Objective. To analyze the cost avoidance resulting from clinical interventions made by pharmacy students completing an advanced pharmacy practice experience (APPE) at a psychiatric hospital. Methods. A retrospective database review of documented clinical interventions by pharmacy students was conducted to classify interventions by type and significance. Interventions were assigned a cost avoidance value determined by an evaluation of the literature. Results. Three hundred-twenty interventions were documented by 15 pharmacy students during the 1-year study period. The majority of interventions were related to psychiatric medication classes and most (n 5 197; 61.6%) were classified as being of moderate significance. The most common interventions included patient education (13.1%), order clarification (11.6%), therapeutic dosing adjustments (10.9%), and laboratory order monitoring (8.8%). The estimated cost avoidance from all interventions made by pharmacy students was approximately $23,000. Conclusions. Pharmacy students completing APPEs at a psychiatric hospital contributed to a variety of significant clinical interventions and provided considerable cost avoidance value to the institution.

Mirtazapine may be considered a treatment option for antipsychotic-induced akathisia. It may be especially useful for patients with contraindications or intolerability to beta-blockers and for those with comorbid depression or negative symptoms. Additional studies should be conducted to provide further evidence of mirtazapine's effectiveness in treating akathisia.

Introduction:Hyperparathyroidism begins as a benign disease that is often left undetected unless the patient presents with severe symptoms. Often, the first sign of hyperparathyroidism is elevation in serum calcium.Case Description:A 38-year-old man presented with new onset acute psychosis. Laboratory testing revealed co-occurring untreated hyperparathyroidism.Discussion:A literature search was performed using PubMed to identify articles published in English with the following key terms: “hyperparathyroidism,” “psychosis,” and “hypercalcemia.” A review of findings follows the case report. Despite a thorough literature review, any pathophysiological explanation for psychiatric manifestations of hyperparathyroidism remains hypothetical.

Given the limitations of current literature, low-dose oral selegiline cannot be recommended for treatment of negative symptoms associated with schizophrenia. Additional controlled trials are needed to better delineate whether there is a role for selegiline in decreasing the burden of negative symptoms associated with schizophrenia.

Despite the advantages of second‐generation antipsychotics, effectiveness trials and cost‐effective analyses have caused first‐generation antipsychotics to be reexamined with regard to place in therapy. Developing an understanding of all aspects of first‐generation antipsychotics, including the pharmacokinetic complexity of long‐acting decanoate formulations, are essential for practitioners in order to optimally manage both symptoms and adverse events. We describe a 55‐year‐old schizophrenic man with a severe movement disorder whose symptoms were mistaken for lithium toxicity. Further examination revealed that his fluphenazine plasma level was still detected 4 months after his last dose of fluphenazine decanoate had been administered. The incorrect diagnosis of lithium toxicity resulted in delayed treatment of his severe extrapyramidal symptoms. Administration of a routine dosage of benztropine titrated to 4 mg/day resolved his drug‐induced movement disorder within 72 hours. This case report demonstrates the persistent need for practitioners' awareness of the complex pharmacokinetic properties of long‐term fluphenazine decanoate treatment, resulting in prolonged absorption, and the continued importance of both recognizing adverse events resulting from dopamine D2‐receptor antagonism and developing the ability to distinguish between various types of movement disorders. The potential for increasing use of first‐generation antipsychotics highlights the need to revisit the nuances of long‐acting, injectable pharmacokinetics to improve patient outcomes.