NEW MEXICO STATE UNIVERSITY
Post-Doctoral Training in Clinical Psychopharmacology
TRAINING and COURSE OUTLINE
Class #19
Course #: RXPP 609
Official Title: Psychopharmacological Treatment in Special Populations I
Topic: The Psychopharmacologic Considerations & Treatment of Older Adults
Credit Hours: 3.0 Credit Hours
Continuing Education: 13.5 CE (Provided by SIAP, Sponsored by APA)
SIAP is approved by the American Psychological Association
to sponsor continuing education for psychologists.
SIAP maintains responsibility for the program and its content.
Location: Online Only: You will be provided with a ZOOM link each day.
Class Meeting Dates: February 13 & 14, 2021
8:00 am-5:00 pm MST
Instructor(s): Marlin Hoover, PhD, MSCP, ABPP Prescribing Psychologist
Required Reading:
Stahl, S. M. (2017). Stahl’s Essential Psychopharmacology: Prescriber’s Guide to Psychopharmacology (6th Ed.). New York, New York: Cambridge University Press. Review: References to anticholinergic side effects.
Benjamin Sadock, Virginia Sadock & Pedro Ruiz (2017) Kaplan & Sadock’s Comprehensive
Textbook of Psychiatry (10th ed). Wolters Kluwer.
Kindle online version recommended for reference through the remaining Courses.
Read Chapter 57 Geriatric Psychiatry.
Procyshyn, R. M., Bezchlibnyk-Butler, K. Z., & Jeffries, J. J. (2020). Clinical handbook of psychotropic drugs (23rd ed.). Boston: Hogrefe Publishing. Drugs for the Treatment of Dementia.
Recommended Readings:
Ballard, C., Youakim, J.M., Coate, B., & S. Stankovic. (2019). Pimavanserin in Alzheimer’s disease Psychosis: Efficacy in Patients with More Pronounced Psychotic Symptoms. The Journal of Prevention of Alzheimer’s Disease, 6(1), 27–33.
Brenes, G., Divers, J., Miller, M., & Danhauer, S. (2018). A randomized preference trial of cognitive-behavioral therapy and yoga for the treatment of worry in anxious older adults. Contemporary Clinical Trials Communications, 10, 169–176.
Kenny, K., de Nicola, P., & Schmidt, M. (2017). Randomized, dose-controlled double-blind trial: Efficacy of an ethanoic kava (Piper methysticum rhizome) extract for the treatment of anxiety in elderly patients. Traditional & Kampo Medicine, 5(1), 3–10.
Maatouk, I., Müller, A., Angerer, P., Schmook, R., Nikendei, C., Herbst, K., Gantner, M., Herzog, W., & Gündel, H. (2018). Healthy ageing at work- Efficacy of group interventions on the mental health of nurses aged 45 and older: Results of a randomised, controlled trial. PloS one, 13(1), e0191000.
Course Description: In this RXPP 609 class we begin our study of psychopharmacological considerations and treatment in special populations, specifically treatment of elderly adults. Major topics include the aging process, measures of functioning in major organ systems, and response to drug treatments for a variety of psychiatric conditions. The prescription, management, and use of psychotropic medications will be discussed in the management of agitation, pain, sleep, and behavior disorders. The primary framework uses a multidisciplinary lens in the interest of patient-centered care. Issues regarding ethnicity, race, and cultural diversity, individual differences, rights, and values will be approached during our approach to the treatment of elderly populations as well as in all classes in clinical psychopharmacology. Ethical issues related to pharmacologic interventions with older adults will be explored, including end-of-life pain management and attention to Alzheimer’s/dementia.
This course is congruent with the College of Education's Conceptual Framework in that it provides a general knowledge background, addresses assessment competencies, and integrates content knowledge and professional knowledge.
Objectives: Students will:
1. Assess the renal function of one elderly patient using a Glomerular Filtration Rate (GFR) calculator.
2. Learn how to order and interpret one renal functioning laboratory study, then the most appropriate course of treatment for an elderly patient with major depressive disorder.
3. Learn how order and interpret one hepatic functioning laboratory study, then the most appropriate course of treatment for an elderly patient with major depressive disorder.
4. Calculate one Child-Turcotte-Pugh score of hepatic function for a patient.
5. Appraise one elderly patient’s medication list.
6. Calculate one Beers score for the patients’ medication list after primary appraisal.
7. Analyze the patient’s Beers score to select an appropriate medication for four conditions: insomnia, psychosis, depression, and anxiety.
