# Presentation: 111815

## Psychotropic Medications: How the CMHC Can Help Students on Medications—Enhancing Adherence to Treatment Plans

- David P. Kraft, MD, MPH
- Regional Mental Health Consultant
- John Kulig, MD, MPH
- Principal Medical Consultant

- Boston Region Health and
- Wellness Conference
- September 27, 2006

## A.	Problem

- Reported increase in number of students arriving at center on psychotropic medications (up to 25% at some centers)
- Many students on multiple medications
- Most psychotropic medications are expensive
- Most psychotropic medications need to be continued indefinitely

## B.	Issues Raised

- Expense of medications
- Resistance of center physicians to prescribe psychotropic medications
- Poor compliance by students in taking medications regularly
- Limitations on CMHC time to clinically treat students
- High volume of students overwhelms center’s capacity to provide effective treatment

## C.	Expense of Medications

- HWC staff enroll students in Medicaid
- Prescribers obtain samples of medications for students not covered by insurance
- Request that hometown prescriber consider simplifying/reducing medications needed before student arrives at center, or during vacation breaks
- Psychotherapy skills for students, such as CBT for depression, to help eventually reduce need for medication for many students

## D.	Resistance of Prescribers to Use 	Psychotropic Medications

- Help center hire psychiatric consultant (MD or NP) to supervise psychotropic medication use
- Encourage center MD’s/NP’s/PA’s to learn to prescribe and monitor psychotropic medications
- Continue to use local practitioners to follow students living close to center
- Acquaint HWC staff with TAGs (e.g., TAG H) covering major types of medications used

## E.	Poor Compliance of Students in 	Taking Medications

- CMHC/TEAP Specialist review medications list with each student
- Behavioral problems due to poor compliance result in disciplinary hearing and development of behavioral contracts
- HWC staff help monitor compliance with potentially dangerous medications
- Therapy includes support of regular medication use as goal of treatment

## F.	Limitations on CMHC and TEAP 	Time for Supporting Students

- Familiarize staff with major medications used and issues with each
- Teamwork with other HWC staff regarding compliance issues
- Consider medication groups if large number of students with problems
- Help students approach prescribers, especially at home, to help reduce medications during vacation, if clinically indicated

## G.	Limited Center Resources for 	Large 	Numbers of Students on 	Medications

- Consider group education of students on chronic medications (medical and psychiatric), to assist compliance
- Encourage continued contacts with hometown prescribers, if helpful for monitoring and refining treatment
- Consider special staffing in HWC if numbers of students exceeds defined limits, to make sure safe practices are maintained

## Medications Where Limited Samples May Be Available (Need to contact drug reps)

- Antidepressants:
- Cymbalta (Eli Lilly)—20-60qd
- Wellbutrin XL (GlaxoSmithKline)—150-300qd
- Paxil CR (GlaxoSmithKline)—12.5-25-37.5qd
- Mood Stabilizers:
- Depakote ER (Abbott)—250-500 tablets
- Lamictal (GlaxoSmithKline)—starter paks
- Antipsychotics:
- Abilify  (Bristol-Myers Squibb)—5-10-15-20-30 caps
- Geodon (Pfizer)—20-40-60-80 capsules

## Summary

- Medications should be continued in Job Corps, if possible, due to threat to continued training if stopped prematurely
- Most Psychotropic Medications need to be taken chronically—no permanent changes in brain
- Use creative mechanisms to help students continue medications, without breaking the budget for the center, if they had to pay for all medications
- Refer to TAG-H, Mental Health Disabilities, for detailed medication review