psych np's taking over

[vistaril]

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So did you come into medschool knowing you were going into psych? Seems like if none of those things were atleast at some level interesting to you, what was it that motivated you to do medschool instead of PhD/etc?

well since none of those things were interesting to me, psych is a good field🙂

And no, I didn't know for sure coming into med school(like before starting) I was going to do psych.

My shelf scores on medicine, ob, surgery, etc were always pretty good. So I didn't totally blow those rotations off or anything. It's just not particularly relevant to day to day practice of what we do.

 

[Atom bum]

obviously, it's all a matter of degree....there is NO SINGLE FIELD where all of the material learned in school and training is relevant. That much is obvious. Likewise, I'm sure there are some jobs that aren't even on our radars in this discussion(occupational therapists to pick one example) where *some small* percentage of the training and education may be useful. The point is that internists and surgeons and obs and peds work in areas where the day to day practice makes more use of what is learned in med school than psychiatrists.....now we could argue about whether that % is 20% vs 80% or 40% vs 60%(we could throw numbers around all day), but the point is that it is all along a spectrum.

So your argument is, out of every single specialty derived from medical school training, psychiatrists use the least? Very well... It still doesn't matter. None of this matters.

I think I am going to specialize on something incredibly specific that uses even LESS knowledge than what you think psych uses.
Perhaps I will focus on nothing but the hamate.

You are a stubborn individual.

 

[JourneyAgent]

There needs to be medical doctors within the mental health team. The separation of psychopharm and medical problems overlapping with psychiatric illness is poor judgement. Could there be more efficient training...sure. Let's talk about it.
QUOTE]

another poor argument....there are medical problems overlapping with dental and podiatry issues as well. Probably moreso than in psychiatry.

Also, note that with a more efficient and ideal training model psychiatrists wouldn't neccessarily get less 'of the medical'. Ideally, they would get just as much or more that is relevant.

It's easy to start rhetorical fires here and there to distract and subvert.

It's much harder to convince the sincere of your sincerity when your engaging in spineless deceit like a worm tongued coward.

 

[vistaril]

So your argument is, out of every single specialty derived from medical school training, psychiatrists use the least? Very well... It still doesn't matter. None of this matters.
QUOTE]

sure...that is part of my argument. As to your 'it doesn't matter' comment, ummm, none of this 'matters'. That's the nature of a discussion board. People discuss things about the current state of their field, what could be done differently/better/worse/etc, what the future holds....that is sort of the concept of these boards. Disagreement is acceptable.

That said, if this same series of posts were started in a medicine or surgery forum, the overwhelming consensus would be 'well duh.....'

 

[vistaril]

It's easy to start rhetorical fires here and there to distract and subvert.

It's much harder to convince the sincere of your sincerity when your engaging in spineless deceit like a worm tongued coward.

lol...I haven't seen you try to defend one of your 'points' yet. otoh, I'm always happy to answer questions directly....for example earlier you or something else asks me who I was(with an expletive thrown in). I've been very clear who I am....I am a pgy-4 psychiatry resident in the northeast. Who are you?

 

[Atom bum]

So your argument is, out of every single specialty derived from medical school training, psychiatrists use the least? Very well... It still doesn't matter. None of this matters.
QUOTE]

sure...that is part of my argument. As to your 'it doesn't matter' comment, ummm, none of this 'matters'. That's the nature of a discussion board. People discuss things about the current state of their field, what could be done differently/better/worse/etc, what the future holds....that is sort of the concept of these boards. Disagreement is acceptable.

That said, if this same series of posts were started in a medicine or surgery forum, the overwhelming consensus would be 'well duh.....'

It doesn't matter because it isn't going to happen. At least not for a long time. We might as well be arguing the pros vs cons of glaciers.

That said, if this same series of posts were started in a medicine or surgery forum, the overwhelming consensus would be 'well duh.....

Prove it.

I'm sorry you are so jaded. I'm sure you will say that you are not jaded, but you certainly come off that way in my eyes.

 

[Armadillos]

It seems to me the main reason a physician needs knowledge of organ systems outside their specialty is to have a grasp of how medications they provide systemically will interact with a patients other medications and medical conditions. Given that psych currently does a huge amount of prescribing systemic medications with substantial side effect profiles, seems like psychiatrists would have plenty of reason to have knowledge of general physiology,pharmacology and pathophysiology. The fact that the disorders being treated seem less "medical" doesn't mean the chemicals being used to treat them are any less "medical".

 

[Atom bum]

It seems to me the main reason a physician needs knowledge of organ systems outside their specialty is to have a grasp of how medications they provide systemically will interact with a patients other medications and medical conditions. Given that psych currently does a huge amount of prescribing systemic medications with substantial side effect profiles, seems like psychiatrists would have plenty of reason to have knowledge of general physiology,pharmacology and pathophysiology. The fact that the disorders being treated seem less "medical" doesn't mean the chemicals being used to treat them are any less "medical".

