Use of Antipsychotics in Treating Schizophrenia and other Psychotic Disorders
|
|
|
- Timothy Bridges
- 7 years ago
- Views:
Transcription
1 2013 Winter Conference Use of Antipsychotics in Treating Schizophrenia and other Psychotic Disorders Nurse Practitioners of Idaho
2 Workplace Perspective Region IV - DHW Ada County Jail Access Behavioral Health
3 Schizophrenia Neurodegenerative process Multiple theories of causation Current treatment is palliative Significant social and occupational disruption Life expectancy is 20% shorter Suicide will claim 10% Medical diseases under-recognized & undertreated Over-represented in homeless, jail and prison populations
4 and other Psychotic Disorders (proposed DSM-V and other classification) Schizophrenia (DSM-IV) Delusions Hallucinations Disorganized speech Disorganized or catatonic behavior Negative symptoms Marked dysfunction Duration 6 or more months Excludes Schizoaffective and Mood Disorder Not due to SA Schizophrenic Spectrum
5 Schizophrenia Subtypes Paranoid Disorganized Catatonic Undifferentiated Residual
6 Schneiderian First Rank Symptoms Delusions of being controlled by an external force Belief that thoughts are being inserted or withdrawn from one s conscious mind Belief that one s thoughts are being broadcast to other people Hearing voices (AH) commenting on one s thoughts or actions or hearing voices communicating with other voices
7 Positive Symptoms Hallucinations AH most common VH (often associated with substance abuse) Tactile Olfactory Gustatory Delusions Often bizarre, maybe paranoid, grandiose Ego syntonic or dystonic
8 Negative Symptoms Alogia: few words, little to say Blunted Affect: reduced perception, experience and expression Asociality: little or no social drive Anhedonia: loss of ability to experience pleasure Avolition: loss of desire, motivation, persistence
9 Impaired Cognition Working Memory Verbal Learning Visual Learning Processing Speed Attention/Vigilance Reasoning and Problem Solving ( Executive Functions ) Social Cognition
10 Treatment of Psychoses Non pharmacological treatments Are atypical antipsychotics really any better than typical antipsychotics? What do we need to know about antipsychotics? Off label use Substance abuse Impact How to get started? When to ask for a consult or referral?
11 Non Pharmacological CBT Skills Training (social interactions, independent living, related psychosocial abilities Family Interventions (NAMI, etc.) Supported Employment Assertive Community Treatment Wellness (SA, smoking, weight)
12 Antipsychotics How do they work? The Dopamine Theory: Dopamine Pathways: Mesolimbic hyperactivity (euphoria, hallucinations, delusions) Mesocortical hypoactivity ( cognitive, affective and negative symptoms) Nigrostriatal (Extrapyramidal System) Tuberofundibular (Prolactin secretion) Fifth Dopamine Pathway
13 Antipsychotics What makes them atypical? Rapid dissociation from binding sites Partial agonism of DA receptors (Abilify) Serotonin 5HT2A Receptor Antagonism (increase DA release to tune DA system) Full or partial agonism of 5HT1A receptors Many differences in receptor binding among the atypicals
14 Atypicals Are they any better? CATIE, PORT, Cochrane Review: No evidence that any antipsychotic has an advantage over any other for acute schizophrenia, except for Clozapine (PORT) Young people with schizophrenia are particularly sensitive to metabolic SE (PORT) Newer antipsychotics have similar efficacy and SE when compared with older agents (PORT)
15 Atypicals Are they any better? No difference in mortality rates (PORT) between Typicals & Atypicals No better at cognitive enhancement (CATIE) Moderate doses of mid-potency typical antipsychotics 20mg/day) are as effective with relatively few side effects -- PORT, CATIE, Cochrane Review
16 Antipsychotics What Do We Need to Know? Consider effectiveness in treating symptoms with drug safety/risk profile for each drug and individual patient Effectiveness and tolerability are equally important to long term treatment Long-term treatment adherence improves outcomes Therapeutic Alliance is critical
17 Treatment Goal Hierarchy Symptom Management Physical Health Reduce Hospitalization Reduce Criminal Activity Reduce Substance Abuse Stable Housing
18 Treatment Goal Hierarchy Employment Community Involvement Treatment Alliance Cognitive Ability Empowerment Recovery Andrew J. Cutler, M.D. NEI Conference 2012
19 Antipsychotics Typical (FGAs) TRADE NAME GENERIC NAME Haldol Loxitane Orap Thorazine Prolixin Trilafon Stelazine Mellaril Navane Haloperidol Loxapine Pimozide Chlorpromazine Fluphenazine Perphenazine Trifluoperazine Thioridazine Thiothixene
20 Clinical Indications Schizophrenia - Acute and maintenance Acute Mania of Bipolar Disorder Acute Psychosis MDD with psychotic features
21 Clinical Indications High Potency D2 blockers: Haldol, Navane, and Prolixin (oral) Haldol Lactate (Haldol, Ativan, Benadryl are all injectable, ) Haldol Deconate and Prolixin Deconate (LAI); can improve absorption, tolerability, and adherence Low Potency D2 blockers Mellaril and Thorazine: Mellaril is less sedating with least EPS, but more ECG effects. Thorazine: more sedating, good for combative people, less EPS risk than Haldol but can cause hypotension and convulsions Mid Potency : D2 blockers: Loxapine, Trilafon, and Stelazine: less sedating but more EPS risk
22 Side Effects: FGAs Typical Antipsychotics (FGAs): Anticholinergic Cardiovascular CNS (check ferritin levels) Akathisia Dystonia (prevent with ACA) Parkinsonism NMS Rabbit Syndrome Tardive Dyskinesia
