Friday, June 20, 2008

Not Getting Enough OCD Meds?

According to a study released today, about 67% of patients newly diagnosed with OCD were insufficiently medicated, either in dosage or duration of therapy. You can read the story at . That certainly sounds dramatic, doesn't it? But considering the methodology of the research, it may not be quite so surprising. The data came from a retrospective claims analysis looking back nine years at 987 Medicaid recipients who were newly diagnosed with OCD. Could it be that the standard of care was deficient because of the insurance? Medicaid providers are notoriously underpaid and drugs are tightly managed. I'd place my bet that reimbursement rather than medical incompetence was the real issue.
I can't find anywhere in the study that pinpoints psychiatrists as the providers who either diagnosed or prescribed. In any event, I wanted to underscore how important it is that a psychiatrist, not your family physician, be responsible for psychiatric diagnoses and treatment. I just finished meeting with a client who was probably under-medicated for OCD by his family physician. Going to your family doctor for psychiatric treatment is akin to seeing an infectious disease doc to have your teeth cleaned.
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Wednesday, June 18, 2008

Depressed, Just Not Sad

I'm not sure how much, if any, literature exists on depression sans sadness. I've seen it revealed so often in clinical practice, but how do we identify it, understand it? In common usage of the word "depressed," the speaker is often referring to the all-too-human condition of sadness. "I'm so depressed because I'm broke," we might hear one say.From a clinician's viewpoint, "depression" is diagnosed when there is a constellation of "symptoms" such as decreased appetite, insomnia or hypersomnia, lack of joie de vivre, and most significantly, a negative self-referral system ("I'm useless anymore," "Nobody cares about me," "I'm a terrible parent," etc).In fact, this self-deprecation is the hallmark of true depression. The relative battering one's self-esteem has endured is how we can separate the depressive from the sad. Feeling sad is part of how we're built; feeling depressed is the product of self-flagelltion run amok.That, then, is perhaps why there are so many cases in which an individual is depessed without feeling sad. At the end of a day flled with self-reprisals, the feelings would likely be numbed.Sphere: Related Content
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