Virtual CPNP 2020 Self-Study Sessions

As the opioid epidemic continues to affect patients and families across the United States, it is imperative health care professionals continue to work towards effective and lasting treatment for patients with opioid use disorder (OUD). Ongoing stigma and lack of education contributes to less than optimal care for those with OUD. Initiating medication assisted treatment (MAT) in an inpatient or emergency department setting and transitioning patients to office-based treatment upon discharge may improve treatment retention.

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CPNP members share their experiences dealing with clinical problems. Pearls include an esketamine clinic, pain management and buprenorphine, and haloperidol as a non-opioid alternative in the ED.

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Research suggests that although alterations of central monoamines might contribute to the generation of depressive states, they do are not necessarily the primary cause of depression. Treatment resistant depression occurs in at least 15–30% of major depressive disorder cases, and in the post-partum depression population, remission rates remain low. Currently available antidepressants require 4-6 weeks of administration prior to the onset of therapeutic efficacy, during which time patients continue to experience symptoms of depression and suicidal ideation.

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E-cigarette use has been increasing among adults and adolescents since these products were introduced to the United States in 2007. The e-cigarettes market-place has rapidly evolved due to targeted marketing and studies on multiple aspects of e-cigarette use are being published faster than those in health care can assess their importance to clinical practice Given these changes in the products being used and what is known about them, it is important for pharmacists and other health care providers to stay current on emerging data regarding e-cigarettes.

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Psychiatric and neurologic pharmacists are frequently asked about evaluating toxicological test results. Unfortunately, post-mortem medication levels do not correlate with those observed in living individuals. This requires additional knowledge about what fluids and/or tissues should be tested based on the suspected substance. This program will provide an overview of the challenges of post-mortem/forensic toxicology, while also reviewing established references, and the challenges of detecting novel psychoactive substances.

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Long-acting injectable antipsychotics are commonly prescribed in community and inpatient mental health settings. While there is a great deal of evidence regarding their place in therapy and recommended dosing/administration/monitoring, there is less evidence available that focuses on real world scenarios and what to do after recommended dosing/administration/monitoring has not been followed.

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In the US, deaths due to suicide and unintentional overdose are on the rise and pose an urgent public health concern. In 2017, over 40% of suicide and overdose deaths, so-called “Deaths of Despair”, were due to opioids. This represents a 2-1/2 fold increase from 17% in 2000.¹ Pain alters neurocircuitry and increases the risk of suicide, which may be unknown to many psychiatric pharmacists. There are several key shared risk factors and prevention approaches that should be known by psychiatric pharmacists.

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Several clinical conditions and substances can produce symptoms of psychosis that mimic the clinical presentation of schizophrenia and other mental illnesses. There is ongoing debate in the medical literature about a “standard” medical work-up for patients presenting with first-episode psychosis (FEP). Extensive medical work-up can be potentially expensive and traumatic for the patient, especially for children presenting with psychosis.

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Suicide is the 10th leading cause of death in the United States resulting in more than 47,000 deaths in 2017, or about one death every 11 minutes. Suicide rates vary by race/ethnicity, age, and other population characteristics, and there are more than 120 prescription drugs with labeling that includes language about suicidal ideation or behavior. There is a great need for widespread education about suicide awareness and prevention and for health care entities to adopt a collaborative approach to the problem.

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Attention deficit/hyperactivity disorder (ADHD) is one of the more common psychiatric diagnoses within the pediatric population. While rates may decline with age, a large percentage of these individuals will continue to meet criteria for diagnosis in adulthood.

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The most recent guidelines for the monitoring and treatment of patients with antipsychotic-related metabolic side effects were published in 2005 Since then, there have been many changes to metabolic disorder treatments and new antipsychotics have become available. While the disease states comprising metabolic disorder may each have relevant guidelines, it is important to understand how to treat these issues in the context of mental illness. Health care providers should also be aware of the risks of metabolic syndrome associated with various antipsychotic medications.

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