Background: This project evaluated the clinical use of pharmacogenetic testing in an outpatient psychiatric practice, integrated a standardized measure for assessing depressive symptoms, and captured data regarding treatment efficacy. Local Problem: According to the Centers for Disease Control and Prevention (2016), more than 10% of all outpatient office visits include a depression-related diagnosis. Patients who require more medication trials to experience remission of depressive symptoms are more likely to relapse in the follow-up period than those who do not (National Institute of Mental Health, 2001). Methods and Interventions: Baseline Patient Health Questionnaire-9 (PHQ-9) scores and medication regimens were recorded for 15 adults with major depressive disorder who completed pharmacogenetic testing. Repeat PHQ-9 scores and medication regimens were recorded at follow-up appointments within 6 weeks post-pharmacogenetic testing and compared with baseline data. Results: The PHQ-9 scores ranged from a 5-point reduction to a 2-point increase in depressive symptoms at follow-up appointment. The PHQ-9 scores were lower at follow-up screening for 14 participants. Six of the 15 participants were on a single medication, with significant drug–gene interactions. Medications with significant drug–gene interactions were eliminated from the regimen for three of the six patients. For the remaining three patients, providers deemed it to be reasonable to continue the medications with significant drug–gene interactions. Conclusions: Pharmacogenetic testing is a useful clinical tool for guiding medication selection but does not replace provider judgment. Drug–gene interaction testing results should be considered in addition to patient preference, medication cost, possible side effects, and immediate clinical needs.

There is a well-documented demand for psychiatric providers, clinicians whose scope of practice includes all essential psychiatric services, such as assessment, diagnosis, psychotherapeutic/psychotherapy interventions, and psychotropic medication treatment (American Psychiatric Nurses Association, International Society of Psychiatric Mental Health Nurses, & American Nurses Association, 2014). Psychiatric mental health (PMH) Advanced Practice Registered Nurses (APRNs) have the education, training, and licensure to meet this demand. The PMH APRN workforce has been growing over the past 20 years and has the potential to mitigate the Mental Health Professional Shortage Areas (MHPSAs) that states are attempting to address (Delaney, 2017; Kaiser Family Foundation, 2016). However, federal reports and mental health workforce studies often mischaracterize the PMH APRNs' scope of practice and present conflicting data on the number of currently certified practitioners. The profession must meet the pervasive misinformation about PMH APRNs with a consistent, clearly articulated message about the scope of practice, range of skills, and types of services provided. To effectively participate in mental health workforce planning, the specialty must be armed with an accurate depiction of current PMH APRNs, data on the educational pipeline, the anticipated growth of the workforce, and expected retirements. Objective This article outlines the anticipated number and characteristics of the PMH APRN entrants to the workforce. Enrollment and graduation trends are examined to estimate 5-year growth of the workforce, taking potential retirements into consideration. We discuss facilitators and 806571J APXXX10.

Psychiatric nurses are at the forefront of optimizing psychiatric care, including educating patients and caregivers on the risks of antipsychotic-induced movement disorders such as tardive dyskinesia (TD). Nurses should be aware that all patients taking antipsychotics should be regularly monitored for the development of TD. Given the current pandemic and increase in telehealth, assessing for TD is challenging; however, evaluation can be successfully completed by implementing the best practices described in this paper. Once TD is diagnosed, nurses can reassure patients that safe and effective FDA-approved treatments for TD (e.g., valbenazine) are now available.

Significant challenges exist to growing the PMH NP lifespan workforce including how to assist PMH clinical nurse specialists, Adult PMH NPs, and other NPs wanting to obtain the PMH NP lifespan degree.

IntroductionTardive dyskinesia (TD) is a persistent and often disabling hyperkinetic movement disorder associated with prolonged exposure to dopamine receptor blocking agents (e.g., antipsychotics, antiemetics). The use of anticholinergics for the treatment of movement disorders including TD is a common practice, despite a lack of supportive evidence and the potential to worsen TD. Moreover, there are now FDA-approved medications specifically indicated for TD. Two virtual meetings were held with movement disorder experts from neurology and psychiatry to better understand the real-world use of anticholinergics for TD.MethodsIn November 2020, a panel of eight experts was convened to gather insights on the challenges of differentiating TD from other drug-induced movement disorders (DIMDs) and to discuss appropriate treatments for TD and other DIMDs. A follow-up meeting was held in June 2021 to consolidate these insights. Key recommendations based on the panel discussions are presented.ResultsThe panel emphasized that while anticholinergics can help with managing some DIMDs, current evidence indicates that they are not effective in TD and may even worsen symptoms. Therefore, FDA-approved vesicular monoamine transporter 2 (VMAT2) inhibitors like valbenazine were recommended by the panel as first-line TD therapies. The panel noted that TD is often grouped under the term “extrapyramidal symptoms,” which leads to difficulty in differentiating TD from other DIMDs and the inappropriate treatment of TD with anticholinergics. The panel agreed that prophylaxis with anticholinergics is only appropriate in patients at high risk of acute dystonia. However, chronic anticholinergic use should be avoided whenever possible due to potentially serious adverse effects (e.g., cognitive difficulties) and anticholinergic burden, particularly in older patients. The potential for abuse, addiction, and diversion should also be considered when prescribing anticholinergics. Abrupt anticholinergic discontinuation can result in cholinergic rebound, which is characterized by sleep disturbances, gastrointestinal problems, urinary urgency, and manifestations of DIMDs. Thus, when used appropriately (e.g., for acute dystonia), anticholinergics should be prescribed at minimally effective doses and slowly tapered for successful discontinuation.ConclusionsThese findings align with the current TD treatment guidelines, including the lack of evidence for anticholinergic use and recommended first-line treatment with approved VMAT2 inhibitors. Conclusions from this panel highlight educational needs across HCPs on the phenomenology of DIMDs, the inappropriate use of anticholinergics for TD, TD risks and assessment, and treatment strategies for TD.FundingNeurocrine Biosciences, Inc.