Psychiatric pharmacy, also known as mental health pharmacy, is the area of

clinical pharmacy 230px, A hospital pharmacist is checking a liquid solution. Clinical pharmacy is the branch of pharmacy in which clinical pharmacists provide direct patient care that optimizes the use of medication and promotes health, wellness, and disease pr ...

specializing in the treatment of people with

psychiatric illness A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...

es through the use of psychotropic medications. It is a branch of neuropsychiatric pharmacy, which includes neurologic pharmacy. Areas where psychiatric pharmacists are found most abundantly are in chemical dependency, developmental disabilities, long-term care facilities, adherence clinics, mental health clinics, and within the prison system. However, psychiatry and neurology are not the only areas where psychiatric pharmacists require comprehensive knowledge. They must also be proficient in clinical problem solving, interprofessionalism, and communication with understanding and empathy for the patient population they serve, as they are a sensitive group.

History

Psychiatric pharmacy was introduced in the late 1960s. The first time a psychiatric pharmacist was able to practice in a psychiatric unit was in 1971, as assigned by the US Public Health Service. This became the setting for the first published case where the role of a psychiatric pharmacist was elaborated upon. Psychiatric pharmacists were working not only in psychiatric inpatient and outpatient settings, but in methadone and disulfiram clinics, along with centers for mentally disabled people. During this time, the University of Tennessee created contracts which allowed for pharmacy dispensing and clinical services for local psychiatric facilities. This treatment paradigm involved some of the collaborative drug therapy management and medication therapy management (MTM) systems in which psychiatric pharmacists employ today. The College of Psychiatric and Neurologic Pharmacists (CPNP) is a

professional organization A professional association (also called a professional body, professional organization, or professional society) usually seeks to further a particular profession, the interests of individuals and organisations engaged in that profession, and th ...

that represents psychiatric pharmacists within the United States. CPNP credits two key

pharmacists A pharmacist, also known as a chemist ( Commonwealth English) or a druggist (North American and, archaically, Commonwealth English), is a healthcare professional who prepares, controls and distributes medicines and provides advice and instru ...

with developing clinical psychiatric pharmacy as a specialty: Dr. Glen Stimmel, PharmD, BCPP and Dr. R. Lee Evans, PharmD, FASHP, BCPP. Dr. Stimmel would later become a founding member of CPNP, as well as serve as its president. Dr. Matthew Fuller PharmD, BCPP, FASHP, CPNP Foundation President 2006–2007, has recognized Dr. Stimmel as the "Father of Psychiatric Pharmacy." The specialty of psychiatric pharmacy was recognized by the

Board of Pharmacy Specialties The Board of Pharmacy Specialties (BPS) was established in 1976 and is an independent division of the American Pharmacists Association that grants recognition within the United States to appropriate pharmacy practice specialities and establishes s ...

(BPS) in 1992.

Practitioners

In the United States

Psychiatric pharmacy is practiced by psychiatric (also called "neuropsychiatric")

. Psychiatric pharmacists tend to have a board certification in the specialty of psychiatric pharmacy, granting the title of Board Certified Psychiatric Pharmacist (BCPP) by the

(BPS), and attach the post-nominals after their professional degrees. Because the BPS does not have a separate certification for neurologic pharmacists, neurologic pharmacists may be classified as BCPP's as well (indeed, there is a significant amount of overlap between the two subspecialties). It is not uncommon for psychiatric pharmacists to be residency trained through a specialized

residency Residency may refer to: * Domicile (law), the act of establishing or maintaining a residence in a given place ** Permanent residency, indefinite residence within a country despite not having citizenship * Residency (medicine), a stage of postgra ...

(post-graduate year 2, abbreviated "PGY2") program in psychiatric pharmacy. The BCPP program validates that the pharmacist being certified has the progressive knowledge and experience to improve outcomes and recovery for patients with mental or neurological disabilities by designing, implementing, monitoring, and modifying treatment plans for patients as needed. It also ensures that the pharmacist being certified will educate patients, health care professionals, and other stakeholders. Psychiatric pharmacists work in both the

inpatient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health car ...

and

outpatient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care ...

settings. Psychiatric pharmacists working for the

Veterans Health Administration The Veterans Health Administration (VHA) is the component of the United States Department of Veterans Affairs (VA) led by the Under Secretary of Veterans Affairs for Health that implements the healthcare program of the VA through a nationa ...

can have salaries between $112,268-145,955.