23 Side Effects: FGAs Typical Antipsychotics (FGAs): Endocrine effects EENT effects GI effects Hematologic effects Renal effects Sexual effects Skin, allergies, and temperature Drug and food allergies
24 Atypical Antipsychotics TRADE NAME GENERIC NAME Clozapine Risperidone Olanzapine Quetiapine Ziprasidone Aripiprazole Paliperidone Iloperidone Asenapine Lurasidone Clozaril Risperdal Zyprexa Seroquel Geodon Abilify Invega Fanapt Saphris Latuda
25 Clinical Indications FDA-Approved for SGAs Bipolar Disorder Schizophrenia Risperdal Zyprexa Seroquel Geodon Abilify Saphris Risperdal Clozaril Zyprexa Seroquel Geodon Abilify Invega Fanapt Saphris Lurasidone
26 Clinical Indications More Lower cost due to generic formulations: Risperdal, Zyprexa, Seroquel (not XR) Abilify is the only DPA: exceptionally long half-life (75 and 94 hours); discontinuation kinesia delayed Zyprexa and Geodon: available in short-acting injectable Risperdal, Invega, Zyprexa and (coming-soon) Abilify: in LAI
27 Clinical Indications More Clozaril: 2 nd or 3 rd line in treating Schizophrenia; serious potential SE/requisite monitoring; may be most effective Invega: only atypical that does not require hepatic metabolism No evidence supporting concurrent use of 2 atypicals except in a cross-tapering situation Some support for concurrent use of an SGA and FGA in difficult to treat patients
28 Atypical Antipsychotics Side Effects Hyperglycemia, glycosuria, DM Type II, Metabolic Syndrome Dyslipidemia Weight gain EPS including TD Sedation Prolactin elevation
29 More Side Effects Hematologic Effects: Agranulocytosis, eosinophillia, leukopenia Seizures Hypothyroidism Anticholinergic side effects Cardiovascular side effects
30 More Side Effects EENT Effects GI Effects Renal effects Sexual side effects Skin, Allergies, and Temperature Drug and Food Interactions
31 Evidence Based Practices Current (Worst) Polypharmacy Frequent switching Rare use of Clozapine Minimal individual and family support Proposed (Best) Monotherapy SGAs and some FGAs with minimal adjuncts Use of Clozapine and LAIs Psychosocial, individual/family education, support Rx and CBT
32 Antipsychotics Off Label Use AHRQ Review of Strength of Evidence for Efficacy for Off-Label Indications, July 2012 Strength of Evidence Scale High Confidence that evidence reflects true effect; further research unlikely to effect estimate of effect Moderate Confidence that evidence reflects true effect; further research may effect estimate of effect Low Confidence that evidence reflects true effect; further research likely to change confidence in estimate of effect
33 Conditions Reviewed Dementia MDD Augmentation MDD Monotherapy OCD Augmentation PTSD Adjunctive GAD Borderline Personality Disorder Anorexia Nervosa (body weight) Substance Abuse (reduction in use)
34 Dementia Agitation, Psychosis and Overall Condition Improves Symptoms: Risperdal (High) Abilify (Low to Moderate) Seroquel & Zyprexa (Low)
35 MDD Augmentation Improves Symptoms: Risperdal (Moderate) Remission NNT = 8 Response NNT = 7 Abilify, Zyprexa (with Fluoxetine), and Seroquel have approved indications
36 MDD Monotherapy Improves Symptoms Zyprexa (Moderate) Seroquel (Moderate) Remission NNT = 13 Response NNT = 6 NO trials for Abilify or Risperdal
37 OCD Augmentation Improves Symptoms Risperdal (Moderate): NNT=5 Zyprexa (Low) (Head-to-head comparisons of Zyprexa and Risperdal are similar in effect) NO trials for Abilify or Seroquel
38 PTSD and GAD Improves Symptoms of PTSD Risperdal for combat-related PTSD (Moderate) (Insufficient evidence for treatment of abused women; insufficient evidence for analysis for Zyprexa and Seroquel) Improves Symptoms of GAD Seroquel (Moderate) NNT= 8
39 BPD & Anorexia Nervosa Improves Symptoms in Borderline Personality Disorder Abilify and Seroquel (Low) Does NOT Improve Symptoms for Anorexia Nervosa (body weight) Zyprexa (Moderate) Seroquel (Low)
40 Substance Abuse Reduction in Use Does NOT Improve Symptoms Alcohol Abilify (Moderate), Zyprexa (Low), Seroquel (Low) Methamphetamine Cocaine Abilify (Low) Zyprexa (Low), Risperdal (Low) Methadone Risperdal (Low)
41 Atypicals (AHRQ) Adverse Effects In the Elderly: Increased mortality: NNH 100 in week trials; (NNH not available for Typicals used in trial) Risperdal (NNH=34) associated with higher risk of CVA Risperdal (NNH=53) and Zyprexa (NNH=48) associated with higher risk of cardiovascular events
42 Adverse Effects in the Elderly EPS are common with Risperdal (NNH=20) and Zyprexa (NNH=10) Atypical antipsychotics associated with sedative effects (NNH=8-16) and fatigue (NNH=18-21)
43 Adverse Effects in the Elderly Atypical antipsychotics increase risk of urinary adverse effects (infections, incontinence); Degree of risk unable to be calculated
44 Adverse Effects Adults years Atypical antipsychotics are associated with weight gain (NNH=16-35); Zyprexa is associated with greater risk (NNH=3) than typicals or other atypicals Some atypicals carry a greater risk of endocrine and metabolic abnormalities (Zyprexa carries highest risk)
45 Adverse Effects Adults Increased EPS risks for Atypicals: Abilify (NNH=11 for EPS; NNH=7 for akathisia) Seroquel (NNH=36) Geodon (NNH-24) Increased risk of sedation and fatigue for Atypicals: Abilify, Zyprexa, Seroquel, Risperdal, and Geodon NNH=3-11 for sedation, highest for Seroquel; and NNH=14-19 for fatigue
