Monday, May 3, 2010

Mobanished. A passing prompts a favorable reflection upon psychiatry, and meds.

In the recent Am J Psychiatry, a Dr. Neimark laments the discontinuation of Moban. I feel ya.

This strikes a chord for me. I have known a fair handful of people who have found help from Moban, out of the damningly frustrating puzzle of psychoticism relief.

Positive, negative, side effects, EPS, NMS, TD, AIMS, weight gain, weight loss, insight, light sensitivity, agranulocytosis, and on an on and on. Itself, maddening.

The people stricken with schizophrenia are heroes, with the heroism thrust upon them by misfortune. However, the docs who sign up to treat these patients have a choice. You don't have to make your professional life a matter of shots-in-the-dark, pages, scripts, drool, disappointment, and compromise. But the docs who venture to treat such a population are heroes. And are wise to grab hold of, and get trained with, any weapon that might come in handy.

Something occurs to you: maybe we will trial Moban.

For a couple weeks, you have a feeling, or a belief, that is hard to describe. That is in between confidence, surety, hope, and long-shot luck.

In the face of all of this lottery-ticket, against-the-odds foolish optimism, you know the task you must fulfill.

Achilles must take his fated stand.

You run through the questions you know you must ask, against your intuition, your hopes, your desire, your hunch, your clinical judgment. And, these must be recorded. Possibly only for the pharmacist to count. But then again to suffice for the highest level of subpoena scrutiny that might arise.

Some times it works.

And you incorporate that limited victory into the matrix that is a mix of clinical lore, evidence, memory, parataxy, receptor profiles, and who-knows-how-the-mind-calculates.

Some times it works.

God help us. The families are commited out of love and family bonds. A face only a mother could love? There is something that works inside of us to commit in a similarly endless-devotional way. We might say "professionalism." I don't know if there is a term for it. But we charge in, declaring that we surely might be able to help, and are confident. But we know the challenge we are in for. Yet commit. And show up day after day.

So, when you are right, when Moban works, you want to underline the victory in the record. And you cleverly store away any clue, like you might tuck away the knowledge of an awesome, but isolated, restaurant or coffee shop at some vacation destination.

Boston? Oh, you have to go here.

Sarasota? You have to go here - totally off the guide map.

Sedona? you have to stay here.

[Symptom and patient profile]? Moban.

What? They're no longer in business? What a shame. What a loss.