Abstract

Introduction

The primary objective was to determine if gender diverse (GD) youth receive different psychotropic prescribing compared with cisgender (CG) peers with the same diagnosis. Secondary objectives include evaluation of readmission rates and the effect of gender-affirming hormone therapy (GAHT) on psychiatric outcomes in transgender (TG) patients.

Methods

A total of 255 GD youth patients were retrospectively matched to CG controls based on age, primary discharge diagnosis, and year of admission. Data collection included psychotropic medications at admission and discharge, baseline demographics, time to readmission, and total number of readmissions within 6 months. Use of GAHT was also documented. Wilcoxon signed rank test was used for continuous and χ² for nominal data with an a priori α of 0.05.

Results

MDD was the primary discharge diagnosis in 74% of patients. GD youth were more likely to present on antidepressants (P = .031) and antipsychotics (P = .007), and to be discharged with antipsychotics (P = .003). They were additionally more likely to be readmitted within 30 days of discharge (P = .032). TG youth on GAHT (13%) had fewer readmissions (P = .046) than those not on GAHT, but there were no differences in psychotropic prescribing.

Discussion

Higher antipsychotic and antidepressant prescribing were seen in the GD population despite the same mental health diagnosis. Despite higher prescribing in the GD population, patients presented for readmission within 30 days more frequently, which may represent a need for more rigorous transitions-of-care practices in this population.

Abstract

Introduction

Higher rates of mental health conditions, increased incidence of psychiatric diagnoses, and symptom relapse with minimal access to psychotherapeutic services are reported during the COVID-19 pandemic. A local area clinic in the United States that exists to serve underprivileged patients helps to combat poor psychiatric outcomes by offering psychiatric clinics, pharmacotherapy management, and medications at reduced or no cost.

Methods

Recruitment and data collection were conducted from May 3, 2021, to March 3, 2022. Patients were seen by psychiatrists or the mental health clinical pharmacy specialist (MHCPS), and consent was obtained for the completion of satisfaction surveys. Five-point Likert scale comparisons were utilized to assess patient-perceived differences in clinician care. The primary study objective was to determine if access to care could be increased with the addition of an MHCPS, and secondary objectives included evaluating patient perceptions of clinician care as well as reporting MHCPS interventions.

Results

Participant baseline demographics and common psychiatric diagnoses are reported. An MHCPS was incorporated into the clinic during the study allowing for 1 additional patient care period per month. The most frequent score among all surveys was 4.8 (P > .05) on a 5-point scale, indicating no statistically significant differences between clinician care. MHCPS interventions are reported.

Discussion

The addition of an MHCPS allowed for additional patient care appointments for the clinic each month. MHCPS care offered no significant differences from psychiatrist care based on patient satisfaction surveys, highlighting the utility of pharmacist involvement for managing psychiatric disease states and increasing access to mental health services.

Abstract

Introduction

In general, racial and ethnic differences exist in antipsychotic prescription practices. However, little is known about such differences between individual long-acting injectable (LAI) antipsychotic formulations, specifically. This study's primary objective was to determine racial and ethnic differences among LAI antipsychotic use. Secondary objectives were to identify if discontinuation rates differed between agents and by race or ethnicity.

Methods

International Classification of Diseases, 10th edition (ICD-10) codes were used to identify patients with schizophrenia and related disorders (18-64 years) who received an LAI antipsychotic between 2016 and 2020 using Merative Multi-State Medicaid databases. Using National Drug Code numbers for LAI antipsychotics, pharmacy claims were identified and data analyzed. Cochran-Mantel-Haenszel tests and odds ratio estimators were used to investigate conditional association between race or ethnicity and medication, while controlling for age, sex, health plan, and prescription year. Kaplan-Meier survival curves were examined, and stratified log-rank tests were conducted to compare the time until discontinuation distributions by race or ethnicity.

Results

The analysis included 37 712 patients. Blacks received an LAI first-generation antipsychotic more often than Whites (OR: 1.64, 95% CI: [1.56, 1.73], Hispanics (OR: 1.46, 95% CI: [1.21, 1.75]) and others (OR: 1.44, 95% CI: [1.20, 1.73]). Aside from fluphenazine decanoate showing earlier discontinuation rates for Whites over Blacks (P = .02), no significant differences in discontinuation across race or ethnicity were identified.

Discussion

Despite no significant differences in second-generation antipsychotic LAI discontinuation rates between Blacks and other racial or ethnic groups, Blacks received second-generation antipsychotic LAIs significantly less often than other groups. Further studies are needed to determine why differences may be occurring.

Dear Editor:

A recent systematic review by Laguado and Saklad highlighted the importance of addressing olanzapine-associated weight gain.¹ While highly efficacious, olanzapine use has been limited by its propensity to cause significant weight gain. The authors considered the role of opioid antagonists in this setting by reviewing efficacy and safety data from the clinical development program of combination olanzapine and samidorphan (OLZ/SAM), concluding in part that samidorphan effectively mitigates olanzapine-associated weight gain. We provide comments on the authors' methodology, as their conclusions may underestimate weight gain mitigation with OLZ/SAM.

We suggest that a more precise estimate of OLZ/SAM's

Evaluation of burnout among Board-Certified Psychiatric Pharmacists in the United States

Samantha CatanzanoPharmD, BCPP,

Jennifer N. GemmellaroPharmD, BCPP, BCPS,

Melissa Mooers GrossBS, PharmD, MHA, BCPP, BCPS, BCGP, BCIDP, CPEL, CPPS,

Monica FahmyPharmD, BCPP, BCPS,

Gregory H. PayneMBA, CAE, and

Kelly C. LeePharmD, MAS, BCPP, FCCP

Comparison of inpatient psychiatric medication management in gender diverse youth with cisgender peers

Abstract

Introduction

Methods

Results

Discussion

Increasing access to psychiatric care during the COVID-19 pandemic through mental health clinical pharmacy specialist services

Abstract

Introduction

Methods

Results

Discussion

Racial and ethnic differences in patterns of use and discontinuation of long-acting injectable antipsychotics using Medicaid claims data

Abstract

Introduction

Methods

Results

Discussion

A case report on the effects of COVID-19 on ANC monitoring in a patient on long-term clozapine treatment

Abstract

Background

Case Report

Discussion

Conclusions

Diltiazem for clozapine-induced generalized hyperhidrosis

Abstract

Background

Case Report

Conclusion

Comment on “Opioid antagonists to prevent olanzapine-induced weight gain: A systematic review”

Offering a combined resident research training program and pharmacy student elective may help improve resident publication rates

Evaluation of burnout among Board-Certified Psychiatric Pharmacists in the United States

Clozapine plasma level toxicity induced by a pharmacokinetic interaction with bupropion: A case report

Guanfacine for the management of the behavioral manifestations of delirium in older hospitalized adults

Impact of psychiatric pharmacist-led ambulatory alcohol withdrawal management

Management of antidepressant-induced bruxism