Current pharmacologic treatment options for clozapine-induced sialorrhea are limited in number and efficacy. Although few randomized controlled trials have been conducted, this review identifies potential treatment alternatives for this common and sometimes severe adverse effect.

Objective. To describe pharmacy curricula in psychiatry and neurology and to report on neuropsychiatric pharmacy specialists' views on optimal curriculum. Methods. Design and administer one electronic survey to accredited pharmacy programs asking them to report information on curricula in psychiatry and neurology for the 2014-2015 academic year. Design and administer a separate electronic survey to board certified pharmacists with an academic affiliation who are members of the College of Psychiatric and Neurologic Pharmacists (CPNP) asking about their teaching activities and their opinion on optimal curricula. Results. Fifty-six percent of pharmacy programs and 65% of CPNP members responded to the surveys. The program survey revealed greater than 80% of topics were taught by full-time faculty. Didactic lecturing, teambased learning, and case studies were the most common teaching methods. Programs dedicated the most didactics (3 to 51 hours) to epilepsy, depression, schizophrenia, substance use disorders, and pain. Autism, traumatic brain injury, personality, and eating disorders were either not taught or given # 1 hour of didactics in most programs. Inpatient psychiatry had the most APPE placements with a mean of 19.6, range 0-83. APPE electives in psychiatry outnumbered those in neurology 5 to 1. CPNP member survey results showed 2 out of 3 members agreed that curriculum could be improved with additional APPEs in psychiatry and neurology. Conclusion. Didactic hour distribution in psychiatry and neurology could be improved to better align with board certification in psychiatric pharmacy (BCPP) recommendations and disorder prevalence and complexity. Specialists recommend an experiential component in neurology and psychiatry to combat stigma and improve pharmacist knowledge and skills.

Background Several psychoactive medications are known to cause QTc prolongation. Patient factors also increase the risk for QTc prolongation, including bradycardia, female sex, older age, metabolic abnormalities, and polypharmacy. Donepezil, a cholinesterase inhibitor, prolongs the QTc interval through a multimodal mechanism. Patient History A 26-year-old African American female was admitted to the inpatient psychiatric hospital following a suicide attempt that was not an overdose. Past medical history was significant for major depression, traumatic brain injury, seizures, hemiplegia, gastroesophageal reflux disease, and tachycardia. Two baseline electrocardiograms (EKGs) were obtained showing normal QTc intervals. After several weeks, donepezil (5 mg by mouth once daily) was initiated for cognitive rehabilitation and titrated over 3 weeks to a dose of 20 mg. An EKG performed after the last dose change showed a prolonged QTc of 463 ms. Another follow-up EKG performed 9 days later showed further prolongation to 528 ms. Laboratory values were within normal limits during her hospital stay. Donepezil was discontinued completely, leading to normalization of the QTc interval. Discussion QTc prolongation and torsades de pointes have been identified in postmarketing case reports of donepezil. Instances of QTc prolongation have predominantly been documented in the geriatric population, primarily in those with additional risk factors. Additionally, current literature does not support the use of donepezil for neurocognitive rehabilitation in daily doses exceeding 10 mg. A temporal and causal relationship was observed between the initiation and titration of donepezil and development of QTc prolongation.

Background: Patients with mental health disorders experience difficulty in selecting treatments. With a paternalistic approach, patients are not offered an opportunity to provide input. Shared decision making (SDM) occurs when providers and patients collaborate on informed treatment decisions. Research on psychiatric providers' perceptions toward SDM is limited. Objective: This pilot study aimed to determine psychiatric providers' willingness to engage in SDM and factors that influence willingness. Methods: This cross-sectional, self-report study measured willingness, attitude, experiences, and barriers related to SDM as well as demographic/practice characteristics. A survey was e-mailed to psychiatric providers at 3 psychiatric institutions. Results: Out of 80 providers e-mailed, 29 (36.3%) responded. Providers had a favorable attitude toward SDM (3.26 ± 0.24, range = 1-4) and a high willingness to use SDM (3.43 ± 0.50, range = 1-4). The most common SDM methods were discussions (96.6%) and written material (89.7%). Common perceived barriers included limited patient capacity (86.2%) and limited time with patient (62.1%). Current SDM users (3.46 ± 0.51) had a higher willingness to engage in SDM than noncurrent users (3.00 ± 0.00), t = 4.63, df = 25.0, P < .001. Attitude and willingness were positively related (r = .62, P < .001). Attitude did not vary based on demographic/practice characteristics. Conclusions: Willingness to use SDM was positively related to a favorable attitude toward SDM. Larger, geographically diverse, randomized controlled trials need to be conducted to evaluate the willingness of psychiatric providers to conduct SDM.