Here are some of the more common consultation questions received by our PCL psychiatrists. The central themes are requests for guidance on diagnosis, medication management, and treatment planning for challenging or difficult to treat symptoms.
What are next steps for treatment-resistant depression? This is one of the most common scenarios on the PCL. Providers call after a patient has not responded to one or more standard antidepressants (like an SSRI). They’re looking for evidence-based advice on next steps, such as optimizing the current dose, switching to a different medication class, or using augmentation strategies.
How can I tell if my patient has bipolar disorder or depression? Callers often present with a patient who has depression but may have other signs (like irritability or a poor response to standard antidepressant medications) that suggest an underlying bipolar disorder. They call to discuss how to screen for a history of mania and to get advice on the safest medication choices.
What’s the best way to treat patients with both a mental health and substance use condition? Nearly 80% of all PCL substance use disorder consults involve a patient with a co-occurring mental health condition. Providers call to ask for guidance on choosing safe psychiatric medications for patients who are actively using substances, to clarify diagnosis, and to discuss strategies for treating both conditions simultaneously.
What monitoring is recommended when my patient is on an antipsychotic? Questions about antipsychotic medications are common on the PCL, and providers often call us to confirm best practices for patient safety and monitoring. They ask for clear guidance on what labs to order (e.g., fasting glucose, lipids) and how often to monitor for metabolic syndrome and other potential side effects.
How do I safely start a patient on buprenorphine for Opioid Use Disorder? An increasing number of PCL calls are practical “how-to” questions about treating patients with substance use conditions, especially those who use opioids. The most frequent is a request for guidance on buprenorphine induction, including how to ensure the patient is in proper withdrawal, what the starting dose should be, and how to manage the titration schedule.
How do I manage agitation in a patient with dementia? Providers call seeking strategies for managing behavioral symptoms of dementia such as apathy, depression, anxiety, aggression, agitation, and delusions. These symptoms can significantly affect a person’s quality of life and the well-being of caregivers. Callers are often looking for advice on non-pharmacological interventions and want to discuss the risks and benefits of using antipsychotic medications in this often-vulnerable population.