46 Substance Abuse Chicken or Egg Marijuana, Methamphetamine, Cocaine, Bath Salts, Spice all can cause psychotic symptoms in general population, acute and chronic All can increase risk of developing a psychotic disorder, with continued use All are thought to worsen the course of established psychotic disorders, with continued use
47 Substance Abuse For those with established psychotic disorder More relapses, hospitalizations Poorer psychosocial functioning Worsened course of illness More likely to get arrested
48 Substance Abuse Why some patients with Schizophrenia use Self-medicating symptoms (positive and negative) Social milieu rewards are immediate adverse (effects) delayed Stahl s Essential Psychopharmacology Part 1: Psychosis and Related Cases
49 Getting Started FGAs do not equal SGAs and Neither FGAs nor SGAs are homogeneous groups Individualize treatment Share decision making with patient and family potential drugs, evidence for efficacy and side effect profile consider existing health problems, required monitoring, lifestyle, substance use, any financial issues that could affect adherence Trade-offs between benefits and risks: What symptoms are most bothersome to your patient? Time with medication adherence and no SA improve course of illness
50 Asking for Help Consultation or referral considerations: Before initiating antipsychotic therapy Treatment resistant psychosis When prescribing off-label Polypharmacy
51 Q & A
52 Case Studies
53 Thank YOU!
I. The Positive Symptoms...Page 2. The Negative Symptoms...Page 2. Primary Psychiatric Conditions...Page 2
SUTTER PHYSICIANS ALLIANCE (SPA) 2800 L Street, 7 th Floor Sacramento, CA 95816 SPA PCP Treatment & Referral Guideline Assessment & Treatment of Psychosis Developed March 1, 2003 Revised September 21,
State of Louisiana. Department of Health and Hospitals Bureau of Health Services Financing
Bobby Jindal GOVERNOR State of Louisiana Department of Health and Hospitals Bureau of Health Services Financing Kathy H. Kliebert SECRETARY The purpose of this memo is to advise you that effective September
Psychotic Disorder. Psychosis. Psychoses may be caused by: Examples of Hallucinations and Delusions 12/12/2012
Psychosis Psychotic Disorder Dr Lim Boon Leng Psychiatrist and Medical Director Dr BL Lim Centre For Psychological Wellness Tel: 64796456 Email: info@psywellness.com.sg Web: www.psywellness.com.sg A condition
ATYPICALS ANTIPSYCHOTIC MEDICATIONS
The atypical antipsychotics are a class of drugs that are used to treat a number of behavioral health disorders, including schizophrenia, other psychotic disorders, mood disorders, and behavioral agitation
Psychotic Disorders. Goals. Goals continued. Goals continued. What is Psychosis? Where does it occur? Provide a working definition for psychosis
Psychotic Disorders Robert W. Marvin, MD Assistant Professor Acting Residency Training Director Department of Psychiatry rwmarvin@uic.edu 1 Goals Provide a working definition for psychosis Understand the
PSYCHOPHARMACOLOGY AND WORKING WITH PSYCHIATRY PROVIDERS. Juanaelena Garcia, MD Psychiatry Director Institute for Family Health
PSYCHOPHARMACOLOGY AND WORKING WITH PSYCHIATRY PROVIDERS Juanaelena Garcia, MD Psychiatry Director Institute for Family Health Learning Objectives Learn basics about the various types of medications that
Understanding Antipsychotic Medications
Understanding Antipsychotic Medications NARSAD RESEARCH National Alliance for Research on Schizophrenia and Depression 60 Cutter Mill Road, Suite 404 Great Neck, NY 11021 516-829-0091 1-800-829-8289 516-487-6930
Medication Side Effects:
Medication Side Effects: Staying Healthy While on Psychotropic Medications Megan Maroney PharmD, BCPP Clinical Assistant Professor Ernest Mario School of Pharmacy Rutgers the State University of New Jersey
Bipolar Disorder. Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include:
Bipolar Disorder What is bipolar disorder? Bipolar disorder, or manic depression, is a medical illness that causes extreme shifts in mood, energy, and functioning. These changes may be subtle or dramatic
A Manic Episode is defined by a distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood.
Bipolar disorder Bipolar (manic-depressive illness) is a recurrent mode disorder. The patient may feel stable at baseline level but experience recurrent shifts to an emotional high (mania or hypomania)
Chapter 18 Drugs Used for Psychoses Learning Objectives Identify signs and symptoms of psychotic behavior Describe major indications for the use of
Chapter 18 Drugs Used for Psychoses Learning Objectives Identify signs and symptoms of psychotic behavior Describe major indications for the use of antipsychotic agents Identify common adverse effects
GUIDELINES FOR THE USE OF ATYPICAL ANTIPSYCHOTICS IN ADULTS. January 2012. 1 P a g e
GUIDELINES FOR THE USE OF ATYPICAL ANTIPSYCHOTICS IN ADULTS January 2012 1 P a g e First episode of psychosis or chronic psychosis First line: (equivalent choices, trial for 6 to 10 weeks) a) Risperidone
Antipsychotics and the Nursing Home
Antipsychotics and the Nursing Home Lisa M. O Hara, PharmD, CGP Corporate Director of Clinical Services The State Operations Manual Part 1: F329 Unnecessary Drugs Medication Management Defined Helps promote
A BRIEF OVERVIEW OF PSYCHOTROPIC MEDICATION USE FOR PERSONS WITH INTELLECTUAL DISABILITIES
INTRODUCTION A BRIEF OVERVIEW OF PSYCHOTROPIC MEDICATION USE FOR PERSONS WITH INTELLECTUAL DISABILITIES Individuals with intellectual disabilities are not uncommonly prescribed psychotropic medications.
