Wednesday, November 30, 2022

Comments by vaurien

Showing 7 of 7 comments.

  • Psychiatry indeed sought legitimacy from mainstream medicine by trying to redefine emotional disorders as biological. This move was successful, but has come home to roost. There are fewer and fewer graduates of medical schools who want to become psychiatrists. There are fewer and fewer psychiatrists – try to find one if you need one – you’ll be surprised, they are disappearing. The lack of sense of mission and the devaluation of the training in the psychological aspects are partly to blame. The prostitution of all of medicine by insurance companies, big pharma and hospital executives play a bigger part.

    So who do you find in the trenches today? NP’s.

    All these issues are very complex and determined by powerful economic forces that determine outcomes behind the scenes. Focusing on psychiatrists as drug pushers is chasing ghosts, specifically ghosts from the 60’s-70’s.

  • You are responding to exactly one sentence from my comment, which is mostly about who treats insomnia. However, if we focus on the issue of who wants to taper up or down, my experience is indeed very different.

    1) Psychiatric inpatient units: psychiatrists are pressured to kick the patients out ASAP so that hospital administrators can win their beauty contests of “decreasing length of stay”. Insurance companies call daily to approve every day and if you did not raise doses you did “nothing” – case denied. So in inpatients settings, yes, psychiatrists push doses up.

    2) Adult outpatient settings: psychiatrists often have to fight with patients demanding controlled substances, usually benzo’s and stimulants for self-diagnosed ADHD (this is an epidemic). Patients also demand to have other meds increased, it’s nearly impossible for psychiatrists to push doses up – patients go home and take whatever they want.

    3) Community outpatient settings for Developmentally Disabled adults: here you have an army of group home counselors, various therapists and anguished family members who practically lynch you if you don’t get the patient’s behavior “under control”. I left one such clinic because I would not budge an inch in these wars and refused to sign off on established cocktails from hell. We were 4 psychiatrists, 2 of us had the same careful attitude, 2 did not, one of them left as well.

    4) Nursing homes: I have treated literally thousands of patients in nursing homes. They come from hospitals where the MD’s from various specialties want them sedated, so they drug them with psychotropics. These are not allowed in nursing homes and psychiatrists are mandated to taper them down every 3 months, and not prescribe anti-psychotics in cases of dementia (black box warning). Here you have the battered nurses the agitated patients assault and administrators gang up on you to prescribe meds to sedate patients instead of hiring more staff and give them competitive salaries, but nursing homes are closely monitored and this show doesn’t go very far, or the facility gets a citation.

    You have experience with youth. I don’t treat kids. Child psychiatrists are disappearing, if you need one you are not likely to find any. The idea of prescribing psychotropics to minors feels me with horror, it’s quackery.

  • Insomnia is treated by primary care physicians and as a secondary diagnosis by other specialties, not by psychiatrists. Most psychotropics (like 90%) are prescribed by non-psychiatric practitioners because of the stigma of being treated by psychiatrists. These non-psychiatric practitioners sometimes go overboard, I’ve seen crazy excesses. Patients would not refer themselves to psychiatrists for insomnia and psychiatrists would not get referrals or accept patients with a primary diagnosis of insomnia. Most psychiatrists in community settings find themselves struggling to taper patients off from unnecessarily prescribed psychotropics. The pharmaceutic medical-industrial complex does a good job of persuading clinicians that these meds are harmless magic-cures. Psychiatrists are more jaded.

  • I am not going to be baited.

    Regarding being shocked – seriously? Nothing would shock me, every imaginable insanity is perpetrated by some MD’s. It wouldn’t shock me to hear of an MD’s who infect their patients intentionally with HIV or murder and eat them. But prescribing these meds at these doses for insomnia is less and worse than stupid; and I have not heard of even psychopathic lunatic MD’s who are that stupid. It’s no different than performing brain surgery for insomnia.

  • Because of the nature of my work I see 160 patients a week for years. I have never heard of anyone prescribing seroquel 400, 600 or 800 mg, and/or zyprexa 20 mg, and/or ambien 20 mg (???) for insomnia. Most cases of psychopathic prescribing I’ve seen (many MD’s will prescribe you anything you ask for money) involve benzo’s, opioids and amphetamins. Some MD’s are simply drug dealers, but these doses of antipsychotics for insomnia – no, not even in rural communities with crazy solo practitioners. I’ve reviewed malpractice suits and medical license forfeiture cases in NY state – never heard of such a scenario. If such a patient gets to a second psychiatrist it’s difficult to believe the second one will continue this bizarre practice. I will be surprised if this comment gets approved.

  • I’ve been a psychiatrist for 37 years. Any MD who prescribes an anti-psychotic for insomnia is out of their mind. I refuse to prescribe anything for insomnia because in my experience nothing works without a price to pay in the long term, except for 2 pills of CalmAid, a German lavender extract you can buy on Amazon – no one know if it is safe, though.