HOW WE'RE DIFFERENT
The Value of Integrated Medical-Psychiatric Care
Ketamine treatment for psychiatric illness has two necessary components embedded within it. One is the medical competence to administer IV ketamine safely, with attention to dose, vital signs, medications, tolerability, and medical risk.The other is the psychiatric knowledge to put the treatment to its proper and most effective use: understanding the diagnoses being treated, recognizing whether meaningful progress is occurring, and knowing when timely adjustments should be made.​
Most treatment models are weighted more toward one side than the other.
Many ketamine treatments occur in infusion clinics, which naturally orient toward the efficient medical administration of ketamine: the infusion itself, physiologic monitoring, and immediate tolerability.
Standard mental health involvement is often through symptom rating scales, such as the PHQ-9, completed before each infusion.
To be clear, this is not wrong. It is a model that flows understandably from the scope of the provider's training.​
But the purpose of ketamine treatment is to treat serious and often complicated diseases.
Treatment is most effective when the person conducting treatment also understands the condition being treated in depth.​These demands need not require a compromise between medical safety and psychiatric outcome.
Dr. Dull's training allows safe, controlled IV treatment with the psychiatric expertise necessary to ensure ketamine is being put to its best use.​
Dr. Dull completed an internal medicine internship at Johns Hopkins Bayview, with rotations in inpatient medicine, cardiac and medical intensive care, neurological intensive care, and inpatient neurology. He completed psychiatric residency at Johns Hopkins, where he was appointed chief resident in his final year.​
Ketamine With Precision
Monitoring heart rate, rhythm, blood pressure, and oxygenation is the beginning. Understanding and managing those variables is crucial, and is what all good ketamine treatment should have in common.​
Psychiatric training changes what can be seen beyond them. A shift in dissociation, a change in anxiety or cognition mid-infusion, an unexpected response to a familiar dose — these are not readings on a monitor. They are clinical findings, and they mean something to a physician who knows the illness being treated.
In this practice, they are interpreted in real time, as part of a coherent whole: changes in response, tolerability, dissociation, anxiety, cognition, blood pressure, medications, dose, infusion speed, and infusion duration. Each may signal the need for adjustment in timing, duration, medication dosing, or treatment strategy.
​Those adjustments are not made only for physical stability or comfort. They are also made in service to the psychiatric response across the full course of ketamine treatment.
Because patients frequently take other psychiatric medications during treatment, these observations can also inform whether medication adjustments, laboratory testing, or other clinical decisions are needed to make sure the treatment plan is working together optimally.
​For patients receiving ongoing psychiatric care at Zionsville Psychiatric Medicine, these observations can be incorporated directly into the larger treatment plan. For patients referred by an outside psychiatrist, therapist, or other clinician, our role is to complement — not replace that relationship. When clinically useful, we communicate observations clearly and respectfully so the patient and treating clinician have timely, meaningful information to consider.​
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