Psychiatry's Warm Coat Approach

 

I sometimes envy scientists and physicians from a century ago who took credit for simple discoveries, even attaching their names to them. For example, the Bernoulli Principle describes how the pressure of an inviscid material decreases as the flow of the material increases, and why the disgusting shower drape in cheap motels is pulled toward the person in the shower. I'm sure I noticed that effect when I was about six years old, and if it hadn't already been figured out, I'm sure I would have discovered it eventually! However, the days of simply thinking long and hard and coming up with a "discovery" are long gone.

 

Or do they? I believe I have a good one... and with the right presentation and reader assistance, I could become famous. Or maybe not. In any case, it's worth a shot... As a result, I'd like to present Junig's Warm Coat Theory of Psychotropic Prescribing. (I know, the title could be better.)

 

When I was an anesthesiologist, surgeons would sometimes say, 'Better is the enemy of good.' The point was that in some cases, the best approach was to remove the infected or diseased tissue, stop the bleeding, close the wound as soon as possible, and return the patient to the ICU. Spending another 4 hours picking at the tissue to make it pretty risked lowering the patient's body temperature, decreasing clotting and immune function, and increasing the stress response, all of which increased the chances of a bad surgical outcome. I must give credit where credit is due, and note that the warm coat theory is similar in some ways to the phrase "enemy of good" that I have heard recited over the years. In fact, it's entirely possible that my unconscious mind stole the phrase and adapted it for psychiatry. If that's the case, please accept my apologies for the actions of my unconscious—and please excuse my ignorance of the entire situation!

 

When medication (11 buy kalma Mylan Xanax Australia) is prescribed for psychiatric conditions such as ADD or anxiety, the patient may initially notice positive effects but later ask, "Perhaps I'd do better with a higher dose—should we try a little more?" With any medication for any condition, there is a balance between the medication's positive effects and the medication's risks or side effects. Serotonin reuptake inhibitors work well for depression and anxiety, but as their doses are increased, they can cause sexual side effects. They may cause drowsiness or nausea at higher doses. The positive effects of a medication increase with dose, but so do the side effects. The goal for both the patient and the physician is to strike the right balance between positive and negative side effects. Sexual side effects should not limit the dose if the patient has no interest in sex (or does not WANT an interest in sex). Nausea or sedation, on the other hand, may be barriers to increasing the dose. Different people have different concerns about risks and side effects, and different people require different medication doses. These distinctions, by the way, are why I believe psychiatrists should spend more time with patients than they do—but that's a discussion for another day.

 

When we go outside in January in Wisconsin,

 we consult the Weather Channel and dress accordingly. But we don't dress for 14 degrees Fahrenheit; we dress for "pretty darn cold." If I'm going to a Packer game, I'll wear my long-johns (too much information? ), jeans, and the Fleet Farm snowsuit (that changed my life when I finally bought it, after suffering a few football seasons without it). I'll also put on a stocking cap and possibly a face mask, as well as a thick pair of gloves. If the drunken guys on each side of me take off their shirts so their body heat radiates toward me and warms me up, I'll remove my face mask and possibly my cap at some point during the game. If the sun is shining, I might even take my own shirt off by the end of the game. Of course, the guys next to me may tyre of the game and spend the rest of it at the bar, just as the sun disappears behind a thick layer of clouds. Then I'll put the heavy stuff back on and maybe rub my hands together or jump around to warm up. If I get too cold, I'll go inside and warm up for a few minutes. The point is that I don't bring a spring jacket to wear when it's warm, and I don't bring extra coats for when it's cold. Instead, I alter my activity, change my location, or make minor changes to my wardrobe.

 

According to the warm coat approach, 

I recommend that patients consider their psychiatric medications in the same way that I consider dressing for a Packer game in January. When a person considers increasing the dose, he or she is receiving a good response from the medication, usually with few side effects. 'Better' may be the enemy of 'good' at this point. In January, the person is essentially wearing a warm coat. There's no need to rush home and buy a few more coats; instead, change your behaviour to fine-tune the level of symptom relief. If the target symptoms are attention problems and the current stimulant dose has gotten the person 85 percent of the way there, the correct action is to change behaviour. Locate a quiet place to study. Get enough rest. Create reminders and plan ahead of time to avoid time crunches that impair performance. These are preferable approaches to increasing the dose of stimulant, which may raise blood pressure or cause addiction. If the target symptoms are anxiety-related, practise positive self-talk and try to figure out why the anxiety exists in the first place. Learn to relax by taking deep breaths or going for a walk to get away from the stressful situation.