Side Effects Of Psychotropic Medications Research Articles

Tardive Dyskinesia: Assessing and Treating a Debilitating Side Effect of Prolonged Antipsychotic Exposure

Tardive Dyskinesia: Assessing and Treating a Debilitating Side Effect of Prolonged Antipsychotic Exposure

Psychotropic medications use and side effects of individuals with intellectual and developmental disabilities.

Many people with intellectual and developmental disabilities (IDD) are treated with psychotropic medications, and polypharmacy is common. Although few studies address psychotropic side effects in the population, people with IDD have been found more likely to experience side effects than others who do not have IDD. Because many individuals with IDD may not report side effects reliably, there is risk that side effects may be missed. Psychotropic use and side effects of 71 adults with IDD admitted for a 30-day crisis stay to a Systemic, Therapeutic, Assessment, Resources, and Treatment (START) Resource Center were reviewed. START is a specialised behavioural health outreach, training and crisis programme for individuals with IDD. During crisis stays, centre nurses administer the Matson Evaluation of Drug Side Effects screen, a psychometrically established psychotropic medication side effects screen developed for use with people with IDD. Data reviewed were de-identified data used to inform day-to-day practices and assess outcomes for individuals START served. The average age was 28years, and 56% of the sample was male. All individuals were taking at least one psychotropic, while 79% were taking three or more. The average number of psychotropics used was 3.94. Antipsychotics were the most commonly prescribed medications taken by 85% of the sample; 49% of whom were not reported to have psychosis. Although the overall number of psychotropics did not correlate with Matson Evaluation of Drug Side Effects scores, the average scale scores for all participants was high in contrast to prior studies of people with IDD not taking psychotropics, with central nervous system side effects being the most commonly reported. In the present study, data for individuals experiencing a crisis were reviewed and indicated high rates of psychotropic polypharmacy and side effects rates higher than previously reported for people with IDD not taking psychotropics. Prospective study in larger samples is needed to determine if missed or under-appreciated psychotropic side effects may play a role in behavioural health challenges of some people with IDD.

Le score des pictogrammes pour les patients conducteurs

IntroductionAs there is a case-law sentencing the lack of information to the patients who drive, we propose to clinically stabilized patients, sessions of therapeutic education. A driving simulator was used as therapeutic education tool and driving assessment tool. At the same time we calculated a score called pictograms’ score corresponding to the sum of risk level of each psychotropic driving-impairing medicine of the patient's prescription. Driving skill scores were then compared to the calculated pictograms’ score. Material and methods15 stabilized outpatients (depressive, bipolar or schizophrenic), (8M, 7F, 50.67±6.53 years old), having a French B driving license since 29.53±8.16 years, without somatic pathology and receiving psychotropic medications at usual dosages gave their consent and entered the study. 15 healthy control subjects (8H and 7F of 32±8.67 years and 13.07±7.94 years of license) taking no medication (with exception for hormonal contraception for women) were also tested for driving skills on the driving simulator used by the French Driving Schools ran on a desktop computer. The pictograms’ score is the weighted sum of the regulatory levels of harmonized warning pictograms for all the psychotropic prescribed. ResultsThe average simulator driving skills scores of the patient group are significantly lower than those of the healthy control group with 64.67±10.40 (32 to 82) and 79.67±6.84 (62 to 92), respectively (P=0.0018). While 20% of the patients in our sample failed (score≤50/100), 74% have comparable simulator driving skills as to the healthy subjects. In the previous 12 months before the study, their background was some road accidents among patients but only excess speed tickets for the healthy control subjects. The psychiatrists, including a doctor certified for the medical check of driving license, observed that the therapeutic education sessions are useful in moving the patient “in the right way” by overcoming his “innner conflicts”, and fears when driving. The pictograms’ score of the prescription allow us to measure the risk of multiple medications. It is analyzed taking into account the type of molecule, the dosage, the time passed since the initiation of treatment and since the last dose, the age of the patient and the diagnosis. For a psychotropic score greater than 17, we observed a worsening of the driving simulator score and potentially a risk threshold to be taken into account. ConclusionGuidelines that physicians use to assess fitness for driving are limited in their currency, and applicability. All in all, the pictograms’ score of the patient's prescription help him to understand the risk scale and act more safely. We use the pictograms’ score calculated by data mining in our health institution to refer patients with a score greater than or equal to 17 to a therapeutic education session. The pictograms’ score reflects only the treatment effect. With regards to the simulator’ driving score, the pictograms’ score differentiates the effects of the pathology from side effects of psychotropic medications on driving. Thus, it can help medication checking and reduce risk for patients who needed to drive.

