Mental Health Clinician Volume 4: Issue 3

According to epidemiological data obtained from 2001 to 2003 by the National Comorbidity Survey Replication, approximately 25% of adults in any given year have a mental illness, with 68% of those having one or more general medical conditions. ¹ ² Risk factors for both mental and medical conditions include exposure to early trauma and chronic stress as well as socioeconomic factors, such as low income and poor educational status. ³ ⁴ Those with mental illness have higher rates of substance use (including tobacco, alcohol, and illicit substances), poor eating habits, and physical inactivity, thereby increasing the risk of

Compared with the general adult population, patients with schizophrenia and bipolar disorder have a 1.5 to 2.8 fold increase in mortality rates. This increase in mortality is multifactorial, including both natural causes and suicide. Additionally, antipsychotic medications have been associated with several adverse effects, including weight gain, hyperlipidemia, and the onset of diabetes. These adverse effects can place patients at risk for metabolic syndrome and atherosclerotic cardiovascular disease (ASCVD). Regular monitoring and treatment of risk factors for ASCVD, including hyperlipidemia, should be provided in clinical practice. The American College of Cardiology and the American Heart Association recently published updated recommendations for the management of cholesterol to reduce ASCVD. These national guidelines, based on a large body of clinical trials, describe 4 specific patient populations at high risk for ASCVD that should be considered candidates for therapeutic lifestyle changes and pharmacologic treatment. Statin therapy should be considered a first-line treatment option for these patients due to a favorable benefit versus risk profile. Of note, the new guidelines do not recommend a specific LDL target for patients. Instead, either a moderate or high-intensity statin should be recommended based on the patients' comorbidities. Health care providers can have a significant impact on the cardiovascular health of psychiatric patients by appropriately monitoring and treating hyperlipidemia.

Individuals with schizophrenia and schizoaffective disorders are at higher risk than the general population for the development of chronic medical conditions, such as type II diabetes. This review article will focus on the 2014 recommendations from the American Diabetes Association for diagnosis, management, and assessment of glycemic control in patients with type II diabetes

Depression is the most common psychological condition in patients with cancer. These patients often have worse outcomes, such as decreased adherence to treatment and increased suicide rates. Since depression is common and often under recognized in this patient population, guidelines recommend screening every patient with cancer for depression. Both psychotherapy and pharmacotherapy are shown to be effective to treat depression in patients with cancer. Psychotherapy, specifically cognitive behavioral therapy, is preferred in patients with more mild depressive symptoms, while pharmacotherapy is used for more severe depression. Dignity therapy and supportive-expressive therapy are also recommended for patients near the end of life. Pharmacotherapeutic options for treatment include antidepressants and psychostimulants. Guidelines recommend SSRIs, SNRIs, or mirtazapine as first line treatment, with TCAs often avoided due to side effects. Psychostimulants, such as modafinil and methylphenidate, can be used as well, and are especially effective for patients near the end of life. SSRIs may also be useful to prevent the development of depression in patients taking drugs known to cause depression, such as interferon alfa. Treatment of depression in patients with cancer should be based on patient specific symptoms and situation. This article will review both non-pharmacologic and pharmacologic treatment options in patients with cancer and comorbid depression.

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

A holistic approach to patient care in psychiatry

Management of elevated blood cholesterol in the psychiatric patient: What's new in the guidelines?

Screening, diagnosis, and management of type II diabetes: A review of the 2014 American Diabetes Association guidelines

Treatment of depressive symptoms in patients with cancer

An overview of clinically significant drug interactions between medications used to treat psychiatric and medical conditions

Medication prescribing in liver dysfunction

Psychotropic-induced sexual dysfunction

Recent changes in the treatment of hypertension

Assessment and management of chronic pain in patients with depression and anxiety

Clearing the air: Chronic respiratory illnesses and smoking cessation in the adult psychiatric population

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

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

A primary care psychiatric pharmacist clinic for addressing hypertension and mental health disparities in black patients

Re: Hernandez Bustamante et al. “Pharmacist administration of long-acting injectable medications for substance use disorders”

CPNP Announcements

The annual state of CPNP report

CPNP Announcements

Pursuing provider status

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