When Your Patient Is on Too Many Psych Meds

COMMENTARY

When Your Patient Is on Too Many Psych Meds

Stephen M. Strakowski, MD

Disclosures

April 08, 2016

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Hello, I'm Dr Stephen Strakowski. I'm professor of psychiatry, psychology, and biomedical engineering at the University of Cincinnati, where I also serve as senior vice president and chief strategy officer in UC Health, our affiliated health system.

Today I'm going to talk about polypharmacy in psychiatry. I'm going to use a specific patient example of mine and use that example to talk about general principles when dealing with prescribing multiple medications. My interest in this partly arises from my role as a regional consultant, where I frequently am sent complicated patients to help physicians manage them—and I have to say, many times my strong recommendation is to simplify their medication regimens.

Introducing Our Patient With Polypharmacy: Mr A

To frame our discussion, let's talk about a patient. We'll call him Mr A, and he is a 40-year-old man with established bipolar II disorder. He has had clear hypomanic episodes in the past, but most of the time has struggled with depression and anxiety, which is fairly typical in bipolar II disorder. He came to me initially on a consultation, but eventually transferred his care to our practice.

Despite years of treatment and a lot of medications, Mr A continued to have significant depressive and anxiety symptoms—specifically a lot of lethargy and hypersomnolence, and then alternating with anxiety and restlessness that he found very troubling.

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