No Post Thursdays...

Too busy...

What's Going On

The school has begun. Auspiciously, I would say. We had a fairly thorough orientation for the younger students on Thursday and Friday, and for all the students on Monday and Tuesday. We had the first of our workshop series on Tuesday. Doctors Chris Caffery and Lauren Caffery presented some material on the relationship between breathing, posture, and cortex functioning. They are neuro-chiropractors, or more accurately, "Functional Neurologists" who approach rehabilitation as a brain function more than as the failure of a particular part of the body. Most of the students seemed to find it interesting. We will be posting material related to this later on.

Over the course of the school year we will be conducting workshops on hygiene, nutrition, sleep, brain function, emotional and physical development and, of course, study skills. This Friday our Ass't Principal and one of our senior students, Madeline Rublee (who was in an intensive program at Phillips Academy this summer) will be presenting that very subject to our students.

Stay tuned for news on the Parent's night, our full day of student workshops, and an overview of classes this term.

Proscribing Any Drug for Anything, Part Four Hundred Sixty

Oh boy. Here we go again. A study published online ahead of print at the Journal of Clinical Psychiatry notes that among Oregon Medicaid patients who received a prescription for an atypical antipsychotic:

• 52% had a depression diagnosis
• 34% had an anxiety diagnosis
• 15% had a PTSD diagnosis

But only 15% had a schizophrenia diagnosis and 27% had a bipolar diagnosis. So... the majority of atypical scripts were written off-label. Seroquel was the most frequently prescribed atypical, followed by Zyprexa, then Risperdal.

Doses less than what are typically given to treat schizhophrenia or bipolar disorder (subtherapeutic dosing) were quite common. As in 86% of Seroquel scripts were subtherapeutic, 59% of of Risperdal scripts, and 48% of Zyprexa prescriptions. Wait, am I calling for higher doses of these drugs? That doesn't sound like me at all, right? Don't worry, I haven't lost my mind (I think).

Here's the deal. The authors suspect that a lot of these low-dose prescriptions are being written to manage agitation and as sleep aids. The authors note that there are likely less expensive/more effective medications for such conditions. Not to sound too cavalier, but one could also recommend behavioral treatment to help with sleep as well. Nah, that's crazy talk -- not enough money to be made in that.

Primary care docs were more likely than psychiatrists to dish out low-dose antipsychotics. I guess that the Viva Zyprexa marketing blitz was a success after all. Thanks to Daniel Hartung and collagues for their study, which provides another insight into the wonderful world of atypical antipsychotics as a treatment for everything imaginable. Sorry to beat a dead horse with my zillionth post about the topic of atypicals, but isn't this getting just a teeny bit out of control?

I would say so. About six years ago one of our students was having a lot of difficulty sleeping. His mother took him to a psychiatrist. After a ten or fifteen minute "evaluation" the doctor proscribed Risperdal, which is a pretty big time anti-psychotic, and at that time, not often used for teenagers. When the mother told me this, I was astounded that such a powerful drug, that had been subjected to no safety studies regarding children, would even be considered.

This boy was a heavy smoker, a heavy pot smoker, lived in a emotionally chaotic home, ate terribly, and drank lots of soda. The good doctor apparently knew none of this. Or cared.

An Epidemic

I spent much of last night digesting a huge chunk of a procedure manual for the DSM-IV-tr, the "bible", as it were, of psychiatry. It was interesting, in an intellectual history sort of way, and some of it actually made some sense. Fortunately I am in the middle of a gigantic Erik Satie binge- hours and hours of that mad Frenchman's marvelous music- so that formed the soundtrack. Dark chocolate gave me the requisite umfph for gliding though "caffeine disorders" at about 1 in the morning. Then, distracted, I stumbled on this:

http://www.youtube.com/watch?v=RoppJOtRLe4

A parody, true. But not far from the state of things....