New Treatments. For Bipolar Disorder. Po W. Wang, MD Clinical Associate Professor Bipolar Disorders Clinic Stanford University School of Medicine
New Treatments For Bipolar Disorder Po W. Wang, MD Clinical Associate Professor Bipolar Disorders Clinic Stanford University School of Medicine Abbott Laboratories AstraZeneca Bristol-Myers Squibb Corcept
Chronic mental illness in LTCF. Chronic mental illness. Other psychiatric disorders.
Chronic mental illness in LTCF Abhilash K. Desai MD Medical Director Alzheimer s Center of Excellence Chronic mental illness 1. Schizophrenia and Schizoaffective disorder. 2. Bipolar disorder (Type 1 and
Below, this letter outlines [patient name] s medical history, prognosis, and treatment rationale.
![Below, this letter outlines [patient name] s medical history, prognosis, and treatment rationale.](/thumbs/25/5563775.jpg "Below, this letter outlines [patient name] s medical history, prognosis, and treatment rationale.")
[Date] [Name of Contact] [Title] [Name of Health Insurance Company] [Address] [City, State, Zip Code] Insured: [Patient Name] Policy Number: [Number] Group Number: [Number] Diagnosis: [Diagnosis and ICD-9-CM
Update on guidelines on biological treatment of depressive disorder. Dr. Henry CHEUNG Psychiatrist in private practice
Update on guidelines on biological treatment of depressive disorder Dr. Henry CHEUNG Psychiatrist in private practice 2013 update International Task Force of World Federation of Societies of Biological
INNOVATIONA IN MODEL PROGRAMS: Empowered for Life Home Treatment for Behavioral Health Conditions
INNOVATIONA IN MODEL PROGRAMS: Empowered for Life Home Treatment for Behavioral Health Conditions Mary Lynn Stewart, RN, BSN, MSN Amedisys Home Health Care Learning Objectives: Identify key components
ASSESSMENT AND MANAGEMENT OF PSYCHOSIS IN PERSONS WITH DEMENTIA
ASSESSMENT AND MANAGEMENT OF PSYCHOSIS IN PERSONS WITH DEMENTIA Overview: Psychosis is a common clinical feature of dementia. Hallucinations and delusions are the two most common types of psychotic symptoms
Conjoint Professor Brian Draper
Chronic Serious Mental Illness and Dementia Optimising Quality Care Psychiatry Conjoint Professor Brian Draper Academic Dept. for Old Age Psychiatry, Prince of Wales Hospital, Randwick Cognitive Course
Emergency Room Treatment of Psychosis
OVERVIEW The term Lewy body dementias (LBD) represents two clinical entities dementia with Lewy bodies (DLB) and Parkinson s disease dementia (PDD). While the temporal sequence of symptoms is different
How Is Schizophrenia Treated?
Treatments for Schizophrenia and Other Severe Mental Disorders Chapter 15 Slides & Handouts by Karen Clay Rhines, Ph.D. Northampton Community College Comer, Abnormal Psychology, 8e How Is Schizophrenia
Objectives. The use of Psychotropics in Children
Objectives The use of Psychotropics in Children Ashley E. Little, Pharm.D. Psychopharmacology Resident Nova Southeastern University College of Pharmacy Dade County Pharmacy Association To understand current
DIABETES SCREENING FOR PEOPLE WITH SCHIZOPHRENIA OR BIPOLAR DISORDER WHO ARE USING ANTIPSYCHOTIC MEDICATIONS (SSD)
DIABETES SCREENING FOR PEOPLE WITH SCHIZOPHRENIA OR BIPOLAR DISORDER WHO ARE USING ANTIPSYCHOTIC MEDICATIONS (SSD) APPLICATIONS OBJECTIVE Purpose of Measure: ELIGIBLE POPULATION Which members are included?
