Sodium Amytal Interview

[Merovinge]

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Just got asked by an employer about why I am not applying for Na Amytal interview privileges. Anyone have literature on this? It's so far outside of what I think of as psychiatric practice but don't have any literature to cite.

 

[wolfvgang22]

Did you tell them no because it doesn't work?

 

[WisNeuro]

Where is this job at? 1954?

 

[splik]

why arent you applying for narcosynthesis privileges? you can still bill for it - it has its own CPT code 🙂 also it does work, it is just not usually necessary. it is part of the toolkit of any discerning neuropsychiatrist.

 

[Merovinge]

why arent you applying for narcosynthesis privileges? you can still bill for it - it has its own CPT code 🙂 also it does work, it is just not usually necessary. it is part of the toolkit of any discerning neuropsychiatrist.

Well first, I am not a neuropsychiatrist. I wish I was somedays, and have the utmost respect for the field, but alas I found out I was better at talking to 13 year olds then reading MRIs. I have heard conflictual reports on the evidence basis for it (by different neuropsychiatrists) but was generally under the impression this was not something done in med/surg hospitals. Do you have any citations I should familiarize myself with?

The reality is that there is no way I would be comfortable performing a procedure I have never even heard of someone doing but I would like to be reasonably informed when I respond. Plus it's truth serum, even if much of the hype didn't pan out, it's still a pretty cool thing to talk about at parties.

 

[nitemagi]

Most of the citations I've read on it are from the 70s. I remember discussing it with my old chairman to approach a refractory conversion disorder case.

 

[clausewitz2]

I mean, in some respects it sort of anticipates the current push in some circles towards MDMA or psilocybin assisted therapy, no?

 

[splik]

I mean, in some respects it sort of anticipates the current push in some circles towards MDMA or psilocybin assisted therapy, no?

well MDMA and psilocybin facilitated therapy are not new and were also investigated as "truth serums" as part of MK ULTRA.

in terms of amytal interviewing nowadays I have a protocol somewhere, but in practice no psychiatrist should be administering IV barbiturates these days. What we do is put them on the ECT list and have the anesthesiologist administer the barbiturate (brevital works just as well).

Personally I would do hypnosis as first line but in some cases (for example dissociative amnesia) it could be helpful. Be careful re: severe abreaction tho.

 

[SpinDktr]

I have never done an amytal interview, but I did come across a case on a consult at the hospital which was interesting recently. It was an elderly, partially mute schizophrenic and they were trying to determine capacity for decision making. His outpatient psychiatrist said he responded well to benzodiazepines although they weren't frequently prescribed. I have an interest in hypnosis, but I am a recent graduate doing med management, so I really don't get to practice it. Anyway, I recommended they give him some lorazepam, and used some of the additional hypnosis training on an elective I did in residency. It was personally rewarding; really got him to open up in a very unique way.

At the end of the day, it really didn't actually change the decision making. He was more talkative for sure, but he really still wasn't decisional, so the question was actually pretty easy to answer. Benzos are safer and more readily available, and I don't think amytal would have provided any more information than I was able to get anyway.

 

[clausewitz2]

well MDMA and psilocybin facilitated therapy are not new and were also investigated as "truth serums" as part of MK ULTRA.

in terms of amytal interviewing nowadays I have a protocol somewhere, but in practice no psychiatrist should be administering IV barbiturates these days. What we do is put them on the ECT list and have the anesthesiologist administer the barbiturate (brevital works just as well).

Personally I would do hypnosis as first line but in some cases (for example dissociative amnesia) it could be helpful. Be careful re: severe abreaction tho.

Sure, new only in the sense that there is a non-trivial chance they will be legal again in the next ten years and are becoming fashionable once more.

Do you have any suggestions for resources re:hypnosis for someone who is interested but has minimal knowledge? Where should I start investigating this?

 

[splik]

Sure, new only in the sense that there is a non-trivial chance they will be legal again in the next ten years and are becoming fashionable once more.

Do you have any suggestions for resources re:hypnosis for someone who is interested but has minimal knowledge? Where should I start investigating this?

The American Society of Clinical Hypnosis, the Society of Clinical and Experimental Hypnosis, The Milton Erickson Foundation, Michael Yapko's 100 hour clinical hypnosis training, or you could attend the International Society of Hypnosis's triennial meeting in Montreal this summer. If training is not available through your training program I would encourage you to seek formal training especially if you still have an interest in somatoform disorders

 

[nitemagi]

The American Society of Clinical Hypnosis, the Society of Clinical and Experimental Hypnosis, The Milton Erickson Foundation, Michael Yapko's 100 hour clinical hypnosis training, or you could attend the International Society of Hypnosis's triennial meeting in Montreal this summer. If training is not available through your training program I would encourage you to seek formal training especially if you still have an interest in somatoform disorders

Look for ASCH or SCEH approved trainings. ME foundation is included in that. I'm an ASCH approved consultant, and after training in over 7 therapies think it's the most underutilized psychotherapy intervention there is.

 

[NickNaylor]

Now I’m looking at workshop schedules...

 

[deleted343839]

The ASCH trainings are good though some presenters/trainers are stronger than others. If you know someone who is active kn the field it’s worth asking them to take a look at the roster for a given workshop.

Both the SCEH and ASCH national meetings have scientific sessions, but my impression has been that SCEH is stronger in this respect.

 

[Armadillos]

Just got asked by an employer about why I am not applying for Na Amytal interview privileges. Anyone have literature on this? It's so far outside of what I think of as psychiatric practice but don't have any literature to cite.

Do you work at Hopkins/Shepherd Pratt, seem to remember meeting someone at a conference who made it sound like barbiturate interviews are still used at one of those places

 

[WingedOx]

Now I’m looking at workshop schedules...

If you need a grand rounds speaker on the topic, I know just the person to ask.

 

[whopper]

1-There is data showing it does work.
2-Despite the above the accuracy of it is no where close to 100%. In fact except for psychosomatic illness I've seen no clinical need to use this approach. Even then I don't know if I'd do it because it's not a safe procedure in general. I don't even see a use for it in cases where the "truth" needs to be found such as some type of military intel case (we psychiatrists aren't supposed to go there anyways) cause if the subject told you something there's no way to verify it as the truth.
3-A landmark forensic psychiatry case arose where an Amityal interview was inappropriately done.
Father Wins Suit in 'False Memory' Case

In this case the psychiatrist who did the interview falsely told the patient the "truth serum" is 100% accurate leading her to believe she was molested by her father during the delirium caused by the "truth" serum. During that time she was under coercion from her therapist who was already convinced it happened without any solid proof, that her father molested her.

The same psychiatrist, I googled his name, out of curiosity and saw his contact information and also saw he was still practicing. I had an immediate impulse to contact him and tell him he ticked me off and he was a disgrace to the profession.