When to contact prescribing physician?

[psychma]

I have a bp1 client who was stable on her medication for a year. She was doing very well. A few months ago she stopped taking risperdal due to significant weight gain. Within two months, she had a mixed episode with significant paranoia. I helped support her getting back on risperdal as this is what her doctor advised. Since restarting, she has gained 10 pounds and once again has gone off the medication. I don’t think her psychiatrist knows this. Should I contact her psychiatrist? I have a release. Is this something you would want to know or would I be interfering/overstepping/be a stupid therapist? I’m concerned she will fall back into a crisis.

Some details have been changed.

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[annoyedpsychiatrist]

i think this is useful information that I would value. I like to know if patients arent using the meds I prescribe.

What I hate, is when a therapist starts implanting the idea that the pt may have ADHD and to bring it up with me.

 

[randomdoc1]

i think this is useful information that I would value. I like to know if patients arent using the meds I prescribe.

What I hate, is when a therapist starts implanting the idea that the pt may have ADHD and to bring it up with me.

Ditto. ADHD is the reason for every life adversity and the stim will surely launch them to CEO status and massively increase their sex appeal and popularity.

 

[hamstergang]

Should I contact her psychiatrist? I have a release. Is this something you would want to know or would I be interfering/overstepping/be a stupid therapist?

Collaborating and providing information could never be overstepping. Now, if you started telling the psychiatrist what to do with medications, that would be overstepping, but that doesn't sound like what you're talking about.

Also, I want to point out that while it's nice you have a release, there's nothing about HIPAA that would prevent this communication anyway. In fact, it explicitly allows for communication between two active treating providers without the patient's explicit consent.

 

[WisNeuro]

Collaborating and providing information could never be overstepping. Now, if you started telling the psychiatrist what to do with medications, that would be overstepping, but that doesn't sound like what you're talking about.

Also, I want to point out that while it's nice you have a release, there's nothing about HIPAA that would prevent this communication anyway. In fact, it explicitly allows for communication between two active treating providers without the patient's explicit consent.

I'm always amazed at how much people do not understand HIPAA within healthcare. Like the countless times someone has referred a patient to me, and when I contact their office explaining that I also need notes/recent imaging/labs, with the order sent to me, and the medical records assistant insists that they need an ROI first.

 

[wolfvgang22]

I have a bp1 client who was stable on her medication for a year. She was doing very well. A few months ago she stopped taking risperdal due to significant weight gain. Within two months, she had a mixed episode with significant paranoia. I helped support her getting back on risperdal as this is what her doctor advised. Since restarting, she has gained 10 pounds and once again has gone off the medication. I don’t think her psychiatrist knows this. Should I contact her psychiatrist? I have a release. Is this something you would want to know or would I be interfering/overstepping/be a stupid therapist? I’m concerned she will fall back into a crisis.

Some details have been changed.

Yes, of course you should call the doctor!

But do not tell the patient "Ask your doctor if you need a medication change or adjustment." Because what happens a lot then is the patient then shows up asking for med changes without being able to say why, or shows up asking for adderall and says you told them to say that. It sets up miscommunication and even possible splitting behavior. Instead simply call or email the prescribing physician. Don't say " I think so-and-so needs a med adjustment" unless you wish to annoy. This annoys because there may be factors making med changes difficult, it's not just ego. Just give the facts "Mr./Ms. X says they had weight gain with Risperidone, stopped taking it, restarted it and gained 10lbs, and stopped taking it again. I'm concerned their symptoms aren't adequately controlled due to medication non-adherence. Thank you for your help!"

 

[psychma]

Thanks. I have no intention of suggesting ADHD or telling the client they need a medication change. I am concerned that this patient will quickly become unstable again. I have not been successful at encouraging them to be compliant. They have gained a very significant amount of weight and are concerned about their health and appearance.

 

[Celexa]

Thanks. I have no intention of suggesting ADHD or telling the client they need a medication change. I am concerned that this patient will quickly become unstable again. I have not been successful at encouraging them to be compliant. They have gained a very significant amount of weight and are concerned about their health and appearance.

Patients are often more willing to tell their therapist certain things than their doctor. The patient may not have told their doctor why they stopped the med or that they stopped it at all. You should definitely encourage the patisnt to talk to their psychiatrist about their concerns, but also as a psychiatrist I would be thrilled to get a message from a therapist to discuss a patient who has gone off their meds BEFORE they hit crisis. That's good collaboration for good patient care.