8. Inventory three psychotropic medications that do not require a dose adjustment based on the patient’s GFR.
9. Appraise an elderly patient’s current medication list using two screening tools: Screening Tool of Older People's prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria.
10. Consistent with the STOPP/START guidelines, characterize and defend the one most appropriate medication for a patient experiencing delirium.
11. Estimate one elderly patient’s vulnerability score using the Vulnerable Elders Survey 13th Edition (VES – 13).
12. Differentiate three psychotropic medications that are hepatotoxic and should not be used in patients with cirrhosis.
13. Compile the ten most common medical illnesses in the elderly.
14. Based on evidence in peer-reviewed articles, justify use of two empirically validated Decision Support Tools (DST’s) used for the treatment of Late Life Depression (LLD).
15. Defend a risk/benefit analysis with four of the following drug classes often used the elderly treatment populations: second-generation antipsychotic (SGA’s); Alzheimer/Dementia (AZD) prescriptions; hypnotics; and mood stabilizers.
16. Evaluate the relationship between outcome and sponsorship in at least two studies, of the comparative efficacy of evidence based combined medicine (psychotropic medications and psychotherapy) researched in older adults.
17. Develop expected dosage adjustments in four drug classes using with older treatment populations: benzodiazepines, Selective Serotonin Reuptake Inhibitors (SSRI’s), anticonvulsants, and hypnotics.
18. Prepare a medication strategy for each of five patients in case vignettes presented during the class.
Homework: The students will be presented with one or more complex case(s) and will be asked to respond to questions about that case. At times, students will also be expected to read journal assignments; and respond in class or discussion threads (in Canvas).
Evaluation: Student participation, preparation, and attendance is observed. There will be a test (multiple choice, short answer or true/false) which, depending on the plan of the Instructor, may be given to students before class. If the test is given to the students before class, then students should come to class with the test completed because the content will be reviewed during the lecture(s). The exam will be graded after it is taken as a closed-book, time limited test at the end of the weekend of didactic training. Case studies presenting patients with dual diagnoses of medical and psychological problems will be distributed. Students will be expected to formulate a comprehensive analysis of the case(s) utilizing clinical judgment, course materials, and any necessary references. Instructors may also elect to include reading (e.g. journal) assignments for discussion and/or written assignments that demonstrate clinical documentation which meets the standard of care for patient care documentation. Additional assignments will be factored into a weighted or alternative point value system leading to the determination of a letter grade using the rubric below. Typically, students have two weeks to complete all assignments. All submissions must be made by 11:59 pm on the day of the announced deadline.
Standard Grading Assignments Points Possible
Test (30 questions @ 2 pts each) 30 pts.
Case Study Analysis/Vignette 60 pts.
Participation/Attendance (live or via AdobeConnect) 10 pts.
Course grades:
90-100 pts total = “A”
80-89 pts total = “B”
70-79 pts total = “C”
Students with Disabilities: If you have or believe you have a disability, you may wish to self-identify. You can do so by providing documentation to the Office of Student Accessibility Services (SAS), located at the Corbett Center Student Union, Room 208 (Telephone 575-646-6840, Fax 575-646-5222, E-Mail: sas@nmsu.edu). Appropriate accommodations may then be provided for you. If you have a condition which may affect your ability to exit from the premises in an emergency or which may cause an emergency during class, you are encouraged to discuss this in confidence with the instructor and/or the Director of SAS, Trudy Luken. If you have questions about the Americans with Disabilities Act (ADA), call 575-646-3635. Students should contact the Office of Institutional Equity (575-646-3635) only if they feel they have been discriminated against in any category.
Student complaints: If students have a complaint about a course, they are advised to discuss their concerns directly with the instructor whenever possible. If that does not resolve the problem or if they cannot approach the instructor, students should either access NMSU’s online complaint system at https://dos.nmsu.edu/concerns/ or seek out the department head Dr. Phillip Post, (ppost@ad.nmsu.edu) for for help resolving the problem. Both of these processes provide opportunities for the department head to know about issues that need attention and for instructors to receive information about student concerns so that they can respond.
