Naturopathic Doctor

[Sushirolls]

So in digging around the Spravato website and seeing whose getting on their directory in different places in the country, I made the mistake of looking up Portland, OR and saw a bunch of naturopathic doctors on the list. That in itself is concerning, a ND is prescribing Esketamine Spray, for depression patients. But it doesn't stop there, I looked up one website:

"...We work with a variety of conditions including depression, anxiety, bipolar disorder, ADHD, psychosis, schizophrenia, OCD, eating disorders, and addictions of all kinds. We are diagnosis-neutral, meaning we do not require endorsement, or deny, psychiatric diagnosis. Our goal is to meet people where they are at. ..."

What does that mean? And even with insurance? Are you just putting down mood disorder for every one? Documenting nothing in the Assessment section?

Digging further on their intake forms they have questions about if the insurance will cover 99354, 90833, 99214.

I'm still trying to wrap my around an ARNP recently diagnosing a middle aged patient with Autistic Spectrum Disorder, on a short inpatient hospitalization for depression, with no supporting HPI or Formulation to justify it in their note, and the patient in my office was like 'yeah, ARNP said (s)he had ASD and thinks I do too.'

I'm just speechless.

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[MBBSMOM]

This is insane what is going on. I even know psychiatric pharmacists are allowed to prescribe. I don’t know the full extent to what they are allowed to prescribe but they are allowed in certain states.

 

[watto]

I had to stop seeing patients who had naturopaths as PCPs - too tired of dealing with them and their adrenal fatigue / cortisol managers / gabaergic placebos that didn't cross the blood-brain barrier, all essentially covering with band aids to the point of mummification to ostensibly treat symptoms when the real problem was some unaddressed core fear that we needed to discuss in therapy. Absolutely impossible trying to educate the patients who had been brainwashed by the naturopaths about this stuff.

There is a former naturopath online who saw the error of her ways and has exposed some of the questionable messages she encountered during her education:

Naturopathic Diaries

Former naturopathic doctor. Current Master's of Science student in biomedicine. I share the hard truths about naturopathic education and practice to protect patients. Please don't be fooled by natural and alternative medicine.

www.naturopathicdiaries.com

 

[Daedra22]

In Oregon ND's have expanded prescribing rights compared to other states. I've had patients whose ND's were prescribing their antipsychotics - I've also seen ND's frequently prescribing antipsychotics + stimulants concurrently. It amazes me the risks these folks are willing to take, and unfortunately a lot of patients intrinsically trust their ND more than a psychiatrist.

 

[octopuszebra]

I've had patients whose ND's were prescribing their antipsychotics - I've also seen ND's frequently prescribing antipsychotics + stimulants concurrently.

Off-topic but because it is important to me, there is data for using antipsychotics and stimulants in certain patients. For example, in patients with severe sedation from antipsychotics or with severe negative symptoms.

Here's a case series: Methylphenidate as Treatment for Clozapine-Induced Sedation in Patients with Treatment-Resistant Schizophrenia. - PubMed - NCBI

Here's a systematic review: A systematic review of psychostimulant treatment of negative symptoms of schizophrenia: challenges and therapeutic opportunities. - PubMed - NCBI. "The literature points to evidence that, used adjunctively, DA agonists may improve NSS without worsening of positive symptoms in selected patients who are stable and treated with effective antipsychotic medications."

Unfortunately, the data is slim, but this certainly isn't the only area of psychiatry where data is slim.

 

[clausewitz2]

Off-topic but because it is important to me, there is data for using antipsychotics and stimulants in certain patients. For example, in patients with severe sedation from antipsychotics or with severe negative symptoms.

Here's a case series: Methylphenidate as Treatment for Clozapine-Induced Sedation in Patients with Treatment-Resistant Schizophrenia. - PubMed - NCBI

Here's a systematic review: A systematic review of psychostimulant treatment of negative symptoms of schizophrenia: challenges and therapeutic opportunities. - PubMed - NCBI. "The literature points to evidence that, used adjunctively, DA agonists may improve NSS without worsening of positive symptoms in selected patients who are stable and treated with effective antipsychotic medications."