Upskilling Mental Health Nurses to Address the Burden of Poor Metabolic Health: A Mixed Method Evaluation

People living with a severe mental illness experience a life expectancy gap compared to the rest of the population that is largely driven by preventable cardiovascular diseases stemming from lifestyle factors, and the side effects of psychotropic medications. Mental health nurses are well positioned to help address the gap using lifestyle interventions. However, many nurses don’t prioritise delivering such care, or lack the skills and confidence to implement these strategies. This study used a mixed method approach to determine the effectiveness of 2-day metabolic workshops that aimed to provide nurses with the skills to provide lifestyle interventions. The quantitative component compares pre and post measures of attitudes, confidence, knowledge and perceived barriers of providing metabolic care using a validated tool (M-BACK) and the qualitative component to elicit more details of the needs, expectations and plans of participants. Fifty-six nurse participants demonstrated statistically significant improvements in M-BACK post scores (p < 0.001), with 53 of the 56 participants (95%) achieving improved M-BACK scores. Participants identified three primary barriers to delivering metabolic care, related to individual staff members, consumers, and system issues. Prior to the course participants stated they hoped to improve their knowledge, enhance their practical skills and provide education for others. Following completion of the course participants planned to implement lifestyle education and interventions for consumers, provide education and support to other staff and integrate metabolic health care into clinical reviews and planning. This study demonstrates that education on metabolic health care can be effective in improving the attitudes, confidence, and knowledge of mental health nursing in providing metabolic health care and a decrease in the perceived barriers to delivering that care.

HALOPERIDOL DECANOATE INDUCED PANCYTOPENIA: A CASE REPORT

Introduction Blood dyscrasias can occur secondary to antipsychotic drug use which may be due to direct drug toxicity or immunologic mechanisms causing bone marrow suppression. Antipsychotic use mostly causes neutropenia and less frequently thrombocytopenia. Drug-induced pancytopenia is a very rare side-effect of psychotropic medications and is even rarer with butyrophenones like haloperidol Methods We reviewed the case of a geriatric patient who developed pancytopenia while on haloperidol decanoate monthly injection Results We present the case of an 85-year-old African-American woman with a long history of schizophrenia, who was stabilized on Haloperidol Decanoate 50?mg monthly IM for a few years at another hospital. She was then maintained on the Haloperidol decanoate for a few months after she moved outpatient care to our hospital. She was noted to have pancytopenia at initial presentation in the clinic and her RBC, Platelets, and WBC (including neutrophil) counts gradually declined to the point where her Haloperidol Decanoate was placed on hold in order to further monitor the blood counts. Baseline leukocyte count was 3000/mm³ when she started outpatient treatment at our clinic, which gradually dropped to 1860/mm³ within 6 months of Haloperidol decanoate treatment. During this time, hemoglobin dropped 0.8 points (10.9?g/?dL to 10.1 g/dL), and platelet count decreased from 154,000/mm3 to 140,000/mm3. Within one month of discontinuation of haloperidol decanoate, patient decompensated and was admitted to the psychiatry inpatient unit. Hematology was consulted; lab work to exclude other causes of pancytopenia was completed and haloperidol induced pancytopenia was suspected. She didn't receive any more haloperidol decanoate during her hospital stay. She consistently refused oral medications and became catatonic. Court order for medication-over-objection was obtained but she continued refusing oral medications. As a result, she received Olanzapine 5?mg IM consistently for few days which ultimately resulted in clinical improvement. She was discharged after 2 months of inpatient stay. Her cell counts gradually trended upwards during the inpatient stay. At the time of discharge from the inpatient unit, her WBC count had increased to 5100/mm3, hemoglobin increased to 11.2?g/?dL, and platelet count remained stable at 138000/mm3. It took roughly three months, after stopping the haloperidol decanoate, for the counts to normalize. Conclusions Blood dyscrasias should be suspected in patients treated with antipsychotics. Patients on long acting depot antipsychotics might need longer time to recover from blood dyscrasias due to slow wash-out of depot preparations This research was funded by: Not Applicable

Patients and Caregivers Helping to Shape the Undergraduate Pharmacy Mental Health Curriculum

