How do you explain the difference between a Psychiatrist/Psychologist?

[TrustmeI'maPhd]

So as I student I remember researching what the difference was as I was interested in both careers, and every site I went to only looked at it from the perspective of how the education was different, and that this educational difference meant that Psychiatrists could prescribe meds and Psychologists couldn't. But that's like describing how two similar technologies are built different, but not actually getting to the heart of how that makes them different in practice. ie Are they actually different in practice?

So I feel I understand what a Psychologist is ideally, and I feel Psychology as a profession contributes way more to mental health..and I can't really understand the role of a Psychiatrist for most part. Let me explain. In Clinical practice, both assess, diagnose and treat mental illness. When we look at assessment and diagnosis, all the top tests we have..essentially the mental health version of x-rays and blood tests, are psychological assessment tools that were created mostly by Psychologists (or totally?). Clinical Psychologists bread and butter is psycho-metrics and understanding how to use these tools/tests. Without it, all we have is clinical judgement, and we know how accurate that is. In terms of treatment, absolutely medications have a place, and they are the first and best treatment for some mental health issues..but for many, talk-therapy does as well if not better.

The point in saying this is that I can easily make a connection between the training Clinical Psychologists get, and the work they do day to day. I can't do the same for Psychiatrists. Help me out. How does the training of a Psychiatrist differ from a Psychologist in the sense that it contributes uniquely? How relevant is the stuff learned in med school for Psychiatry?

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[Doctor Bagel]

Is it me, or are we being trolled here? Heading out ...

 

[smalltownpsych]

The main difference is that psychologists are really really good looking and psychiatrists only so so.

Seriously though, differential diagnosis is a relatively small aspect of what both professions do. Conceptualizing how the illness manifests and should be treated for the individual is really where the expertise lies and both of us do that coming from different angles. Also, psychometric tests, while incredibly useful for many reasons, are of relatively little practical use most of the time for diagnosis of mental disorders. If you want more info about the practical utility of psychological assessments, feel free to visit the psychology forum.

The main difference obviously is that psychiatrists have the highest level of medical training and are phsyicians who can prescribe medications whereas psychologists don't which means we tend to focus on other aspects of mental illness. There is also a wide variation within each group so for an example some psychiatrists are highly skilled psychotherapists and many psychologists don't provide psychotherapy at all.

One more point to add, the current tendency or movement to relegate psychiatry to only writing scripts is reductionistic, short sighted and doesn't benefit the profession or treatment of our patients. It is analogous to reducing what a psychologist does to only providing psychotherapy which is far from the case.

 

[TrustmeI'maPhd]

Is it me, or are we being trolled here? Heading out ...

Not a troll post at all. I'm not the only one to think along these lines.

I think there is a good argument to be made that the first 4 yrs of medical school do little to prepare someone for Psychiatry, but are of high utility to all the other specialties.

 

[TrustmeI'maPhd]

both of us do that coming from different angles.

Please give 3 concrete examples. I feel that people keep saying this but I'm not sure if this is true in practice. This is my main argument. Is there an actual difference on a practical level between these two professions, despite having different training?

If person A comes in with suspected social anxiety disorder, how differently will the conceptualization be if a Psychologist saw the person instead of the Psychiatrist?

If person B comes in with suspected bipolar, how differently will the conceptualization be?

If person C comes in with schizophrenia, how..?

 

[Doctor Bagel]

Not a troll post at all. I'm not the only one to think along these lines.

I think there is a good argument to be made that the first 4 yrs of medical school do little to prepare someone for Psychiatry, but are of high utility to all the other specialties.

We spend enough time out in the world justifying our profession and training. It would be nice to have a break from it here in our own freaking forum.

 

[TrustmeI'maPhd]

We spend enough time out in the world justifying our profession and training. It would be nice to have a break from it here in our own freaking forum.

You are a Physician, and you're successful..you don't have anything to prove. This thread is not about that. You will have a very successful career, a great life, and you'll help people. I'm not doubting any of that.(though I can see how one sentence in my original post makes it sound that I'm saying "Psychiatrists seem redundant". I apologize for that. I'm just trying to get a sense, and the truth, to see if there is on the ground (so to speak) a real practical difference in how a Psychologist compared to a Psychiatrist would conceptualize/assess patients...or if this is just talk to justify two providers that are really doing the same thing...and it is redundant.

 

[smalltownpsych]

Please give 3 concrete examples. I feel that people keep saying this but I'm not sure if this is true in practice. This is my main argument. Is there an actual difference on a practical level between these two professions, despite having different training?

