Prescribing Psychologist

Your Information Source on Medications, Mental Health, and Psychology Resources

Ohio RxP Bill Introduced

April 14th – Ohio Senator Keith Seitz introduced a psychologists’ prescribing bill. This has been assigned to the Senate Health and Human Services Committee.  See the link below for details.

http://ohiosenate.gov/committee/health-and-human-services

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Hawaii RxP Bill Seeking Consensus

April 13 – Hawaii HB1072 passed third reading on the Senate floor with 22 ayes and 2 noes. The next step is for it to go to Conference Committee so that the differences in the House and the Senate bills can be ironed out. The bill would allow Psychologists with advanced training in psychopharmacology to prescribe. Let’s see how this one moves forward.

Iowa prescribing bill loses by 1 vote

The vote in the Iowa Senate was close, but came up 1 vote short. Iowa’s prescribing bill  vote count was 25 to 24.  A narrow loss in conservative state that suggests a high level of grassroots support. The arguments for and again reflect the same old song from the medical establishment. Here is a summary from the Iowa Medical Association’s review of the bill.

Idaho Psychologist Prescribing Bill Looks Positive

http://www.idahostatesman.com/2015/02/23/3659726/idaho-psychologists-seek-authority.html

Prescribing Bill for Illinois Psychologists Passes House & Senate

Prescribing Bill for Illinois Psychologists Passes House & Senate

An agreement has been reached by the Illinois Legislature on the RxP Bill. The states’ psychiatric community, along with medical and nursing associations gave input and agreement to various aspects for the final bill. 

Illinois Psychologists Answering the Crisis in Mental Health Care

The Illinois Psychological Association is making substantial headway with a bill authorizing appropriately trained Psychologists to prescribe. They understand the role that Psychologists can play in expanding access to mental health care.

 

 

Psychologist Prescribing – Movement ‘Fizzling’ in New England?

Are efforts toward psychologist prescribing beginning to fade. Here’s a perspective from the northeast.

http://www.nepsy.com/articles/leading-stories/privileges-quest-fizzles/

Illinois Senate Bill on Psychologist Prescribing

Chicago Sun Time Weighs in on Illinois Senate Bill on Psychologist Prescribing

The Chicago Sun Times article about prescriptive authority for Psychologists seems a bit one-sided given the public concerns and need for better access to mental health treatment.

APA Aims to Nix ‘Knee-Jerk’ Antipsychotic Prescribing

A list of 5 key antipsychotic prescribing recommendations released by the American Psychiatric Association (APA) addresses some of the most common diversions from what should be standard practice, most of which can be attributed to one common culprit — the knee-jerk reaction to go directly to an antipsychotic before considering other alternatives.

Released last week and reported by Medscape Medical News at that time, the APA list is part of the Choosing Wisely effort, an initiative of the American Board of Internal Medicine Foundation that was designed to spur discussion on appropriate care regarding procedures and tests that are known to be overused or inappropriate. The initiative includes more than 80 medical specialty societies.

Released last week and reported by Medscape Medical News at that time, the APA list is part of the Choosing Wisely effort, an initiative of the American Board of Internal Medicine Foundation that was designed to spur discussion on appropriate care regarding procedures and tests that are known to be overused or inappropriate. The initiative includes more than 80 medical specialty societies.

 APA’s list of 5 key recommendations relating to antipsychotic prescribing

Don’t prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring

Patients on these drugs need to be monitored for the known metabolic adverse effects, and that can include taking a lipid profile and monitoring their weight, in addition to monitoring for potentially serious neurological side effects, such as tardive dyskinesia and extrapyramidal symptoms.

Don’t routinely prescribe 2 or more antipsychotic medications concurrently

There will always be circumstances when psychiatrists will want to prescribe 2 different medications, perhaps in an effort to work with different target profiles, for instance, but the admonition is that you shouldn’t start out prescribing 2 antipsychotic medications before you are able to see the effects of 1.

Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia

Clinicians will too often turn to antipsychotic drugs as a first-line treatment for dementia when other behavioral measures should be first considered.

Initial measures that should instead be considered in managing dementia include behavioral interventions, such as training family members on how to work with patients with techniques such as lighting orientation, kindness, music, or enlisting the help of skilled caregivers — these are all measures that can help patients with dementia settle down.

Don’t routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults

Antipsychotics are far down on the list of medications that should be used for insomnia, yet there are some prescribers using quetiapine (Seroquel [AstraZeneca Pharmaceuticals LP]), for instance, as a first line for sleep. Instead, begin with measures such as sleep hygiene, which can include measures ranging from avoiding stimulants or napping to making sure the bedroom is dark and the bed is comfortable.

Don’t routinely prescribe antipsychotic medications as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders

It has become a first reaction in trying to get on top of a child’s or adolescent’s behavioral problem quickly, but the bottom line is that antipsychotic drugs are not to be used simply for a child who has frequent temper tantrums. Too many practitioners prescribe these drugs as a first option instead of trying to understand what they’re dealing with and making a more accurate diagnosis.

Think Before Prescribing

Philip R. Muskin, MD, a professor of psychiatry at Columbia University Medical Center in New York City, commented that a comprehensive list of routine antipsychotic prescribing habits that should be discouraged could feasibly be much longer, but he said the list captures key prescribing issues.

He noted that with dementia in particular, antipsychotics have become much more of a “go-to” drug than they should be.

“It’s not bad to put a patient on an antipsychotic for dementia, but it shouldn’t be the first thing you do because there’s really no evidence that antipsychotics treat dementia,” Dr. Muskin said.

Pharmacology Exam for Psychologists

The Performance Report on the PEP examination – from the American Psychological Association

The APA College of Professional Psychology developed the Psychopharmacology Examination for Psychologists (PEP Exam) as a proficiency examination for psychologists in the area of psychopharmacology. Several states use the PEP as part of their required evaluation as evidence of competence as part of granting prescriptive authority to psychologists.

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