Question for the attendings...

[MDhasbeen]

---

Members do not see this ad.

Given that residency cannot possibly teach you everything that one needs to know to practice in the large number of clinical settings we're employed in, how useful were your elective choices with regards to your current employment? Did you end up largely learning from scratch again? Was it mostly the bread and butter stuff that was useful? I'm wondering what the chances are of my, hypothetically, never closely treating an eating disordered person during residency but then being required to treat a bunch of such individuals at a job someday.

 

[whopper]

As for being an attending, keep your skilled mentors & colleagues close. You still get cases where being able to discuss them with a colleague or mentor will help because it'll be the first time you've experienced it. You may learn psychiatry, but the scenarios you see and the ways they are handled can vary greatly between institutions.

For example, I worked in one state institution for an elective, and I'm currently working as one in another state institution. There was a lot of technical jargon that differed that was confusing for me at first. E.g in NJ its called commitment, in Ohio its called Probate, the precautions we'd put patients on differed, the privelidges patients could obtain differed.

And while the basic psychiatry may be the same the "game" differed in several ways. E.g. by the time you graduate residency, you may know all the community managers in the county very well, but if you work at a new place, they're different, and you need to get to know who they are. That may sound a bit more simplistic than it really is...for example one case manager was splitting between myself & the patient's family. My treatment team & I only figured this out after working with this case manager for about 2 months.

I too wasn't getting too much Eating Disorder experience at my program so I did an elective at a place for 2 months. The shame of it was that I really got what I was going to get out of it after only 2 weeks. The rest of the time there I felt was boring & a waste.

If you're in your 3rd to 4th year, you will hit a point where you may feel you have learned all there is from a particular attending or rotation. That's a very good reason to do an elective in a different scenario.

 

[OldPsychDoc]

Agree with what Whopper said--I also crossed state lines between residency and practice, and though I returned to a familiar area, I wasn't as familiar with things like commitment proceedings, local case management agencies, etc.
I leaned heavily on my social workers (still do! 😍) and asked lots of questions of colleagues.

For me, electives were somewhat about building confidence. I did a student health service elective that gave me tons of autonomy and a lot of starting anxious and depressed young people on SSRIs--and educating them on such basics as "this is how you fill a prescription...". I also did an ECT elective which was very valuable upon entering my new position.

 

[Regnvejr]

Given that residency cannot possibly teach you everything that one needs to know to practice in the large number of clinical settings we're employed in, how useful were your elective choices with regards to your current employment? Did you end up largely learning from scratch again? Was it mostly the bread and butter stuff that was useful? I'm wondering what the chances are of my, hypothetically, never closely treating an eating disordered person during residency but then being required to treat a bunch of such individuals at a job someday.

You always learn from your patients, and residency generally teach the basics and you get a good idea of what you do not know enough of. When I knew I was going to Wyoming as a Child and Adolescent Psychiatrist, i did extra work with our specialist in autism over the last month of my residency. There is no autism team in Wyoming, and I felt that I really was not comfortable flying solo on these patients. Now I see a bunch and I'm becoming relatively comfortable with them.

You will always learn more as you go along. No doubt an attending knows more 10 years out than 2 years out, and if you have connections and know community resources, they can back you up.

It is always scary when you see your first patients on your own, but you will soon figure out that you do ok. What you could do in the last part of residency, you can do on your own as well. Reality of the last part of residency is that you really are doing your own stuff and that attending are more looking on in the background. So in that sense, it is more of the same.

 

[whopper]

Some cases I've had that were very new to me as an attending...

Having to medicate a pregnant schizoaffective disorder patient with psychotropic meds with something besides Haldol.

A Williams syndrome patient with ADHD, Malingering, Factitious Disorder & Narcissistic personality disorder. I'm still ruling out Conversion Disorder. Add on top of that, I believe her mother has a weak spectrum Munchausen's by Proxy which is what may have initiated so many problems in the patient.

Having to do a 16 year discharge summary (that really blows).