Further Notice: Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act Amendments Act (ADAAA) covers issues relating to disability and accommodations. If a student has questions or needs an accommodation in the classroom (all medical information is treated confidentially), contact:
Trudy Luken, Director
Student Accessibility Services (SAS) - Corbett Center Student Union, Rm. 208 Phone: (575) 646-6840 E-mail: sas@nmsu.edu
Website: http://sas.nmsu.edu/
NMSU policy prohibits discrimination on the basis of age, ancestry, color, disability, gender identity, genetic information, national origin, race, religion, retaliation, serious medical condition, sex, sexual orientation, spousal affiliation and protected veterans status. Furthermore, Title IX prohibits sex discrimination to include sexual misconduct: sexual violence (sexual assault, rape), sexual harassment and retaliation.
For more information on discrimination issues, Title IX, Campus SaVE Act, NMSU Policy Chapter 3.25, NMSU's complaint process, or to file a complaint contact:
Lauri Millot, Director and Title IX Coordinator
Agustin Diaz, Associate Director, Title IX Deputy Coordinator
Office of Institutional Equity (OIE) - O'Loughlin House, 1130 University Avenue Phone: (575) 646-3635 E-mail: equity@nmsu.edu
Website: http://eeo.nmsu.edu/
Other NMSU Resources:
NMSU Police Department:
(575) 646-3311
NMSU Police Victim Services:
(575) 646-3424
NMSU Counseling Center:
(575) 646-2731
NMSU Dean of Students:
(575) 646-1722
For Any On-campus Emergencies:
911
The Instructor of Record reserved the right to make announced changes in the syllabus; as feasible, changes will be made with student input.
Academic Resources
NMSU provides students with academic resources such as tutoring, final exam schedules, library and research, and transcript information on the NMSU Current Student webpage.
Student Support Services
Find information and support on advising, registration, and financial aid on NMSU Current Student webpage. You will also find links to the academic calendar, Student Affairs, the student handbook, and Student technologies on this page.
Technical Support
The ICT Customer Service Center is equipped to deal with all of your information technology (IT) and telecommunications needs at NMSU. Please feel free to contact them at (575) 646-1840 or via email at helpdesk@nmsu.edu. You can also go to the Student Technology Help Student Technology Help web page and Student Resources located at the Canvas web page for additional information on Canvas.
Dispositions: The disposition of Professionalism will be assessed in this class. Professionalism is assessed by examining your conduct as a student both in your interactions with the instructor as well as other students. Students who show impairment in this regard may be assessed as deficient. Students who exhibit exemplary conduct will be assessed as such on this dimension.
Diversity: Your program is committed to issues of diversity including, but not limited to, race, gender, sexual orientation, social class, ethnicity, ability status. This class is designed to facilitate your development as a culturally competent professional; able to work effectively with diverse clients and communities.
Student complaints: If students have a complaint about a course, they are advised to discuss their concerns directly with the instructor whenever possible. If that does not resolve the problem or if they cannot approach the Instructor, students should either access NMSU’s online complaint system at https://dos.nmsu.edu/concerns/ or seek out the department head, Dr. Phillip Post, (ppost@ad.nmsu.edu) for help resolving the problem. Both of these processes provide opportunities for the department head to know about issues that need attention and for instructors to receive information about student concerns so that they can respond.
Reporting COVID-19 at NMSU
(Updated: 7/7/2020)
Any student or employee of the NMSU system or affiliated agencies who has tested positive for COVID-19 and had been on campus at any time 48 hours prior to the onset of symptoms or COVID-19 positive test must notify their supervisor and Aggie Health and Wellness Center (575-646-1512 or davidcar@nmsu.edu) immediately.
The positive individual may not come to work and must follow current CDC guidance regarding self-quarantine or self-isolation. Any individual who has tested positive for COVID-19 will need to be cleared to return by their health care provider and in accordance with CDC guidance. Any student is also strongly encouraged to report a positive test to Aggie Health and Wellness Center (575-646-1512 or davidcar@nmsu.edu) immediately.
When NMSU is notified of a person with confirmed COVID-19, Aggie Health and Wellness Center (AHWC) will coordinate the process to notify exposed individuals (those who have been within 6 feet for 15 minutes) and disinfect buildings. The identity of the COVID-19 positive person will not be disclosed. Supervisors of staff who may have been in the affected building (e.g. Facilities, ICT) will be alerted in order to share with those staff.
Academic and non-academic misconduct: The Student Code of Conduct defines academic misconduct, non-academic misconduct and the consequences or penalties for each. The Student Code of Conduct is available in the NMSU Student Handbook online:
http://studenthandbook.nmsu.edu/
Academic misconduct is explained here:
http://studenthandbook.nmsu.edu/student-code-of-conduct/academic-misconduct/