Working with Medicaid providers to:

n Improve behavioral health prescribing practices n Improve patient adherence to medication n Reduce clinical risks and medication side effects n Improve behavioral and physical health outcomes

The following treatment guidelines are available on our website at Medicaidmentalhealth.org

n Autism Spectrum Disorder & Intellectual Disability Disorder: Psychotropic Medication Recommendations for Target Symptoms in Children & Adolescents n Psychotherapeutic Medication Guidelines for Adults n A Summary for Monitoring the Physical Health and Side-Effects of Psychiatric Medications in the Severely Mentally Ill Population n Psychotherapeutic Medication Guidelines for Children and Adolescents

The Florida Pediatric Psychiatry Hotline is a program that provides timely telephonic psychiatric and clinical guidance to primary care clinicians treating children with psy-chosocial and mental health conditions. The service is free and provides consultation about medication management.

September 2015

The Expert Panel Meeting to Update the Florida Best Practice Psychotherapeutic Medication Guidelines for Adults was held in Tampa, Florida on September 25-26, 2015.

We convened a panel of national and Florida experts to update the adult guidelines for treating schizophrenia, bipolar disorder, and major depressive disorder.

Meeting presentations included:

Bipolar Disorder: Increasing Probability for Best Health Outcomes: Roger McIntyre, MD

Pharmacological Treatment of Schizophrenia: New Findings and Guidance for Best Practice: Rajiv Tandon, MD

Schizophrenia is a Heterogeneous Syndrome Requiring an Array of Novel Pharmacotherapies: Henry Nasrallah, MD

Major Depressive Disorder: Where Does the For the Evidence Take Us: Roger McIntyre, MD

Mood Disorders in Pregnancy: Rona Hu, MD

first time, the new Adult Guidelines will include a

section on treating mood disorders during

pregnancy and the postpartum period. Providers

often face practice challenges in deciding whether

or not to treat women with pharmacotherapy

during pregnancy because the evidence to guide

decision making is often limited and confusing. The

new guidelines for treating mood disorders during

pregnancy will provide more clarity on prescribing

and help Florida providers in weighting the risks and

benefits of pharmacologic treatment during

pregnancy.

To pre-order guidelines, please contact Sabrina Singh at sabrinasingh@usf.edu

New Adult Psychotherapeutic Medication Guidelines Coming Soon...

Include Recommendations for Treating Mood Disorder During Pregnancy

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Program Publications

Florida Best Practice Psychotherapeutic

Medication Guidelines for Adults With Bipolar

Disorder: A Novel, Practical, Patient-Centered

Guide for Clinicians

Authors: Michael J. Ostacher, Rajiv Tandon, and

Trisha Suppes,

The Journal of Clinical Psychiatry,

dx.doi.org/10.4088/JCP.15cs09841

The article describes the process for updating the

2014 Florida Best Practice Psychotherapeutic Medication Guidelines for Adults with Bipolar Disorder. The authors state that “the Florida guidelines for the treatment of bipolar disorder is a practical, simple, patient-focused guide to treatment for acute mania and acute bipolar depression and maintenance treatment that considers safety and harm in the hierarchy of treatment choices.” This article can be accessed at:

http://www.psychiatrist.com/JCP/article/

Pages/2015/aheadofprint/15cs09841.aspx

The Risks and Benefits of Switching Patients with

Schizophrenia or Schizoaffective Disorder from Two

to One Antipsychotic Medication: A Randomized

Controlled Trial.

Authors: Robert J. Constantine, Ross Andel, Marie

McPherson, and Rajiv Tandon.

Schizophrenia Research, Volume 166, Issue 1-3,

August 2015, Pages 194 - 200.

104 clients with schizophrenia or schizoaffective

disorder who were stable on two antipsychotics were

randomized to two groups: 1) stay on 2

antipsychotics (polypharmacy - stay group); and 2)

switch to one antipsychotic (monotherapy - switch

group). The study duration lasted one year and client

symptoms and side effects were assessed every 2

months.

Clients assigned to the monotherapy group had

significant increase in symptoms in the last 6 months

of the study and had significantly higher all-cause

treatment discontinuation than the polypharmacy

group (42% vs 13%).

The authors conclude that the risks of transitioning

stable clients to monotherapy may outweigh the

benefits and require close monitoring during the

process.

This article can be accessed at:

http://schizophrenia.elsevierresource.com/system/

files/articles/assets/S0920996415003114/604/

September 2015 page 2

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Sponsored presentation at the Florida Medical

Association Annual Meeting in Orlando, Florida on

July 31, 2015.

