SECTION 415.11. Special Populations

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.

Source Note: The provisions of this §415.11 adopted to be effective August 31, 2004, 29 TexReg 8325