Bridging Community Mental Health and Primary Care to Improve Medication Monitoring and Outcomes for Patients With Mental Illness Taking Second-Generation Antipsychotics-Phase 2: Quality Improvement Initiative Over 15 Months.

To evaluate the effectiveness of a quality improvement (QI) initiative to improve family medicine residents' metabolic monitoring of second-generation antipsychotics (SGAs) for patients comanaged across nonintegrated community mental health and family medicine clinics. Patients were aged ≥ 18 years seen by family medicine residents and prescribed at least 1 SGA (N = 175). Preparative and scheduled QI interventions were nonblinded and included collaboration across organizations, education, and monthly interprofessional care conferences.

Observed Sex Differences in Cardiometabolic Indices in Patients on Antipsychotics: Secondary Analyses of a 12-Month Multicenter, Randomized, Controlled Trial.

Objective: To define sex differences in cardiometabolic indice changes over 12 months in patients on antipsychotics and to describe treatment complexity, interventions, and patient satisfaction of pharmacist comprehensive medication management (CMM) services.

Methods: Secondary analyses of time effect-associated sex differences in cardiometabolic indices within and between study groups were done at baseline and 12 months. Each group consisted of 60 subjects who received full pharmacist CMM services (PCS) and 60 subjects who received either modified or no CMM services (NCS).

Impact of Interprofessional Care Conferences Across Primary Care and Mental Health Organizations on Family Medicine Resident Learning.

Background And Objectives: Patients with severe mental illness often lack care coordination between primary care and mental health providers which can negatively impact patient outcomes. Team-based care is integral in the effective management of patients with multiple comorbidities, with the family physician central in coordinating holistic care. Family medicine residency programs must provide models of effective interprofessional collaboration and mental health treatment to prepare residents to navigate an evolving health care landscape.

Using pharmacogenomics and therapeutic drug monitoring to guide drug selection and dosing in outpatient mental health comprehensive medication management.

Pharmacogenomic (PGx) testing aided by therapeutic drug monitoring (TDM) has the potential to improve medication-related outcomes in some individuals prescribed psychiatric medications. Many commonly prescribed psychiatric medications are metabolized through polymorphic drug metabolizing enzymes such as cytochrome p450 (CYP) 2D6 (CYP2D6) and CYP2C19. Through PGx testing, clinicians can make biologically informed choices when selecting a new medication, and TDM may help inform dose adjustments or assess exposures to current treatments.

Bridging Community Mental Health and Primary Care to Improve Medication Monitoring and Outcomes for Patients With Mental Illness Taking Second-Generation Antipsychotics-HDC/DFMC Bridge Project, Phase 1: Group Concept Mapping.

Objective: Patients with severe mental illness often lack care coordination between primary care and mental health providers. Siloed patient care across separate health care systems can negatively impact quality and safety of patient care. The purpose of the project discussed in this article is to effectively engage stakeholders from separate primary care and mental health organizations to develop an ideal cross-organization communication system to improve metabolic monitoring for their comanaged patients prescribed second-generation antipsychotics (SGAs).

Awareness of state legislation on naloxone accessibility associated with willingness to prescribe naloxone.

Background: Increasing rates of opioid-related deaths, state naloxone legislation changes, and negativity prompted investigation of predictive factors associated with willingness to prescribe naloxone to populations at risk of overdose, including knowledge of risk factors, assessment of persons at risk, awareness of legislative changes, perceptions of professional responsibility, and confidence around naloxone prescribing and distribution.

Methods: Cross-sectional, Web-based, anonymous, voluntary survey to prescribers of 2 regional health care systems serving urban and rural North Dakota, northern Minnesota, and northwestern Wisconsin. Human subject research was approved by university and health care systems' institutional review boards.

Pharmacogenetic evaluation to assess breakthrough psychosis with aripiprazole long-acting injection: a case report.

Background: Given the complex nature of symptom presentation and medication regimens, psychiatric clinics may benefit from additional tools to personalize treatments. Utilizing pharmacogenetic information may be helpful in assessing unique responses to therapy. We report herein a case of wearing-off phenomena during treatment with aripiprazole long-acting injectable (LAI) and a proof of concept strategy of how pharmacogenetic information may be used to assess possible genetic factors and also hypothesize potential mechanisms for further study.

Serum clomipramine and desmethylclomipramine levels in a CYP2C19 and CYP2D6 intermediate metabolizer.

Pharmacogenetics within psychiatry has the potential to aid in the dose and selection of medications. A substantial number of psychiatric medications are metabolized through either of the highly polymorphic drug-metabolizing enzymes CYP2D6 and CYP2C19. Of these, clomipramine is subject to metabolism by both CYP2C19 and CYP2D6, leaving individuals with deficiencies of these drug-metabolizing enzymes at risk of higher concentrations of the parent molecule.

Twelve-month prospective randomized study of pharmacists utilizing point-of-care testing for metabolic syndrome and related conditions in subjects prescribed antipsychotics.

Objective: Determine the percentage of subjects taking antipsychotics who meet criteria for metabolic syndrome based on point-of-care testing analyses. Evaluate pharmacist comprehensive medication management services using point-of-care tests to reduce the mean difference in number of metabolic syndrome risk parameters at 6 and 12 months.

Method: This 12-month, prospective, multisite, randomized, controlled study included 120 subjects taking antipsychotics (mean [SD] age of 42.

Treatment settings and metabolic monitoring for people experiencing first-episode psychosis.

Monitoring for metabolic sequelae of antipsychotic medications is inconsistent in clinical settings. In this study, frequency of such monitoring in 40 individuals experiencing a first episode of psychosis was analyzed according to the setting in which they received treatment (i.e.

Assessment of a point-of-care metabolic risk screening program in outpatients receiving antipsychotic agents.

Study Objective: To assess the usefulness of a metabolic risk screening program, including point-of-care glucose testing, to quantify baseline metabolic risk in outpatients receiving antipsychotics.

Design: Retrospective, cross-sectional, cohort study.

Setting: University-affiliated department of psychiatry clinic.

Is acetazolamide similar to topiramate for reversal of antipsychotic-induced weight gain?

Acetazolamide (AZD), a sulfa-like moiety, is a potent, nonspecific inhibitor of carbonic anhydrase (CA) enzymes and has been demonstrated to decrease lipogenesis in adipose cells in in vitro cell culture studies. In contrast, topiramate (a sulfamate moiety) appears to inhibit specific (CA) enzymes II and V. Four placebo-controlled trials with topiramate have demonstrated positive results in weight loss.