What Clinicians Need to Know About Antipsychotic Pharmacy Lauren - - PowerPoint PPT Presentation
What Clinicians Need to Know About Antipsychotic Pharmacy Lauren Hanna, M.D. and Delbert Robinson, M.D. Northwell Health National Council for Behavioral Health Montefiore Medical Center Northwell Health New York State Office of Mental Health
Lauren Hanna, M.D. and Delbert Robinson, M.D. Northwell Health
National Council for Behavioral Health Montefiore Medical Center Northwell Health New York State Office of Mental Health Netsmart Technologies
antipsychotic polypharmacy.
polypharmacy and which do not.
What is your primary role in your organization?
significant medical or substance history is diagnosed with first episode psychosis after experiencing symptoms of auditory hallucinations and referential delusions daily for the past month. He is prescribed risperidone but has no insight into his illness and
What is the most likely reason the antipsychotic is ineffective for treating the psychosis?
A. This particular antipsychotic is not effective for this particular patient. B. This patient is likely a non-responder to all antipsychotic medications. C. This patient was not treated with an adequate dose of antipsychotic medication to accurately judge its effectiveness. D. This patient was not treated for a sufficient length of time to accurately judge the antipsychotic medication’s effectiveness. E. This patient was not taking the antipsychotic consistently enough to accurately judge the medication’s effectiveness.
adherence.
poor response due to sub-optimal adherence.
therapy1
medication adherence2
prescribed)3
9
What is the most likely reason the antipsychotic is ineffective for treating the psychosis?
A. This particular antipsychotic is not effective for this particular patient. B. This patient is likely a non-responder to all antipsychotic medications. C. This patient was not treated with an adequate dose of antipsychotic medication to accurately judge its effectiveness. D. This patient was not treated for a sufficient length of time to accurately judge the antipsychotic medication’s effectiveness. E. This patient was not taking the antipsychotic consistently enough to accurately judge the medication’s effectiveness.
good prior treatment response to olanzapine is admitted for decompensation of symptoms after his insurance changed a few months ago and he was not able to continue with his most recent
due to a long waiting list. Once he meets the psychiatrist there, despite taking the olanzapine 5mg daily (getting refills from Emergency Departments in the interim) he is still significantly symptomatic.
What is the most likely reason the antipsychotic is ineffective for treating the psychosis?
A. This particular antipsychotic is not effective for this particular patient. B. This patient is likely a non-responder to all antipsychotic medications. C. This patient was not treated with an adequate dose of antipsychotic medication to accurately judge its effectiveness. D. This patient was not treated for a sufficient length of time to accurately judge the antipsychotic medication’s effectiveness. E. This patient was not taking the antipsychotic consistently enough to accurately judge the medication’s effectiveness.
started on an antipsychotic medication after psychiatry is consulted while she is hospitalized for a minor medical procedure. She is started
long-acting injectable antipsychotic of paliperidone and thought started on the recommended maintenance dose, is increased over the next 4 months due to non-response of her symptoms to treatment.
What is the most likely reason the antipsychotic is ineffective for treating the psychosis?
A. This particular antipsychotic is not effective for this particular patient. B. This patient is likely a non-responder to all antipsychotic medications. C. This patient was not treated with an adequate dose of antipsychotic medication to accurately judge its effectiveness. D. This patient was not treated for a sufficient length of time to accurately judge the antipsychotic medication’s effectiveness. E. This patient was not taking the antipsychotic consistently enough to accurately judge the medication’s effectiveness.
from paliperidone LAI to olanzapine and transitioned to its LAI formulation, her symptoms still do not respond despite another 2 months on the new medication.
What is the most likely reason the antipsychotic is ineffective for treating the psychosis?
A. This particular antipsychotic is not effective for this particular patient. B. This patient is likely a non-responder to all antipsychotic medications. C. This patient was not treated with an adequate dose of antipsychotic medication to accurately judge its effectiveness. D. This patient was not treated for a sufficient length of time to accurately judge the antipsychotic medication’s effectiveness. E. This patient was not taking the antipsychotic consistently enough to accurately judge the medication’s effectiveness.
when changing from one antipsychotic to another due to poor response or inability to tolerate side effect.
Dose/ Level
Dose/ Level
Dose/ Level
RED closed line: Initial antipsychotic dose GREEN closed line: New antipsychotic dose Dotted Line: Antipsychotic plasma concentration *Stepwise start with partial D2 agonist with lower starting dose recommended
Adapted from: Correll CU. J Clin Psychiatry 2006;67(1):160-1
4-5 half lifes % % % Days Days Days
intravenous injectable options.
such as inpatient medical or psychiatric hospitals in order to acutely treat dangerous behavior for patients who are not able or willing to take the medication by mouth.
Byerly et al 2007
assigned patients with schizophrenia and risperidone-induced hyperprolactinemia to…
10mg/day (n=29), or 20mg/day (n=30) added on to fixed dose risperidone treatment.
weeks.
the 5mg/day group.
variety of antipsychotics and is doing well with their current antipsychotic except for symptomatic hyperprolactinemia
difficult
formulations: aripiprazole monohydrate or aripiprazole lauroxil)
An adequate trial of an antipsychotic in first episode psychosis is 12 – 16 weeks A patient should have 2 subop
tipsychotic tri trials of maxi ximized dose
t lea least t 6 weeks duration before their illness is considered treatment refractory. One of these trials id idea eally ly shou
e with ith an LA LAI to rule out non-response due to poor adherence Aft fter 2 failed iled tri trials, the next recommendation is clo clozapine It is important to give clozapine sufficient time to work (can expect positive response within 3 months, but trial of 1 year of monotherapy is appropriate). For su subo boptimal trea treatment with ith clo clozapi pine, ECT is is re recommende ded to augment treatment. Usin ing g more th than 1 antip tipsychotic doe
Event Date and Time Health Information Technology and Behavioral Health Performance Metrics Wednesday, May 28 from 1:00-2:00pm Practitioner Interventions: Assessing, Documenting and Addressing Medication Non-Adherence Thursday, May 29 from 12:00-1:00pm Organizational Practices and Policies to Support Medication Adherence Tuesday, June 11 from 12:00-1:00pm
Lauren Hanna, M.D. LHanna1@northwell.edu The Zucker Hillside Hospital Northwell Health Delbert Robinson, M.D. drobinso@northwell.edu The Zucker Hillside Hospital Northwell Health
The project described was supported by Funding Opportunity Number CMS-1L1-15-003 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. Disclaimer: The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.