“Adult” ADHD

[docksan]

Esp when they crush it and snort it

IR more than XL if I recall, and usually in doses of 400mg+.

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[Ceke2002]

If all they want is addy and think that an increase in the medication is what they need every time hey are stressed out, then they probably won’t do anything else. However, if the patient wants to improve functioning without overreliance on stimulants, the tips and strategies just involve effective management of stress and coping and organization. Some of the same stuff that works for helping anyone else works for people with attentional problems and most of the time there are stressors or negative thought patterns and maladaptive strategies that are making it worse. Helping a client learn what works for them individually is key. Prioritizing of tasks, small chunks vs big chunks, time of day, structuring the week, using a planner or calendar and whether it is electronic or paper; all of these will vary in what works from individual to individual regardless of distractibility. When a patient is actively trying to improve, we can come up with things to try at every session and review what works and what didn’t. Exercise and good nutrition and general self-care also seem to help improve function.

This is really good, although I'd expect no less from you. 🙂 The sorts of things I found most helpful in dealing with ADHD without medication was definitely starting out with basic stuff like sleep health, stress levels, better overall life coping strategies, and so on. Also just accepting that I'm never going to be 100% 'normal' and that's okay, as long as I'm doing well in most areas of my life then having a few ADHD quirks isn't the end of the world. I have a lot more stuff I've learnt over the years, that has gradually helped the impact of symptoms to be reduced, but I'd end up writing an essay & this thread if titled 'Adult ADHD' not 'Ceke tells you her life story'.

 

[ArdorAyurveda]

This whole adult ADHD business is such a rack. I struggled with one of my clerkships, went to my school's disability services, and they were like "oh, go get neuropsychological testing to make sure you don't have a learning disability". They needed an independent assessment to grant me accommodations. No hx of trouble in school, trouble paying attention, nothing to suggest any hx of ADHD. But I was desperate and went through with it anyways. Of course neurospych testing found absolutely nothing abnormal, in fact, I was rather high functioning in several domains

Bye-bye $3000.

The following year, my friend at a different medical school is having trouble with classes. Schedules a telehealth appointment with an NP. NP writes a script for Adderall without even seeing my friend in person. My friend very clearly just wanted some Addy. No collateral requested, no hx really suggesting past struggles with inattention or hyperactivity. Just wanted a performance enhancer so that he could continue to play video games for hours on end and pass his tests.

Just makes my blood boil, but I suppose it represents different approaches to life....some people just want a quick fix, whereas others are willing to put in the hard work to get it done...

I'm glad there's a shortage, honestly.

Edit: I will also say that my buddy made no effort to change his study habits or anything like that. Whereas I worked with my accommodations office to identify my study habits and identify learning behaviors...he just went straight to "I need meds". That's another thing that really made me mad, was that it feels like so many med students just see adderall as a shortcut/performance enhancer for tests, and don't even consider behavioral methods.

I'd be a terrible child psychiatrist, that's for damn sure

 

[tr]

. That's another thing that really made me mad, was that it feels like so many med students just see adderall as a shortcut/performance enhancer for tests, and don't even consider behavioral methods.

Ahem, it *is* a shortcut/performance enhancer. Works great. No behavioral method is going to duplicate the effect of amphetamine.

I'm not personally interested in being a dispenser/gatekeeper for controlled subs but if healthy people with no CV risk factors are interested in occasional neuroenhancement, I really rather they go to an online pill mill than come bug me to give them a bogus diagnosis.
Let's just all be honest about the fact that they don't have AD/HD.

 

[calvnandhobbs68]

Ahem, it *is* a shortcut/performance enhancer. Works great. No behavioral method is going to duplicate the effect of amphetamine.

I'm not personally interested in being a dispenser/gatekeeper for controlled subs but if healthy people with no CV risk factors are interested in occasional neuroenhancement, I really rather they go to an online pill mill than come bug me to give them a bogus diagnosis.
Let's just all be honest about the fact that they don't have AD/HD.

