1. Discuss the Mental Health and Addiction System in Canada and identify the strengths and limitations of such systems.

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1 Course Outline and Syllabus for Students Mental Health and Addiction Elective Course Outline Coordinator Names: Jamie Kellar and Maria Zhang Course Number: PHM386 Course Title: Mental Health and Addictions Elective Course Description: This course is designed to provide students interested in mental health and addictions with a broader knowledge base in the field. It will introduce students to the mental health and addiction system in Canada, the role of stigma in accessing and providing care, the role of psychotherapy and the evidence base for specific modalities, including cognitive behaviour therapy (CBT), interpersonal psychotherapy (IPT), mindfulness therapy, and motivational interviewing. The course will also address issues such as medication adherence and mental health first aid. Students will also be taught how to use validated scales to assess for psychotropic-induced movement disorders. The course will introduce additional mental health disorders/issues, not covered in PHM 302 including psychotropic medication use in pregnancy and lactation and child and adolescent psychiatry. It will also cover key substance use disorders/issues in more depth than was possible in PHM 302, including harm reduction principles, cannabis use (recreational and medicinal), recreational drugs and anabolic steroids. The course will be taught using a variety of techniques including didactic lectures, observed patient interviews (video-simulation), case-based learning and interactive group learning. Required: No Elective: Yes 1. Course Learning Objectives: Upon completion of this course, students will have achieved the following level of learning objectives: Introductory = knowledge and comprehension of concepts, definitions, Intermediate = application of concepts to simple situations Advanced = application of concepts to more complex situations with ability to synthesize and evaluate Knowledge Mental Health 1. Discuss the Mental Health and Addiction System in Canada and identify the strengths and limitations of such systems. [INTERMEDIATE] 2. Recognize the intersection of the health and legal systems as they relate to mental illness in Ontario. [INTERMEDIATE] 3. For the following selected mental health disorders, summarize the etiology, neuroscience concepts, epidemiology, clinical presentation, risk factors and progression: eating disorders and attention deficit and hyperactivity disorders. [INTERMEDIATE] 1

2 4. Identify the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders IV and 5, used in the diagnosis and ongoing monitoring of the selected disorders. [INTERMEDIATE] 5. Recognize different movement disorders in patients with mental illness and be able to apply the following rating scales (Abnormal Involuntary Movement Scale [AIMS], Barnes Akathisia Rating Scale [BARS], Symptom Angus Scale [SAS]) to a patient for the purpose of assessing side effect severity at the time of diagnosis and throughout treatment. [INTERMEDIATE] 6. Compare and contrast the available classes of medications used for the selected disorders based on the following criteria: indications, efficacy, mechanism of action, pharmacokinetics, pharmacodynamics, pharmacogenomics, adverse effects, warnings/precautions, contraindications, drug interactions (drug-drug, drug-food, drug-laboratory), convenience, cost, formulations and stability. [INTERMEDIATE] 7. Discuss the evidence of non-drug measures used to treat different mental health disorders (e.g., Electroconvulsive Therapy (ECT), Repetitive Transmagnetic Stimulation (rtms), Cognitive Behavioural Therapy (CBT), Interpersonal Psychotherapy (IPT), Mindfulness therapy and Motivational Interviewing. [INTRODUCTORY] 8. Describe the role of Mental Health First Aid programs in Canada and the utility for practicing pharmacists. [INTRODUCTORY] 9. Recognize the role of the pharmacist in medication adherence and identify evidence based strategies to facilitate this process in patients with mental illness. [INTERMEDIATE] 10. Identify the role for psychotropic medications in pregnancy and lactation. [INTERMEDIATE] 11. Explain stigma and how it impacts patient care. [INTERMEDIATE] Knowledge Substance Use Disorders 12. Compare and contrast the available classes of medications used for the selected disorders based on the following criteria: indications, efficacy, mechanism of action, pharmacokinetics, pharmacodynamics, pharmacogenomics, adverse effects, warnings/precautions, contraindications, drug interactions (drug-drug, drug-food, drug-laboratory), convenience, cost, formulations and stability. [INTERMEDIATE] 13. Recognize the intersection of provincial, national and international health and legal systems as they relate to addiction. [INTERMEDIATE] 14. Discuss the evidence of non-drug measures used to treat different substance use disorders (e.g., Cognitive Behavioural Therapy (CBT), Interpersonal Psychotherapy (IPT), Mindfulness therapy, Motivational Interviewing, and group versus individual therapy. [INTRODUCTORY] 2

