This is a bulletin which features hospital pharmacists who are experts in their specialty. In this month’s issue, we are featuring Miss Amy Leo Wen Ling (BSc (Pharm) Hons, BCPP), a psychiatric pharmacist from the Institute of Mental Health, who has 10 years of experience in Pharmacy and 7 years in the field of Psychiatry. She will be sharing with us on her experience in Psychiatry and giving us some updates in the field of Psychiatry.

1. What are some of your day to day duties e.g. special services, rounds that are offered in your pharmacy? 
   
   My day to day duties include medication reconciliation, medication review, medication counselling and daily ward rounds. I also attend the weekly multidisciplinary team meeting where the team would discuss patients’ progress and find ways to optimise patients’ therapies. Unlike the ward rounds in a general hospital, in Institute of Mental Health (IMH), the nurse would bring the patient into the consultation room to be seen by the ward team which consists of a consultant, a medical officer, a pharmacist, an Advanced Practice Nurse, a medical social worker, a psychologist, an occupational therapist and a case manager. Before seeing the patient, I would read up on the patient’s case in detail and summarize the information for my own reference. During ward rounds, I contribute by providing information on medications, advising on alternative medication choices and assessing patients for compliance and adverse effects. Other than considering patients’ symptoms and conditions, it is also important to understand patients’ worries and preferences as well as the cost of medications when determining the choice of medications so as to improve patients’ compliance to their medications.
   
    
2. What are some of the challenges that pharmacists working in your specialty might face and what are the approaches to overcome these challenges?
   
   We may encounter aggressive patients who may become violent at times due to their mental illness. Our hospital provides panic alarm for all ward pharmacists and if we require assistance, we can activate the panic alarm and the nurses will come and assist us. We also face patients with poor insight of their illness. Such patients tend to be non-compliant to their medicines. Psycho-educating patients and their family members about their illness and the role of medicines can help improve medication compliance. We would also recommend the use of pill boxes to aid medication administration and compliance.
   
    
3. As an expert in your specialty, what are some of the latest practice updates/ resources which you would like to highlight to fellow pharmacists who want to learn more about your field of practice?
   
   Two new medications, deutetrabenzine and valbenazine, are approved for the treatment of tardive dyskinesia by FDA in 2017. These two medications serve as alternative to tetrabenzine which has been used off-label for this indication. Besides that, two new long-acting injectable antipsychotics, IM paliperidone (Invega Trinza®) and IM aripiprazole (Abilify Maintena®) are also available in the market. Invega Trinza® is a 3-monthly injection, which provides convenience to patients who are working as they have to take time-off in order to go the clinic for their injection.
   
    
4. Is there anything else that you would like to share e.g. words of advice regarding your specialty?
   
   Even though one may face many challenges when helping psychiatric patients, but as long as you have empathy, passion and patience, you will be able to understand and assist these patients. Often, these patients need a listening ear for their problems, by talking to them face-to-face, you know them better and are in a better position to provide recommendations to the ward team on how to help these patients.

Leo Wen Ling Amy (BSc (Pharm) Hons, BCPP)
Senior Pharmacist
Institute of Mental Health