Right just be honest and say it's cognitive enhancement (in these cases). It's like all those dudes who go get testosterone from those "wellness" clinics for "low T"...just be real and say it makes you feel better.

 

[erg923]

Right just be honest and say it's cognitive enhancement. It's like all those dudes who go get testosterone from those "wellness" clinics for "low T"...just be real and say it makes you feel better.

Can you cite me a study that objectively shows this? Tell me more about the "enhancement."

 

[allantois]

Right just be honest and say it's cognitive enhancement. It's like all those dudes who go get testosterone from those "wellness" clinics for "low T"...just be real and say it makes you feel better.

I’ve seen some clinics offer both; along with ozempic lol

 

[vanfanal]

There’s so much blurring between treatment and enhancement these days. Stimulants for concentration and mood, sedatives for sleep and not insomnia, GLP-1 peptides for convenience weight loss instead of severe obesity or diabetes…

 

[vanfanal]

Not to derail too much, but I’ve seen that CVS risks are pretty negligible with stimulants as long as no history of something like hocm or a previous stroke. Anyone say different?
Check baseline BP and HR and then every so often thereafter?

 

[docksan]

What?

 

[ObsequiousAplomb]

Not to derail too much, but I’ve seen that CVS risks are pretty negligible with stimulants as long as no history of something like hocm or a previous stroke. Anyone say different?
Check baseline BP and HR and then every so often thereafter?

Yeah. In healthy people they're minimal risk. Even in cardiac patients they're not that risky.

 

[WisNeuro]

Yeah. In healthy people they're minimal risk. Even in cardiac patients they're not that risky.

Not an area that I've researched, what would be the cardiac factors that would put someone in a "risky" group for stimulants, where you would go for a non-stimulant method instead? E.g., Family history of sudden cardiac death, high cholesterol, high BP, etc? At what level do those cross a risk threshold?

 

[ObsequiousAplomb]

Not an area that I've researched, what would be the cardiac factors that would put someone in a "risky" group for stimulants, where you would go for a non-stimulant method instead? E.g., Family history of sudden cardiac death, high cholesterol, high BP, etc? At what level do those cross a risk threshold?

Those are all things that increase risk and warrant a serious discussion of risk/benefits/alternatives.

Aside from WPW, brugada syndrome, hypertrophic cardiomyopathy, and a few other rare situations I still would recommend stimulants. Anyone with any of those histories should have a cardiologist, and the cardiologist should be aware of the stimulants.

Cholesterol isn't ever a contraindication for stimulants. Most of the psychotropics would be equally contraindicated in many cardiac settings. Effexor, Cymbalta, and high dose Wellbutrin are more likely to elevate BP than standard stimulant doses. Most APs would be more arrhythmogenic than stimulants.

Hypertension is of course a great opportunity to discuss guanfacine or clonidine for ADHD symptoms, if appropriate.

There are no major medical contraindications to most of the behavioral management techniques, and I think they should be tried to some degree in everyone.

 

[clausewitz2]

Those are all things that increase risk and warrant a serious discussion of risk/benefits/alternatives.

Aside from WPW, brugada syndrome, hypertrophic cardiomyopathy, and a few other rare situations I still would recommend stimulants. Anyone with any of those histories should have a cardiologist, and the cardiologist should be aware of the stimulants.

Cholesterol isn't ever a contraindication for stimulants. Most of the psychotropics would be equally contraindicated in many cardiac settings. Effexor, Cymbalta, and high dose Wellbutrin are more likely to elevate BP than standard stimulant doses. Most APs would be more arrhythmogenic than stimulants.

There are no major medical contraindications to most of the behavioral management techniques, and I think they should be tried to some degree in everyone.

Seriously, the one time I unintentionally put a patient into a hypertensive crisis that got them hospitalized was by giving them 225 mg of Effexor. If you are super worried about BP with stimulants you better be worried about BP with a lot of other common drugs we use first.

