The Impact of High-density Lipoprotein Cholesterol (HDL-C) Levels and Risk of Movement Disorders in Patients Taking Antipsychotics.

Introduction: Well-known adverse events of antipsychotics are movement disorders, or extrapyramidal symptoms, such as drug-induced parkinsonism and tardive dyskinesia.

Objective: With new evidence suggesting a link between low high-density lipoprotein cholesterol (HDL-C) and risk of Parkinson's disease, this study sought to investigate if that link also translated to patients taking antipsychotics with low HDL-C and an increased risk for developing a movement disorder.

Design: Adult patients (n=89) at an inpatient state psychiatric facility taking at least one antipsychotic with at least one HDL-C level were assessed for signs of a movement disorder through their history and physical, progress notes, and Abnormal Involuntary Movement Scale (AIMS) score.

Impact of COVID-19 on the Mental Health of Psychiatric Inpatients.

Purpose: The perceptions and responses to acute states of emergency may vary for people experiencing serious mental illness (SMI). Therefore, studying the mental health toll of the COVID-19 pandemic on psychiatric inpatients can inform psychiatric care in the event of future global crises. The objective of this study was to determine if there was a difference in the incidence of mental health manifestations in an adult inpatient state psychiatric facility during the COVID-19 pandemic, compared to the immediately preceding year.

Impact of the Medication Shortages on Psychiatric Patients: Exploring the Consequences of Lorazepam Injection Scarcity.

Objective: This study reviewed the cases of 13 patients in a psychiatric hospital during the 2022 lorazepam injection shortage in the United States (US). The objective was to determine if there were any patterns to the management of the medication shortage of an essential psychiatric medication at a psychiatric hospital.

Methods: A retrospective review of eligible patients who had an order for lorazepam injection prescribed as needed (PRN) between July and October 2022 were divided into, and compared between, two groups: those who had orders permitting continued PRN administration of the medication and those who were discontinued.

Navigating the pharmacologic complexities of QTc prolongation: assessing the cumulative burden in individuals with serious mental illness.

The scientific progress made in the pharmacologic management of serious mental illness (SMI) has been significant. However, the benefits of medication management must continually be weighed against the risks of adverse effects of the agents prescribed. While many medications pose increased danger of QTc prolongation, which may result in malignant arrhythmia and sudden cardiac death, the combination of medications contributing QTc risk can result in an impact of unpredictable pharmacodynamic magnitude.

Exploring the Impact of COVID-19 Vaccination on Patients Taking Clozapine.

Objective: Individuals with serious mental illness (SMI) are recognized to be among the highest risk patients to experience more severe symptoms of COVID-19, not only due to poor baseline health and associated disparity, but also due to medications prescribed to manage their illness that are known to compromise immunity even further. Clozapine, a gold standard antipsychotic used in the treatment for refractory schizophrenia, is considered to be the antipsychotic with the greatest risk of compromising immunity due to its potential to cause blood dyscrasia, including leukopenia and rarely, but potentially, agranulocytosis. The objective of this study is to determine if there is any potential hematological consequence for the use of COVID-19 messenger ribonucleic acid (mRNA) vaccines or the impact of active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients receiving clozapine therapy.

Perceptions and barriers of adverse drug reaction reporting within inpatient state psychiatric facilities.

Introduction: Adverse drug reactions (ADRs) are a leading cause of morbidity and mortality for hospitalized patients. Health care organizations track ADRs to reduce patient mortality, reduce hospital readmissions, decrease costs, and improve patient care. Differing definitions of ADRs cause confusion among providers, leading to hesitation with ADR reporting.

Trends of Adverse Drug Reaction Reports in a Hospitalized Psychiatric Population: Exploring Prescriber Discontinuations as Potential Unreported Adverse Drug Events.

The review of adverse drug reactions (ADRs) is a safety mandate required by numerous organizations in the medication safety community. For adverse reactions to be properly reviewed, they must first be reported as potential events. There are notable challenges to ensure adequate and accurate reporting of ADRs that could be overcome if obstacles were better understood and addressed in a manner that is not punitive or threatening.

Pharmacological and philosophical considerations for the around-the-clock use of scheduled melatonin to promote sedation and reduce aggression in individuals with serious mental illness: a case report.

