Undiagnosed PTSD
Groundhog day in my consult clinic:
Pt has a history of either "depressionanxiety" or "bipolar".
I perform my evaluation.
Pt has textbook PTSD.
I discuss my findings with patient. Patient says something like "I've always suspected that but no one had ever [diagnosed me/confirmed that/talked to me about it]"
These are often satisfying visits because I can make a real difference (by getting them towards the right types of therapy and the right meds--including reducing antipsychotic use...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - May 19, 2023 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Board complaints
Another Sunday morning without tongue in cheek commentary today. We've had some threads here about patients filing frivolous board complaints. I am interested in hearing perspectives and experiences when you file a board complaint on another physician.
My service (CL) had a case come in this week that was egregious. It has been decided we will file a complaint with the medical board. For obvious reasons I will not get into specifics except to say that it involved more than just over...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - April 16, 2023 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Eating disorders in adults: what can we even do
I have no pithy comments for this week's conversation starter. Just frustration and frequent helplessness. I do CL and so of course see adult eating disorder patients in the hospital who are extremely ill. The adult hospital is not equipped to take care of them. I have seen some very bad outcomes.
These diseases have a very high mortality rate, but I wish I knew what the mortality rate would be if they actually got quality care (inpatient OR outpatient). I'm sure it would still be high but...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - April 9, 2023 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Seroquel--the worst antipsychotic?
People seemed to like my Sunday morning musings last week so here's another.
I dislike seroquel intensely. Which doesn't mean I don't use it. But, reasons I hate it--
1. Makes people fat. Recently was looking through data on metabolic effects and was shocked in the literature it's not shown to be one of the worst. My experience is people gain tons of weight.
2. Orthostatic hypotension. I do a lot of geri and CL, so seroquel is obviously often a theoretical first line for pts with...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - April 3, 2023 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Alpha blockade
I'm curious people's thoughts and experiences with alpha blockade in PTSD.
Obviously prazosin is used fairly frequently for nightmares. The research evidence is not exactly the strongest. My personal experience has been of two types: either the med doensnt do jack, or it is ****ing magical.
Not just prazosin, either--I had a patient recently who reacted poorly to prazosin so I tried guanfacine. It's been life-changing for them to not wake up every night reliving their trauma in their...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - March 26, 2023 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Malpractice insurance in private practice.
Am starting a small private practice next year in addition to my primary academic gig. Thoughts on specific companies? Notable good or bad experiences? (Source: Student Doctor Network)
Source: Student Doctor Network - March 9, 2023 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Roe v. Wade: implications for psychiatrists?
Recognizing that this topic is a lightning rod, I am interested in hearing people's thoughts on the implications today's ruling has for us as psychiatrists. Particularly from folks who were practicing prior to the original decision, currently practicing in places with extremely limited access to reproductive health care, and people working in CL settings.
Not interested in a debate about rights and wrongs of the law, but rather how this change may impact our clinical practice. (Source: Student Doctor Network)
Source: Student Doctor Network - June 24, 2022 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Droperidol is back
The ED docs are rapturous about it. Had my first pt get it for agitation in the ED a few weeks ago. Anyone have experience with it on the psychiatric side? Wondering if it has a place in agitation management of medical floor patients or psychiatric inpatients. (Source: Student Doctor Network)
Source: Student Doctor Network - February 1, 2022 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Antidepressants in patient with arrhythmias
I haven't found much data to suggest which medications might have the best safety profile, with the exception of recommendations to avoid TCAs and possibly celexa. I also see mirtazapine is associated with potential for slight increase in qtc, but nothing concrete in terms of guidelines. How would you handle a patient with history of arrhythmia on rate control? (Source: Student Doctor Network)
Source: Student Doctor Network - December 23, 2020 Category: Universities & Medical Training Authors: Psychresy Tags: Psychiatry Source Type: forums
New patient visits vs. return patient visits
Hi all,
I'm a resident in a large academic program. Many aspects of our outpatient clinics are frustrating to the residents, but one of the most immediate issues is that there doesn't seem to be a lot of thought put into how many new patients we should see vs. the amount of time we need for our return visits. We are a traditionally structured program, with outpatient starting third year. New PGY3s inherit patient panels from outgoing residents. The default schedule leads to more than 40% of...
New patient visits vs. return patient visits (Source: Student Doctor Network)
Source: Student Doctor Network - September 21, 2020 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Lamictal dosing for bipolar disorder
I was reviewing some information about a new patient I will be seeing in a couple of weeks, and was surprised to see that the patient reports taking 500 mg of Lamictal for bipolar disorder. Other current medications include Abilify 15 mg, Elavil 25 mg, Celexa 40 mg, and Adderall 10 mg.
I have several patients on Lamictal, and usually stop around 100-200 mg. I have taken it up to 250 mg on occasion, but I don't think I've ever prescribed higher than that and certainly not 500 mg. I...
Lamictal dosing for bipolar disorder (Source: Student Doctor Network)
Source: Student Doctor Network - July 17, 2019 Category: Universities & Medical Training Authors: SpongeBob DoctorPants Tags: Psychiatry Source Type: forums
celexa vs. lexapro: clinical questions
i know that lexapro (escitalopram) is the active isomer of celexa (citalopram) and that lexapro is dosed as being exactly twice as powerful as celexa. i've got a couple questions about their use.
1. are the drugs clinically interchangeable at the appropriate dose? can a patient be switched from 10mg lexapro to 20mg celexa without first titrating down the lexapro and titrating up the celexa?
2. clinically, do you guys notice any difference in side effects?
3. are there any...
celexa vs. lexapro: clinical questions (Source: Student Doctor Network)
Source: Student Doctor Network - January 28, 2018 Category: Universities & Medical Training Authors: stoic Source Type: forums
Back on Citalopram after 3-4 years...
Forum: Mental health
Posted By: Anonymous
Post Time: 25-08-2016 at 18:19 (Source: The Student Room)
Source: The Student Room - August 25, 2016 Category: Universities & Medical Training Source Type: forums
Venlafaxine, citalopram and escitalopram: risk of adverse cardiovascular effects and of overdose deaths.
(Source: BMJ Comments)
Source: BMJ Comments - April 2, 2016 Category: Journals (General) Source Type: forums
Citalopram side affects, help please.
Forum: Mental health
Posted By: amandar
Post Time: 20-12-2014 at 19:53 (Source: The Student Room)
Source: The Student Room - December 20, 2014 Category: Universities & Medical Training Source Type: forums
