CEimpact Podcast

Updates in Antipsychotic Medications

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Stay up-to-date on the latest advancements in antipsychotic medications and how they’re shaping the management of mental health conditions. This episode highlights new formulations, expanded indications, and emerging treatment trends that every pharmacist should know. Don’t miss the chance to enhance your expertise and improve patient care!

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
Katelynn Mayberry, PharmD
Clinical Assistant Professor of Pharmacy Practice
Mercer University College of Pharmacy

REFERENCE
The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. https://psychiatryonline.org/doi/10.1176/appi.ajp.2020.177901

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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Recall recent advancements in antipsychotic medications, including new formulations and expanded therapeutic indications.
2. Identify key considerations for pharmacists in optimizing the use of updated antipsychotic treatments to improve patient outcomes.

0.05 CEU/0.5 Hr
UAN: 0107-0000-25-031-H01-P
Initial release date: 2/17/2025
Expiration date: 2/17/2026
Additional CPE details can be found here.

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Speaker 1:

Hey, CE Impact subscribers, welcome to the Game Changers Clinical Conversations podcast. I'm your host, Josh Kinsey, and as always, I'm excited about our conversation today. The field of antipsychotic medications is evolving rapidly, offering new options that could transform the way we manage mental health conditions. In today's episode, we'll explore the latest advancements, including innovative formulations and expanded uses, and discuss how pharmacists can play a pivotal role in optimizing these treatments for better patient outcomes. It is so great to have my friend, Caitlin Mayberry with us today as our guest expert. Caitlin and I go back gosh, going on 10 years now, probably right.

Speaker 2:

Almost 2016.

Speaker 1:

Yeah, so almost 10 years. So Caitlin and I were on faculty together back several years ago before I transitioned to this role with CE Impact. So, yeah, just super great to have you with us, caitlin, I'm so glad that you took time out of your busy schedule.

Speaker 2:

Yes, thanks for having me, and always good to see you.

Speaker 1:

Likewise Well for those of us for those are learners on the call who haven't known you for this long give us a little bit of background about yourself, tell us about your practice site and maybe why you're passionate about today's topic.

Speaker 2:

Sure. So, as Josh said, I'm Caitlin Mayberry. I am a faculty at Mercer College of Pharmacy. My practice site is a state-funded psychiatric hospital, which we can talk about some of those challenges of being a state-funded institution a little later. So as far as, like my patient cohorts, I tend to see a lot of treatment resistant, refractory, mainly psychotic disorders, bipolar disorders, some depression, substance use disorders.

Speaker 2:

So, a lot of the psychiatric complications. Let's see what else. Passionate about mental health, I've always kind of had a draw to that patient population and decided to pursue a psychiatric residency. So that was my training before coming to my current position. And yeah, Charmaine, what was the other question? Was that it?

Speaker 1:

I think that was it. You did it All right. That was great. I had the pleasure of shadowing Caitlin one time at her site, at her practice site, when we were on faculty together and it's just, it's a fascinating space and just the things that she did and how she did it and interact with her patients, it was just. It was really really interesting and great.

Speaker 2:

So I remember, I think you emailed me or someone told me that you were asking like, what do I wear, like what's appropriate to wear? I know you always see on.

Speaker 1:

You know, like, make sure you don't do this, and I was like, can I wear a tie, or is that, you know, not allowed, or whatever. So, yeah, those are, those are the things that I was worried about that day was my tire, but we're very casual. Our goal is to just kind of blend in, not stand out Exactly, not stand out as the practitioner Tell the students to not wear their flashy stuff, mainly because you don't want to draw attention.

Speaker 2:

But again, like I said, our patient population, a lot of them, don't have really anything to their name, so who are we to come in, kind of showing off?

Speaker 1:

all of our. Yeah, I know I got all my jewelry on today.

Speaker 2:

I probably don't wear that at the hospital.

Speaker 1:

Yeah, no, that's a great point yeah.

Speaker 2:

Very good.

Speaker 1:

Yep, Exactly, Exactly. Well again, thank you so much for taking time out of your busy schedule and for joining us today. So we're going to dig right into our topic of novel antipsychotic medications and advancements in this field. So I always like to set the stage for our learners. I always like to make sure that we're all on the same page and we know what we're talking about. So can we just have a little historical context from you on managing mental health conditions, kind of the progression of antipsychotic meds, how they've come over the years? We know that there have been some rough patches with those, especially many years ago. There weren't very many options and it wasn't a very well-studied field. So just kind of give us a little bit of historical context and background to kind of set the stage.

