Expanding Cessation Pharmacotherapy Via Videoconference Educational Outreach to Prescribers

According to studies that assessed current smoking rates among the population, it was found that people diagnosed with a mental illness are two to three times more likely to smoke than those who are not. For this reason, this study focused at providing these patients underutilized forms of smoking cessation pharmacotherapy to determine if a change could be made in this pattern. Researchers utilized two different forms of smoking cessation education methods in an attempt to determine the best way to deliver this information to patients. While the first method provided traditional group in-person cessation education sessions,  the second method aimed at determining if the use of videoconferencing technology would be an adequate alternative method for education. Members of the study analyzed the results by examining filled Medicaid pharmacotherapy claims along with the prescribers’ attitudes toward the different forms of education services. Although researchers hypothesized that in-person delivery of smoking cessation programs would be more effective than videoconferencing, they found that there were no significant differences between the two groups of patients receiving this service. They did note that patients receiving either form of this service were more likely to follow through with actions to quit smoking than those who did not.

I believe studies like these are important for future pharmacists to be aware of because it is our goal to make sure that patients are utilizing treatment options in an appropriate matter to ensure that they will receive the best health benefit. Since we are often the easiest person within the health care system for patients to approach with their issues, it is crucial that we know how to counsel them on these types of health-related concerns. Knowing that just providing some form of cessation education improves the likelihood that a patient will attempt to follow actions required to quit harmful behaviors is a positive sign that our work as professionals can have a significant impact on the people we are serving. It is for this reason that we should continually provided counseling services to patients at multiple stages in the treatment process, such as initiation of therapy and follow-ups. I believe that these actions will have a beneficial impact on patients and will make doing our job a much more fulfilling experience. I would be very interested to see how this type of study would show improvement in limiting the harmful impact that other health concerns have on the population.

Brunette MF, Dzebisashvili N, Xie H, et al. Expanding cessation pharmacotherapy via videoconference educational outreach to prescribers. Nicotine Tob Res. 2015;17(8):960-7.

Use of Stimulants in Children of Mentally Ill, Increased Risk of Psychotic Symptoms

This article concerned a study showing that children aged 6-21 with one or more parents with a severe mental illness had a higher likelihood of experiencing psychotic symptoms when taking stimulants.  It was once thought that psychotic symptoms, including hallucinations, delusions, and psychotic-like experiences, were rare side effects of stimulants in children.  This study demonstrated that it might not be the case that they are such rare side effects, especially in children of one or more parent with a severe mental illness.  In the study, the children of parents with mental illnesses including major depressive disorder, bipolar disorder, and schizophrenia were tested for ADHD, a common indication for use of stimulants in children.  Of the children with ADHD, those that had taken stimulants had a much higher rate of experiencing psychotic symptoms than those who had not taken stimulants.  The study showed that there was a temporal relationship between taking stimulants and experiencing psychotic symptoms.  It also ruled out the possibility that the real cause of the psychotic symptoms was ADHD and not the use of stimulants.  The study used multiple sophisticated instruments for assessing psychotic symptoms, and the results were statistically significant.  Additional studies are necessary to confirm that there is indeed a causal relationship between stimulants and psychotic symptoms in children of parents with mental illnesses.  Further studies will also be necessary to determine of the stimulant methylphenidate, the most frequently seen in the study, produces results that can be generalized to other stimulants.  However, the results of this study alone are enough to encourage doctors and psychiatrists to consider familial history of severe mental illnesses when considering prescribing stimulants for children with ADHD.

I was happy to see this article because I think it is important to continue testing in the field of mental illnesses and medications for learning disabilities and mental illnesses.  There has always been a stigma attached to mental illness, and it is possible that this stigma has affected how mental illness and medications for mental problems have been studied and presented to the public.  Further studies in this area will help to clear any misconceptions that have formed and to improve medical practice in this area.

MacKenzie LE, Abidi S, Fisher HL, et al. Stimulant Medication and Psychotic Symptoms in Offspring of Parents With Mental Illness. Pediatrics. 2016;137:1-10.

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