outpatient psychiatry interesting/controversial topic

[tonyrob]

i'm doing an elective in outpatient psychiatry. part of our assignment is to do a 15 minute talk on an interesting/controversial topic such as treatment of depression in pregnancy. does anyone have any ideas or interesting articles they have stumbled upon that might make for a good talk?

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[whopper]

Commitment criteria. Ther'es plenty of "grey" area cases where you don't want to commit, but if you don't you're running a real risk of letting the patient hurt themself.

I've had cases where the safe thing to do was to commit the patient, but it really screwed the patient over. E.g. we had a teacher jokingly make a suicidal statement. He was just joking, but because of Columbine the school brought him to the hospital. He was committed (which I didn't like).

Unfortunately for him, it was done on a Thursday night--and he's unlikely to be DC'd the next day. Another problem is no one in my hospital is DC'd on weekends. So he ended up being in the hospital for 4 days---at a cost to him of $1500 a day, just because the doc wanted to play it safe.

 

[OldPsychDoc]

Commitment criteria. Ther'es plenty of "grey" area cases where you don't want to commit, but if you don't you're running a real risk of letting the patient hurt themself.

I've had cases where the safe thing to do was to commit the patient, but it really screwed the patient over. E.g. we had a teacher jokingly make a suicidal statement. He was just joking, but because of Columbine the school brought him to the hospital. He was committed (which I didn't like).

Unfortunately for him, it was done on a Thursday night--and he's unlikely to be DC'd the next day. Another problem is no one in my hospital is DC'd on weekends. So he ended up being in the hospital for 4 days---at a cost to him of $1500 a day, just because the doc wanted to play it safe.

Actually, unless he went before a judge and was committed, this is really just a case of involuntary hospitalization. Now if he'd been sent to my unit on a hold, we would then have to petition the county to take him to court for commitment--and if his story is true, it never would have made it there, and unless I'd seen other danger signals (past hx, unstable social situation, substance abuse, etc.) I'd probably have d/c'd him home Friday morning.

 

[TheWowEffect]

Actually, unless he went before a judge and was committed, this is really just a case of involuntary hospitalization. Now if he'd been sent to my unit on a hold, we would then have to petition the county to take him to court for commitment--and if his story is true, it never would have made it there, and unless I'd seen other danger signals (past hx, unstable social situation, substance abuse, etc.) I'd probably have d/c'd him home Friday morning.

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[whopper]

Thanks for the correction.

 

[Anasazi23]

i'm doing an elective in outpatient psychiatry. part of our assignment is to do a 15 minute talk on an interesting/controversial topic such as treatment of depression in pregnancy. does anyone have any ideas or interesting articles they have stumbled upon that might make for a good talk?

AOT (Assisted Outpatient Treatment)
It's also known as "outpatient commitment." Patients are essentially forced to see a psychiatrist to ensure medication compliance. Patients often see it as a violation of their rights. It has, however, proven effective.

Here's a link describing it.