Psychiatry & Psychology--General/Medications For BPD

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Question
My son, who is 28, is finishing up a DBT IOP at Yale/New Haven. When he began this IOP, his anxiety was so intense his psychiatrist admitted him to the psych unit to get a grip on his medications. He was already on 105mg of methadone. He's also a recovering heroin addict. His psychiatrist prescribed Thorazine for the anxiety and Effexor for depression. The thorazine takes the edge off his anxiety but he's always tired. In social situations, he gets incredibly anxious even with the thorazine. This is a young man who used to be outgoing and it seemed.....everybody's friend. He now mostly stays in his room and watches TV and goes to his IOP. He's told his doctor that the thorazine makes him tired and is really not getting the anxiety under control but he just ups the dosage. Obviously I'm no doctor and I'm not trying to second guess my son's psychiatrist, but wouldn't you think that thorazine might not be the way to go? He's always had ADHD too but is not being treated for that for whatever reason. Would Provigil and/or Lamotrigine be an option perhaps? I understand that giving me a definitive answer is impossible without a thorough evaluation. I'm just curious about your thoughts?

Answer
James,

I am very sorry to hear about the difficulties you are experiencing with your son's, bipolar disorder medication.  As a psychologist I have thirty years experience dealing with Bipolar patients, many of whom also present with other psychiatric diagnoses, but I do not prescribe medication.

Medicating Bipolar patients, as I am sure you are aware, is a terrific challenge because of the need for both sedation for mania and elevation of mood for depression.

I think the wise choice is to get a referral from a trusted doctor to a second psychiatrist who is not associated with the doctor who is presently treating your son and get an objective assessment of the value of his present medication regime and what alternatives might be for your son.

Best,

Dr. Andrew Elmore  

Psychiatry & Psychology--General

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Andrew M. Elmore, Ph.D.

Expertise

I can answer questions about: Stress. Headaches. Stress-related Disorders. Anxiety/Panic Disorder. Depression. Psychopathology. Cognitive Behavioral Therapy. Personal Problem Solving. Life in General. Relationships: Love, Friendship, Business Partner, Coworker, Family,Child/Parent. What makes us tick. The use of psycho-pharmacological agents in combination with psychological treatment. How to deal with evil people in your life. How to improve your outlook under duress. How to control stress. How to control mood. How to control headaches. I cannot answer: Questions about Eating Disorders. Questions about computers.

Experience

30 years in private practice as a psychologist in Manhattan. Dealing with people from almost every conceivable ethnic and socioeconomic backgrounds, and as many character types as exist in this country. Dealing with patients from 8 years old to 90 years old. Pioneer in biofeedback and the treatment of stress-related disorders. Assistant Clinical Professor of Psychiatry at the Mount Sinai School of Medicine since 1982. Treatment of stress-related, anxiety and depressive disorders with biofeedback and cognitive behavioral therapy. Developed personal problem solving, an extremely precise form of psychotherapy. Relationship therapy for couples, families, parent/child issues, business partners, coworkers, employers, and dealing with psychopathic individuals in your life.

Organizations
American Psychological Association. Association for Applied Psychophysiology and Biofeedback. Biofeedback Certification Institute of America. New York Academy of Sciences.

Publications
The journal, Psychophysiology. The book, Expanding Dimensions of Consciousness. The journal, Headache. The journal, Biofeedback and Self-Regulation. The journal Psychiatry Digest. The book, The TMJ Book. The book, Dental Phobia. The network, CNN. Parade Magazine. The newspaper, Newsday. The Manhattan TV station, WCBS. The national news program, The CBS Evening News. The newspaper, The New York Post. The national TV program, The Phil Donohue Show. The magazine, The New Yorker. The magazine, Glamor. The magazine, Redbook. The magazine, Health. The magazine, Bottom Line Personal. Web MD. The website, Healthology. The magazine, Newsweek.

Education/Credentials
Ph.D. SUNY at Stony Brook, 1979. B.A., magna cum laude with Honors in Psychology, Illinois Wesleyan University, 1974.

Awards and Honors
Who’s Who in Medicine and Healthcare, First, Second and Third Editions, 1997-2000. Appointed to the Training Faculty of the Biofeedback Certification Institute of America (BCIA), 1993. Senior Fellow BCIA. New York Academy of Sciences, 1987. Who’s Who in the East, 1983-present. Who’s Who in Frontier Science and Technology, First Edition. Citation Paper Author. Eleventh Annual Meeting of the Biofeedback Society of America, Colorado Springs, Colorado, 1980. Biofeedback Society of America Scholar, 1979. Co-author, USVA Grant, “Variables Affecting the Experience of Pain in Migraine,” USVA Medical Center, Northport, New York, 1977-1979. Biomedical Research Fellow, Department of Biomedical Engineering, SUNY at Stony Brook, Stony Brook, New York, 1978. NIMH Predoctoral Fellowship, 1976. BA, Magna cum laude, with Honors in Psychology, 1974. Danforth Fellowship Nominee, Illinois Wesleyan University, Bloomington, Illinois, 1973.

Past/Present Clients
Most of my clients are my private patients. However I have provided many seminars, lectures and workshops for: Columbia University. The Mount Sinai School of Medicine. The Metropolitan Museum of Art. The Museum of Natural History. The UJA Federation. The university, CW Post. The College of New Rochelle. Equinox Fitness. Travelers Insurance. AutoOne Insurance. Chubb Insurance. Metropolitan Life. Allstate Insurance. State Farm Insurance. Encompass Insurance. The public relations firm, Porter Novelli. The investment firm, Capital Re:. The Estee Lauder corporation. The law firm of Irwin Abrams. The National Insurance Crime Bureau. GEICO Insruance. Beth Israel Hospital.

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