What role does a pharmacist have in mental health care?

[soul21]

I am actually very interested in the pathology of the mind. I am mostly interested in the organic causes for mental illneses and not so much enviromental factors as well as the pharmacology involved in treating these kinds of illnesses. I was considering studying medicine and eventaully entering a pyschiatry residency but it seems that pyschiatry residencies dont just concentrate on the organic causes of mental illness they also conduct psychotherapy which I would not like to do. I was thinking that a pychiatry residency after pharmacy school would allow me to concentrate more on what it is I want to learn. If I where do this what role would I have in the care of mental patients?

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[kwizard]

I am actually very interested in the pathology of the mind. I am mostly interested in the organic causes for mental illneses and not so much enviromental factors as well as the pharmacology involved in treating these kinds of illnesses. I was considering studying medicine and eventaully entering a pyschiatry residency but it seems that pyschiatry residencies dont just concentrate on the organic causes of mental illness they also conduct psychotherapy which I would not like to do. I was thinking that a pychiatry residency after pharmacy school would allow me to concentrate more on what it is I want to learn. If I where do this what role would I have in the care of mental patients?

It sounds like your first question may be regarding how much do you see yourself involved in pt care. The best place to look up psych pharmacy residencies would be www.cpnp.org (College of Psych and Neuro Pharmacists); however, it seems that you have more of a focus on psychopharmacology so a fellowship or clinical track PhD program may be more applicable. The residencies themselve vary a bit depening on practice site, but are mainly in the Dept of Mental Health or the Veterans Affairs Health System (i.e. the VA). The VA is nice b/c clin pharmacists may obtain prescribing privileges w/ a lot of autonomy; however, psychotherapy as a primary role is somewhat minimal as it is hard to bill for services so instead any psychotherapy (really just counseling) would be incorporated into medication management of pts response to medication in context of dz state. Dept of MH is ok as well but typically don't have prescribing priviliges like in the VA so it would be hard to run your own clinic like in the VA unless you could to a collaborative practice agreement depending on state laws and MD cooperation. So most role in DOMH is assessing side effects, clinical reccommendations, and drug monitoring (metabolic effects via DURs, etc). Assisting w/ clinical trials would be an option in both VA and DOMH depending on resources (MD or PharmD w/ grants/funding). However, if that is not your idea of a fun time and you envision yourself studies pharmacogenomics and/or dopamine receptors I'd inquire about a clinical PhD programs at a school of pharmacy or a fellowship (PhD may be the preferred route for success w/ grantmanship, but this depends on individual and at what point in life you find the desire to study the unknown).

 

[CalGrl05]

I'm glad i found this thread cuz i, too, am very interested in specializing in psychiatry as a clinical pharmacist, delving into the use of medication in treating mental illness. Although pharmacists specialize in the use of medication, I was also interested in looking at mental illness from a more wholistic approach, incorporating the mind-body connection that is sometimes forgotten when illnesses are treated from a single viewpoint or when symptoms are treated at the expense of understanding the root causes.

How difficult is it to get get into a psych residency after pharm school? and how much room is there for the pharmacist to give input into treatment of mental illnesses? By this i mean, are they simply allowed to give input related to medication management or can they also assess causes and treatment options like medical doctors?


Thanks for the help!

 

[kwizard]

I'm glad i found this thread cuz i, too, am very interested in specializing in psychiatry as a clinical pharmacist, delving into the use of medication in treating mental illness. Although pharmacists specialize in the use of medication, I was also interested in looking at mental illness from a more wholistic approach, incorporating the mind-body connection that is sometimes forgotten when illnesses are treated from a single viewpoint or when symptoms are treated at the expense of understanding the root causes.

How difficult is it to get get into a psych residency after pharm school? and how much room is there for the pharmacist to give input into treatment of mental illnesses? By this i mean, are they simply allowed to give input related to medication management or can they also assess causes and treatment options like medical doctors?


Thanks for the help!

Yes, primarily pharmacists who specialize in psych will focus on medications, but in the psych/neuro area (especially in psych) the medications and/or dz states can cause physicial side effects (akathisia, tardive dyskinesia, tremors, gynecomastia, etc) that the clinician (regardless of practice (MD/NP/PA/Pharm.D) must be able to assess. How much you get into physical assessment depends largely on your ability as a clinician and freedom provided w/i practice site. In a progressive VA hospital w/ prescribing privileges the door is pretty much open to do a little bit of everything. In the avg progressive VA, you can set up you scope of practice to run your own med management clinic and manage the pts as you desire w/o MD input. Typically you see Pharm.D. doing clinics for refractory pts and/or pts w/ mult therapies w/ potential for drug interactions, etc. Fiscally, in the Dept of Mental Health (DOMH) (depending on the area) the pay can be considerably less than private sector (i.e. 10-20k/yr less) and the VA can be down right hard to get into as few people ever leave employment once getting into the VA. But clinically in the DOMH a couple of pharmacists have achieved special status to rate side effects to medications for clinical trials (i.e. pseudoparkinsonism, extrapyramidal symptoms, tardive dyskinesia, etc.).

