Legal Disclaimer: Responses to questions should not be construed as medical advice or treatment. Readers should not rely on the information contained on this web page for diagnosing or treating any illness, condition, or disorder. If emergency medical or mental health care is needed, call 911 or go to the nearest emergency room. Neither Butler Hospital nor the authors of the answers are responsible for how readers use the information.
Partial Hospital Homepage Q: I have a sister who has bi-polar. She has been at Butler several times. I don't believe her doctor is the right one for her. She really needs better care. Recently, she dropped her divorce against her husband. Upon his return, her mental health declined to the point that she was admitted to Butler. I believe she was released too soon. Since being home she has not slept and has become abusive. She doesn't even know how to take her meds. What, as a sister, can I legally do?
A: It is a difficult spot to be in--to see someone you love failing and feeling like you are helpless. There are laws in place protecting the confidentiality and right to make one's own decisions about treatment. However, doctors and other helping professionals may listen to a family member's concerns even if they can't report about the patient. A concerned family member can encourage a relative to seek or continue treatment. If a family member believes that a relative is so mentally incapacitated that the relative cannot make their own treatment decisions, family members may initiate guardianship hearings (although this is not easy). If a family member believes that a relative’s continued unsupervised presence in the community creates a likelihood of serious harm because the relative is mentally ill, the family member may initiate a court proceeding to have the relative evaluated by a psychiatrist (although this process is not easy either.) Some people find it helpful to get connected to family support groups, such as those offered by NAMI Rhode Island.
Q: I have PCOS (Polycystic Ovarian Syndrome). I am 39 years old and have suffered from depression from when I was a teenager. I have been treated by my doctor for depression. I have been on Paxil, Zoloft, Effexor, Cymbalta and Wellbutrin. I have been on Zoloft the longest. Right now I am currently on Zoloft and Wellbutrin at the same time, but I am trying to wean myself off of Zoloft because I feel that it is not working for me anymore and I don't like how it makes me feel. The other medications that I was on did not work for me either. Are there any other medications that I can try? Should I try therapy? I tried going to a therapist in the past, but I have not found one that I really felt comfortable with. I never think of suicide because I have two beautiful boys and plus I am scared to do anything to myself. I just want to know are there other options for me? Thank you.
A: It is important to discuss all changes in medications with your physician. There are other antidepressants available that you have not mentioned, as well as other augmentation strategies. Psychotherapy in conjunction with medication has been shown to be the most effective treatment for depression. Discuss your situation with your physician to get a referral to a therapist or to the Partial Hospital at Butler.
Q: Is the Partial Hospital/Day Hospital program covered by Medicaid? Medicare?
A: Butler Hospital does accept Medicare, though there is an approximate $60 per day copay for partial hospitalization. Medicaid does not pay for Partial Hospital services. However, a member of Butler's Patient Financial Services Department can discuss insurance options and/or policy limits with you, as well as develop a payment plan if necessary.
Q: I've been vomiting for over a year, probably with the considence of Litium. I am also on Cymblata and Tranzadone along with a whole slew of medical meds. Thus far they haven't found a cause whether pysch or medical. In the past I did have a Litium toxic problem. I was in Butler to detox on all my pills. I felt fine after that that doctors started pilling me up again. The last time I felt good was October 2007. I vomit just about everyday. I have had it. Can you be of help? Thank you.
A: Sometimes it can be challenging to find the right medications, ones that help and also are tolerable. It is important that you have a doctor that you can work well with. Vomiting can be caused by many things. It would be important that you see your primary care physician for an evaluation as well. The Partial Hospital is a good setting for a thorough psychiatric assessment and re-evaluation of treatment. Speak with your doctors to see if it is right for you, and hang in there.
Q: Can you give me some information/prognosis on schizoaffective disorder (diagnosed for a 21 yr old woman)? Also, do the benefits of taking Zyprexa outweigh (no pun intended) the significant weight gain? Are there any support systems in place in RI where family members of someone with schizoaffective disorder, as well as the patients themselves can get help? Thank you!
A: Schizoaffective disorder is classified as a psychotic spectrum disorder where an individual experiences both symptoms of schizophrenia such as delusions, hallucinations, thought disorder, and apathy in addition to having a full blown major depressive or manic episode. Schizoaffective disorder tends to be a chronic illness, but the symptoms are manageable with appropriate treatment. Medication is part of the treatment, generally antipsychotic medication, such as zyprexa. The risk/benefit ratio of a particular medication is a very individual decision. Zyprexa is an excellent medication, but there are other antipsychotics that do not cause as much weight gain. However, we don't always know if a person is going to respond favorably if a switch is made. An excellent support system for family members and patients is the Rhode Island Chapter of National Alliance on Mental Illness (NAMI) Rhode Island (401-331-3060).