Having a post surgical patient medically cleared that was clearly not suitable for a psychaitry unit. She had several square inches of fascia exposed.

Having a Bipolar & Histrionic homosexual patient--the guy was cleared of his Bipolar, but didn't want to leave the unit because he was surrounded by men. While arranging for a discharge, he threatened to cause a public scare to get back into the psyche unit. We discharged him anyway since his threat was clearly not due to an Axis I illness.

Just refused someone to be discharged--I was the independant psychiatric evaluator. The guy shot his wife in the eye, stabbed his brother in the back, tried to shank a hospital police officer, and tried to kill someone with a razor. The administration wants the guy out. No way IMHO.

I currently have a patient who every 4 weeks, she visciously attacks someone due to psychosis, but in the time in between is symptom free, cooperative & directable. I'm wondering if her psychosis is somehow tied to her menstrual cycle. I'm still investigating this one.

Got a patient on Zyprexa 40mg/day, Risperdal 16mg/day, Depakote (serum level 120 ug/ml) Lithium with a serum level of 1.1 mmol/L, and Haldol 5mg QHS and she is still grossly psychotic. I can't use Clozaril because her ANC is too low. What will I do next? I'm still trying to figure this one out.

During residency our inpatient unit was a short term unit. Having worked on a long term unit for months, the experience is different, and there are several dimensions that need to be exploited by the psychiatrist that I was not trained in during residency. For example, in long term, we can actually do some very good psychotherapy, and my partner psychologist & I have been working out a lot of that with our patients. This was not an option in short term. I have also used her to do a lot of psychometric testing on various patients, using tools I've never seen in residency such as the M-FAST, or only read about but never seen much in clinical action such as the MMPI. Pharmacologically, I've had several patients who do not get better on one, 2 or even 3 meds, even at doses much higher than the manufacturer's maximum reccomended dosages. There are very little evidenced based treatment guidelines with this type of thing, but nonetheless, you have to try to treat these people with such because nothing else worked and Clozapine might not be an option becuase their ANC is too low. My own polypharmacy algorithm has dramatically changed since residency based on the experiences I've had in the last few months.

I've also seen some of the things you hear about in prison-a guy getting shanked, people being able to light their cigarettes using a paper clip and battery, someone making a weapon out of a pair of D batteries & socks, someone getting a CD, breaking it and then trying to cut someone's neck with it.

I'm starting to develop an opinion that one really has to work in several scenarios that are not available in all programs to get the most out of a psychiatric education. I've learned things in this long term facility that I never would have learned while working in the short term one. I've also seen several things that are practiced different here in Ohio than were done in NJ.

E.g. several here use 150ug/ml as the limit for Depakote, not 125. Several doctors here do an antithyroid antibody panel on their patients before starting lithium. The HCR-20 is the standard test used here to predict future violence, but several areas have not even heard of this test. I've done lithium augmentation on Clozaril patients several times now, and never did that in residency.

I've definitely had to consult with my colleagues on scenarios I have not seen before.

Some ways to keep your connections open are to actively participate in your local APA chapter. You will develop good networking & friendships there. Keeping good contact with your residency program and fellow residents helps. Your bosses at work will also be good sources of information. A few months ago a colleague of mine who already completed his forensic fellowship had to do a sit down & explain to me the US VS SELL case, since I had not heard of it at the time, and I had a patient who fit the guidelines to be forced medications based on that case.

 

[nancysinatra]

A Williams syndrome patient with ADHD, Malingering, Factitious Disorder & Narcissistic personality disorder. I'm still ruling out Conversion Disorder. Add on top of that, I believe her mother has a weak spectrum Munchausen's by Proxy which is what may have initiated so many problems in the patient.

Whopper, that is so interesting! That would be my dream patient to at least meet, although I have no idea what could be done for them. Is it common to see Narcissistic PD in a patient with developmental delay? And aren't Williams syndrome patients usually very friendly and, I'd presume, non-exploitative of others, arrogant, etc? So this is interesting... What were the patient's narcissistic features? And what do you think can be done about the factitious DO and malingering? When a patient with developmental delay has psychiatric problems that can usually only be treated with psychotherapy (like Narcissistic PD), what do you do? Is there some form of modified psychotherapy? I do realize that NPD is not so easily treated in anyone but I just wondered...

