Example Calls

Below are examples of real calls we’ve received that help show the breadth and depth of what we consult on.

A physician assistant at a residential substance abuse treatment facility in Spokane County called about a young woman with a history of depression, PTSD and opioid/alcohol/methamphetamine abuse. The patient was being prescribed nine psychiatric medications simultaneously.

Question: How do I systematically reduce the patient’s polypharmacy?

A King County primary care provider called about a young man with a long history of generalized anxiety disorder. For the last decade, the patient has been abusing dextromethorphan at doses exceeding 1.8g/day.

Question: What are some ideas for next steps in helping motivate him to pursue sobriety and treatment for his anxiety?

An emergency department physician in central Washington called about a young adult with no past psych history, presenting with symptoms concerning for a first manic episode, including decreased need for sleep, erratic and impulsive behavior, auditory and visual hallucinations, disorganized and tangential thoughts, delusional beliefs, hyper religiosity, and elevated mood. The patient was not on any medications and urine toxicology was negative. The patient had no known medical or psychiatric history.

Question: Is this a manic episode and what treatment is indicated?

A jail physician in rural King County called about a 34-year-old man who was currently incarcerated and who had a history of alcohol use disorder, bipolar disorder and epilepsy.

Question: Which bipolar medications are the least likely to worsen epilepsy?