Objective. To develop a model system for involving patients and caregivers in curriculum development of mental health education in an undergraduate pharmacy program. Methods. Purposive recruitment was used to convene a focus group of nine people with experience in using mental health services from either the patient or caregiver perspective. Group members were asked about their experience with using pharmacy services and their suggestions for enhancement of the undergraduate curriculum. Thematic analysis was conducted independently by two researchers. Results. Patients and caregivers believed that pharmacists could contribute to the care of people who experience mental health conditions by supporting shared decision making, providing information, actively managing side effects of psychotropic medication, and conducting regular medication review. Subjects suggested that the pharmacy undergraduate curriculum should introduce mental health from the beginning, include self-care for students, integrate mental and physical health education, and enhance students' communication skills. The curriculum should include broader issues relevant to mental health beyond the use of medication, such as stigma, the recovery approach, and interprofessional cooperation. These changes could support graduates in engaging proactively with people experiencing mental health difficulties. Conclusion. Involving patients and caregivers in the design of an undergraduate pharmacy curriculum in mental health resulted in a more person-centered and student-centered approach to mental health education at our university. Ultimately, the changes made to the undergraduate curriculum will improve the ability of pharmacy graduates to better meet the needs of patients.

Gastrointestinal dysfunction in autism displayed by altered motility and achalasia in Foxp1+/− mice

Gastrointestinal dysfunctions in individuals with autism spectrum disorder are poorly understood, although they are common among this group of patients. FOXP1 haploinsufficiency is characterized by autistic behavior, language impairment, and intellectual disability, but feeding difficulties and gastrointestinal problems have also been reported. Whether these are primary impairments, the result of altered eating behavior, or side effects of psychotropic medication remains unclear. To address this question, we investigated Foxp1+/- mice reflecting FOXP1 haploinsufficiency. These animals show decreased body weight and altered feeding behavior with reduced food and water intake. A pronounced muscular atrophy was detected in the esophagus and colon, caused by reduced muscle cell proliferation. Nitric oxide-induced relaxation of the lower esophageal sphincter was impaired and achalasia was confirmed in vivo by manometry. Foxp1 targets (Nexn, Rbms3, and Wls) identified in the brain were dysregulated in the adult Foxp1+/- esophagus. Total gastrointestinal transit was significantly prolonged due to impaired colonic contractility. Our results have uncovered a previously unknown dysfunction (achalasia and impaired gut motility) that explains the gastrointestinal disturbances in patients with FOXP1 syndrome, with potential wider relevance for autism.

Managing the Side Effects of Psychotropic Medications, Second Edition.

Managing the Side Effects of Psychotropic Medications, Second Edition.

A quantitative assessment of the views of mental health professionals on exercise for people with mental illness: perspectives from a low-resource setting.

Exercise is nowadays considered as an evidence-based treatment modality in people with mental illness. Nurses and occupational therapists working in low-resourced mental health settings are well-placed to provide exercise advice for people with mental illness. We examined the current exercise prescription practices employed by Ugandan health care professionals when working with people with mental illness, and identified perceived barriers to exercise prescription and exercise participation for people with mental illness. In this study, 31 Ugandan health care professionals 20 men; 31.2 ± 7.1 years completed the Exercise in Mental Illness Questionnaire- Health Professionals Version EMIQ-HP. The vast majority of the respondents 29/31, 94% reported they prescribed exercise at least "occasionally" to people with mental illness. Exercise-prescription parameters used were consistent with those recommended for people with mental illness. Regarding barriers to exercise participation, coping with side effects of psychotropic medication at the individual level and reducing stigma at community level should be prioritized. A health care reform to enable collaboration with exercise professionals, such as exercise physiologists or physiotherapists, might increase exercise uptake for people with mental illness, thereby improving health outcomes for this vulnerable population.

