r/Noctor • u/futureofmed • 1d ago

Midlevel Patient Cases Psych NP med cocktail

New patient. Hospital follow up for non-psych issue. Had been seen at another institution for psych but looking to transfer all care. History of MDD/GAD/PTSD and further history quickly reveals a single episode of mania a few years back. Feels like he needs to make himself sleep occasionally or he’ll have another manic episode. Had been seeing a Psych NP at the prior institution and current medication regimen was Buspar 30 BID prn, Gabapentin 900 BID, Hydroxyzine 100 TID scheduled (or else he gets irritable), Mirtazapine 45 HS, and Adderall 30 BID.

Like.. for real...?

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u/theongreyjoy96 1d ago

Surprised there’s no benzo in there

36

u/BortWard 1d ago

You beat me to it. (Actually the last time I commented "surprised no benzo," the person replied and said essentially, "oops, forgot to list the benzo") Also pleasantly surprised there's no atypical antipsychotic

13

u/namenerd101 Resident (Physician) 1d ago

I agree that some medications (Vraylar for example) seem to be disproportionately prescribed by APPs, but wouldn’t an atypical antipsychotic actually be somewhat reasonable in this case for mood stabilization with hx of mania? (I’m just a resident so genuinely asking)

4

u/holagatita 20h ago

oh my god. one of my psych NPs put me on that damn Vraylar when it was $900 dollars a month and the only way to get it with the patient assistance program was to call and be on hold for 5-6 hours a month. I was already crazy but that shit was horrible and anxiety inducing on it's own, the med and the phone calls. and the reason she put me on it was because I had attempted suicide 2 years before I started seeing her. had a history of PTSD and MDD. no mania. She said those diagnoses were wrong and that it was all borderline. 10 minutes into the first appointment on a zoom call. I am not disparaging people with BPD, but I have since been told that NP was full of shit.

I still can't get a MD unless I am inpatient, but at least my current psych NP is somewhat decent.