EppsNet Archive: Risk

25 Concepts to Facilitate Judicious Use of Psychiatric Drugs

20 Sep 2015 /

I’m not a doctor, nor do I play one on TV, but I did stay at a Holiday Inn Express last night . . . I also took a Colgate University class on medicating for mental health and judicious use of psychiatric drugs.

Pills
  1. A psychiatric medication is only one useful tool among a collection of useful tools. Remember to also consider non-drug options for therapy.
  2. The benefits of psychiatric medications are always accompanied by risk. Become familiar with the potential risk of your medication. Be alert to potential risks that might be intolerable to you.
  3. Establishing a diagnosis is a difficult and imperfect task, but it establishes the starting point for determining which treatments are appropriate.
  4. Engage your physician or a psychologist in a dialogue regarding the structure of your treatment program. Be an active participant in establishing the structure of that program. Having confidence that your treatment program will work is important for its success.
  5. Become familiar with the vocabulary of psychopharmacology and with some basic principles of psychopharmacology. It will improve your ability to communicate with your physician or therapist.
  6. Be forthcoming and candid with your physician or therapist when working to establish realistic goals for your use of psychiatric medication. These goals should include the meaningful improvement of symptoms and side effects that are acceptable to you.
  7. A treatment program should aim to not only produce meaningful improvement of symptoms but also should include a plan to prevent relapse.
  8. A psychiatric medication is limited in its effectiveness for improving a problem that has biological, psychological, and social characteristics.
  9. Ask whether the use of your recommended psychiatric medication is supported by published evidence or is an off-label prescription based upon educated guesswork. If your prescribing physician doesn’t know the answer to that question tell him or her to find out for you.
  10. Remind yourself that a psychiatric medication will alter the neurochemistry of your brain and that the effects of medication on the brain can persist and may be permanent.
  11. The ideal dosage of a psychiatric medication is the smallest dosage that is able to provide meaningful relief of symptoms.
  12. Fulfill your responsibilities for ensuring the success of your treatment program. Be fully cooperative regarding instructions for using medication and for taking the advice of the therapist.
  13. Remember that counseling, psychotherapy, or behavioral therapy may enhance the effectiveness of a psychiatric medication.
  14. Remember also that a psychiatric medication may enable counseling, psychotherapy, or behavioral therapy to be more effective.
  15. Newer psychiatric medications are often more expensive medications despite the fact that those newer drugs may not be more effective than older medications.
  16. Newer psychiatric medications have been used for a shorter period of time and by fewer people than older medications. This fact increases the likelihood that newer medications might bring unpleasant surprises.
  17. Herbal remedies and dietary supplements may or may not be effective or safe and very few of those remedies have been studied in well-designed experiments to evaluate their effectiveness and their relative safety.
  18. If possible, avoid using multiple medications in order to minimize the possibility of harmful drug interactions.
  19. Direct-to-consumer advertising of psychiatric medication is principally intended to get you to buy a product. That product may or may not be in the best interest of your own physiological, emotional and psychological well-being.
  20. Be aware that your health insurance provider may structure costs to you, the patient, in a way that provides some incentive to use one drug instead of some other drug or to use medication instead of psychotherapy. If possible, try to make the principal goal of your therapy to be the relief of symptoms, not the lowest cost of treatment.
  21. The elderly present special vulnerabilities for psychiatric medications — for example, enhanced sensitivity, likelihood of polypharmacy, or increased risk of falling.
  22. Exposing the young, still-developing brain of a child or adolescent to a potent psychiatric medication risks creating problems for those brains when they reach adulthood.
  23. The recent trend is to rely more upon psychiatric medication than upon non-drug therapies to treat psychopathology. Resist that trend when you are not convinced that medication is the best choice for you or for a member of your family.
  24. The study of brain and behavior is a frontier science. Thus the use of drugs that alter brain neurochemistry to treat psychopathology is based upon an incomplete understanding of brain and behavior.
  25. Because our current understanding of brain and behavior is incomplete, contemporary psychiatric medications are imperfect tools that are clinically useful until we learn enough to develop better tools.

Risk = Cumulative Cost – Cumulative Value

9 Mar 2014 /

Henrik Kniberg has a presentation online called “What is Agile?” It includes a method of visualizing risk as the gap between cumulative cost and cumulative value, as well as methods of visualizing risk mitigation strategies.

I found it valuable. Here are some representative slides:

Big Bang = Big Risk

Agile = Iterative + Incremental

Improving the Value Curve


EppsNet Book Reviews: The Big Short by Michael Lewis

10 Nov 2013 /

I worked in the information technology department of a mortgage bank in the run-up to the 2007 implosion of the subprime mortgage market . . .

Given that it was fairly evident at the time that complicated financial instruments were being dreamed up for the sole purpose of lending money to people who could never repay it, it’s remarkable that very few people foresaw the catastrophe and that even fewer actually had the nerve to bet on it to happen.

Long story short, the major rating agencies — Standard and Poor’s and Moody’s — were incompetent in their rating of subprime mortgage bonds, giving investment-grade and, in some cases, triple-A ratings to high-risk instruments. A lot of people took the ratings — which implied that subprime mortgage derivatives were no riskier than U.S. Treasury bonds — at face value and acted accordingly.

But there were also some interesting psychological factors in play, not specific to the investment arena:

  1. Nothing really bad had ever happened in the subprime mortgage market. Every tiny panic was followed by a robust boom. Since nothing really bad had ever happened (albeit over a short and statistically insignificant period of time), nothing really bad ever would happen.
  2. The collapse of the subprime mortgage market would be a national catastrophe, and was unlikely precisely because it would be such a catastrophe. Nothing that bad could ever actually happen.

And the time came when the risk to remain tight in a bud was more painful than the risk it took to blossom. — Anais Nin


For Some Things, You Need a Man

2 Jul 2012 /
Lightning

80 Percent Of Lightning Strike Victims Are Male, But Why?NPR

Same reason all of your top executives are men — because we’re risk takers and we don’t run and hide under our blankies at the first sign of danger.


Visibility and Feedback

18 Jun 2011 /

Forgive my ignorance. How do increased visibility and tighter feedback loops manage and reduce risk?

Get in your car. Drive to a winding road. Get up to a decent speed. Close your eyes for two minutes. Then come back and ask your question again.

Ron Jeffries, Yahoo Groups (kanbandev)

A Longstanding Absurdity

12 Feb 2011 /

Is the bad-software problem really caused by bad requirements definition, which we could fix by doing a better job up front, if only we were more diligent and more professional in our work?

We have made this our primary excuse for bad software for decades. If this was really the problem, and if processes focusing on early lockdown of requirements provided the needed solution, wouldn’t we have solved this by now?

A process that requires us to lock down decisions early will maximize our risk, not manage it.

Cem Kaner

Twitter: 2010-08-10

10 Aug 2010 /
Twitter
  • RT @joshcomers: “I’m ready to take this to the next level!” (overly dramatic guy walking into an elevator) #
  • RT @joshcomers: Just saw that a guy following over 28,000 people unfollowed me. I must have really fucked up. #
  • Risk creates value. Except when it destroys value. #
  • RT @Jesus_M_Christ: #ILaughEverytime I send a Fundamentalist to Hell. #
  • RT @Jesus_M_Christ: Whenever someone pleads with me for World Peace then ends their prayer by asking for bigger boobs #ilaugheverytime #