CHALLENGES IN 21ST CENTURY INPATIENT GERIATRIC PSYCHIATRY AND LONG TERM CARE PRACTICE.: Session 112

With the increase in life span, there has been a rise in the number of older adults. In 2010, approximately 40 million persons aged 65 years and older lived in the United States and this statistic is projected to increase to 88.5 million by 2050, accounting for 20.2% of the population. The number of older adults with psychiatric disorders is also expected to increase to 15 million by 2030. A significant proportion of these older adults will also have co-morbid medical issues, which may pose challenges. In this session, we will provide an overview of how nursing home facilities and inpatient geriatric psychiatry units are adapting to changes and challenges to provide care for this vulnerable population. In the last 20 years, the number of elderly patients cared for in nursing homes has increased, with facilities expanding to include more beds to respond to this need. The average resident age has also increased, with a corresponding increase in functional limitations, disabilities, cognitive and mental disorders requiring advanced care. Additionally, policy and industry changes over the years have affected the way we provide care for these residents. There has been rapid growth in assisted living facilities in order to provide an alternative care setting for these individuals who require more assistance with activities of daily living. This has led to the development of specialized units that will meet the needs of these residents. Since the implementation of the minimum data set (MDS) system, many prevalence reports have relied on either recorded diagnoses or scales derived from MDS to identify residents with psychiatric conditions. These have also been used as screening tools to identify residents in need of treatment. Available data indicates that there are an inadequate number of geriatric psychiatrists in the USA to care for these older adults with mental illness. The unfortunate consequence has been providers without specialist training or oversight attempting to provide care for residents. This often includes prescribing multiple psychotropic medications that are inappropriate for their symptoms and their age, which can ultimately lead to substantial psychological and functional morbidity. Additionally, these medication side effects and undertreated psychiatric disorders have a significantly negative impact on the residents’ quality of life, disability, and cost of care. Approximately 75-80% of residents in long- term care have a neurocognitive disorder. Although most major neurocognitive disorders are incurable, appropriate comprehensive treatment can substantially improve the quality of life of a resident, their family, and their caregivers. Routine provision of evidence-based care by a mental health care team with expertise in long-term care is essential for maintaining dignity and reducing suffering for these patients. This includes ongoing staff education, discontinuation of inappropriate medications, optimal use of appropriate psychotropic medications and other behavioral interventions. We will review how the geriatric psychiatrist, along with other allied health care professionals, can work as a team in today's highly regulated environment of long term care to improve patient outcomes. With the projection that the older adult population will swell over the next several decades, inpatient geriatric psychiatry facilities have arisen to address the need to provide acute services for these patients. These units appear to have distinct clinically relevant assessment and treatment advantages. They are more comprehensive in their diagnostic assessment of patients, are more likely to provide cognitive assessments and are more cognizant of potential side effects of psychotropic medications. They are also more likely to provide more age-specific aftercare recommendations, which is important in maintaining success after the hospitalization. However these specialized units are limited, expensive, and may encounter a unique set of challenges as the landscape changes for healthcare delivery, reimbursement and managed care. In this session, we will describe key characteristics of a typical geriatric psychiatry unit, discuss advantages of such a unit over a general psychiatry unit, discuss different models of geriatric psychiatry facilities, outline standard admission screening criteria for appropriate patient selection, address treatment challenges associated with the need for rapid improvement in patient psychopathologies and discuss the increased pressures in providing high quality care in the context of reduced length of stays with scarce resources for aftercare. At the end of our presentation, we will briefly showcase the unique characteristics of our inpatient geriatric psychiatry unit.

Cognitive deficits, depressive symptoms, insight, and medication adherence in remitted patients with schizophrenia.

Objective:To study the relationship between cognitive deficits, depressive symptoms, insight, and medication adherence in remitted patients with schizophrenia.Methods:Fifty-four patients aged 18–60 years, with schizophrenia in remission, were evaluated for adherence using the Medication Adherence Rating Scale (MARS), cognitive deficits using the Schizophrenia Cognition Rating Scale (SCoRS), depressive symptoms using the Calgary Depression Scale for Schizophrenia (CDSS), and insight using the Beck Cognitive Insight Scale.Results:Twenty-one (38.9%) patients were found to be nonadherent to their medication. A significant negative correlation was found between MARS total score with SCoRS attention/vigilance (r = −0.28), attitude toward negative side effects of the psychotropic medication with SCoRS total score (r = −0.36), SCoRS attention/vigilance (r = −0.27), verbal learning and memory (r = −0.32), reasoning and problem-solving (r = −0.30), and social cognition (r = −0.28). A significant negative correlation was found between CDSS total score with MARS total score (r = −0.50), medication adherence behavior (r = −0.44), and attitude toward negative side effects of psychotropic medication (r = −0.60). MARS total score significantly positively correlated with years in remission (r = 0.29).Conclusions:Poor medication adherence was seen in more than one-third of remitted patients with schizophrenia and was associated with global cognitive deficits, depressive symptoms, and the number of years in remission.