In the United Kingdom

Psychiatric pharmacy is practiced by specialist mental health pharmacists. Specialist mental health pharmacists tend to work in the

setting, within mental health hospitals. Credentialing is performed through the College of Mental Health Pharmacy (CMHP), which assesses the experience and aptitude of pharmacists working in the field of mental health (psychiatric) pharmacy. Credentialed members are granted the title of Member of the College of Mental Health Pharmacy (MCMHP), and attach the post-nominals after their professional degrees.

Scope of practice

As experts in pharmacotherapy, psychiatric pharmacists are trained to assure that patients with mental illness are treated with the most appropriate medications for their conditions. They provide a variety of services aimed at making sure that patients are treated safely, that side effects are minimized (if not eliminated), and that pharmacologic treatments are efficacious at controlling or halting disease progression.

Comprehensive medication management

Psychiatric pharmacists provide a service called comprehensive medication management (CMM), which involves a thorough assessment of a patient's present and past medication history, laboratory work-up and exam findings, and treatment goals. During CMM, psychiatric pharmacists look for drug related problems (DRPs) related to their patients' pharmacotherapy and correct them in collaboration with

psychiatrists A psychiatrist is a physician who specializes in psychiatry, the branch of medicine devoted to the diagnosis, prevention, study, and treatment of mental disorders. Psychiatrists are physicians and evaluate patients to determine whether their sy ...

social workers Social work is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social work ...

, and other members of the interdisciplinary healthcare team, collaborating closely with the patient and their family.

Therapeutic drug monitoring

Psychiatric pharmacists provide

therapeutic drug monitoring Therapeutic drug monitoring (TDM) is a branch of clinical chemistry and clinical pharmacology that specializes in the measurement of medication levels in blood. Its main focus is on drugs with a narrow therapeutic range, i.e. drugs that can easily ...

, which involves ordering laboratory tests that will measure the concentration of a medication in the blood. This is especially useful in the area of psychiatric pharmacy because a lot of drugs used to treat psychiatric illnesses (for example,

lithium citrate Lithium citrate (Li3C6H5O7) is a chemical compound of lithium and citrate that is used as a mood stabilizer in psychiatric treatment of manic states and bipolar disorder. There is extensive pharmacology of lithium, the active component of this ...

and

clozapine Clozapine is a psychiatric medication and is the first atypical antipsychotic (also called second-generation antipsychotic). It is primarily used to treat people with schizophrenia and schizoaffective disorders who have had an inadequate respo ...

) have a narrow

therapeutic window The therapeutic index (TI; also referred to as therapeutic ratio) is a quantitative measurement of the relative safety of a drug. It is a comparison of the amount of a therapeutic agent that causes the therapeutic effect to the amount that causes ...

. There is a lot of potential for severe adverse reactions when using certain psychiatric medications, making therapeutic drug monitoring a useful tool for preventing harmful outcomes. The National Council for Behavioral Health, a collaborative that represents the interests of psychiatric professional organizations, offers recommendations for targeted, interdisciplinary interventions by psychiatric pharmacists, including pharmacist-lead

clinics and providing long-acting injectable

antipsychotic Antipsychotics, also known as neuroleptics, are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of ...

administration services. Psychiatric pharmacists are sometimes involved in collaborative practice agreements which physicians, which allows pharmacists to add or remove medications from a patient's drug regimen, change the strengths/dose or frequencies of medications, the duration of treatment, and the route of administration. Combined with therapeutic drug monitoring, this allows psychiatric pharmacists to directly make changes to a patient's drug regimen based on the results from laboratory tests.

References

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External links

"Explore Psychiatric Pharmacy Practice Settings"
a video by CPNP interviewing psychiatric pharmacists about their clinical practice.
Psychiatry Toolkit
by Pharmacist's Letter Pharmacy Psychopharmacology