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Introduction:Our objective was to develop and evaluate dietary teaching tools for a select population diagnosed with a severe mental illness and limited financial ability. Patients with severe mental illnesses face many challenges, including common health comorbidities of diabetes, high blood pressure, high cholesterol, and obesity. Cognitive deficits may limit educational programming; financial resources can affect access to a healthy diet. The Integrated Multidisciplinary Program of Assertive Community Treatment (IMPACT) program, a university-based program, provides individualized services to this population. One focus is healthy nutritional choices.Methods:In Phase One, a clinical pharmacist and a first-year pharmacy resident created visual aids. These cards were given to health care providers (HCPs) to be used with IMPACT members. HCPs were asked to participate in a focus group and provide feedback. Phase Two: Based on specific focus group feedback, additional resources were created to address identified nutritional needs.Results:Phase One: Ten cards were created and distributed to the HCPs. A focus group was conducted. HCPs reported the cards were useful in opening dietary choices dialogues and were able to give more specific information on alternative choices. Phase Two: From focus group feedback, specific cards for disease states, calorie guidelines, and budget limitations were developed. HCPs immediately utilized them.Discussion:This pilot project was used to design and create educational cards to facilitate discussions on healthy or healthier dietary choices. Feedback from the HCPs participating in the focus group was positive, and they were enthusiastic about both sets of cards, particularly those pertaining to budget choices.

A brief overview of psychiatric signs and symptoms of SC use and information to help clinicians are included. The presentation of psychotic symptoms secondary to SC may be consistent with those of psychosis or other substances of abuse. Because of the variability in the symptoms produced by SC use, clinicians are encouraged to consider SC use in the diagnostic evaluation.

Purpose To report the first descriptive case of a mouth lesion following one dose of sublingually administered asenapine. Summary Asenapine is a second-generation antipsychotic, approved in the United States in August 2009, for the treatment of schizophrenia and acute mania associated with bipolar disorder. It is administered as a sublingual tablet to be taken twice daily. Although the mechanism of action has not been fully elucidated, it is thought to be mediated through a combination of antagonist activity at the dopamine and serotonin 5-HT2A receptors. Sublingual bioavailability is estimated at 35% and is highly plasma protein bound (95%). Oral administration results in low bioavailability (< 2%) due to extensive first-pass metabolism. Adverse tissue reactions identified by the manufacturer include mouth ulcers, blisters, and peeling/sloughing of the contact area. In one manufacturer-sponsored trial, oral paresthesia events were reported for the following administration routes: sublingual (75.8%), supralingual (55.9%), and buccal (45.7%). Case Report A 35-year-old patient diagnosed with schizophrenia and swallowing problems was on a regimen that included liquid haloperidol via oral syringe. Adherence was problematic and psychotic symptoms were poorly controlled. The patient was prescribed asenapine 5-mg sublingual tablets to be dissolved under the tongue twice daily. Following the first dose, the patient developed an extremely painful ulcerated lip lesion and refused additional doses. The Naranjo Probability Scale was applied and indicated a probable reaction (7 of 12). Conclusions In our patient, the adverse event occurred following one dose. Rechallenge was not attempted. Primary care providers may not be fully aware of the potential severity for this medication-related effect. Based on findings from the manufacturer, clinicians are encouraged to counsel patients and conduct follow-up to determine whether any adverse oral effects were experienced that might have an impact on medication adherence.