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Has anyone worked for a youth correctional facility? How did you like it? I am considering this move.
Has anyone worked for a youth correctional facility? How did you like it? I am considering this move.
A lot of it depends on the state and facilities you are working in. I have worked with youth within the correctional system in my conservative state at a couple of different facilities for a full year during child fellowship. It is medication management, not doing psychotherapy. I have observed:Has anyone worked for a youth correctional facility? How did you like it? I am considering this move.
Has anyone worked for a youth correctional facility? How did you like it? I am considering this move.
Lots of borderline and antisocial PD. At least they usually take what you prescribe them as the nurse looks in their mouth after they take it.
You know that as a doctor, you're allowed to not prescribe a medication if you don't think it will help. One is not doomed to make mistakes just because others may have in the same setting.Almost certainly in this role you ... will be throwing medications(every class probably) at pathology that isn't going to respond all that well to these medications.
What medication does one prescribe for young, burgeoning Antisocial PD? Same question in relation to borderline...
You know that as a doctor, you're allowed to not prescribe a medication if you don't think it will help. One is not doomed to make mistakes just because others may have in the same setting.
What I see mostly prescribed is Zyprexa or Seroquel + Depakote. Almost always depakote. But I'm sure there are some variations across institutions.
I guess was speaking more academically. Knowing what we know (or what we think we know) about the development of these disorders, why are these medications viewed as appopriate and effective treatment agents?
I can say that I've used similar medications to improve impulse control.I guess was speaking more academically. Knowing what we know (or what we think we know) about the development of these disorders, why are these medications viewed as appopriate and effective treatment agents? And i really hope someone doesnt say "mood regulation", lest I tear my hair out.
Thanks Vistaril, great comments. I 100% agree.why are they prescribed or why are there variations across institutions?
They're prescribed for reasons you could probably guess- there is pressure to 'do something'(even if there is no evidence it works) and throwing money into the med mgt visits and pharmacy is easy to do at least. So you're covered on two fronts- you're 'doing something' and it's also not that
hard to put a contract in place to do it(ie call up MHM, they send you an agency psych or psych np to write meds for these troubled kids, and voila you have a 'mental health program' as part of your correction center). MHM gets their cut, the psych or psych np gets their wages without too many neurons having to go off in their head, and the correction officials are satisfied because they are doing something, or at least giving the appearance. Win all the way around....well except for the taxpayers and kids/inmates.
To the second question- anytime something doesn't have great evidence a lot of different approaches(well in this case really not all that different) tend to be adopted here and there.
We use antipsychotics and mood stabilizers off-label. They are not approved by the FDA as safe and effective for use in children for impulse control. To my knowledge there is no FDA approved medication for the treatment of "impulse control" or "aggression" in children or adolescents. Yeah, they may work to treat the immediate symptom of aggression, but it doesn't treat the underlying personality and behavioral problems wrought by a child's developmental environment. And then they develop diabetes, tardive dyskinesia, and so on which costs our society money down the line.I can say that I've used similar medications to improve impulse control.
Thanks Vistaril, great comments. I 100% agree.
We use antipsychotics and mood stabilizers off-label. They are not approved by the FDA as safe and effective for use in children for impulse control. To my knowledge there is no FDA approved medication for the treatment of "impulse control" or "aggression" in children or adolescents. Yeah, they may work to treat the immediate symptom of aggression, but it doesn't treat the underlying personality and behavioral problems wrought by a child's developmental environment. And then they develop diabetes, tardive dyskinesia, and so on which costs our society money down the line.
I think one day history is going to look back at how we treat children and adolescents in psychiatry today in a similar way to how we look at the mass institutionalization of mentally ill patients in past years. We can do better.