Mental Health Clinician Volume 3: Issue 3

Antipsychotics are considered the mainstay of treatment for psychotic disorders such as schizophrenia and schizoaffective disorders. While the first generation antipsychotics (typical antipsychotics) are effective for treating psychosis, the second generation antipsychotics (atypical antipsychotics) have largely supplanted their older cousins as the “go to” medications for this indication. The main reason for the switch to newer agents is not because of increased efficacy, but because of reduced adverse effect burden. The reduced propensity of the second generation antipsychotics to cause neurological adverse effects such as extrapyramidal symptoms and tardive dyskinesia has been established. However, these agents have a different adverse

Hiccups are a product of involuntary, intermittent spasmodic contraction of the diaphragm and inspiratory intercostal muscles that results in sudden inspiration and abrupt closure of the glottis. The exact pathophysiology of hiccups remains unknown. However, certain neurotransmitters, medications, and other factors have been implicated.

We report a case of a 38 year old patient who developed hiccups three days after adding aripiprazole 5 mg once a day to his medication regimen. Medical and environmental causes were ruled out and aripiprazole was discontinued. One day later, the hiccups resolved.

Several case reports have described patients who developed hiccups when treated with aripiprazole and related this to changes in neurotransmitter concentrations. However, due to limited literature, it was difficult to determine rate of occurrence of this adverse event with aripiprazole.

A temporal but not a causal relationship was observed between initiating aripiprazole and development of hiccups in this patient. A causal relationship cannot be established since the patient was not re-challenged with aripiprazole. Nonetheless, clinicians should be cognizant that use of aripiprazole may be associated with hiccups.

Background: Atypical antipsychotic agents serve an important role in the treatment of many psychiatric disorders but have the potential to cause adverse effects, notably metabolic disturbances. These agents are known to cause increases in obesity, glucose intolerance, dyslipidemia and hypertension. In 2004, the American Diabetes Association (ADA) and the American Psychiatric Association (APA), in collaboration with other organizations, acknowledged the association between the use of atypical antipsychotics and the development of metabolic abnormalities and provided monitoring recommendations for the use of these agents. Despite these recommendations, rates of monitoring remain low.

Objective: The purpose of this study is to assess whether a pharmacist recommendation form is effective in improving baseline metabolic monitoring for patients admitted to an acute inpatient psychiatry unit who are ordered a scheduled atypical antipsychotic.

Methods: A pharmacist recommendation form with metabolic monitoring parameters was placed on the charts of patients ordered a scheduled atypical antipsychotic during a two month period. A retrospective chart review was conducted to compare the percentage of baseline monitoring ordered pre-intervention versus the intervention period. Patients ages 18 years or older who were ordered a scheduled atypical antipsychotic were included.

Results: During the intervention period, there was a significant increase in documentation for presence or absence of diabetes (p = 0.018) and cardiovascular disease (p < 0.001). A significant difference in the number of orders for hemoglobin A1c (p = 0.007) and lipid panels (p < 0.001) were noted. No other significant differences were found.

Conclusion: A pharmacist recommendation form was effective in improving the baseline monitoring of personal history of diabetes and cardiovascular disease and monitoring of hemoglobin A1c and lipid panels, but rates of other baseline monitoring parameters did not improve.

Serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) are two rare, but serious adverse reactions associated with psychotropic medications. While the disorders may share certain features, there are differences in how they are managed and treated. This article reviews the risk factors, clinical presentation, and treatment of SS and NMS.

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Book: Essentials of Clinical Psychopharmacology, Third Edition

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A potential case of refeeding syndrome in a patient with severe mental illness

Amber R. DouglassPharmD, BCPS, BCPP, FAAPP,

Eliana SpeyBS, and

Kimberly A. EhrhardPharmD, BCPP

Adverse effects from atypical antipsychotics

Toolbox: Metabolic adverse effects of atypical antipsychotics

Aripiprazole induced hiccups

Baseline metabolic monitoring of atypical antipsychotics in an inpatient setting

Differentiating serotonin syndrome and neuroleptic malignant syndrome

Evaluation of the link between chronic antipsychotic use and osteoporosis

Management and prevention of agranulocytosis in patients receiving clozapine

Pulmonary embolism in a patient receiving risperidone and paliperidone: A case report and review of the literature

Retrospective review of a case of serotonin syndrome after discontinuation of risperidone: Was withdrawal neuroleptic malignant syndrome missed?

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Strategies for prevention and management of second generation antipsychotic-induced metabolic side effects

Treatment of antipsychotic-induced hyperprolactinemia with bromocriptine: A case report

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A potential case of refeeding syndrome in a patient with severe mental illness

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