COMPREHENSIVE MANAGEMENT OF THE ELDERLY PATIENT WITH MANIA
COMPREHENSIVE MANAGEMENT OF THE ELDERLY PATIENT WITH MANIA Manic depressive illness is a biological brain disorder that produces significant alterations of mood and psychosis. Mania in the elderly occurs
Update and Review of Medication Assisted Treatments
Update and Review of Medication Assisted Treatments for Opiate and Alcohol Use Disorders Richard N. Whitney, MD Medical Director Addiction Services Shepherd Hill Newark, Ohio Medication Assisted Treatment
North of Tyne Area Prescribing Committee
North of Tyne Area Prescribing Committee ANTIPSYCHOTICS IN PSYCHOSIS, BIPOLAR DISORDER AND AUGMENTATION THERAPY IN TREATMENT RESISTANT DEPRESSION Information for Primary Care Updated November 2013 This
Mental Health Ombudsman Training Manual. Advocacy and the Adult Home Resident. Module V: Substance Abuse and Common Mental Health Disorders
Mental Health Ombudsman Training Manual Advocacy and the Adult Home Resident Module V: Substance Abuse and Common Mental Health Disorders S WEHRY 2004 Goals Increase personal comfort and confidence Increase
BIPOLAR DISORDER A GUIDE FOR INDIVIDUALS AND FAMILIES FOR THE TREATMENT OF BIPOLAR DISORDER IN ADULTS
BIPOLAR DISORDER A GUIDE FOR INDIVIDUALS AND FAMILIES FOR THE TREATMENT OF BIPOLAR DISORDER IN ADULTS A publication of the Massachusetts Department of Mental Health and the Massachusetts Division of Medical
Understanding Schizophrenia and Recovery
Understanding Schizophrenia and Recovery What you need to know about this medical illness Schizophrenia interferes with a person s ability to think clearly, manage emotions, make decisions, and relate
PARTNERSHIP HEALTHPLAN OF CALIFORNIA MEDI-CAL PROVIDER MANUAL CLAIMS DEPARTMENT
PARTNERSHIP HEALTHPLAN OF CALIFORNIA MEDI-CAL PROVIDER MANUAL CLAIMS DEPARTMENT X.J. Mental Health Services 1. For claims with dates of service on or before January 1, 2014: Mental Health Services are
Overview of Mental Health Medication Trends
America s State of Mind Report is a Medco Health Solutions, Inc. analysis examining trends in the utilization of mental health related medications among the insured population. The research reviewed prescription
prodromal premorbid schizophrenia residual what are the four phases of schizophrenia describe the Prodromal phase of schizophrenia
what are the four phases of prodromal premorbid residual describe the Prodromal phase of a period of normal functioning describe the Premorbid phase of there are signs and symptoms existing that precede
Lithium. Generic name = lithium carbonate (tablets and capsules), or lithium citrate (liquid)
Lithium Brand and Generic Names Eskalith - Capsules: 300 mg Eskalith CR slow release - Tablets: 450 mg Lithobid slow release - Tablets: 300 mg Generic name = lithium carbonate (tablets and capsules), or
Zyprexa (olanzapine)
Zyprexa (olanzapine) FDA ALERT [04/2005] Zyprexa is a type of medicine called an atypical antipsychotic. FDA has found that older patients treated with atypical antipsychotics for dementia had a higher
Schizoaffective Disorder
FACT SHEET 10 What Is? Schizoaffective disorder is a psychiatric disorder that affects about 0.5 percent of the population (one person in every two hundred). Similar to schizophrenia, this disorder is
Summary of the risk management plan (RMP) for Aripiprazole Pharmathen (aripiprazole)
EMA/303592/2015 Summary of the risk management plan (RMP) for Aripiprazole Pharmathen (aripiprazole) This is a summary of the risk management plan (RMP) for Aripiprazole Pharmathen, which details the measures
Preferred Practice Guidelines Bipolar Disorder in Children and Adolescents
These Guidelines are based in part on the following: American Academy of Child and Adolescent Psychiatry s Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder,
Disclosure Statement. Nursing Facility Regulations and Psychotropic Medication Use. Learning Objectives (Cont) Learning Objectives
Nursing Facility Regulations and Psychotropic Medication Use Jeffrey C. Reist PharmD, BCPS College of Pharmacy The University of Iowa December 2010 Disclosure Statement I, Jeffrey Reist, PharmD, BCPS do
ICD- 9 Source Description ICD- 10 Source Description
291.0 Alcohol withdrawal delirium F10.121 Alcohol abuse with intoxication delirium 291.0 Alcohol withdrawal delirium F10.221 Alcohol dependence with intoxication delirium 291.0 Alcohol withdrawal delirium
A PERSPECTIVE ON CMS'S ANTIPSYCHOTIC REDUCTION INITIATIVE DAVID GIFFORD MD MPH SR VP QUALITY & REGULATORY AFFAIRS
A PERSPECTIVE ON CMS'S ANTIPSYCHOTIC REDUCTION INITIATIVE DAVID GIFFORD MD MPH SR VP QUALITY & REGULATORY AFFAIRS ASCP National Harbor MD November 8 th, 2012 Faculty Disclosure Dr Gifford has no financial,
Treatment of Behavioral Health Disorders in Adolescents: Depression, Bipolar Disorder, Schizophrenia
Treatment of Behavioral Health Disorders in Adolescents: Depression, Bipolar Disorder, Schizophrenia ELINORE F. MCCANCE-KATZ, MD, PHD CHIEF MEDICAL OFFICER SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
Schizoaffective disorder
Schizoaffective disorder Dr.Varunee Mekareeya,M.D.,FRCPsychT Schizoaffective disorder is a psychiatric disorder that affects about 0.5 to 0.8 percent of the population. It is characterized by disordered
Thorazine (chlorpromazine)
Generic name: Chlorpromazine Available strengths: 10 mg, 25 mg, 50 mg, 100 mg, 200 mg tablets; 100 mg/ml oral concentrate; 25 mg/ml injection Available in generic: Yes Drug class: First-generation (conventional)
Background. Population/Intervention(s)/Comparator/Outcome(s) (PICO)
updated 2012 Role of anticholinergic medications in patients requiring long-term antipsychotic treatment for psychotic disorders Q6: In individuals with psychotic disorders (including schizophrenia) who
o DOSAGE AND ADMINISTRATION Dosage in Special Populations: The recommended initial dose is 0.5 mg BID in patients who are elderly
Some critics of Janssen, including plaintiff s lawyers, have stated it is improper for Risperdal to have been used to treat elderly dementia patients. As you consider that position, we suggest you consider
MOOD DISORDERS PART II BIPOLAR AFFECTIVE DISORDER (BAD) Todd Stull, M.D. James Sorrell, M.D.