If person A comes in with suspected social anxiety disorder, how differently will the conceptualization be if a Psychologist saw the person instead of the Psychiatrist?

If person B comes in with suspected bipolar, how differently will the conceptualization be?

If person C comes in with schizophrenia, how..?

Why would I need to give concrete examples of how different training and experiences shapes your perspective? I think we have a wealth of data on that in a broad sense. Does having these different perspectives lead to better outcomes for patients? Good luck trying to design a research study to parse that out. We often can't even demonstrate that knowlededge and experience leads to better outcomes for our patients which, if you follow that logic, then a caveman could do it too, but does that really make sense?

 

[Psychotic]

The literal difference? Four years of medical school (at which point an MD is qualified to enter any medical residency), then as a psychiatry resident an intern year spent on the wards and in outpatient clinics, plus 3 more years of focused training in all aspects of psychiatry and immersion in the intersection of medicine and mental health, something that is very valuable to the medical system (and you will appreciate your medical training when you are a resident working the graveyard shift at the PES and ED is trying to push every problem patient they have through your doors...).

That some psychiatrists choose to work in practice settings that leaves little differentiation between their training/capabilities vs NPs or psychologists is their choice, but a psychiatrist's training is quite different (medically broader and more rigorous) and coming out of residency a psychiatrist has far more career options than any midlevel or psychologist.

 

[TrustmeI'maPhd]

The literal difference? Four years of medical school (at which point an MD is qualified to enter any medical residency), then as a psychiatry resident an intern year spent on the wards and in outpatient clinics, plus 3 more years of focused training in all aspects of psychiatry and immersion in the intersection of medicine and mental health, something that is very valuable to the medical system (and you will appreciate your medical training when you are a resident working the graveyard shift at the PES and ED is trying to push every problem patient they have through your doors...).

Did you not read the opening post? I know the literal difference..I'm asking for the practical/on the ground difference. How does it inform/change conceptualization or assessment of different mental illness?

 

[lymphocyte]

May I ask what your level of training is? I mean this question as gently as possible, but you strike me as quite naive. Perhaps a bit of the Dunning-Kruger effect? No psychologist or psychiatrist would be confused about their roles and scopes of practice. They're both important but distinct.

In Clinical practice, both assess, diagnose and treat mental illness.

Sure. Okay. Kind of. Some illness, but not all. How many psychologists do you know manage unwell patients with schizophrenia? How many feel comfortable juggling neuroleptics? What about monitoring bloods and bowel symptoms in a patient starting clozapine? Would they recognize neuroleptic malignant syndrome? What about a subtle serotonin syndrome? Acute dystonia? Tardive dyskinesia? What about manic patients ramming themselves into a wall every minute or two. How far will talk therapy get them then?

Okay, let's talk about more common illnesses, like depression or type 2 bipolar. What are you first, second, third line, and augmentation strategies--because STAR*D tells you that you're very likely going to have repeated treatment failure? When would you consider thyroid hormone? How would you monitor that? When would you consider a TCA? What baseline tests would you order? How much amitriptyline can you safely prescribe to somebody who might be suicidal? Is that even safe? What about lithium-induced hypothyroidism? Do you treat subclinical or wait for overt symptoms? What's the literature say about subclinical hypothyroidism and rapid cycling? Your bipolar patient is on lithium and olanzapine and tells you he's peeing a lot. Could this be diabetes insipidus or diabetes mellitus? What tests would you order? Oh crap, his prolactin is really high. Could this be neurogenic diabetes insipidus? What specialist would you refer him to?

Sample day from my C/L Sub-i:

We diagnosed oculogyric phenomenon in a young woman with metoclopramide overdose, demonstrated multiple focal lesions through a careful neurological exam on a woman being worked-up for delirium (turned out to be brain mets, as we suspected), managed two behavioural emergencies, one with simple non-pharmacological interventions and the other with haloperidol and benzodiazepines, discovered non-epileptic seizures were really drug-induced sleep-attacks on a woman with restless-leg syndrome on pramipexole, caught long-QT on an EKG missed by the primary team, and assessed competency for a woman denying treatment for DKA (this requires knowing a few things about DKA--treatment, natural history, etc.).

Other days included: steroid-induced psychosis on a COPD exacerbation, catching UTI-related delirium (another unfortunate miss by the primary team), distinguishing depression from pseudobulbar affect post-stroke, pharmacological management of excited delirium, and lots, and lots, and lots of suicide-risk assessment (some in the ICU, some in the ED, some on the wards--all requiring some understanding of lethality, sequelae, likely mechanism of injury versus what was reported, etc. A social worker was ready to 5150 an embarrassed woman who took 4 clonazepam in front of her boyfriend but I'm MUCH, MUCH more worried about the sullen-looking guy who might have swallowed stockpiled warfarin even though his INR is normal--oh, and by the way, how quickly does INR change after warfarin overdose?)

