Imagine being a...

[tomfooleries]

clinical neuropsych with prescription privileges?

Would one not be well-equipped to evaluate and/or treat from all angles?

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[tomfooleries]

Answer me, elitists! I write for our benefit, not just mine!

 

[IT514]

The 2nd sequence of psychopharm at my program is taught by a neuropsychologist who is also a licensed MP (in Louisiana). I'm a year or so away from taking it, so I cant tell you much about the prof or the course except that it is a very solid perspective to learn from. I dont have any interest in prescribing, just a desire to learn more about the effect of meds, both obvious and subtle, in doing assessments and therapy.

If you want to look him up, his name is John Courtney, Psy.D, MP.

 

[erg923]

Answer me, elitists! I write for our benefit, not just mine!

This is poor form, but I will answer anyway.

I would argue that although it would provide certain advantages in understanding how a medication would affect behavior and possibly cognition, having this knowledege would not neccacarily make you a better neuropsychologist in practice. Knowledge of the behavioral aspects of pharm (ie., knowing which drugs have the potential to affect cogntion) is very important and I think npsychs are actually pretty well trained in this already. As the previous poster mentioned, a basic class in pharm that foucses heavily on the behavioral and cognitive aspects of meds is standard in any clinical psych doctoral program. However, the knowledge neccasary for prescribing them is less fundamental to what npsychs do. Having extensive knowledge prescribing meds has little to do with the functional/behavioral and cognitive aspects of neuroanatomy. So for the assesment and differential diagnostic knowledge that is the core of npsych, Im not sure it would add all that much.

I would also argue that assessment and diagnostic issues are the main area most practicing neuropsychologists are interested in. All of them can do treatment (therapy) and interventions (cogntive rehab), but many choose not too simply because they dont want to. And I dont see extensive knowledge of prescribing being too much of advantage when engaing in these activities anyway. Someone once told me that people go into npsych for 2 reasons. 1.) they like the brain. 2.)they hate doing psychotherapy. So....if my main interest is in being a diagnostician and suggesting recommendations to the referal source (many of which are psychosocial and behavioral anyway), pursing the MS in pharm provides no real return on investment in my npsych practrice.

Further, you many want to think about where your referal base is coming from. For npsychs, its mostly medical physicians. The npsychs role in this context is that of a liasion, or consultant. Not as a medical provider/treater. The doc wants your opinion about the knowledge that he does not have and does not have training in how to do- That is, assessing cogntion through use of standardized tests and using knowledge of functional neuroanatomy to assist in differntial diagnosis. In my experience, your referal sources are not going to apppreciate sending their patients to someone who they view as a (non-medical) consultant and then having their treatment/meds altered because you (a non M.D.) ordered it. Dont bite the hand that feeds you and dont trample on someone elses territory and job. If you constiently do this, your referals from that doc will quickly dry up and they will send their patients to other npsychs who provide only the service they are looking for.

All this said, i would be interested in John Courtney's opnion on all this, and how he (and if) utiilizes PP in his npsych practice. Im on the npsych list server, so I would be willing to send him an email about this if anyone is interested.

 

[Therapist4Chnge]

Excellent post erg923....I completely agree.

While the knowledge can help inform, functionally they are quite separate. I believe the pharmacology training really informs my clinical side, I think it will only be marginally useful in the neuropsych arena. My opinion may change as I get more intensive training in neuro, though it seems to hold true so far.

As for Dr. Courtney, he's a really bright guy and comes highly recommended. I've met him a few times and he's always been very knowledgeable on a range of pharma topics.

 

[tomfooleries]

This is poor form, but I will answer anyway.

I would argue that although it would provide certain advantages in understanding how a medication would affect behavior and possibly cognition, having this knowledege would not neccacarily make you a better neuropsychologist in practice. Knowledge of the behavioral aspects of pharm (ie., knowing which drugs have the potential to affect cogntion) is very important and I think npsychs are actually pretty well trained in this already. As the previous poster mentioned, a basic class in pharm that foucses heavily on the behavioral and cognitive aspects of meds is standard in any clinical psych doctoral program. However, the knowledge neccasary for prescribing them is less fundamental to what npsychs do. Having extensive knowledge prescribing meds has little to do with the functional/behavioral and cognitive aspects of neuroanatomy. So for the assesment and differential diagnostic knowledge that is the core of npsych, Im not sure it would add all that much.

I would also argue that assessment and diagnostic issues are the main area most practicing neuropsychologists are interested in. All of them can do treatment (therapy) and interventions (cogntive rehab), but many choose not too simply because they dont want to. And I dont see extensive knowledge of prescribing being too much of advantage when engaing in these activities anyway. Someone once told me that people go into npsych for 2 reasons. 1.) they like the brain. 2.)they hate doing psychotherapy. So....if my main interest is in being a diagnostician and suggesting recommendations to the referal source (many of which are psychosocial and behavioral anyway), pursing the MS in pharm provides no real return on investment in my npsych practrice.