Unfortunately, the data is slim, but this certainly isn't the only area of psychiatry where data is slim.

The chief of our SMI/psychosis service line has a few patients who are on cautious doses of Ritalin for just this reason. I have seen more modafinil but I think that is from medicolegal caution instead of clear evidence base.

Let us not also forget the people with ADHD who end up on small doses of Abilify or Seroquel or Latuda for depression who have been on Vyvanse for years.

I think neuroscience based nomenclature sometimes overstates its own case but I think if we got to a point where no one ever referred to "antipsychotics" again it would be a positive change.

 

[Mad Jack]

Off-topic but because it is important to me, there is data for using antipsychotics and stimulants in certain patients. For example, in patients with severe sedation from antipsychotics or with severe negative symptoms.

Here's a case series: Methylphenidate as Treatment for Clozapine-Induced Sedation in Patients with Treatment-Resistant Schizophrenia. - PubMed - NCBI

Here's a systematic review: A systematic review of psychostimulant treatment of negative symptoms of schizophrenia: challenges and therapeutic opportunities. - PubMed - NCBI. "The literature points to evidence that, used adjunctively, DA agonists may improve NSS without worsening of positive symptoms in selected patients who are stable and treated with effective antipsychotic medications."

Unfortunately, the data is slim, but this certainly isn't the only area of psychiatry where data is slim.

Actually was going to say the same- there is a place for those with negative symptoms in particular in the research, however scant it may be

 

[Mad Jack]

This whole thread makes me want to go get a JD and start hunting down the no doubt numerous malpractice cases involving naturopaths inappropriately prescribing psychiatric meds with resulting harm

 

[whopper]

This whole thread makes me want to go get a JD and start hunting down the no doubt numerous malpractice cases involving naturopaths inappropriately prescribing psychiatric meds with resulting harm

One of the reasons why I like forensic psychiatry is cause sometimes you're on the plaintiff end and you get to cut apart a bad doctor's pathetic work.

 

[Sushirolls]

This whole thread makes me want to go get a JD and start hunting down the no doubt numerous malpractice cases involving naturopaths inappropriately prescribing psychiatric meds with resulting harm

The key to this will be doing those mid day commercials.

 

[Sushirolls]

Home - Physicians for Patient Protection

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www.physiciansforpatientprotection.org

Just learned about this organization. Society representing physician only approach. Check it out.

 

[deleted343839]

Every few months I see a patient who has been diagnosed and medicated by a self-styled mental health "expert." Though some are NPs, quite a few are non-psychiatrist MDs who have gone rogue doing some variant of lifestyle/holistic/boutique medicine or "I'm an expert on a rare disease that all of my patients seem to have." I try to persuade these patients to get a second opinion from a board certified psychiatrist.

 

[clausewitz2]

Every few months I see a patient who has been diagnosed and medicated by a self-styled mental health "expert." Though some are NPs, quite a few are non-psychiatrist MDs who have gone rogue doing some variant of lifestyle/holistic/boutique medicine or "I'm an expert on a rare disease that all of my patients seem to have." I try to persuade these patients to get a second opinion from a board certified psychiatrist.

"Why yes, I am the world's leading authority on this surprisingly common condition no one else has heard of. I have published extensively. Where? Oh, well, my blog. And PLOS One."

 

[WisNeuro]

Board certified doesn't always help. Isn't that quack Horowitz who treats "chronic Lyme" BCd in Internal?

 

[deleted343839]

Board certified doesn't always help. Isn't that quack Horowitz who treats "chronic Lyme" BCd in Internal?

