Psychiatric symptoms and synthetic cannabinoid use: Information for clinicians.

BACKGROUND: Limited treatment information is available when patients present with psychotic symptoms secondary to synthetic cannabinoid (SC) use. Symptoms associated with use are often indistinguishable from those encountered with a primary mental illness and also include aggression, confusion, and anxiety. For these patients, clinicians rely on physical presentation, symptom(s) onset, and episode duration when evaluating patients. PATIENT HISTORY: An adult man was involuntarily admitted to inpatient status secondary to reports of bizarre behaviors that included paranoia and psychomotor agitation. Because of the severity of the symptoms, he was unable to participate in the admission assessment. On day 2, he reported having smoked a substance provided by a friend. In addition, he admitted to previous SC use on 3 occasions, with each occasion resulting in an involuntary admission to inpatient status. The course of this admission was unremarkable. CONCLUSIONS: A brief overview of psychiatric signs and symptoms of SC use and information to help clinicians are included. The presentation of psychotic symptoms secondary to SC may be consistent with those of psychosis or other substances of abuse. Because of the variability in the symptoms produced by SC use, clinicians are encouraged to consider SC use in the diagnostic evaluation.

A design and focus group evaluation of dietary choices tools for an underserved population.

INTRODUCTION: Our objective was to develop and evaluate dietary teaching tools for a select population diagnosed with a severe mental illness and limited financial ability. Patients with severe mental illnesses face many challenges, including common health comorbidities of diabetes, high blood pressure, high cholesterol, and obesity. Cognitive deficits may limit educational programming; financial resources can affect access to a healthy diet. The Integrated Multidisciplinary Program of Assertive Community Treatment (IMPACT) program, a university-based program, provides individualized services to this population. One focus is healthy nutritional choices. METHODS: In Phase One, a clinical pharmacist and a first-year pharmacy resident created visual aids. These cards were given to health care providers (HCPs) to be used with IMPACT members. HCPs were asked to participate in a focus group and provide feedback. Phase Two: Based on specific focus group feedback, additional resources were created to address identified nutritional needs. RESULTS: Phase One: Ten cards were created and distributed to the HCPs. A focus group was conducted. HCPs reported the cards were useful in opening dietary choices dialogues and were able to give more specific information on alternative choices. Phase Two: From focus group feedback, specific cards for disease states, calorie guidelines, and budget limitations were developed. HCPs immediately utilized them. DISCUSSION: This pilot project was used to design and create educational cards to facilitate discussions on healthy or healthier dietary choices. Feedback from the HCPs participating in the focus group was positive, and they were enthusiastic about both sets of cards, particularly those pertaining to budget choices.

Use of visual cueing for blood glucose documentation in a person with schizophrenia and diabetes.

Persons diagnosed with schizophrenia are also at-risk for medical comorbidities. We present the case of one such patient with the comorbidity of diabetes. By applying the research on visual cueing for this population, we developed a glucose monitoring form that increased documentation. We encourage other healthcare practitioners to develop visually appealing or interesting documentation forms for their patients to help empower them for self-care.

Case report: increased patient response to intramuscular haloperidol decanoate following a change in needle length.

INTRODUCTION: Intramuscular (IM) injection is a commonly used administration route for a variety of medications. Determining the optimum needle length for administration of IM formulations based on individual patient variables has not been extensively reported in patients receiving antipsychotic medication via IM administration. CASE REPORT: The patient, a 23-year-old African American female diagnosed with schizophrenia, was referred to a community-based treatment program following multiple inpatient admissions. At age 19, she began experiencing psychiatric symptoms that resulted in assault and incarceration. Treatment included separate trials of haloperidol and fluphenazine decanoate formulations with minimal success reported. At the time of evaluation, she was experiencing constant positive psychiatric symptomatology. Oral haloperidol was started. Haloperidol decanoate 150 mg by IM injection using a 1.5-inch needle was added and titrated to 350 mg IM over 11 months. Auditory hallucinations continued. Following refusal of a haloperidol level, the physician changed to a 2-inch needle for decanoate injections. Noticeable and continued slow improvement of her psychotic symptoms resulted. CONCLUSION: Needle length may be of new importance to practitioners. If anticipated results of IM antipsychotic medication administration are not realized, practitioners are urged to consider patient variables, notably the amount of adipose tissue in the administration area.

Probable quetiapine-mediated prolongation of the QT interval.

PURPOSE: QT prolongation can occur with both first- (FGA) and second-generation antipsychotics (SGA). QT prolongation was identified in an adult patient who presented to the emergency room with schizophrenia, fluid and electrolyte imbalances, and pneumonia. Quetiapine, an SGA, was a component of the pharmacotherapy regimen. Based on the Naranjo adverse drug reaction probability scale rating criteria, a probable causal association was made. METHODS: PubMed and Ovid were searched using the terms antipsychotic, psychotropic, QT interval, corrected QT interval (QTc) prolongation, and quetiapine. References were examined for additional articles related to antipsychotic drugs and the QT interval. DISCUSSION: In this patient, the use of quetiapine was identified as a contributing factor in QT prolongation. Prior QT prolongation was experienced with ziprasidone, another SGA. The antidepressant and dose remained consistent throughout the inpatient course of treatment. Other risk factors in this patient included hypokalemia, dehydration, pneumonia, age, gender, and concurrent usage of an antidepressant. Dual psychiatric diagnoses, preexisting cardiovascular disease, and electrolyte disturbances may increase this risk potential. CONCLUSION: Psychiatric patients may be more at risk of cardiovascular complications, such as QT interval prolongation. The pharmacist can help evaluate risk factors and provide input into the care of all patients, particularly those identified as at risk.