This is the scope of practice of any competent psychiatrist. They are DOCTORS first. They assess patients MEDICALLY before constructing psychodynamic formulations, which include biopsychosocial factors. And once they've completed their formulations, they can use their knowledge of neuroanatomy, psychopharmacology, and the empirical evidence to TAILOR and MONITOR medical as well as psychological interventions.

This distinction will become even sharper as our understanding of psychopathogenicity improves. Did you read that incredible Nature article about C3 complement over-activation and synaptic pruning in early psychosis? I can tell you a psychiatrist and a psychologist would react very differently to that paper.

I can go on for days.

It's just a very, very, very different perspective. Hopefully, you'll understand it better once you've had more exposure to the field.

 

[Psychotic]

Did you not read the opening post? I know the literal difference..I'm asking for the practical/on the ground difference. How does it inform/change conceptualization or assessment of different mental illness?

Clearly you did not read my post that began with the literal difference in training, and then gave an example of how the medical training of the psychiatrist comes into play in a "practical/on the ground" difference.

I am checking out of this thread because you are clearly a troll...that, or you have severe reading comprehension issues.

 

[Mad Jack]

Not a troll post at all. I'm not the only one to think along these lines.

I think there is a good argument to be made that the first 4 yrs of medical school do little to prepare someone for Psychiatry, but are of high utility to all the other specialties.

The first step of psychiatric diagnosis is ruling out an organic cause to a perceived mental illness. Furthermore, meds are an enormous part of treatment for the vast majority of mental illness out there. As we move further into the realm of neuropsychiatry in the future, this will continue to hold true. While a brief course in psychopharmacotherapy might be enough for many psychologists to prescribe psychiatric medications, physicians have much more experience with how those medications interact with non-psychiatric medications, and are better equipped to handle potential interactions between the literally hundreds of pharmaceuticals that are out there in common use. And then there's the fact that psychiatrists actually can and do utilize various forms of non-medication therapy. Basically, psychiatrists have a good amount of everything to bring to the table. A better question for you would be, what don't psychiatrists bring to the table in regard to mental health treatment and care?

 

[TrustmeI'maPhd]

Clearly you did not read my post that began with the literal difference in training, and then gave an example of how the medical training of the psychiatrist comes into play in a "practical/on the ground" difference.

I am checking out of this thread because you are clearly a troll...that, or you have severe reading comprehension issues.

You did not provide any differences...you provided what the difference in training was..and you said some very general things. You said it was different, but aside from talking about differences in training, and using words like "distinct" and "different"..you did not provide concrete examples of how different it was in case conceptualization and assessment..

 

[TrustmeI'maPhd]

May I ask what your level of training is? I mean this question as gently as possible, but you strike me as quite naive. Perhaps a bit of the Dunning-Kruger effect? No psychologist or psychiatrist would be confused about their roles and scopes of practice. They're both important but distinct.



Sure. Okay. Kind of. Some illness, but not all. How many psychologists do you know manage unwell patients with schizophrenia? How many feel comfortable juggling neuroleptics? What about monitoring bloods and bowel symptoms in a patient starting clozapine? Would they recognize neuroleptic malignant syndrome? What about a subtle serotonin syndrome? Acute dystonia? Tardive dyskinesia? What about manic patients ramming themselves into a wall every minute or two. How far will talk therapy get them then?

Okay, let's talk about more common illnesses, like depression or type 2 bipolar. What are you first, second, third line, and augmentation strategies--because STAR*D tells you that you're very likely going to have repeated treatment failure? When would you consider thyroid hormone? How would you monitor that? When would you consider a TCA? What baseline tests would you order? How much amitriptyline can you safely prescribe to somebody who might be suicidal? Is that even safe? What about lithium-induced hypothyroidism? Do you treat subclinical or wait for overt symptoms? What's the literature say about subclinical hypothyroidism and rapid cycling? Your bipolar patient is on lithium and olanzapine and tells you he's peeing a lot. Could this be diabetes insipidus or diabetes mellitus? What tests would you order? Oh crap, his prolactin is really high. Could this be neurogenic diabetes insipidus? What specialist would you refer him to?