Maybe. I don't know. Of course nothing is 100% certain. But if I can get a very obviously mismanaged patient to see a physician who has actually completed a psychiatry residency and passed their boards (preferably someone at my AMC), I feel I've done that person a service.

 

[OldPsychDoc]

I had to stop seeing patients who had naturopaths as PCPs - too tired of dealing with them and their adrenal fatigue / cortisol managers / gabaergic placebos that didn't cross the blood-brain barrier,...

I read that as Garbage-ergic for some reason...

 

[Daedra22]

Off-topic but because it is important to me, there is data for using antipsychotics and stimulants in certain patients. For example, in patients with severe sedation from antipsychotics or with severe negative symptoms.

Here's a case series: Methylphenidate as Treatment for Clozapine-Induced Sedation in Patients with Treatment-Resistant Schizophrenia. - PubMed - NCBI

Here's a systematic review: A systematic review of psychostimulant treatment of negative symptoms of schizophrenia: challenges and therapeutic opportunities. - PubMed - NCBI. "The literature points to evidence that, used adjunctively, DA agonists may improve NSS without worsening of positive symptoms in selected patients who are stable and treated with effective antipsychotic medications."

Unfortunately, the data is slim, but this certainly isn't the only area of psychiatry where data is slim.

I didn't mean to imply stimulants + antipsychotics are never OK, only that I think it's ill-advised for an ND to start and manage those medications. The kind of complications which would lead to that combination warrant a specialist in my opinion. I've seen extremely reckless prescribing, including flordily manic patients on sub-therapeutic mood stabilizers and high-dose stimulants from ND's (yes, multiple times). It's a huge problem. And yes, plenty of traditional physicians can make questionable choices too, but I view it as an additional problem when a person prescribes this far beyond their educational background.

 

[whopper]

Take a step back. Jansen pretty much wants anyone who can get Spravato out of the warehouse and into someone's nose. They'll let any doctor that can prescribe it do so and put their name on their referral website. That doesn't mean this doc is any good, and as I usually rant, plenty of doctors out there, especially psychiatrists don't know WTF they are doing.

 

[Duloxetini]

Why "especially psychiatrists" in there whopper?

 

[FatherPsychiatry]

Take a step back. Jansen pretty much wants anyone who can get Spravato out of the warehouse and into someone's nose. They'll let any doctor that can prescribe it do so and put their name on their referral website. That doesn't mean this doc is any good, and as I usually rant, plenty of doctors out there, especially psychiatrists don't know WTF they are doing.

If I got a dime for every Spravato ad and dinner invite I got, I’d have enough to pay out of pocket for Spravato

 

[Sushirolls]

I second this question, why "especially psychiatrists" whopper?

 

[Sushirolls]

Recently had a patient come in on FDA max of an SSRI, and an adjunct medicine too with it. Person just saw a ND in past few weeks and was told to come off the SSRI and replace with St John's Wort. Thankfully patient didn't and sought professional Psychiatric advice first.

Another day in the rodeo.

 

[Merovinge]

Recently had a patient come in on FDA max of an SSRI, and an adjunct medicine too with it. Person just saw a ND in past few weeks and was told to come off the SSRI and replace with St John's Wort. Thankfully patient didn't and sought professional Psychiatric advice first.

Another day in the rodeo.

I'm consistently told "natural" is better, particularly with all the legislation around marijuana lately. This is why I recommend patients ask for opium and cocaine for any ailment from their PCPs!

 

[calvnandhobbs68]

I'm consistently told "natural" is better, particularly with all the legislation around marijuana lately. This is why I recommend patients ask for opium and cocaine for any ailment from their PCPs!

Yeah next time they’re in status asthmaticus or DKA recommend they go the all natural route and let nature take its course.

 

[hallowmann]

Yeah next time they’re in status asthmaticus or DKA recommend they go the all natural route and let nature take its course.

Reading this, all I could think of was this video:

 

[Sushirolls]

Low dose naltrexone + morphine PRN in Fibromyalgia.