<div class="title" data-jats-encoding-type="nlm-3.0">Mental Health Clinician</div> Volume 2: Issue 9

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Editorial: Use of psychotropics in those with HIV

PharmD, BCPP

As psychiatric pharmacists, we are often called upon to evaluate drug interactions between psychiatric medications and medications used for other illnesses. We use evidence-based medicine combined with clinical judgment to make the determination whether a medication regimen needs to be completely revamped or just slightly adjusted. This decision can become complicated when the medications involved are life preserving and changing them may not be a valid option. This issue of the Mental Health Clinician will address many of these complex questions regarding drug interactions between Highly Active Antiretroviral Therapy (HAART) and psychotropic medications.

The articles in this issue include one

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HAART and psychotropic drug interactions toolbox

MD,

DO, MPH, and

DOI: 10.9740/mhc.n140751

This toolbox on the next page is meant to be used as a quick reference when determining the level of evidence for and severity of drug interactions between antiretroviral therapy and psychotropic medications. A key is included describing each level of evidence and the various colors used in the document.

As you are working with individuals living with mental illness, you will find the NAMI Medication Fact Sheets developed by CPNP members to be helpful in educating your patients about their medications.

HAART and Psychotropic Drug Interactions Toolbox

ADs & PIs
ADs & NRTIs
ADs & NNRTIs-IIs-EIs

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Clinical implications and management of drug-drug interactions between antiretroviral agents and psychotropic medications

PharmD,

PharmD, BCPS,

PharmD,

PharmD, MS, and

PharmD, BCPS, AE-C

DOI: 10.9740/mhc.n139874

Medications used in the treatment of human immunodeficiency virus (HIV) often have drug-drug interactions which complicate treatment of psychiatric illnesses in HIV-infected patients. Protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) are the two classes of HIV medications most likely to be involved with interactions, with the majority occurring via the cytochrome P450 (CYP450) system. These interactions can result in either increased or decreased exposure to psychotropic and antiretroviral medications, often requiring dosage adjustments and increased monitoring. This article reviews some of the major drug interactions with antiretroviral agents.

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Evidence-based pharmacological treatment recommendations for managing depression in persons living with HIV (PLWH)

PharmD

DOI: 10.9740/mhc.n140588

BACKGROUND

Clinical depression is common among Persons Living with HIV (PLWH) and untreated depression is associated with risk behaviors that may lead to HIV transmission, non-adherence to antiretroviral (ARV) medications, frequent hospitalizations, and decreased survival.¹

The pathology of depression in PLWH is multi-factorial and management can be complex. Diagnosis of HIV may directly or indirectly lead to depression in PLWH. The initial shock of the diagnosis and coping with the disease may be a direct psychological stressor or further complicate pre-existing depression. Neuropsychological changes as the disease progresses, HIV-related medical conditions, anti-retroviral side effects, as well as the socioeconomic

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A review of human immunodeficiency virus (HIV) and postpartum depression

PharmD Candidate,

PharmD Candidate, and

PharmD, BCPS, AE-C

DOI: 10.9740/mhc.n140593

Depression is common among HIV-infected women, predicts treatment non-adherence, and may impact mother to daughter (vertical) transmission of HIV. A majority of women who develop HIV are of child-bearing age, and are at risk for postpartum depression (PPD). A literature review was performed to analyze the literature regarding PPD in HIV-positive women. This review specifically looked at literature regarding the incidence, risk factors, outcomes, and treatment of PPD in HIV-positive women compared to the general population. While existing literature is limited, it seems to imply that there is no difference between HIV-positive women and unaffected women when it comes to PPD incidence or risk factors. A majority of studies did conclude that routine screenings are needed for depressive symptoms in HIV-positive women.

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Practitioner Profile: Somer Smith, PharmD

PharmD

DOI: 10.9740/mhc.n140595

This practitioner profile describes a unique practice setting where the clinical pharmacist works in an HIV clinic to help manage patients' medications and conduct grant-funded research.

What got you interested in becoming a pharmacist who specializes in HIV?

In my last year of pharmacy school, I had the privilege of taking an International Medicine Elective in Kijabe, Kenya, Africa. The International Medicine Elective was a great opportunity to broaden my horizons and learn about pharmacy in a different perspective. The goals of this rotation were to enhance my knowledge about healthcare systems outside the country, compare and contrast the international

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Second- and third-hand smoke exposure: Selected literature for healthcare professionals providing home-based services to the severely mentally ill

PharmD Candidate,

DO, and

PharmD, MS, BCPP, CGP

DOI: 10.9740/mhc.n140755

Purpose: To develop recommendations for healthcare professionals at risk for exposure to secondhand (SHS) and thirdhand smoke (THS) while providing home-based services to patients with severe mental illnesses (SMIs), such as schizophrenia.

