By Moryt Milo
One of NAMI Santa Clara County’s most popular general meetings is “Ask the Doctor”, and this year drew a crowd.
Dr. Katherine Taylor, Interim Medical Director for Mental Health and Addiction Services at El Camino Hospital, addressed a range of questions that included various treatments and diagnosis, autism spectrum later in life, dual diagnoses, the increase in psychosis due to cannabis use and much more.
She talked about the mental health landscape pre- COVID, during COVID and post pandemic. Before the pandemic patients being admitted to the psychiatric unit had psychosis, schizophrenia, anxiety and depression, she said. During the heart of the pandemic the hospital saw more individuals with anxiety and depress. Then as the world came out of the pandemic a lot more people were being admitted for substance use. On the medical side it was alcohol, but on the psychiatric side it was cannabis induced psychosis and other illnesses.
Most importantly, though, the pandemic brought mental illness to the forefront, Dr. Taylor said. More people were talking about it. More people were experiencing it and more people needed help. But the lack of resources is still inadequate, she said.
Yet even with these challenges Dr. Taylor provided a wealth of insight exploring and discussing various options. Below is an edited sample of questions Dr. Taylor addressed during the June general meeting.
Can ADHD medications cause psychosis?
ADHD or Attention-deficit/hyperactivity disorder is a medical condition that makes it difficult for an individual to pay attention. It can cause hyperactivity and impulsive behavior. During the pandemic the drug Adderall used to treat the disorder was in short supply.
KT: ADHD can cause psychosis and it’s something that needs to be watched. She said it’s the prescriber’s responsibility to monitor a stimulant and watch the patient carefully, making sure they are not developing symptoms. Should this occur the individual needs to stop taking the medication. There are alternatives.
After trying six different medications and 20 sessions of electroconvulsive therapy (ECT), what options are available to help address auditory hallucinations.
KT: That’s a really hard question. ECT is a treatment for not responding to medication. When I look at a patient not responding to medication, I want to make sure people are taking their medication. The process is to usually try three to four atypical antipsychotics when the patient is not responding. Then I might try an older medication like Haldol or Clozaril if the individual is treatment resistant. The doctor also want to determine if there is something else going on such as substance use.
What happens with patients that have cannabis withdrawal?
KT: We are seeing that a lot more. The patients usually become very anxious. Medications are given to reduce the agitation and anxiety like the antipsychotic Seroquel. Most of the patients seen on the floor are agitated from lack of sleep, because they have been using it to help them sleep. So the hospital needs to confirm if they are withdrawing from cannabis or something else.
When someone has a dual diagnosis which one do you treat first?
KT: My first priority is to make sure the person is safe. The person way be withdrawing from alcohol or opioids. People can have depression and are self-medicating or they can be using a substance that creates depression or psychosis. Depending on the level of severity I start with the environment. Coming off alcohol or opioids can cause seizures or cardiovascular problems. This requires an in-patient controlled environment. There are also out-patient partial hospital programs, but this depends on the situation.
What can I do if my 27-year-old son doesn’t want to go to a doctor and has not been diagnosed? Can St. John’s Wort help?
KT: There is some indication that it can help with depression. There are some kinds of things that can certainly help people who don’t want to seek treatment. Exercise and dietary changes, but it depends on what the person is not being treated for. What is this illness preventing them from doing in their lives. Sometimes there is a hidden anxiety component. To me it’s about communication and trying to find out what is going on and what you can do. Family support is a start, whether it’s going to a therapist together, connecting then with peers, getting the communication started is key.
My son received a diagnosed of schizophrenia from two doctors and each visit was only 15 minutes.
I am always uncomfortable with the idea of someone diagnosing an individual in 15 minutes without doing a full history. You may suspect where things are going depending on the length of time. But if someone has psychotic symptoms for a month, you can’t officially diagnosis omeone with schizophrenia — you can’t use that label. There are specific characteristics and time periods to diagnose. This is a big diagnosis, and families need support and time to digest it. Families need to know what to expect in three, five, ten years. What do they need to do? How do they plan to move forward? Families and patients need to be working with someone they can trust.
Dr. Taylor said there is reason to be optimistic about the future even when a family receives a difficult diagnosis.
“There is a lot of hope,” she said. “There are a lot of medications. There are a lot of treatment options and sometimes it just involves holding on and doing the treatment and getting to the other end.”
To watch the ‘Ask the Doctor’ YouTube presentation click here.