Mental Health Clinician Volume 14: Issue 5

Case

Mrs. M is a 36-year-old female, 2 weeks postpartum, with a past medical history of depression and migraines. She presented to the emergency room with her husband, and upon

Introduction

Acute agitation is a common presenting symptom in medical and mental health emergencies that may require pharmacologic intervention. There is a manufacturer recommendation against intramuscular coadministration of olanzapine with parenteral (intramuscular or intravenous) benzodiazepines despite a deficiency of high-quality evidence. The purpose of this study was to contribute to available literature regarding intramuscular olanzapine and parenteral benzodiazepine use in acutely agitated patients in the emergency department (ED).

Methods

This was a single-center retrospective chart review of adult ED patients who received intramuscular olanzapine and a parenteral benzodiazepine within 2 hours. The composite primary endpoint evaluated the occurrence of cardiac or respiratory compromise within 2 hours of medication administration. Secondary endpoints mirrored the primary endpoint within 30 minutes and evaluated the occurrence of cardiac arrest or desaturation in the ED outside the 2-hour window.

Results

One hundred eleven patients were included in the analysis, 64 (57.7%) of whom had documented vitals or oxygen status within 2 hours of medication administration. The composite primary endpoint occurred in 8 patients (12.5%), with only 1 patient requiring intervention with intravenous fluids. The secondary composite endpoint occurred in 2 (9.5%) of 21 patients with documented vitals or oxygen status within 30 minutes of treatment, neither of which required intervention. There were no identified events of intubation or significant cardiac events.

Discussion

Until better evidence is available, this combination therapy should, at minimum, include appropriate patient monitoring. Future studies should investigate risk factors for serious adverse effects.

Introduction

One in 5 adults in the United States have depression and are at risk for suicide, the 11th leading cause of death in the United States. Community pharmacy settings are ideal for increasing access to mental health services. Our objectives were to assess PHQ-9 scores and evaluate participant satisfaction in a student pharmacist–led depression screening program in a community pharmacy.

Methods

Student pharmacists trained in mental health first aid recruited participants 18 to 90 years old in a community pharmacy to complete the PHQ-9 and provided mental health education, referrals, and resources. A 2-week follow-up was completed, and participants reported on actions taken since the initial visit. Descriptive statistics, independent t tests, and χ ² tests were used in data analysis.

Results

Twelve depression screening events were held, and 70 participants completed the screenings. The mean age was 52 years, and 75.7% were female. PHQ-9 scores ranged from 0 to 24 with an average of 3.96. Most participants (92.9%) reported the depression screening program was helpful. More than 90% of participants completed the 2-week follow-up, and 92.3% reported being comfortable seeking mental health services from a pharmacist. About half (53.8%) reported reading the educational materials, 24.6% helped a friend or family member, and 16.9% made an appointment with their health care provider.

Discussion

Student pharmacists successfully provided depression screenings and mental health education in a community pharmacy. Most participants had low PHQ-9 scores, found the program helpful, and are willing to utilize mental health services in a community pharmacy.

Introduction

Bupropion is an antidepressant approved for the treatment of major depressive disorder (MDD), seasonal affective disorder, and smoking cessation. Nausea, headache, tremor, and insomnia are well-known adverse effects of this medication. Less well-recognized adverse effects include delayed allergic reactions, which, in some cases, can appear 2 or more weeks after bupropion initiation.

Case Report

A 27-year-old male with recurrent MDD was referred for medication treatment at an outpatient mental health clinic and prescribed bupropion XL. On day 28 of treatment, he reported significant improvement in depressive symptoms and the development of itchiness and urticaria on his extremities and back. Bupropion was tapered over the course of 7 days, and he was given cetirizine 10 mg daily. He was transitioned to venlafaxine treatment and experienced complete resolution of hives and pruritus.

Discussion

Despite published reports on bupropion causing delayed hypersensitivity reactions, there remains limited clinical recognition of this side effect, and the risk of underrecognition may be greater when the onset of the reaction is more than 2 weeks after bupropion initiation.

Conclusion

Bupropion can cause delayed hypersensitivity reactions, including delayed pruritis and urticaria. The risk may be highest in males aged 17 to 40 years and those with a history of allergic reactions.

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

Leah A. SurbaughPharmD, BCPP,

Taylor KelseyPharmD, BCPP,

Brittany L. MeltonPharmD, PhD, and

Karen E. MoellerPharmD, BCPP

Treatment of postpartum psychosis in breastfeeding females

Case

A retrospective review of intramuscular olanzapine and parenteral benzodiazepine coadministration in the emergency department

Introduction

Methods

Results

Discussion

Evaluation of a student pharmacist–led depression screening program in a community pharmacy

Introduction

Methods

Results

Discussion

Delayed allergic reaction from bupropion in a 27-year-old male with MDD: A case report and literature review

Introduction

Case Report

Discussion

Conclusion

Risperidone-induced angioedema

Abstract

High frequency of clozapine-associated myocarditis and troponin elevation: Need for slower titration prospective studies

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

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

Use of psychostimulants in the management of treatment-resistant major depressive disorder

Memantine leading to physical aggression in the treatment of chronic catatonia secondary to schizophrenia: A case report

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