Speaker 2:

Sure, and if I get too long-winded, please interrupt me.

Speaker 1:

I'm kind of unnerved about it.

Speaker 2:

So the general accepted hypothesis of the pathophys of psychosis, what causes the elements of psychosis, so like hallucinations, delusions and that disorganized thinking like your thoughts are just disorganized really comes from too much dopamine activity in the mesolimbic section of your brain, so like in the VTA. So what we think is too much dopamine hyperactivity, so why not block that activity? So ultimately, what's really happening is we need to figure out how to slow down the release of dopamine from the presynaptic. But all of our drugs just sit on the receptors and block the receptors postsynaptically. So really generalizing them all. If we could lump them all into one big class, all antipsychotics block dopamine at the D2 receptor postsynaptically, and so in theory that should help with the symptoms of hallucinations and delusions. We call those positive symptoms, but, as we hopefully remember way back when in pharmacology is you have to do some significant blockade, otherwise you're going to have that upregulation of release to try to account for that.

Speaker 2:

So you have to have about 60% to 80% occupancy on the D2 receptor. So that's how you can get it to work as an antipsychotic. However, we know that not all dopaminergic tracts are the same and there's all these different dopamine areas in our brain that also affect other physical symptoms in our body. So why that's important is when we get to the side effects. So if something antagonizes or blocks, I say block. It's easier. If it blocks D2, and it blocks D2 really well, it'll probably help with psychotic symptoms, but it's also going to have some nasty side effects because it'll block D2 everywhere, not just in the mesolimbic. But so far that has been the general accepted hypothesis of how psychosis is happening and how the drugs work.

Speaker 1:

They're going to work, okay.

Speaker 2:

So you had your first generations and that's all they did. They were D2 blockers. Then the second generations came along, also blocked D2. And then they also antagonized 5-HT2A, so a serotonin receptor, and what that does. Just real short and sweet. We can go way in detail, but it kind of gives some dopamine back to those other areas of the brain that need it.

Speaker 2:

So in theory it should help with some of those cognitive deficits that you see with psychosis as well. Then we have kind of the argument of maybe possible third generations, where we get some partial agonism and in theory there you're just trying to tailor it more. I like to think like in baseball you try to find the sweet spot in a bat to hit a home run. Partial agonism kind of helps you tailor and find that sweet spot of D2 blockade.

Speaker 1:

Got it.

Speaker 2:

So that's kind of what we had up until 2024. So now we have a new drug that's in a completely different class that we'll talk about later, but that's kind of where we've been, yeah, um and yeah, and when talking about side effects, just to kind of summarize, is blocking dopamine and all those other areas. If we block dopamine in the nigrostriatal, what happens is we get uncontrolled movement. That's really the pathophys of Parkinson's disease.

Speaker 1:

I was just going to say that sounds like you just described Parkinson's.

Speaker 2:

Yeah, exactly so it'll. We call it pseudo Parkinson's, but it looks like Parkinson's disease. It's just drug induced because we're not getting enough dopamine activity in that area of the brain. And then the other kind of main dopamine type side effect is too much prolactin release, and so hyperprolactinemia has some really uncomfortable, possibly maybe embarrassing, side effects that patients may not be forthcoming. And telling you about things that affect fertility, sexual dysfunction, a big one that you'll see there's always a commercial on like daytime TV about it but it's gynecomastia, so enlargement of breasts, or even development of enlarged breast tissue in males, so things that patients may not be that forthcoming and telling you about that could be really concerning that we have to be the professional and be forthcoming to say hopefully you can tell us and we can give you relief.

Speaker 2:

You don't have to suffer in silence.

Speaker 1:

Right and, and you know, to also say, be on the lookout for these certain things, and this is a potential side effect. So, yeah, that's great. That was a fantastic historical context, caitlin, thank you, and also a lesson in pharmacology which I haven't had in a very long time. So thanks for that. That was great, very good. So let's talk a little bit about some of the recent advancements in the different formulations. So I'll date myself and tell you that the last thing I remember was the long acting versions that came out about a decade or so ago, probably a little bit more than that now, but any other expanded formulations or anything new in that space that you can tell us about.

Speaker 2:

Yes, so originally we had two kind of first generations that came out first with long acting that ranged about every two to four weeks and they were intramuscular.

