u/Dry_Twist6428

The past couple of weeks a lot of the local psych hospitals have been full and EDs are overflowing with psych boarders in my geography.

I’m wondering if many people all at once have started to admit more “edge cases” as a result of the recent trial.

I’ve probably been a bit more cautious and I feel like I’ve seen colleagues being a bit more cautious too.

I might just be imagining things. But I wonder if just thinking about liability with such a public case has made everyone more cautious.

I wonder if there is risk of over correction the other direction too - not pushing as hard for using outpatient resources.

I know there is some ire about psychiatric nurse practitioners, but I have seen a much more worrying trend which is family nurse practitioners opening up psychiatric clinics and offering grossly incompetent psychiatric care.

Like really bizarre med combos, switching meds every couple of days for unclear reasons, and using lots of super expensive new meds for unclear reasons (maybe pharma rep talked to them?)

I have seen a couple of really atrocious cases of iatrogenic harm caused by these practices bringing the pts in to the ER. Like intolerable side effects caused by practice that is way outside the standard of care - layering on bizarre combos of meds for relatively straightforward MDD or bipolar disorder cases.

In both cases the pt did not realize the person they were seeing really had no psychiatric training, and it was marketed as a “mental health” practice.

To me this seems like something that PMHNPs should also be concerned about as encroachment.

Have you guys seen this?

It’s a poorly kept secret that for profit hospitals generally prefer to “cherry pick” patients that are low acuity, have good insurance, and generally encourage the docs to keep the patients until the insured days run out.

In states with lots of for profit psychiatric beds, the more “malinger-y” presentations, are often admitted, because there are lots of beds. I say “malinger-y” because the pts may be malingering a chief complaint of SI or overreporting the severity of SI, but also have true mental health problems, like a poorly treated psychiatric condition along with substance use disorder. In states like Texas, where >50% of psychiatric beds are at for-profit hospitals, what I have generally seen is these patients are often admitted to inpatient.

You also have repeated presentations for BPD with SI with self harm or actual attempts, often associated with borderline personality disorder. Again, in states with lots of for profit inpatient beds, if they have insurance, a lot of these patients are just admitted for a brief inpatient stay.

However in a state like New York, where there are basically no for profit beds in the state (1 for profit hospital in Long Island), there is always a shortage of inpatient beds and there is a constant state of backup and boarding of patients in CPEP settings.

There is still the revolving door of pts who presented with a malingered chief complaint but with psychiatric issues and substance use, but there is no break from admitting these pts to the psych unit. A common clinical scenario is when there are no EOB beds or inpatient beds but a patient is still reporting SI, and then you have to try to safety plan as best as possible, document a good risk assessment, and discharge.

Sometimes I feel like it would be nice to decompress the CPEP or inpatient units by sending all the lower acuity patients to a for profit hospital. It would leave a lot of high acuity patients but decompress the milieu. (It might cause some financial issues for the public safety net hospital)

It is probably better care not to admit the BPD pt with repeated presentations for SI unless it is truly imminently dangerous, but in practicality it ends up happening when there are lots of beds to fill. In Texas I see these cases usually end up admitted, but then again there is very little outpatient treatment available like IOP or DBT programs.

But then again even in New York where those programs are available, I often see revolving door style patients get declined due to acuity.

I’m just thinking out loud, and I don’t really have any conclusions on this, but I wonder if other people have thoughts on this.

Definium announced phase 3 results from LSD in MDD.

What’s incredible, is it seems to work after one dose, and almost immediately. By the end of week 1, the MADRS dropped over 14 points versus placebo. At the end of 6 weeks, it was down 8.1 points versus placebo, and at the end of 12 weeks, it was down 7.3 points versus placebo. P values less than .0001.

They seem to give a single dose in office, and everyone seems ready for “end of session” by 5-8 hours after dosing.

Seems likely with these kind of results it would get FDA approval, though I’m not sure what the FDA protocol or REMS might be.

People throw around the word “paradigm shift” a lot, but this might really be a big paradigm shift in how we treat depression.

What’s that saying? Turn on, tune in…

I frequently get sent results for patients I have never seen and never had any contact with.

I am not sure if people mistake me for someone else or why this is happening.

There is no option to decline. I don’t want to click acknowledged as I am not reviewing these results or participating in this patients care.

I sometimes forward back to sender or whoever ordered the test. But this requires digging in the chart of this patient to see who ordered it and why.

It is incredibly time consuming.

Does anyone know ways around this? Like a simple decline and bounce back button I can click?