thelastpsychiatrist.com - Are Antipsychotics Overprescribed To Kids? Adnotated.

does this make me look like I'm keeping an eye on waste?

10 year studyⁱ of inpatient kids: 44% got antipsychotics. Is that a lot? Yes. It's a lot. And most of the time, not even for psychosis. 44% of the PTSD and ADHD kids got antipsychotics.

You can wrack your brain trying to figure this out or blame the usual suspects, but the answer is right there in the article:

Variables associated with antipsychotic use [included] male genderⁱⁱ, age 12 years and under, being nonwhite, and a length of stay 13 days or longer.

You'll observe that none of those words is "diagnosis" or "severity."

The cause of these high levels of medications is so simple you'll recoil from the truth of it, but pour yourself a drink and take it like a man: the kids showed up. That's it. The kid is in front of you and you have to do something, now, that results in an acute change. Not better grades 4 years out, or less sadness over the teen years; change the sleep tonight, make the kid less hyper now, and when it "stops working" you can up the dose or change the med.ⁱⁱⁱ

It doesn't matter what the diagnosis is or what the symptoms are, really, whether he ate his dog or got a C on a test he's going to be getting something^iv at qd and hs^v because that's what you get when you put psychiatry as the cornerstone of a Multidisciplinary Treatment Team.

When a kid is presented to a psychiatrist, the psychiatrist is pressured, obligated, to do something pharmacological. If a psychiatrist looked a single parent a joint away from a nap right in the eye and said, "nope, he's acting out because of X, Y, Z, and medications aren't going to fix this" that doctor will get his head handed to him by parent or by lawyer. Justice will be done, you negligent elitist.^vi

And the simple reason why the kids showed up is that the parents and the schools and the cops and the courts were told that's where you go when a kid punches another kid or becomes hispanic. That's why outside the oakwood offices of the private docs the shingle says "Practice of Psychiatry" in Palatino Linotype, but get within fifty blocks of a black kid and the whole thing is labeled "Behavioral Health" in what I think is Erasermate.

This is why reducing antipsychotic prescription is a Chuck Grassley^vii political diversion, if the kids don't get antipsychotics they won't get nothing.^viii The problem is the overprescription of prescriptions.

I get that when a 15 year old starts up with cocaine it is a bad thing. But is it automatically true he has ADHD or BPD and needs medications? Check the map:

There's a very large system in place for not doing what's best for people, it is expedient and simple and the law but nevertheless ineffective and counterproductive in the long run. The trouble is, this system screws it up for people who actually need it. Just because a 10 minute med check is perfect for the vast majority of patients who don't have any psychiatric illness, doesn't mean it'll work on the kid with prodromal^ix schizophrenia and the crying parents who look at you like, wtf? Are you kidding me with this?

1. The illustration incidentally brings a point in focus : Back in 2009, when Robert Mueller was the director of FBI, the USG spent millions each year to send government workers to Harvard for a month. The practice came to light when Grassley (depicted) asked Harvard about its Senior Executive Fellows program and to explain why it costs so much.

   Do you remember what they called this back in the other soviet ? Do you remember why exactly it was absolutely necessary ? Well then! You're in a position to ask much better questions than Grassley, in the limited sense that you really don't need to ask any questions at all.

   It's self-fucking-obvious why they have to attempt and conventionally sync their wooden tongue, what. [↩]

2. And this isn't misandry, yes ? The boys just happen to be "genuinely sick", right ?

   Fuck. You. [↩]

3. This all sounds pretty amped up... [↩]
4. Hey, this sounds almost exactly like the "criminal justice" system. [↩]
5. qd is "quaque die", Latin for "once each day" (confusingly, qid is "quarter in die", ie, four per day ; while qs is "quantum satis/sufficit", ie "as much as sates/suffices") ; hs is "hora somni", Latin for "bedtime". None of these are all that usable, nor really used anymore because of the ample opportunity for confusion and the drastic reduction in cost-of-writing since the 1700s. Their only utility remains showing off, and it's likely to increase as they slip away from public mind. [↩]
6. Proving in yet another form and venue the one universal truth of mankind -- that you can't have working systems without elitism. [↩]
7. He's still there, by the way, currently president pro tempore of the whole senate. Yeah, you got his scheming number right from the first pic. Ninety years old, half of which "serving" his country as a senator. [↩]
8. He means, "it won't be the case they get nothing at all ; they'll still get something". I think. [↩]
9. This inane bullshit... calling it "prodromal" just because ~nobody knows what qs is and it sounds medical doesn't do jack for the argument. I wish to see this kid with schizophrenia sometime, if anyone ever manages to locate one. [↩]