Speaker 2:

Since then we've had advancements in IM long acting injections that have lasted a significantly longer period of time. On average a lot of them have about a four-week injection and then, if you do well, you can step up to an eight-week injection, maybe a three-month injection, and the longest IM that we have is every six months. So we have found ways to have it stay longer in your body and have a steady release of the drug level, and so those would be for your really high functioning individuals that show that they're showing up regularly for their appointments, getting their injections, having a high quality of life. Why not reward them with only having to get four or maybe two shots a year? So that's kind of the main trajectory that I've seen is just improving on the IM long actings. But then they've started to explore other, different routes. Another big one that has just come out in the past less than five years has been the long acting subcutaneous in the long-acting subcutaneous.

Speaker 2:

Now that could be beneficial for individuals that may have had unfortunately, maybe some like possible traumatic experiences with long-acting injectables A lot of them.

Speaker 2:

the longer you want to give it, sometimes that increases just the sheer volume. So an injection that you give every three months will probably have a lot more volume in the syringe than one every one month. So when you start increasing the volume you need a larger muscle to absorb it. So the smaller ones can be deltoid in your arm but unfortunately those larger ones will probably be gluteal. And someone who may have had some unfortunate experiences with long actings or just based on their upbringing, their struggle with mental health, maybe they've had some traumatic experiences of assault from other things.

Speaker 2:

So those gluteal injections could pose a challenge. So, now these subcutaneous, the needle and the gauge are both so significantly smaller and it's a much smaller volume that they may not even feel it, so that could be a huge advantage there. So we have a subcutaneous every month and then we have one that's every two months. So they've already improved on the sub-Q ones as well.

Speaker 1:

Yeah, that's great. That's great. Any other new formulations that are out there, anything that has been studied or that you know to be on the horizon, or anything.

Speaker 2:

As far as long acting, there is a long acting patch as well, but that could pose challenges based on you need them to be highly motivated because they could also just remove the patch if they don't have what we say like insight. Do they have the right awareness into their illness and know that the treatment is helping them? If they have poor insight, which is common with mental illness, I'm not fully understanding why they need medication or treatment. Then they could just remove the long acting patch. So that could be a challenge.

Speaker 1:

That could definitely be a challenge. Yeah, I could see where that would be a problem.

Speaker 2:

Yeah, so most of them are sub-Q or IM, because that way you can at least guarantee that there was the delivery. So it will be in their system for that period of time, normally about at least a month.

Speaker 1:

Got it. Okay, that's great. Those are great outlines of all the different formulations, thanks. Let's talk about, obviously, our listeners or pharmacists. So what's our role in this? Why is this important for pharmacists to understand these advancements obviously beyond the fact that we're probably going to potentially see them come across our practice site, you know in some form but what's our role in addressing the patient needs and the treatment options?

Speaker 2:

Yeah, I think the pharmacist's role is kind of twofold. I think first, as far as the drug information expert, our role can be providing the education and counseling points on side effects, administration of the drug itself. So if we're thinking more like oral medications, some do better on empty stomachs, some do better with food because it helps with absorption, some do better on empty stomachs.

Speaker 2:

Some do better with food because it helps with absorption. So providing that education, education on side effects. So again we talked about how there are some that might be a little bit more sensitive, that patients may not be immediately forthcoming about, so making sure we let them know and keep them aware of what to monitor, for are definitely some areas where the pharmacist could serve as a role to patient care.

Speaker 2:

As far as being a member of a treatment team, I think we can also be a liaison of knowing, then being abreast on all the new, different formulations, to be able to provide options to a prescriber that may not know of the new formulations that could help a certain patient.

Speaker 1:

Yeah, I mean after all we're the medication experts, so we should be the one to know of the new formulations that could help a certain patient. Yeah, I mean, after all, we're the medication experts, so we should be the one to know of what's out there and what's available. And if this is not working, here's another option. So yeah, Exactly.

Speaker 1:

Yep, okay, that's great. So I want to roll into talking about some of the opportunities and challenges that are posed with these advancementsments, with these new medications, new profiles of side effects and so forth. So let's you just kind of perfectly segwayed into that with talking about how one of the ways that pharmacists can really be involved is bridging the gap in education for both patients and healthcare teams. So what are some of the other opportunities, I guess, or positives, that are coming out of these new formulations or these new advancements in the meds? What are some of the things that you're like? These are great because they do A, b and C or whatever.

