PhD vs. MD

[Psyclops]

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I have met psychiatrists from other parts of the country though that see medications/ECT as their chief (only?) responsibility.

One day, late in the afternoon, when I was working as an admissions cousnelor in a standalone psychiatric facility with associated outpatient clinics, one of our psychiatrists came in as he often did to hang out for a second. He seemed a little edgier than usual, when I asked him what was up he said that the clinic and hsoptial had been billing him out for more hours than there were in the day. So, he was seeing so many patients, that even at 15 increments it added up to more than 24 hrs. He was concerned that they might catch on and do something about it.

 

[pingouin]

One day, late in the afternoon, when I was working as an admissions cousnelor in a standalone psychiatric facility with associated outpatient clinics, one of our psychiatrists came in as he often did to hang out for a second. He seemed a little edgier than usual, when I asked him what was up he said that the clinic and hsoptial had been billing him out for more hours than there were in the day. So, he was seeing so many patients, that even at 15 increments it added up to more than 24 hrs. He was concerned that they might catch on and do something about it.

YIKES!

 

[pschmom1]

Those of you who are so pro-medications for things like depression, anxiety, ADHD, etc. are single-handedly supporting big pharmaceutical companies that have no concern for the well-being of our society, other than to make a profit.

I would like to know if you have ever suffered from anxiety or depression? Or how about ADHD? Do you have ADHD? Do you have any idea what it is like to have ADHD? Do you have any competent understanding of ADHD or anxiety or depression? I'm sorry Mr/Mrs. Cruise, but a little treadmill action is NOT, NOT, and again NOT going to alleviate ADHD or serious cased of anxiety and depression! To tell someone with ADHD to just focus and retain info it is like telling a diabetic to just produce insulin! It's just asinine! I don't even know what your argument or any others stand for anymore! In one breath it's "psychologists should be able to prescribe meds", then "psychiatrists prescribe too many meds" then "psychiatrists should do more psychotherapy" then "psychiatrists don't have adequate training in psychotherapy" then "psychologists are trained better in psychotherapy" then "all psychiatrists want to do is prescribe meds" then "psychologists should be able to prescribe meds" then "therapy works better than meds" then "placebos have the same effect as psychotropics" then "psychotherapy works better than meds" then "psychologists should prescribe meds" then,,,, the list goes on!!! I mean, what is it? I'm really trying to understand the whole issue and argument, yet I find myself in a malicious circle! 🙄

 

[clinpsychgirl]

I would like to know if you have ever suffered from anxiety or depression? Or how about ADHD? Do you have ADHD? Do you have any idea what it is like to have ADHD? Do you have any competent understanding of ADHD or anxiety or depression? I'm sorry Mr/Mrs. Cruise, but a little treadmill action is NOT, NOT, and again NOT going to alleviate ADHD or serious cased of anxiety and depression! To tell someone with ADHD to just focus and retain info it is like telling a diabetic to just produce insulin! It's just asinine! I don't even know what your argument or any others stand for anymore! In one breath it's "psychologists should be able to prescribe meds", then "psychiatrists prescribe too many meds" then "psychiatrists should do more psychotherapy" then "psychiatrists don't have adequate training in psychotherapy" then "psychologists are trained better in psychotherapy" then "all psychiatrists want to do is prescribe meds" then "psychologists should be able to prescribe meds" then "therapy works better than meds" then "placebos have the same effect as psychotropics" then "psychotherapy works better than meds" then "psychologists should prescribe meds" then,,,, the list goes on!!! I mean, what is it? I'm really trying to understand the whole issue and argument, yet I find myself in a malicious circle! 🙄

Just to put some interesting (child-specific) findings out there:

With regards to ADHD, the MTA study (multimodal treatment of ADHD) found medication to be a superior treatment to behavioral therapy and the combinded med/behavioral treatment to have no statistically signifcant difference in treatment outcome then meds alone. Combined therapy would really be the treatment of choice- and even if you had to chose- meds appears to trump behavioral interventions, atleast in the context of this study.

While I don't recall the exact results of the multi-site/multi-modal study for depression (TADS), I believe the results were of a similar vein. There have been other studies lauding the efficacy of IPT and CBT for depression. Perhaps someone who is more familiar with this area can discuss this in greater detail.

For anxiety, a similar study is in the works (CAMS) and should be complete by 2007/2008. Note, there is an array of literature that notes the efficacy of CBT for anxiety, particularly with regards to the exposure component.

