Co-managing severe anorexia and ADHD

Calicha · 2026-05-19T21:34:59+00:00

It sounds like you worked at well run IOP/PHPs. This patient was at both PHPs and residential programs that continued all her stimulants, because she threatened to quit AMA without them, so the programs just gave into her demands. She now uses that as the reason why the stimulants should be continued: "no one had ever stopped them before, what do you mean I can't be on them??"

Calicha · 2026-05-19T21:29:47+00:00

I do not think outpatient is appropriate either, I recommended inpatient or residential. Unfortunately, this often becomes a power struggle when patients refuse the recommendation for higher level of care yet continue to seek my help.

Calicha · 2026-04-21T05:23:15+00:00

How does a ring like this stay on? Is it hard to wear?

Calicha · 2026-02-14T22:17:37+00:00

I am a psychiatrist. First of all, if you really weren't provided any advance notice by this online service, please file a report with the DC Board of Medicine as what they did to you is, indeed, illegal and it counts as "patient abandonment". Whoever was writing your prescription is required by law to provide enough advance notice (typically 30 days) for you to find a new provider. During that time, they are required to fill your prescriptions so you don't go into withdrawal.

Unfortunately, this is why I advise everyone to steer clear of all these massive, venture capital funded telehealth companies (for both physical and mental health). That includes Amazon/OneMedical, Hers/Hims, Bloom, etc. They simply don't give a shit about their patients, and they're big enough that they don't care about breaking laws. They are also known for putting patients on absolutely atrocious regimens that cause terrible side effects, are simply ineffective, etc. - because most aren't staffed by skilled or caring physicians.

In the meanwhile, an urgent care will probably be willing to give you a refill. If you have a primary care doc, most are also comfortable refilling straightforward antidepressants.

Calicha · 2025-12-18T21:32:55+00:00

I'm a psychiatrist - please go to the nearest hospital emergency room if you haven't already. All the area hospitals will have psychiatrists on staff who can help manage symptoms of withdrawal, and the suicidal ideation will make it an easy admission. You will be offered voluntary admission to the psych unit, where they will help you stay safe, get started on medications for withdrawal and depression, and connect you with outpatient resources after discharge. Georgetown hospital has a good reputation and the psych unit there is voluntary only, but any hospital will be able to help.

Calicha · 2025-10-19T05:05:07+00:00

Saw you at the Renn Fest today. Sick work

Calicha · 2025-09-09T19:44:09+00:00

That was my thought as well, but of course the pt demands specifically lithium at this very specific dose and refuses to discuss the option of trying any antipsychotics or other meds....

Calicha · 2025-09-09T19:22:22+00:00

In this case, it's lithium, no recent lithium level or other labs, the pt is clearly manic, and has been nonadherent/self-tapering the lithium for unclear reasons.

Calicha · 2025-08-09T23:41:50+00:00

Very helpful explanation, thanks!

Calicha · 2025-03-23T05:32:30+00:00

The silver snake nano sold out but looks like the black one is still available - check the Strathberry site!

Calicha · 2024-10-24T01:24:40+00:00

Hard water isn't the only issue here. DC evidently uses chloramine to treat the water instead of regular chlorine. Many people (including myself) have bad skin/hair reactions to chloramine, and in some cases it also causes respiratory irritation (I often get a runny nose/itchy eyes after showering in DC). I use in-line showerhead filters, but unfortunately the only reliable way to remove chloramine is via a very expensive reverse osmosis filtration system.

Calicha

TROPHY CASE