3 15. Describe how harm reduction principles are important in providing patient-centred care. [INTERMEDIATE] 16. Identify key referral resources for patients experiencing problems related to substance use. [INTRODUCTORY] 17. Justify an evidence-based, patient-centered approach in managing patients with concurrent opioid use disorders and pain. [INTERMEDIATE] Skills 1. Select relevant data from patient demographics, review of systems (ROS), laboratory tests, medical imaging, and, drug therapy in order to identify drug therapy problems. [INTERMEDIATE] 2. Analyze relevant information from subjective and objective sources, (e.g., review of systems, medical imaging, diagnostic tests, biochemical markers), to identify drug therapy problems, urgency, and priority for a given clinical situation. [INTERMEDIATE] 3. Justify the selection of a preferred alternative for a given therapeutic scenario based on the assessment of relevant therapeutic alternatives and specific patient population. [INTERMEDIATE] 4. Demonstrate the skills required to initiate varenicline and bupropion for smoking cessation, and to adapt and renew medications for the selected disorders. [ADVANCED] 5. Develop a care plan for a given clinical situation. [INTERMEDIATE] 6. Locate reliable sources of information in the area of psychiatric therapeutics. [INTERMEDIATE] 7. Demonstrate the ability to critique and interpret results from observational studies, randomized controlled trials and meta-analyses in mental health and addictions [INTERMEDIATE] 8. Assess patients for movement related disorders using the Abnormal Involuntary Movement Scale [AIMS], Barnes Akathisia Rating Scale [BARS], Symptom Angus Scale [SAS]. [INTERMEDIATE] 9. Evaluate the scientific literature for evidence for or against the use of psychoactive substances for therapeutic purposes. [INTERMEDIATE] 3

4 Attitudes / Values Mental Health and Addiction Elective Course Outline 1. The student will undertake assessment and care plan development activities in a manner that illustrates their understanding of the importance of respecting patient autonomy and individual therapeutic goals. [INTERMEDIATE] 2. The student will use interprofessional patient-centered care principles to reach decisions for therapeutic alternatives with members of their peer groups. [INTERMEDIATE] 3. The student will articulate the importance of demonstrating a non-judgmental, empathetic, and professional attitude towards patients who have psychiatric and substance use disorders, which continue to be associated with significant stigma. [INTERMEDIATE] 2. Rationale for Inclusion in the Curriculum: Mental Health Disorders account for significant morbidity and mortality worldwide. The World Health Organization lists several mental health disorders on their list of the top 10 leading causes of disability worldwide. In Canada, 1 in 5 Canadians will personally experience a mental illness during their lifetime. (Health Canada. A Report on Mental Illness in Canada, 2002). In Ontario, the Select Committee on Mental Health and Addiction reviewed the mental health system in Ontario and in their final report (2010), recommended that primary care providers should be given the proper tools and support to enable them to develop a greater sensitivity for the mental health and addictions needs of their patients, and that all interdisciplinary primary care models should include a mental health and addictions treatment component. A key recommendation in the College of Physicians and Surgeons of Ontario report entitled, Avoiding Abuse, Achieving a Balance: Tackling the Opioid Public Health Crisis (2010) is that enhanced training and ongoing education of health care providers in the safe use of opioids is needed. For students with a particular interest in the field of Mental Health and Addictions, this course provides learning and experiences beyond the core disorders and pharmacotherapy taught in Phm 302: Neuropsychiatry. It introduces students to the mental health system in Canada, the social issues faced by patients with mental illness, the role of non-drug measures in the treatment of mental illness and provides enhanced learning opportunities for pharmacy students who wish to learn how to manage patients with complex mental health disorders. 3. Pre-requisites: Phm Statement of agreement from course coordinators of courses for which this course is a prerequisite: N/A 5. Co-requisites: (for the current and subsequent year) N/A 4

5 6. Statement of agreement from coordinators of courses for which this course is a co-requisite: N/A 7. Course Contact Hours and Teaching Methodologies: Didactic (lecture) Large group problem-based or case-based learning Large Group Size (eg 30, 60, 120, 240) Laboratory or Simulation Tutorial/Seminar/Workshop/Small Group Small Group Size (eg 5, 10, 15, 20, 25) Experiential On-line Other (please specify)* * Other specific information: Total course contact 26 persons persons Estimate and description of student's weekly out-of-class preparation time excluding exam preparation: Review learning objectives, required readings, and notes for each lecture (3 hrs/ week), higher during weeks of assignment and exams. 9. Course Coordinators and Contact Information: Jamie Kellar, BScHk, BScPhm, PharmD PB 701 (416) jamie.kellar@utoronto.ca Maria Zhang, BScPhm, PharmD, PB 739 (416) x maria.zhang@camh.ca 5

