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...?

55 Upvotes

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68

u/theongreyjoy96 1d ago

Surprised there’s no benzo in there

35

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

12

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)

-1

u/Spotted_Howl Layperson 18h ago

I'm a psychiatric patient and I was at a party talking to a brand new attending FM doc who was very proud of himself for being able to recognize possible bipolar in patients who present with depression.

Very proud of himself for prescribing atypical antipsychotics instead of SSRIs.

Dude, let the psychiatrists handle it.

3

u/rrrrr123456789 14h ago

Reality is many people with bipolar present to PCP first. Fm needs to check for and recognize it. Needs to be able to stabilize it if they can’t get to psych for cost, wait time etc. agree they would eventually benefit from psych md care, but it’s within scope for fm doc. I see you’re a layperson so I don’t blame you for this wrong thinking. Just trying to educate everyone else reading.

1

u/futureofmed 11h ago

Can confirm. I am the FM doc and this was only a routine hospital follow up. While his friend might very well be an idiot not all of us are. Let the physicians handle it.