stimulants and benzos together :P

[supertrooper85]

i would like to know what is the rationale behind prescribing methylphenidate as well as TID prn benzodiazepine in a patient aged more than 60 yrs?

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[wolfvgang22]

I've seen some veteran's with TBI and PTSD on such regimens. Not really the best thing, IMHO.

 

[doctorpilgrim]

Just saw a patient on consult ritalin , diazepam, oxycodone and tramadol , who is using double the diazepam and taking one extra ritalin along with marijuana with dysphoria, restlessness who is seeing mice infestation in the house.

 

[heyjack70]

Narcolepsy and intractable idiopathic catatonia might justify that regimen. Also if the patient is a drug addict. I've had patient's who claim to have ADHD so bad they are "anxious about not concentrating" and "need" the stimulant to treat their ADHD induced anxiety, but also the benzo because they have PTSD or some other nonsense that doesn't get better with SSRIs. Nope, SSRIs just "make me want to attack people," in fact "aside from Valium, the only thing that's ever worked for my anxiety are 4mg Dilaudids." In essence it seems many people are just getting the dopamine rush from the habit forming meds and this temporarily provides relief and their doc is functioning as a drug dealer, but getting paid far less.

 

[supertrooper85]

its frustrating when one inherits such cases in clinic.

 

[heyjack70]

its frustrating when one inherits such cases in clinic.

Start a therapeutic benzo taper, and offer to go really slow, and they may just discover they need a smarter doctor.

 

[Doctor Bagel]

duh, you need both uppers and downers.

On a serious note, yes, it sucks to inherit cases like this. Big things -- you don't have to continue any treatment that you don't believe it (or more importantly think is harmful). However, whatever you do, like heyjack is saying, go slowly.

 

[OldPsychDoc]

Misinterpreting euphoria as euthymia.

 

[MacDonaldTriad]

Addiction is a very difficult problem, but the demand is so high you can make a living with the finesse of a sledge hammer:


“Your doctor referred you to me and is no longer seeing you because your addictive polypharmacy combination is out of control and he/she is uncomfortable continuing it. I have experience helping people climb out of this kind of hole if that is your goal. You will not be completely comfortable during this process, but it is the way out of your dilemma if that is what you wish. If it isn’t, there is a sea of expert “psychopharmacologists” who will take your money and continue this as you wish. The door is over there. When you change your mind, you have my number. Next!”

 

[smalltownpsych]

Just saw a patient on consult ritalin , diazepam, oxycodone and tramadol , who is using double the diazepam and taking one extra ritalin along with marijuana with dysphoria, restlessness who is seeing mice infestation in the house.

Either the mice are real because he is too twacked out to keep his house clean or he should lay off the meth pipe for awhile. You could always do what I have seen some providers do: diagnose it as schizoaffective and add in quetiapine. I have heard on the street that it really helps take the edge off the harsh comedown from methamphetamine and if you can fight off the sleep then the high is pretty decent, too.
https://drugs-forum.com/forum/showthread.php?t=2378

 

[Shikima]

i would like to know what is the rationale behind prescribing methylphenidate as well as TID prn benzodiazepine in a patient aged more than 60 yrs?

I've asked myself this question many times.

Oh the agony and insomnia that persists! Is it wrong to say I need a beer?

 

[supertrooper85]

thank you all for ur inputs, i guess i will be fired soon ....

 

[whopper]

Its the dice rolling prescribing algortihm based on the Dungeons and Dragons 20 sided die..

Roll to determine # of starting meds.
1-7= 1 med
8-13= 2 meds
14-17=3 meds
18-19=4 meds
and...
Critical Hit: 5 meds!

1-Prozac
2-Citalopram
3-Lexapro
4-Sertraline
5-Paxil
6-Lithium
7-Depakote
8-Carbamazepine
9-Trileptal
10-Lamictal
11-Risperdal
12-Zyprea
13-Geodon
14-Abilify
15-Methylphenidate
16-Concerta
17-Vyvanse
18-Valium
19-Ativan
and...
Critical Hit 20-Clozapine.

Simply see a patient, play video games while your computer screen's back is to the patient and roll a 20 sided die to determine the medication.



And I'll bet you this dice rolling method would probably end up with better results than some psychiatrists.

And what about diagnosis?

