tag:blogger.com,1999:blog-26666124.post7912825390608964729..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: I Have A Friend....Unknownnoreply@blogger.comBlogger14125tag:blogger.com,1999:blog-26666124.post-27630527648822630232008-09-14T19:41:00.000-04:002008-09-14T19:41:00.000-04:00Thanks, Clink, don't fall. And the blindfold is a...Thanks, Clink, don't fall. And the blindfold is a bit too kinky for the blog.<BR/><BR/>Anon: Life has it's quite frequent moments of transient uncomfortableness. Friend didn't seem distressed, so this was pretty minor. Thanks for the support.<BR/><BR/>TigerMom: I was expecting you to say something, thanks for not letting me down.<BR/><BR/>Still Dreaming: I talk too much to everyone.<BR/><BR/>TP: Thank you. I wonder if thyroid meds would make me lose weight.... Oh, and in private practice, I take 2 hours to do an evaluation and often still don't have the answer.<BR/><BR/>Nardilfan: ? can I take a swipe at "Flight of Ideas"..some form of thought disorder. "Loose associations," maybe?<BR/><BR/>Rach, You are absolutely right that the spur of the moment thing caught me off guard. The same day another friend asked me for help but that didn't make it to the blog because I didn't say anything stupid. Chocolate is always good.<BR/><BR/>Cancer Doc and Anon on Xanax: It remains a mystery to me why one medication (any med) can be so helpful to some and so harmful to others.<BR/><BR/>Novalis, I think kind of yes and no. If your friend had had a bad reaction to cipro, or if it hadn't cured her infection but had then made it impossible to get an accurate culture, you might be feeling like this wasn't as simple. I think I agree more with "S" that it's an issue in much of medicine-- friends ask for suggestions and to really understand a problem, you need to understand all sorts of personal things-- maybe it's Do You Have a History of Bipolar Disorder, or what other meds are you taking, or maybe it's questions about bowel or sexual habits...sometimes it's just a little uncomfortable.<BR/><BR/>Dr. Pink, Thanks but I still think I'll be more careful in the future about making medication suggestions without knowing someone's history...Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-76401689202002645452008-09-14T18:55:00.000-04:002008-09-14T18:55:00.000-04:00OK, I'm back and done looking for something to cli...OK, I'm back and done looking for something to climb. Just did a 30 foot technical 5.4 route blindfolded. (Really.) It was cool.<BR/><BR/>Now I've got reports to edit.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-15389331695174446572008-09-14T18:13:00.000-04:002008-09-14T18:13:00.000-04:00I just want to say that I have the same experience...I just want to say that I have the same experience as your friend with Xanax. None of the antidepressants are effective for anxiety for me, and I have a prn script for Xanax 0.25 mg twice daily. I take between 5 and 10 pills per month, and I have had a script for 30 pills last from 3 to 6 months at a time. I don't even necessarily take it weekly, but just when my anxiety begins to feel out of control. I find this very effective, and I certainly don't have any addiction problems. I have taken it like this for years with never a need or desire to increase the dose. It also works very well for me.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-68536814104852561102008-09-14T14:15:00.000-04:002008-09-14T14:15:00.000-04:00Dinah,In my opinion, you did nothing wrong. You w...Dinah,<BR/><BR/>In my opinion, you did nothing wrong. You were asked a question, and responded with an honest answer. To be disingenuous, or avoid the questions would have been equally inappropriate with a patient, or a friend. I always preface any sort of comment or advice with, "Because I know you personally, I can only comment on what I've observed..." This avoids the dual role issue for me. In any event, if honest, and passion about convictions are a character flaw, well then, maybe you're guilty of something. I respect and admire your sincerity and integrity.<BR/><BR/>On another note, this benzo thing has gotten out of hand. I often have new adjudications to my prison endorsing "racing thoughts", when it's really ruminative thought processes, so I can appreciate your observation regarding treating the appropriate symptom. Also, offering Xanax (alprazolam) as a front line of treatment, isn't, in my opinion the best option. I have found though, that with SSRI, or TCA therapy, if the patient is given the opportunity to have a small amount of Xanax to keep on hand, it can be helpful both PRN, and for anticipatory anxiety, if panic is involved. With other anxiety disorders, having a small ration of Xanax available can reduce anxiety, by affording the patient the peace of mind that if things get "out of hand", there is a fast acting option. I like prophylactic approaches like this.<BR/><BR/>This all being said, Xanax works very well in many instances where other options do not. Unfortunately, with psychiatrists, it's become for anxiety, what Oxycontin has for pain management; over-prescribed, and underutilized in appropriate instances.<BR/><BR/>A final thought. All this being said, the single best predictor of achieving and maintaining sobriety (in established addicts) is social support. How many psychiatrists actually assess this before prescribing a benzo? Granted, self-report is notoriously unreliable, but if your patient reported an intact, social support system, and no addictions (and there were no warning flags), would you be so hesitant to prescribe a benzo?Dr. Pink Freudhttps://www.blogger.com/profile/12090769288313695919noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-86533365890987521212008-09-14T09:02:00.000-04:002008-09-14T09:02:00.000-04:00I'm not sure this is specific to psychiatrists...i...I'm not sure this is specific to psychiatrists...it's all docs.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-34959461475455352672008-09-14T06:57:00.000-04:002008-09-14T06:57:00.000-04:00This is a good example of why psychiatry remains d...This is a good example of why psychiatry remains different from other specialties, and mental disorders different from straightforward medical ailments. Both the discipline and the disorders involve ambiguous and peculiarly private areas of human experience.