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Transition of pharmacology from community to corrections 

Transition of pharmacology from community to corrections
Transition of pharmacology from community to corrections

Robert L. Trestman

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date: 11 December 2019

Psychopharmacology in general is a challenging field that includes much art as well as science. Clinicians usually depend upon self-report in making decisions regarding medication selection and dosing. When a patient becomes incarcerated, there are multiple potentially conflicting, or synergistic, situations. There are issues of different formularies, different environmental stressors, changed support groups, and practice patterns that all may contribute differentially to medication management decisions. Current community medications may have been determined while ongoing illicit drug use confounded the diagnostic picture. Collaboration between clinician and patient may have been poor, and subsequently treatment adherence may in turn have been marginal. Many similar issues apply when a patient transfers from a jail to a prison or from one prison to another. Preparation and review of transfer summary sheets and more detailed records are just as important in these situations and should be seen as the minimum standard in policy and in practice. Ideally, continuity of care, and any concerns about diagnosis or treatment are best shared through direct communication. A telephone exchange between treating psychiatrists is always better than simple written documentation. This chapter discusses both the issues and pragmatic management opportunities that can lead to improved patient care and enhanced functioning.

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