MOOD DISORDERS PART II BIPOLAR AFFECTIVE DISORDER (BAD) Todd Stull, M.D. James Sorrell, M.D. BIPOLAR AFFECTIVE DISORDER (BAD) General Assessment is challenging Input important Change in level of functioning
PSYCHOSOMATIC INSTITUTE OF SAN ANTONIO New Patient Information
PSYCHOSOMATIC INSTITUTE OF SAN ANTONIO New Patient Information Name: Last: First: MI: Birth Date: Sex: M F Marital Status: Single Married Divorced Separated Widowed Partnered Other Preferred name: Emergency
Genome wide association study of extreme obesity defined by electronic medical record phenotyping
1 Genome wide association study of extreme obesity defined by electronic medical record phenotyping The pseudo code and flowchart for Geisinger extreme obesity cohort are below. Questions regarding this
BIPOLAR DISORDER IN PRIMARY CARE
E-Resource January, 2014 BIPOLAR DISORDER IN PRIMARY CARE Mood Disorder Questionnaire Common Comorbidities Evaluation of Patients with BPD Management of BPD in Primary Care Patient resource Patients with
Abnormal Psychology Practice Quiz #3
Abnormal Psychology Practice Quiz #3 1. People with refuse to maintain a minimum, normal body weight, and have an intense fear of gaining weight. a. anorexia nirvana b. anorexia bulimia c. bulimia nervosa
Olanzapine Odt. olanzapine kills. olanzapine rapids. olanzapine sleep. olanzapine treats what. olanzapine neuroleptic malignant syndrome
Olanzapine Odt olanzapine kills olanzapine rapids olanzapine sleep olanzapine treats what olanzapine neuroleptic malignant syndrome olanzapine nausea olanzapine eps olanzapine how supplied olanzapine formulations
Olanzapine Renal Dosing
Olanzapine Renal Dosing olanzapine uses olanzapine binge eating olanzapine fluoxetine olanzapine benzo olanzapine other names olanzapine generic availability olanzapine generic name olanzapine adverse
Olanzapine Elderly Dementia
Olanzapine Elderly Dementia olanzapine journal articles olanzapine generic name olanzapine recreational olanzapine used for anorexia olanzapine usp olanzapine liquid olanzapine jubilant olanzapine how
Olanzapine Urinary Retention
Olanzapine Urinary Retention olanzapine monitoring olanzapine joint pain olanzapine benzo olanzapine fda indications olanzapine japanese pharmacopoeia olanzapine high erowid olanzapine classification olanzapine
Olanzapine Maximum Dose
Olanzapine Maximum Dose olanzapine breastfeeding olanzapine hyponatremia olanzapine blood sugar olanzapine class olanzapine long acting olanzapine for delirium olanzapine jubilant 10 mg olanzapine tab
Olanzapine Uses. olanzapine generic name. olanzapine uptodate. olanzapine other names. olanzapine vomiting. olanzapine leukopenia.
Olanzapine Uses olanzapine generic name olanzapine uptodate olanzapine other names olanzapine vomiting olanzapine leukopenia olanzapine nami olanzapine high abuse olanzapine medication olanzapine grapefruit
Olanzapine Generic Availability
Olanzapine Generic Availability olanzapine msds olanzapine kills olanzapine grapefruit juice olanzapine neuroleptic malignant syndrome olanzapine abuse olanzapine used for anxiety olanzapine off label
Olanzapine Dosage Forms
Olanzapine Dosage Forms olanzapine rash olanzapine history olanzapine ingredients olanzapine ketoacidosis olanzapine msds olanzapine narcotic olanzapine classification olanzapine geriatric olanzapine chemical
Olanzapine Kidney Damage
Olanzapine Kidney Damage 1 olanzapine generic price 2 olanzapine ocd 3 olanzapine uk 4 olanzapine grapefruit juice 5 olanzapine contraindications 6 olanzapine manufacturer 7 olanzapine drug test 8 olanzapine
Olanzapine Uptodate olanzapine make you gain weight olanzapine structure olanzapine st john's wort
Olanzapine Uptodate olanzapine drug class olanzapine generic name olanzapine youtube olanzapine action olanzapine medscape olanzapine ingredients olanzapine make you gain weight olanzapine bluelight olanzapine
olanzapine is it a narcotic olanzapine narcotic olanzapine how supplied olanzapine vomiting olanzapine jubilant 10 mg olanzapine teaching olanzapine
Olanzapine Kick In olanzapine nursing implications olanzapine mechanism of action olanzapine images olanzapine dosing olanzapine kick in olanzapine neuroleptic malignant syndrome olanzapine xerostomia
Olanzapine Nms olanzapine narcotic olanzapine street value olanzapine japanese pharmacopoeia olanzapine pharmacokinetics olanzapine yahoo answers
Olanzapine Nms 1 olanzapine narcotic 2 olanzapine used for sleep 3 olanzapine street value 4 olanzapine japanese pharmacopoeia 5 olanzapine zyprexa 6 olanzapine how supplied 7 olanzapine chemical structure
Olanzapine Gynecomastia
Olanzapine Gynecomastia 1 olanzapine drug 2 olanzapine black box warning 3 olanzapine nursing considerations 4 olanzapine images 5 olanzapine lab tests 6 olanzapine klonopin 7 olanzapine tab 2.5mg 8 olanzapine
NAVIGATE Psychopharmacological Treatment Manual
NAVIGATE Psychopharmacological Treatment Manual Developed by The NAVIGATE Psychopharmacological Treatment Committee. The Committee is chaired by Delbert G. Robinson, M.D. Christoph U. Correll, M.D., Ben
Olanzapine Benzo. olanzapine glaucoma. olanzapine jubilant 10 mg. olanzapine trade name. olanzapine drug class. olanzapine yahoo answers
Olanzapine Benzo olanzapine glaucoma olanzapine jubilant 10 mg olanzapine trade name olanzapine drug class olanzapine yahoo answers olanzapine makes you sleepy olanzapine onset of action olanzapine action
olanzapine pregnancy olanzapine overdose treatment olanzapine ketoacidosis olanzapine zopiclone olanzapine odt olanzapine chemical structure
Olanzapine Xtc olanzapine oral olanzapine nursing implications olanzapine off label uses olanzapine insomnia olanzapine dosage forms olanzapine classification olanzapine interactions olanzapine kills olanzapine
Olanzapine For Cinv. olanzapine schizophrenia. olanzapine ingredients. olanzapine contraindications. olanzapine adverse effects.