Q: Can someone with suicidal thoughts (who has not acted on them)be a patient of the the partial hospital or would they have to be committed in house? And how could this person get help without jeopardizing there work or reputation?
A: Suicidality is on a continuum. Thoughts are very different than behaviors. After a careful assessment, the most appropriate level of care would be determined. Many partial hospital patients present with suicidal thoughts and are able to be helped in the partial setting. All evaluations/treatment are confidential. Information is only released to those who the patient consents to have it released to. It is often difficult for a patient to work while they are receiving treatment in the partial hospital. The physician in the partial hospital would be able to provide a note to the employer regarding the patient's inability to work due to medical illness. Getting help should not hurt someone's reputation!
Q: What is the best treatment for someone suffering with severe generalized anxiety disorder?
A: Once it has been determined that an individual is suffering from generalized anxiety disorder (that is, no other medical condition has been identified that could explain the symptoms), the best treatment is a combination of cognitive behavioral therapy and medication. Antidepressant medications affecting the neurotransmitter serotonin have been effective.
Q:What medication is the best to deal with extreme anxiety? I currently take Xanax .5 - 3 times daily; Seroquel 25 mg - 3 times daily; and Lexapro 20 mg per day; but, I still have a lot of anxiety?
A: It is best to consult with your physician and follow his or her recommendations.
Q:I have severe anxiety with panic attacks, I have been on Paxil for many years now, but have gain about 30 pounds, Is there a different option of medication that will help without the weight gain?
A: Many factors may be associated with weight gain. It is important to discuss this concern with your physician and make sure there is no other explanation for the weight gain. That being said, anecdotally, Paxil tends to be associated with more weight gain than some of the other selective serotonin receptor uptake inhibitors. Unfortunately, weight gain is associated with many of the medications that tend to treat panic disorder. Please discuss which options make the most sense for you with your physician.
Q:My mother-in-law was admitted this weekend for an evaluation due to a change in her meds, and she has a new her psychologist. We are concerned about my mother's understanding of what meds she should be taking when changes are made. Is the Partial Hospital a resource that could assist her, and the family, to ensure her wellbeing and piece of mind?
A: The partial hospital program provides short term treatment and is often an appropriate step-down from a higher level of care. It can provide a smoother transition home with monitoring of symptoms and medications while the patient is spending time in his/her home. Nursing staff are available to assist with medication education. Family involvement is solicited as well on a routine basis.
Q: Do you accept Harvard Pilgrim HMO? I am a Massachusetts resident; will my insurance cover your services?
A: Butler Hospital does accept Harvard Pilgrim HMO. Coverage for partial hospital services will depend on your particular plan with Harvard. Most insurance plans cover partial hospitalization. While some plans may cover treatment completely, others may require a co-pay. Either way, a member of the Butler’s Patient Financial Services Department can discuss insurance options and/or policy limits with you, as well as develop a payment plan if necessary. You can also call your insurance company directly to inquire if partial hospitalization is covered under your policy.
Q: During partial hospitalization, what if a patient feels unsafe or needs help at home in the evening?
A: It is important that a patient let his/her physician or therapist know if they are at risk of harm to self or someone else. Should a patient experience difficulty at home during partial hospitalization,Butler staff is available 24-7. A patient should follow his/her doctor’s instructions as how to reach the physician after hours, and may also call 401-455-6214 or 401-455-6215, or come into the hospital.
Q: How do I know if partial hospital is the right level of treatment for me?
A: You can call the Partial Hospital at 401-455-6214 or 401-455-6215 and speak to a call center representative. They will do a brief assessment to determine what level of care is right for you, then refer you to a Hospital clinical nurse specialist for further assessment and/or a full evaluation, if appropriate.
Q: Do I have to live in Rhode Island to attend the Partial Hospital?
A: No. Although patients primarily reside in Rhode Island and nearby New England states, people have come from all over the country and Canada to seek treatment in Butler's Partial Hospital.
Q: Do I need a doctor's referral to attend the Partial Hospital?
A: Butler Hospital does not require that patients be referred to the Partial Hospital by a physician. However, if you're experiencing symptoms of depression, anxiety, or have an eating disorder or an addiction, you should talk to your primary care physician or therapist about it. Many of our patients are self-referred or are referred by a family member. Some insurance plans do require their members to get a doctor's referral. If in doubt, please call your insurance company to inquire if a referral is necessary.