Not to mention the push towards evidence based medicine will hopefully mean further research into primary causes of the stuff psychiatrists treat. So you know the symptoms of schizophrenia and can prescribe an antipsychotic, big whoop. With research we can find out why the symptoms are present in the first place and the knowledge we learn in medical school will be used to understand the disease process.

Or maybe not. Whatever happens, it's adapt or die just like every other career.

 

[vistaril]

It doesn't matter because it isn't going to happen. At least not for a long time. We might as well be arguing the pros vs cons of glaciers. .

No but what does happen is the constant shifting in the practice of certain fields, especially psychiatry(others to some degree as well). From the way it's practiced, to the way it's viewed.

Psychiatry practiced in 2012 looks different than the psychiatry practiced in 1990 which looks different than the psychiatry practiced in 1968........And psychiatry in 2034 is going to look different as well(probably the size of change more consistent with 1968 to 1990 than 1990 to 2012)......

and all these things(and how psychiatry will change) is very much related to our training, biological psychiatry vs non-biological psychiatry.

Another thing that is relevant(if a lot of the posters on here are any indication) is how we are viewed by others.....you would have to be living in an igloo to not know that current attitudes towards psychiatry(both in the medical community and especially amongst the professional non-medical community) are not going in a good direction right now. And I'm not talking about scientologists and stuff like that. I'm talking about marcia angell, the whitaker book, all the studies on antidepressants and efficacy, pediatric bipolar d/o, etc.....

Now I'm not a fortune teller....but it is pretty clear the times ahead are not going to be static for psychiatry going forward. There are going to be lots of changes.

 

[kindasorta]

Clearly med school doesn't teach proper use of the quote function. Reading this thread is giving me a migraine.

 

[vistaril]

It seems to me the main reason a physician needs knowledge of organ systems outside their specialty is to have a grasp of how medications they provide systemically will interact with a patients other medications and medical conditions. Given that psych currently does a huge amount of prescribing systemic medications with substantial side effect profiles, seems like psychiatrists would have plenty of reason to have knowledge of general physiology,pharmacology and pathophysiology. QUOTE]

not really....I don't have to have a tremendous foundation in endocrine or DM to know be able to know how to monitor atypical use and when not to prescribe them.

 

[vistaril]

Not to mention the push towards evidence based medicine will hopefully mean further research into primary causes of the stuff psychiatrists treat.

which brings up another critical issue.....for the last 25 years psychiatry has been promising medicine that 'oh, some biological mechanisms for Bipolar d/o and schizophrenia and depression are coming...really...I promise'......about 5-8 years ago medicine as a whole became pretty skeptical when they didn't come. Now, with that known biological foundation still nowhere in sight(and in many ways less promising and uncertain than ever), medicine is starting to believe they aren't ever going to come.....

 

[Armadillos]

No but what does happen is the constant shifting in the practice of certain fields, especially psychiatry(others to some degree as well). From the way it's practiced, to the way it's viewed.

Psychiatry practiced in 2012 looks different than the psychiatry practiced in 1990 which looks different than the psychiatry practiced in 1968........And psychiatry in 2034 is going to look different as well(probably the size of change more consistent with 1968 to 1990 than 1990 to 2012)......

and all these things(and how psychiatry will change) is very much related to our training, biological psychiatry vs non-biological psychiatry.

Another thing that is relevant(if a lot of the posters on here are any indication) is how we are viewed by others.....you would have to be living in an igloo to not know that current attitudes towards psychiatry(both in the medical community and especially amongst the professional non-medical community) are not going in a good direction right now. And I'm not talking about scientologists and stuff like that. I'm talking about marcia angell, the whitaker book, all the studies on antidepressants and efficacy, pediatric bipolar d/o, etc.....

Now I'm not a fortune teller....but it is pretty clear the times ahead are not going to be static for psychiatry going forward. There are going to be lots of changes.

This could be a regional thing, and also related to the fact that psych is particularly prominent at my medschool, but all the psychiatrists I talk to about the field have said there is dramatically less stigma against psychiatry (both from within medicine and the general population), than there was when they choose the field 10 or 20+ years ago. They said it used to be really, really bad.

 

[Atom bum]

which brings up another critical issue.....for the last 25 years psychiatry has been promising medicine that 'oh, some biological mechanisms for Bipolar d/o and schizophrenia and depression are coming...really...I promise'......about 5-8 years ago medicine as a whole became pretty skeptical when they didn't come. Now, with that known biological foundation still nowhere in sight(and in many ways less promising and uncertain than ever), medicine is starting to believe they aren't ever going to come.....

LOL. Seriously? You are just a barrel of laughs.

I guess medicine believes they will never come so they are going to stop utilizing psychiatrists? I guess physicians somehow forgot how research works? I suppose they don't teach that in med school so they just assume things should happen according to schedule?

Are you really this pessimistic in real life?

Fu*king Poe's law!

This could be a regional thing, and also related to the fact that psych is particularly prominent at my medschool, but all the psychiatrists I talk to about the field have said there is dramatically less stigma against psychiatry (both from within medicine and the general population), than there was when they choose the field 10 or 20+ years ago. They said it used to be really, really bad.

