Posted by desolationrower on October 8, 2008, at 23:55:06
In reply to fellow armchair psychiatrists, look at our peers, posted by desolationrower on October 8, 2008, at 23:29:25
On the first patient, i prescribed nortriptyline. sounds like pretty classic endogenous depression. Somehow she is supposed to be "treatment resistant" because two sris didn't help here?!? wtf. I guess the point of this CME is to learn to prescribe 'augmenting agents' which just means antispychotics. >:(
Results say:
Therapies
* 2% of peers prescribed nortriptyline
* 70% of peers prescribed at least 2 of the Antidepressant Augmentation Meds.
* 29% of peers prescribed at least 1 of the Antipsychotics - Second Generation.
Ok second guy:
It wants you to check the blood alcohol level right there? He drinks when he's depressed and binges on the weekends - and that was before he sobered up. he never was drinking on the job. i got docked points for that. Then, I prescribed mirtazapine. but look how other people prescribed:
Therapies
* 10% of peers prescribed mirtazapine
* 79% of peers prescribed venlafaxine
* 10% of peers prescribed mirtazapine
* 22% of peers prescribed at least 1 of the Antipsychotics - Second Generation.2x as many people thought a neuroletic was the best choice as adding mirt?? actually the antipsych have some benefit here, in that when they work, its usually quickly. But so does mirtazapine, and its just a better drug, espcially considering he can't sleep or eat. It even notes: "Optional therapy: For this patient, it may have been appropriate to order at least 1 of the Antipsychotics - Second Generation.
A good augmentation strategy would be to add an atypical (second generation) antipsychotic to the patient's current regimen. This might work more rapidly than adding a second antidepressant."
the other thing, this guy needs to stay on an antidepressant as a prophylactic. no consistancy at all.Ok, third girl. I actually went with mirtazapine again, this time with pregabalin. i almost wanted to give her an maoi to take care of the depression (been depressed for 2 decades? ouch.), but old people are frail and she has trouble sleeping, which is bad for fibro. only thing to watch woudl be weight gain. She's the first that actually sounds like treatment-resistant depression. but most people didn't prescribe an augmentation. look at the numbers:
# 2% of peers prescribed mirtazapine
# 3% of peers prescribed pregabalin
# 38% of peers prescribed at least 2 of the Antidepressant Augmentation Meds.
# 17% of peers prescribed at least 1 of the Antipsychotics - Second Generation.
# 21% of peers prescribed at least 1 of the Analgesic Antidepressants.
What. I missed that the sim thing let you do a consulrt for sleep apnea. That is a good idea. and nutrional consult def. i really wonder if some post-partum depression has to do with omega-3 depletion. but why is noone prescribing something for her pain? or are they prescribing opioids? i think the sim wants you to prescribe duloxetine, which isn't a terrible choice, but still. and why was her retard doctor giving her higher, lower, etc. dosages of a drug that wasn't helping her? girl needs her sleep.overall, way too many antipsychotics. i was a little surprised the guy wasn't bipolar on the questionaire. but many of these treatemnts strategies taht they are supposed to be learning from this aren't even optimal strategies. i'm really surprised at it. no wonder its hard to get good treatment.
-d/r
poster:desolationrower
thread:856521
URL: http://www.dr-bob.org/babble/20081006/msgs/856529.html