Decreasing the stigma surrounding alcohol use disorder.

INTRODUCTION: There is a paucity of data on educational interventions that prepare students to mitigate the stigma or burden of alcohol use disorder. The objectives of this study were to (1) assess the impact of an interprofessional symposium on personal knowledge and stigma of alcohol use disorder and (2) inform future educational models. METHODS: The symposium highlighted the impact of alcohol at one private Midwestern university and reviewed the pharmacology of alcohol, diagnostic criteria for alcohol use disorder, and treatment for alcohol use disorder. Prior to and after the symposium, participants were given nine statements (two knowledge-based and seven stigma-based) about alcohol use disorder. Agreement with each statement was measuring on a five-point rating scale, and responses were collapsed into three categories: 1 = low stigma/high understanding, 2 = neutral, and 3 = high stigma/low understanding. Change between response categories before and after the symposium were analyzed using a Wilcoxon signed-ranked test (W). RESULTS: A total of 87 responses were collected pre-symposium and 45 responses were collected post-symposium. Both knowledge-based statements showed an increase in individual respondent understanding of alcohol use disorder as a disease. All stigma-based statements conveyed a decrease in individual respondent stigma of alcohol use disorder as a disease. Test statistics (Z) for significant items raged between Z = 3 to 5, P < .05. CONCLUSIONS: The symposium was successful at conveying positive changes in attitudes toward alcohol use disorder.

Changing student attitudes and perceptions toward opioid use disorder.

INTRODUCTION: With the opioid epidemic creating a group of patients with unique health care needs, pharmacists have an opportunity to be a good resource for patients recovering from opioid use disorder (OUD). To accomplish this, it is essential that pharmacists are knowledgeable and unbiased toward this patient population. METHODS: Because the curriculum in place to obtain a PharmD at Drake University does not include in-depth information on substance use disorders, study investigators offered students an opportunity to receive more intensive education. Faculty members at Drake University provided didactic and panel discussion presentations on topics such as opioid pharmacology, OUD, and treatment options. The students were assessed for their perception of knowledge and stigma before and after the summit by using a 5-point Likert scale to measure their attitudes toward 10 statements. RESULTS: Total knowledge scores showed a significant change of 3.1, indicating an increase in perceived understanding of materials presented (P < .0001). Total stigma scores also changed by 1.4, illustrating a statistically significant decrease in negative perceptions (P = .0198). DISCUSSION: By providing more in-depth education, the summit showed that increasing pharmacy student knowledge about OUD and its treatment may decrease associated stigma.

"Pimping" in Pharmacy Education: A Survey and Comparison of Student and Faculty Views.

BACKGROUND: "Pimping" is an informal teaching technique that is widely used in medical education. Pimping is characterized by questioning the learner with the intent of reinforcing clinical hierarchy. To date, there are no studies of the use of pimping in pharmacy education. OBJECTIVES: To describe the use of pimping as a teaching method in pharmacy education and to compare student and faculty perceptions of this technique. METHODS: Faculty and fourth-year PharmD (P4) students from 2 colleges of pharmacy were invited to participate in a survey about experiences and perceptions of pimping. Faculty and P4 surveys each contained up to 17 items to assess personal experiences, utilization, perceived risks and benefits, and preferences regarding the role of the technique in pharmacy education. RESULTS: The response rate was 49.5% (159 of 321). Of faculty, 74.1% reported they had been pimped in their training, but less than half (45.8%) use pimping themselves. Similarly, 73.7% of students reported that they had been pimped at some time in their pharmacy education. Students nearly equally viewed their experiences as positive (35.3%) versus negative (38.2%). Responses were similar between faculty and students recommending that the method should be avoided entirely ( P = .259), used sparingly ( P = .072), or used consistently ( P = .309). Perceived benefits and risks of pimping were similar between faculty and students, but there were many differences in rationales offered by faculty versus students' perceived rationales. CONCLUSION: Pimping is common in pharmacy education and its use is controversial. The perceived rationale for use of pimping differs, which may undermine student/faculty relationships.

Ketamine for the treatment of major depressive disorder and bipolar depression: A review of the literature.

INTRODUCTION: Over the past decade, ketamine has been studied for major depressive disorder and bipolar depression. Ketamine is believed to exert its antidepressant properties through N-methyl-D-aspartate receptor antagonism. METHODS: Study authors completed a literature review of seven randomized controlled trials of ketamine usage in major depressive disorder and bipolar depression. RESULTS: Ketamine demonstrated a statistically significant improvement over placebo or midazolam in major depressive disorder. Ketamine also exhibited a statistically significant improvement over placebo in bipolar depression. DISCUSSION: Ketamine has shown promise in quickly reducing symptoms in patients with treatment resistant depression and bipolar depression. Using ketamine may be helpful for patients that have exhausted other therapeutic options.

Effects of depressive and other psychiatric disorders on anticoagulation control in a pharmacist-managed anticoagulation clinic.

