OBJECTIVE:The objective of this study was to assess the impact of mindfulness meditation offered in a community pharmacy on patients with current anxiety or a history of anxiety, depression, or both.SETTING:Community pharmacy clinical space located in a grocery store.PRACTICE DESCRIPTION:An 8-week, once-per-week mindfulness meditation program for patients with anxiety or depression.PRACTICE INNOVATION:A pharmacist provided mindfulness meditation within the clinical space in a community pharmacy.EVALUATION:PHQ-9 and GAD-7 were used to assess prestudy and poststudy depression and anxiety severity, respectively. Items pertaining to participant demographics and experience in the program were also included.RESULTS:Twelve participants completed the study requirements. Three-quarters of participants experienced a reduction in the severity of their depression or anxiety, and no participant experienced an increase in the severity of his or her condition.CONCLUSION:Findings from this study indicated that a mindfulness meditation program delivered in a community pharmacy and provided by a pharmacist for patients with depression or anxiety, or both, can result in a reduction in severity of their conditions for participants.

IntroductionScreening driving ability is challenging in psychiatry due to the fluctuating nature of psychiatric diagnoses, psychosocial factors, and the impact of medications. An examination of best practice and a literature review yielded few results, highlighting the need for the development of a driving screening framework. The goal was to develop a clinical reasoning guide, agreed upon by psychiatric occupational therapists, to improve systematic driving screening for this population. MethodA series of surveys distributed to occupational therapists examined the key components to consider, utilizing a modified Delphi technique. Data from 94 completed questionnaires over three rounds were filtered, analyzed, summarized, and redistributed. Survey distribution and guideline amendment continued until consensus was achieved. FindingsThe Saskatchewan Psychiatric Occupational Therapy Driving Screen (SPOT-DS) has been developed as the first comprehensive clinical reasoning guide for screening drivers with psychiatric conditions. ConclusionThe SPOT-DS can assist in protecting clients’ driving privileges, while ensuring public safety on the roads by providing a systematic approach to screening drivers. Further testing on its validity is warranted.

OBJECTIVE:To determine the impact of a drug information service on patient outcomes.DESIGN:Prospective evaluation of patient-specific drug information requests.SETTING:Healthcare professional and consumer drug information service located at a college of pharmacy.PARTICIPANTS:Consumers and healthcare professionals of the province.INTERVENTION:Patient-specific questions received by the drug information service were reviewed and evaluated for actual patient outcome, inquirers' opinion of impact of the service with respect to patient outcome, and for objectivity and timeliness of the response. An expert panel determined whether the responses and recommendations given by the service were appropriate, determined what impact the service had on the patient, and assessed the seriousness of the inquiry.MAIN OUTCOME MEASURE:Classification of patient outcome by objective and subjective data based on predetermined desired outcomes.RESULTS:Ninety-eight and 68 patient-specific requests were received from healthcare professionals and consumers, respectively. The panel concluded that 94.9% of the healthcare requests and 98.5% of the consumer requests were answered appropriately and that the majority of the requests involved potentially serious drug-related problems. The panel also determined that 46.8% of the recommendations to healthcare professionals and 41.0% of the recommendations to consumers resulted in positive patient outcomes. The majority of the positive outcomes involved the prevention of a disease or its symptoms (professional section) and the reduction or elimination of symptoms (consumer section).CONCLUSIONS:The drug information service not only met its objectives of providing drug information in an accurate, objective, and timely manner, but was also able to provide positive patient outcomes.

The elderly are high consumers of both prescription and over-the-counter medications. As a result of age-related changes in drug pharmacokinetics and pharmacodynamics, they experience twice the number of adverse effects than in the general population. Using the health insurance data bases of the province of Saskatchewan, the prescribing pattern of drugs which have anticholinergic properties, was studied in the elderly. Of patients less than or equal to (< or =) 64 years of age 3.8% compared to 11.3% of patients greater than or equal to (> or =) 65 years of age were prescribed an anticholinergic medication. In the elderly group, 9.3% of the ambulatory subjects and 43.8% of the special care home (SCH) residents received a prescription for an anticholinergic drug. The concurrent prescribing of two or more anticholinergic medications was also higher in the elderly (0.16% of patients < or = 64 versus 0.54% of patients > or = 65). All differences between patients < or = 64 and those > or = 65, as well as between the ambulatory elderly subjects and the SCH elderly residents, were statistically significant. Approximately 25% of all anticholinergic medications were prescribed in the high to excessive dosage range. The study also looked at prescribing patterns for individuals with a diagnosis of dementia. Despite the potential detrimental adverse effect of anticholinergic therapy in that patient group, 35.5% received a prescription for anticholinergic medication. These data confirm that the elderly are at high risk for receiving a prescription for anticholinergic medications. The high prevalence of anticholinergic prescribing in a patient population known to be sensitive to anticholinergic side-effects has the potential to cause significant adverse clinical consequences.