Melatonin, the endogenous hormone that helps maintain circadian rhythm, has been used exogenously for both primary and secondary sleep disorders. While the effects of melatonin given prior to planned sleep and to restore normal circadian sleep phases have been well studied, there is little information on the use of melatonin as a pharmacotherapeutic intervention for around-the-clock sedation to prevent agitation and aggressive patient behaviors. This is the first case report to our knowledge of melatonin used throughout the day, as a scheduled dose for prolonged treatment duration, to reduce aggression in a patient with severe mental illness.

Challenges associated with treating and preventing antipsychotic-induced constipation: considerations and cautions when prescribing novel interventions.

Antipsychotic-induced constipation is a treatment-limiting side effect for patients with serious mental illness (SMI). In addition to increased risk of constipation, due to adverse medication effects, individuals diagnosed with SMI are also prone to lifestyle factors that contribute to this medical complication. The USA Food and Drug Administration (FDA) recently released enhanced warnings about the risk of serious, sometimes fatal, complications associated with constipation caused by the antipsychotic, clozapine.

The Role of Serum Lithium Concentration on Pill Burden in Psychiatric Populations.

: Current research validates the use of lithium as a first-line agent in bipolar disorder, yet it remains underutilized. This might, in part, be the result of lithium's risk of toxicity. A lower serum lithium concentration would decrease the risk of toxicity.

High-dose Clozapine Withdrawal: A Case Report and Timeline of a Single Potential Withdrawal Seizure.

Clozapine, a second-generation antipsychotic (SGA), is known for its superior efficacy in the treatment of refractory schizophrenia. Clozapine's hallmark side effects are well-known, including, but not limited to, drug-induced seizures associated with daily goal doses greater than 600mg and rapid dose escalation, which can also contribute to significant risk of orthostatic hypotension, bradycardia, and syncope. However, less well-known is the potential withdrawal that can occur from its rapid discontinuation.

Exploring the Effectiveness of Team-based Enablement Interventions to Improve Antibiotic Prescribing within a Psychiatric Hospital.

Antimicrobial resistance threatens the effective prevention and treatment of many types of infections. Infection occurs more frequently in patients diagnosed with psychiatric illness due to a number of risk factors. Urinary tract infections (UTI) are among the most common infections in this patient population.

Impact of Ramadan fasting on medical and psychiatric health.

Ramadan is a religious month dedicated to prayer, fasting and feasting. Recently, there has been an increased interest among healthcare providers regarding possible health-related complications as a consequence of religious fasting such as that seen during Ramadan. In , a 34-year-old female patient with a diagnosis of schizoaffective disorder, depressive type, was admitted for inpatient hospitalization to an inpatient psychiatric hospital in Buffalo, New York.

Exploring the Potential Psychiatric Implications of Astronomical Phenomena.

Our study evaluates the potential psychiatric impact of the full phase of the moon on patients in a state psychiatric hospital in Buffalo, New York, between September 2013 and July 2018. This relationship is presented as the average number of restraints or seclusions (R&S) and code green psychiatric emergencies (CG) recorded 14 days before and 14 days after a full moon. Since the timeframe of the analysis included the August 21, 2017, solar eclipse, we also highlight the correlation between a partial solar eclipse and the number of CG events.

A review and study of aspirin utilization for the primary prevention of cardiovascular events in a psychiatric population.

In April 2016, the US Preventive Service Task Force (USPSTF) updated the aspirin guidelines for the primary prevention of cardiovascular disease (CVD) and colorectal cancer. This review assesses the importance of appropriate use of aspirin for the primary prevention of CVD and, specifically, how individuals with psychiatric disorders may benefit from such use. This study examined how current prescribing practices of aspirin in a state psychiatric hospital align with these new guidelines and how inappropriate prescribing may jeopardize patient safety.

Examining prescriber perceptions of statin therapy and the potential implications these perceptions may have on guideline adherence.

Not all psychiatric inpatients who are candidates for statin therapy are prescribed statin medication. It is unclear whether this is because of prescriber guideline uncertainty or purposeful avoidance because of other reasons. This study aims to determine prescribers' perceptions of recent cholesterol treatment guidelines, and whether their prescribing may be influenced by recent, potentially oversimplified headlines in the media.

Effects of Statins and Cholesterol on Patient Aggression: Is There a Connection?