Further, you many want to think about where your referal base is coming from. For npsychs, its mostly medical physicians. The npsychs role in this context is that of a liasion, or consultant. Not as a medical provider/treater. The doc wants your opinion about the knowledge that he does not have and does not have training in how to do- That is, assessing cogntion through use of standardized tests and using knowledge of functional neuroanatomy to assist in differntial diagnosis. In my experience, your referal sources are not going to apppreciate sending their patients to someone who they view as a (non-medical) consultant and then having their treatment/meds altered because you (a non M.D.) ordered it. Dont bite the hand that feeds you and dont trample on someone elses territory and job. If you constiently do this, your referals from that doc will quickly dry up and they will send their patients to other npsychs who provide only the service they are looking for.

All this said, i would be interested in John Courtney's opnion on all this, and how he (and if) utiilizes PP in his npsych practice. Im on the npsych list server, so I would be willing to send him an email about this if anyone is interested.

Thanks for the reply, Erg. I don't visit the site much, only when I start rethinking what I want to do with my life again (every 3 months), but I passed some "elitist" threads that seemed pretty silly. I thought I'd poke fun at it, secretly hoping it would elicit a quicker response.

I agree with all points too. My idea, I suppose, stems from a personal desire to do more with ph.d. in clinical psych. I am stuck between wanting a strong research background with behavioral/therapeutic training of a ph.d., with the medical background and full prescription privileges of a psychiatrist. So I can't choose which long and arduous path I want to take and I'm getting too old to continue to idle.

I'm an RA at a big Uni, my background is in autism. On the studies I've worked on, I've had lots of access to the psychologists and the physicians - developmental pediatricians, child psychiatrists, geneticists, neurologists, etc. It would be so useful to have neuropsych training and prescriptions privileges as a psychologist working w/ this population.

Diagnosis is often difficult because of all the comorbidities - autism and ADHD, OCD, MR, etc. - and underlying physicial conditions. Once those are teased apart, making recommendations can be so difficult because a). a lot of insurance companies won't reimburse for med. evaluation or treatment, and b). although something is going on in these cases, the dx isn't always clear (ex: PDD-NOS w/ MR) and services can't be obtained without one. Training in neuropsych is huge here; we have one psychologists w/ the training and her recs are so much stronger for it. Difficult enough to be teasing apart MR from an ASD, but to be able to do further testing helps tremendously to rec services in school or privately. The sad part is there is such an influx of families looking for evaluation that, across the country, they're waiting 6 mos. to see a psychologist.

Comorbidities abound, a lot of them need to see a developmental pediatrician or a child psychiatrist (at best), sometimes a neurologist, to manage meds. The problem is that there aren't any, so they are waiting another 6 months for medical care! We have one developmental pediatrician at our large, well known Uni... who specializies in managing meds for kids with autism. She is seeing well over 400 patients each year, and she is spending only 2 days/week in clinic. She hasn't taken a new patient in a long time, and has a wait-list of 2 years. We can find someone to replace her, and she has been looking to retire for some time. And it is insane to see how many of these kids are taking meds for ADHD, OCD, sleep problems, etc. It's insane. Risperidone for all.

So being in this environment makes me want to have it all. I really like autism and I know I would enjoy pursuring a career in research and/or assessment. But I do feel it would be so valuable for a clinical psych, who spends 6 hours with a kid to make a sound dx, to be able to follow-up on a behavioral and/or educational plan and , if necessary, support that with the administration of meds. Even beyond my interest in autism, I just think it would be so cool, and helpful, to also have the psychopharm training (and honestly, a wealth of medical knowledge in general). I want both. I have this vision of the perfect, all-encompassing mental health professional with the education and abilities of both a clinical psych (w/ neuropsych training) and a psychiatrist. How cool would that be? I'll never choose between the two.

 

[erg923]

Unfortunatley, the split model of treatment does not permit an all encompasing career (at least with only one degree).

My opionion is that patient care is best when its a team approach where everyone has there specialty area and contributes jointly to the tx plan. Besides, the MS in psychopharm does not give you the "wealth" of medical knowledge that an M.D has anyway. I think you'd need to really have both an M.D and Ph.D with post-doc in npsych to have all those competecies you describe.

 

[Therapist4Chnge]

I think you'd need to really have both an M.D and Ph.D and post-doc in npsych to have all those competecies you describe.

Agreed.

I think the MS Pharma training would not be sufficient for what you are looking for, so you'd be left having to get a great deal of training to attempt to meet your niche.


I briefly considered MD/Ph.D programs, though none were a good fit for my interests.

 

[tomfooleries]

What do you guys think about the future of clinical psych?