort of patients with depressive symptoms, managed independently by primary care providers. These patients with diabetes and comorbid depression received a higher level of engagement and care from the pharmacists, which led to more therapeutic interventions.

2022 MHC Awards and Recognition

MHC Editors' Choice Award

A preliminary evaluation of N-acetylcysteine's effects on patient adherence to treatment for cocaine use disorder

Abstract

Introduction

Methods

Results

Discussion

Best practices for documentation of psychotropic drug-drug interactions in an adult psychiatric clinic

Abstract

Introduction

Methods

Results

Discussion

Post hoc depression analysis from a pharmacist-led diabetes trial

Abstract

Introduction

Methods

Results

Discussion

Rational antipsychotic polypharmacy in psychotic and bipolar disorders: A focus on D2 receptor partial agonists

Safety considerations for patients using cannabis

Clinical pearls for the treatment of narcolepsy

The efficacy and safety of antidepressants as alternative treatment of attention-deficit/hyperactivity disorder in pediatric populations

Benzodiazepine use in schizophrenia: A review of the literature

CPNP Announcements

CPNP Announcements

Editorial: Elevating to new heights in neuropsychiatric pharmacy at the 2013 CPNP Annual Meeting

Tis the season of endorsements

A review of eslicarbazepine acetate (Stedesa®)