: Psychiatric adverse effects, including aggression, have been reported with the use of statin medications; however, there is little data to support or refute the theory that statins or low serum cholesterol do in fact increase a patient's risk of aggression. : This study examined 1) statin use and increased aggression, measured by the requirement of either emergent psychiatric intervention referred to as "Code Green" (CG) or "Restraint and Seclusion" (RS) and 2) cholesterol level and increased aggression in psychiatric inpatients. : Patient charts from January 1, 2011, to December 31, 2015 were reviewed.

Introduction to pseudobulbar affect: setting the stage for recognition and familiarity with this challenging disorder.

Pseudobulbar affect (PBA), despite its prevalence and distinctive symptoms, is widely underrecognized and undertreated. It is characterized by uncontrollable laughing or crying that can occur in an exaggerated manner or inappropriately to a given situation or stimuli. PBA is thought to center around preexisting neurological conditions, which include Parkinson disease, multiple sclerosis, amyotrophic lateral sclerosis, Alzheimer disease, traumatic brain injury, and stroke.

Implications of infection and trends of antibiotic prescribing in hospitalized patients diagnosed with serious mental illness.

Hospital-acquired infections have been recognized as a significant factor in increased morbidity and mortality across our health system. Unique to infections associated with inpatient psychiatric hospitalization is the additional hypothesized association of the role that antipsychotic agents and/or underlying disease may play in an increased risk for infection. In this paper, we explore the types of infections diagnosed in an inpatient psychiatric hospital, the demographics of the patients infected, and whether or not the patient was on antipsychotic agents at the time of infection.

Physician Prescribing Practices of Vitamin D in a Psychiatric Hospital.

Vitamin D supplementation has become an increasingly popular prescribing practice, despite our limited knowledge of both the definition and degree of deficiency as well as the expected benefits or risks of exogenous administration. Many of the hypothesized benefits of vitamin D supplementation include a variety of improvements in mental health; however, these claims are not consistently or robustly supported by current research. In this paper, we provide a brief overview of what is currently known about vitamin D deficiency and about outcomes of supplementation as well as a summary of the data relative to prescribing practices for inpatients in an urban psychiatric hospital.

Maximizing clozapine utilization while minimizing blood dyscrasias: evaluation of patient demographics and severity of events.

The aim of this study was to determine whether patient characteristics such as age, sex, race/ethnicity, and frequency of monitoring play a role in clozapine-related blood dyscrasias. This study examined all neutropenic events to identify any potential demographic qualities that may pose increased risk to individuals receiving clozapine treatment in accordance with the FDA guidelines released in 2005. These guidelines required the addition of absolute neutrophil count (ANC) tests in addition to white blood cell (WBC) counts to regular monitoring and a reduction in the frequency of testing to once monthly after 1 year of satisfactory WBC counts and ANCs.

Exploring the potential effect of polypharmacy on the hematologic profiles of clozapine patients.

Introduction: Clozapine, an atypical antipsychotic with documented efficacy in the management of treatment-resistant schizophrenia, is associated with the risk of adverse hematological outcomes. Of particular concern are reductions in white blood cells (WBC) and absolute neutrophil counts (ANC). Individuals who display moderate leukopenia (3000/mm(3) > WBC ≥ 2000/mm) upon initiation of clozapine therapy are at increased risk of developing agranulocytosis, defined as an ANC less than 500/mm.

Pseudoephedrine for the treatment of clozapine-induced incontinence.

Clozapine, the first atypical antipsychotic, is well known for superior efficacy in the treatment of refractory schizophrenia. Though the side effect most often associated with clozapine is the potential for causing blood dyscrasias, other lesser known side effects, including clozapine-induced incontinence, may result in the unnecessary discontinuation of this essential psychiatric medication in patients who otherwise have no alternative to treatment. Here we describe a case of pseudoephedrine used successfully as a therapeutic intervention for clozapine-induced incontinence.

Hematologic impact of antibiotic administration on patients taking clozapine.

Objective: The purpose of this study was to determine if the drop in white blood cell/absolute neutrophil count for clozapine patients on antibiotics is a normal response to the resolution of infection or if the concurrent administration resulted in an abnormal drop in blood counts and further reduction of white blood cell/absolute neutrophil below baseline prior to infection.

Design: This was a retrospective record review of all patients who received clozapine and antibiotics concurrently between June 30, 2010, and June 30, 2011.

Setting: Subjects included inpatients on clozapine therapy at a state psychiatric facility.