Pharmacist-led sedative-hypnotic deprescribing in team-based primary care practice.

BACKGROUND: Sedative-hypnotic (SH) medications are often used to treat chronic insomnia, with potentially serious long-term side effects. The objective of this study is to evaluate an interprofessional SH deprescribing program within a community team-based, primary care practice, with or without cognitive behavioural therapy for insomnia (CBT-I). METHODS: Retrospective chart review for patients referred to the team pharmacist for SH deprescribing from February 2016 to June 2019. RESULTS: A total of 121 patients were referred for SH deprescribing, with 111 (92%) patients who attempted deprescribing (average age 69, range 29-97 years) and 22 patients who also received CBT-I. Overall, 36 patients (32%) achieved complete abstinence, and another 36 patients (32%) reduced their dosage by ≥50%. For the 36 patients who achieved complete abstinence, 26 (72%) patients remained abstinent at 6 months (9 patients resumed using SH and 1 patient was lost to follow-up). The proportion of patients achieving complete abstinence or reduced dosage of ≥50% (successful tapering) was higher with CBT-I than without CBT-I but did not reach statistical significance (77% vs 62%, p = 0.22). There were also no statistically significant differences detected in the success between those who took a benzodiazepine and those who took a Z-drug (67% vs 61%, p = 0.55) or for those who took SH daily and those who took them intermittently (67% vs 44%, p = 0.09). CONCLUSION: Almost two-thirds of patients participating in our pharmacist-led program were able to stop or taper their SH medications by ≥50%. The role of CBT-I in SH deprescribing remains to be further elucidated. Can Pharm J (Ott) 2021;154:xx-xx.

On the Very, Very Frontlines of Mental Health Care.

The role and training needs of client-facing administrative staff in mental health settings is an underidentified topic in the literature. Although interactions between the medical office staff and clients are not typically defined as therapeutic, patients nevertheless often view client-facing staff as an extension of their physician or care team. These interactions can be both meaningful and important to the overall care experience and should be conceptualized and understood as a legitimate part of the larger healing environment. To this end, the authors propose that a more fulsome understanding is needed of the experiences and impact of administrative staff's role in the larger clinical encounter from the perspectives of both clients and staff. The authors also identify a number of unmet training and support needs for client-facing administrative staff.

Lost in Transition: Examining Transitions in Psychotherapy Training.

OBJECTIVE: Disruptions are inevitable during psychiatry residency training and can affect resident learning and patient care. This exploratory study examined the nature and impact of transitions in psychotherapy training. METHODS: PGY2-5 residents (45/150; 30% response rate) and psychotherapy supervisors (46/247; 18.6% response rate) were surveyed about transitional events during residency training in psychotherapy. RESULTS: Supervisors and residents ranked the frequency of occurrence of transitional events and their impact very similarly, as well as the "feed forward" items when transitioning to a new supervisor. Residents feeling confused or overwhelmed with the balancing of learning differing models with differing levels of comfort or knowledge was ranked as the issue that occurred most frequently by both supervisors and residents. CONCLUSIONS: This study highlights issues that arise at transitions during psychotherapy training in psychiatry residency. Strategies for managing these periods are discussed, with a focus on resident learning and improved continuity of patient care.

Integración de estrategias y teorias en la practica psiquiatrica / Integrating strategy and theory in the psychiatric practice

Se describe una dificultad en el ejercicio de la psiquiatría: el dogmatismo y la sectorialización teórico-técnica. A través de un caso clínico (un paciente con eyaculación precoz) se intenta hacer interactuar dos escuelas diversas: psicoanálisis y terapia conductual. Se muestran los efectos enriquecedores de esa interacción en contraste con las limitaciones que establecen algunas divisiones entre escuelas psiquiátricas producto de conflictos narcisistas mas que de un cuestionario científico