Stigma may negatively affect the treatment of people with mental illness, and pharmacists have the opportunity to play a key role in reducing mental health stigma. The purpose of this study was to determine whether a pharmacy student–focused educational intervention impacts stigma toward people with mental illness. A 90-minute interactive learning module, which used social media and fictional case scenarios, was developed and administered to third-year pharmacy students (n = 145) during small group class sessions. The Opening Minds Stigma Scale for Health Care Providers (OMS-HC), a validated tool to measure stigma, was administered immediately before and after the intervention. Pre-post OMS-HC scores were analyzed using related samples t tests. A total of 93 presurvey and postsurvey OMS-HC scores were paired and analyzed. Based on the 15-item version of the scale, stigma was significantly reduced, consistent with a score reduction of 4.6%, from 36.8 (95% confidence interval, 35.4-38.1) to 35.1 (95% confidence interval, 33.8-36.3), P < .0001. Educational interventions for pharmacy students that use social media applications might reduce mental health stigma. After the intervention, most participants believed that stigma impacts the treatment of mental illness, and that pharmacists may play a role in changing mental health stigma.Abstract
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All symptoms in schizophrenia may impact functioning. Although Food and Drug Administration-approved medications typically benefit positive symptoms, negative symptoms are generally refractory to medication interventions. N-acetylcysteine's (NAC) influence on glutamatergic neurotransmission has been established. An emerging body of research has attempted to correlate this action with reduction in symptom severity, evaluating response in positive, negative, and cognitive symptom domains. A literature review was performed to analyze available data on NAC intervention and improvement in the positive, negative, and cognitive symptom domains in patients with schizophrenia. Quality of evidence was systematically assessed to determine level of certainty in results. Three randomized controlled trials were identified. Across studies, negative symptoms decreased more with NAC compared to placebo; ranging between 11.9% and 24.1%. The assessment determined a low level of certainty regarding benefit of NAC on negative and cognitive symptoms and moderate certainty for NAC regarding findings of side effects and lack of benefit on positive symptoms. Consistent reporting of benefit in negative symptoms is found across studies of NAC intervention. These improvements are notable for symptoms that have generally remained refractory to medication intervention. Inconsistent benefit was reported in positive and cognitive symptoms. GRADE (grading of recommendations assessment, development and evaluation) assessment of current evidence indicates a low certainty of benefit for negative symptoms with standard use of NAC in patients with schizophrenia. However, a trial of this low-risk intervention may be warranted in patients with resistant negative symptoms and subsequent impaired functioning despite appropriate antipsychotic therapy as they may experience additional benefit in this symptom domain.Abstract
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One of clozapine's unrecognized potential side effects is renal insufficiency and nephritis. Although most clinicians are aware of the possibility of clozapine-induced myocarditis, less is known about other inflammatory disorders due to clozapine treatment. This patient was started on lithium and clozapine within 4 days of each other although lithium was discontinued after 7 days due to tremor. Routine labs showed an increase in serum creatinine, which was initially attributed to the recent lithium. However, the patient's kidney function continued to worsen, requiring discontinuation of clozapine despite a robust response to a low dose. Several years later, the patient's kidney function improved but has not returned to baseline. This literature review and case report illustrates the similarities in diagnostic presentation of clozapine-associated renal insufficiency as well as potential risk factors. More research should be conducted into the role concomitant sodium valproate and/or lithium play in the risk of clozapine-associated renal insufficiency.Abstract
Several psychoactive medications are known to cause QTc prolongation. Patient factors also increase the risk for QTc prolongation, including bradycardia, female sex, older age, metabolic abnormalities, and polypharmacy. Donepezil, a cholinesterase inhibitor, prolongs the QTc interval through a multimodal mechanism. A 26-year-old African American female was admitted to the inpatient psychiatric hospital following a suicide attempt that was not an overdose. Past medical history was significant for major depression, traumatic brain injury, seizures, hemiplegia, gastroesophageal reflux disease, and tachycardia. Two baseline electrocardiograms (EKGs) were obtained showing normal QTc intervals. After several weeks, donepezil (5 mg by mouth once daily) was initiated for cognitive rehabilitation and titrated over 3 weeks to a dose of 20 mg. An EKG performed after the last dose change showed a prolonged QTc of 463 ms. Another follow-up EKG performed 9 days later showed further prolongation to 528 ms. Laboratory values were within normal limits during her hospital stay. Donepezil was discontinued completely, leading to normalization of the QTc interval. QTc prolongation and torsades de pointes have been identified in postmarketing case reports of donepezil. Instances of QTc prolongation have predominantly been documented in the geriatric population, primarily in those with additional risk factors. Additionally, current literature does not support the use of donepezil for neurocognitive rehabilitation in daily doses exceeding 10 mg. A temporal and causal relationship was observed between the initiation and titration of donepezil and development of QTc prolongation.Abstract
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Designer products, a term referring to analogs of known chemical compounds with no established medical use, represent an easily accessible alternative to prescription-only products. During the past decade, designer benzodiazepines have become widely available on the online forums. Although these agents offer individuals an inexpensive and accessible alternative to prescription-only products, they are not without risk. Because of the lack of federally enforced quality standards, these designer products come with an intrinsic risk of unpredictable and potentially toxic adverse effects. This article presents a 36-year-old male with prolonged bradycardia resulting from the use of flubromazolam, a designer benzodiazepine purchased from the Internet. A PubMed search was conducted for flubromazolam, designer benzodiazepine, and flumazenil. This article will summarize the available literature regarding flubromazolam and the role of flumazenil in managing these overdoses.Abstract
Fairview Pharmacy Services, part of an academic health system, comprises 35+ outpatient pharmacies in Minneapolis, Minnesota. In 2013, the nonprofit organization opened a satellite location at the University of Minnesota Psychiatry Clinic. The original goals of the service were to improve patient satisfaction and medication adherence through comprehensive pharmaceutical care and clinic provider support. A clozapine monitoring program was envisioned and developed by the pharmacists and now provides optimal medication monitoring, dispensing, and coordination for approximately 100 patients.Abstract
Abstract Type: Work in Progress. Background: Urinary tract infection (UTI) is often considered a common cause of mental status changes, particularly in elderly patients and patients with a primary psychiatric condition. Additionally, the presence of genitourinary symptoms isCreation & Implementation of a Urinary Tract Infection Diagnostic & Treatment Algorithm for Psychiatric Inpatients With a Communication Barrier