Bupropion in Comorbid Post-Traumatic Stress Disorder and Methamphetamine Use Disorder.

Background: Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) frequently occur together. Serotonergic agents are preferred medications to treat PTSD, while bupropion is reserved due to limited evidence. Ongoing studies suggest bupropion may be effective for treating methamphetamine use disorder (MUD). Investigators aimed to evaluate if bupropion would confer benefit to patients with Diagnostic and Statistical Manual of Mental Disorders, Fifth edition diagnoses for PTSD and MUD compared to traditional pharmacotherapy. Methods: This report describes four patients with comorbid PTSD and MUD who had a positive response to medication regimens containing bupropion compared to non-bupropion regimens for their trauma symptoms. Investigators were able to compare this to a control group of 41 patients receiving serotonergic agents alone. Case Report: PTSD checklist-civilian scores at time of medication initiation, site discharge, and post-discharge in the bupropion and non-bupropion group were 77, 35, and 29, compared to 51 ± 15, 52 ± 20 and 53 ± 10, respectively. Rates of relapse, average time to relapse, and hospital utilization in the bupropion vs non-bupropion group were 25.0% vs 48.8%, 107 days vs 210 ± 191 days, and 0% vs 29.3%, respectively. Discussion: Use of bupropion showed a greater reduction in PTSD symptom severity and a lower frequency of methamphetamine relapse and hospital utilization. Though missing data limited inclusion of patients in all outcomes, quantitative data suggests benefit with bupropion in comorbid PTSD and MUD. Conclusion: This case series suggests the potential for earlier initiation of bupropion treatment in those with PTSD who have comorbid MUD.

Pharmacist-Driven Alcohol Use Disorder Screening May Increase Inpatient Utilization of Extended-Release Naltrexone: A Single Center Pilot Study.

Individuals with mental illness have a high incidence of comorbid substance use, with one of the most prevalent being alcohol use disorder (AUD). Naltrexone, FDA-approved for AUD, decreases reward associated with alcohol-related social cues. This study aimed to determine if a pharmacist-driven screening tool would increase the use of extended-release naltrexone (XR-NTX) in patients with AUD and a comorbid psychiatric condition. Pharmacists screened and recommended XR-NTX for adults admitted to the inpatient psychiatric unit, who had a DSM-5 diagnosis of AUD, a negative urine drug screen for opioids, and were hospitalized for at least 1 day. Endpoints evaluated included the number of XR-NTX doses administered during the screening period to the prescreening period, 30-day readmission rates, recommendation acceptance rates, and reasons for not administering XR-NTX. Pharmacists identified 66 of 641 screened patients who met the inclusion criteria and were candidates for XR-NTX. Compared to the preintervention period, more patients received XR-NTX for AUD (2 vs. 8). Readmission rates were similar between those with AUD who received XR-NTX and those who did not. Pharmacist-driven screening for AUD led to greater administration of XR-NTX when compared to the same 4-month period the year prior to initiating the study.

Impact of Board Certified Psychiatric Pharmacists on improving urinary tract infection antibiotic appropriateness at an acute psychiatric hospital.

Introduction: Urinary tract infections (UTIs) are one of the most common indications for antibiotic use; patients with psychiatric disorders have a greater risk for UTI compared with patients without these disorders. However, there is little guidance on how best to manage antibiotic therapy in psychiatric hospitals. This study assessed the impact of a Board Certified Psychiatric Pharmacist (BCPP)-driven guideline on managing UTI treatment in an acute psychiatric hospital. Methods: The guideline was developed by the psychiatric pharmacy team and distributed to internists, psychiatrists, and pharmacists. Preintervention data were assessed for patients admitted between November 30, 2019, and February 23, 2020; postintervention data were assessed from February 25, 2020, to April 24, 2020. All patients ages 13 years and older who were admitted and had orders for an antibiotic to treat a UTI were included in this study. Appropriate UTI management was defined as an appropriate agent, dose, route, and frequency per the treatment guideline. Additionally, the following criteria were to be ordered and assessed to be deemed appropriate: urinalysis, urine culture, complete blood count, basic or complete metabolic panel, temperature, and subjective symptoms. Results: Before intervention, 19.0% of antibiotic orders were appropriate; after intervention, 46.7% of antibiotic orders were appropriate (P = .048). Conclusion: The implementation of a BCPP-driven treatment algorithm was associated with a significant increase in appropriate antibiotic regimens for the treatment of UTIs in patients admitted to a psychiatric hospital.

