Dr. H. Steven Moffic discussed the issue with psychiatric polypharmacy in his August 29, 2022 entry on Psychiatric Views on the Daily News. The patient who had been getting 10 psychotropic drugs was found to have a medical problem ultimately, which led to simplification of the complex regimen.
This is a great opportunity to again mention the value of what was a regular part of the teaching component of the University of Iowa Hospital Consultation-Liaison Psychiatry service, at least until my retirement. This was the Clinical Problems in Consultation Psychiatry (CPCP) seminar. Once a week or so, when I was staffing the service, I and the trainees, which included medical students, and psychiatry residents as well as Pharmacy, Neurology, and/or Family Medicine residents.
Whenever we encountered a difficult and interesting case, which was almost every rotation, the trainees did a literature search to bone up on the clinical issue and gave a short presentation about it before consultation rounds. Often the case had both medical and psychiatric features.
I looked through my collection of student presentations and found one that might fit Dr. Moffic’s example in a general way. Medical problems can often look like psychiatric problems, which can include thyroid and other diseases. A very important one is autoimmune encephalitis, one example of which is anti-N-methyl-d-aspartate (NMDA) receptor encephalitis. There is an excellent summary of it in the August issue of Current Psychiatry entitled Is it psychosis, or an autoimmune encephalitis? (Current Psychiatry. 2022 August;21(8):31-38,44 | doi: 10.12788/cp.0273).
Several years ago, three medical students tag-teamed this topic and delivered a top-notch CPCP seminar summarizing the pertinent points. I hope the CPCP is still part of the educational curriculum.
Go Retire Psychiatrist 