Psychiatric Care Is Not Effective
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- Опубликовано: 12 июн 2024
- Psychiatric Care in Ineffective
At least when we are talking about depressed acutely suicidal patients. We know that the method of committing someone to an inpatient facility, setting an arbitrary length of stay, and starting the standard medications does not work.
We do have some evidence-based methods, but they are currently not used or used infrequently.
We are talking about eskatamine Spravoto and ECT. Eskatmaine was approved in 2020 for MDD with acute suicidal ideation or behavior. Why isn’t it used. I’ve asked the same question on my unit, and it seems that there is no payment structure in place for delivering the treatment on an inpatient basis. We are withholding a potentially lifesaving treatment because of money.
ECT on the other had is sometimes done and I do many of those treatments myself. However, most patients who would benefit are not interested. Stigma and barriers such as transportation prevent people for trying this life saving treatment.
We do have treatments that work and we are clearly not doing them but for two very different reasons.
You forgot to mention Lithium. It removes suicidal urges. It works well for my Major Depression with suicidal thoughts and behaviours.
Perhaps the stigma is because it ruins lives.
I dislike how many health instututions aim to save money by focusing on the short term and not long term treatment effects and how they relate to the patient's quality of life.
Great information! Depression and suicidal thoughts are serious mental health concerns that require appropriate and timely intervention. Acutely suicidal patients often require immediate, intensive care to ensure their safety and stabilize their mental health. It's a shame that new lifesaving treatment which was approved, isn't used because of money. Many thanks for the very helpful video Dr. Garrett! 🙌❤👍
Doctor, we don't have strong evidence for hospitalization (involuntary or otherwise), but the simple fact remains we are giving folks a chance to opportunities and social support that they may not otherwise have. I've seen patients have 1 or 2 meaningful chats with the aides / techs and even the lowly entry level workers were able to connect and build confidence and give some glimmer of hope. Safety planning is also extremely effective, and everyone should be dc with one of those.
Insurance and money are the biggest road blocks to getting treatment. I have a low cost way to treat certain Cluster B Personality Disorders and certain instances of PTSD permanently using a therapy method I discovered about 7 years ago. Sadly I do not have the social/academic/financial clout to publish a research paper on it. I feel like I caught lightning in a bottle.
You need to change the title of this bc its harmful to people in need of care. I worked inpatient on a locked psychiatric unit for 10 years and am now a psych np for 11 years. The benefit of inpatient care is rapid med changes with 24 hour support to aid in side effects or withdrawal symptoms med changes and acute symptoms, group therapy, individual psychiatric care daily, individual therapy daily and nursing and mental health worker contact and support 24/7 . Not to mention having an individual social worker assigned to assist with your specific aftercare needs. There is huge stigma around mental health care period.. let alone being inpatient. Inpatient care has helped millions of pts in desperate times . Ive seen it daily and would never have pursued my psych aprn if that wasnt the case. Ect is helpful for some pts. I was thrilled when esketamine came out but like you said its not being used.
Interesting video, I can understand why patients might be reluctant to have ECT, given what it involves, as a patient myself and a psychiatrist. I’m fascinated as to why ECT is so effective, which no doubt it is, I think our only understanding is that it causes release of serotonin/dopamine/noradrenaline, or maybe our understanding has improved & I’m not aware. Seems to me that medication should be tried first, including usual choices for depression & then stimulants in case of undiagnosed adhd underlying depression, emotional dysregulation and impulsivity. Then ketamine. Then ECT as final option, given risks for memory/cognition. I agree lithium is an option but it’s not good for long term physical health, same with atypical antipsychotics.
Hello Dr. Rossi, can you please make a video on Tianeptine?... it's in the TCA class of medications but doesn't have it's characteristic side effects of anticholinergic, antihistaminergic, cardiovascular etc.... It's mechanism of action is also completely different, and there seems to be a relative lack of awareness about this drug, especially in the USA where this is sold as supplement 😑... Would be great if you can explain the mechanism, side effects, efficacy, dosing etc.... BTW I'm from India, and this drug is widely available to use as an Antidepressant
Emotional pain is the worst kind of pain with physical pain
You can usually go to a doctor
And get relief but not when
It comes to mental illness
You just live in pain
Antidepressants or therapy
Are just a bandage
Stigma is a very bad thing , even in so-called 1st world countries.
I’m going to be a psych np in the future, maybe someday ketamine treatment will be available but I will never recommend ect
Then you will be preventing loads of treatments. It's literally the only safe option for pregnant women with mania, for instance
@@albanobustos7286 I would not treat a pregnant woman. I am (going to be) an adolescent psych NP. I will not accept child or adult clients. I work within a small age range: 13-19
If they are pregnant, I would recommend seeing a different doctor because I would not even prescribe them any medication either
SSRI not effective for this, MAOI took away all my suicidal thoughts
And gave me PSSD
why use ECT
if there is MAOI
MAOIs don't work for everyone and they take 6-8weeks to kick in, just like SSRIs. He's talking about suicidal patients who need immediate relief.
@@2Majesties just 5 days in average
@@2Majesties oh in that case yes, but ECT seems really rough
So glad MAOIs work for you😀@@minepolz320
@@minepolz320 ECT is quite comfortable. The person is put under general anesthesia, while "asleep" they have a short seizure, which involves minimal bodily movement due to the muscle relaxant. Some people may have a bit of headache or nausea waking up, others feel just fine. The effect is quite rapid, some people may have maintenance procedures, say once a month.
I believe MAOI can really help some people who don't respond to first-or second-line medications, such as yourself. Then again there are some side effects, dietary restrictions and drug interactions to watch out for, so they're not for everyone.