 

[Ceke2002]

This is probably a bit of a 'well duh, obviously' notation, but just personally I'd be extremely careful of putting someone on stimulant medication if they especially had a problem with meth or ice abuse/addiction (probably more so than any other drug, to be honest). Just from personal experience it can trigger some pretty intense cravings for meth/ice, so if someone who's struggling with substance abuse disorder isn't fully committed to recovery, and has access to a really good support network (therapy, etc), then it could be an issue. It was always meth/ice specifically as well, weirdly enough none of us who were using illicit substances back in the 90s ever took stimulant medications (eg Ritalin, Dexamphetamine) & suddenly had the intense urge to drop an E, for example.

Can you cite me a study that objectively shows this? Tell me more about the "enhancement."

I've only just glanced at these, but here are a few studies on stimulant type medications and cognitive enhancement.

Cognitive enhancement effects of stimulants: a randomized controlled trial testing methylphenidate, modafinil, and caffeine

Cognitive enhancement: Effects of methylphenidate, modafinil, and caffeine on latent memory and resting state functional connectivity in healthy adults

Efficacy of stimulants for cognitive enhancement in non-attention deficit hyperactivity disorder youth: a systematic review

Enhancement stimulants: perceived motivational and cognitive advantages

https://www.cureus.com/articles/59273-stimulant-usage-by-medical-students-for-cognitive-enhancement-a-systematic-review

The Use and Impact of Cognitive Enhancers among University Students: A Systematic Review

The Psychonauts’ World of Cognitive Enhancers

 

[Shikima]

Too much anxiety with depression, too little frustration tolerance, too many demands and high expectations and poor sleep with OSA.

 

[ObsequiousAplomb]

This is probably a bit of a 'well duh, obviously' notation, but just personally I'd be extremely careful of putting someone on stimulant medication if they especially had a problem with meth or ice abuse/addiction (probably more so than any other drug, to be honest). Just from personal experience it can trigger some pretty intense cravings for meth/ice, so if someone who's struggling with substance abuse disorder isn't fully committed to recovery, and has access to a really good support network (therapy, etc), then it could be an issue. It was always meth/ice specifically as well, weirdly enough none of us who were using illicit substances back in the 90s ever took stimulant medications (eg Ritalin, Dexamphetamine) & suddenly had the intense urge to drop an E, for example.



I've only just glanced at these, but here are a few studies on stimulant type medications and cognitive enhancement.

Cognitive enhancement effects of stimulants: a randomized controlled trial testing methylphenidate, modafinil, and caffeine

Cognitive enhancement: Effects of methylphenidate, modafinil, and caffeine on latent memory and resting state functional connectivity in healthy adults

Efficacy of stimulants for cognitive enhancement in non-attention deficit hyperactivity disorder youth: a systematic review

Enhancement stimulants: perceived motivational and cognitive advantages

https://www.cureus.com/articles/59273-stimulant-usage-by-medical-students-for-cognitive-enhancement-a-systematic-review

The Use and Impact of Cognitive Enhancers among University Students: A Systematic Review

The Psychonauts’ World of Cognitive Enhancers

And yet there's all the evidence supporting treating ADHD with methylphenidate in people with co-occuring methamphetamine use disorder. Obviously, there's a high rate of relapse. It's just that it's lower than it is if you don't treat it with Ritalin.

 

[Ceke2002]

And yet there's all the evidence supporting treating ADHD with methylphenidate in people with co-occuring methamphetamine use disorder. Obviously, there's a high rate of relapse. It's just that it's lower than it is if you don't treat it with Ritalin.

Oh yeah, absolutely. Sorry I didn't mean to imply otherwise. Obviously self medicating can be an issue in the ADHD population; I haven't looked at the current stats, but back in the 90s I do remember reading a couple of papers that supported early intervention and treatment (pharmacological and therapy) as a way to reduce substance abuse issues in people with ADHD.

 

[PikminOC]

Patients find the crappy places on their own and will go there anyways, because they will give the answer they want LOL

Doesn't mean I will prescribe based on crappy testing.

 

[PikminOC]

IR more than XL if I recall, and usually in doses of 400mg+.

