Creation of a motivational interviewing-based pharmacy communications course: From dissemination to assessment.

BACKGROUND AND PURPOSE: Pharmacists are frequently faced with evocative patient care conversations surrounding medication taking behaviors and overall health and wellness. Teaching communication is a core focus within pharmacy education; however, there is often less emphasis placed on learning motivational interviewing (MI). We will share challenges and successes associated with the creation and dissemination of a MI-based communications course with pharmacy student learners. EDUCATIONAL ACTIVITY AND SETTING: A fast-paced, five-week, active learning course was created for first-year pharmacy students. Learning activities focused on exploration of ambivalence in clinical practice, roadblocks to active listening, resisting the righting reflex, the spirit of MI, and the core skills of MI. The Motivational Interviewing Competency Assessment was utilized to assess student MI competency at the completion of the course. FINDINGS: This MI-based course has been well-received by pharmacy student learners. It serves as a foundation for communication skills development, as students continue the practice and grow these skills throughout the curriculum. Communication skills assessment and feedback are an integral aspect of MI learning; however, this process does increase the workload of course instructors. A limitation to the global creation of a MI-based course is the reduced number of pharmacy educators who are proficient in training MI. SUMMARY: As the practice of pharmacy and patient care continues to evolve, effective communication skills that include MI, are essential to the provision of person-centered, empathic patient care.

A pilot study assessing client understanding and use of fentanyl test strips for harm reduction.

BACKGROUND: The Centers for Disease Control and Prevention reported a sharp increase in overdose deaths from illicitly manufactured fentanyls (IMFs) occurring between 2020 and 2021 in the United States. Approximately 4 in 10 drug overdose deaths involved opioids and stimulants. Fentanyl test strips (FTS), used to test drug product before use, can be a powerful harm reduction tool to promote safer use behaviors. OBJECTIVES: This pilot study assessed treatment-seeking service users' knowledge and understanding of IMFs and motivation to use FTS to prevent overdose. METHODS: Clients receiving residential-based or office-based substance use treatment services were recruited from a community mental health center in the midwestern United States to complete a harm reduction-focused survey. Eligibility criteria included clients aged 18-89 years with self-reported drug use in the past year. A 20-question survey was administered verbally, both in person and via phone to assess knowledge of IMFs and FTS. RESULTS: Of respondents (N = 30), 80% agreed that IMFs cause more overdoses than heroin. Most (73%) indicated concern about a friend overdosing owing to IMFs, and half (53%) expressed concern about personal risk of overdose. Most (73%) would like to be able to detect whether there is fentanyl in their drug before use, but only 17% indicated that they feel confident in their ability to use FTS. CONCLUSION: Many respondents who were receiving services for past-year substance use lacked understanding of how to use FTS for harm reduction. Clients who primarily use nonopioid (stimulant) drug products are at even greater risk of IMF overdose and would benefit the most from increased access and education surrounding the use of FTS. Our health care system must rapidly continue to explore and expand on overdose prevention efforts, including access to FTS, given that urgent action is needed to reduce the continued rise in overdose deaths in the United States.

Curriculum in Psychiatry and Neurology for Pharmacy Programs.

Objective. To describe pharmacy curricula in psychiatry and neurology and to report on neuropsychiatric pharmacy specialists' views on optimal curriculum. Methods. Design and administer one electronic survey to accredited pharmacy programs asking them to report information on curricula in psychiatry and neurology for the 2014-2015 academic year. Design and administer a separate electronic survey to board certified pharmacists with an academic affiliation who are members of the College of Psychiatric and Neurologic Pharmacists (CPNP) asking about their teaching activities and their opinion on optimal curricula. Results. Fifty-six percent of pharmacy programs and 65% of CPNP members responded to the surveys. The program survey revealed greater than 80% of topics were taught by full-time faculty. Didactic lecturing, team-based learning, and case studies were the most common teaching methods. Programs dedicated the most didactics (3 to 5+ hours) to epilepsy, depression, schizophrenia, substance use disorders, and pain. Autism, traumatic brain injury, personality, and eating disorders were either not taught or given ≤ 1 hour of didactics in most programs. Inpatient psychiatry had the most APPE placements with a mean of 19.6, range 0-83. APPE electives in psychiatry outnumbered those in neurology 5 to 1. CPNP member survey results showed 2 out of 3 members agreed that curriculum could be improved with additional APPEs in psychiatry and neurology. Conclusion. Didactic hour distribution in psychiatry and neurology could be improved to better align with board certification in psychiatric pharmacy (BCPP) recommendations and disorder prevalence and complexity. Specialists recommend an experiential component in neurology and psychiatry to combat stigma and improve pharmacist knowledge and skills.

Tramadol-associated mania: A case report.

