Quick list What we monitor

“we don't use Metformin enough with these medications. Now I'm thinking we don't use GLP-1s enough with these medications”

“for the telehealth people out there you can at least ask the patient to weigh themselves on a regular basis and self-report don't forget to weigh your patients now if you want to be really gold standard you're going to do waist circumference”

“I think that a degree of weight gain that we see on these medications is not fully from the medication effect itself, but is actually from the treatment effect. People, many people, don't eat when they're in emotional distress”

“checker prolactin levels, It's super low threshold to check our prolactin level on these patients”

“Largely, in my experience, outpatient akathisia is subjective. It's something that the patient feels. They can suppress it, especially in the encounter with you”

“You can get abrupt withdrawal dyskinesias that can go away or they can persist. A little scary. and it's definitely more likely to happen in people with mood disorders and have schizophrenia so please use your antipsychotics sparingly and only as needed for the clinical picture”

“schizophrenia has its own rate of movement disorders, okay, without antipsychotic use. If you look at pre-antipsychotic studies, they were already developing tardive dyskinesia anyway”

“some of the antipsychotics can actually worsen OCD. I think clozapine and olanzapine are the most likely”

“a lot of antipsychotics are depressogenic. They can lead patients to depression and long-term aren't great. A lot of these medications come with really bad side effects, really bad metabolic effects. There's risks of... of EPS, tardive dyskinesia, typically not the lower doses”

“If you have an Asian patient, FDA recommends testing for the HLIB 15 for carbamazepine”

“people need to remember they took away the REMS. They didn't take away the recommendation. So technically, anytime you don't do the classical REMS monitoring, you are outside the standard of care and you're putting your license on the line”

“the first half of the year, you do it weekly. Then the second half of the year, you do it every two weeks. And then after one year, you do it monthly”

“the earlier you're taking the medication, the higher the risk. So it peaks within the first six months, especially the first 18 weeks. And then after one year, the risk is very, very low”

“it's considered mild if the count is 1,000 to 1,500. It's moderate if it's 500 to 1,000. And then severe is less than 500”

“If it's severe, you stop the clozapine and you discontinue it until the ANC is greater than 1,000. And then you check it three times per week until it's greater than 1,500”

“Sometimes the number it spits it out, you actually have to multiply it by 1,000 because I remember my lab would just spit out like 3.5, so it would be like 3,500”

“the gist of benign ethnic neutropenia, essentially their ANC is going to be lower and still be functional. So it's not a problem as much for them. So the cutoff kind of bumps down”

“pregnancy will reduce the serum levels of lamotrigine by about half. I believe it's estrogen that does this”

“for lithium levels, treat the patient, not the level. So go off of your actual long-term clinical stability or lack of stability. Look at the sleep patterns carefully”

“We're looking for kidney function, right? We're looking for thyroid function, and we're looking for calcium levels. That's the simplistic way of saying it. Those are the main ones that we're going to see being impacted on labs”

“with low dose lithium we don't need to be monitoring all labs or we don't need to have the same lab monitoring schedule that we have with higher dose lithium. We wouldn't expect the same level of kidney dysfunction”

“if you have a patient that absolutely you know is never going to follow up for labs, lithium probably is not the medication, the correct medication”

“But just know that you don't have to do the ER twice a day. You can dose it all once in the daytime. But you're going to have to time your lithium level draws accordingly, which can be a bit of a challenge”

“The way you're actually supposed to tell if this is really happening or if it's just simple polyuria from lithium, which is, by the way, the most common adverse effect of lithium, is that you're actually supposed to do a 24-hour urine collection study”

“Now, you can also see demargination of the white blood cells and a little higher white blood cell count on lithium. That is fine. Don't worry about that. It's non-pathological”

“Ordering labs is not as big a deal. It's not as time intensive as I once imagined. It's not like you need to go on a website and fax things and all these things. You can make a lab requisition form and give it to the patient”

“I don't recommend testing for any of these. And that's in some ways where the hypothesis falls apart. And the other hole in this hypothesis is that most of the trials, in fact, nearly, well, most of the trials have enrolled people without testing for a deficit”