Summary: Healthcare professionals who provide services to those with SMIs have the potential to be exposed to SHS and THS. Smoking rates in persons diagnosed with schizophrenia are significantly higher compared to the general population (up to 90% versus approximately 30%). According to one study, only 31.5% of patients with SMIs are likely to have smoke-free homes. Currently there are no guidelines available for minimizing the effects of SHS and THS on healthcare professionals. Strategies for minimizing the effects are proposed.

Conclusion: Literature dealing with the effects of SHS, potential occupational hazards of exposure, and the results of anti-public smoking laws to address the problem were reviewed. The health hazards of THS exposure are an emerging area. Data are limited on alternative strategies for healthcare professionals to minimize SHS and THS exposure. Suggestions to minimize exposure are provided.

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The DSM-5 and the mental health clinician as consultant

MD, MTS

DOI: 10.9740/mhc.n137079

How and why do we account for mental distress and illness?

Today, the Diagnostic and Statistical Manual of Mental Disorders, commonly called the DSM, is the predominant way to account for mental distress and illness. Indeed, the DSM has been so widely adopted that it is often characterized as the psychiatric bible.

Like a bible, the community that makes the most use of it also assembles it. The American Psychiatric Association (APA) is the only physician group that produces the definitive diagnostic manual for their specialty. Now, after a decade of meetings, task forces, literature reviews, and field trials, the

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Medication education task force providing valuable resources to CPNP members

The Medication Education Group Task Force,

PharmD, BCPP,

PharmD, MS, BCPP,

MS, PharmD, and

PharmD, BCPP

DOI: 10.9740/mhc.n140747

The Medication Education Groups Taskforce, under the purview of the Legislative Committee initiated and sent a survey during the fall of 2012. The intent was to use the information from the survey to share resources related to group medication education that we are all using in our respective practice sites and to discuss terminology and billing mechanisms. The survey was sent only to those CPNP members who had replied to a listserv email regarding interest in provision of medication education groups.

DATA SUMMARY

The survey was sent to 72 individuals with 47 individuals responding to at least 1 question, for

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Book Review: Positivity: Top-notch research reveals the 3 to 1 ratio that will change your life

RPh, PharmD, BCPP, CGP

DOI: 10.9740/mhc.n137083

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: Positivity: Top-Notch Research Reveals the 3 to 1 Ratio That Will Change Your Life

From the

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Being present; Being heard

PharmD, BCPP

DOI: 10.9740/mhc.n139744

February was a short month, and that seemed to increase the “busy-ness” for CPNP. Now, as April and the 16^th Annual Meeting approach there's a tremendous amount happening. Since the theme of this month's letter is “Being Present; Being Heard”, I wanted to update you on CPNP's efforts to increase the visibility and voice of neuropsychiatric pharmacy.

First, many of you may remember that in early March of 2012, a discussion thread appeared on CPNP's listserve regarding concerns about fluphenazine decanoate only being supplied in multi-dose vials. This was leading to wasted drug – during a time of

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CPNP Announcements

DOI: 10.9740/mhc.n140745

ONLY DAYS REMAIN FOR EARLY BIRD REGISTRATION RATES TO THE 2013 ANNUAL MEETING

CPNP 16^th Annual Meeting Elevating to New Heights in Neuropsychiatric Pharmacy April 21–24, 2013 ▪ Colorado Springs, Colorado

Join hundreds of your colleagues in registering for the 2013 Annual Meeting to be held April 21–24 in Colorado Springs, Colorado. You can save over $100 on your registration fees by registering at early bird rates through March 20.

The Annual Meeting content and networking opportunities is proving to be just as committee members planned for—substantive and cutting-edge. If you are still evaluating

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Editorial: Use of psychotropics in those with HIV

HAART and psychotropic drug interactions toolbox

HAART and Psychotropic Drug Interactions Toolbox

CONTENTS

Clinical implications and management of drug-drug interactions between antiretroviral agents and psychotropic medications

Evidence-based pharmacological treatment recommendations for managing depression in persons living with HIV (PLWH)

BACKGROUND

A review of human immunodeficiency virus (HIV) and postpartum depression

Practitioner Profile: Somer Smith, PharmD

What got you interested in becoming a pharmacist who specializes in HIV?

Second- and third-hand smoke exposure: Selected literature for healthcare professionals providing home-based services to the severely mentally ill

The DSM-5 and the mental health clinician as consultant

Medication education task force providing valuable resources to CPNP members

DATA SUMMARY

Book Review: Positivity: Top-notch research reveals the 3 to 1 ratio that will change your life

From the

Being present; Being heard

CPNP Announcements

ONLY DAYS REMAIN FOR EARLY BIRD REGISTRATION RATES TO THE 2013 ANNUAL MEETING

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