Case examples of Physician liability in NP “Collaborative” agreements

[Mass Effect]

Yes I understand that but I trained at a program with plenty of addiction exposure and we certainly didn't practice like this. Maybe Strattera or welbutrin but definitely would be hesitant to use a stimulant

I trained at a program with strong addiction program and we did prescribe stimulants for ADHD for these people. There are studies showing a correlation between cocaine use and ADHD and some benefit to stimulant medication in cocaine abstinence in these patients.

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[Stagg737]

I really don't understand this newer generation of psychiatrists who are scared at every corner. Just saw a young man with documented bipolar d/o now in the hospital with acute mania and the overnight resident prescribed Depakote 500 mg. I asked why and they were worried about starting too high and side effects. Had another resident tell me a few months ago that they prescribed Seroquel 300 mg for documented schizophrenia with ongoing acute psychosis who was afraid to go higher and wondered if they should switch.

Wtf, those aren't even therapeutic doses. That's the kind of thing I'd expect to see on consults that some PCP started, probably for irritability in a borderline patient. Idk anyone past their intern year being afraid to go above that, and I'd be wary of a residency program that's letting that slide...

 

[deleted1100659]

I think the theory of giving stimulants to prevent illicit stimulant use disorder holds some weight in certain setttings/patients but ultimately in my setting I think it would be dangerous given high level of comorbidities like heart disease, for my patient population. In my area stimulants and even non controlled medications are like gold and would be traded/sold/abused. Then on the routine UDS I wouldnt know if they were relapsing or not because they would cross react.

I do believe theres a link between ADHD and addiction, but also I would suspect that if someone is abusing a ton of illicit stimulants then chronically their attention/concertation would decline and be worse anyways regardless of ADHD. I suppose if someone was clean for a long period of time I would be open to something like vyvanse with close follow ups/agreements in place but would be a case by case basis.

 

[clausewitz2]

I really don't understand this newer generation of psychiatrists who are scared at every corner. Just saw a young man with documented bipolar d/o now in the hospital with acute mania and the overnight resident prescribed Depakote 500 mg. I asked why and they were worried about starting too high and side effects. Had another resident tell me a few months ago that they prescribed Seroquel 300 mg for documented schizophrenia with ongoing acute psychosis who was afraid to go higher and wondered if they should switch. And then there are loads of statements on ADHD and stimulants.

I kind of want to calculate the psi of the force generated by their heads exploding when I tell them about how to safely combine methylphenidate and tranylcypromine for TRD.