Home CPD Schizophrenia: A holistic approach to care

Schizophrenia: A holistic approach to care

CPD

May 17, 2021

CPD credits

Accreditation Number : CAP2105CDMMS

Group 1 : 0.75 CPD credits

Group 2 : 1.5 CPD credits

This activity has been accredited for 0.75 hours of Group 1 CPD (or 0.75 CPD credits) suitable for inclusion in an individual pharmacist's CPD plan, which can be converted to 0.75 hours of Group 1 CPD (or 1.50 CPD credits) upon successful completion of relevant assessment activities.

Case scenario

Mark, 25, diagnosed with schizophrenia 6 months ago, comes to the pharmacy following a session with his clinical psychologist. After an acute episode requiring hospitalisation, Mark is transitioning back into the workforce and is concerned about the impact his medicines and recent physical health may have on his performance as a bricklayer. Since commencing olanzapine at diagnosis, his weight has gradually increased, and he has been recently commenced on metformin XR 500 mg daily. Mark wants to re-establish healthy habits; after many ‘cold-turkey’ attempts, he has finally kicked his smoking habit. Mark is frustrated that the olanzapine he is taking is contributing to his weight gain and asks if he can stop it now that he’s feeling better.

Learning objectives

After successful completion of this CPD activity, pharmacists should be able to:

Describe the ‘negative symptoms’ of schizophrenia
Discuss pharmacological management options for schizophrenia
Identify risk factors for schizophrenia
Discuss how a pharmacist can assist management of a patient with schizophrenia.

Competency standards addressed (2016): 1.1, 1.3, 1.5, 2.3, 2.4, 3.2

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Introduction

Schizophrenia is a psychiatric disorder characterised by alterations in perceptions, behaviours, thoughts and mood.¹ Onset typically occurs in early adulthood, and genetic factors are a strong contributor to the risk of developing the condition.^2,3

The symptoms experienced are highly variable between individ

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Rosuvastatin	Ridker Paul M, MacFadyen Jean G, Fonseca Francisco AH, et al. Number needed to treat with rosuvastatin to prevent first cardiovascular events and death among men and women with low low-density lipoprotein cholesterol and elevated high-sensitivity c-reactive protein. Circ Cardiovasc Qual Outcomes 2009;2(6):616–23.
Atorvastatin	Sever PS, Dahlöf B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ascot-lla): a multicentre randomised controlled trial. Lancet 2003;361(9364):1149–58.
Pantoprazole	Pilotto A, Leandro G, Franceschi M. Short- and long-term therapy for reflux oesophagitis in the elderly: a multi-centre, placebo-controlled study with pantoprazole. Aliment Pharmacol Ther 2003;17(11):1399–406.
Esomeprazole	Gralnek IM, Dulai GS, Fennerty MB, et al. Esomeprazole versus other proton pump inhibitors in erosive esophagitis: a meta-analysis of randomized clinical trials. Clin Gastroenterol Hepatol 2006;4(12):1452–8.
Perindopril	Campbell DJ. A review of perindopril in the reduction of cardiovascular events. Vasc Health Risk Manag 2006;2(2):117–24.
Cefalexin	Rosengren H, Heal CF, Buttner PG. Effect of a single prophylactic preoperative oral antibiotic dose on surgical site infection following complex dermatological procedures on the nose and ear: a prospective, randomised, controlled, double-blinded trial. BMJ Open 2018;8(4):e020213.
Metformin	O'Connor PJ, Spann SJ, Woolf SH. Care of adults with type 2 diabetes mellitus. A review of the evidence. J Fam Pract 1998;47(5 Suppl):S13–22.
Escitalopram	Montgomery S, Hansen T, Kasper S. Efficacy of escitalopram compared to citalopram: a meta-analysis. Int J Neuropsychopharmacol 2011;14(2):261–8.
Amoxicillin	Little P, Stuart B, Moore M, et al. Amoxicillin for acute lower-respiratory-tract infection in primary care when pneumonia is not suspected: a 12-country, randomised, placebo-controlled trial. Lancet Infect Dis 2013;13(2):123–9.
Sertraline	Cipriani A, Furukawa TA, Geddes JR, et al. Does randomized evidence support sertraline as first-line antidepressant for adults with acute major depression? A systematic review and meta-analysis. J Clin Psychiatry 2008;69(11):1732–42.
Top 10 drugs	Top 10 drugs 2019–20. Aust Prescr 2020;43:209.

	Grade of recommendation*	Level of agreement (0–10)^†
1. Education and training in ergonomic principles, pacing of activity and use of assistive devices should be offered to every patient	A	9.3 (1.1)
2. Exercises to improve function and muscle strength, as well as to reduce pain, should be considered for every patient	A	9.1 (1.6)
3. Orthoses should be considered for symptom relief in patients with thumb-base OA. Long-term use is advocated	A	9.3 (1.0)
4. Topical treatments are preferred over systemic treatments because of safety reasons. Topical NSAIDs are the first pharmacological topical treatment of choice	A	8.6 (1.8)
5. Oral analgesics, particularly NSAIDs, should be considered for a limited duration for relief of symptoms	A	9.4 (0.9)
6. Chondroitin sulfate may be used in patients with hand OA for pain relief and improvement in functioning	A	7.3 (2.7)
7. Intra-articular injections of glucocorticoids should not generally be used in patients with hand OA but may be considered in patients with painful interphalangeal joints	A	7.9 (2.4)
8. Patients with hand OA should not be treated with conventional or biological disease-modifying antirheumatic drugs	A	8.8 (1.8)
9. Surgery should be considered for patients with structural abnormalities when other treatment modalities have not been sufficiently effective in relieving pain. Trapeziectomy should be considered in patients with thumb-base OA and arthrodesis or arthroplasty in patients with interphalangeal OA	D	9.4 (1.4)
10. Long-term follow-up of patients with hand OA should be adapted to the patient’s individual needs	D	9.5 (1.7)

Aged care funding confirmed

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3. You need to check AIR before every jab (and upload it, too)

4. Despite administering COVID-19 vaccines, pharmacists still can’t vaccinate against influenza in kids <10 years

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6. Influenza vaccination should be offered throughout the flu season, not just at the start

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Resources

Case scenario

Learning objectives

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Introduction

Illicit drug use and adverse events in Australia

What are novel psychoactive substances?

What is MDMA?

Drug checking in Australia

The drug checking process

What is the evidence?

Knowledge to practice

Case scenario continued

Conclusion

Key points

Case scenario

Learning objectives

Already read the CPD in the journal? Scroll to the bottom to SUBMIT ANSWERS.

Introduction

Aetiology and pathophysiology

Signs and symptoms

Diagnosis

Staging

Screening and prevention

Smoking cessation

Management of lung cancer

Targeted therapy – monoclonal antibodies

Chemotherapy NSCLC

Chemotherapy SCLC

Palliative care

Management of adverse effects of lung cancer treatment

Patient resources

Knowledge to practice

Case scenario continued

Conclusion

Key points

Case scenario

Learning objectives

Already read the CPD in the journal? Scroll to the bottom to SUBMIT ANSWERS.

Introduction

Statistical measures

Calculating the NNT

Interpreting the NNT

Informing patients about risk

Case scenario continued

Conclusion

Key points

Case scenario