Second-generation antipsychotics (SGA) are associated with misuse potential; however, there are limited data describing the prevalence and characteristics of this misuse. This study was conducted to identify and describe quetiapine and olanzapine misuse among US adults. This cross-sectional survey questionnaire was conducted online using Qualtrics research panel aggregator service to identify a quota-based sample of respondents constructed to mimic the general US population aged 18 to 59 years, with regards to gender, geographic region, ethnicity, income, and education level. Misuse was defined as using quetiapine or olanzapine for treatment outside of medical recommendations, for reasons other than a diagnosed medical condition, or obtaining without a prescription. A logistic regression was used to identify factors associated with SGA misuse, incorporating relevant covariates. Among 1843 total respondents, 229 had a history of quetiapine or olanzapine use. Misuse prevalence was estimated to be 6.3% (95% CI: 5.2, 7.5%). Although most respondents (∼70%) using quetiapine or olanzapine reported doing so to treat a diagnosed medical condition, those misusing them most commonly did so because prescribed medications failed to relieve their symptoms. Misuse was commonly reported (∼50%) concomitantly with opioids, benzodiazepines, or alcohol. Factors significantly associated with quetiapine or olanzapine misuse included employment (OR = 4.64), previous substance use disorder treatment (OR = 2.48), and having riskier attitudes toward medication misuse (OR = 1.23). Misuse of quetiapine and olanzapine, while fairly limited in prevalence, appears to be primarily associated with under-treatment of existing medical conditions.Abstract
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Board Certified Psychiatric Pharmacists (BCPPs) practice in a variety of inpatient and outpatient health care settings as part of collaborative, multidisciplinary teams. The American Association of Psychiatric Pharmacists (AAPP) has promoted the expansion of psychiatric pharmacy through the development of psychotropic stewardship programs (PSPs). Based on the standards developed during the creation and expansion of antimicrobial stewardship programs, psychotropic stewardship promotes the safe and appropriate use of psychotropic medications. AAPP envisions every patient with a psychiatric diagnosis will have their medication treatment plan reviewed, optimized, and managed by a psychotropic stewardship team with a psychiatric pharmacist as a co-leader. Because of variations in practice site resources, patient populations, and provider collaboration, the creation and implementation of PSPs should be based on site-specific needs and opportunities. Initial patient identification could prioritize those prescribed multiple medications, high-risk psychotropics, or comorbid medical diagnoses. However, every patient prescribed a psychotropic medication should have the opportunity to work with a PSP. Incremental implementation may be required during the planning stages of stewardship teams. Use of clinical practice-related core outcomes will allow for the optimization of program resources, increased recognition, and improved patient outcomes. PSPs should be patient-focused and integrate patients' preferences and access to recommended treatment options. The eventual goal of PSP implementation is official recognition by key regulatory agencies as a standard of care for patients who receive a diagnosis of a psychiatric or substance use disorder.Abstract
Dear Editor: These authors read with interest the recent psychopharmacology pearls published in the journal. In the update on long-acting injectable antipsychotics (LAIA), Case 4 is about a fictional patient, B.B., who is diagnosed with schizophrenia and stabilized on paliperidone 3-month injectable 546 mg for 3 years.1 B.B. misses a dose of their paliperidone injection because of relocating to a different state and having subsequent delays in establishing psychiatric care. A discussion then follows about the management of missed doses of LAIAs. Although the case is fictional, it describes a real situation that clinicians may very well encounter
Delaney Brainerd, PharmD1; Bruce Alexander, PharmD1,2; Marshall Tague; PharmD, BCOP1; Brian Lund, PharmD, MS1-3 1 Iowa City VA Health Care System, Iowa City, IA; 2 Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City, IA; 3 University of Iowa College of Public Health, Iowa City, IA Type: Original Research. Purpose: Recent reports have linked clozapine to an increased risk of hematologic malignancies, such as lymphomas, leukemias, and myelomas. AResearch Trainee Award Finalists
Clozapine and Risk of Hematologic Malignancies in Veterans with Schizophrenia