Effect of cannabis use on PTSD treatment outcomes in veterans.

Introduction: Researchers have found anandamide (an endocannabinoid) and cannabinoid type 1 receptor activation encourages extinction of aversive memories. Some theorize cannabinoids such as those in cannabis may provide a new treatment approach for PTSD, while others suggest it may worsen symptomology. The objective of the current study was to determine if cannabis use impacts the success of evidence-based intensive outpatient PTSD treatment in a veteran population.

Effectiveness of a clinical decision-support tool on adherence to prescribing and practice guidelines of high-risk antidepressant medications in geriatric patients.

Introduction: TCAs and paroxetine, a SSRI, are associated with safety risks in geriatric patients because of anticholinergic properties. The purpose of this project was to evaluate the impact of a clinical decision-support tool (CDST) on adherence with medication prescribing and practice guidance to enhance patient safety.

Methods: Mental health clinical pharmacy specialists and clinical pharmacy leadership led a multidisciplinary creation and integration of a CDST within a Veterans Health Administration EHR.

Impact of marketing to improve patient access to care and clinic utilization for clinical pharmacy specialists.

Introduction: This quality improvement initiative aimed to implement a strategy to increase access to care with clinical pharmacy specialists (CPSs), optimize CPS direct patient care activities, and promote clinical pharmacy services. The primary objective was to assess the impact of patient marketing on expanding access to care and clinic utilization in a CPS clinic.

Methods: A marketing technique was applied by a mental health (MH) CPS to expand clinical pharmacy services.

Prazosin Outcomes in Older Veterans With Posttraumatic Stress Disorder.

Even at relatively high dosages, prazosin was well tolerated and significantly improved posttraumatic stress disorder severity and related nightmares in an older patient population.

Perceived Barriers and Facilitators of Clozapine Use: A National Survey of Veterans Affairs Prescribers.

Although health care providers report that the frequent laboratory monitoring requirement is an unavoidable concern, other barriers, such as logistical concerns and the administrative burden that accompanies clozapine use, can be addressed.

Drug treatment strategies for depression in Parkinson disease.

Introduction: Depression is a common non-motor symptom in Parkinson disease (PD), occurring in approximately 20% of patients with PD. While depression can occur anytime in the disease process, it predates PD diagnosis in about 30% of patients. Between 20% and 60% of depressed patients with PD are either without recognition or treatment of their depression.

Comparison of clozapine monitoring and adverse event management in a psychiatrist-only and a clinical pharmacist-psychiatrist collaborative clinic.

Introduction: In an effort to establish clinical support for providers prescribing clozapine and to help reverse the national decline in clozapine utilization, a clinical pharmacist began seeing half the clozapine clinic patients, preceding the psychiatrist, at this facility in July 2017. The other half of the clozapine clinic patients continued being seen by the psychiatrist only. The purpose was to determine the impact of the pharmacist on clozapine management and identify barriers to clozapine use to potentially increase its utilization.

An Overview of Pharmacotherapy Options for Alcohol Use Disorder.

Clinical trials have found a number of pharmacotherapy options to be effective, but despite the need and the proven benefits, the use of pharmacotherapy remains low.

Propranolol for mirtazapine-induced akathisia: Single case report.

Despite psychomotor restlessness and akathisia being an occasionally reported side effect of antidepressants as a class, and mirtazapine specifically, there is no general consensus on the best treatment approach. Propranolol may prove to be an effective treatment approach in patients who are not candidates for alternative therapies.

Clozapine-induced myocarditis: Two case reports and review of clinical presentation and recognition.

Myocarditis is a potentially fatal cardiac disease marked by inflammation of the heart muscle. With a noted black-box warning, rates of clozapine-induced myocarditis are reportedly as high as 3%. Since the first case of clozapine-induced myocarditis was documented in 1994, more than 250 cases have been described in literature with an approximate 33% case-fatality rate.

Rechallenge of lamotrigine after development of rash.

