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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	Active Ingredient	Dosage	Onset of action	Side effects	Counselling points
Stool softeners	Poloxamer Coloxyl Drops 10%, 30 mL	<6 months: oral 0.3 mL three times daily 6–18 months: oral 0.5 mL three times daily 18 months – 3 years: oral 0.8 mL three times daily	1–3 days	Abdominal discomfort, diarrhoea (with excessive doses)	Can be given with expressed breast milk, formula, water or fruit juice to aid administration
	Docusate Coloxyl	3–6 years: oral 50 mg daily 6–12 years: oral 50–150 mg daily (may divide dose)	1–3 days	Abdominal cramps, diarrhoea, nausea	Take with plenty of fluid and fibre
	Liquid paraffin Parachoc (chocolate) 50% emulsion, Agarol (vanilla) 32% emulsion	Parachoc 12 months – 6 years: oral 10–15 mL once daily. Increase or decrease in 5 mL graduations to achieve a soft stool 7–12 years: oral 20 mL once daily. Increase or decrease in 5 mL graduations to achieve a soft stool Agarol 12 months – 6 years: oral 15–20 mL once daily. Increase or decrease in 5 mL to achieve a soft stool 7–12 years: oral 20 mL once daily. Increase or decrease in 5 mL graduations to achieve a soft stool	2–3 days	Anal leakage and rectal irritation	Not to be taken within 2 hours of lying down due to aspiration risk Teeth must be brushed after intake Take with plenty of fluid and fibre
Osmotic laxatives	Lactulose Actilax, Dulose, Duphalac	1–12 months: oral 5 mL once daily 1–7 years: oral 5–10 mL once daily 7–12 years: oral 15 mL once daily	1–3 days	Bloating, abdominal cramps/pain	Can be given undiluted, in formula, expressed breast milk, water or fruit juice Daily dose can be divided and given twice daily
	Macrogols or polyethylene glycols (PEGs) Movicol Junior (with electrolytes) OsmoLax (without electrolytes)	Movicol Junior 2–6 years: oral 1 sachet daily. Adjust to achieve a soft stool. Maximum 4 sachets daily >6 years: oral 2 sachets daily. Adjust to achieve a soft stool. Maximum 4 sachets daily if <12 years OsmoLax 2–6 years: oral 8.5 g once daily. Adjust to achieve a soft stool. Maximum 17 g daily 6–12 years: oral 17 g once daily. Adjust to achieve a soft stool. Maximum 25.5 g daily	1–3 days	Nausea, bloating, cramps, vomiting	Iso-osmotic with normal intestinal contents, reducing electrolyte and water loss. Movicol Junior has a salty taste. Movicol Junior is not recommended in children <2 years OsmoLax is not recommended in children <2 years May be mixed with cordial or juice to improve palatability
	Glycerol suppository Glycerol Infant 700 mg Glycerol Child 1.4 g	1 month – 1 year: one 700 mg rectal suppository once daily when required >1 year: one 1.4 g rectal suppository once daily when required	5–30 minutes	Rectal irritation, abdominal pain, swelling and loose stools	Moisten or lubricate the tip of the suppository with water before insertion
Stimulant laxatives	Bisacodyl Dulcolax (tablets and suppository) Lax-Tab (tablets) Bisalax (tablets) Bisalax (enema)	>2 years: 5–10 mg rectal suppository once daily when required >3 years: oral 5–10 mg at night when required >10 years: one 10 mg rectal suppository once daily when required	Suppository: 15–60 minutes Oral: 6–12 hours Enema: 5–15 minutes	Abdominal pain, diarrhoea, hypokalaemia	Evidence suggests that chronic use of stimulants does not harm the colon For Dulcolax SP Drops: place drops on a spoon or mix with some water and take immediately
	Senna Senokot 7.5 mg tablets Senna-Gen 7.5 mg tablets	2–6 years: oral 3.75–7.5 mg at bedtime 6–12 years: oral 7.5–15 mg at bedtime	6–12 hours	Abdominal pain, diarrhoea
	Sodium picosulfate Dulcolax SP Drops 7.5 mg/mL	2–4 years: oral 250 micrograms (half a drop)/kg at night. Maximum 5 mg 4–10 years: oral 2.5–5 mg (5–10 drops) at night >10 years: oral 5 mg (10 drops) at night. Increase to a maximum of 20 drops (10 mg) at night if required.	6–12 hours	Burping, diarrhoea, abdominal cramps

Making a difference in rural and remote health

Missed opportunity

Residential Medication Management Reviews

Harms to patients

Pharmacists and medicine safety in aged care facilities

Chemical restraint

Government’s budget response

Top tips

Securing a role

Finding the right practice

Carving out a role

A critical juncture

Vaccinating in the outback

In the hospital

In the community

FAQs

TAREN GILL MPS

Accessibility issues

EVA QUEK MPS

Impact on patients

Counselling advice

Efficacy of treatment

Collaborating with allied health professionals

Pharmacists critical to rollout

A lack of knowledge

Pharmacist intervention

Case scenario

Learning objectives

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Introduction

Normal (acute) constipation

Chronic constipation

When is referral required?

What is the management approach?

What are the preventive measures?

Knowledge to practice

Where can I find further information?

Conclusion

Case scenario continued

Key points:

Case scenario

Learning objectives

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Introduction

Epidemiology

Pathophysiology

Symptoms and complications

Aetiology

NSAID-induced peptic ulcers

Idiopathic peptic ulcers

Conclusion

Case scenario continued

Key points:

Case scenario

Learning objectives

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Introduction

Pharmaceutical drug misuse in Australia

Staged supply

7CPA eligibility criteria

Association with other services

Knowledge to practice

Conclusion

Case scenario continued

Key points

Case scenario

Learning objectives

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Introduction

Aetiology and risk factors

Pathophysiology

Symptoms and diagnosis

Management

Knowledge to practice

Conclusion

Case scenario continued

Key points:

Case scenario

Learning objectives

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