Other thoughts:

I think it is misinformed to infer that a psychologist should have had the mental disorder (ADHD) to understand and treat the disorder. If a clinician has a mental disorder, in most cases, it would be a hindrance to client treatment outcome. Also, I think this point has been made somewhere in the forum before, but medical doctors don't get the, "well have you ever had disease X..." An "expert" is one who has substantial clinical experience (not typically personal experience) and one who is empirically-informed in their given area- or better, on the forefront of research in their given area. This operationalization is no different in the field of psychology.

Also, I also think its important to note that symptom severity is just one factor to potentially effect treatment outcome. There are countless other barriers- comorbidity, low SES, etc... to be taken into account. These barriers are more likely to reduce treatment outcome than a pure mood or anxiety disorder with a high symptom severity.

 

[pschmom1]

I think it is misinformed to infer that a psychologist should have had the mental disorder (ADHD) to understand and treat the disorder. If a clinician has a mental disorder, in most cases, it would be a hindrance to client treatment outcome

I wasn't by any means suggesting that a psychologist should have a mental illness in order to understand and treat a disorder. Obviously that would be ridiculous. I was, however, directing that post to positivepsych who seems to believe that with a little exercise, symptoms of ADHD, depression, and anxiety are alleviated just the same or better than if they were to take meds. And how people are somewhat lazy and unmotivated b/c they choose to take meds. I am well aware that physical exercise helps one not only physically but mentally as well. But that is not the case for ADHD and for serious cases of depression and anxiety. Medications are very important and often a necessity in some cases. I'm sure that this is an agreeable statement considering psychologists are trying to get rx privileges. And a clinician with the mental disorder, ie ADHD, as you put it, would NOT be a hindrance to the client treatment outcome.

 

[clinpsychgirl]

I'm not saying that someone with ADHD cannot do the job. I recognize that there are many successful adults out there with ADHD who engage in a variety of professions, including clinical psychology. I, by no means, meant to offend you regarding that statement.

However, it should be noted that in the case of severe ADHD of the clinician (just like any other mental disorder) it could indeed be a hindrance to the therapy outcome, especially in instances where the clinician is not receiving treatment himself/herself. This is largely due to the attention to detail that is often required in practicing evidence-based psychotherapies such as CBT. These therapies require staying on task with a concrete agenda, careful planning, and case forumulation. As such, an attentional disorder could (sometimes, but not always) adversely effect the progress of the treatment.

I agree with you that medication can be a viable treatment option for the treatment of mental health disorders, especially in the case of ADHD. While I am going the clinical psych route myself, I personally tend to favor the idea of collaborating with a multidisciplinarian team (psychiatrists, psychologists, social workers, etc...) when such an opportunity is afforded. Thus, I'm happy work with a collaborating psychiatrist in making treatment recommendations. Moreover, I am happy to let the psychiatrist write the prescription, if needed, and I'll provide the behavioral intervention!

I wasn't by any means suggesting that a psychologist should have a mental illness in order to understand and treat a disorder. Obviously that would be ridiculous. I was, however, directing that post to positivepsych who seems to believe that with a little exercise, symptoms of ADHD, depression, and anxiety are alleviated just the same or better than if they were to take meds. And how people are somewhat lazy and unmotivated b/c they choose to take meds. I am well aware that physical exercise helps one not only physically but mentally as well. But that is not the case for ADHD and for serious cases of depression and anxiety. Medications are very important and often a necessity in some cases. I'm sure that this is an agreeable statement considering psychologists are trying to get rx privileges. And a clinician with the mental disorder, ie ADHD, as you put it, would NOT be a hindrance to the client treatment outcome.

 

[Psyclops]

I wasn't by any means suggesting that a psychologist should have a mental illness in order to understand and treat a disorder. Obviously that would be ridiculous. I was, however, directing that post to positivepsych who seems to believe that with a little exercise, symptoms of ADHD, depression, and anxiety are alleviated just the same or better than if they were to take meds. And how people are somewhat lazy and unmotivated b/c they choose to take meds.

With al due respect, PM, I think you are mischaracterizing PP's comments. She/he was reporting the results of a study. But to evaluate them we would need to know more info. In these depression clinical trials, SSRIs don't always show very impresive results. The fact that the same number responded to "excercise therapy" isn't that surprisng.

As to the motivation level of clients, you and she/he are talking about different groups. She/he seems to be lamenting the clients who are not interested in anything that takes any effort, only want a pill, don't want to work on the things that might apparently be causing the d/o etc. You are talking abou those who are so extreemly depressed that they would require medical intervention (I.e., meds or ECT) to even be able to proces thier issues.

Just my thoughts on the discussion.