Clinical Pharmacy in Psychiatry: Towards Promoting Clinical Expertise in Psychopharmacology

Abstract

Although clinical pharmacy is a discipline that emerged in the 1960s, the question of precisely how pharmacists can play a role in therapeutic optimization remains unanswered. In the field of mental health, psychiatric pharmacists are increasingly involved in medication reconciliation and therapeutic patient education (or psychoeducation) to improve medication management and enhance medication adherence, respectively. However, psychiatric pharmacists must now assume a growing role in team-based models of care and engage in shared expertise in psychopharmacology in order to truly invest in therapeutic optimization of psychotropics. The increased skills in psychopharmacology and expertise in psychotherapeutic drug monitoring can contribute to future strengthening of the partnership between psychiatrists and psychiatric pharmacists. We propose a narrative review of the literature in order to show the relevance of a clinical pharmacist specializing in psychiatry. With this in mind, herein we will address: (i) briefly, the areas considered the basis of the deployment of clinical pharmacy in mental health, with medication reconciliation, therapeutic education of the patient, as well as the growing involvement of clinical pharmacists in the multidisciplinary reflection on pharmacotherapeutic decisions; (ii) in more depth, we present data concerning the use of therapeutic drug monitoring and shared expertise in psychopharmacology between psychiatric pharmacists and psychiatrists. These last two points are currently in full development in France through the deployment of Resource and Expertise Centers in PsychoPharmacology (CREPP in French).

Keywords: clinical pharmacy; expertise; mental health; psychiatry; psychopharmacology.

Figure 1

Collaborative view of psychiatric pharmacists and psychiatrists for a shared expertise in clinical psychopharmacology and the development of CREPPs. CCI: Case Conferencing Intervention—mainly developed in Scandinavian countries and in Australia; CMM: Comprehensive Medication Management and MTM: Medication Therapy Management—mainly structured in English speaking countries; CREPPs: Centres de Ressources et d’Expertise en PsychoPharmacologie = Resource and Expertise Centers in PsychoPharmacology—currently in full expansion in France; MedRec: Medication reconciliation—widely developed around the world; TDM: Therapeutic Drug Monitoring—applied to psychotropic drugs has been particularly developed in certain German-speaking countries—Germany, Austria and Switzerland—which have proposed the "Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology" at the initiative of the TDM task force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP); TPE: Therapeutic Patient Education—widely developed around the world.