Current through Reg. 49, No. 38; September 20, 2024
Special populations will be managed according to accepted
guidelines as appropriate to their special needs.
(1) Patients with dyskinesias, including
tardive dyskinesia.
(A) A diagnosis of a
dyskinesia will be verified by a psychiatrist or neurologist and documented in
the patient record along with suspected or known duration and
severity.
(B) The patient and, as
appropriate, family and LAR will receive relevant education about the diagnosis
and its implications for psychoactive medication use.
(C) Risks and benefits of continued
psychoactive medication use will be assessed and communicated to the patient
and, as appropriate, family or LAR. If continued use is recommended, a new
consent for medication will be obtained.
(D) If continued use of psychoactive
medication is contemplated, then the prescribing professional, if not a
psychiatrist or neurologist, must obtain and document consultation from a
psychiatrist or neurologist.
(2) Children.
(A) Except in an emergency, if the
prescribing professional is not a child psychiatrist, then prescribing
psychoactive medication which falls outside accepted guidelines requires
consultation from a child psychiatrist in addition to any other
requirements.
(B) If the
prescribing professional is a child psychiatrist, then use of polypharmacy is
governed as indicated in §
415.7 of
this title (relating to Prescribing Parameters).
(3) Patients with mental retardation.
(A) A specific psychiatric diagnosis will be
made in accordance with the DSM prior to initiating psychoactive medication. If
it is not possible to make a specific diagnosis in accordance with the DSM,
clinical justification for initiating psychoactive medication will be
documented.
(B) Except in an
emergency or acute psychiatric hospitalization, psychoactive medications are
prescribed only after behavioral and clinical baselines have been
established.
(C) Specific target
behaviors or clinical signs and quality of life outcomes must be objectively
defined, quantified, and tracked using recognized empirical measurement methods
appropriate to the service setting in order to monitor psychoactive medication
efficacy.
(4) Patients
with substance use disorders.
(A) Service
settings will assess the occurrence of co-occurring psychiatric and substance
use disorders during evaluations for medication, initiation of medication, and
medication monitoring, and will have policies and procedures which address the
assessment.
(B) Provision of
medication services to this population will be in accordance with accepted
guidelines for patients with these comorbid conditions and will be in
collaboration and coordination with other treatments that the patient may be
receiving for substance use.
(5) Pregnant or nursing patients.
(A) Informed consent for use of psychoactive
medication in this population must specifically document that the risk and
benefits of that use on the fetus or infant have been discussed with the
patient and, as appropriate, LAR and family.
(B) Prior to prescribing psychoactive
medication, the prescribing professional will seek to collaborate with the
physician or clinic providing prenatal, postnatal, or pediatric care to include
providing, with consent, appropriate documentation of diagnoses and plan of
care to that service provider.
(6) Geriatric patients. Service settings will
have policies and procedures for prescribing psychoactive medication which are
responsive to the special needs of geriatric patients..
(7) Other special populations. Prescribing
professionals will be aware that other populations exist that may have
particular clinical or special risk factors associated with their treatment
with psychoactive medications. Consultation with an appropriate specialist or
expert will be considered when treating these populations.