Impact of a pharmacist-driven tardive dyskinesia screening service.

INTRODUCTION: Tardive dyskinesia (TD) is defined as involuntary movements that can develop with prolonged antipsychotic use. Regular monitoring using the Abnormal Involuntary Movement Scale (AIMS) is recommended to be conducted every 3 to 6 months for early recognition, although the AIMS is underused. Several studies have investigated risk factors that may be associated with TD, including age, sex, and long-term antipsychotic use. This study aimed to increase the monitoring and treatment of TD for those assessed to be at higher risk. METHODS: This was a prospective quality improvement study on the effectiveness of a psychiatric pharmacist-driven TD screening service (PPDTSS) in an inpatient psychiatric facility. Participants were composed of adult patients admitted between May and November 2018. Patients were screened daily by a clinical pharmacist and, if determined to be high risk based on studied risk factors, prioritized to receive a formal TD screening via the AIMS. The primary objective was to optimize standard of care by increasing the number of AIMS screenings conducted. The secondary objective was to increase the treatment of TD. RESULTS: A total of 402 patients were assessed prior to implementation of the PPDTSS, and 390 patients were screened following implementation. The PPDTSS increased the number of AIMS screenings attempted by 85.1% for high-risk individuals. Of the 75 patients who had an AIMS screening attempted in the postintervention group, 46 (61.3%) had an AIMS screening completed, of which 3 (6.5%) were positive. DISCUSSION: The results of this study demonstrate that psychiatric pharmacists can be used to improve the regular monitoring of patients at high risk for TD.

Use of Intramuscular Chlorpromazine Versus Intramuscular Olanzapine for the Management of Acute Agitation and Aggression in Youth.

OBJECTIVES: In the inpatient psychiatric setting, one treatment strategy used to manage acute agitation in youth includes administration of IM antipsychotics. The aim of this study was to compare the effectiveness and safety of IM chlorpromazine versus IM olanzapine in treating aggression in youth. METHODS: We conducted a retrospective chart review of patients younger than 18 years hospitalized in the inpatient psychiatric unit who received either IM chlorpromazine or IM olanzapine for acute agitation. Demographic, efficacy, and tolerability data were collected using the electronic health record EPIC. The primary outcome was change from baseline to end point in the Behavioral Activity Rating Scale (BARS) score. BARS was applied retrospectively using nursing and physician documentation to evaluate for clinical response. RESULTS: Among 145 patients who met the inclusion criteria, 72 received IM chlorpromazine, compared with 73 who received IM olanzapine. The mean change in BARS score (before and after IM antipsychotic) was greater with olanzapine (3.58 ± 0.99) than with chlorpromazine (3.07 ± 1.18, p = 0.006). The target BARS score of 4 was achieved more frequently with chlorpromazine (45.8%) than with olanzapine (24.7%, p < 0.008). Coadministration of IM diphenhydramine occurred significantly more often in the olanzapine group than in the chlorpromazine group (71.2% vs 36.1%, p < 0.001). CONCLUSIONS: Management of acute agitation with IM olanzapine resulted in a greater change in BARS score, despite more youth requiring coadministration with diphenhydramine. In comparison, IM chlorpromazine demonstrated a higher likelihood of returning patients to baseline. Study results suggest tolerability of IM chlorpromazine and olanzapine.