This bag was visibly fake before even handling - loose threads, plasticky leather, and this "certificaie of autbenticity". Being sold for $2800. I notified the employee who showed it to me that it's fake, and she just stared at me blankly and put it back in the case for sale...
Is there any way to report this??
Early career outpatient psychiatrist here, looking for advice managing anorexia in this setting. I recently saw a patient with clear comorbid BPD and anxiety, who IMO needs a higher level of care as weight has continued to drop recently (BMI <15).
She also reports severe ADHD diagnosed in childhood, and was most recently seeing a psych NP who prescribed 60-80mg of Vyvanse and 10-20mg of Adderall daily.
The patient has no primary care doctor or cardiologist, dropped out of several residential programs in the past year, and was discharged from an outpatient program recently due to hypokalemia / not being medically stable (she did get K repleted in the ED after that).
I'm frankly not comfortable refilling any stimulants in this kind of case due to both appetite suppression and increased risk of cardiovascular side effects, especially without close medical monitoring. While I realize that untreated ADHD can be debilitating, that is not likely to kill her like anorexia might. However, all other options are unacceptable to her - I recommended a higher level of care (patient adamantly refused) and trialing non-stimulants (also refused). My attempts to build trust seem to be failing, and I imagine that she will simply fire me and find another, less scrupulous provider to prescribe her stimulants (and whatever else she demands). Is that simply the way it goes with these cases? CAN anorexic, highly anxious patients be safely prescribed high dose stimulants when weight restoration is the immediate priority?