BACKGROUND: The impact of psychiatric disorders on International Normalized Ratio (INR) control and adverse events for patients receiving warfarin has not been fully elucidated. OBJECTIVE: To determine the effect of depressive and other psychiatric disorders on anticoagulation control in a pharmacist-managed anticoagulation clinic. METHODS: A retrospective chart review evaluated outcomes of patients with no history of psychiatric disorders and compare it with that of patients with either a history of depression or any form of psychiatric disorder. Data was obtained from patient medical records over a 24-month period. The primary outcome was a comparison of time in therapeutic range, calculated using 3 separate methods (percentage of INRs in therapeutic range, a modified Rosendaal's linear interpolation, and mean INR in goal). RESULTS: A total of 151 patients met the inclusion criteria (control = 79, psychiatric disorders = 72 patients). Control patients had a significantly greater proportion of INRs in the goal range compared with either the depression or psychiatric disorders groups (control, 55.7%; depression, 43.5%; psychiatric, 45.8%). Utilizing the Rosendaal's method, patients with psychiatric disorders were in the goal range significantly less often than those in the control group (53.0% vs 61.3%). No differences were seen when adjusting for multiple comparisons or when comparing the control and depression groups (54.5% vs 61.3%). There was no difference between the groups when comparing percentages of patients with a mean INR in their goal range. CONCLUSIONS: Patients with psychiatric disorders who take warfarin may spend less time in the therapeutic range.

Team-based learning in pharmacotherapeutics.

OBJECTIVE: To compare student examination performance in pharmacotherapeutics before and after implementation of team-based learning. DESIGN: After the traditional lecture and workshop method for teaching pharmacotherapeutics was replaced with team-based learning in January 2009, students were expected to come to class having read assigned chapters in order to successfully complete an individual quiz, a group quiz, and group application exercises. ASSESSMENT: Student learning was assessed using performance on individual quizzes, group quizzes, and the examination at the end of the psychiatry module. Students performed as well on the examination at the end of the module as they did prior to team-based learning implementation. CONCLUSION: Substituting team-based learning for traditional lecture ensured that students prepared for class and increased student participation in class discussions.

Effects of antidepressants in patients with irritable bowel syndrome and comorbid depression.

BACKGROUND: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that affects up to 15% of community dwelling individuals. Psychiatric comorbidities, particularly symptoms of major depressive disorder (MDD), occur in up to 90% of patients with IBS. OBJECTIVE: This article reviews the available literature on the use of antidepressants for both IBS and psychiatric depressive symptoms in patients with IBS. METHODS: MEDLINE and International Pharmaceutical Abstracts (both, 1980-May 2010) were searched for English-language publications that involved antidepressant treatment of MDD in patients with IBS. The search terms were depression, irritable, bowel, treatment, and functional. The reference lists of key articles were searched for additional pertinent articles. Randomized controlled trials published in the past 10 years were given priority. RESULTS: Of 46 articles identified by the literature search, 11 were included in the review: 4 studies of selective serotonin reuptake inhibitors (SSRIs), 4 of tricyclic antidepressants (TCAs), 1 comparing an SSRI and a TCA, 1 of the serotonin-norepinephrine reuptake inhibitor duloxetine, and a case report involving the tetracyclic antidepressant mirtazapine. Most of the identified studies excluded patients with a diagnosis of depression and/or anxiety. No controlled studies were identified in which the primary outcome was objective assessment of MDD symptoms in patients with IBS. Two of the SSRI studies, one of citalopram and the other of paroxetine, reported approximately 50% improvement in IBS symptoms (both studies, P = 0.01); the study of paroxetine reported a 30% improvement in scores on the Beck Depression Inventory (P = 0.01). The 2 studies of fluoxetine found no statistically significant benefit on IBS symptoms. TCAs were reported to have benefits on IBS symptoms, predominantly diarrhea. Only one of the TCA studies examined and found a significant improvement in depressive symptoms with desipramine 150 mg/d (P = 0.025). Both the open-label study of duloxetine and the case report involving mirtazapine found improvements in IBS and psychiatric symptoms. CONCLUSIONS: The evidence for the benefit of antidepressant treatment in patients with IBS and comorbid depression was limited and contradictory. Some anti-depressants may help symptoms of IBS, although whether the same drugs and doses are associated with improvements in concomitant depressive symptoms remains to be elucidated.

Methamphetamine: putting the brakes on speed.

In only recent history, illicit use of methamphetamine, once isolated to urban areas on the West Coast, has spread into rural areas of the Midwest and southern United States. Although past and current methamphetamine legislation has increased penalties for methamphetamine manufacturers and tightened restrictions on sales of known precursors, the problem still persists. In fact, a 2004 survey indicates that an alarming 6.2% of high school seniors have tried methamphetamine. A number of biological, genetic, and environmental factors influence children's and adolescents' paths to substance abuse. Nurses should recognize the symptoms of methamphetamine abuse, which include agitation; aggressive behavior; rapid mood swings; hypertension; tachycardia; and eventually lesion-marked skin, clinical depression, and paranoid psychosis. Treatment for methamphetamine addiction includes behavioral therapy. Research on pharmacologic therapy is lacking. Educating youth on methamphetamine prevention appears to be the best approach to curb the spreading use of this addictive and deadly drug.