I've always wondered if a person with a parent who has Munchausen's by Proxy is at increased risk for Munchausen's. Also, what Axis does the Munchausen's by Proxy go on in the patient's diagnostic formulation?

 

[michaelrack]

Got a patient on Zyprexa 40mg/day, Risperdal 16mg/day, Depakote (serum level 120 ug/ml) Lithium with a serum level of 1.1 mmol/L, and Haldol 5mg QHS and she is still grossly psychotic. I can't use Clozaril because her ANC is too low.
.

sounds like a tough case. I would Discontinue one of the atypicals, increase haldol to maximally tolerated dose. Would then try to taper the other atypical. Might want to try giving haldol decanoate.

 

[Solideliquid]

sounds like a tough case. I would Discontinue one of the atypicals, increase haldol to maximally tolerated dose. Would then try to taper the other atypical. Might want to try giving haldol decanoate.

Would ECT be an option for this patient? What do you think about the role of ECT in treatment resistant psychosis if clozapine isn't an option?

 

[whopper]

That would be my dream patient to at least meet, although I have no idea what could be done for them. Is it common to see Narcissistic PD in a patient with developmental delay? And aren't Williams syndrome patients usually very friendly and, I'd presume, non-exploitative of others, arrogant

Well she certainly is an interesting patient. I was considering publishing her case since on a psychodynamic level she is perhaps the most interesing patient I've had so far. I'm still mulling on the idea because I am detecting some possible mild Munchausen's by proxy by her mother (who is her guardian). Publishing this case could worsen that. I wrote a little about her a few months back.

She's very friendly, but very exploitative. The character that comes most to mind when I think of this patient is that little kid from the old black & white Twilight Zone that pretty much destroyed the universe. Everyone was scared of him so they gave the kid anything he wanted. Well she doesn't have the power to the destroy the universe, but she has learned to exploit her cutesy appearance to manipulate others. She basically ended up in the forensic unit becuase she tried to burn a home down--because she didn't like the home & wanted a better one. Problem for her was this was the first she crossed the line to the point where it was illegal. She didn't know it would get her to a forensic unit. Up until then it was a constant "I'm suicidal" "I hear voices etc which were pretty much all bull that her parents had dealt with for years. When on the unit she'd get laundry detergent and put it on her lips & claimed she tried to commit suicide.

But she clearly has no severe mental illness (e.g. psychosis or mania). This is really a case where psychotherapy can help with something so pathologically warped that she would be a danger to self & others.

sounds like a tough case. I would Discontinue one of the atypicals, increase haldol to maximally tolerated dose. Would then try to taper the other atypical. Might want to try giving haldol decanoate.


Would ECT be an option for this patient? What do you think about the role of ECT in treatment resistant psychosis if clozapine isn't an option?

That has crossed my mind. However, getting patients ECT from a state institution presents with several barriers, many of which are political.

I had a similar case a few months ago--where I couldn't give the guy Clozapine, he was already on Zyprexa 40mg/day, Depakote-with a serum level of 129 ug/ml. I just kept upping his Haldol. By the time he reached about 60mg/day he finally stabilized. He also showed no signs of EPS. I don't know why he in particular needed so much of it. Perhaps he was a rapid metabolizer.

Problem with the guy was that I knew that the second he was discharged he would stop his meds. I tried to get him to take a Dec shot but he refused. A Dec also wasn't an easy option because exactly how much Haldol Dec will have to be given to make an equivalent dose of 60mg/day oral?

As for the lady I got now with this current problem, that had crossed my mind--upping the Haldol and seeing where it was maximally tolerated.

Anyways, in a long term facility, you're going to get patients like this.