The presenter Dr. B. Sahasranaman, the Medical

Director at Henderson Behavioral Health, provided a

talk entitled “Psychotherapeutic Medication Use in

the Florida Pediatric Population and Integrated

Care.” Dr. Sahasranaman’s presentation focused on

prescribing antipsychotic medication to children. She

reviewed the 2014-2015 Florida Psychotherapeutic

Guidelines for Children and Adolescents and

emphasized the importance of integrating care and

monitoring the physical health of children and

adolescents in the context of pharmacotherapy.

The presentation is available at:

http://www.medicaidmentalhealth.org/

2015 Autism Spectrum Disorder and Intellectual

Disability Disorder: Psychotropic Medication

Recommendations for Target Symptoms in

Children and Adolescents

Dr. Manal Durgin, a practicing psychiatrist at

Devereux Hospital and Children’s Center of

Florida, reviewed the ASD/ISD guidelines at a CME

lunch sponsored by the Florida Psychiatric Society in

Tampa, Florida on September 19, 2015.

The guidelines can be accessed at:

http://www.medicaidmentalhealth.org/

Sponsored ADHD treatment presentation at the

Florida Chapter, American Academy of Pediatrics

Meeting in Orlando, Florida on Sept. 4, 2015.

Dr. Richard E. D’Alli, Associate Professor in

Psychiatry at the University of Florida, facilitated a

presentation entitled “Adolescent ADHD and

Mental Health: Theory and Practice in Primary

Care.” Highlights of the presentation were:

ADHD is best understood as a familial,

neurodevelopmental syndrome (not a disruptive

behavioral disorder as in past DSM editions).

Reward/motivation disruption should also be

included as part of the primary symptoms of

ADHD— inattention, impulsiveness, and

hyperactivity.

ADHD presentation changes across

development with impulsivity and hyperactivity

decreasing in severity while inattention remains

salient into adulthood.

30 years of imaging the brains of ADHD patients

demonstrates structural and functional brain

abnormalities.

ADHD symptoms in youth often overlap with

anxiety and depressive symptoms.

The presentation provides a detailed summary of

pharmacotherapy for ADHD and is available at:

http://www.medicaidmentalhealth.org/

viewVideo.cfm?VideoID=63

September 2015

Presentations Promoting Best Practices at Florida Professional Meetings

page 4

- Offering individual health coaching only to

those who need support outside of class.

Findings from the Women’s Reproductive Health Survey—a survey of 30 women with serious mental illness who had a recent pregnancy covered by Florida Medicaid:

80% reported their pregnancy was unplanned.

89 percent reported they had a prenatal care visit in the first trimester, however most also said they saw a different provider at each prenatal care check-up (lack of continuity of care).

The majority of women discontinued using their medication for their mental health condition upon learning they were pregnant (65%).

The majority of women reported mental health symptoms during pregnancy and were not seeing a mental health provider.

Women felt they had to manage their mental health symptoms alone.

33% reported smoking in the last trimester of pregnancy.

Efforts are underway to address these findings through additional analyses, a state-wide meeting, and targeted interventions.

For more information about smoking cessation, whole health programs, or women’s reproductive health contact Kai LeMasson at kaidawn@usf.edu

Smoking Cessation Program for Persons with Serious Mental Illness at Henderson Behavioral Health—Lessons Learned:

Clients are generally interested in quitting smoking but may not be ready to quit; lacking the confidence and/or motivation to quit.

Clients are prone to relapse and need multiple quit attempts. Thus, as recommended by the U.S. Department of Health and Human Services Tobacco Use Dependence Guideline Panel, tobacco dependence should be managed as a chronic disease.

Enhance smoking cessation programs by including individual motivational interviewing to provide additional support to clients in identifying their personal motivation to quit smoking.

The NOW Project at Directions for Living—Lessons Learned Implementing a Peer-Led Whole Health Program:

A peer-led, whole health program can be

successfully implemented at a community

mental health center.

Peers can effectively provide long-term

manualized programs to consumers that benefit

not only clients but themselves.

Clients with serious mental illness can set whole

health goals and successfully achieve them.

A CMHC could implement The NOW Program

and provide whole health peer services to

approximately 120 clients a year for $61,807 (at

a cost of $515.00 per client).

The program costs can be reduced by:

- Have only one peer lead the class.

- Increasing the class size.

September 2015

Programmatic Lessons Learned in Partnership with Florida Community Mental Health Centers

Program Staff: Marie McPherson, MBA, Director Kai Stauffer LeMasson, PhD Sabrina Singh, MPH

Visit our website at http://medicaidmentalhealth.org