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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by desolationrower on October 8, 2008, at 23:29:25
If you are signed up at medscape.com (free signup), look at the 'therapeutic simulator' page. You are given three patients, and can run tests on thm, diagnos, and prescribe. I'd like to talk about what it suggests and what the other people taking it (mostly psychiatrists, i presume) suggest. I'll post my answers in the second comment, so you can go look at with without any spoilers!
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
Posted by Phillipa on October 9, 2008, at 0:46:00
In reply to fellow armchair psychiatrists, look at our peers, posted by desolationrower on October 8, 2008, at 23:29:25
Well signed up went in and can't find the page you're at did search too. Phillipa signed as my profession RN does that make a different?
Posted by desolationrower on October 9, 2008, at 0:52:59
In reply to Re: fellow armchair psychiatrists, look at our peers » desolationrower, posted by Phillipa on October 9, 2008, at 0:46:00
Oh wow i forgot the link! I wish i could edit posts. Here it is:
"Challenging Presentations in Major Depressive Disorder"
http://www.medscape.com/viewprogram/17371I don't think you need to be registered as anything in particular to take it, just if you want to get the CME credit.
-d/r
Posted by yxibow on October 9, 2008, at 0:57:10
In reply to Re: fellow armchair psychiatrists, look at our peers » desolationrower, posted by Phillipa on October 9, 2008, at 0:46:00
> Well signed up went in and can't find the page you're at did search too. Phillipa signed as my profession RN does that make a different?
It only makes a difference as to whether you check boxes for emails and what sort of home page you may see.
Yes, I have used the site as it is free (emedicine/WebMD/Medscape -- they are linked), and has peer reviewed articles rather than just pages searched on Google which seem to be heavy on trying to sell something.
The detailed articles on eMedicine subscribe to the HON code (Health on The Net Foundation) which is a sign of a more reliable source. Of course even one study doesn't necessarily mean that another could also be valid, but the write-ups are pretty technical, diagnostic, and clinical, as they should be since they are primarily directed at the medical community.I believe there is a signup option to the effect of "of medical interest" or something identifying someone of a non practitioner. I don't think it makes a difference, but I can't say.
-- Jay
Posted by Hygieia's Bowl on October 9, 2008, at 5:56:09
In reply to fellow armchair psychiatrists, look at our peers, posted by desolationrower on October 8, 2008, at 23:29:25
I recall the day when playing doctor meant something else entirely.
I probably learned more then and, even with a foggy recall, I believe it was more fun.... : )
Posted by Phillipa on October 9, 2008, at 12:31:06
In reply to fellow armchair psychiatrists, look at our peers 2, posted by desolationrower on October 8, 2008, at 23:55:06
I read it and quite frankly you're right no wonder it's difficult if not impossible to get proper care. And the use of antipsychotics for all three was not right to me. And since when do nurses and pharmacists get credits for diagnosing and prescribing for patients? That is what docs are for. And the patients to me were like numbers. No wonder the 10minute visits for meds? Didn't used to be this way at all. Now this is just my opinion and this was depressing for me. Phillipa
Posted by Phillipa on October 9, 2008, at 19:17:09
In reply to Re: fellow armchair psychiatrists, look at our peers » Phillipa, posted by yxibow on October 9, 2008, at 0:57:10
Jay I get daily newsletters from webmd as that is the one my internist said he likes. I noticed at the top that there were a few sites connected webmd being one. Love Phillipa
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