I mentioned that my own logarithm had changed-how it did was if Clozaril is not an option, I've had several schizophrenic patients so far where adding lithium to their regimen cleared them up, even though the data on the use of lithium on schizophrenia (I'm not talking Schizoaffective disorder, I'm talking Schizophrenia) is questionable. Take into consideration that by that time I've already used around 3-4 atypicals, and 1-3 typicals, several of them in combination at higher than maximum dosages with no to little benefit. And despite that the data on the use of lithium is questionable with psychosis, I did see dramatic beneifts with it as an augmentation agent.

The other way it changed was that I've had patients where I had to give them mega doses of Haldol such as 60mg/day-as a chronic medication. Most of my attendings in residency would've flipped if that was given. Also like the above, I only tried this if several other options were tried & failed & Clozaril was not an option.

I've seen several residents choose to work where they trained right after graduation. I was presented with that option a few months before I graduated. While there certainly is nothing wrong with that, I've learned so much more information than I could've possibly learned by staying at the same place.

 

[surftheiop]

I mentioned that my own logarithm had changed

I assure you the natural logarithm is almost always the best choice 😉

 

[Tradewind]

There is no autism team in Wyoming.

Do you think that affects the overall care of your patients with autism? Where I'm at, there are reportedly plenty of autism services, but I previously had a patient who was the mother of a child with autism. My patient expressed frustration in accessing psychosocial services for her child. What symptoms of autism are treatable with medications?

I just kept upping his Haldol. By the time he reached about 60mg/day he finally stabilized. He also showed no signs of EPS. I don't know why he in particular needed so much of it. Perhaps he was a rapid metabolizer.

Would you consider checking a Haldol level? Could he have been cheeking meds? A 16 year discharge summary? Ouch. 🙁

 

[whopper]

To prevent the possibility that he was cheeking his meds, it was given in liquid form & he had to sit at the medroom for 15 minutes after taking his meds.

Checking the haldol levels in his blood did cross my mind, but I didn't do it. Instead I was checking to see if the benefit from the medication as I was increasing the dose plateaued, or if he started to develop EPS. Every time I increased the dose--the more & more he got closer to stability. I'm talking raising it about 5-10 mg every 3-4 days. If that effect stopped I would've stopped increasing it.

 

[Regnvejr]

Do you think that affects the overall care of your patients with autism? Where I'm at, there are reportedly plenty of autism services, but I previously had a patient who was the mother of a child with autism. My patient expressed frustration in accessing psychosocial services for her child.

Oh, Marjory, yes. Many of the schools refuse to accept the diagnosis and provide IEP's, would rather discourage the parents to the point where they switch school. I'm getting unpopular with a couple of the schools around here because of that.

I have schools who refuse OT for anything other than wheelchair training, I have some OT providers who refuse to treat autism and even Asperger's. The reality of an autism patient in Wyoming is a 15 min visit because that's all they can handle, and then 1-1.5 hrs on the phone afterward to coordinate services. But since a lot of traditional treatment here was to snow them, I clear them up, they become less aggressive,and I look good.

What symptoms of autism are treatable with medications?

Aggression, to some extend, and frustration. Risperdal is approved, but the more data we get on the atypicals, the less I like them for any reason.

Also sometimes focus and concentration needs some help. Strattera does OK in these patients. Anything you can do to give these patients better control results in improved function and behavior (And, not the least, learning from their skills training programs).

I also see depression and other traditional conditions, but you really have to know them well to make such determinations. Their direct caregivers are the ones with the best sense of their mood changes.

 

[Tradewind]

How did you know my name? 😀

...I have schools who refuse OT for anything other than wheelchair training, I have some OT providers who refuse to treat autism and even Asperger's....

I wonder if this has to do with billing, ignorance, laziness or if it's a turfing issue.

...Risperdal is approved, but the more data we get on the atypicals, the less I like them for any reason.

Right, weight gain, metabolic syndrome...

Phew...Sounds challenging. I wonder when/if adult psychiatry residents will learn more about autism with regularity. I'm glad to know there are at least a few dedicated psychiatrists like yourself around. Thanks, Regnevjr.

