Medical Monitoring Often Missing From Care of Patients
From Psychiatric News
November 7, 2008
Psychiatrists are told that they must assume responsibility for screening and monitoring severely mentally ill patients at high risk for diabetes, cardiovascular disease, and metabolic syndrome.
Studies of lab orders for patients receiving second-generation antipsychotic (SGA) medications reveal that few are getting screened or monitored for cardiovascular and metabolic risk factors, reported Elaine Morrato, Dr.P.H., at a symposium at APA’s Institute on Psychiatric Services last month in Chicago….
….children and adolescents who might benefit most from primary prevention of cardiovascular disease and metabolic syndrome are even less likely than adults to receive screening and monitoring.
“There is a disparity that continues to exist between guideline recommendationsfor cardiometabolic monitoring and screening and the monitoringthat actually exists in practice, with a gap between what psychiatristsare telling us in terms of their practice and what we are seeing whenwe look at lab claims for glucose and lipid testing,”
…..just 29 percent of the psychiatrists said they monitorlipid levels in all or some of their patients.
I can vouch that never once in my 20 year psych patient career was I ever asked to get my lipids or glucose tested, in spite of a 90lb weight gain. I will say my doctor was careful when I was on Lithium and then Depakote to get blood levels of those drugs as toxicity and death are possible on both of them.
Hallelujah! I’m not on anything that needs monitoring anymore and I’ve somehow managed to get out without diabetes or any risk factors for heart disease other than being fat. But that is thanks to my extremeley healthy lifestyle and LUCK. Bottom line, no matter how healthy one is in terms of diet and excercise these drugs can still make you fat, give you heart disease, diabetes, and kidney failure among other ailments and these diseases can all potentially kill you.
km: “i understand that maybe a head doc doesn’t have time to study every single research finding on the many medications out there-however, it is their job and they are paid well (we pay them well)”
I’ve heard the no-time-argument thousands of times. And I’ve tried to understand. I can’t and I won’t. Me too, I have a full time job. And a social life. Nevertheless, I managed to gather together more information about psych drugs, psychiatric “treatment”, the whole system, in the past three years, than most of the professionals seem to have the “time” to gather together in a whole lifetime, their ignorance taken into account. I came to the conclusion, that time (and energy), or a lack of, can’t be the problem. The problem rather seems to be a profound lack of interest, engagement and responsibility. Or: indifference and laziness.
Apart from that, the fact that your psychiatrist insisted on prescribing Seroquel lets me wonder if she’s on AstraSeneca’s pay roll.
Teresa
You’re working and you’ve come off Lamictal way too fast…anything you’re feeling is probably withdrawals…also most of us get on drugs because of something that didn’t feel good to begin with and that is why accompanying lifestyle changes are so important.
My best guess is you should probably go back on Lamictal, but I don’t remember the details of your situation to know how much you should go back on….
I’m not talking about permanently, I’m talking about doing it long enough to stabilize and then withdraw responsibly…
You should not look at my level of debilitation as representative of people coming off drugs. I had 7 drugs to come off of. My case is extremely complex and unusual
With the one drug you’re coming off of (perhaps you on another one, I don’t remember) but in any case there is no reason why you shouldn’t do this slowly and responsibly while also making big lifestyle changes to support your process.
You don’t need to be suffering like this. So yeah, going back on meds sounds quite reasonable if you want to keep your job and do this right.
Please send me an email. I’ll make a couple of suggestions about where to get support.
best to you.
Gianna-
Are you still going through withdrawals from Lamictal? I have been off of it now for about 6 days, and at first all of my symptoms were physical, accept being anxious, but I wasn’t depressed, now all of the sudden today I am really depressed and my vision is blurred again really bad. Could this be another part of the withdrawal? I hate feeling this way, because it makes me want to go back on meds because I can’t handle feeling this way, and feeling so helpless and out of control. Unable to control my feelings or emotions and feeling as though I am outside of myself. Detached as alot of people have said.
Recently a psychiatrist attempted to prescribe me Seroquel. Clearly she had not read my patient history or listened to me for a couple reasons:
1) my previous experience with Seroquel was disastrous. It lead to a sixty pound weight gain and sleeping 12-16 hours a day.
2) I told her my maternal grandmother passed away from complications of diabetes and my father was diabetic. I told her I was aware of the links between Seroquel and diabetes.
and yet she still insisted on prescribing it. needless to say, i never saw her again.
it saddens me really—i understand that maybe a head doc doesn’t have time to study every single research finding on the many medications out there-however, it is their job and they are paid well (we pay them well) and numerous times doctors have completely ignored my research. infuriating.
“and so it has to be us, fighting to change for those of us who cannot help themselves…that’s how I feel anyway.”
Please do! And yes, it’s so, I think. I’m not up to much of a fight right now, but I do what I can in my little corner of the world. If we would all do at least that, it would have to have a huge impact.
Jan,
I’m not sure why you’re asking if .25 mg is a small dose…
If it’s in order to withdraw after years of taking it, then no it’s not necessarily a small dose and some people might need months to get off of it…
Otherwise in terms of what gets prescribed in general it is a relatively small dose…but the key word here is “relatively.”
Gianna:
Thanks for the article from Psych News. How appalling but also no surprise either. And I agree with you. We have to be the voice for those people who are not able and have no one to do it for them. Thanks, too, for telling me a while ago who to get in touch with in the Withdrawal and Recovery group. I soon plan on talking with Catherine and look forward to her insight. It will be quite a relief to have the reassurance of what it is I’m going through and why.
Also, I remember you telling someone that .5mg of Klonopin is not a small dose. Could I then assume from this that .25mg of clonazepam is not necessarily a small dose either?
Thanks,
Jan
yes, Immi, I agree.
the tragedy is that many people are so desperate and alone they cannot take those steps for themselves…and some one should be looking out for those folks.
and so it has to be us, fighting to change for those of us who cannot help themselves…that’s how I feel anyway.
I’m don’t find it particularly surprising that they don’t screen, or tell patients to get screening before or during psychiatric care. While I do use psych drugs, I take responsibility for fact finding and screening because it’s sensible, not because anyone asked me to. I’ve gone round and round with psychiatrists over my refusal to take lithium and certain other medications because they’re known to cause problems in areas I already have challenges dealing with. It’s kind of amazing that even when you throw the established facts in their face they still argue. That level of denial is disgusting. So I strongly advocate that anyone who is going to use psych meds, or any other sort, go learn about them first and choose to responsible for them, since apparently no one will do it for them.
Gianna,
This article brings back memories….
When both of my boys were toddlers….they used to pull a blanket over their head….and hide….
If they couldn’t see dad….they were “invisible”…and dad couldn’t see them….(never mind their arms and legs were in plain sight)….
So it is with conventional psychiatry….these “docs” simply pull a blanket over their head….and refuse to “see”….afterall, if they can’t see the injury and death the drugs are causing….then, the injured patient can’t see them…
It works with infants….why not medicine, right?
Duane