Can crush xl too

 

[PikminOC]

Oh yeah, absolutely. Sorry I didn't mean to imply otherwise. Obviously self medicating can be an issue in the ADHD population; I haven't looked at the current stats, but back in the 90s I do remember reading a couple of papers that supported early intervention and treatment (pharmacological and therapy) as a way to reduce substance abuse issues in people with ADHD.

Papers written by the pharm companies shilling the drugs?

 

[PsyDr]

Can crush xl too

Have you ever seen someone prescribed desoxyn? Just curious.

 

[ObsequiousAplomb]

Can crush xl too

Agreed. People will abuse whatever they get their hands on. While I imagine IR Wellbutrin is more fun if all they have is XL they'll go for that too. They'll even crush buspar.

 

[ObsequiousAplomb]

Have you ever seen someone prescribed desoxyn? Just curious.

I never have. I always hear about it either as a joke or a drug of last resort. With all the formulations of stimulants out there I've never even considered Desoxyn.

 

[PsyDr]

I never have. I always hear about it either as a joke or a drug of last resort. With all the formulations of stimulants out there I've never even considered Desoxyn.

I know it exists, but I've never heard of someone prescribed it. I was just curious if people were actually prescribing it.

 

[PikminOC]

I never have. I always hear about it either as a joke or a drug of last resort. With all the formulations of stimulants out there I've never even considered Desoxyn.

The meth addicts ask for it.

 

[PikminOC]

Doesn't mean I will prescribe based on crappy testing.

And this is why that school I posted earlier is strict with exactly the testing and documentation needed. So people can't come in with crappy testing for documentation.

 

[smalltownpsych]

And yet there's all the evidence supporting treating ADHD with methylphenidate in people with co-occuring methamphetamine use disorder. Obviously, there's a high rate of relapse. It's just that it's lower than it is if you don't treat it with Ritalin.

That is kind of funny. Of course there is going to be a lower rate of relapse if you give the drug that they want. It’s like the controlled drinking experiments. They all yield great results in the short term (even up to a year is short term in my view) and especially if they are self report which they typically are. In the long run, I saw a ten year retrospective study of a controlled drinking experiment that had very high rates of hospitalization, incarceration, and death. Unfortunately, it is incredibly difficult to compare the groups but coming from a family with high rates of addiction I’m kind of in the live sober or die group myself. We just buried a nephew who was being “treated medically” for his addiction and have many other family members who are abstinent and doing extremely well in their recovery.

 

[ObsequiousAplomb]

That is kind of funny. Of course there is going to be a lower rate of relapse if you give the drug that they want. It’s like the controlled drinking experiments. They all yield great results in the short term (even up to a year is short term in my view) and especially if they are self report which they typically are. In the long run, I saw a ten year retrospective study of a controlled drinking experiment that had very high rates of hospitalization, incarceration, and death. Unfortunately, it is incredibly difficult to compare the groups but coming from a family with high rates of addiction I’m kind of in the live sober or die group myself. We just buried a nephew who was being “treated medically” for his addiction and have many other family members who are abstinent and doing extremely well in their recovery.

The studies are ones where they test for methamphetamine, not self report. And in general the meth users are asking for amphetamines, not Ritalin. The doses are very modest, and they confirm this in the relevant studies.

There will always be people who die being treated medically and who are abstinent. The data is clear that fewer die when treated medically. Saying one person died who was being treated medically while others didn't who weren't means that medical treatment is bad is rather anti-scientific and absurd.

 

[docksan]

Can crush xl too

People that are desperate will crush anything.

 

[PikminOC]

People that are desperate will crush anything.

And there are lots of desperate people.

 

[PikminOC]

The studies are ones where they test for methamphetamine, not self report. And in general the meth users are asking for amphetamines, not Ritalin. The doses are very modest, and they confirm this in the relevant studies.

There will always be people who die being treated medically and who are abstinent. The data is clear that fewer die when treated medically. Saying one person died who was being treated medically while others didn't who weren't means that medical treatment is bad is rather anti-scientific and absurd.

The ex meth patient I saw was getting Adderall 30 from a psychiatrist. He wanted more than that. Or desoxyn.

