Spent today at a seminar on psychopharmicology given by a psychiatrist who specializes in child and adolescent disorders. The neurochem and neurophysiology was pretty basic and oversimplified, but the medication review was excellent. Not sure I found it enlightening though. Mostly I came to the conclusion that I had already arrived at, which is that we don't have a fucking clue what we're doing and much of our medication treatment for mental disorders is a crapshoot.
Now don't get me wrong, I do think medication can be helpful in many cases, and vital in others, but we're still so woefully unclear on how the brain works, even when it's working right, that it's hard to know what is going to happen when we add a complicated disorder in an even more complicated human being!
Take home lesson? SRIs (Yes, I left the first S off on purpose because they are not very selective after all) seem to work for most any DSM disorder you can name and are much less likely to make you twitch or fall down than most other psychoactive meds. Of course there is that little issue of heart attacks, but not too often really, and there are lots of flavors to choose from!
It was refreshing though, to hear a psychiatrist say:
1) We need more collaboration in treatment among various specialties in mental health and medicine and a whole lot less contributions from insurance companies on how to provide care
2) Medication ALWAYS needs to be accompanied by some sort of psychotherapy and/or supportive care and monitoring -he went as far as to say it is doubtful that medication alone ever effectively treats anything since it involves the treatment of symptoms and does not address the causal issue.
3) Prescribing psychoactive meds needs to be limited to those who have training in the field. I.e. NOT primary care physicians, pediatricians, dermatologists etc. (No discussion of psychologists prescribing came up, but it's not legal in this state yet and most of the attendees were masters level)
4) Handing out psychiatric medications to kids like candy is a very bad idea, particularly considering there is no research on these meds in children so ALL prescribing is done off label based on adult data.
5) And this one is important to consider in light of #4: Mental disorders in children often look radically different than the same disorders in adults.
It was interesting to learn that there is a big flurry of research being done into the intrauterine effects of drug use by pregnant women on the development of fetal brains. One place that the presenter mentioned was the Center for Behavioral Teratology at San Diego State University (not surprising, as he is from San Diego)
I have heard from many professionals in the field that there seems to be a new syndrome developing in children that they are theorizing is a direct result of methamphetamine use during pregnancy. It is being theorized that many kids who look ADHD and BiPolar are actually suffering from neurological damage from their mothers' drug use. Impulsivity, aggression and mood lability are the primary symptoms. The sudden rash of these problems in adolescents corresponds with the dramatic increase in meth use beginning in the early 1990s. Children born then are now in their teens. What's scary is that meth use has not decreased significantly since then, so if there really is this kind of effect going on, then it is going to continue until the trend stops.
So good questions to ask, assuming there is some equivalent to fetal alcohol syndrome but involving meth are:
*Will medications used to treat impulsivity, mood lability and aggression work in this population?
*Are these individuals likely to benefit from psychotherapy, and if so, what types?
*Would very early intervention, like at birth, ameliorate some of the (alleged) brain damage? So that is, can the brain recover via plasticity if we provide intensive family intervention with parenting classes and specific therapeutic approaches for the child?
Lots of fodder for study here, and upsetting as this trend may be, lots of hope too! Once you understand there is a problem and know a little about the etiology then you can begin to find answers!
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3 comments:
What an interesting talk that would have been! A lot of people seem to forget that children are not little adults and react so much differently to medication.
And I think you're right...med treatment is really a crapshoot. If one thing doesn't work, try another, add something else, take this away...and on and on, trying to find the perfect solution for each patient. I'm sure a large part of it is that we really don't know exactly how the meds work, just that studies show that Medication X seems to help those with depression, so it might help others.
About the RxP thing...I am not sure at all if psychologists should be allowed to prescribe, but I would hope that the learning involved in the possibility be available to all psychologists. Since there are so many patients that take meds concurrently with therapy, a psychologist really should know all they can about the meds. That means more education, not just the words from a drug rep or a drug company seminar.
The ongoing problems associated with meth use/abuse are just scary.
I agree about meds being a crapshoot myself!! I feel like they are profusely over used. It is like, "Oh sleep problems? Here try this, this and this." If you one of those weird people that want to try an alternative to the drugs people don't understand. I am pretty amped up on this topic because I myself am going through this exact scenario. I think drugs should be the VERY last resort.
I think it is vital that a psychologist be "in the know" about what kind of medications are out there. They should implement that in the workshops they make them go to every year.. what is it called continuous education or something like that?
I hope you are feeling better.
Oh, you both have great new pictures to look at. How fun!
On prescription rights... if psychiatrists were readily available and reasonably priced, AND the only sort of MD allowed to prescribe psychoactive meds then I would be fine with that. My gripe is that most psychiatric meds are prescribed by other sorts of MDs who have no specialized training in psychopharmicology or neurophysiology and are unlikely to have any idea at all about the need for concurrent therapy and no means to monitor their patients. (And while I'm on that topic, I'd love to know why there is no legislation to guide MDs about staying within their scope of practice/competency) Unless that changes significantly then I can only see prescription privileges for properly trained psychologists as a boon.
Nurse practitioners, physician's assistants, dentists, podiatrists and optometrists all prescribe medication and none have MDs. Since any Psychologist who wants to prescribe must go through a rigorous program with specific medical training about neuroanatomy, physiology, toxicology and pharmacology I don't see how that differs from any of these other professions that prescribe under the supervision of an MD.
The pilot program enacted by the military had excellent outcomes with less medication prescribed and no harm done to any clients, plus it is now legal in three states and I have yet to hear any disastrous results being reported.
If this is needed anywhere, I think it is needed in CA where the cost of everything is so high.
I want to go through the post doc certification program (which would make me about retirement age by the time I finished all my schooling), but I'm not sure I'd want to prescribe even if it was legal in my state. I agree with both of you that it is critical that psychologists be thoroughly trained in this area and that it be included in their continuing ed. (and it is NOT included in the CEU requirements for any MD except psychiatrists, btw)
Oh my.. I've gone off again. LOL! Well it's MY blog, so there!
Thanks for the interesting comments!
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