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Catherine Yao, PharmD

Psychiatric pharmacy preceptors often encounter pharmacy trainees on rotation who may not initially share a strong interest in psychiatric pharmacy, which can undoubtedly be challenging. How can we keep these trainees engaged throughout the rotation? It’s worth noting that many students may not fully grasp the close integration of general medical conditions with psychiatric disorders. To address this, we should find creative ways to emphasize the medical aspects that align with the student’s areas of interest.

Integrating Medicine and Psychiatry in Ambulatory Care 

For students who are interested in ambulatory care, ask them to start an informal “metabolic monitoring clinic” by tracking the metabolic monitoring for all the patients on your roster or panel who are on antipsychotic therapy. Involving students in answering the following relevant questions could help with their engagement: Which labs and monitoring are recommended and when? What antihypertensive and hyperlipidemia medication recommendations can you make based on those labs? Which antipsychotics have the most and least impact on metabolic disturbances? Ask the student to do a medication review specifically to identify the medical conditions that may be impacting a patient’s poor mood (i.e., vitamin D deficiency, hypothyroidism, uncontrolled pain, etc.) and what pharmacists can to do to monitor and treat these conditions. Review and make recommendations on non-psychiatric medications that may be contributing to mood changes (i.e., montelukast, levetiracetam, varenicline). Assess the patient’s other chronic medical conditions to determine whether there are contraindications to certain mental health medications (i.e. seizures and bupropion).

Integrating Medicine and Psychiatry in Acute Medicine

For students who are interested in acute medicine, organize formal and informal topic discussions, case presentations, and in-services on conditions related to psychiatric disorders and medications that they may see on the acute care or intensive care unit. Some examples are Stevens-Johnson syndrome from lamotrigine, serotonin syndrome, neuroleptic malignant syndrome, Wernicke’s encephalopathy, alcoholic cirrhosis, bowel obstruction from clozapine, medication overdoses, etc. Discuss the medications used to manage patients with acute aggression and agitation. Have the student practice antibiotic stewardship for patients with HIV, hepatitis, or skin and soft tissue infections from injection drug use. Focus on the acute monitoring of laboratory, EKG, and vitals required for many mental health medications such as clozapine and mood stabilizers – and what physical manifestations may occur with abnormal lab values.

The Goal of Comprehensive Care

If available at your facility, coordinate with other services that integrate medicine and psychiatry such as an acute psychiatry consult team who evaluates patients on the medicine floor with mental health needs or a team who provides mental health care to primary care patients. If possible, organize a day for the student to shadow these teams to highlight the prevalence and relationship between medicine and psychiatry.

By providing a learning experience that is catered towards the trainee’s interests, they will be more engaged and open to learn. This will help train well-rounded pharmacists who are capable of providing comprehensive care to psychiatric patients – understanding how their conditions and medications may be contributing to primary care or acute care needs, and vice-versa. This approach may decrease stigma around caring for patients with mental illnesses and increase the willingness and comfortability in treating these patients.

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