Love & Potions:

In Cat We Trust

Pharmacotherapy to support relationships
In a graphic novella

Love & Autism Conference
San Diego, August 24, 2014

Joshua D Feder, MD
Child and Family Psychiatry
jdfeder@mac.com

Disclosures, August 2104
clinic: my main job

iPad -UCI research

peace building

COC policy work

UCSD toddler research

Circlestretch web info

Cherry Crisp media


Relias courses for paras
!
Thank You
Jenny Palmiotto
Mara Goverman
Caron Schiffman

Outline
You are eatingI am talking.
I made you a graphic novel (a aka comic
book): Jill and Robert - In cat we trust
Q & A



There are so many
stories in the city.
This one begins in a
suburban home



Jill: He didnt notice
my new hybrid car



Jill: What mom?
Its NOT stalking.






Mom: Dr. Lewis will
see you both?



Jill: If I can get him
there - its like
herding the cat..



Later
that
month

Dr. Lewis:
It
looks
like
Jill
dragged
you
here.




Robert: My parents
think I should settle
down



Dr. Lewis: Jill, you can be
pretty intense Robert
you seem more low key.



Jill: We want
medication
Robert: Ow - Dont
grab!



Dr. Lewis: I get it we need
to cool you down and try to
warm him up



Dr. Lewis: Medication can
help a good plan, but you
need a good plan.



Dr. Lewis: Love is about
selfless giving and
treasuring time together.



Dr. Lewis: to do that you
both need to be calm,
connected and
communicating.



Dr. Lewis: Lets go slow
with the medications.



Across town afterward
Jill: We can work this out.



Jill: Ill have spicy arribiata, please
Robert: Plain pasta for me thanks







Jill: Maybe the wine is a
good medicine.




Robert: I dont drink.



Jill: Smells can work: cheese,
musk, mushrooms, meat..



Jill: Anyway, Dr. Lewis said
its more than meds



Jill: we have to connect...
Hey! Robert!
ARE YOU LISTENING?!?


Robert: We have to be
calm first you have to
stop freaking me out



Jill: ok, ok Ill warn you
before I touch you



Robert: The Prozac might help
but it might make my
concentration worse.



Robert: And if it makes my
parts down there not work
so well, thats not good, if
you know what I mean



Jill: I know what you mean
SSRIs did that to me.



Jill: But its better than the
Xanax from Dr. Smith.



Robert:
Benzoshmmmyuck: falls,
forgetting, accidents,
addiction


Jill: Yeah I stay away
from those



Robert: Dr. Lewis talked about
Adderall for concentration



Jill: Concerta is a stimulant
too it keep me awake



Jill: And I got
depressed on it



Robert: Dr. Lewis said its
tricky to balance stimulants
and SSRIs



Jill: I liked it when the
Concerta killed my appetite



Jill: But it made my blood
pressure go up



Jill: And I had to
get an EKG



Robert: If the Adderall doesnt
work for me I want guanfacine.



Jill: Look at themI want us
to be them



Robert: maybe guanfacine will
help me be calm enough for
that. Dr. Lewis said its calming
and not addicting.



Jill: It might also make
you dizzy.



Robert: I keep hearing
about research on
oxytocin.



Jill: Thats the hormone
that helps labor and birth,
nursing, and rodent bonding



Jill: If we hug 8 times a day it
makes your brain release the
right amount of oxytocin..



Robert: Uh.. Ill
try the hormone
nasal spray
first....



Jill: I hope it works



Jill: Im willing to pay for the
Abilify if it will settle me down



Robert: I thought its supposed to
be for psychosis



Jill: Its FDA approved for
marketing for irritability in
ASDs



Robert: Got to watch for
weight gain and other side
effects



Jill: Maybe it will build my
bust



Robert: You wont be happy
if you get milk with that



Jill: Oy.

Robert:
Yeah. Oy.
But I guess
they do help
sometimes,
and if were
careful and
we get a
good check
up well be
ok?



18 Months
later

Robert:
We found
stuff in
common



Robert: We both love the
green and techand cats



Robert:
I knew it
was love
when she
got me
the
poster




Robert: She gives me some
space to do my thing



Bill: I want to find
someone too



Bill: You do seem calmer,
and happier



Bill: But Jill can be a
firecracker



Robert: were both better
and its more than meds
its sharing



Robert: when we do stuff
together we are both better
people



Robert: But that first kiss
nearly killed me.





Across the
parking lot










Jill: We talk
theres lots of
missed cues.



Jill: but were getting
better at fixing things.



Jill: When I slow down he
comes to me



Mary: But he doesnt
look at you



Jill: Its not about eye
contactits about caring.



Mary: Wow. Can you
introduce me to his friend?



A few
months
later

Dr.
Lewis:
Its
been
quite a
ride



Dr. Lewis: Theres a lot
more ahead



Robert: Its stressful but
good



Jill: Scary, wonderful
but not so crazy




Robert: And well figure it
all out




T
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S
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T
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C
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Stimulants +/- +/- - +/- - - +/- - +? - - - Wt
Ht
tics
SSRIs - - +/- -/+ +? -/+ +? +? -/+ Wt, Ht
Sz
Neuroleptics +? -? + -/+ +? ++? - +? ++?? +? + + Wt. Sz
TD
NMS
AEDs +? -/+ + -
/+?
+? ++? -? +? +? +? +? +/- Mult.
SE
Steroids -? -? +? +? -/+ -? +? -? ++? -? +? -? Mult
SE
Central Alpha
Agonists
+? +? +? -/+ +/- 1/+? -/+? +? +? +? +? + Sleep
BP
Etc
LIST OTHER
TREATMENTS!




Kim:
tearful