Improving Adherence in Patients with Mental Health Disease

Contributed by: Phi Delta Chi

Bipolar disorder is a disease that is characterized by changes in mood, energy, activity, and the ability to carry out day-to-day tasks.  There are four categories of Bipolar Disorder; Bipolar 1, Bipolar 2, Cyclothymic Disorder, and other.   Patients with Bipolar Disorder experience periods of manic and depressive symptoms.  These symptoms can even mix of emotions such as feelings of hopelessness in depressive episodes or episodes of high energy and irritability in manic states.  Schizophrenia, another mental disorder, is a chronic and severe disease that affects how a person thinks, feels, and behaves.  Schizophrenic patients can experience a wide variety of symptoms.  These symptoms can range from hallucinations, delusions, reduced feelings of pleasure, speaking, and trouble focusing and paying attention.

Abilify, otherwise known as Aripiprazole, is a medication that is indicated for Bipolar Disorder and Schizophrenia.  Abilify is a second generation anti-psychotic. This class is defined by the ability to block serotonin release and increases dopamine levels in the neuronal synapse.  Patients who take Abilify have reported such side effects as nausea, vomiting, constipation, headaches, dizziness, uncontrollable body movements, anxiety, insomnia, restlessness, and weight gain.  Abilify can increase the risk of death in elderly patients with dementia-related psychosis.  It can also increase the risk of suicidal ideation in children, adolescents, and young adults.

The FDA has recently approved the release of the digital ingestion tracking system for Abilify.  The Abilify MyCite has an ingestible sensor within the pill that records the time at which the medication was taken.  The patient wears a patch that sends information from the sensor to a phone.  This information can be sent to the primary provider as well.  The information feedback from the Abilify MyCite could revolutionize the way both providers and patients understand their medications and increase compliance.

The Abilify MyCite has not provided information about patient compliance but this can be used to track drug ingestion in “real time” or during an emergency due to delayed detection.  The implied benefits of using the Abilify MyCite is that it should increase patient compliance.  Patients would be more compliant because providers would be able to see if the patient is taking their medications regularly.  By allowing providers the ability to see in real time the compliance and how the medications are being taken could help patients minimize side effects and allow the best individualized care for each patient.

 

 

References

https://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/6384#f_pharmacology-and-pharmacokinetics

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm584933.htm

https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

https://www.abilifymycite.com/

A Sensitive Subject

Contributed by: NCPA

Going into Fall 2017, NCPA Student Chapter at the University of Charleston School of Pharmacy underwent a major transition in leadership.  This somewhat impacted our organizations extent of involvement in participating and assisting with events thus far.  Although off to a rocky start, our organizations progress and development culminated into assisting with the Remote Area Medical (RAM), a volunteer corporation.  It is a mobile clinic that provides free services such as prevention/screenings, medical, dental, vision, and education to patients interested in signing up.  This event took place on Saturday and Sunday, October 21st-22nd at the Bible Center School in Charleston, WV.  NCPA collaborated with the PDC organization to help screen over 90 people during this event.  About 15 total volunteers were involved in this aspect of screening. The event turned out to be a great success all around, along with our particular organization being able to offer help to a vast patient population.

NCPA primarily assisted with administering finger sticks to patients interested in being tested for Hepatitis C. It is known that Hep C is a serious concern, especially in this Charleston area and surrounding rural areas, due to the high incidence of drug abuse and injection drug users.  These screenings are essential in identifying patients who may need referred so to receive proper treatment and also crucial in terms of preventing the spread of Hep C and concern for public health safety. Our advisor was in charge of actually reading the results, however, our volunteers had the opportunity to ask each patient to fill out a form for the test they were requesting.  Then we’d just sit down with the patient and make small talk in order to make them feel more comfortable.  This was the chance to inquire about which finger they’d prefer us to use.  We also informed the patient that this test was not intended to be diagnostically conclusive.  We further explained, that it was just a preliminary test, for which the results could indicate to us who should be referred for further assessment.  This event led to us only referring a handful of patients.

In conclusion, this event provided the opportunity to hone our skills as future pharmacists in communicating with many different patients who may be uncomfortable with a situation or a conversation.  This helped us learn how to gently approach these types of topics which are sure to arise in future pharmacy practice.  We can help patients feel at ease in hopes they may provide us with more information so that we can provide them with optimal care.  As future pharmacists, we will encounter sensitive situations on a daily basis and need to be prepared to handle these times with composure and sensitivity.  This experience also strengthened our organization as a whole in providing us with skills in assisting with events.  In addition, this learning process provided us with structure in preparing for a greater involvement in future events.