The more you get into the pathology and/or neuroscience of psychiatry you may need to lean more to a fellowship/PhD track depending on your training and how much of a clinical role you want. At the end of the day you are a pharmacist so you typically have to relate bulk of research you do back to a drug effect in some way as that is your specialty by trade. However, this isn't necessarily limiting if you can use various methods of thought like pharmacogenomics to study how brain receptors may differ from one group of people vs another (i.e. genetic polymorphisms) or metabolic issues (possible mech for atypical antipsychotics causing elevations in glucose and/or lipids via affect on various serotonin sub-receptors and/or histamine/alpha receptors). C. Lindsay DeVane a Pharm.D. researcher at MUSC (in S. Carolina) would be a good person to look at or Larry Ereshefsky, Pharm.D. (did more research on pharmacokinetics and drug interactions) who used to teach at Univ of Texas San Antonio (UTSA) but is now in CA w/ CA Clinical Trials. There is also another group pharmacists in Iowa that do a lot of genomics research in addition to clinical duties (Vicki Ellingrod, Pharm.D and Paul Perry, PhD. are the two main researchers, they offer both fellowship and residency training). UTSA also has probably the largest psych residency program in the nation as well w/ area in mental health outcomes, VA, DOMH, etc. Either way most residency programs will familiarize the resident how to conduct various psychometric tests to evaluate severity/progression of dz(MMSE (mini-mental state exam), GDS (geriatric depression scale), HAM-D (Hamilton Depression), BPRS (Brief Psychiatric Rating Scale), and so on).

Either way I'd really look into www.cpnp.org (I think membership is still free for students). They have a listserv in which clinical dilemmas are frequently discussed. Supply/demand varies from one yr to the next, but psych residencies aren't any more competitive than any other field as the talent pool is still growing but considerably less than other specialties (i.e. ambulatory care, oncology, critical care, etc.) Most of the residencies are in either the DOMH and/or VA system.

In short, in some ways the sky is the limit as the realm of the Pharm.D. is expanding but this tends to vary based on geographic area. Things are much more progressive the further west you go so it is kind of hard to find a psych job (let alone a descent paying one) on the East Coast (as most of the jobs are within academia). So you tend to have more options if you are willing to travel and/or are already located in the Midwest/West, but just try to continue to seek out information and try to develop a realistic plan for what you would like to do upon completing such training. After putting some of those pieces together, try to find someone out there who may already be doing such work and use that person as a template (if not a direct mentor) for your own aspirations and go from there.

List of residency/fellowship sites: http://cpnp.org/jobs/residencies.htm

I hope this answers all of your questions.

 

[CalGrl05]

Yes, primarily pharmacists who specialize in psych will focus on medications, but in the psych/neuro area (especially in psych) the medications and/or dz states can cause physicial side effects (akathisia, tardive dyskinesia, tremors, gynecomastia, etc) that the clinician (regardless of practice (MD/NP/PA/Pharm.D) must be able to assess. How much you get into physical assessment depends largely on your ability as a clinician and freedom provided w/i practice site. In a progressive VA hospital w/ prescribing privileges the door is pretty much open to do a little bit of everything. In the avg progressive VA, you can set up you scope of practice to run your own med management clinic and manage the pts as you desire w/o MD input. Typically you see Pharm.D. doing clinics for refractory pts and/or pts w/ mult therapies w/ potential for drug interactions, etc. Fiscally, in the Dept of Mental Health (DOMH) (depending on the area) the pay can be considerably less than private sector (i.e. 10-20k/yr less) and the VA can be down right hard to get into as few people ever leave employment once getting into the VA. But clinically in the DOMH a couple of pharmacists have achieved special status to rate side effects to medications for clinical trials (i.e. pseudoparkinsonism, extrapyramidal symptoms, tardive dyskinesia, etc.).

