Why not benzo + stimulant for patients?

[nancysinatra]

Great point about not making it a personal crusade. Additionally, the patient is more likely to listen to the options we present if we don't threaten to take away the medicine they believe is working for them. Fits in with an MI approach.

So now it's ok to have someone on xanax and adderall? When I posted about it earlier, it clearly wasn't. Can someone please explain? Thanks.

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[notdeadyet]

My point was: the local standard of care is the only standard used in malpractice cases.

This is not true. Splik went into great detail on this in his post, but in case someone skipped it, local standard of care is NOT the only standard used in malpractice. You can't provide poor care and say, "everyone else around here does it" and not expect to get your a$$ handed to you in court. Read splik's post for greater detail.

Local standard is fine for why you can't provide ECT in an area that does have local resources to do so. It isn't when it comes to overprescribing or under prescribing according to recognized standards.

 

[smalltownpsych]

So now it's ok to have someone on xanax and adderall? When I posted about it earlier, it clearly wasn't. Can someone please explain? Thanks.

I was referring to patients who are on this regimen already and are resistant to changing it. I equate it with any type of problematic substance use or other problematic behavior for that matter. I don't prescribe so my stance is obviously coming from a different perspective, but it is all about shads of grey. If the patient insists on continuing the regimen and there are not obvious contraindications, and another doctor was comfortable with prescribing this prior, then educate the patient about benefits and risks of said regimen and let them make the choice and document this. If as their doctor you feel strongly that this regimen is harmful and you don't want to risk that, then you explain this to the patient and start to d/c. Example of harmful in my mind to use in this thinking would be lack of functioning, suicidality, legal problems, disability, etc.

 

[thoffen]

These last few posts about the research argument are reminding me a bit too much of the couples session I refereed the other day.

Great. How am I supposed to tell my wife I've been cheating on her?

 

[keifernny2]

If I was a covering psychiatrist for an 80 y/o psychiatrist who *supposedly* will be coming back, I probably wouldn't force them change things, in 1-2 visits, but I would counsel the patient that the drug combination that they are on is not standard practice.

I would inform them that should their 80 y/o psychiatrist decide to retire someday soon (a very strong possibility), then their next psychiatrist will likely change their treatment plan because it it does not fit with current guidelines for treatment.

If the patient wishes to start that change now, that I'd be happy to offer that option to them.

I would also inform them that should our visits extend out past 2 months (ie: psychiatrist decides not to come back), I will start making changes for them.

Oh, and I'd get a drug screen on each of these Xanax/Adderall patients before I even get out my prescription pad.