A variety of medications, most notably tricyclic antidepressants, and other antidepressants including venlafaxine have been reported to have triggered manic episodes in patients with bipolar disorder. The synthetic opioid tramadol has also been associated with mania activation. This report describes an unusual case of tramadol-associated mania in a patient without a charted diagnosis of bipolar disorder. However, she had a history of two prior episodes of mania following administration of tramadol that were also believed to be related to medication-induced mood disorder rather than underlying bipolar disorder. We hypothesize that tramadol-associated mania may have an underlying mechanism involving monoamine neurotransmission and increased oxidative stress.

A mental health elective to improve pharmacy students' perspectives on mental illness.

OBJECTIVE: To evaluate the impact of a mental health elective on pharmacy students' perceptions and stigmatizing views of mental illness. DESIGN: An elective was designed that featured an advanced overview of psychopharmacology; student training in motivational interviewing; a presentation by the National Alliance on Mental Illness (NAMI) local chapter; introduction to pharmacy collaborations with peer support specialists, social workers, and psychiatrists; mock patient counseling sessions; and a required psychiatric patient interview at a local community mental health center. ASSESSMENT: A survey instrument with 17 Likert-scale items was constructed to measure 2 distinct areas: social distance and stigmatizing views. The survey instrument was administered at the beginning and end of the spring 2010 semester to pharmacy students enrolled in the mental health elective course and to a control group of pharmacy students enrolled in an unrelated clinical elective. The course had a positive impact on pharmacy students' perceptions of mental illnesses. Students' social distance and stigmatizing views of mental illnesses improved, while no significant change in views occurred among students in the control group. CONCLUSION: Advanced training in psychiatric medicine and exposure to mental health care are vital to prepare pharmacy students to provide unbiased, patient-centered care to this population.

Clinical pharmacist interventions on an assertive community treatment team.

Assertive Community Treatment (ACT) is a community-based treatment approach intended to help in the recovery and rehabilitation of clients with severe and persistent mental illnesses. A clinical pharmacist is not routinely a member of an ACT team. The purpose of this study is to demonstrate the role of a pharmacist by reviewing recommendations and interventions made by a clinical pharmacist on an ACT team. Information was gathered through a chart review of clients at Community Alternatives in St. Louis, Missouri. All recommendations and interventions performed by the clinical pharmacist between February 1, 2008 and July 31, 2008 were recorded. A total of 341 interventions and recommendations for 29 clients were completed by the pharmacist. Medication management, medication adjustment recommendations, and mental health assessments were the most frequent interventions. This study suggests a clinical pharmacist can be beneficial to an ACT team and provide diverse services to both clients and other team members.

Psychotropic medication use at a private eating disorders treatment facility: A retrospective chart review and descriptive data analysis.

BACKGROUND: The extent of psychotropic medication use in patients with eating disorders worldwide is unknown. OBJECTIVES: THE PURPOSES OF THIS STUDY WERE TO: (1) describe the extent and pattern of psychotropic medication use at a private treatment facility for patients with eating disorders and (2) describe patient characteristics and treatment outcomes at the facility. METHODS: This retrospective chart review included data from a private treatment facility (inpatient or outpatient) for patients with eating disorders in the greater Los Angeles area. Data from all patients of any age who attended the facility between January 1, 2004, and January 1, 2005, and who met the criteria for anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (ED NOS) defined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision were included. Two investigators used a consistent chart-review method for recording clinical status, including treatment-related adverse effects and discharge status (improved, no change, or decompensated from admission). Improved was defined as meeting 1 or more of the following criteria: achieved ideal body weight, stabilized mood, decreased eating disorder symptoms (binge-purge, restrictive, or ritualistic behavior), eating disorder remission, or decreased suicidal ideation plus another improvement in this list. RESULTS: Data from 60 patients were included (31 with AN, 28 with 13N, and I with ED NOS). Ages ranged from 12 to 47 years, and the mean duration of treatment was 35 days. Fifty-eight (96.7%) patients received a psychotropic agent; 35 (58.3%) patients were prescribed 2 or more agents concomitantly. Selective serotonin reuptake inhibitors (SSRls) were the most commonly prescribed class of psychotropic medication (86.7%), followed by antipsychotics (38.3%). Fluoxetine, escitalopram, and aripiprazole were the most commonly prescribed agents (41.7%, 28.3%, and 23.3%, respectively). A total of 63.3% of patients had a comorbid diagnosis of major depressive disorder, with 96.7% of these patients prescribed an antidepressant. At discharge, 51.6% of the inpatients and 37.9% of the outpatients had improved (AN, 52.6% and 33.3%, respectively; BN, 54.5% and 41.2%, respectively). Of the patients prescribed an SSRI, 40.4% had improved. In the inpatient setting, 35.5% of patients receiving an antipsychotic had improved, versus 6.9% in the outpatient setting. CONCLUSIONS: The results of this retrospective chart review and descriptive analysis of data from patients at a private eating disorders treatment facility in the United States suggest that psychotropics, particularly antidepressants and antipsychotics, were highly utilized, largely to treat comorbid symptoms. Fluoxetine, escitalopram, and aripiprazole were the most commonly prescribed agents. We observed that psychotropic medication selection was based on patient comorbidities and symptom expression and severity.