The more you get into the pathology and/or neuroscience of psychiatry you may need to lean more to a fellowship/PhD track depending on your training and how much of a clinical role you want. At the end of the day you are a pharmacist so you typically have to relate bulk of research you do back to a drug effect in some way as that is your specialty by trade. However, this isn't necessarily limiting if you can use various methods of thought like pharmacogenomics to study how brain receptors may differ from one group of people vs another (i.e. genetic polymorphisms) or metabolic issues (possible mech for atypical antipsychotics causing elevations in glucose and/or lipids via affect on various serotonin sub-receptors and/or histamine/alpha receptors). C. Lindsay DeVane a Pharm.D. researcher at MUSC (in S. Carolina) would be a good person to look at or Larry Ereshefsky, Pharm.D. (did more research on pharmacokinetics and drug interactions) who used to teach at Univ of Texas San Antonio (UTSA) but is now in CA w/ CA Clinical Trials. There is also another group pharmacists in Iowa that do a lot of genomics research in addition to clinical duties (Vicki Ellingrod, Pharm.D and Paul Perry, PhD. are the two main researchers, they offer both fellowship and residency training). UTSA also has probably the largest psych residency program in the nation as well w/ area in mental health outcomes, VA, DOMH, etc. Either way most residency programs will familiarize the resident how to conduct various psychometric tests to evaluate severity/progression of dz(MMSE (mini-mental state exam), GDS (geriatric depression scale), HAM-D (Hamilton Depression), BPRS (Brief Psychiatric Rating Scale), and so on).

Either way I'd really look into www.cpnp.org (I think membership is still free for students). They have a listserv in which clinical dilemmas are frequently discussed. Supply/demand varies from one yr to the next, but psych residencies aren't any more competitive than any other field as the talent pool is still growing but considerably less than other specialties (i.e. ambulatory care, oncology, critical care, etc.) Most of the residencies are in either the DOMH and/or VA system.

In short, in some ways the sky is the limit as the realm of the Pharm.D. is expanding but this tends to vary based on geographic area. Things are much more progressive the further west you go so it is kind of hard to find a psych job (let alone a descent paying one) on the East Coast (as most of the jobs are within academia). So you tend to have more options if you are willing to travel and/or are already located in the Midwest/West, but just try to continue to seek out information and try to develop a realistic plan for what you would like to do upon completing such training. After putting some of those pieces together, try to find someone out there who may already be doing such work and use that person as a template (if not a direct mentor) for your own aspirations and go from there.

List of residency/fellowship sites: http://cpnp.org/jobs/residencies.htm

I hope this answers all of your questions.

Thank you so much for all that information. It helped out a lot.

 

[kwizard]

Thank you so much for all that information. It helped out a lot.

Last thoughts...Not sure exactly where you are in your training (pharmacy vs medicine or in the pre- category of either discipline), but I wouldn't rule out medical training either. If you go to med school this would be much easier, but some med fellowships will allow pharmacists to apply as well assuming you have some previous research training of some sort (depends on the program). The medical field just tends to have more concrete outcomes as it is more consistent vs the continued transitions you tend to see in pharmacy based settings (however, this will vary w/ the principal investigator and/or how their interests coincide w/ yours). If you are really into patho of psych a Neuroscience program or a PhD in neuropharmacology might suit you best??

Other possible sites to check on for background info (not necessarily specific to pharmacy would be Society for Neuroscience (www.sfn.org) and check out their Brain Facts book (its free), American College of Neuropharmacology (www.acnp.org) and/or American College of Clinical Pharmacology (www.accp1.org) or American College of Pharmacology and Therapeutics (www.ascpt.org). Probably the best text to read on psychopharmacology and underlying pathology would be Stephen Stahl's Essential Psychopharmacology: A Neuroscientific Basis and Practical Applications (a great book for anyone interested in psychiatry and/or psychopharmacology).

I think I'll stop rambling now.

 

[CalGrl05]

Last thoughts...Not sure exactly where you are in your training (pharmacy vs medicine or in the pre- category of either discipline), but I wouldn't rule out medical training either. If you go to med school this would be much easier, but some med fellowships will allow pharmacists to apply as well assuming you have some previous research training of some sort (depends on the program). The medical field just tends to have more concrete outcomes as it is more consistent vs the continued transitions you tend to see in pharmacy based settings (however, this will vary w/ the principal investigator and/or how their interests coincide w/ yours). If you are really into patho of psych a Neuroscience program or a PhD in neuropharmacology might suit you best??

Other possible sites to check on for background info (not necessarily specific to pharmacy would be Society for Neuroscience (www.sfn.org) and check out their Brain Facts book (its free), American College of Neuropharmacology (www.acnp.org) and/or American College of Clinical Pharmacology (www.accp1.org) or American College of Pharmacology and Therapeutics (www.ascpt.org). Probably the best text to read on psychopharmacology and underlying pathology would be Stephen Stahl's Essential Psychopharmacology: A Neuroscientific Basis and Practical Applications (a great book for anyone interested in psychiatry and/or psychopharmacology).

