Ask the Expert: New Antipsychotic for Schizophrenia & More
Jeremy Mills, DNP, PMHNP-BC is a Clinical Assistant Professor and Coordinator of the Psychiatric Mental Health Nurse Practitioner Program at the University of Tennessee in Knoxville. He also works as a prescribing clinician in a community mental health outpatient center. This June, he joins the star-studded faculty presenting at the APNA 23rd Annual Clinical Psychopharmacology Institute to share new psychopharmacologic discoveries and apply them to clinical nursing practice.
APNA: You have taught psychopharmacology to master’s and doctoral students for many years and have published and presented on this topic, including at the APNA Annual Conference! What drew you to this area?
Mills: “As a PMHNP student, I always knew I really wanted to work in community mental health. I’ve now worked in it for over 12 years. Much of my interest in community mental health was fueled by a desire to work with individuals who have schizophrenia spectrum disorders. Additionally, I’ve taught psychopharmacology at the University of Tennessee since 2014, and you certainly can’t teach it to students if you don’t have an interest in it!”
APNA: There’s a lot to consider when caring for individuals with schizophrenia spectrum disorders. What are some key points you’ll explore at the APNA Clinical Psychopharmacology Institute?
Mills: “I’ll talk a lot about the new antipsychotic xanomeline-trospium (brand name Cobenfy), as it’s the first antipsychotic in long time with a novel mechanism of action. Its cholinergic — that is, involving acetylcholine — mechanism of action shows us that not only are new medications still possible, but depending on how things shake out in the next few years, they might even become a very important part of the prescriber’s toolkit. I’ll also discuss the tried-and-true medications we’ve known and used for decades, because many of the most common psychiatric medications have lots of anticholinergic side effects. Many clinicians and prescribers don’t realize just how many anticholinergic side effects are possible — there’s an incredible array, really — or just how much they can reduce our patients’ quality of life.”
“Many clinicians and prescribers don’t realize just how many anticholinergic side effects are possible — there’s an incredible array, really — or just how much they can reduce our patients’ quality of life.”
APNA: Both new and advanced prescribers are looking for practical ways to improve quality of life for those with this mental health disorder. What will especially interest nurses at different stages of the professional journey?
Mills: “I think there’s lots about acetylcholine that will be interesting to both newcomers and seasoned prescribers. New prescribers might have been taught in school that schizophrenia was all about dopamine — and new information shows that acetylcholine might have a role to play. Advanced prescribers might be interested in the theoretical combination of cholinergic antipsychotics and dopaminergic antipsychotics that could result in improved symptom relief, though that is still something that remains unsolved (I’ll talk about some clinical trials booting up to examine this combo). And I think both newer and advanced prescribers will be able to improve their detection of iatrogenic anticholinergic complications, avoid layering on anticholinergic burden unnecessarily, and really help many patients improve their cognitive abilities and overall health after being freed from oppressive anticholinergic side effects.”
Register now for the APNA 23rd Annual Clinical Psychopharmacology Institute and explore advances and new psychopharmacologic discoveries in clinical psychopharmacology – and earn up to 22 pharmacology contact hours.
Published January 2025
