I am a Brazilian psychiatrist with a master degree in preventive medicine. This year I will coordinate an academic ambulatory for medical students. I would like to teach deprescribing in psychiatry. The students are in the final year of medicine degree, and they will spend one month in this ambulatory. The ambulatory is part of a primary care setting which don’t have psychiatrists or other specialists. So, my major difficult is how to select patients? Which patients would benefit of this approach? Anyone has previous experience or suggestion??
Thank you!
One successful situation that comes to mind is the treatment of Seasonal Affect Disorder with Vitamin D and light therapy.
Also, I believe there have been studies where Vitamin D had a slight mood elevating property when given to the mildly depressed patient. I don't have an immediate reference to such, but will look for it when I have time.
Furthermore, melatonin has been somewhat successful with mild sleep disorder patients. Better to start patients with Melatonin that initiating with Trazodone.
That's about all I have right off the top of my head.
Hope this helps.
I teach medical students and residents as well as allied staff dm me if you want some assistance
Overtreatment and polymedicine is a worrying and relevant issue in primary care, and especially in the area of psychotropic drugs.
Very often we come across patients with long lists of medications to be taken every day and for whom it seems that the risks or disadvantages do not outweigh the expected benefits. Moreover, they are often chronic treatments without a clear indication or without a clear goal to maintain treatment.
A careful review of the list of treatments evaluating the expected goals or benefits and the effectiveness achieved in the specific patient, indications, adherence to treatment, risks of drug interactions, risks of concomitant diseases or the characteristics of fragility of the patient, the clinical judgment of the doctor and the opinion of the patient, can tell us which drugs we could withdraw.
This must be a careful, progressive and monitored process, with the patient informed and with their agreement.
Regarding psychotropic drugs, benzodiazepines deserve special attention, as well as chronic treatments with antidepressants, long-term treatments with neuroleptics in dementia, or the specific drugs for Alzheimer's disease themselves (in which often no clinical benefit can be seen).
These are generalities based on my own clinical experience. I hope I helped you
See https://www.researchgate.net/publication/260196534
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