Sunday, March 25, 2018

Mental Health Medications: Common Unspoken Issues


Mental health meds. too often get a “bad rap.”  It’s definitely true that they have their problems, are used too hastily by some doctors, don’t solve everything, may cost too much and are promoted by an industry with questionable ethics, but they do offer significant help and relief to millions.  Ask those people to give-up their meds.  Go ahead!  It is also clearly true that these meds. should, most always, be used only in conjunction with other treatments. 
Here are a few points that way too often are not mentioned in discussions about MH meds. 
Most Primary-Care Physicians Have Inadequate MH Knowledge
  • PCP’s are the main prescribers of psych. meds. in the USA!
  • 2013 Study = 92% of PCP’s do not follow guidelines for MH eval. or treatment
Inadequate/Misdiagnosis
Due to any of the following:
  • Too limited/narrow an evaluation.
  • Failure to consider “Differential” diagnosis.
  • Failure to explore co-occurring conditions.
  • Inadequate pt. education, poor pt./dr. relationship, inadequate monitoring
  • Clinician resistance to certain diagnoses, e.g., ADHD or ASD in seniors
Inadequate Monitoring, Due to Clinician Shortages
  • Shortage of clinicians leads to insufficient time spent on monitoring meds.
Inadequate Monitoring, Due to Clinician Ignorance
  • About evidence-based matching of meds. with pt. symptom-profiles
  • About typical pt. experiences with specific meds.
  • Does-Response Method vs. mg/kg dosing for all psych. meds.
  • About nuances of dosing considerations with certain meds.
  • About meds. efficacy and side-effects
  • Resulting in prolonged use of ineffective meds.
Inadequate Patient Education Re Meds.
  • An aspect of all the above.
Failure to give sufficient consideration to additional/alternative treatments
  • Psychotherapy – CBT, Family
  • Pediatric OT – for kids with Sensory issues
  • Case Management for impaired seniors
Negative Propaganda
  • Over-emphasis on side-effects without preventive information
  • Over-focus on pharmaceutical industry profit-motive
  • Vilification of meds. as “drugs”
  • Minimizing symptom severity plus over-emphasizing pt. self-sufficiency
  • Emphasis on “natural” remedies without solid evidence
  • Outright denial of existing scientific evidence about MH conditions


           



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