 

[smalltownpsych]

The studies are ones where they test for methamphetamine, not self report. And in general the meth users are asking for amphetamines, not Ritalin. The doses are very modest, and they confirm this in the relevant studies.

There will always be people who die being treated medically and who are abstinent. The data is clear that fewer die when treated medically. Saying one person died who was being treated medically while others didn't who weren't means that medical treatment is bad is rather anti-scientific and absurd.

I am not saying that there isn’t a role for medical treatment, but what I see happening in the real world is typically not anything like the studies. And I have a little more than n=1 and also know the literature very well in this area, was just using the anecdote to amplify the point a bit.

 

[ObsequiousAplomb]

The ex meth patient I saw was getting Adderall 30 from a psychiatrist. He wanted more than that. Or desoxyn.

Only 30 a day? That's not bad. Can go higher if indicated. Not saying I'd treat him though.

 

[Ceke2002]

Papers written by the pharm companies shilling the drugs?

Possibly, but from memory I'd say unlikely. I'm in Australia, back in the 90s getting prescribed stimulant medication for ADHD as an adult was basically the equivalent of being asked to perform a 3 ring circus act. Maybe I'm wrong here, but I can't see pharm companies bothering to shill for something that was that highly regulated.

That is kind of funny. Of course there is going to be a lower rate of relapse if you give the drug that they want. It’s like the controlled drinking experiments. They all yield great results in the short term (even up to a year is short term in my view) and especially if they are self report which they typically are. In the long run, I saw a ten year retrospective study of a controlled drinking experiment that had very high rates of hospitalization, incarceration, and death. Unfortunately, it is incredibly difficult to compare the groups but coming from a family with high rates of addiction I’m kind of in the live sober or die group myself. We just buried a nephew who was being “treated medically” for his addiction and have many other family members who are abstinent and doing extremely well in their recovery.

Not talking about the meth equivalent of methadone for heroin addiction. These research papers I remember talked more about early intervention in childhood (intervention not just being medication, but therapy interventions as well) helping to reduce the likelihood of substance abuse disorders later in life. Definitely not along the lines of 'give a meth addict some stims and you'll prevent relapse by treating their ADHD'.

I'm sorry for your loss as well, sincerely. We buried a close friend due to alcohol addiction last year, it's never easy. I do partially agree with the stance on not medically treating addiction (outside of medically supported detox of course), mainly from the point of view that it always did bother me to see people on the methadone program (for example) for over a decade, with no plan to wean off, and still treating themselves to a shot of heroin every so often. My methadone prescribing doctor at the time might have been an arrogant and rude so and so, but at least he made it clear I was going to be on methadone for a maximum of 2 years only, & also referred me to intensive therapy. That seems like a better approach that just putting someone on the methadone equivalent of the never ending story. Again I'm sorry for your loss, and for your family struggles.

 

[watto]

Somewhat related given the discussion above about cardiac effects of stimulants - I just read a somewhat game changing article challenging the dogma that ADHD predisposes one to Periodic Limb Movements of Sleep. More recent research suggests it is the reverse. People with PLMS have known autonomic fluctuations in sleep as well as microarousals that correlate with those seen in subjects with ADHD (as well as iron deficiency that unites the two diagnoses in some). An editorial about the piece by Arthur Walters cites his own work finding that up to 90% of the subjects he studied with PLMS were later diagnosed with ADHD. Interesting in that it highlights possible baseline autonomic changes that provide support for awareness of if not monitoring of with or without meds. It's in the Advance Articles section of Sleep, you need to subscribe to access.

 

[Ceke2002]

The meth addicts ask for it.