“Just warn about it. You don't need to get levels on oxcarbazepine, but you can. Some people do that. I don't find that very helpful clinically”

“high levels of lithium guarantee you decline of kidney function. High levels of Depakote do not guarantee any end-organ dysfunction necessarily. You've got to monitor for it, but it's not a guarantee. You're pretty much looking out for a low platelet issue. Hyperammonemia, the liver producing too much ammonia”

“I'm a fan of using the PHQ-9 not as a screener, but rather to track symptoms because it covers a lot of the symptoms. It's shorter and easier to administer than something like the ham. or the BEC, and I can do it in a visit”

“The neurotic range of obsessive-compulsive would be somebody who has ritualistic practices that they know are crazy. They know it involves internal anxiety that they have to do something about. They can make a good relationship with a therapist”

“At the borderline and psychotic levels, you have all those rituals and compulsions, but they tend to be egocentronic. In other words, you tend to think of them as natural and you don't know any other way to be”

“it's for the second gen antipsychotic, the most prolactin elevating and also the most likely to cause EPS, especially when you're hitting the four milligrams and above”

“checker prolactin levels, It's super low threshold to check our prolactin level on these patients”

“you should know how to do an AIMS. See the research. Read the AIMS. Read the AIMS. Read the directions and actually do an AIMS. And you can do a modified version of the AIMS over video if you have assistance from a family member or a nurse”

“picture the levels in a descending pyramid, reverse pyramid, the one that you do the most. This is the top part of your food groups. This is level zero. That's the supportive elements, the alliance, and technical containment”

“This is basically asking any kinds of questions or doing anything that gets the patient to go into more depth or detail about what they're talking about. But even if it redirects the narrative, it doesn't challenge the narrative”

“it's basically anything that explicitly makes a link between a pattern or a defense towards some kind of an unconscious process for the patient. Wishes, desires, conflicts, ways of relating”

“I do believe in a Rogerian way that if you're just doing zero, one, two, your work is done. The patient will heal on their own”

“for OCD, please get a Weibach score of some kind, track it across visits, see if it's changing over time with increased doses, even though it takes a longer time, maybe for anxiety and OCD to respond to SSRI medication”

“if you are going to be using it for your longitudinal treatment monitoring, obsessional people being such role followers, make sure to tell them you don't need to fill out the symptom checklist every time. Okay, just the numerical one we're monitoring”

“We're looking for kidney function, right? We're looking for thyroid function, and we're looking for calcium levels. That's the simplistic way of saying it. Those are the main ones that we're going to see being impacted on labs”

“high levels of lithium guarantee you decline of kidney function. High levels of Depakote do not guarantee any end-organ dysfunction necessarily. You've got to monitor for it, but it's not a guarantee. You're pretty much looking out for a low platelet issue. Hyperammonemia, the liver producing too much ammonia”

“Just warn about it. You don't need to get levels on oxcarbazepine, but you can. Some people do that. I don't find that very helpful clinically”

“Ordering labs is not as big a deal. It's not as time intensive as I once imagined. It's not like you need to go on a website and fax things and all these things. You can make a lab requisition form and give it to the patient”

“if you have a patient that absolutely you know is never going to follow up for labs, lithium probably is not the medication, the correct medication”

“I will titrate Up to the range of around 750 or even 900 depending on the reported adverse effects even without the first lab draw. But this is because I'm in a low resource clinic where despite my efforts many people will refuse or be unable to get lab draws”

“I'm willing to give up to 450 or maybe even 600 of lithium without labs in the long run if the patient is competent, has the capacity to understand the risks that they're taking on”

“someone who is neurotic has full contact with reality and doesn't really lose it okay their problems are mostly about worrying and fear and control And they are able to form a full and stable connection with other people and themselves psychologically”

“the borderline range is people who are somewhere in the middle they've got characteristics Both, they're basically medium level in terms of their ability to connect to themselves, others, and regulate emotions”

“Psychotic is when there is essentially psychosis in the way that we talk about loss of touch with reality. Okay. thinking process and reality testing is disrupted in some way that is different than normal people especially under stress”

“pregnancy will reduce the serum levels of lamotrigine by about half. I believe it's estrogen that does this”