 

[michaelrack]

Right, weight gain, metabolic syndrome...
.

don't forget "risperidone breasts" in men due to hyperprolactinemia

 

[Regnvejr]

don't forget "risperidone breasts" in men due to hyperprolactinemia

and more and more signs of rather serious longterm cardiac effects.

But the prolactin is indeed a problem. I inherited a guy with schizophrenia and longterm risperdal use. Not only gynecomastia but also breast cancer and double mastectomy. No wonder he is not to trusting of psychiatry. I also had a 14 year male patient lactating. He was not amused.

 

[Regnvejr]

How did you know my name? 😀

Hi. 🙂

I wonder if this has to do with billing, ignorance, laziness or if it's a turfing issue.

Mainly ignorance and fear.

 

[Kazema]

Is anyone else getting disturbed by the increasing use of Seroquel by both psychiatrists and PMDs for treating depression?

I was recently at a drug lunch by AstraZeneca; the rep offered us medical students a special teaching session on the various uses of Seroquel. Seemed pretty fishy to me.

 

[whopper]

Is anyone else getting disturbed by the increasing use of Seroquel by both psychiatrists and PMDs for treating depression?

I started a Seroquel rant thread several months ago. I think its over 2 years old.

I've noticed Seroquel used for a lot of questionable purposes.

As a sleep med-has no FDA approval, however much of its sleep benefits are from its antihistaminic mechanisms. Why give Seroquel at a cost of hundreds a month when Benadryl is less than 10% of that cost and works by the same mechanism? (yeah yeah yeah, I know its not exactly the same as benadryl but you get the point.

Several patients develop eventual sleep tolerance to Seroquel. This then causes their doctor to raise the dosage, eventually reaching true antipsychotic dosages such as 600-800 a day, where the histamine receptors are fully occupied so increasing the dosage will most likely not add sedation. Then the person shows up on the consult floor and the CL person (me in this case) can't figure out why they're on such a high dosage, and I'm speculating that the person may have Bipolar or Schizophrenia, but its actually controlled by the medication. They think Seroquel is a sleep medication, and I explain to the patient that its an antipsychotic, and they flip out. Turns out the PCP gave it only for sleep purposes.

I've noticed several attendings telling their patients that it has less side effects vs the other antipsychotics. Then their patient has a developed tremendous weight gain, sedation, hypotension and don't know why this "side effect free" medication is doing that. (Have these doctors read CATIE?)

Then I get the occasional senior citizen patient on CL service who's been told by their PCP that she has dementia, and for that reason is put on Seroquel. Hmm...MMSE is a perfect 30 out of 30, she's not complaining of any memory problems, no brain scan was done Bottom line-I end up stopping the Seroquel, and now her family thinks I've stopped the medication that is preventing her dementia ("that's why her memory is so good! Her doctor put her on the right medication!").

I hate saying this but there seems to be a significant number of doctors where the doctor appears to be throwing a pill at the patient, without following the standard of care steps to truly diagnose the disorder, and then give the right medication for it. Unfortunately, Seroquel from my own clinical experience appears to be a top offender in this area. (Others-Xanax, Ativan).

 

[sunlioness]

Is anyone else getting disturbed by the increasing use of Seroquel by both psychiatrists and PMDs for treating depression?

I was recently at a drug lunch by AstraZeneca; the rep offered us medical students a special teaching session on the various uses of Seroquel. Seemed pretty fishy to me.

It is actually FDA approved for Bipolar depression.

But why are you having teaching sessions conducted by drug reps in medical school??? That sounds fishy too!

 

[whopper]

But why are you having teaching sessions conducted by drug reps in medical school??? That sounds fishy too!

Only way some drug companies can peddle their product is by offering "teaching".

I emphasize the qoutation marks. (This is coming from a guy who thinks that some pharm representation isn't a bad thing--but it can go way overboard. IMHO the overprescribing of Seroquel is a classic case of this).

 

[billypilgrim37]

It is actually FDA approved for Bipolar depression.