Lamotrigine (LTG) is associated with the potential for a life-threatening rash (eg, Stevens-Johnson syndrome or toxic epidermal necrolysis). The incidence has been linked to rapid titration and an interaction with valproic acid that can increase the level of LTG. Providers often have difficulty discriminating between serious versus benign rashes, and the package insert recommends discontinuing the medication at the first sign of a rash.

Integrating a mental health clinical pharmacy specialist into the Homeless Patient Aligned Care Teams.

Introduction: To address the complex needs of the homeless veteran population, the US Department of Veterans Affairs created the Homeless Patient Aligned Care Team (H-PACT) model. The South Texas Veterans Health Care System has an established H-PACT model, however it does not include a clinical pharmacy specialist in mental health (MH).

Methods: An H-PACT MH pharmacy resident clinic was created and managed by a postgraduate year-2 psychiatric pharmacy resident.

Evaluating psychiatric outcomes associated with direct-acting antiviral treatment in veterans with hepatitis C infection.

Introduction: Approximately 70% of veterans with hepatitis C virus infection have at least one psychiatric illness. The advent of direct-acting antiviral (DAA) therapy provided an alternative to interferon-alpha regimens and revolutionized treatment, however, the extent of psychiatric effects attributed to these agents are unclear. The primary objective of this pilot study was to prospectively analyze psychiatric outcomes, specifically depression, in veterans with hepatitis C virus infection who are initiated on DAA therapy.

A retrospective chart review of opioid represcribing following nonfatal overdose at a Veterans Affairs hospital.

Introduction: Opioid-related overdoses have risen despite extensive media coverage and apparent awareness of this public health crisis. Emergency department visits related to opioid use nearly tripled from 2004 to 2011. Patients with mental illness are more likely to be prescribed opioids and have higher rates of overdose.

Mental health pharmacists as interim prescribers.

Introduction: Turnover leading to fluctuations in prescriber availability presents many challenges, most notably in access to and continuity of care. In 2015, the Veterans Affairs Eastern Colorado Healthcare System (VA ECHCS) experienced a period of significant mental health prescriber turnover leading to patient utilization of psychiatric emergency services (PES) for nonemergent medication management. The resulting increase in volume placed excessive stress on PES prescribers.

Impact of a mental health clinical pharmacist on a primary care mental health integration team.

Introduction: Primary care mental health integration (PCMHI) teams function to improve access and quality of integrative physical and mental health (MH) care through a stepped care treatment approach. The project's primary objective was to evaluate the impact a PCMHI clinical pharmacist made on treatment outcomes and interventions. The secondary objective was to assess medication adherence rates.

Cardiometabolic management in severe mental illness requiring an atypical antipsychotic.

Introduction: Cardiometabolic management was evaluated in patients with diabetes and a severe mental illness that require treatment with an atypical antipsychotic.

Methods: Seventy-four patients with diabetes and a severe mental illness treated with an atypical antipsychotic from the Fargo Veterans' Affairs Health Care System were included in this retrospective study. Primary end points analyzed the change in hemoglobin A1c (Hgb A1c), blood pressure, and low-density lipoprotein (LDL) cholesterol 12 months prior to and 12 months following the initiation of an atypical antipsychotic.

Hospitalization Risk With Benzodiazepine and Opioid Use in Veterans With Posttraumatic Stress Disorder.

Combat veterans with PTSD who are prescribed benzodiazepines and/or opioids in addition to first-line pharmacotherapy are at significantly increased risk for hospitalization.

Anti-NMDA receptor encephalitis: An emerging differential diagnosis in the psychiatric community.

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a new diagnosis, as recent as 2007, that develops as a result of autoantibodies to the NMDA receptor. The clinical manifestations of the disorder include complex psychiatric symptoms, seizures, movement disorders, cognitive dysfunction, and autonomic instability. Tumor resection, if present, and immunotherapy are the mainstays of therapy.

The Overdose Education and Naloxone Distribution Program at a VA Hospital.

A pilot program was developed to distribute naloxone kits, educate patients on opioid use risks, and reduce the number of overdose deaths.