Sample day from my C/L Sub-i:

We diagnosed oculogyric phenomenon in a young woman with metoclopramide overdose, demonstrated multiple focal lesions through a careful neurological exam on a woman being worked-up for delirium (turned out to be brain mets, as we suspected), managed two behavioural emergencies, one with simple non-pharmacological interventions and the other with haloperidol and benzodiazepines, discovered non-epileptic seizures were really drug-induced sleep-attacks on a woman with restless-leg syndrome on pramipexole, caught long-QT on an EKG missed by the primary team, and assessed competency for a woman denying treatment for DKA (this requires knowing a few things about DKA--treatment, natural history, etc.).

Other days included: steroid-induced psychosis on a COPD exacerbation, catching UTI-related delirium (another unfortunate miss by the primary team), distinguishing depression from pseudobulbar affect post-stroke, pharmacological management of excited delirium, and lots, and lots, and lots of suicide-risk assessment (some in the ICU, some in the ED, some on the wards--all requiring some understanding of lethality, sequelae, likely mechanism of injury versus what was reported, etc. A social worker was ready to 5150 an embarrassed woman who took 4 clonazepam in front of her boyfriend but I'm MUCH, MUCH more worried about the sullen-looking guy who might have swallowed stockpiled warfarin even though his INR is normal--oh, and by the way, how quickly does INR change after warfarin overdose?)

This is the scope of practice of any competent psychiatrist. They are DOCTORS first. They assess patients MEDICALLY before constructing psychodynamic formulations, which include biopsychosocial factors. And once they've completed their formulations, they can use their knowledge of neuroanatomy, psychopharmacology, and the empirical evidence to TAILOR and MONITOR medical as well as psychological interventions.

This distinction will become even sharper as our understanding of psychopathogenicity improves. Did you read that incredible Nature article about C3 complement over-activation and synaptic pruning in early psychosis? I can tell you a psychiatrist and a psychologist would react very differently to that paper.

I can go on for days.

It's just a very, very, very different perspective. Hopefully, you'll understand it better once you've had more exposure to the field.

Thanks very much. You actually answered the question. I'll have to re-read what you said as you provided a lot of details.

Is the work of a Psychiatrist and Psychologist much more similar however once you get into the context of private practice?

 

[lymphocyte]

Thanks very much. You actually answered the question.

Is the work of a Psychiatrist and Psychologist much more similar however once you get into the context of private practice?

No--not if you're good--because you'll always carry that unique medical perspective with you. The outpatient psychiatrists I worked with were generally sharp, sharp, sharp medical practitioners. (And the psychologists were sharp too, but in different ways.)

I already mentioned some specific differences in the private setting (treatment strategy, monitoring, patient acuity, comorbidity, complications, etc.).

Why do you think we get so miffed about psychologists winning prescribing rights? There's plenty of need. We'll always have a job. But it's a SAFETY issue. It takes 4 years of medical school + 4 years of residency to realize how unsafe things can be just a few steps beyond the protocol...

Can I ask why you're asking these questions? Are you thinking about psychology versus psychiatry? I can tell that you either profession requires interpersonal skill and thoughtfulness. In less than 10 posts, you've already managed to alienate some of the most helpful and accomplished psychiatrists on this forum. Please consider treading with some more courtesy...

 

[Mad Jack]

No--not if you're good--because you'll always carry that unique medical perspective with you. The outpatient psychiatrists I worked with were generally sharp, sharp, sharp medical practitioners. (And the psychologists were sharp too, but in different ways.)

I already mentioned some specific differences in the private setting (treatment strategy, monitoring, patient acuity, comorbidity, complications, etc.).

Why do you think we get so miffed about psychologists winning prescribing rights? There's plenty of need. We'll always have a job. But it's a SAFETY issue. It takes 4 years of medical school + 4 years of residency to realize how unsafe things can be just a few steps beyond the protocol...

Can I ask why you're asking these questions? Are you thinking about psychology versus psychiatry? I can tell that you either profession requires interpersonal skill and thoughtfulness. In less than 10 posts, you've already managed to alienate some of the most helpful and accomplished psychiatrists on this forum. Please consider treading with some more courtesy...

CYP450, diabetes insipidus, and neutropenia, oh my!

I really have no clue how someone can safely competently prescribe with the flurry of drug-drug interactions and side effects out there without having a comprehensive medical education. Unless they're just handing out stimulants or a similarly somewhat safe (and even that is debatable) class of meds, there's just too much that can go wrong and too little ability for a non-physician to have a full enough picture for what, exactly, might be happening a good deal of the time.

This isn't to knock on prescribing psychologists, but the simple fact is pharmacology is way too difficult to master than a simple brief psychopharm course- half of your job is understanding how your meds interact with everything else going on with a patient health and med-wise.