Speaker 2:

Yeah, yeah, I think. As far as the new formulations, like long-acting formulations, I think the biggest positive is it can help prolong stability because you are getting a steady release of your medication for an extended period of time. So for four weeks your drug levels are going to stay the same, versus when you eat pills. There's peaks and troughs, right, it'll start to go down. By the time you're ready to eat your next pill peaks and troughs right.

Speaker 2:

Like it'll start to go down by the time you're ready to eat your next pill. So I think that this could really help prevent relapse, prevent readmissions to hospitals. So I think, as pharmacists, we could help. If we could help bridge the gap and get individuals comfortable, maybe address some of their fears of these injections, that we could help get more people enrolled in these programs and could help prevent readmissions to hospitals. I think that's the big one.

Speaker 1:

Yeah, which overall, you know, affects healthcare costs in general and the burden of that on the economy and so forth. So, yeah, lots of downplay actions that occur from that. So that makes perfect sense. And obviously, you know, adherence in general is a positive and I would imagine you know you get even bigger peaks and drops if the patient forgets to take their medicine a couple of days a week. But, as you said, with this you have that steady state release for, you know, two weeks, four weeks, 12 weeks, whatever it is. So I would imagine adherence rates are obviously much better.

Speaker 1:

But there are still some challenges in that. We can talk about that in a minute too. Having more treatment options allows for us to hit a lot of different groups of people. So maybe how, as you mentioned which I found fascinating, the fact I would have never even thought about how some individuals might have had an experience in the past where it would scarred them from getting a gluteal injection. Is there anything else in that realm where these novel formulations have allowed us to kind of expand care to different groups of patients that maybe didn't want to receive it before?

Speaker 2:

Yeah, I think that's one area of depending on where they come from and their history and kind of their whole outlook on life. That could cause some stress as far as like gluteal injections.

Speaker 1:

Sure.

Speaker 2:

Some other things to think about. Obviously is sometimes individuals, depending on how long they've been struggling with this illness and the stress that's had on their psychosocial limitations is cost and access. So we may put them on a pill, but if they can't get a ride to the pharmacy every single month to get it filled, something that's longer acting that could be every three months could be beneficial to those individuals. That way they just get their injection when they go to their appointment instead of having to try to get to the pharmacy every time.

Speaker 1:

So that could be In between appointments, yeah.

Speaker 2:

So that could be beneficial. One other area that I was thinking about is there is a new antipsychotic that just got approved, at the very end of 2024. It is oral only but because it has a completely different mechanism of action, it doesn't have those side effects that we were talking about, those movement side effects, those prolactin side effects, side effects, those prolactin side effects. So in theory, what they're trying to push is, even though it's an oral medication, only because it doesn't have that side effect profile, they're hoping it's going to increase adherence because, they're not having to deal with the side effect part of it on top of it.

Speaker 2:

It's pretty generally well tolerated. So that could be exciting if the clinical trials obviously show it's effective. But it'll be interesting to see as the prescribing increases to see if it really does change. Does it affect adherence and does it change what we know about antipsychotics? Maybe we need to go away from the D2 blockade and focus more on this cholinergic kind of activity as well.

Speaker 1:

Interesting, so it's a whole different a whole different yeah, wow, okay Interesting.

Speaker 2:

Yeah.

Speaker 1:

Okay, so some of the challenges and you kind of set this up as well. Obviously, access cost insurance coverage, like I imagine, you don't see a ton of that because it's a state funded facility. Obviously, cost is still an issue, but just in general, like these things aren't cheap, right, like these long acting injectables, yeah.

Speaker 2:

No. So what inpatient hospitals have? I can at least talk on that first and then expand a little bit with my limited knowledge for community but, all of the long acting injectables that are second generation, on names that you've probably heard.

Speaker 2:

They have patient assistance programs for the community, but what they do is they have contracts with hospitals to where we can get inpatient. Hospitals can get an allotment for free and the goal is that's supposed to be their discharge regimen and it's supposed to help bridge the gap, to give them time to set up the outpatient services and so like.

Speaker 2:

One thing we try to do is we try to fill out all that paperwork for the patient assistance program while they're still under our care and then we give them their injection at discharge, which means they should have, in theory, four weeks of steady drug release and hopefully by then the patient assistance program will kick in and they'll have their outpatient appointment. So it's all trying to bridge the gap. So all the long actings are doing, I think, a great job of trying to establish some sort of bridge program to help get it onboarded inpatient and then outpatient.

