Monday, October 08, 2007

My Three Shrinks Podcast 36: Just Do It

[35] . . . [36] . . . [37] . . . [All]

Folks, we have heard your requests for us to upgrade our sound quality. That is coming up, probably in Podcast #38. Yes, the Google Ads have paid only about 5% of the cost of the upgrade, but we may keep them on the site until they've hit $100, as I believe that is the minimum for a pay-out ($19.05 for September).

October 8, 2007: #36 Just Do It

Topics include:
  • Crisis in the Treatment of Incompetence to Proceed to Trial. In the recent Online AAPL Journal, an article by Wortzel about problems with assessing defendants who are not competent to stand trial and restoring them to competence. [hmm, wonder whose topic this one is] At any given time, these people occupy about 10% of our nation's state psychiatric hospital beds. A complicated discussion ensues about who pays for forensic mental health care and how the system results in decreasing access to care for uninsured non-forensic patients.

  • We respond to a question to the NYT Ethicist column, by Randy Cohen, which you can read here (as well as his answer). [Note: we last saw Randy when he stopped by to respond to a discussion about a previous column of his about suicidal people making wills.] The question involves whether it is okay for a physician, who is a psychiatrist, to prescribe a stimulant (Adderall) to his college kid for the purpose of improving test-taking performance. (We discussed the practice of treating family members in a prior post, My Patient, Myself.) A secondary question involves that kid sharing the medication with a friend. We also discuss the issue of using performance-enhancing amphetamines for non-illnesses, in addition to the potential for a performance-reducing effect due to side effects (which is also taken on my Gawker's Unethicist). (We also ask for help from any DEA agent listeners.)

  • Clink celebrates her 25th Running Anniversary. She's been just doing it for a quarter century.

  • Price Transparency for Psychotropic Drugs. Dinah discusses her post about the list of prices for antidepressants. Roy unsuccessfully looks for the prices of these drugs on the Maryland Medicaid website.

Coming up in Podcast #37... SSRI Poop-out (aka tachyphylaxis) and other good stuff. Oh, and here's a pic from my Vegas conference trip. Yummy!

Find show notes with links at: The address to send us your Q&A's is there, as well.

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Midwife with a Knife said...

Just the thought of deep fried twinkies make me nauseous. Haven't listened to the pod cast yet.

Anonymous said...

I look forward to the tachyphylaxis piece. It seems tough to develop a cause and effect here with existing data. One obvious place to start would be a longitudinal DMPK study (metabolic adaptation), but I haven't seen any such studies. Incomplete nosology probably also interferes with inference.

If we assume depression to be ecological, and that SSRIs improve a patient's disposition, writing this down to a worsening of the condition seems somewhat questionable. A placebo effect arising from the social experience of a doctor visit (many of these patients are truly isolated) might be a worthy hypothesis for some cases.

Still, I'd love to learn more about ad hoc treatment strategies for chronic cases.

Roy said...

*DMPK = drug metabolism, pharmacokinetic (I think)