 

[splik]

Please give 3 concrete examples. I feel that people keep saying this but I'm not sure if this is true in practice. This is my main argument. Is there an actual difference on a practical level between these two professions, despite having different training?

If person A comes in with suspected social anxiety disorder, how differently will the conceptualization be if a Psychologist saw the person instead of the Psychiatrist?

If person B comes in with suspected bipolar, how differently will the conceptualization be?

If person C comes in with schizophrenia, how..?

I think this post reveals that you are clearly not a clinical psychologist as you would know that people don't come in with "suspected social anxiety" or "suspected bipolar" or "schizophrenia". Patients come in with experiences and symptoms and the process of diagnosis is a semiotic act and reflects the different ways we might conceptualize these sorts of problems. Historically clinical psychologists have rejected the biomedical model which is what has separated psychiatry from other mental health fields where we make diagnoses. Nowadays clinical psychology has become increasingly entrenched in the biomedical model and in the US at least has jumped on the bandwagon of using diagnostic labels (and a minority even seek prescribing privileges) however in other countries such as the UK, clinical psychologists reject the reductionism of diagnosis and instead use psychological formulations such as cognitive-behavioral conceptualizations to create a shared explanatory framework. Frankly if clinical psychologists are going to use (pseudo)medical diagnoses based on DSM-5 criteria and want to prescribe drugs then I don't see what purpose they serve. Clinical Psychology at its best does not focus on mental disorder, diagnostic labels, or techno-medical interventions, and instead uses socio-culturally informed and reflexive psychological theories to understand human experiences and develop theory-based assessments and treatments.

As for the difference between the two, the chair of psychiatry at my med school used to say, "psychologists are more intelligent, but psychiatrists are better paid" (this is probably true in the UK at least where clinical psychology is a highly competitive field with very few training spots which are all fully funded.

 

[TrustmeI'maPhd]

Frankly if clinical psychologists are going to use (pseudo)medical diagnoses based on DSM-5 criteria and want to prescribe drugs then I don't see what purpose they serve. Clinical Psychology at its best does not focus on mental disorder, diagnostic labels, or techno-medical interventions, and instead uses socio-culturally informed and reflexive psychological theories to understand human experiences and develop theory-based assessments and treatments.

I see what you did here!

 

[lymphocyte]

I think this post reveals that you are clearly not a clinical psychologist as you would know that people don't come in with "suspected social anxiety" or "suspected bipolar" or "schizophrenia". Patients come in with experiences and symptoms and the process of diagnosis is a semiotic act and reflects the different ways we might conceptualize these sorts of problems. Historically clinical psychologists have rejected the biomedical model which is what has separated psychiatry from other mental health fields where we make diagnoses. Nowadays clinical psychology has become increasingly entrenched in the biomedical model and in the US at least has jumped on the bandwagon of using diagnostic labels (and a minority even seek prescribing privileges) however in other countries such as the UK, clinical psychologists reject the reductionism of diagnosis and instead use psychological formulations such as cognitive-behavioral conceptualizations to create a shared explanatory framework. Frankly if clinical psychologists are going to use (pseudo)medical diagnoses based on DSM-5 criteria and want to prescribe drugs then I don't see what purpose they serve. Clinical Psychology at its best does not focus on mental disorder, diagnostic labels, or techno-medical interventions, and instead uses socio-culturally informed and reflexive psychological theories to understand human experiences and develop theory-based assessments and treatments.

As for the difference between the two, the chair of psychiatry at my med school used to say, "psychologists are more intelligent, but psychiatrists are better paid" (this is probably true in the UK at least where clinical psychology is a highly competitive field with very few training spots which are all fully funded.

Fantastic post.

 

[deleted343839]

Clinical Psychology at its best does not focus on mental disorder, diagnostic labels, or techno-medical interventions, and instead uses socio-culturally informed and reflexive psychological theories to understand human experiences and develop theory-based assessments and treatments.

Well stated.

One way that I am different from a psychiatrist is that my practice is not devoted primarily to managing mental disorders. I am essentially a behavioral consultant working within a medical subspecialty (not psychiatry) environment. My patients are often coping with some of the greatest adversities of their lives, sometimes under circumstances that are traumatic. At times these patients exhibit symptoms that warrant psychiatric attention, so I collaborate with our psychiatry service and provide front-line psychotherapy if indicated. For the most part, I'm not in the business of diagnosing DSM-5 disorders, except when the patient needs psychiatric care and I need a standardized way to justify that referral.

