The purpose of this study was to compare pharmacists' level of training and/or experience in psychiatric pharmacy to (1) their self-perceived preparedness to provide pharmacotherapy services to individuals with psychiatric disorders and (2) barriers to providing pharmacotherapy services to individuals with psychiatric disorders. This study used data from an Internet-based questionnaire. Respondents were divided into 2 groups: group A completed the Arizona Pharmacy Association's Psychiatric Certificate Program, and/or was board certified in psychiatric pharmacy, and/or was a member of the College of Psychiatric and Neurologic Pharmacists, and/or had completed a psychiatric pharmacy residency; group B had no specialized training and/or experience in psychiatric pharmacy. A Mann-Whitney U test was used to compare the scaled responses for each group. Compared with pharmacists without training and/or experience in psychiatry (N = 235), respondents with specialized training and/or experience in psychiatric pharmacy (N = 38) reported more frequent interactions with patients with psychiatric disorders and provided more counseling and drug information, monitoring for adverse drug reactions, screening for treatment issues, and both pharmacologic and nonpharmacologic treatment recommendations (P < .05). Pharmacists trained in psychiatry reported being more prepared to provide all pharmacotherapy services (P < .003), except in addressing nonadherence, utilizing online resources, and providing pharmacotherapy services to patients with attention deficit hyperactivity disorder. They reported fewer barriers to providing pharmacotherapy services (P < .005), except for time to provide services, having a private consultation area, and reimbursement for patient care activities. This study found that responding pharmacists without psychiatric training/experience may need additional education and training after graduation and that they perceive more barriers in providing services to the population with psychiatric disorders.Abstract
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Introductory pharmacy practice experiences (IPPEs) are 1 requirement schools and colleges of pharmacy must fulfill to meet accreditation standards. The purpose of this manuscript is to report existing IPPEs in psychiatry and neurology across the United States. Two separate electronic surveys were administered to individual College of Psychiatric and Neurologic Pharmacists members with board certification in psychiatric pharmacy with an academic affiliation and academic institutions in the 2014-15 academic year to assess the neuropsychiatric curriculum in pharmacy programs. Results focusing on IPPEs were summarized using descriptive statistics. Academic institutional data reveal only 37.3% offered IPPEs in psychiatry, and 6.7% offered neurology. The number of available IPPEs is low even if a program offered an available rotation. The majority of College of Psychiatric and Neurologic Pharmacists member respondents (69.9%) did not offer IPPEs in psychiatry in the 2014-15 academic year, and none offered an IPPE in neurology. More than half of individual respondents feel their institution should increase IPPEs in psychiatry and neurology in order to enhance their curriculum. To expand IPPE availability, pharmacy programs should increase early exposure of pharmacy students to patients with psychiatric and neurologic conditions. Longitudinal experiences may allow students to engage in hands-on experiences, which may impact future career aspirations and reduce stigma. Current example IPPEs at the authors' institutions are included to stimulate discussion and action among readers on how IPPEs in these practice areas may be developed. Implementation of IPPEs in psychiatry and neurology is needed for students to gain experience working with these patients.Abstract
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Substance use disorders (SUDs) are a significant US health problem affecting roughly 20 million Americans, but there continues to be limited access to SUD treatment and inadequate addiction medicine training. Therefore, it is important to understand how SUD education is being delivered to US health professionals, including pharmacists. A recent survey of US pharmacy programs' neuropsychiatry curricula was evaluated to identify any progress made toward increasing SUD education since the last national survey in 2004 and determine any remaining gaps between what is currently being taught and American Association of Colleges of Pharmacy (AACP) curricular guidelines for SUD education updated in 2010. A survey of psychiatric pharmacists, regarding what they thought should be taught, was also evaluated and compared with the 2010 AACP curricular guidelines. Our survey of US pharmacy programs demonstrated that 94% of programs reported teaching SUD content in 2014-15, which has increased from 81% reported in a survey study from 2004. There was also an increase for average hours of SUD didactic instruction, which increased from 2.2 hours in 2004 to 2.7 hours in 2015. The majority of members (84%) recommended at least 2 hours of SUD instruction, and 27% recommended teaching ≥4 hours. There was an overall increase in SUD instruction, but the average hours taught still falls short of 2010 AACP curricular guideline recommendation suggesting ≥4 hours. Furthermore, a majority of the psychiatric pharmacists we surveyed did not agree with the AACP curricular guideline recommendation because only 27% of members recommended ≥4 hours of SUD instruction, and the average hours recommended was only 2.7 hours.Abstract
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Cases in Psychiatry was a multi-campus elective course aimed to expand psychiatry knowledge beyond the required course curriculum. The format of the class included didactic course work, small group discussion of patient cases and article evaluation, submission of written notes, debates, and script concordance test questions delivered via a live online platform. Based on student assessment and feedback at the end of the course, the elective course was determined to meet the prespecified course objectives.Abstract
