How do you feel about Psychologist prescription privileges?

[WisNeuro]

One thing I am curious about is how exactly do psychologists get exposure to mental illnesses?

Depends on the program. Most of my colleagues have fairly extensive SMI and inpatient exposure in training. Runs both ways, really. Like when I see Bipolar disorder diagnosed because the person is depressed, but also reported that they sometimes do not sleep. Upon asking several more questions, it's very clear that they have never had a manic or hypomanic episode, but have still been diagnosed and prescribed meds for Bipolar Disorder.

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[F0nzie]

Depends on the program. Most of my colleagues have fairly extensive SMI and inpatient exposure in training. Runs both ways, really. Like when I see Bipolar disorder diagnosed because the person is depressed, but also reported that they sometimes do not sleep. Upon asking several more questions, it's very clear that they have never had a manic or hypomanic episode, but have still been diagnosed and prescribed meds for Bipolar Disorder.

Well maybe the psychologists I have worked with did not have good training. I can't say.

I agree that the Bipolar diagnosis is over used. If you've never actually seen a manic episode though you might miss it even if it punches you in the face. For example there was an NP that wrote a 5 page HPI basically word for word of a patients nonsensical manic rant and didn't know that was mania...this guy had not slept in weeks and believed he was the monopoly guy. If you don't know and you don't ask...well then you don't know and you cannot treat.

 

[F0nzie]

I hope the day never comes where I have delirium secondary to a UTI and pneumonia and get sent home with a diagnosis of late onset Schizophrenia and a script of Zyprexa. I have seen it. The way mental health is heading with the bar getting progressively lower, psychiatrists retiring and being the minority player, this will be an every reality. Maybe it already is.

 

[nitemagi]

I hope the day never comes where I have delirium secondary to a UTI and pneumonia and get sent home with a diagnosis of late onset Schizophrenia and a script of Zyprexa. I have seen it. The way mental health is heading with the bar getting progressively lower, psychiatrists retiring and being the minority player, this will be an every reality. Maybe it already is.

If you don't look for it, you won't find it.

 

[smalltownpsych]

Well maybe the psychologists I have worked with did not have good training. I can't say.

I agree that the Bipolar diagnosis is over used. If you've never actually seen a manic episode though you might miss it even if it punches you in the face. For example there was an NP that wrote a 5 page HPI basically word for word of a patients nonsensical manic rant and didn't know that was mania...this guy had not slept in weeks and believed he was the monopoly guy. If you don't know and you don't ask...well then you don't know and you cannot treat.

Definitely sounds like poor training, they sound more like LPCs. I wonder if Az is overrun with the non-university based professional school grads who tend to have very limited training experiences. They are probably the equivalent for us of the lower tier Caribbean med schools. I had two solid years of inpatient experience and two years of outpatient with exposure to broad spectrum (VA and CMH) by the time I was licensed. Most of those professional school grads don't get that level of exposure. Also, watch out for the phonies that are practicing under a counseling license, but have a doctorate degree of some sort. ASU has a program specifically designed for that purpose called a doctor of behavioral health.

 

[WisNeuro]

I hope the day never comes where I have delirium secondary to a UTI and pneumonia and get sent home with a diagnosis of late onset Schizophrenia and a script of Zyprexa. I have seen it. The way mental health is heading with the bar getting progressively lower, psychiatrists retiring and being the minority player, this will be an every reality. Maybe it already is.

I get more than several consults a year to go see inpatients for what residents think is Wernicke-Korsakoff/encephalopathy simply because the person has an alcohol history. Imaging is fine, labs are all out of whack (Sodium, Potassium, Magnesium). I then usually explain to the resident that the patient is delirious and will likely clear once they are medically stable. They disagree, insist on WK. 2 weeks later, labs improve, and suddenly the patient is back to normal (ish). For some reason, some people have no idea what a delirium is, even when it's textbook. I think about only once in about 15 times in the past several years, has it actually been W-K/E.

 

[TexasPhysician]

I hope the day never comes where I have delirium secondary to a UTI and pneumonia and get sent home with a diagnosis of late onset Schizophrenia and a script of Zyprexa. I have seen it. The way mental health is heading with the bar getting progressively lower, psychiatrists retiring and being the minority player, this will be an every reality. Maybe it already is.

Easy solution. Olanzapine already comes as combo pill with Prozac. Compounding pharmacies could easily do an Olanzapine/Bactrim DS combo.

 

[smalltownpsych]

I get more than several consults a year to go see inpatients for what residents think is Wernicke-Korsakoff/encephalopathy simply because the person has an alcohol history. Imaging is fine, labs are all out of whack (Sodium, Potassium, Magnesium). I then usually explain to the resident that the patient is delirious and will likely clear once they are medically stable. They disagree, insist on WK. 2 weeks later, labs improve, and suddenly the patient is back to normal (ish). For some reason, some people have no idea what a delirium is, even when it's textbook. I think about only once in about 15 times in the past several years, has it actually been W-K/E.

Ditto for over/mis-diagnosis of Korsakoff's (I didn't know Wernicke was in that, is that part of the name or involvement of that region?) and for elderly as having dementia or psychosis when they have uti's. Correct me if I'm wrong, but I am pretty certain that there is no such thing as sudden onset dementia. Maybe a stroke or brain injury could cause similar impairments, but then it wouldn't be dementia. Seen this occur in several different hospitals with numerous physicians. Seen a few patients with mental ******ation diagnosed as psychotic, as well.

 

[WisNeuro]

Ditto for over/mis-diagnosis of Korsakoff's (I didn't know Wernicke was in that, is that part of the name or involvement of that region?) and for elderly as having dementia or psychosis when they have uti's. Correct me if I'm wrong, but I am pretty certain that there is no such thing as sudden onset dementia. Maybe a stroke or brain injury could cause similar impairments, but then it wouldn't be dementia. Seen this occur in several different hospitals with numerous physicians. Seen a few patients with mental ******ation diagnosed as psychotic, as well.

WE is the acute form of the Wernicke-Korsakoff syndrome. Actually, there are sudden onset dementias in a sense. Stroke, if severe enough causes vascular dementia. The other would be a prion disease, like CJD, where you will have psychological manifestations for several years, but when the cognitive stuff starts, it's usually quick and the person usually doesn't last the year. Another issue could be a hypoxic/anoxic event during say, a surgery, also an acute onset. So, acute onset of a dementia condition is not rare. AD is still the #1 cause in older adults, but there are plenty of other causes, each with different timelines.