Psychiatrists are able to manage a wider variety and severity of frank psychopathology than psychologists, whereas IMO psychologists are able to manage a wider variety of maladaptive or dysfunctional behaviors, not all of which are truly pathological (ie, often these are learned/reinforced/shaped behaviors in a person with no other obvious functional deficits).

 

[Psychotic]

I can tell that you either profession requires interpersonal skill and thoughtfulness. In less than 10 posts, you've already managed to alienate some of the most helpful and accomplished psychiatrists on this forum. Please consider treading with some more courtesy...

Courtesy and respect.

This forum is one of the most civil on SDN, and the OP came in with the antagonistic attitude more commonly found in pre-allo, which is where he belongs.

 

[smalltownpsych]

May I ask what your level of training is? I mean this question as gently as possible, but you strike me as quite naive. Perhaps a bit of the Dunning-Kruger effect? No psychologist or psychiatrist would be confused about their roles and scopes of practice. They're both important but distinct.



Sure. Okay. Kind of. Some illness, but not all. How many psychologists do you know manage unwell patients with schizophrenia? How many feel comfortable juggling neuroleptics? What about monitoring bloods and bowel symptoms in a patient starting clozapine? Would they recognize neuroleptic malignant syndrome? What about a subtle serotonin syndrome? Acute dystonia? Tardive dyskinesia? What about manic patients ramming themselves into a wall every minute or two. How far will talk therapy get them then?

Okay, let's talk about more common illnesses, like depression or type 2 bipolar. What are you first, second, third line, and augmentation strategies--because STAR*D tells you that you're very likely going to have repeated treatment failure? When would you consider thyroid hormone? How would you monitor that? When would you consider a TCA? What baseline tests would you order? How much amitriptyline can you safely prescribe to somebody who might be suicidal? Is that even safe? What about lithium-induced hypothyroidism? Do you treat subclinical or wait for overt symptoms? What's the literature say about subclinical hypothyroidism and rapid cycling? Your bipolar patient is on lithium and olanzapine and tells you he's peeing a lot. Could this be diabetes insipidus or diabetes mellitus? What tests would you order? Oh crap, his prolactin is really high. Could this be neurogenic diabetes insipidus? What specialist would you refer him to?

Sample day from my C/L Sub-i:

We diagnosed oculogyric phenomenon in a young woman with metoclopramide overdose, demonstrated multiple focal lesions through a careful neurological exam on a woman being worked-up for delirium (turned out to be brain mets, as we suspected), managed two behavioural emergencies, one with simple non-pharmacological interventions and the other with haloperidol and benzodiazepines, discovered non-epileptic seizures were really drug-induced sleep-attacks on a woman with restless-leg syndrome on pramipexole, caught long-QT on an EKG missed by the primary team, and assessed competency for a woman denying treatment for DKA (this requires knowing a few things about DKA--treatment, natural history, etc.).

Other days included: steroid-induced psychosis on a COPD exacerbation, catching UTI-related delirium (another unfortunate miss by the primary team), distinguishing depression from pseudobulbar affect post-stroke, pharmacological management of excited delirium, and lots, and lots, and lots of suicide-risk assessment (some in the ICU, some in the ED, some on the wards--all requiring some understanding of lethality, sequelae, likely mechanism of injury versus what was reported, etc. A social worker was ready to 5150 an embarrassed woman who took 4 clonazepam in front of her boyfriend but I'm MUCH, MUCH more worried about the sullen-looking guy who might have swallowed stockpiled warfarin even though his INR is normal--oh, and by the way, how quickly does INR change after warfarin overdose?)

This is the scope of practice of any competent psychiatrist. They are DOCTORS first. They assess patients MEDICALLY before constructing psychodynamic formulations, which include biopsychosocial factors. And once they've completed their formulations, they can use their knowledge of neuroanatomy, psychopharmacology, and the empirical evidence to TAILOR and MONITOR medical as well as psychological interventions.

This distinction will become even sharper as our understanding of psychopathogenicity improves. Did you read that incredible Nature article about C3 complement over-activation and synaptic pruning in early psychosis? I can tell you a psychiatrist and a psychologist would react very differently to that paper.

I can go on for days.

It's just a very, very, very different perspective. Hopefully, you'll understand it better once you've had more exposure to the field.

Great points and the psychiatrist has four years of medical training to learn all of those things, but many psychologists also have some medical knowledge gleaned from various sources so I could answer many of those questions. Just saying that so you don't lump us in with the social worker worried about clonazepam verse warfarin. At the very least, most psychologists would know that this is rat poison and could be fatal. Bleeding into the brain would be what I would think would scare me the most, but that might show the limitations of my knowledge right there. Oh, and I catch UTI related delirium more than the average IM doc it seems, but that again goes to different focus and perspective.

