rached

I'm nurse-liason for a psychiatrist, and do medication management for our patients once they have been stabilized. The bulk of our suburban practice is comprised of anxiety disorders (ocd being primary), bipolar disorders (mostly depressives), and to a lesser degree schizophrenia and other chronic thought disorders. When patients initially come to us, it is usually because they or their families are desperate for help, and their situations are acute and intolerable. While CBT and other forms of talk therapy certainly have their legitimate and useful place in the treatment of mental/emotional illness......what these folks are looking for is NOT referral to a therapist, but relief from pain, and the sooner the better. Who can blame them? We can go on all day decrying that yes, we're a culture used to the "instant fix" but I think that psychotropic drug therapy gets a bum rap, frankly. Every single day I witness what I consider to be near-miracles primarily due to psych drugs; can't argue with that. And yes, we do strongly encourage traditional talk therapy for every patient for whom it's appropriate. Generally speaking, that's most of them, once they're stabilized.

If anyone has had experience with cocaine psychosis (and not their own, I hope!) I'd like to hear what those experiences were. The son of a dear friend has been a cocaine abuser for a number of years. For most of that time, he managed to confine it to so-called "recreational" use, but in the last year has spiraled out of control. He began having classic paranoid delusions that his house was being monitored, there were cameras in the ceiling fans, etc. He also had auditory hallucinations.....an entire chorus of distinct, individual voices describing his every move and mocking him. To make a long (and depressing) story short, he is currently not using & has been 'clean' for approximately 2 months. His psychiatrist rx'd Abilify for the hallucinations. He also takes Trileptal and Effexor (diagnosis of BiPolar 2) Question: Just wondering how often permanent psychosis results from heavy cocaine abuse ( the research I've done is equivocal...maybe yes, maybe no); and would there be a risk in d/cing the Abilify at some point? Hate to think he would remain on a powerful antipsychotic indefinitely if it were not necessary. Anyone with any experience with this, please weigh in. Thanks jackie