"Well, is there really any other kind of depression?" says the AZ rep in the corner. 😉

 

[Kazema]

Kind of off-topic but still relevant - was just at a grand rounds about hyperglycemia in hospitalized patients, especially in the ICU. The speaker made a pretty strong case for using Lantus as much as possible, with Humalog instead of regular insulin for postpriandial control.

Well, a strong case until I noticed that his disclosures were Sanofi Aventis and Eli Lilly. So can I really believe anything he talked about? I don't know, and don't have the time (or motivation...I am after all a fourth year) to look it up myself.

 

[Tradewind]

don't forget "risperidone breasts" in men due to hyperprolactinemia

...But the prolactin is indeed a problem. I inherited a guy with schizophrenia and longterm risperdal use. Not only gynecomastia but also breast cancer and double mastectomy. No wonder he is not to trusting of psychiatry. I also had a 14 year male patient lactating. He was not amused.

Yes... I've seen a few Risperdal breasts, but I can't say I see it every day, and not with that severity. Thanks for pointing this out, Regnvejr and Michaelrack.

In scanning through articles on "risperidone breasts", I notice that Eli Lilly is cited on many of these papers. And not just in the conflict of interest section at the end, but as a primary affliliation for several of the authors. Since Lilly made Zyprexa, not Risperdal, there seems to be a conflict of interest. A 2008 article in the J of Psychopharmacology by Bushe, et., al. studied a cohort of 178 patients. They found that 55% of patients on risperdal (PO) and 67% on risperdal consta (depot IM) developed hyperprolactinemia. This paper sites Lilly as a primary author site. Dr. Uriel Halbreich at SUNY Buffalo has published other similar studies warning against risperdal breasts, and many of these studies list Eli Lilly (the maker of Risperdal's rival, Zyprexa) as a coauthor affiliation.

Avoiding the input of drug companies is near-impossible! Yes, they're biased, but they produce some necessary data and have made numerous life-saving drugs. This is one area where attending input is really helpful. Critically reading papers involves being familiar with common misinterpretations/pitfalls, knowing which authors are reliable and having clinical experience, among other things.

 

[whopper]

Well, a strong case until I noticed that his disclosures were Sanofi Aventis and Eli Lilly. So can I really believe anything he talked about? I don't know, and don't have the time (or motivation...I am after all a fourth year) to look it up myself.

Avoiding the input of drug companies is near-impossible! Yes, they're biased, but they produce some necessary data and have made numerous life-saving drugs. This is one area where attending input is really helpful. Critically reading papers involves being familiar with common misinterpretations/pitfalls, knowing which authors are reliable and having clinical experience, among other things.

And this is why I mention that some & limited representation by pharm companies is sometimes a good thing.

I hate saying it but several pharm reps do sometimes give valuable and succinct presentations. For example if you simply use journals as your source of data, especially in the formative years of residency where the foundations of psychopharm is still being developed, its hard to mentally fit an article that often times only shows limited aspects of a medication and its effect. E.g. "Seroquel shows increased Anthihistamanic Activity." Antihistaminic activity is only 1 of several aspects with the medication. Reading that article, without much of a foundation & understanding of the medication IMHO is like trying to teach a kid Calculus without first teaching Algebra.

Pharm company presentations I admit did help somewhat in establishing a framework for my then psychiatrically uneducated mind. Add to that, we all got to admit, as a first & second year resident, life is hard. Calls, IM rotations and having to worry about Step III really do make high yield sources important.

But despite everything I'm mentioning, pharm representation really is candy coating. It has its place, but it should be limited at best and considered basic & biased. If you're a resident psychiatrist worth his/her salt, by the time you reach the end of your 2nd year, you really should be getting to the point where your own ability to discern & choose the right meds are matured enough so that pharm company info is redundant & not needed. Your decision making process with meds should be heavily evidenced based, and not based on "this is my favorite med". There is no such thing as a favorite med in my book. Any one of them are superior to the other given the right situation. (Its a pet peeve of mine to see a doctor, especially a psychiatrist just give out the same antidepressant, the same antipsychotic, the same mood stabilizer to every patient they see.) And I'll point out that several doctors I've seen who do the 1 med for everything approach appear to have been bought by the pharm companies or perhaps have a tinge of laziness or both.

