The RIPS elective was successful in improving residency candidate confidence at the ASHP Midyear Clinical Meeting. Students reported that the course was helpful and improved their confidence and ability to interview.

Paliperidone, the major active metabolite of risperidone (9-hydroxyrisperidone), is a second-generation antipsychotic that was recently approved by the United States Food and Drug Administration for treatment of acute schizophrenia and for maintenance treatment of schizophrenia. We performed a literature search of PreMEDLINE, MEDLINE, and International Pharmaceutical Abstracts from 1966-October 2007 to review the available data on the pharmacology, pharmacokinetics, clinical evidence, and safety and tolerability profile of paliperidone extended-release (ER). Articles from randomized controlled trials, abstracts, and posters presented at national scientific meetings were included in this review. Paliperidone ER has been shown to be significantly more effective in improving schizophrenic symptoms according to the Positive and Negative Symptom Scale (PANSS), Clinical Global Impressions-Severity Scale, and Personal and Social Performance Scale compared with placebo (p<0.05). In addition, limited evidence suggests similar efficacy between paliperidone ER 6-12 mg/day and risperidone 4-6 mg/day. A 2-week, double-blind comparison with quetiapine demonstrated that paliperidone ER was significantly better than quetiapine in improving PANSS scores (p<0.001). Paliperidone ER appears to be well tolerated at the recommended starting dosage of 6 mg/day. The most commonly reported adverse effect was dose-related extrapyramidal symptoms. Weight gain and metabolic disturbances were minimal. The cost of paliperidone ER appears to be slightly higher than that of other second-generation antipsychotics. Paliperidone ER tablets may be a safe and effective treatment option for acute schizophrenia and maintenance treatment of schizophrenia compared with placebo. Because well-designed comparative data are lacking, an additional benefit over other antipsychotics is yet to be determined.

Purpose Previous evidence suggests psychiatric pharmacists have improved patient symptoms and provide valuable information. However, there are limited recent data regarding clinical pharmacists performing interventions in a psychiatric setting and its effects on costs. Additionally, there are no data that differentiate between psychiatric hospital staff pharmacists' (HSP), faculty clinical pharmacists' (FCP), and student pharmacists' (SP) interventions. Therefore, the objective of this study is to evaluate and describe interventions made by HSPs, FCPs, and SPs in a psychiatric hospital and cost savings. Methods A retrospective review of interventions made in a psychiatric hospital over 18 months was performed. Descriptive statistics and cost analysis were also determined through Pharmacy OneSource. Results A total of 2,220 interventions were made. Among HSPs (n = 4), there were 1,734 interventions including clarifications of orders (n = 592) and MAR discrepancies (n = 385). FCPs (n = 2) contributed 358 interventions consisting of dose recommendations/adjustments (n = 78), drug lab/level recommendations (n = 47), and therapeutic recommendations (n = 37). Additionally, SPs (n = 27) made 128 interventions including patient medication history (n = 31), drug information (n = 30), and counseling patients (n = 25). Annual cost savings were estimated at $125,500 with approximately 90% contributed by HSPs. Conclusion Pharmacy personnel contributed a considerable amount of interventions providing a cost savings to the hospital. Also, HSPs provided a greater number of interventions resulting in decreased costs. In our setting, HSPs, FCPs, and SPs contribute different clinical therapeutic interventions that may optimize patient care.

Graves' disease is an autoimmune syndrome with symptoms such as tachycardia, atrial fibrillation, and psychiatric symptoms. Limited evidence exists for the treatment of Graves' hyperthyroidism-induced psychosis with atypical antipsychotics. A 47-year-old female with a psychiatric history of bipolar disorder presented for the first time to the psychiatric hospital. She was agitated and grossly psychotic with delusions. Electrocardiogram showed atrial fibrillation and tachycardia. Drug screen urinalysis was negative. Endocrine workup resulted in a diagnosis of Graves' disease (thyroid-stimulating hormone [TSH]: 0.005 μIU/mL, triiodothyronine [T3]: 537 ng/dL, thyroxine [T4]: 24 mcg/dL, free T4: 4.5 ng/dL, positive antithyroid peroxidase antibody, and antinuclear antibody). Aripiprazole 10 mg daily was initiated and titrated to 15 mg daily on day 4. On day 16, her suspicious behavior, judgment, and insight improved. Other medications given included aspirin 325 mg daily, metoprolol 25 mg twice daily, titrated to 12.5 mg twice daily, and methimazole 30 mg daily, titrated to 20 mg twice daily, and discontinued on day 29. The patient received radioiodine I-131 treatment 1 week later. We report the first known case on the use of aripriprazole to treat Graves' hyperthyroidism-induced psychosis. Further studies examining the long-term effects and appropriate dose and duration of aripiprazole in this patient population are needed.

Iloperidone demonstrated efficacy in acute exacerbations and long-term maintenance in adults with schizophrenia. Caution may be warranted in elderly patients and patients with cardiac disease, due to orthostasis. Further studies regarding pharmacogenomic testing related to the drug's efficacy and tolerability are needed to justify its routine use in practice.