Study Objective. To evaluate whether serum anticholinergic drug activity would be a useful clinical tool in helping to predict anticholinergic toxicity Design. A prospective study that included a retrospective chart review Setting. Two nursing home facilities.Subjects. Thirty-one elderly volunteers between ages 69 and 98 years.Intervention. Each subject completed a two-part interview. First, anticholinergic symptoms were evaluated and then cognitive function was assessed by three neuropsychiatric tests. Blood (10 ml) was collected to measure anticholinergic activity Measurements and Main Results. Eight subjects had detectable serum anticholinergic activity and scored higher on the Symbol Digit Modalities test than those with no detectable activity No statistical difference was seen between the groups with respect to symptoms or results of the Mini-Mental and Auditory-Verbal Learning tests.Conclusion. The clinical usefulness of serum anticholinergic activity as a predictor for anticholinergic toxicity was not established under the experimental design of this study

OBJECTIVES The study examined whether patients who responded to an antidepressant in one episode of depression responded to the same agent in a subsequent episode. It also sought to determine whether in a subsequent episode clinicians prescribed an antidepressant that had previously been effective. METHODS Charts of inpatients with a diagnosis of major depression who were consecutively admitted to general hospital psychiatric wards were screened to determine whether the patients met the inclusion criteria of recurrent major depression and had responded to antidepressant therapy in a previous episode. Data were collected on type of treatment and treatment response for each episode. RESULTS Fifty-nine patients met the inclusion criteria. Thirty-five of the patients (59.3 percent) were prescribed the same antidepressant in both the current and previous episodes. Of these, 20 patients responded and 15 did not. Of the 24 patients who did not receive the same antidepressant, 14 were attended by the same clinician in both treatment episodes. Nineteen of the 24 patients responded to a new antidepressant, and five did not. CONCLUSIONS Patients with recurrent depression are often prescribed antidepressants other than those that were effective in previous treatment episodes. Use of a previously effective antidepressant may not increase the treatment response rate in a subsequent depressive episode.

Sandoz Canada Inc. began distributing clozapine in Canada under the Clozaril Support and Assistance Network (CSAN) in 1990. The costs associated with the required compliance to the CSAN program has prompted much debate regarding the ethical and clinical considerations in selecting patients to receive clozapine therapy. We undertook a one year cost-comparison analysis of clozapine therapy by assessing total mental health care costs for a patient with an extensive hospitalization history who was prescribed clozapine. Average yearly hospitalization costs were $17,413. The average yearly cost associated with clozapine therapy for this patient, with no hospital admissions was $8,411. The total health care cost for the year following initiation of clozapine was $17,828, compared to a cost of $68,423 in the year prior to clozapine, or $27,754 in an estimated average year. This case is representative of costs savings that can be achieved by using clozapine and breaking the institution-dependency of many schizophrenic patients.

Unconjugated (U-PAA), conjugated (C-PAA), and total phenylacetic acid (T-PAA) concentrations in blood plasma and monoamine oxidase (MAO) activity in platelets towards phenylethylamine (PE) were determined in 40 drug-free, depressed patients (23 melancholic, 17 nonmelancholic) from five psychiatric treatment centers, and in 34 normal healthy volunteers. No significant differences were found between controls and all depressed patients or between melancholic and nonmelancholic depressed patients. Treatment of the depressed patients with amitriptyline or fluoxetine over a 6-week period resulted in clinical improvement and in a significant increase in plasma PAA concentrations. A decline in the Beck and Hamilton rating scores during treatment correlated significantly with increases in the concentrations of unconjugated, conjugated, and total phenylacetic acid but not with MAO activity, which did not change during treatment. At each of the three assessment times, however, plasma PAA concentrations and psychiatric rating scores were not significantly correlated. Except for higher end-of-study T-PAA concentrations in the amitriptyline-treated subjects, no significant differences were found between the effects of the two drugs with regard to plasma phenylacetic acid levels, MAO activity, or rating scores.

1. Depressed and normal subjects were challenged with deuterium-labelled p-tyramine and urine was collected for 3 h.2. Urinary excretion of conjugated p-tyramine was not significantly different between normal, melancholic and non-melancholic depressed subjects.3. Platelet phenolsulfotransferase activity to p-tyramine (p < 0.05) and to phenol (p < 0.005) were significantly lower in the depressed patients.

Aminoglycoside antibiotics are frequently used for the treatment of suspected and confirmed sepsis in the newborn patient. In an attempt to evaluate gentamicin dosing based on serum creatinine concentrations, two groups of neonates were studied (infants less than 34 weeks n = 8 and greater than 34 weeks n = 14). The dosing interval was adjusted per protocol depending on the serum creatinine concentrations. Analysis of the results indicate reasonable therapeutic serum gentamicin trough and peak concentrations in most infants.