 

[Moose A Moose]

 

[TrustmeI'maPhd]

Thanks very much for the clarifications. My apologies for not showing courtesy.

You guys have certainly changed my mind!

 

[lymphocyte]

Great points and the psychiatrist has four years of medical training to learn all of those things, but many psychologists also have some medical knowledge gleaned from various sources so I could answer many of those questions. Just saying that so you don't lump us in with the social worker worried about clonazepam verse warfarin. At the very least, most psychologists would know that this is rat poison and could be fatal. Bleeding into the brain would be what I would think would scare me the most, but that might show the limitations of my knowledge right there. Oh, and I catch UTI related delirium more than the average IM doc it seems, but that again goes to different focus and perspective.

I agree and I'm sorry. I was just sort of fumbling at the much better distinction that @splik and @MamaPhD made.

 

[vistaril]

I don't really try to explain other than say something like "well we are both mental health professionals and a lot of what we do does overlap depending on what area and setting each works in. So we are pretty similar".

 

[hamstergang]

I don't really try to explain other than say something like "well we are both mental health professionals and a lot of what we do does overlap depending on what area and setting each works in. So we are pretty similar".

So you read the title of the thread and nothing else? Seems like a useful way to contribute to a discussion.

 

[smalltownpsych]

I agree and I'm sorry. I was just sort of fumbling at the much better distinction that @splik and @MamaPhD made.

Yeah, they did a better job explaining than I did too actually, but I agree with your basic point that a psychiatrist would have much more.medical knowledge and that informs their treatment. I do think the difference is deeper than what we are talking about though and that aspect is difficult to describe. There is a precision and practicality to the thinking of psychiatrists that I assume comes from their medical training. Psychologists have a completely different paradigm. Just read the two different forums for a while and you can get a sense of a difference. I actually struggle with how to characterize how psychologists think. I guess it's like asking a fish to describe water.

 

[Guyton]

I think you guys finally cleared up my psychologist/psychiatrist confusion. Now... whats the difference between an MD and a DO?




j/k

 

[Shikima]

I think you guys finally cleared up my psychologist/psychiatrist confusion. Now... whats the difference between an MD and a DO?




j/k

The difference between han solo and luke skywalker.

 

[Doctor Bagel]

Yeah, they did a better job explaining than I did too actually, but I agree with your basic point that a psychiatrist would have much more.medical knowledge and that informs their treatment. I do think the difference is deeper than what we are talking about though and that aspect is difficult to describe. There is a precision and practicality to the thinking of psychiatrists that I assume comes from their medical training. Psychologists have a completely different paradigm. Just read the two different forums for a while and you can get a sense of a difference. I actually struggle with how to characterize how psychologists think. I guess it's like asking a fish to describe water.

From discussion with my female psychiatrist friends and observation here, psychologists (the Ph.D. ones) are all attractive super thin females who look perfect without a hair out of place. I suspect they spend 30 minutes each day doing their makeup. This makes me wonder if everything in their life is "just so" and about OCPD traits. I know you've got to be pretty driven to go the clinical psychology Ph.D. route so maybe to make it there, there's no room for imperfection. The PsyD types seem to have more variability.

I don't think this is what the OP was asking about, though.

 

[WisNeuro]

From discussion with my female psychiatrist friends and observation here, psychologists (the Ph.D. ones) are all attractive super thin females who look perfect without a hair out of place. I suspect they spend 30 minutes each day doing their makeup. This makes me wonder if everything in their life is "just so" and about OCPD traits. I know you've got to be pretty driven to go the clinical psychology Ph.D. route so maybe to make it there, there's no room for imperfection. The PsyD types seem to have more variability.

I don't think this is what the OP was asking about, though.

Hey now, some of us are super attractive dudes. Also, if you saw how messy my office usually is, OCPD would be the last thing to come to mind.

 

[deleted343839]

From discussion with my female psychiatrist friends and observation here, psychologists (the Ph.D. ones) are all attractive super thin females who look perfect without a hair out of place.

Hahahaha, I wish.

 

[whopper]

Psychiatry is the use of medicine as a field to treat mental illness.

Psychology is the study of the entire human mind.

That's not the same thing. A psychiatrist has no training in trying to figure out what makes a person want to buy something. Psychologists, for example, are sometimes hired by advertising agencies to give them insight on these matters.

The training is different and leads to different types of thinking. An MD's training, while in medical school, is about treating pathology, getting hammered with memorizing inhuman amounts of data in a short period of time, and most of the training has nothing to directly do with mental health.

