Sometimes meds are not the answer

I wanted to share an article that brought a smile to my face.  Dr Miguel Rivera is my hero of the day!

Under the direction of psychiatrist Dr. Miguel Rivera, caregivers at the Pines have deployed such simple spa comforts as music, massage and calming colors to help reduce agitation. As a result, dosages of antipsychotic medications have dropped to less than half the state average for this most challenging patient population.

I have never worked in a long-term care facility, although I have treated many patients from such places.  I have great respect for those who can work on a sustained basis with people who have progressive neurological or developmental disorders and who cannot adequately report feelings, thoughts, or emotions the way other patients can.

Unfortunately, with few exceptions, when patients are brought to my office from a long-term care setting, the concern is not a disturbance in mood, recurrent psychotic ideation, problematic anxiety, or a need for acute hospitalization for imminent danger to self or others.  Instead, it is because the patient is “causing problems”– maybe yelling in the middle of the night or fighting with a staff member.  Perhaps he refuses to take his medications, or he’s throwing food.  He might wander off from the facility or accuse staff members of stealing from him.

Many chronically disabling conditions, including progressive dementia, can be associated with psychiatric symptoms such as delusional thoughts or agitation.  And it is true that many of our most potent medications can, when used judiciously, treat these symptoms (noting, of course, the black-box warning against using antipsychotics for the treatment of dementia-related psychosis).  However, as with most things in psychiatry, there is a fine line between treating a psychophysiological symptom that causes distress to a patient, and treating a behavioral phenomenon that causes distress to a caregiver.

The most common question I hear from attendants, family members, nursing staff, and others who accompany these patients to my office is, “Can you do something about his [insert troublesome symptom here]?”  And my answer is always the same:  Yes, if you mean you want me to sedate him or calm him with a powerful chemical.  But it’s more important, in my mind, to understand other ways to alleviate his suffering, while preserving his dignity and whatever autonomy he still retains.

It’s an extremely difficult process, but Dr Miguel Rivera seems to have found a solution.  And it didn’t come from the pharmacopoeia, but from his unique ability to listen, to empathize, and to design therapies to appeal to patients’ own unique needs.  It’s a model we all ought to follow.

One Response to Sometimes meds are not the answer

  1. Jamee Adkins Kerkman says:

    Steve, your blog on empathic treatment of clients with chronic conditions is beautifully spoken! Thank you for "putting it out there".-Jamee

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