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1.
Clin Ther ; 45(10): 1008-1011, 2023 10.
Artículo en Inglés | MEDLINE | ID: mdl-37567844

RESUMEN

Deprescribing, the identification and discontinuation of medications that are no longer indicated or that cause adverse effects that outweigh clinical benefit, relies on the integration of clinical expertise and patient values using shared decision making (SDM). This case series describes the application of SDM to the process of deprescribing in patients with serious mental illness, illustrating the ways in which SDM builds a therapeutic alliance between patient, psychiatrist, family members, and other health care professionals to collaboratively develop treatment plans.


Asunto(s)
Deprescripciones , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Esquizofrenia , Humanos , Esquizofrenia/tratamiento farmacológico , Toma de Decisiones Conjunta , Personal de Salud , Toma de Decisiones , Participación del Paciente
2.
Ann Clin Psychiatry ; 33(2): 80-92, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33878282

RESUMEN

BACKGROUND: Long-term prescribing of anticholinergic medications (ACM) for antipsychotic-associated extrapyramidal symptoms (EPS) is not recommended, yet is widely prevalent. Adverse effects of ACM include memory impairment, dry mouth, constipation, blurred vision, urinary retention, and tachycardia, which can seriously impact quality of life. This quality improvement deprescription project sought to reduce chronic ACM use in patients with serious mental illness (SMI). METHODS: Education directed at psychiatrists combined with clinical pharmacy support for deprescription was used to target clinically stable patients diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder with no EPS and ACM prescriptions of ≥6 months. Scales were used to assess anticholinergic adverse effects, memory impairment, and quality of life. ACMs were tapered and discontinued over 1 to 6 months. RESULTS: More than 75% of targeted patients successfully tapered or discontinued ACM, which coincided with significant improvements in anticholinergic adverse effects, memory impairment, and quality of life. Approximately 10% of patients were restarted on ACM for re-emergent EPS. CONCLUSIONS: For most clinically stable patients with SMI without EPS, our findings suggest that gradual deprescription of chronic ACM is clinically appropriate, well tolerated, and improves quality of life. A randomized trial could provide more definitive answers.


Asunto(s)
Antipsicóticos , Deprescripciones , Esquizofrenia , Antipsicóticos/efectos adversos , Antagonistas Colinérgicos/efectos adversos , Humanos , Calidad de Vida , Esquizofrenia/tratamiento farmacológico
3.
J Clin Psychiatry ; 78(9): e1270-e1275, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29178683

RESUMEN

OBJECTIVE: Anticholinergic medications are prescribed to treat extrapyramidal side effects (EPS) associated with antipsychotics. Anticholinergic medications cause several side effects and can often be withdrawn during the maintenance phase of antipsychotic treatment without EPS reemergence. The purpose of this quality improvement (QI) project was to reduce anticholinergic medication burden and improve quality of life in patients with severe mental illness. METHODS: Patients with DSM-IV-TR-diagnosed schizophrenia, schizoaffective disorder, and bipolar disorders in an outpatient psychiatric clinic who were prescribed benztropine were identified, screened for anticholinergic side effects by the treating psychiatrist, and referred to an on-site clinical pharmacist for a comprehensive medication review. Anticholinergic side effects, cognitive impairment, and impact on quality of life were assessed using a Likert scale. Recommendations for potential medication changes were discussed with the prescriber. Initial and follow-up assessments were conducted over 1-8 months to identify improvements in side effects and quality of life. RESULTS: Twenty-nine patients were assessed from November 2014 to December 2015. Patients were receiving from 1 to 6 medications with anticholinergic properties (median = 3 medications). Of the 29 patients, 19 were recommended for a medication change, with 13 having 1 or more anticholinergic medications discontinued and 6 having the dose decreased. A significant reduction in anticholinergic side effects and improvements in memory and quality of life were observed for these patients (P ≤ .05). CONCLUSIONS: In this interdisciplinary, collaborative QI project, patients whose anticholinergic burden was reduced experienced a significant improvement in side effects, memory, and quality of life.


Asunto(s)
Antipsicóticos/efectos adversos , Enfermedades de los Ganglios Basales/tratamiento farmacológico , Trastorno Bipolar/tratamiento farmacológico , Antagonistas Colinérgicos/uso terapéutico , Trastornos Psicóticos/tratamiento farmacológico , Adulto , Anciano , Antipsicóticos/uso terapéutico , Enfermedades de los Ganglios Basales/epidemiología , Costo de Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Mejoramiento de la Calidad , Calidad de Vida
4.
Am J Pharm Educ ; 76(2): 28, 2012 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-22438600

RESUMEN

OBJECTIVE: To compare 3 strategies for pharmacy student learning of motivational interviewing skills, knowledge of motivational interviewing principles, and confidence in and attitudes toward their application. DESIGN: Following a motivational interviewing lecture, first-year students were randomized to perform practice activities (written dialogue, peer role-play, or mock-patient counseling activities). Motivational interviewing skills, knowledge, confidence, and attitudes were measured. ASSESSMENT: All students demonstrated improvement in skills, knowledge, and confidence. Students in the mock-patient counseling group demonstrated significantly better motivational interviewing skills during practice and trended toward higher scores on the summative evaluation. They also demonstrated a significant improvement in knowledge compared with that of the written dialogue group during practice. Feedback at the end was generally positive, with students expressing recognition for the value of motivational interviewing. CONCLUSIONS: Students demonstrated their best performance of motivational interviewing during assessments using interactions with mock or standardized patients.


Asunto(s)
Educación en Farmacia/métodos , Conocimientos, Actitudes y Práctica en Salud , Motivación , Aprendizaje Basado en Problemas , Estudiantes de Farmacia/psicología , Curriculum , Método Doble Ciego , Evaluación Educacional , Humanos , Aprendizaje , Relaciones Profesional-Paciente
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