Progression of Mental Health

As with any other factor in life we grow and learn from our past mistakes. Mental health is a stigmatized concept that needs to be put in the forefront of current day medicine for the country to see a change in its population. The stigma has been around for countless years and often deters people from seeking help in their times of need. Mental health has seen some rough days where we were unsure of the treatment for such patients and often had a lack of understanding of what was happening in their minds. As a society, we have reflected and today are remarkably better than were we once were.

Starting back in the ancient times to middle ages we can see that mental illness was looked at to be a serious problem. Persons would often be considered to be possessed. In these cases, it was often a priestly duty to perform treatments on the individuals. Treatments ranged from drilling holes in the head to release the demon or beating the patient. Hippocrates was unlike the rest and treated the mentally ill with medicines or changing the patients work/environment. This is the only logical treatment from back in those days that would still be used today in some instances. Coming from a modern-day standpoint we know that none of these allegations of superstition were truthful in nature and we now understand the causes of many psychiatric problems.

Taking a look at the treatment options more in depth will show how we have progressed rapidly in the last couple hundred years. Previously we mentioned the religious healing of patients and the occasional use of drilling holes in the head. As a society, we now know this is not acceptable. We progressed from this to utilizing techniques such as electric shock therapy. The technique was used heavily before and is still used today but under much safer conditions. Another therapy option was the use of hydrotherapy where the patient was submerged head deep in hot water and wrapped in a blanket and left to soak. Evidence is lacking for support of this option but there is no harm to the patient with this treatment. A major surgery performed on patients was often a lobotomy and that has since been made illegal in our country. The lobotomy separated the brain in half and left the patient in an emotionless state. Persons could often die from this surgery or other complications arose. In current day treatments, we use prescription drugs that affect the neurotransmitters in the brain to actively control mental diseases and sometimes we use older therapies such as electric shock in conjunction for additional support.

Another major progression through history when dealing with mental health has been the affect in the mental hospitals/institutions. Original institutions were overcrowded and kept people for all kinds of reasons. Reasons for being committed ranged from having a fever to disagreeing with your spouse. Being committed in modern times is much more professional and requires usually a doctor’s approval or evidence that would require someone to be institutionalized. The overcrowding was so bad before that hospitals that were supposed to hold 200 or so patients had at max capacity almost 2000 patients. Now we have strict laws and regulations on facilities to prevent this from occurring. There has also been new laws and statutes put into place to monitor these facilities. Before these facilities operated under their own terms and now there is broad-spectrum regulations they must follow and maintain from the federal government.

In conclusion, one can see how we have come a long way from our ancestors in the field of mental health. One can only hope that each new day brings better advancements and we continue down the current path of reform we are currently on. One big concept still in place in many minds is that mental illness shouldn’t be discussed. The stigma needs to be broken so that we can further our advancements. This can be one call to action to any health care provider who works with patients suffering from a mental illness.

References

http://www.uniteforsight.org/mental-health/module2

http://www.dualdiagnosis.org/mental-health-and-addiction/history/

The Pharmacist’s Role in Mental Health

Mental health issues can present unique challenges for both healthcare professionals and patients.  Disorders like depression, bipolar and schizophrenia are primarily treated with medications.  This makes pharmacists a crucial part of optimal patient care.  There are multiple drugs within many classes of medication to choose from to treat each of these disease states.  Pharmacists can make recommendations based on expertise on the nuances of mental health medications side effect profiles.  As medication experts, pharmacists can ensure that patients are taking the best medications for their disease states.

Beyond recommending medicines, pharmacists can help end the stigma surrounding mental health in our communities.  Often, patients may be embarrassed to discuss mental health with anyone.  Pharmacy staff may perceive patients with mental health disorders negatively.  Pharmacists can lead by example in they way they address mental health.  A high level of professionalism with non-judgmental communication in the community setting can help decrease stigma.  Education about mental health disorders for pharmacy professionals can also be helpful.

Mental health medications can be some of the worst offenders for adverse effects. Pharmacists are often on the “front lines” in the reporting of side effects.  They can give patients realistic expectations about their medications.  Knowing how long a medicine will take to become effective is vital information for patients.  Counseling on what to look out for and when to call their prescriber can truly make a difference with patients struggling to find effective therapy.

Finally, duplicate therapy can be all too common in this patient population.  Often patients see a psychiatrist as well as a primary care provider and may receive mental health prescriptions from both.  Proper medication reviews can prevent duplicate therapies leading to adverse events like serotonin syndrome.  Pharmacists are ideally positioned to affect positive change in the management of mental health disorders.

 

References:

Rubio-Valera M, Chen T, O’Reilly C. New Roles for Pharmacists in Community Mental Health Care: A Narrative Review. International Journal of Environmental Research and Public Health. 2014;11(10):10967-10990. doi:10.3390/ijerph111010967.

 

Contributed by:

Leila Fleming, Parliamentarian, Class of 2019