Evidence-Based Reviews

A shot in the arm: Boost your knowledge about immunizations for psychiatric patients

Current Psychiatry. 2017 August;16(8):18-20,22-24,29-30,32

Use the mnemonic ARM SHOT as a foundation to counsel your patients on their vaccination needs

References

1. Newcomer JW, Hennekens CH. Severe mental illness and risk of cardiovascular disease. JAMA. 2007;298(15):1794-1796.
2. Raj YP, Lloyd L. Adult immunizations. In: McCarron RM, Xiong GL, Keenan GR, et al, eds. Preventive medical care in psychiatry. Arlington, VA: American Psychiatric Publishing. 2015;215-227.
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4. Kroger AT, Atkinson WL, Marcues EK, et al; Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations on the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2006;55(RR-15):1-48.
5. Centers for Disease Control and Prevention. Recommended Adult Immunization by Vaccine and Age Group. http://www.cdc.gov/vaccines/schedules/hcp/adult.html. Updated February 27, 2017. Accessed February 1, 2017.
6. National Center for Immunization and Respiratory Diseases. General recommendations on immunization—recommendations on the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60(2):1-64.
7. Centers for Disease Control and Prevention. ACIP votes down use of LAIV for 2016-2017 flu season. https://www.cdc.gov/media/releases/2016/s0622-laiv-flu.html. Updated June 22, 2016. Accessed February 1, 2017.
8. Hales CM, Harpaz, R, Ortega-Sanchez I, et al; Centers for Disease Control and Prevention. Update on recommendations for use of herpes zoster vaccine. MMWR Morb Mortal Wkly Rep. 2014;63(33):729-731.
9. Petrosky E, Bocchini Jr JA, Hariri S, et al; Centers for Disease Control and Prevention (CDC). Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccine recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep. 2015;64(11)300-304.
10. Iversen OE, Miranda MJ, Ulied A, et al. Immunogenicity of the 9-valent HPV vaccine using 2-dose regimens in girls and boys vs a 3-dose regimen in women. JAMA. 2016;316(22):2411-2421.
11. Zipprich J, Winter K, Hacker J, et al; Centers for Disease Control and Prevention (CDC). Measles outbreak—California, December 2014-February 2015. MMWR Morb Mortal Wkly Rep. 2015;64(6):153-154.
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Patients with chronic, severe mental illness live much shorter lives than the general population. The 25-year loss in life expectancy for people with chronic mental illness has been attributed to higher rates of cardiovascular disease driven by increased smoking, obesity, poverty, and poor nutrition.¹ These individuals also face the added burden of struggling with a psychiatric condition that often interferes with their ability to make optimal preventative health decisions, including staying up to date on vaccinations.²A recent review from Toronto, Canada, found that the influenza vaccination rates among homeless adults with mental illness—a population at high risk of respiratory illness—was only 6.7% compared with 31.1% for the general population of Ontario.³

Mental health professionals may serve as the only contacts to offer medical care to this vulnerable population, leading some psychiatric leaders to advocate that psychiatrists be considered primary care providers within accountable care organizations. Because most vaccines are easily available, mental health professionals should know about key immunizations to guide their patients accordingly.

In the United States, approximately 45,000 adults die annually from vaccine-preventable diseases, the majority from influenza.⁴ When combined with the most recent Adult Immunization Schedule and general recommendations adapted from the CDC,^5,6 the mnemonic ARM SHOT allows for a quick assessment of risk factors to guide administration and education about most vaccinations (Table 1). ARM SHOT involves assessing the following components of an individual’s health status and living arrangements to determine one’s risk of contracting communicable diseases:

Age
Risk of exposure
Medical conditions (comorbidities)
Substance use history
HIV status or other immunocompromised states
Occupancy, or living arrangements
Tobacco use.

We recommend keeping a copy of the Adult Immunization Schedule (age ≥19) and/or the immunization schedule for children and adolescents (age ≤18) close for quick reference. Here, we provide a case and then explore how each component of the ARM SHOT mnemonic applies in decision-making.

A shot in the arm: Boost your knowledge about immunizations for psychiatric patients

References

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