- Joined
- Jan 1, 2018
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- 36
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I have a client prototypical of my clients in early meth remission. a lot of meth in my city and we work in collaboration with an addiction treatment program at an FQHC. This client is a 35 year old who was placed on Rexulti (not by me) in an acute psych setting just around the same time he got sober from meth 6 months ago. No other hx of mental health dx except probably depression, anxiety, with prominent irritability (but also meth). Had been using meth for decades. Brief periods of sobriety with no mania or psychosis apart from meth. Hx of psychosis involves "seeing shadows" (typical of meth users). No negative symptoms. No hx of aggression or violence. I took him off Rexulti around 3 mos sober and put him on Zoloft via a slow cross taper and told him to call with any uncomfortable changes in symptoms. Was this too risky of a move too early in knowing him- probably was 4th session? My main motivator was his treatment resistant EPS (didn't respond to amantadine or cogentin) which led me to think maybe we could get away without an antipsychotic. Now he's doing well but I'm in this malpractice prevention lecture and they're like- be super careful taking patients off antipsychotics! I probably should have been more careful getting past records or collateral before making this change? Thoughts?