Speaker 2:

I do know that the long actings and that new antipsychotic that I was talking about. They have patient assistant programs so if you don't have insurance or if you have Medicare, you can get it at a reduced copay cost.

Speaker 1:

Yeah, okay, that makes sense and that you know. I think that's super helpful for our listeners because obviously, the majority of them probably fall into one of those categories, whether it be inpatient or community practice, and so it sounds like there's a clear role for our pharmacy teams in both settings either to make sure that the paperwork gets done and that they understand that that needs to happen in order to bridge that gap and to be set up for success with the patient assistance program, or it's to make sure that the patient assistance program comes to fruition and actually works for the filling. So those are great take-homes for our listeners because, again, the majority of our listeners are going to fall into one of those categories. So that's a place where you can make a difference as a pharmacist and making sure that the access is there, because with those long-acting injectables, while there are still negative side effects, we do see better adherence and we do see better outcomes in general, just because we know that the patients are getting their medication.

Speaker 2:

So yeah, I will add a caveat. I was just going to say I think there's a challenge here in a sense that they may not show up for appointments, right? Yes, I was going to say so my, my mentor, dr Marshall. He just retired, but he always told us, you know, long acting does not guarantee adherence. All it guarantees is delivery. So that's what we were trying to say is it can help with adherence.

Speaker 2:

All it guarantees is delivery so that's what we were trying to say is it can help with adherence. It can help with relapse prevention, because we can guarantee, at least for those four weeks you have drug in your system, but you still have to be adherent with coming to your appointments. So, again, trying to be as a pharmacist that's our role is to try to educate them about the reason why you're feeling better or the reason why you're doing well. Sometimes they buy into this argument of I'm doing well, so let me try getting off of it for a while, instead, saying the reason why you're doing well is because you're stable and this medication is getting you to your goals that you're wanting to achieve.

Speaker 2:

So, we could be that. You know there's a pharmacist on every corner and this medication is getting you to your goals that you're wanting to achieve.

Speaker 1:

So we could be that you know there's a pharmacist on every corner.

Speaker 2:

We could be that accessible advocate to educate them that, because you're doing well, that should encourage you to come back.

Speaker 1:

Yep, exactly. Yeah, that's great, great point. Thanks for bringing that up. The other thing I want to talk about in the challenges category is are there any well, and potentially, is there anything that we need to think about? Oftentimes, patients with mental health disorders have other comorbidities. Are there things that we have to think about with these meds? Do they interact with things? Do they interact with food? You know, like what? What other considerations do we need to have, as as the pharmacy teams, to try to help out, you know, to make sure that, um, they're on the right medication and the right dose, and all that kind of stuff yeah, um, not to make things even worse, not only do we have to worry about patients with comorbidities, these can cause some comorbidities.

Speaker 1:

That's exactly right, yep.

Speaker 2:

A major complication of our antipsychotics is what we call metabolic syndrome. So it'd be very easy that we're not only managing their mental health, but we also might be needing to do some point of care, might need to see what their blood sugars are doing, see if they have a recent lipid panel. We could be managing things like diabetes, dyslipidemia, hypertension, on top of the mental health challenges.

Speaker 2:

So, all of those medications are at play. It's very common to see someone antipsychotic and like metformin. So making sure all those clinical applications that we've been doing for managing all those disease states which a lot of communities are very well versed in, because a lot of individuals struggle with those metabolic issues that also has to be into play. As far as major drug interactions, almost all of them except for one is metabolized by cytochrome P450 enzymes. So just making sure you have a up-to-date drug information database with all of your pharmacy softwares to be looking for any of those major drug interactions?

Speaker 1:

Sure, especially when new things are added, like an antibiotic or anything specific that might be coming on, just as an interim period making sure that it matches up with the long-term effects of that drug.

Speaker 2:

Yeah, and then being careful of pop-up fatigue. But one thing that will always pop up, because it's a class effect, is prolonging the QTC interval. So risk of arrhythmias. So they will always pop up and sometimes as pharmacists, we're quick to try to just breeze through them.

Speaker 2:

And normally a single agent, we're not worried. But it's if they have underlying heart issues or, like you were saying, it's that compounding effect of they're on a maintenance med but now they have an infection and now they have an antifungal that inhibits that metabolism. Right, it's when we start adding on and compounding things. So just be aware and don't just be quick to breeze through those pop-ups that come up.

