how to talk?

There is surprisingly little published to guide therapeutic conversations with psychotic patients.
There is of course increasing data related to CBT principles which could be modified to fit in with the day-to-day work of treating patients on an inpatient unit with acute illness. It is difficult for various reasons including their lack of insight and intensity of their symptoms. In particular paranoia.

I have had the fortune of working with my supervisor who has like-minded concerns in this area. We have had a number of conversations within the context of supervision that has generated an enthusiastic drive to seek and learn of ways of working in a meaningful way with psychotic patients (+ the silent patient, the belligerent patient etc). Of course most of us would say that experience has much to contribute to the effectiveness of how a clinician communicates - its not true that experienced clinicians are always effective. There is always something to learn. Our counterparts in medicine, general practice and surgery have studied situations where communication between patient - doctor could mean the avoidance of a law suit or death. The use of acronyms such as A.S.S.I.S.T in the context of patient/family complaints has been particular useful and effective. The use of a structured way to communicate subverts clinician anxiety / fumbling for words and maybe minimises the risk of worsening the situation by saying something daft. One wonders if there are similar tools to use when talking to patients in psychiatric settings?

As with everything in psychiatry - more research is needed.

Learning goals part 1

Some bits and bobs re: learning goals

So it turns out you can co-administer zuclopenthixol decanoate with acuphase in the same syringe - both oil based vehicle. First dose of depot can be conveniently given together with more acute treatment.
Prof Castle and his team in OZ have developed a set of guidelines around the use of acuphase. A course of injections is recommended in preference to unsystematic use of crash Acuphase for patients its indicated for - recommend not exceeding >4 injections consecutively or stopping injections if total dose = 400mg.
Review articles say that most depots are much of a muchness but in general depot seem to improve compliance vs orals for various reasons - some more obvious.

Lithium - not much evidence supporting its use in teenagers with bipolar d/o.
Also not great for depressive phase of bipolar disorder.

Gender identity disorder (social/cultural)