6 10. Course Instructors and Contact Information: Jamie Kellar, BScHk, BScPhm, PharmD PB 701 (416) Maria Zhang, BScPhm, PharmD PB 739 (416) x maria.zhang@camh.ca 11. Required Resources/Textbooks/Readings: a) Pharmacotherapy: A Pathophysiologic Approach, 8 th edition, J DiPiro, RL Talbert, G Yee, G Matzke, B Wells, LM Posey (eds), McGraw Hill Medical, b) Assigned articles related to clinical discussions for critical appraisal. c) Other readings as assigned. 12. Recommended Resources/Textbooks/Readings: Primary literature and reviews, determined based on current literature related to each therapeutic topic. 6

7 13. Topic Outline/Schedule: Thursday Afternoons 1:00-3:00 pm PB B150 Week Date Topic Duration 1 January 7 Introductions/Course Overview/Expectations/Delivery.25 hrs S is for Stigma 1.75 hrs 2 January 14 Mental Health and the Law 3 January 21 Harm Reduction 4 January 28 Cannabis Recreational and Medical Use 5 February 4 6 February 11 7 February 25 Understanding and Assessing Movement related disorders and Tardive Dyskinesia in patients with Mental Health Disorders Part 1 Understanding and Assessing Movement related disorders and Tardive Dyskinesia in patients with Mental Health Disorders Part 2 IN CLASS ASSIGNMENT IS DURING THIS LECTURE Mental Health First Aid History and evolution of the DSM 1 hr 1 hr.75 hrs The role of non-drug measures in treating mental health and addiction disorders 1.25 hrs Psychotherapy (CBT, IPT, Mindfulness) Electroconvulsive Therapy (ECT) Repetitive Transcranial Magnetic Stimulation 8 March 3 Child and Adolescent Psychiatry: Attention Deficit Hyperactivity Disorder 1.5 hrs Eating Disorders 0.5 hrs 9 March 10 Recreational Drugs and Anabolic steroids 10 March 17 Opioids and Pain 11 March 24 Therapeutic applications of Psychedelics 12 March 31 Psychotropic drugs in pregnancy and lactation 13 April 7 Smoking Cessation Ready to prescribe? 7

8 14. Assessment Methodologies Used: Mental Health and Addiction Elective Course Outline Assignments: Movement Disorder Assessment Examinations: Midterm and Final (multiple choice / short answer questions) Learning Objectives Addressed Assessment 1: Relevant knowledge, skills, attitudes/values for topics in weeks 1-6 as per Topic Outline/Schedule above. Assessment 2: Skills used to identify and assess patients for movement related side effects Assessment 3: Relevant knowledge, skills, attitudes/values for topics in weeks 7-13 as per Topic Outline/Schedule above. Assessment Method Used Assessment 1: Midterm Test (multiple choice / short answer questions) Assessment 2: Assessment of Movement Related Disorders Using validated scale Assessment 3: Final Exam (multiple choice / short answer questions) When Administered Assessment 1: Midterm Test period Assessment 2: Week 6 Assessment 3: Final Examination period Percentage of Course Grade Assessment 1: 40% Assessment 2: 20% Assessment 3: 40% For Group Work (maximum 10% of course grade) indicate how marks within groups are allocated: Individualized or Same for all Group Members Assessment 1: Assessment 2 Assessment 3: Remediation Opportunities? Assessment 1: Students who do not achieve a passing grade are invited to review their test responses with a course coordinator. Assessment 2: Students who do not achieve a passing grade are invited to review their assignment with a course coordinator. Assessment 3: One or more sessions with course coordinator prior to the supplemental exam to enhance student understanding of course materials may be scheduled. Expectation for pass grades for all Pharmacy courses is 60%. 8

9 15. Policy and procedure regarding make-up assignments/examinations/laboratories: Mental Health and Addiction Elective Course Outline Missed Exam Students who miss an examination or a test and who have a valid petition filed with the Registrar s office will be eligible to complete a make-up examination or test. The format of this examination or test will be at the discretion of the course coordinator, and may include, for example, an oral examination. Missed Assignment Students who miss the in-class assignment and who have a valid petition filed with the Registrar s office will be eligible to complete a make-up assignment. 16. Policy and procedure regarding supplemental assignments/examinations: As outlined in the current Leslie Dan Faculty of Pharmacy Calendar. 9