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

Disclaimer: The editorial below does not reflect any opinion of or endorsement by the United States Government or the Department of Veterans Affairs.

The theme of this year's CPNP Annual Meeting was “Elevating to New Heights in Neuropsychiatric Pharmacy.” This editorial will explain one perspective on how attendees at the annual meeting were encouraged to pursue this goal.

First and foremost, we were encouraged to elevate our knowledge. This was done primarily through the informative continuing education (CE) sessions provided throughout the conference. While all the sessions were informative, we have chosen to highlight a few of the presented topics in this month's issue. In this issue, the reader will find an article discussing the use of antipsychotics in the maintenance treatment of bipolar disorder. There is an article which highlights the use of pharmacotherapy in pediatric obsessive-compulsive disorder, to contrast with the presentation that focused on the use of cognitive-behavioral therapy (CBT) in this population. In addition, the reader will find a more in-depth discussion of two of the clinical pearls that were presented in the general clinical pearls session; these articles relate to opioid induced analgesia and the urea cycle disorder.

Secondly, we are encouraged to elevate our contributions toward neuropsychiatric pharmacy. There were two primary ways in which this was accomplished. Firstly, the boards and committees met on site during the annual meeting. CPNP has nine standing committees and three editorial boards, in addition to the board of directors and the past presidents council, that work hard to provide the best programming, publications, and advocacy opportunities to the CPNP membership. Secondly, the poster session was a specific forum for encouraging contributions from the membership. Over 130 posters were presented at this session, including 9 finalists in 5 award categories. It is the goal of CPNP to see these posters developed into quality manuscripts which can be published in journals relevant to neuropsychopharmacology, including this publication.

Thirdly, we were encouraged to elevate our practice of neuropsychiatric pharmacy through several sessions which addressed the concept of Comprehensive Medication Management (CMM), including the CMM clinical pearls session and the CMM meeting which followed that session. CMM is best defined as: “the standard of care that ensures each patient's medications…are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the comorbidities and other medications being taken, and able to be taken by the patient as intended.”¹ By further pursuing CMM, we are meeting the goals of the Psychiatric Pharmacy Manifesto, which lists a goal of psychiatric pharmacists “to prevent medication errors and enhance medication outcomes, promoting appropriate, evidence-based, and measurement-based medication use.”² CMM is discussed in this issue in the CPNP member news section in our interview with incoming CPNP President Julie Dopheide.

Fourthly, and perhaps most importantly, we were encouraged to elevate our level of interactions with others, both with other providers and with our patients. The sessions regarding academic detailing highlight one method of approaching the physician-pharmacy relationship. In this month's issue, this area of pharmacy practice is highlighted in an article which reviews the content presented in these presentations. In regards to the elevation of our interactions with patients, this specifically relates to the area of interviewing ability. This was particularly evident in Dr. Shawn Shea's presentations. At both the pre-meeting workshop and the keynote presentation, techniques and strategies were given to improve our ability to practice. The information presented at the workshop focused on suicide assessment, specifically the CASE Approach.³ In other words, the techniques and strategies covered focused on uncovering sensitive information about the patient's thoughts and plans. At the keynote presentation, Dr. Shea presented information that focused on the Medication Interest Model.⁴ This is a series of techniques and strategies aimed at ultimately influencing patient behavior in relation to medications. These two presentations were especially pertinent because the skills discussed cover the two areas of symptomatology we are most concerned with in psychiatric pharmacy: thoughts and behaviors.

This area of elevating our practice by improving our interviewing skills is perhaps the area that is most needed. Most of the members of CPNP are very well versed in the technical aspects of pharmacotherapy. But do we know how to interview a patient effectively and efficiently? Given a 30 or 60 minute clinic slot, can we gather the relevant history and symptomology? Can we assess symptoms, adherence and adverse events in a patient that might not want to be present in clinic, or worse, is distrustful of you as a practitioner and the health-system at large?

This topic came up in a discussion with some colleagues of mine during one evening of the conference. Most of those present are currently practicing in inpatient settings, although a couple of us (including this editor) practice with an ambulatory psychiatric population. We all noted that we have been well prepared with a high-level of pharmacotherapeutic knowledge. We know which guideline to cite and we know the relative side effect profiles of each drug. What we noted that we were less confident in was the ability to interview the patient and elucidate the right information. This is a skill that takes time and practice to build. What these presentations provided was an example of interviewing skills to use in practice and, with time, to gain experience using. Therefore, these presentations were valuable to this end in helping CPNP members to elevate their level of practice.

My charge to the reader is to elevate your practice to new heights. Continue to elevate your knowledge. Continue to contribute to the advancement of neuropsychiatric pharmacy practice by both advocating for the profession through active participation in organizations such as CPNP, through advocating for an elevated role for neuropsychiatric pharmacists (via CMM) as well as contributing to the literature by publishing in this publication (the Mental Health Clinician) or other publications relevant to neuropsychiatric pharmacy practice. Lastly, apply the principles discussed regarding interviewing techniques to be a more effective clinician.