Mental Health Clinician Volume 2: Issue 3

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Editorial: Use of psychotropic agents in intellectual and developmental disabilities

Pharm.D., BCPP

The American Association on Intellectual and Developmental Disabilities defines intellectual disability (ID) specifically as a disability originating before the age of 18 and characterized by significant limitations both in intellectual functioning and in adaptive behavior.¹ ² Intellectual disabilities are included in the umbrella terminology of “developmental disabilities” that also includes many other disabilities recognized during childhood, such as cerebral palsy, autistic spectrum disorders (ASD), and epilepsy.² ³ “Intellectual Disability” is currently the preferred terminology and includes the same group of individuals diagnosed previously with “Mental Retardation”, which is no longer used internationally or in the U.S.

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September 2012 toolbox: Common rating scales for disruptive/challenging behaviors

Pharm.D., BCPP

DOI: 10.9740/mhc.n115485

The September Toolbox features information about common rating scales for disruptive and/or challenging behaviors including the number of items on each rating scale and how scales are rated. Citations are provided should readers seek more detailed information about each rating scale.

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Behavioral activation secondary to antidepressant use in an intellectually disabled woman

Pharm.D., MS, BCPP, CGP and

Pharm.D., MS, BCPP

DOI: 10.9740/mhc.n115478

INTRODUCTION

The under-appreciation for and potential lack of recognition of medication-related adverse effects in persons with intellectual disabilities (ID) can be a function of a variety of factors, including under-recognition of the prevalence of psychopathology in those with IDs compared to the general population, rating scales completed by the caregiver rather than the patient, low familiarity of healthcare needs by this special population, and lack of consensus criteria for diagnostic purposes.¹ Recognition and management of unintended medication-related effects may represent an area for clinical interventions and quality of life improvement for practitioners, especially pharmacists working with this population.

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Medical and psychiatric conditions in patients with developmental disabilities

Pharm.D.

DOI: 10.9740/mhc.n115483

CASE PRESENTATION

May is a 62 year old female with intellectual disability who presents to the regional hospital emergency room from a residential care facility (RCF). She was brought to the hospital due to complaints from staff members of increased combativeness and agitation when staff try to help her complete her activities of daily living. May had a similar episode of increased agitation in the winter and was found at that time to have a urinary tract infection. She is otherwise relatively easy to care for at the facility.

May's caregiver states that the psychiatrist who sees May at the

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Naltrexone use for self-injurious behavior in patients with developmental disabilities

Pharm.D.

DOI: 10.9740/mhc.n115484

Self-injurious behavior (SIB) is a serious problem seen in individuals with developmental disabilities (DD). Evidence-based options for the treatment of SIB in patients with DD are limited and no medication is approved for this indication. Non-pharmacotherapeutic options including environmental change and behavioral therapy are generally recommended for use as first line therapy. However, these options are sometimes inadequate.¹ Despite lack of strong evidence, a variety of medications are used for SIB in DD. These include: antipsychotics (typical and atypical), antiepileptic drugs (e.g. divalproex, carbamazepine, etc.), lithium, and antidepressants (particularly selective serotonin reuptake inhibitors). First line agents include atypical

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The role of second generation antipsychotics in autism disorder

Pharm.D., BCPP

DOI: 10.9740/mhc.n115491

EG is a 9-year old boy who is brought to clinic for evaluation; he is accompanied by his father who appears distressed. He apologizes for being late to the appointment, but he states that he had a hard time getting EG to leave the house because he would not stop playing with his Yu-gi-oh cards. When dad tried to take the cards away, EG became angry, began to cry loudly, and started to hit himself and his dad. Dad says this is common behavior for the past few years and now that he is getting older they are worried that

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Use of antipsychotics and psychostimulants for challenging behaviors in the intellectually disabled

Pharm.D., BCPP

DOI: 10.9740/mhc.n115492

Challenging behavior is a term often used in the field of the intellectually disabled (ID) to define a range of disruptive and dangerous actions.¹ Behaviors often referenced in this category include aggression, hyperactivity, impulsivity, self-injury, property destruction, and occasionally obsessive-compulsive behaviors.² ³ These behaviors not only burden the individual but also increase strain on caregivers and impair social interactions. The incidence of disruptive behaviors and/or self-injury has been cited as occurring in 10–62% of individuals with ID, regardless of age, residing in institutions as well as in community settings.⁴ For children and adolescents with

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The role of the clinical pharmacist in the management of psychotropic polypharmacy in the treatment of patients with mental retardation and development disabilities