Psychology training is heavily statistically based, they get trained in statistics on a much more advanced level than MD's do (if it's graduate level psychology), and to get a Ph.D. or Psy.D. you have do something on the order of cutting edge while this is not the same of medical doctors.

People often times get into the argument which field is superior. There is no superiority. Each field has people that in general do something better. Only way anyone could ever argue that MD's are better IMHO is if MDs were required to do a doctorate level thesis. While getting data rammed into your brain more so than we're designed to take and at torturous amounts, getting a thesis done is incredibly difficult too in a very different way.

IMHO it's kind of like training and finishing a triathlon vs learning to shoot a hole in one in golf to the point where you can do it reliably.

From discussion with my female psychiatrist friends and observation here, psychologists (the Ph.D. ones) are all attractive super thin females who look perfect without a hair out of place.

Not true in all cases but I do see some demographics that fit this. A lot of the smart girls that like social sciences that aren't the math and chemistry go into psychology. I don't know what it is but geeky guys tend to this this more (I got my theories). E.g. you see sorority girls going into psychology quit often but you rarely see them going to medical school.

While I was at the American Academy of Forensic Sciences there were literally several dozen very young and attractive graduate students who went into the field but were not MDs.

 

[Ceke2002]

One more point to add, the current tendency or movement to relegate psychiatry to only writing scripts is reductionistic, short sighted and doesn't benefit the profession or treatment of our patients. It is analogous to reducing what a psychologist does to only providing psychotherapy which is far from the case.

Oh but didn't you realise psychiatrists are just incredibly well trained monkeys that throw pills at people, and seeing a psychologist is the equivalent of catching up with your BFF for a nice chat over coffee.

 

[Salpingo]

At the risk of beating a dead horse, the way I conceptualize the difference is that the psychologists are behavioral scientists and psychiatrists diagnose and treat mental illness. In practice, that's why I refer to psychologists for psychometric testing: they have a better understanding of "normal" human behavior and cognition, and can help people move along that axis. So if you're someone who is having trouble at school/work, don't have an illness per se, but want help figuring out what practical accommodations you need for your given brain, its helpful to go to a psychologist. Or if you have a fear of something but otherwise are functioning well in life and want a targeted alteration in those thoughts and behaviors.

However, psychiatrists have more exposure to illness (mental or otherwise), meaning they're GENERALLY better equipped to deal with emergencies, severe decompensation, medical complications, etc. While the psychologists I know are spending tons of time on their dissertation or research, we're taking call to deal with whatever comes up in the middle of the night, seeing consult after consult, taking admission after admission, so that we can ideally deal with problems in an organized, rote way that would make most people panic (although we also have our limits and range of comfort). And that also distinguishes us from the midlevels.

I agree that the blurred lines are a problem, particularly with the diploma mills in both fields. I've mostly worked with PhD's. Like splik said, they're generally of a higher academic caliber than most psychiatrists, and the top programs/internships/externships really seem to select for truly bright and dedicated people. I'm not sure about they PsyD's, and I'm concerned about movement to somehow replace psychiatrists as treaters of mental illness with some cheaper or more available set of letters. Conversely, psychiatrists get in trouble when they leave illness and start invading the "normal spectrum", pushing pathology where it doesn't belong. I think there's a role for promoting good general mental health and taking preventive measures (the same way a GP recommends diet and exercise), but that's not the primary focus of our job.

 

[MacDonaldTriad]

I just had a conversation with a colleague about how the charting has changed and the transparency has changed with EMRs, but the patients haven’t changed and even the new medications are the same thing all over again. The conclusion was, “So much for the decade of the brain” and psychology has a parallel course in my opinion. It doesn’t matter if you use the old MMPI or a more modern personality inventory, the concepts of character are the same. Similarly behavioral concepts are consistent no matter what three letter acronym with a “B” in it you salute. Psychologist and psychiatrists both attempt to provide relief to the mentally ill, but that is about where the overlap ends. We don’t do much of what they do, and vice versa. They can be remarkably constructive with treatment planning and observations, but at the end of the day, they do their thing and we do ours. The public has an image of us in some sort of competition to dominate some theoretical common ground, but that isn’t reality that often. Dentists and oral surgeons refer to each other and live in peace. We aren’t that different.

 

[whopper]

Oh but didn't you realise psychiatrists are just incredibly well trained monkeys that throw pills at people, and seeing a psychologist is the equivalent of catching up with your BFF for a nice chat over coffee.

Not all psychiatrists but I do see a lot of what you say.

I spend at least half an hour with all of my patients unless we both know and agree they just want and need a med-refill.