Olanzapine For Cinv olanzapine schizophrenia olanzapine ingredients olanzapine contraindications olanzapine adverse effects olanzapine pill olanzapine nursing implications olanzapine j code olanzapine
HIV Case Conference: Use of Anti Psychotics for Non Psychotic Disorders
AM1 F/C AETC Faculty Psych Thursday, June 19, 2014 12:30 1:30pm (EDT) Facilitator Debbie Cestaro Seifer, MS, RN University of South Florida Didactic Presenter Patrick Marsh, MD University of South Florida
Antipsychotic drug prescription for patients with dementia in long-term care. A practice guideline for physicians and caregivers
SUPPLEMENT 1: (Supplementary Material for online publication) Antipsychotic drug prescription for patients with dementia in long-term care. A practice guideline for physicians and caregivers About this
Drugs PSYCHOSIS. Depression. Stress Medical Illness. Mania. Schizophrenia
Drugs Stress Medical Illness PSYCHOSIS Depression Schizophrenia Mania Disorders In preschool children imaginary friends and belief in monsters under the bed is normal (it may be normal in older developmentally
Understanding tardive dyskinesia
Understanding tardive dyskinesia 1 Contents What is tardive dyskinesia? 3 What does TD look like? 3 What might affect the risk of me getting TD? 4 Will TD disappear if I stop my medication? 5 What else
Olanzapine Half Life. olanzapine recommended dosage. olanzapine liquid. olanzapine trade name. olanzapine zydis. olanzapine overdose
Olanzapine Half Life olanzapine recommended dosage olanzapine liquid olanzapine trade name olanzapine zydis olanzapine overdose olanzapine fluoxetine olanzapine mechanism of action olanzapine taper olanzapine
PSYCHOTROPIC MEDICATIONS
PSYCHOTROPIC MEDICATIONS 644.3 Bipolar Disorder This Instructor s Guide contains: Brief Description, Objectives, Discussion Questions, Pretest, Post-test, Answer Keys and Glossary for this program, Psychotropic
How To Make Olanzapine
Olanzapine Manufacturer olanzapine medicine olanzapine sleep olanzapine gynecomastia olanzapine kidney damage olanzapine seizure olanzapine structure olanzapine serotonin syndrome olanzapine tab 5mg olanzapine
Behavior and Developmental Disorders, Bipolar Disorder, and Schizophrenia Comparing safety and effectiveness
Use of Antipsychotic Medication in Children and Teens to Treat: Behavior and Developmental Disorders, Bipolar Disorder, and Schizophrenia Comparing safety and effectiveness Contents Our Recommendations.......................................
Pharmacological treatment of Schizophrenia. Dr Anthony Harris Prevention Early Intervention and Recovery Service
Pharmacological treatment of Schizophrenia Dr Anthony Harris Prevention Early Intervention and Recovery Service schizophrenia - symptoms delusions and hallucinations dopaminergic hyperfunction disorganisation
REFERRAL FORM FOR ADMISSION TO HOMEWOOD HEALTH CENTRE
Date of Referral: REFERRAL FORM FOR ADMISSION TO HOMEWOOD HEALTH CENTRE PATIENT INFORMATION Patient Name: Date of Birth (YYYY-MM-DD): E-mail Business/Mobile Phone: Gender: Health Card #: Version Code:
[KQ 804] FEBRUARY 2007 Sub. Code: 9105
![[KQ 804] FEBRUARY 2007 Sub. Code: 9105](/thumbs/26/8053833.jpg "[KQ 804] FEBRUARY 2007 Sub. Code: 9105")
[KQ 804] FEBRUARY 2007 Sub. Code: 9105 (Revised Regulations) Theory : Two hours and forty minutes Q.P. Code: 419105 Maximum : 100 marks Theory : 80 marks M.C.Q. : Twenty minutes M.C.Q. : 20 marks 1. A
Olanzapine Benzo. olanzapine kidney damage. olanzapine generic name. Norvasc Pitting Edema. olanzapine elderly dementia. olanzapine contraindications
Olanzapine Benzo olanzapine kidney damage olanzapine generic name Norvasc Pitting Edema olanzapine elderly dementia olanzapine contraindications olanzapine for anxiety olanzapine treats what olanzapine
Contemporary Psychiatric-Mental Health Nursing. Assessing the Effectiveness of Medications. Administering Medications
Contemporary Psychiatric-Mental Health Nursing Chapter 32 Psychopharmacologic Nursing Interventions Assessing the Effectiveness of Medications Include how well the medications are helping the client to
Olanzapine Serotonin Syndrome
Olanzapine Serotonin Syndrome olanzapine for delirium olanzapine for cinv olanzapine generic price olanzapine relprevv olanzapine yellow olanzapine lab tests olanzapine benzodiazepine olanzapine depression
Important Safety Information about ZYPREXA RELPREVV (olanzapine) For Extended Release Injectable Suspension
Important Safety Information about ZYPREXA RELPREVV (olanzapine) For Extended Release Injectable Suspension Boxed Warnings Post-Injection Delirium/Sedation Syndrome Adverse events with signs and symptoms