<BR/><BR/>Not long ago a colleague asked if I would write her a few days of cipro for a bladder infection she had. I didn't hesitate to write it (she knew the symptoms and had taken cipro before). If she had asked for any psychiatric medication (not to mention Xanax), things would have been rather different.<BR/><BR/>So we remain "special," with all the pros and cons that entails.Novalishttps://www.blogger.com/profile/10501890494890617030noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-39547941390678314792008-09-14T06:27:00.000-04:002008-09-14T06:27:00.000-04:00I went to a medical school where we were taught th...I went to a medical school where we were taught that Xanax is the "work of the devil." That imprinted. Despite my field, I have a policy of referring people back to their primary prescriber for xanax refills because I don't want to be a part of that problem. I live in a community where Xanax is the anxiolytic of choice among the PCP's. There are a lot of addicted people as well as abuse of this drug in our community. Even when Xanax use comes up in the professional realm (and not the drive by social realm) it can create some awkwardness.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-28566196352635366212008-09-13T23:58:00.000-04:002008-09-13T23:58:00.000-04:00A dear friend of mine has a mother who is a genera...A dear friend of mine has a mother who is a general practitioner with a side specialty in something much more specialized and less practised... so we all bombard her with questions... but she puts a quota on how many questions we can ask! <BR/><BR/>But that's really very awkward, particularly in public and on the spur of the moment. <BR/>When in doubt, recommend chocolate? is that an option?Rachhttps://www.blogger.com/profile/11897760883997811787noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-72827298085349722362008-09-13T23:50:00.000-04:002008-09-13T23:50:00.000-04:00It seems to be a common phenomenon that the genera...It seems to be a common phenomenon that the general public gets hold of a technical medical term and uses it to mean something different, meaning that doctors have to find a different term for what they want to talk about. Maybe this needs to happen for "racing thoughts".<BR/><BR/>(I've occasionally wondered if there is a term for the symptom of multiple trains of thought all going on at the same time, to such an extent that the pt gets confused and becomes incapable of following all of them. It seems similar in some ways to the symptom of racing thoughts, but I've never come across it written down anywhere.)<BR/><BR/>The medicolegal implications of having friends and family while being medically qualified are just things that you have to live with, I think - you poor things :-)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-33002718582904964062008-09-13T23:17:00.000-04:002008-09-13T23:17:00.000-04:00I LOVE that you are so responsible. It's the way a...I LOVE that you are so responsible. It's the way all doctors ought to be. I think a short caveat that explains you'd need an hour to ask all the necessary questions before you'd REALLY know the right answer.<BR/><BR/>Meanwhile, many GP's out there prescribe psych drugs with carefree abandon and not a second thought about it. A female friend of mine (NOT ME!) has a GP who she bugged long enough about possibly being hypothyroid (because she's overweight in her eyes at 140lbs and 5'6") that he put her on 250 mcg of Levoxyl with no referral to an endocrinologist. I told her that my endocrinologist said the rule of thumb is 1 mcg per pound of body weight and she seemed possibly overprescribed but she loved the weight loss effects, but then she was overly anxious so he wrote a prescription for an anti-anxiety med which she LOVES. THAT verges on malpractice, having a social conversation with caveat attached does not in my opinion.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-69738700317982991292008-09-13T22:45:00.000-04:002008-09-13T22:45:00.000-04:00I think I give more advice to my friends then my c...I think I give more advice to my friends then my clients... With my clients, I want to listen, reflect, listen, reflect etc... have goals, move towards something, NOT offer advice, empower them, etc... With my friends, I don't have that responsibility. <BR/><BR/>I'm a social worker, so things of course are very different, but if a client asked me about xanax I would probably give them information about benzodiazipines in general, remind them I'm not a doctor or pharmacist, and help them get in touch with their own or with further sources of info. If my friend asked, I'd tell them not to take it, to look for something else. That their doctor was a nut job for prescribing it... that sort of thing. I'd tell them that I see people on a zillion different drugs in detox, but never that one.Awake and Dreaminghttps://www.blogger.com/profile/13257495492315814077noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-76586821148785246282008-09-13T21:37:00.000-04:002008-09-13T21:37:00.000-04:00Oh, I have so been there.Oh, I have so been there.Tigermomhttps://www.blogger.com/profile/15525962425980447155noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-5239073142688584212008-09-13T20:18:00.000-04:002008-09-13T20:18:00.000-04:00Ouch.Sorry you all have to experience that. It rea...Ouch.<BR/><BR/>Sorry you all have to experience that. It really does sound uncomfortable.<BR/><BR/>(There was more to this post, but I kept erasing and rewriting, and finally ended up with nothing.)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-4646067448118698162008-09-13T18:22:00.000-04:002008-09-13T18:22:00.000-04:00This is a great post that illustrates what happens...This is a great post that illustrates what happens when your friends, neighbors or relatives know you're a psychiatrist. It's that inward cringe that comes right after you hear the phrase "this is what my doctor is doing...what do you think?" It's hard to be supportive without offering advice, and to set boundaries without making the person feel that they're being blown off. I think this may be one of those situations where "I don't know" is the correct answer. <BR/><BR/>I'm trying to get a new computer but the Apple Store isn't returning my calls. How can they do that to a geek fan?ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.com