High serum levels of FGF21 are decreased in bipolar mania patients during psychotropic medication treatment and are associated with increased metabolism disturbance

Bipolar disorder (BD), a psychiatric illness, results partly as a side effect of psychotropic medications and presents a high risk of metabolic disturbance. Fibroblast growth factor 21 (FGF21) is as an important regulator in carbohydrate and lipid metabolism. In this study, we investigated the serum levels of FGF21 and analyzed its association with metabolic parameters in bipolar mania patients at pre- and post-treatment with psychotropic medications. Bipolar mania inpatients (n = 99) and healthy controls (n = 99) were included at baseline; the patients were followed up after four-week treatment. Serum levels of FGF21 and several metabolic parameters were measured by appropriate detection methods. We found that baseline serum FGF21 levels were significantly higher in bipolar manic patients when compared to that in controls. After four-week medication, FGF21 levels were found to be decreased in patients when compared to the baseline suggesting that FGF21 may be associated with the psychopathology of bipolar mania. Moreover, FGF21 levels were found to be negatively correlated with the serum triglycerides (TG), cholesterol (CHO), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo B), glucose (Glu), and Body Mass Index (BMI). In addition, our data also indicates that FGF21 may monitor and/or prevent the metabolic abnormalities induced by psychotropic drugs.

Low frequency rTMS ameliorates akathisia: Case report

Introduction: Akathisia is a common side effect of psychotropic medications, including selective serotonin reuptake inhibitors (SSRI). Recently, a mechanism in which compensatory increased noradrenergic activity is triggered by dopamine reduction has been proposed1.

Genetic testing for CYP2D6 and CYP2C19 suggests improved outcome for antidepressant and antipsychotic medication

Individuals carrying genetic variants that result in non-extensive CYP2D6 and CYP2C19 enzyme activity seem to be more prone to non-response and side-effects of psychotropic medications. Therefore, tailoring prescriptions using genetic information may improve patient outcomes. This study examined treatment outcome in psychiatric care after CYP2D6 and CYP2C19 genetic information was provided to patients and physicians. CYP2D6 and CYP2C19 genotyping, assessment of side effects and medical histories were obtained from 80 subjects who were prescribed either antidepressant or antipsychotic medications. Our measure of outcome was mainly physicians’ opinions however UKU side effects scores were also used. For CYP2D6, we calculated an activity score based on genotype and psychiatric medications. Correlation analysis was performed for CYP2D6 activity scores and UKU scores. Overall, we received supportive responses from physicians who enrolled patients in our study. Notably, while almost every fourth physician reported improvement in patient outcome, not a single physician indicated that their patient's symptoms worsened after they had used a pharmacogenetic report to guide treatment. We did not observe statistically significant differences in side effects. Overall, our results suggest improved patient outcome following pharmacogenetic testing; nonetheless, more research is required to assess the exact benefit of pharmacogenetics in clinical practice.

Adverse Side Effects of Psychotropic Medication and Challenging Behavior: Pilot Work Assessing Impact.

Psychotropic medications are often prescribed to reduce challenging behavior in individuals with intellectual and developmental disabilities (IDD). Functional analyses (FAs) have demonstrated utility in assessing medication impact on behavior; however, the impact of adverse side effects (ASE) on challenging behavior is under-assessed. The purpose of this study was to develop a methodology, similar to FAs, to explore potential medication ASE impact on challenging behavior in seven individuals with IDD. Results revealed response rate differences in designed ASE conditions for most participants. Outcomes support further development and use of this methodology to assess the presence and impact of ASEs.

Effective assessment of psychotropic medication side effects using PsyLOG mobile application

Effective assessment of psychotropic medication side effects using PsyLOG mobile application

Improving the physical health assessment of people with serious mental illness

Individuals with severe mental illness (SMI) die on average 20 years younger than the general population. The aim of the review described in this article was to examine relevant literature on the physical health of those with SMI and identify areas for improvement. Four electronic databases were searched and areas identified included side effects of psychotropic medications, obesity, cardiovascular diseases and diabetes, risky sexual behaviour, poor dietary intake and physical inactivity. The authors conclude that physical care of people with SMI can work well when physical health needs are assessed. Additional training is required for mental health nurses in physical health care.