Wait? Do they actually think they're going to be getting the pharmaceutical equivalent of crystal meth? I mean I know desperate measures and all that, but LOL. Never taken Desoxyn myself, but I can't see it giving the equivalent 24-36 hour high that good crystal meth does. And if all they're really after is meth, why go bothering a Doctor about it, that's what your dealer's for. Idiots. 🙄

 

[PikminOC]

Wait? Do they actually think they're going to be getting the pharmaceutical equivalent of crystal meth? I mean I know desperate measures and all that, but LOL. Never taken Desoxyn myself, but I can't see it giving the equivalent 24-36 hour high that good crystal meth does. And if all they're really after is meth, why go bothering a Doctor about it, that's what your dealer's for. Idiots. 🙄

Yes they ask and then write me bad reviews

 

[PikminOC]

Possibly, but from memory I'd say unlikely. I'm in Australia, back in the 90s getting prescribed stimulant medication for ADHD as an adult was basically the equivalent of being asked to perform a 3 ring circus act. Maybe I'm wrong here, but I can't see pharm companies bothering to shill for something that was that highly regulated.



Not talking about the meth equivalent of methadone for heroin addiction. These research papers I remember talked more about early intervention in childhood (intervention not just being medication, but therapy interventions as well) helping to reduce the likelihood of substance abuse disorders later in life. Definitely not along the lines of 'give a meth addict some stims and you'll prevent relapse by treating their ADHD'.

I'm sorry for your loss as well, sincerely. We buried a close friend due to alcohol addiction last year, it's never easy. I do partially agree with the stance on not medically treating addiction (outside of medically supported detox of course), mainly from the point of view that it always did bother me to see people on the methadone program (for example) for over a decade, with no plan to wean off, and still treating themselves to a shot of heroin every so often. My methadone prescribing doctor at the time might have been an arrogant and rude so and so, but at least he made it clear I was going to be on methadone for a maximum of 2 years only, & also referred me to intensive therapy. That seems like a better approach that just putting someone on the methadone equivalent of the never ending story. Again I'm sorry for your loss, and for your family struggles.

It should be difficult to get. It's not hard to get in the US.

 

[Ceke2002]

It should be difficult to get. It's not hard to get in the US.

Yeah, absolutely no offence meant, but the US does seem a tad ar5e backwards with some things.

Not sure if things have changed here, or not, but in order for me to be prescribed Dexamphetamine back then I had to first of all get a GP's referral to even see a Psychiatrist, then go through a full assessment, including neuro testing and head scans, then my prescribing Psychiatrist had to send in an application to the State Health Minister for an authority to prescribe, then I had to sign a legal contract (and provide two forms of ID as well, from memory) which registered me with the State Health Department as someone who was being prescribed Dexamphetamine, and after all that I was also supposed to be reviewed every 12 months in order for the authority to prescribe to be continued. Honestly, If I wasn't absolutely dead serious about wanting to legitimately treat my ADHD back then, and I was just looking to get high, it would have been far quicker, and easier for me to just ring a dealer and get a nice hit of crystal meth within the hour.

I've never bothered to try and go back on stimulant medication since I stopped taking it, mainly because I don't like the side effects and now prefer to manage my ADHD symptoms with non medication methods, but also because I really, really cannot be bothered jumping through that many hoops again.

 

[Jules A]

Yeah, absolutely no offence meant, but the US does seem a tad ar5e backwards with some things.

Not sure if things have changed here, or not, but in order for me to be prescribed Dexamphetamine back then I had to first of all get a GP's referral to even see a Psychiatrist, then go through a full assessment, including neuro testing and head scans, then my prescribing Psychiatrist had to send in an application to the State Health Minister for an authority to prescribe, then I had to sign a legal contract (and provide two forms of ID as well, from memory) which registered me with the State Health Department as someone who was being prescribed Dexamphetamine, and after all that I was also supposed to be reviewed every 12 months in order for the authority to prescribe to be continued. Honestly, If I wasn't absolutely dead serious about wanting to legitimately treat my ADHD back then, and I was just looking to get high, it would have been far quicker, and easier for me to just ring a dealer and get a nice hit of crystal meth within the hour.

I've never bothered to try and go back on stimulant medication since I stopped taking it, mainly because I don't like the side effects and now prefer to manage my ADHD symptoms with non medication methods, but also because I really, really cannot be bothered jumping through that many hoops again.