No need for dice there.

EVERYONE HAS BIPOLAR DISORDER. EVERYONE. If the patient disagrees with you...simply tell them that if you have ups and downs they have it.
If you're feeling like an artist, throw something that depends on your fancy on the moment. Schizophrenia, depression, panic disorder, etc.

 

[whopper]

Another method of prescribing.

Drug reps.
Which med has the hottest drug rep where there's a chance you'll score with more than a professional relationship? Go with that med.
Which med has the hottest drug rep that gives you free stuff like food? 2nd line med.
Which med has the hottest drug rep but nothing else will happen outside of giving you info? 3rd line med.

Simply tailor the dx to fit the med.

For those new here that don't know me, yes I'm joking but I swear the above will get better results than some doctors I've seen.

 

[675015]

Its the dice rolling prescribing algortihm based on the Dungeons and Dragons 20 sided die..

Roll to determine # of starting meds.
1-7= 1 med
8-13= 2 meds
14-17=3 meds
18-19=4 meds
and...
Critical Hit: 5 meds!

1-Prozac
2-Citalopram
3-Lexapro
4-Sertraline
5-Paxil
6-Lithium
7-Depakote
8-Carbamazepine
9-Trileptal
10-Lamictal
11-Risperdal
12-Zyprea
13-Geodon
14-Abilify
15-Methylphenidate
16-Concerta
17-Vyvanse
18-Valium
19-Ativan
and...
Critical Hit 20-Clozapine.

Simply see a patient, play video games while your computer screen's back is to the patient and roll a 20 sided die to determine the medication.



And I'll bet you this dice rolling method would probably end up with better results than some psychiatrists.

And what about diagnosis?

No need for dice there.

EVERYONE HAS BIPOLAR DISORDER. EVERYONE. If the patient disagrees with you...simply tell them that if you have ups and downs they have it.
If you're feeling like an artist, throw something that depends on your fancy on the moment. Schizophrenia, depression, panic disorder, etc.

Can I quit residency now?

 

[nitemagi]

Simply tailor the dx to fit the med.
For those new here that don't know me, yes I'm joking but I swear the above will get better results than some doctors I've seen.

Many use this part alone in diagnosing ADHD and bipolar as well. "I focused better on adderall, so that proves I have ADHD."

 

[whopper]

Which is why my post, despite the sarcasm is both funny and horrifying. Psychiatry is a real field, psych disorders are real, the treatments can work but there's enough unethical practitioners in our field willing to bend the rules to the degree where it just has no basis in what is really going on with the patient. Enough to the point where I know all of us have seen it with our own eyes and more so than we'd like unless we're brand new to practice.

I'm preparing a grand rounds and possible paper on intentional misdiagnosis. A problem I'm finding is while all of us have seen this problem there is a paucity of data on it and the reasons are obvious. No one wants to do research that'll expose the colleagues they work with, and if unethical providers are put into a research study to expose intentional misdiagnosis, the provider will obviously change their tune and do the right thing only cause they're being monitored.

 

[Shikima]

Its the dice rolling prescribing algortihm based on the Dungeons and Dragons 20 sided die..

Roll to determine # of starting meds.
1-7= 1 med
8-13= 2 meds
14-17=3 meds
18-19=4 meds
and...
Critical Hit: 5 meds!

1-Prozac
2-Citalopram
3-Lexapro
4-Sertraline
5-Paxil
6-Lithium
7-Depakote
8-Carbamazepine
9-Trileptal
10-Lamictal
11-Risperdal
12-Zyprea
13-Geodon
14-Abilify
15-Methylphenidate
16-Concerta
17-Vyvanse
18-Valium
19-Ativan
and...
Critical Hit 20-Clozapine.

Simply see a patient, play video games while your computer screen's back is to the patient and roll a 20 sided die to determine the medication.



And I'll bet you this dice rolling method would probably end up with better results than some psychiatrists.

And what about diagnosis?

No need for dice there.

EVERYONE HAS BIPOLAR DISORDER. EVERYONE. If the patient disagrees with you...simply tell them that if you have ups and downs they have it.
If you're feeling like an artist, throw something that depends on your fancy on the moment. Schizophrenia, depression, panic disorder, etc.

THIS!
+1 to your Vorpal sword of Psychiatry