Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Saturday, October 24, 2015
What I'm Learning at the MGH Psychopharm Conference, Continued
Moving right alone here, but I'm now many lectures behind. I'll do my best:
Dr. Jenike on Obsessive Compulsive Disorder
"It's almost unheard of to have a patient get all better."
~SSRI's are the usual medication, often at higher doses than used to treat depression.
~Cognitive Behavioral therapy is the best augmenter.
~MAOIs may help with OCD with panic attacks.
~Lots of other stuff has been tried including Dilantin, Neurontin, morphine, Zofran, pindolol, tramadol St. John's Wort, inositol.
~Glutamate may be involved in OCD and medications that effect glutamate have shown some promise, Including Namenda (memantine), riluzole (a medicine used to treat ALS), and N-Acetylcysteine
~In sudden onset of OCD, consider infectious etiologies, including PANDAS (Google it)
Dr. Simon on PTSD
~propranolol doesn't seem to prevent PTSD (sorry, Roy)
~People who get opiates may be less traumatized -- better pain control likely
~steroids may have some some role in preventing PTSD if administered soon after a trauma
~Don't use benzos for PTSD, they interfere with extinction learning and ultimately make PTSD worse.
~Don't use benzos for PTSD.
~Prazosin helps with nightmares. Lunesta may help with insomnia
~SSRIs help, but not a lot. Risperidone and quietiapine may be helpful, there is not enough data to say much about other antipsychotics.
~There's not enough data to support that smoking marijuana is helpful.
~We need more research.
Dr. Zakhary on OCD-related disorders: Body dysmorphic disorder, trichotillomania (hair pulling), skin picking and hoarding
~There are no FDA approved medications to treat these disorders. Check out http://Trich.org
~People with body dysmorphic disorder can spend up to 8 hours/day looking in the mirror.
~SSRIs may help. There is no indication for using an antipsychotic even if the patient is delusional.
~Tricotillophagia is the name for eating the hair after it's been pulled out. You learn something new every day.
~N-acetylcysteine may be helpful (NAC), dose of 1200mg -2400mg/day. Brand names Jarrow or Swanson, and you can get it from Amazon. Swanson is cheaper.
~Also Naltrexone at 50-100mg, or Olanzapine, 10mg/d
~For skin picking: SSRIs may help. Olanzapine 5mg/d, Abilify 5-10mg/d, Lithium, or Milk Thistle. It's all case reports.
~An itch workup should be done.
~Hoarding: medications studies are inconsistent and very limited. CBT!
So, I've gotten you to 5:15 yesterday. I went to sessions on Sleep Disorders (avoid meds, refer for >CBT!, and apparently trazadone doesn't work) and Natural medications for psychiatric disorders at night, and then dinner at a wonderful French restaurant on Newbury Street with a friend. It made for a late night, and it all started over this morning with more to come tonight, and all day tomorrow.
Thanks for listening.
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Note: Im a patient and not a medical professional. :)
Wow. very fascinating! So, are benzos good for anything? From reading your blog of the last few months (including past posts and those wonderful podcasts I wish you'd continue), benzos sound terrible. So when would an appropriate use for them be? It reminds me when I was 16 (Im 33) and a doctor in the ED prescribed me xanax because I was having anxiety in school ( i was there for something else). I took one pill and it didnt do anything for me so I never took them again. Holy crap am I glad I did that!
Anyway, I love these posts. Hope you get to post more!
As for your post on criticism from drive-by-commenters and those criticizing you for being insensitive or whatever: Bah! I love this blog and check it daily. Haters gonna hate! I get a lot out of this blog and hope you continue it. It's hard to find quality and reliable writing on the internet regarding psychiatry.
@bluejonah, It's pretty well established that benzos aren't good for PTSD. In my opinion, though, they're overly demonized of late. The best use of a benzo is an occasional time-limited situation that brings anxiety, e.g., an airplane flight. Even if the anxiety arises in everyday life, I see little to worry about if the med is taken once or twice a week, or less. Problems arise when this slides into daily use, at which point tolerance and dependence may occur. (And I'm not a child psychiatrist, but I'd be much more hesitant about giving them to a 16 year old.) Given that benzos are safer than most of our other psych meds, I think we should distinguish meds like benzos with some potential drawbacks, versus those that commonly cause serious side-effects, like mood stabilizers and neuroleptics. (Common antidepressants are in between, in my opinion.) Like everything else in medicine, there are risks and benefits to weigh.
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