If a new antipsychotic were to come out, yeah, I'd want see the pharm rep's presentation on the medication. It can be a good, basic & quick intro. I'd also then want to take that presentation, and read up what the journals & PDR has to say about it. Residents being exposed to pharm company representation should also be exposed to attendings & senior residents giving opposing views & possibly exposing exagerated claims. I also really wouldn't need to see a pharm presentation on a med more than once unless new data was presented. Its a clear sign of conflict of interest when reps meet doctors on the order of once a week--give an expensive meal & gifts to that doctor every week--that clearly is something over the line. Just what more is that doctor going to learn after having gone to 25 lunches with the same rep about the same medication?

One advantage I have at working at a psychiatric hospital is the pharmacists here are psychiatry specialized. I can go to the pharmacist & get someone with doctoral level knowledge more focused on the pharmacological aspects. I did not have that oppurtunity at the University & Community Medical Hospitals I worked at in residency.

 

[Tradewind]

...and if you're a resident psychiatrist worth his/her salt, by the time you reach the end of your 2nd year, you really should be getting to the point where your own ability to discern & choose the right meds are matured enough so that pharm company info is redundant & not needed.

I don't use pharma fliers to guide my medication choices, but I will read peer-reviewed articles I come across in lit searches.

When you say pharm company info, do you mean the pounds of fliers and DVD's they keep sneaking in my box? Or do you mean peer-reviewed original articles?

Some of these articles are challenging to appraise. Particularly when they account for the majority of a topic... eg, 'risperidone breasts.' Anyone know anything about Halbreich's work?

 

[whopper]

pharm company info

On occasion, they actually do get some good information across. I mentioned this in the past when this topic was brought up but Phil Resnick among several other great lecturers I've seen because of pharm company representation.

But allowing even some of the more gaudy & biased presentation (in a controlled & limited manner) to arm residents that are future attendings on the BS aspects of pharm advertising IMHO isn't a bad thing. Completely blocking the evils of pharm representation IMHO is like trying to create a guilded Siddartha world. New attendings exposed to the biased advertising of pharm companies, with no previous exposure? Sounds bad to me. Its going to happen, and residents should have some education & exposure to the evils it can cause.

peer-reviewed original articles?

Those are the best sources.

 

[michaelrack]

In scanning through articles on "risperidone breasts", I notice that Eli Lilly is cited on many of these papers. And not just in the conflict of interest section at the end, but as a primary affliliation for several of the authors. Since Lilly made Zyprexa, not Risperdal, there seems to be a conflict of interest. .

Zyprexa and Risperidone were among the first atypicals to come out, so Eli Lilly and Jannsen got in a war with each other. The 2 drug companies tried to emphasize the adverse effects of the other product.

 

[OldPsychDoc]

Zyprexa and Risperidone were among the first atypicals to come out, so Eli Lilly and Jannsen got in a war with each other. The 2 drug companies tried to emphasize the adverse effects of the other product.

Similar to the rash of CME on metabolic syndrome funded by Pfizer when Geodon was rolled out...and the arhythmia counterattack by Lilly. 🙄

 

[Tradewind]

Zyprexa and Risperidone were among the first atypicals to come out, so Eli Lilly and Jannsen got in a war with each other. The 2 drug companies tried to emphasize the adverse effects of the other product.

Similar to the rash of CME on metabolic syndrome funded by Pfizer when Geodon was rolled out...and the arhythmia counterattack by Lilly. 🙄

Yes, my point, exactly! We're swimming in it.

BTW, I saw the largest Risperdal breasts yesterday on a man, who was recently switched to Zyprexa. Since then, he has recently put on 30 pounds over 4 months. I hope his psychiatrists documented in their notes the possible adverse effects. But even more so, I feel for the patient. 🙁

Anyone ever see Halbreich give a lecture?