The Pharmacist's Role in Mental Health
Kathy Hitchens, Drug Topics
The newspaper headlines scream "not guilty by reason of insanity" for a criminal on trial. The hot gossip around the office concerns who is taking antidepressants. And the word on the talk shows is that millions of dollars are spent on legal as well as illegal psychoactive drugs every year. How relevant is mental illness to the practicing pharmacist? The short answer: Very. Considering the incidence of mental illness, the therapeutic concerns in pharmacotherapy, the problems of patient compliance, the importance of the pharmacist's expertise in drug therapy, and the pharmacy's presence in almost every neighborhood, R.Ph.s have the potential to play a vital role in assisting people with mental illness.
The estimated incidence of mental illness in the United States in the community setting is significant. According to the Epidemiologic Catchment Area study, 28% of adults had an active mental or addictive disorder in the past year and another 16% had a disorder at some time prior to the past year. Thus, the estimated prevalence of mental disorders in the lifetime of adults living in the United States approaches 44%. If this seems hard to believe, bear in mind that only one-third of disorders have associated impairment and many disorders are of relatively short duration. Even looking at the statistics conservatively, it's a safe bet that a good number of adults affected by mental illness pass through the doors of the community pharmacy.
The prevalence of specific types of mental illnesses varies. As a group, anxiety disorders, including phobia, panic disorder, and obsessive-compulsive disorder, are the most prevalent mental conditions. Approximately 13% of people had active symptoms of anxiety disorders during the preceding year. Next in prevalence are affective disorders (primarily depression) and substance-abuse disorders (primarily alcohol-use disorder). Schizophrenic disorder, somatization disorder, and antisocial personality disorder have a smaller incidence.
Although community pharmacists will encounter patients with undiagnosed mental disorders, most often the pharmacist's role in the community pharmacy will be to assist a patient who has been diagnosed with mental illness with the prescribed therapeutic regimen. Still, the diagnosis is the logical starting point in boning up on mental illness. Diagnosis of mental illness
Diagnosis of mental illness differs from most other medical diagnoses because lab tests, X-rays, and scans do not apply to psychiatric illness. A diagnosis is based primarily on phenomenology-that is, the descriptive symptoms of the syndrome of interest. Clinicians use criteria such as the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), to categorize symptoms into a diagnosis.
The DSM-IV contains a wealth of information on all mental disorders recognized by the American Psychiatric Association. In addition to the DSM-IV rating scales, such as the Hamilton Scale for Depression, the Hamilton Scale for Anxiety, and the Clinical Global Impression Scale, a multitude of others are used to provide objective data about mental illness and to answer clinical or research questions. Rating scales used repeatedly over a period of time can be used to monitor change during treatment.
Even with the established criteria, mental illness diagnosis is not always straightforward. Many factors cloud the picture. First, psychiatric diagnosis can be comorbid with other clinical psychiatric disorders. For example, during their lifetime, more than 40% of patients with major depressive disorder meet criteria for one or more nonmood psychiatric disorders. As one mi ht guess, comorbid conditions often make treatment more complex because a coexisting disorder may change the course of the illness and/or alter treatment response. Second, mental illness may also be comorbid with medical illness.
The subjective nature of diagnosis, treatment, and monitoring of psychiatric illness underscores the need of a patient for professional assistance. …