Olanzapine Level olanzapine pronunciation olanzapine vomiting olanzapine toxicity
Olanzapine Level 1 olanzapine nursing implications 2 olanzapine benzo 3 olanzapine joint pain 4 olanzapine generic name 5 olanzapine insomnia 6 olanzapine usp 7 olanzapine ingredients 8 olanzapine nausea
Delusions are false beliefs that are not part of their real-life. The person keeps on believing his delusions even when other people prove that the be
Schizophrenia Schizophrenia is a chronic, severe, and disabling brain disorder which affects the whole person s day-to-day actions, for example, thinking, feeling and behavior. It usually starts between
Psychotic Disorders. 1995-2013, The Patient Education Institute, Inc. www.x-plain.com mhff0101 Last reviewed: 01/10/2013 1
Psychotic Disorders Introduction Psychotic disorders are severe mental disorders that cause abnormal thinking and perceptions. These disorders cause people to lose touch with reality. As a result, people
Olanzapine Fda Indications
Olanzapine Fda Indications olanzapine eps olanzapine dosing olanzapine toxicity olanzapine epocrates olanzapine benzo olanzapine abuse olanzapine interactions olanzapine names olanzapine zombie olanzapine
Psychopharmacology. Psychopharmacology. Hamish McAllister-Williams Reader in Clinical. Department of Psychiatry, RVI
Regional Affective Disorders Service Psychopharmacology Northumberland, Tyne and Wear NHS Trust Hamish McAllister-Williams Reader in Clinical Psychopharmacology Department of Psychiatry, RVI Intro NOT
Algorithm for Initiating Antidepressant Therapy in Depression
Algorithm for Initiating Antidepressant Therapy in Depression Refer for psychotherapy if patient preference or add cognitive behavioural office skills to antidepressant medication Moderate to Severe depression
Behavioral Health Best Practice Documentation
Behavioral Health Best Practice Documentation Click on the desired Diagnoses link or press Enter to view all information. Diagnoses: DSM-5 and ICD-10 Codes Major Depressive Disorder Bipolar Disorder Eating
Comparative Effectiveness Review Number 43. Off-Label Use of Atypical Antipsychotics: An Update
Comparative Effectiveness Review Number 43 Off-Label Use of Atypical Antipsychotics: An Update Comparative Effectiveness Review Number 43 Off-Label Use of Atypical Antipsychotics: An Update Prepared for:
Olanzapine Lab Tests. olanzapine controlled substance. olanzapine oral. olanzapine j code. olanzapine level. olanzapine treats what
Olanzapine Lab Tests olanzapine controlled substance olanzapine oral olanzapine j code olanzapine level olanzapine treats what olanzapine used for anorexia olanzapine lab tests olanzapine schedule olanzapine
Trends in Prescribing of Antipsychotic Drugs in General Practice in England (Chart 1) 2.0. Other second generation antipsychotics (SGA)
Antipsychotic drugs Antipsychotics can be broadly classified into first generation antipsychotics (FGAs, formerly known as typical antipsychotics) and second generation antipsychotics (SGAs, formerly known
Olanzapine Liquid. olanzapine kinetics. olanzapine for sleep. olanzapine used for anorexia. olanzapine fluoxetine. olanzapine chemical structure
Olanzapine Liquid olanzapine kinetics olanzapine for sleep olanzapine used for anorexia olanzapine fluoxetine olanzapine chemical structure olanzapine interactions olanzapine constipation olanzapine abuse
Coming off atypical neuroleptics (like Clozaril, Risperdal, Seroquel, Zyprexa): Challenges and Experiences
Peter Lehmann Coming off atypical neuroleptics (like Clozaril, Risperdal, Seroquel, Zyprexa): Challenges and Experiences Workshop at the Third Annual Recovery Conference Medicating Human Distress: Concerns,
Medications Used in the Management of Disruptive Behavior Disorders
The following medication chart is provided as a brief guide to some of the medications used in the management of various behavior disorders, along with their potential benefits and possible side effects.
How To Safely Use Aripiprazole
VI.2 Elements for a Public Summary VI.2.1 Overview of disease epidemiology Bipolar I Disorder Reported prevalence rates for bipolar I disorder differ due to local variations in psychiatric practice, variations
DEPRESSION CARE PROCESS STEP EXPECTATIONS RATIONALE
1 DEPRESSION CARE PROCESS STEP EXPECTATIONS RATIONALE ASSESSMENT/PROBLEM RECOGNITION 1. Did the staff and physician seek and document risk factors for depression and any history of depression? 2. Did staff
Olanzapine Used For Anorexia
Olanzapine Used For Anorexia olanzapine grapefruit juice olanzapine klonopin olanzapine dosage forms olanzapine ati olanzapine hair loss olanzapine teaching olanzapine recreational olanzapine yan etkileri