one advantage to working for the VA or a cmhc....

[vistaril]

---

Members don't see this ad.

real leverage over the stimulant and benzo seekers....

I dont know about other areas, but the % of adults on stims and benzos(and often both) that sees outpt insurance based med mgt psychs is insanely high. And it's usually not for a very good reason.

I have *some* leverage now where I moonlight because they are medicaid patients, so there options are limited and we are the only mh they can go to. Still, my leverage isn't 100% in that my employer does depend on these medicaid patients to keep coming(and thus keep grinding out the 90801's) which means they must be satisfied with care.

A lot of these outpt high med mgt practices...if you removed the regularly filled stims and benzos from their books, what would their new volume look like?

 

[birchswing]

. . .

 

[F0nzie]

Have you found a good benzo withdrawal protocol? Any supplements? I've been researching phosphotidylserine for benzo withdrawal.

I've used Valium with several of my outpatients. Nice long half life and long acting metabolite. The hardest part is finding the correct equivalent dose-- even if you use the charts sometimes they get underdosed or maybe it's just they get overly anxious about tapering. But after the first few days it's smoothe sailing from there!

 

[markglt]

"phosphotidylserine for benzo withdrawal"
that's by far the most ridiculous thing i've ever heard.

...oh dear, and i just read the rest of your post....
houston we have a problem...
somebody pick up that phone, i think it's axis II calling...

chuckle

 

[birchswing]

. . .

 

[vistaril]

I've used Valium with several of my outpatients. Nice long half life and long acting metabolite. The hardest part is finding the correct equivalent dose-- even if you use the charts sometimes they get underdosed or maybe it's just they get overly anxious about tapering. But after the first few days it's smoothe sailing from there!

I rarely do do benzo detox.....I say that because in most cases the person isn't truly interesting in getting off benzos, but rather things are just catching up with them(last dr probably fired them, their state prescription drug report is a mess, etc) and their only chance of getting supplemental benzos(besides what they are getting from family and friends) is to present wanting to get off and switch meds so they can get a long taper.

I am amused by these outpt psychiatrists who supposedly have a 'no benzo'(or rarely) policy but will glady accept people on 6mg xanax daily from outside prescribers and give them a Klonopin taper that stretches out over decades(well 3 months, but same difference)....in most all cases, they were just played.

Think about it- why is the person supposedly wanting to get off benzos? Because they realize that longterm their anxiety hasn't improved since they started them? Yeah right....I'll add all those fictional patients to the same ones who believe their Oxycodone isn't helping their chronic back pain but neurontin will. In most cases they *don't* want to get off, and aren't planning on it. In other cases they want to get off, but are an addict(and likely other substances are in play too), and need more than an outpt med mgt taper in terms of a total treatment plan.

 

[xlithiumx]

"phosphotidylserine for benzo withdrawal"
that's by far the most ridiculous thing i've ever heard.

...oh dear, and i just read the rest of your post....
houston we have a problem...
somebody pick up that phone, i think it's axis II calling...

chuckle

Probably not ideal to reference diagnoses when talking about other posters, even when only used to insult them.

As an aside, I suspect that your patients with axis II disorders would not particularly appreciate their illness being used as an insult. We're kind of moving past that as a field, particularly as we're learning that 1) there is legitimacy to the suffering of these people and 2) they are treatable with both pharmacotherapy and more importantly psychotherapy.

Something to think about.

 

[markglt]

ur soapbox called...it's wondering if you'll be up there long....its back is hurting

 

[xlithiumx]

ur soapbox called...it's wondering if you'll be up there long....its back is hurting

Soapbox or not, you should reflect on your countertransference. If you think about your personality disordered patients so very negatively, it will influence your decision-making, and you'll be a worse doctor for it.

 

[markglt]

ur soapbox called...it's wondering if you'll be up there long....its back is hurting...
it's still calling