OMR Roundup 8-21-13

Primary care of patients with schizophrenia

1.  Motivational interviewing
Here are 3 forms (form 1, form 2, form 3) passed on to us by our guest from psych, Yvonne Yang. Looking over these, you may identify patterns and strategies that you've already found to work, or things you do that are less effective!
Tiffany identified an overview of the rationale/process of motivational interviewing; check it out: http://www.aafp.org/fpm/2011/0500/p21.html

2.  Primary Care – Schizophrenia
Click here for a paper with tips on initial assessment, ongoing monitoring, healthcare maintenance for patients with schizophrenia. (Am. J. Med. Viron et al, 2012)

Comments on this paper from Yvonne: "I thought a little more about its recommendations to start on risperidone or perphenazine...  I think probably from the standpoint of a first-line medication to start in the outpatient setting, and keeping in mind side-effect profiles that will influence compliance, aripiprazole (Abilify) should be somewhere in the top two for any outpatient treatment setting, as it is generally weight-neutral, is not as sedating as the other antipsychotics, and is also a very effective drug.  Risperidone causes less weight gain / diabetes than olanazapine and clozapine, but not by that much, and it is also the antipsychotic most likely to cause lactation.  But, aripiprazole causes more akathisia (uncomfortable feeling of not being able to sit still - can be treated with propranolol BID).  Happily, Abilify goes off patent in I think January 2014 (or 2015)."

Also from Yvonne:
Psychiatry resources in Los Angeles County: (all searchable in Google, all known entities with great reputations)

Suicide Prevention and Urgent Care:
- Didi Hirsch Suicide Prevention Center and Hotline: (877) 727-4747, http://www.didihirsch.org/spc
- Exodus Behavioral Health: http://www.exodusrecoveryinc.com/

To establish psychiatric care:
- UCLA ACCESS, for patients: 1-800-825-9989
- Los Angeles County Dept of Mental Health: http://dmh.lacounty.gov/wps/portal/dmh
- Substance Abuse and Mental Health Services Aministration: http://www.samhsa.gov/
- Didi Hirsch Outpatient Services: http://www.didihirsch.org
- Edelman Mental Health Clinic: Olympic Blvd and Sepulveda Blvd, (310) 966-6500 (part of LA County Mental Health; I believe often has Spanish-speaking care providers)
- Venice Family Clinic: http://www.venicefamilyclinic.org/
- Asian Paciifc Treatment and Counseling Center: http://www.apctc.org/ (Specializes in Asian-speaking services)

Substance Abuse Programs:
- Beit T'Shuvah: http://www.beittshuvah.org/
- Matrix: http://www.matrixinstitute.org/

Low-cost therapy, Eating Disorders Programs:
- Wright Institute: http://www.wila.org/
- Maple Center: http://www.tmcc.org/

For patients and families: (family groups, support groups, counseling, etc)
- National Alliance for Mental Health: http://www.nami.org