Today was Psychiatry day in the office. Very challenging. Some short (ugh -- too short) breaks in the action for some well-child visits and a few upper-respiratory infections, but the majority of my visits today involved depression, anxiety or personality disorders. I find personality disorders especially challenging, since their diagnosis is so difficult, and intervention is equally difficult.
Our colleagues in psychiatry seem equally challenged - I had one patient referred back to me for management of this disorder. Uh ... "tag - you're it" he seemed to say to me. We have a paucity of psychiatrists here in Albany - so it is especially challenging to find services sometimes. Yesterday (ok .. so maybe yesterday was psychiatry day too) .. I saw a man with type 2 diabetes, obesity and depression with some psychotic features. His depression has been very well managed on Risperidal - and he's not seen a psychiatrist in many years. I'd love to get him on to something that would not cause weight gain. Aripiprazole has recently been introduced, and it does not cause weight gain like risperidal. Hmm ... should I change him? I've never used Aripiprazole ... but ... nor have most psychiatrists yet. Hmmm ... what to do? ... I referred him to a psychiatrist today. We'll see what happens. A nice review of the new antipsychotics appears in this month's Archives of General Psychiatry.