I wouldn't want to live anywhere else but the pendulum has swung way too far. We are the land where everyone is a cherished snowflake who deserves a trophy and our patients are no longer patients but customers. Frankly I think it is doing many of them a disservice by being afraid to set limits and say no.

 

[randomdoc1]

I wouldn't want to live anywhere else but the pendulum has swung way too far. We are the land where everyone is a cherished snowflake who deserves a trophy and our patients are no longer patients but customers. Frankly I think it is doing many of them a disservice by being afraid to set limits and say no.

Where is your empathy? You're supposed to be a mental health provider! lol

I'm Asian and back in my country of origin, they now take credit very very seriously. I think the USA could use that too. Every major entity, real estate, banks, clinics, essentially anything that is a registered business has access to your financial credit history. They can decide for things non-emergent if they want to render services (and how restrictive they want to be) to you based on how you've kept up with tabs at other places. If your credit is exceptionally terrible, especially for transportation, you mostly only have access to pay for bus fares, ride a bike or walk to where-ever you need to go. Not saying we need to go that far. But the financial wellbeing of that country is far better than ours. Accountability. Accountability.

 

[Ceke2002]

I wouldn't want to live anywhere else but the pendulum has swung way too far. We are the land where everyone is a cherished snowflake who deserves a trophy and our patients are no longer patients but customers. Frankly I think it is doing many of them a disservice by being afraid to set limits and say no.

Oh god, that's disappointing to hear. I love me a Psychiatrist who sets limits and isn't afraid to say no, I mean what's the point otherwise? You're not going to a session for a friendly watercooler chat, and they're not one of your friends so big deal your treating physician sets limits and dares to use the word 'no' with you, so long as they're empathetic about it I don't see an issue. Obviously it sounds like others do, in which case I'd suggest calling a whaambulance for them, perhaps throw in a prescription for 'cry moar'.

 

[randomdoc1]

Oh god, that's disappointing to hear. I love me a Psychiatrist who sets limits and isn't afraid to say no, I mean what's the point otherwise? You're not going to a session for a friendly watercooler chat, and they're not one of your friends so big deal your treating physician sets limits and dares to use the word 'no' with you, so long as they're empathetic about it I don't see an issue. Obviously it sounds like others do, in which case I'd suggest calling a whaambulance for them, perhaps throw in a prescription for 'cry moar'.

Many people in the US seem to confuse mental health services for spa treatment LOL.
Oh, and it has to be free. How dare you charge me?! You're supposed to be an empathic mental health provider!
And you need to be there whenever they feel like. You must accommodate their requests for nights, weekends and holidays because their schedule is the only one that matters and their problems are bigger than everyone else's.

 

[Shikima]

Yes they ask and then write me bad reviews

Being a good psychiatrist has an inverse relationship to online scores/opinions.

 

[randomdoc1]

Being a good psychiatrist has an inverse relationship to online scores/opinions.

I have not seen you in forever!

 

[allantois]

I wouldn't want to live anywhere else but the pendulum has swung way too far. We are the land where everyone is a cherished snowflake who deserves a trophy and our patients are no longer patients but customers. Frankly I think it is doing many of them a disservice by being afraid to set limits and say no.

Unrelated to ADHD, but the amount of patients who think that we are a get out jail free card who can write them all sorts of accommodation letters or disability requests is absolutely astonishing to me..

 

[PikminOC]

I wouldn't want to live anywhere else but the pendulum has swung way too far. We are the land where everyone is a cherished snowflake who deserves a trophy and our patients are no longer patients but customers. Frankly I think it is doing many of them a disservice by being afraid to set limits and say no.

Many docs have a boat payment and also at least one divorce tho. 🌝

 

[Jules A]

Many docs have a boat payment and also at least one divorce tho. 🌝

Ha yeah or are uncomfortable saying no. Fortunately none of the above have littered my life.

 

[Shikima]

I have not seen you in forever!

I know! Been busy trying to put my life together. I decided it was time to roam the 'ol stompin' grounds dispensing truth and wisdom in the likeness of Red Foreman.