Long-acting injectable (LAI) antipsychotics have become an integral component in the treatment of schizophrenia and other psychotic disorders. Long-acting injectables may be initiated in either the inpatient or outpatient setting; however, there have been no studies to evaluate whether LAI treatment initiation setting impacts patient outcomes. This study sought to assess whether outcomes, specifically psychiatric hospitalization rates, time to hospitalization, and adherence with injections, differed between patients started on LAIs in the inpatient versus outpatient setting. The electronic medical records of all veterans prescribed an LAI at the McGuire Veterans Affairs Medical Center from September 2009 through September 2014 were reviewed in this retrospective study. Veterans met inclusion criteria if they were prescribed an LAI during the study period and were excluded if they had received an LAI prior to September 2009 or if the LAI was started at an outside facility. Patients were separated into treatment groups according to initiation location. The primary outcomes included psychiatric hospitalization rates and time to hospitalization. The secondary outcome measured the proportion of LAI injections received. Fifty-five LAI treatment-naïve veterans were included in this study. No statistically significant differences were found in psychiatric hospitalization rates, time to hospitalization, or proportion of LAI injections received when comparing the inpatient and outpatient treatment initiation groups. Psychiatric hospitalization rates, time to hospitalization, and adherence to LAIs did not differ between the inpatient and outpatient treatment groups, suggesting that treatment initiation location does not have an effect on patient outcomes.Abstract
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The aim of this study was to identify potential gaps in the management of depression and assess the perceptions of primary care providers (PCPs) toward integrating psychiatric pharmacists into primary care settings. This was a retrospective chart review of patients ?18 years of age seen in primary care clinics in Los Angeles County with a documented annual health screening (AHS) between January 1, 2015, through December 31, 2015. Primary outcomes were number and percentage of patients screened for depression with patient health questionnaire (PHQ) assessments, positive depression screenings, and interventions made for positive depression screenings. Secondary outcomes were PCPs' perceptions on management of depression, use of AHS, and roles for psychiatric pharmacists through evaluation of provider survey. Of the patients who received an AHS (n = 6797), 63% received PHQ assessments. Of 145 individuals with a positive PHQ-2, 69% had a positive PHQ-9. Greater than 50% of individuals with a positive PHQ-9 had no preexisting depression diagnosis. Seventy-six percent of individuals with a positive PHQ-9 and 78% with reported suicide ideation had no documented intervention. The majority of providers reported there is a role for psychiatric pharmacists in primary care. Gaps in the management of depression were identified. Although depression screenings were performed for the majority of individuals receiving an AHS, no documented interventions were made for most of those individuals who screened positive for depression. Primary care clinics could benefit from psychiatric pharmacist involvement in depression screening and follow-up processes.Abstract
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Dementia encompasses diseases of progressive memory loss and neurological alterations, including Alzheimer disease. Hypertension is one risk factor proposed for development of Alzheimer disease. The objective is to evaluate the current literature for use of diuretics in the prevention of dementia. Literature was not considered if published before January 1, 2000, or after May 31, 2015. PubMed was used to locate sources. Four search terms were used to find data: Alzheimer disease, antihypertensive agents, diuretics, and dementia. Four studies of efficacy of diuretic usage in the prevention against dementia met criteria. Potassium-sparing diuretics displayed risk reduction of Alzheimer disease and maintenance of cognitive function. Risk reduction was demonstrated when used alone (adjusted hazard ratio [aHR] 0.09, 95% confidence interval [CI] 0.01-0.41) as compared to use of other antihypertensives without potassium-sparing diuretics (aHR 0.76, 95% CI 0.49-1.15). Other antihypertensive drug classes did show some benefit, however. Diuretic and angiotensin receptor blocker users had a lower Alzheimer disease risk versus those with no antihypertensive use (hazard ratio 0.40, 95% CI 0.26-0.61) and (hazard ratio 0.37, 95% CI 0.19-0.72), respectively. Additionally, thiazide diuretics were also shown to reduce Alzheimer risk. Thiazide and potassium-sparing combination significantly reduced risk versus non-antihypertensive users (aHR 0.63, 95% CI 0.42-0.94). Available research demonstrates an inverse association between diuretic use and the incident rate of dementia. Specifically, this has been found with thiazide and potassium-sparing diuretics when used alone or in combination. This review suggests that patients receiving diuretics for hypertension may receive an added neuroprotective effect.Abstract
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Lithium is commonly used to treat various psychiatric disorders and is particularly effective in the maintenance phase of bipolar disorder. Unfortunately, this drug has a narrow therapeutic index and, if not monitored regularly, can result in toxicity. Therefore, for lithium to be prescribed safely, clinicians must ensure that patients are well educated on lithium toxicity, its prevention, and symptom recognition. This article summarizes studies that investigated lithium education strategies to help promote the safe use of lithium. Four electronic databases were searched using key terms and subject headings. Reference lists of relevant papers were also reviewed. The search was limited to literature published in English, without year limits. Eligible studies examined lithium patient education and the impact on patients' knowledge of safe lithium use. Of a total of 517 citations that were retrieved from the electronic database search, 12 were selected for inclusion in this review. Most of the studies included assessed the effect of lithium education on various aspects of patients' knowledge, including but not limited to, lithium toxicity. Of the studies assessing the correlation between lithium knowledge and lithium levels, most demonstrated a positive correlation between lithium knowledge and lithium levels that were more stable and within the higher end of the recommended therapeutic range. Studies evaluating lithium patient education and its effect on improving the safe use of lithium are limited. Nevertheless, this literature review highlights that lithium patient education is critical to promote its safe use.Abstract
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