Pharm.D., MS., BCPP, CGP

DOI: 10.9740/mhc.n115626

For many individuals with mental impairments/developmental disabilities (MR/DD) that reside in supported living centers, the potential to be placed on a myriad of psychotropic medications to manage both behavioral and neuropsychiatric disturbances exists. There are distinctive obstacles that a clinical pharmacist that works in a facility providing services to individuals with MR/DD can face as it relates the prescribing of psychotropic medications. As a result of the limited data or clinical trials on the use of psychotropic medications in this particular population, problems can be encountered when multiple psychotropic medications are prescribed.¹ Based on the practice parameters for

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September 2012 President's Letter

Pharm.D., BCPP

DOI: 10.9740/mhc.n115697

Greetings from the smoky West. The Pacific Northwest and my state, Idaho, are struggling with major wildfires. Smoke is thick in the air in many places. All of this caused me to pause a moment and reflect on important activities going on in CPNP.

Your CPNP Program Committee and the Recertification Editorial Board are definitely “on fire”. Both groups are developing programming for the upcoming 2013 Annual Meeting (April 21 – 24) in Colorado Springs (luckily, our meeting location, the beautiful Broadmoor Resort, was not damaged by the recent wildfires in Colorado!). You will hear more later this month about

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Summary of ASHP National Residency Preceptor's Conference

Pharm.D., BCPP

DOI: 10.9740/mhc.n115912

The ASHP National Residency Preceptor's Conference is held every other year in Washington, DC. This year's conference focused on a number of new changes that will be implemented during 2012–2013, including an online application tool for candidates and programs, a mandatory one-week waiting or “cooling off” period after the Match, and pharmacy resident specific duty hours. There was also strong emphasis on PGY1 residency program expansion.

The Pharmacy Online Residency Centralized Application Service (PhORCAS) will be a web-based tool for both residency candidate and programs to manage the residency application process. All programs registered in the ASHP Resident

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Book Review: The rationale use of psychotropic medication for individuals with intellectual disabilities: Pathways to and from polypharmacy

RPh, Pharm.D., BCPP, CGP

DOI: 10.9740/mhc.n115494

CPNP members maintain a suggested reading list to provide information on peer recommended resources and convenient access to the highest quality neuropsychopharmacology publications. A reminder that if you shop with CPNP, by following the links below to Amazon, a small commission will be paid to CPNP which helps to financially support our mission to improve the minds and lives of individuals with psychiatric and/or neurologic disorders.

You can help grow this list of resources by suggesting a book.

Book: The Rationale Use of Psychotropic Medication for Individuals with Intellectual Disabilities: Pathways to and from Polypharmacy

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CPNP Announcements

DOI: 10.9740/mhc.n115495

SHAPE THE FUTURE OF CPNP

Jerry McKee, Pharm.D., MS, BCPP—Nominating Committee Chair

Thanks to the contributions of time and talent, members have helped CPNP to make great strides in its short 16 years of existence. CPNP is truly a membership-driven organization. This is especially true in selecting future leaders of the organization. Another of the many ways you can contribute is to nominate your peers and colleagues with the dedication and time to take CPNP even further. On or before Tuesday, September 11, you have the opportunity to nominate leaders for 3 positions on the CPNP

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Editorial: Use of psychotropic agents in intellectual and developmental disabilities

September 2012 toolbox: Common rating scales for disruptive/challenging behaviors

Behavioral activation secondary to antidepressant use in an intellectually disabled woman

INTRODUCTION

Medical and psychiatric conditions in patients with developmental disabilities

CASE PRESENTATION

Naltrexone use for self-injurious behavior in patients with developmental disabilities

The role of second generation antipsychotics in autism disorder

Use of antipsychotics and psychostimulants for challenging behaviors in the intellectually disabled

The role of the clinical pharmacist in the management of psychotropic polypharmacy in the treatment of patients with mental retardation and development disabilities

September 2012 President's Letter

Summary of ASHP National Residency Preceptor's Conference

Book Review: The rationale use of psychotropic medication for individuals with intellectual disabilities: Pathways to and from polypharmacy

CPNP Announcements

SHAPE THE FUTURE OF CPNP

Pharmacist administration of long-acting injectable medications for substance use disorders: A scoping review

Transitions of care: Assessment of adherence to long-acting injectable antipsychotic treatment following discharge from inpatient psychiatry

Use of atypical antipsychotics in individuals with anorexia nervosa

Potential changes impacting psychiatric pharmacy by 2030

A model for timely dissemination of critical information: Clozapine toxicity during the COVID pandemic