 

[forchinet121]

I would call likely you won’t be able to talk with the doctor but you can leave a message or email them and message them that way with info. It’s always nice to send someone info but you might not be able to actually have a conversation as there’s a high likelihood they won’t get on the phone with you

 

[comp1]

You're not a stupid therapist; you're asking great questions. That said, you do NOT need a release to speak to the prescriber, nor does the prescriber need a release to talk to you. Quite the opposite, you could potentially be liable if you didn't talk with the other provider when you should have because you thought you needed a release. This is definitely a situation where you should talk to the prescriber. That said, you should generally be having ongoing collaborative relationships with other members of your patient's care team. Where you could likely really help more generally as a therapist is giving a good break down on any personality pathology. We're pretty good with the primary mood disorders (and even better handling ADHD on our own), but it's the therapists who have the time to separate out and focus on personality pathology issues.

 

[Bartelby]

This is a slam dunk for notifying the psychiatrist. Honestly I would be a bit annoyed if a therapist knew this was happening and did not bother to even leave me a message (then of course I will be expected to manage or help manage the crisis once it has arrived).

 

[Candidate2017]

While I'd like to know if a patient is taking their meds, there isn't much I can do in the moment. I've gotten a call from a "therapist" for, "Hey I think X is suicidal. I'm going on vacay, bye." Great, now I'm the one to call 911 based on hearsay. Don't be that idiot. Assess and take care of the safety issues in front of you.

If a patient is experiencing mania, you need to call 911 for transport to the ER, and possibly petition them for hospitalization (you do know how to petition, right?). Bipolar is a serious mental illness. Serious illnesses require serious meds, which always have some side effects. Hence, "patient", which means willing to wait and abide. Bipolar is not like a Vraylar commercial. Bipolar meds will pound patients' livers or kidneys or thyroid, increase weight, cause drooling and tremors, etc.

Assuming no safety issues, therapeutically explore their real issues with medications, and encourage the patient to make an appointment with their doctor to discuss any concerns about med side effects.

I’m concerned she will fall back into a crisis.

Of course she will. Even with meds, 10-25% will relapse annually. A fair number of patients don't want to take meds regularly and occasionally go off their meds. This is par for any chronic med condition, including mental illness.

So, safety first, and understand severe mental illness is like any severe medical illness. Talk doesn't make medical illness go away. And read Kaplan and Saddock PRN.

 

[Merovinge]

Ditto. ADHD is the reason for every life adversity and the stim will surely launch them to CEO status and massively increase their sex appeal and popularity.

Funny you joke about this but the people I know who offered up lines of crushed Adderall 30mg IR's certainly had a massive increase in both their sex appeal and popularity...

 

[WisNeuro]

While I'd like to know if a patient is taking their meds, there isn't much I can do in the moment. I've gotten a call from a "therapist" for, "Hey I think X is suicidal. I'm going on vacay, bye." Great, now I'm the one to call 911 based on hearsay. Don't be that idiot. Assess and take care of the safety issues in front of you.

If a patient is experiencing mania, you need to call 911 for transport to the ER, and possibly petition them for hospitalization (you do know how to petition, right?). Bipolar is a serious mental illness. Serious illnesses require serious meds, which always have some side effects. Hence, "patient", which means willing to wait and abide. Bipolar is not like a Vraylar commercial. Bipolar meds will pound patients' livers or kidneys or thyroid, increase weight, cause drooling and tremors, etc.

Assuming no safety issues, therapeutically explore their real issues with medications, and encourage the patient to make an appointment with their doctor to discuss any concerns about med side effects.



Of course she will. Even with meds, 10-25% will relapse annually. A fair number of patients don't want to take meds regularly and occasionally go off their meds. This is par for any chronic med condition, including mental illness.

So, safety first, and understand severe mental illness is like any severe medical illness. Talk doesn't make medical illness go away. And read Kaplan and Saddock PRN.

This would warrant a call to that provider's board, in my opinion.

 

[TheRightMedication]

If you're worried about a patient, call. Yes, there are many points of art and professionalism to worry about, but that's all secondary to the take-care-of-humans part.

 

[Stagg737]

Agree with everyone above, this is exactly the kind of issue I'd want to know about so I can get them back in to discuss meds ASAP. I always tell my patients to call if they're having med problems or side effects or feel like they need to make significant changes, but many patients don't. Imo, you should absolutely contact psychiatrists when patients go off their meds and decompensate or are at risk of it. Same goes for meds causing severe side effects, like if a patient's recently started an antipsychotic and they've suddenly got a severe tremor.

That being said, use good judgment. I don't want to know about every time a borderline patient with chronic SI says they want to OD or that a patient who just started lexapro "feels funny".