Q: How long will I attend Partial Hospital?
A: On average, patients attend the Partial Hospital anywhere from five to seven days. The exact number of days depends on the diagnosis and clinical needs of the patient and his/her progress in their treatment.
Q: Will I receive individual treatment in the Partial Hospital programs?
A: Treatment is provided in two ways-individually and in group settings. During the day, each patient meets with his/her doctor privately on a daily basis. Patients also meet in groups. Groups help patients who are going through similar experiences share and learn from each other. Treatment also includes group education on life skills, such as stress management techniques, assertiveness training, and leisure skills development.
Q: Is a relapse into depression unlikely if a person stays on a maintenance routine of anti-depressants while the depression is in remission? Are one group of anti-depressants more effective for this as in SSRI's vs. other drugs like Wellbutrin SR. P.S. I would really like to win the Tina Turner tickets!
A: The chance of relapse is significantly lessened if a person stays on maintenance antidepressant medication. This medication should be continued at the same dose that was initially needed to treat the depression. No one category of antidepressant is more effective than another overall, yet in an individual, one medication may work better than another. Good luck with the tickets!
Q: I am a 41 yr. old female who has experienced anxiety for the past 2 1/2 years. I have been taking natural supplements that seem to help somewhat. I haven't had a panic attack in quite awhile but still suffer from anxiety symptoms every day. I tried cognitive therapy for awhile but it didn't seem to help. Some people suggest yoga and hypnotherapy. Do you have any suggestions?
A: We would need more in depth information to understand why cognitive therapy was not effective, because it is a very effective treatment for anxiety. Most treatment for anxiety won't eliminate it, but strive to make sure that an individual is able to function at his/her best. Yoga and other skills that build on mindfulness are effective for anxiety. Medication may also be helpful. Ensuring regular exercise, sleep cycle, nutritious food intake, and elimination of caffeine, nicotine, alcohol, and non-prescribed drugs are also helpful strategies. You may want to seek consultation with a mental health professional.
Q: What antidepressants least affect sex drive?
A: It is thought that buproprion and mirtazapine least affect sex drive.
Q: Do you have a partial hospital program for children? It has been recommended that my 5 year old grandson be admitted to a hospital for his aggressive and non compliant behavior. His mother thinks a hospital stay without her would traumatize him.
A: At this point in time, the Butler Hospital Partial Hospital program provides treatment generally to those patients age 16 or older. Your grandson may benefit from an evaluation with a child psychiatrist to assist in determining the appropriate intensity of treatment and assisting with any needed referrals.
Q: How do you get a bi-polar daughter to recognize her condition and take her medication??? She is a young adult.
A: This is a very challenging, but unfortunately common, situation. Having people that your daughter trusts speak to her may be helpful. It is also advisable to discuss your concerns with her treatment providers. She may also benefit from attending a support group such, as the Manic Depressive and Depressive Association of Rhode Island (MDDA), which meets regularly on the Butler Hospital campus. Visit MDDA-RI.org for more information on meetings. You may also benefit from the support of the National Alliance on Mental Illness of Rhode Island (namirhodeisland.org), which holds support groups that also included family members. Butler Hospital also has a Family Education Resource Center center where you may pick up information regarding bi-polar disease to share with your daughter.
Q: My husband is suffering from severe anxiety and depression. He is currently taking Effexor. He is not in therapy. He has had another severe anxiety episode this weekend. When he gets this way, he cannot function. Please advise.
A: It sounds like he may benefit from seeing his treatment provider and letting the treatment provider know that his symptoms have not remitted. The goal of treatment of anxiety is not necessarily to prevent the anxiety symptoms but to assist an individual in managing his symptoms so that he is able to function. The most effective treatment for depression and anxiety is a combination of medication and psychotherapy. Your husband may benefit from a program like the Partial Hospital if his symptoms are preventing him from functioning and are not improving despite outpatient treatment.
Q: Do you specific treatment for strictly Marijuana addiction?
A: None of our programs are specific to one type of diagnosis. We find that the group format and intensive focus on coping skills is very helpful for most disorders. In the Partial Hospital program, a full assessment would be completed to investigate possible co-morbid diagnoses and develop a treatment plan. We also have an Alcohol and Drug Partial Program to assist individuals struggling with problematic substance use. This program may be appropriate for an individual requiring treatment for marijuana addiction.
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