Psychotropic medications in child welfare: From federal mandate to direct care

Background and objectiveChildren in the welfare system are prone to uncoordinated and unmonitored mental health care, including psychotropic medications. To address these issues, federal legislation mandated that state child welfare agencies improve the coordination and oversight of psychotropic medications. However, there is no clear guidance on how to improve these practices, particularly at the level of direct care. We aimed to identify specific areas for improvement through state-wide surveys of four groups. MethodsWe surveyed all known members of four groups working directly with children in foster care in one small northeastern state. Respondents included 209 foster and adoptive parents, 169 child welfare staff, 84 mental health therapists, and 33 clinical prescribers. Survey items addressed practices and perceptions related to sharing of information and cross-system communication and monitoring of medication effects and side effects. ResultsNearly two in five foster and adoptive parents reported not regularly receiving information about the purpose or side effects of psychotropic medications, and they disagreed among themselves on who was primarily responsible for monitoring safety and effectiveness. One-third of child welfare staff and two-thirds of mental health therapists reported that information about psychotropic medications is not regularly shared with the child's provider team. Half of clinical prescribers reported not regularly communicating with child welfare staff. ConclusionsWe identified specific areas for improvement related to communication, sharing of information, monitoring, and role clarification. Strategies to improving these activities are key to ensuring the safe and effective use of psychotropic medications in this population.

A clinical communication tool for the assessment of psychotropic medication side effects

The primary aim was to assess usability of the My Medicines and Me Questionnaire (M3Q) as a self-reported questionnaire for mental health patients to subjectively express side effects experienced with their psychotropic medications. The secondary aim was to evaluate patients’ attitudes towards treatment and psychotropic medications following dialogue with their clinicians about side effects. Questionnaires were administered at six adult mental health facilities. A total of 205 participants were divided into intervention (facilitated dialogue) and non-intervention groups (no facilitated dialogue). The mean completion time for the M3Q was 15min (SD=6.5) with only 11 (5%) patients requiring assistance. The most commonly reported side effect was sedation (77%) and weight gain was ranked as the most bothersome (23%). The previously validated M3Q provided patients with the opportunity to express the impact these effects had on their lives. Side effects were the most common reason given for non-adherence. There were no significant changes in patient attitudes towards treatment and medications in the intervention group, mainly due to the logistical challenges in the clinicians’ ability to view the questionnaire for the subsequent meeting with the patient. The M3Q demonstrated its usability in allowing patients to easily express their subjective experiences with side effects.

Feasibility and acceptability of patient partnership to improve access to primary care for the physical health of patients with severe mental illnesses: an interactive guide.

IntroductionEven in countries with universal healthcare systems, excess mortality rates due to physical chronic diseases in patients also suffering from serious mental illness like schizophrenia is such that their life expectancy could be lessened by up to 20 years. The possible explanations for this disparity include: unhealthy habits (i.e. smoking; lack of exercise); side-effects of psychotropic medication; delays in the detection or initial presentation leading to a more advanced disease at diagnosis; and inequity of access to services. The main objective of this paper is to explore the feasibility and acceptability of patient partnership for developing an interactive guide to improve access to primary care providers for chronic diseases management and health promotion among patients with severe mental illnesses.MethodsA participatory action research design was used to engage patients with mental illness as full research partners for a strategy for patient-oriented research in primary care for persons with schizophrenia who also have chronic physical illnesses. This strategy was also developed in partnership with a health and social services centre responsible for the health of the population of a territory with about 100,000 inhabitants in East-end Montreal, Canada. A new interactive guide was developed by patient research partners and used by 146 participating patients with serious mental illness who live on this territory, for them to be better prepared for their medical appointment with a General Practitioner by becoming more aware of their own physical condition.ResultsPatient research partners produced a series of 33 short videos depicting signs and symptoms of common chronic diseases and risk factors for the leading causes of mortality and study participants were able to complete the corresponding 33-item questionnaire on an electronic touch screen tablet. What proved to be most relevant in terms of interactivity was the dynamic that has developed among the study participants during the small group learning sessions, a training technique designed for healthcare professionals that was adapted for this project for, and with patient partners.ConclusionThis research has shown the feasibility and acceptability of patient partnership and patient-oriented research approaches to the R&D process of a new medical tool and intervention for patients with serious mental illness, and its acceptability for addressing inequity of this disadvantaged population in terms of access to primary care providers.