I think I'll stop rambling now.

haha not rambling at all. Im surprised you know so much about this field, are u specializing in it? I am actually applying for Fall 2006 and am gonna go on ucsd and ucsf interviews in the next few weeks. Im so nervous! Anyways, although i am interested in psychiatry, im more specifically interested in the action of drugs and medications on the human psyche. This is why i think psychopharmacology within PharmD would be more fitting than med school for me. But what did u mean why the continued transitions of pharmacy based settings?

 

[kwizard]

haha not rambling at all. Im surprised you know so much about this field, are u specializing in it? I am actually applying for Fall 2006 and am gonna go on ucsd and ucsf interviews in the next few weeks. Im so nervous! Anyways, although i am interested in psychiatry, im more specifically interested in the action of drugs and medications on the human psyche. This is why i think psychopharmacology within PharmD would be more fitting than med school for me. But what did u mean why the continued transitions of pharmacy based settings?

Not as much in this field from a research standpoint. I just completed residency training (1-yr in pharmacy practice + 1yr in psych pharm) and am currently in clinical practice and considered fellowship oppurtunities (more focused on outcomes of treatment; epidemiological types of stuff); however, decided against it as it didn't appear realistic for me to pursue research interests and still pursue clinical interests via a training program. Most fellowships and/or PhD programs regardless of profession want a typical 70-80% time devoted to research and maybe 10-20% devoted to clinical aspirations. I didn't have a problem w/ this initially, but the expectation upon completing the program would be that professionally your time would be spent in a similar fashion (i.e. >70% of time spent on research due to time it takes for grantmanship, funding, etc.). It took a while for it to set in, but it just wasn't for me as I wasn't willing to give up clinical aspects so figured I'd take my chances developing research interests on my own, especially since my interest in the neurosciences is more from a comprehensive standpoint vs trying to replicate or perform such studies on my own.

What I meant by "continued transition of pharmacy based settings" is that the evolution of the Pharm.D. and/or pharmacist as a principal investigator in research is still evolving whereas the role of MDs and/or PhD in research has been evident for decades. So in short the template, for a pathway to get from point A-->B in research w/ a Pharm.D. may not be as clear as w/ other professions (i.e. what type of skillset would you need to complement your pharmacy background to be a successful researcher). Otherwise stated would you really need a PhD or could you use your Pharm.D. w/ appropriate clinical and/or fellowship training to to accomplish yours goals.

A possible template worth looking up at UCSD would be John P. Lacro, Pharm.D., BCPP, CGP. He is pretty well published and does a fair amount of research w/ grant funding in medication adherence issues in gero psych population in addition to running a clinic at San Diego VA. While his research interests may not completely coincide w/ yours he may be able to point you in the right direction or work w/ others in that area?

 

[CalGrl05]

Not as much in this field from a research standpoint. I just completed residency training (1-yr in pharmacy practice + 1yr in psych pharm) and am currently in clinical practice and considered fellowship oppurtunities (more focused on outcomes of treatment; epidemiological types of stuff); however, decided against it as it didn't appear realistic for me to pursue research interests and still pursue clinical interests via a training program. Most fellowships and/or PhD programs regardless of profession want a typical 70-80% time devoted to research and maybe 10-20% devoted to clinical aspirations. I didn't have a problem w/ this initially, but the expectation upon completing the program would be that professionally your time would be spent in a similar fashion (i.e. >70% of time spent on research due to time it takes for grantmanship, funding, etc.). It took a while for it to set in, but it just wasn't for me as I wasn't willing to give up clinical aspects so figured I'd take my chances developing research interests on my own, especially since my interest in the neurosciences is more from a comprehensive standpoint vs trying to replicate or perform such studies on my own.

What I meant by "continued transition of pharmacy based settings" is that the evolution of the Pharm.D. and/or pharmacist as a principal investigator in research is still evolving whereas the role of MDs and/or PhD in research has been evident for decades. So in short the template, for a pathway to get from point A-->B in research w/ a Pharm.D. may not be as clear as w/ other professions (i.e. what type of skillset would you need to complement your pharmacy background to be a successful researcher). Otherwise stated would you really need a PhD or could you use your Pharm.D. w/ appropriate clinical and/or fellowship training to to accomplish yours goals.

A possible template worth looking up at UCSD would be John P. Lacro, Pharm.D., BCPP, CGP. He is pretty well published and does a fair amount of research w/ grant funding in medication adherence issues in gero psych population in addition to running a clinic at San Diego VA. While his research interests may not completely coincide w/ yours he may be able to point you in the right direction or work w/ others in that area?

Thanks for this information!! I actually just got back from SD and i love the school!!! Sounds like a perfect opportunity to get involved in the VA there, like you said. Anyways, Best of luck with all ur endeavors, though its obvious that you don't need any