Speaker 1:

Yeah, definitely Don't just bypass. Take a minute to understand exactly what it is that it's telling you and see if it's really an issue for that patient. So yeah, this is all so good, so so good, thank you. So just as kind of a summary, one of the things, well before we get into the full summary. But one of the things that we did talk about is our role as pharmacists, and so, just briefly, I wanted to touch on the fact that there are opportunities for some pharmacies to implement a service that administers long-acting injectables. So, if you can just briefly talk to that, I know that we have advanced training in our catalog for this topic and you were a part of that. So, thank you, but is there anything you can just kind of speak to to that, so that it might just kind of whet the appetite of our listeners to dig around in that more?

Speaker 2:

Sure Very broadly. My big take-home message is it varies state to state.

Speaker 2:

So, please check with your local board of pharmacy, make sure you're going with their protocols. But generally speaking, a majority of states do allow pharmacists to administer intramuscular injections. We've seen this with our huge expansion of immunization services. Now, that being said, these long actings not only can be in deltoid, but they could be in gluteal. So it could require more advanced trainings, a different, more private counseling area than just where you give your flu shots Definitely have to have a witness, so all of those kind of. So there's a lot of opportunity ever since we started doing immunizations that you could easily see how this could expand, but it might require a little bit more additional training. And then, as far as money, as far as reimbursements, and things.

Speaker 2:

Again that will vary state to state. The biggest hiccup I think will be the administration kind of reimbursement. I think you will be able to get reimbursement for the medication itself. But again, that's where it's going to really depend on state to state and especially how their Medicaid is expanded or not Exactly.

Speaker 1:

Well, and just in general, if you're credentialed for reimbursement of some ways or if you know. So what I'm hearing is, again, it varies state by state. But also you know, you need to be sure that you're doing your due diligence to understand the nuances in your state and then making sure you have protocols, policy and procedures, that everything is up to date to protect you legally as well. So that's important and it could expand to monitoring.

Speaker 2:

We know we talked about no-shows, follow-ups, adherence and then if there's metabolic issues. Now we can monitor even more things, so it really could open the door that pharmacy services could do so much for the community and really that bridge to really helping, because this disease state does have a high rate of relapse and readmissions and can we eventually kind of break that cycle and help people achieve stability and a higher quality of life.

Speaker 1:

Yeah, yeah. And like you said you know, you touched on it Not only if their quality of life is improved, but in general, the community is improved, typically in this area of practice. So yeah, that's great.

Speaker 2:

These individuals deserve care. And so, if we can, get them stable, it'll just benefit everybody.

Speaker 1:

Everyone. That's exactly right. Well, like I always like to do with our experts, caitlin, before I let you go, is summarizing up today and sharing with our learners the game changer. So our podcast is the game changers podcast. So, if you can just tell us what's the game changer here, why was it important that they listened all the way to the end to this, to this episode, and you know what, what. What's the take home for today, this episode, and what's the take home for today?

Speaker 2:

Oh, me, okay. So the game changers, I think, for us as pharmacists is we can be the drug information expert and can be the educator to our community providers to help these individuals. Being up to date on all of these new formulations, long acting that can promote stability, I think, is really going to be revolutionary for patient care being able to be the accessible person to educate them. The other kind of big game changer is this could open the door to the opportunity that, not only as an inpatient but maybe even as a community pharmacist, you could even further be the liaison to patient care, from that transition from the inpatient to the community that can ultimately benefit your whole circle around you.

Speaker 1:

Yeah, and the whole community and and your practice, your practice side. So, yeah, that's great. Well, that's all we have time for this week. We've met our limit for today. It always goes by so fast, I know right, caitlin, thank you. So time for this week. We've met our limit for today. It always goes by so fast, I know right, caitlin. Thank you so much for joining me. I really appreciate it. It's so great to see you and I just really am grateful for our friendship and for the ability to just hit you up and be like hey, you're the antipsychotic expert I need you, so thank, you so much for spending your day with me.

Speaker 2:

So good to see you and I love seeing all your pictures of your puppies. So it's always good to make sure you're doing well, and it looks like they're doing well, too.

Speaker 1:

Yes, likewise, thank you. Well, if you're a CE plan subscriber, be sure to claim your CE credit for this episode of Game Changers by logging in at ceinfectcom. And, as always, have a great week and keep learning. I can't wait to dig into another game-changing topic with you all again next week.