Calling it here. You will receive a very negative response about how all of the psychiatrists you are talking to are wrong.

 

[JourneyAgent]

lol...I haven't seen you try to defend one of your 'points' yet. otoh, I'm always happy to answer questions directly....for example earlier you or something else asks me who I was(with an expletive thrown in). I've been very clear who I am....I am a pgy-4 psychiatry resident in the northeast. Who are you?

I'm the vigilante who will haunt your posts until you loose credibility or until you prove to me you're real.

We can exchange personal information if you'd like. Or submit our information to a third party for verification. Perhaps the elegant host of this forum oldpsychdoc would oblige us.

If I'm wrong. And you're actually a resident in psychiatry. Then I will humbly apologize. Kiss your Internet feet and never come to this site again.

Trust me, I want to be wrong. I want to live in a world where interested students can come and get career guidance from all these lovely people. I want there to be no creepy anti-psychiatry people who for some reason can't stand that we're doing the best we can with what we have for a neglected patient population.

But I know they exist. And I cannot reconcile your points of view to somebody who has made the sacrifice to train in psychiatry. I can understand cynicism and disillusionment. I can see the need to fight for something better. But your modus operandi is something different. Or at least I'm convinced of the possibility. Which I'm willing to risk loosing access to this site to find out the truth of.

Take my challenge. Be a man. Be confident is shaming me as a fool for calling you a liar.

--third year medical student on the east coast.

 

[vistaril]

This could be a regional thing, and also related to the fact that psych is particularly prominent at my medschool, but all the psychiatrists I talk to about the field have said there is dramatically less stigma against psychiatry (both from within medicine and the general population), than there was when they choose the field 10 or 20+ years ago. They said it used to be really, really bad.

think about where we were in psychiatry 12-15-18-22 years ago....depending on what point along that spectrum you pick, things from a research standpoint and more importantly a psychopharm standpoint were *much* more promising. At the turn of the 90s you saw the introduction of ssris and hopes for them were high. Then wellbutrin came out. Then the more popular atypicals we all use, and these new antipsychotic drugs were supposed to be better.....oooops.

With these drugs came a lot of excitement and it was anticipated that a second pharm revolution was about to take place, but it never really materialized. Atypicals really arent more effective than typicals in treating what we really want to treat and have no answer for. All the new antidepressants, although there side effect profiles are a little better(depending) aren't clinically better for the most part.

And now....there are no promising drugs on the horizon.

At least before the first big psychopharm revolution(and to a lesser extent between the two), the role of the analyst was somewhat protected within the realm of psychiatry. That's obviously not the case anymore. So with the general failure of the second psychopharm revolution, where does that leave us going forward?

 

[vistaril]

Take my challenge. Be a man. Be confident is shaming me as a fool for calling you a liar.

--third year medical student on the east coast.

lol....I'm not particularly interested in such a thing.

If you were more advanced in your training than you were, it would be pretty easy to see I do work in psychiatry. I post fairly frequently on day to day matters that only someone who works in psychiatry would know and feel that comfortable talking about.

but honestly, apart from that, I'm just not real concerned about shaming you or proving anything to you.

 

[Armadillos]

think about where we were in psychiatry 12-15-18-22 years ago....depending on what point along that spectrum you pick, things from a research standpoint and more importantly a psychopharm standpoint were *much* more promising. At the turn of the 90s you saw the introduction of ssris and hopes for them were high. Then wellbutrin came out. Then the more popular atypicals we all use, and these new antipsychotic drugs were supposed to be better.....oooops.

With these drugs came a lot of excitement and it was anticipated that a second pharm revolution was about to take place, but it never really materialized. Atypicals really arent more effective than typicals in treating what we really want to treat and have no answer for. All the new antidepressants, although there side effect profiles are a little better(depending) aren't clinically better for the most part.

And now....there are no promising drugs on the horizon.

At least before the first big psychopharm revolution(and to a lesser extent between the two), the role of the analyst was somewhat protected within the realm of psychiatry. That's obviously not the case anymore. So with the general failure of the second psychopharm revolution, where does that leave us going forward?

Not sure how this really addressed my post at all, all those I have talked about the field with say there is dramatically less stigma now than when they chose the field. Very few physicians outside the field and essentially none of the general public is going to have any care or opinion about whats going on the world of psych research so this basically has zero impact on how the field is viewed by others. Also your obviously more informed than I am, but from reading a couple of your other posts I'm not inclined to believe things are as dire as you portray.

 

[vistaril]

Not sure how this really addressed my post at all, all those I have talked about the field with say there is dramatically less stigma now than when they chose the field. Very few physicians outside the field and essentially none of the general public is going to have any care or opinion about whats going on the world of psych research so this basically has zero impact on how the field is viewed by others. Also your obviously more informed than I am, but from reading a couple of your other posts I'm not inclined to believe things are as dire as you portray.

oh they aren't 'dire'.....I don't think I am implying such a thing. There is a big difference between having a somewhat pessimistic view and things being not ideal vs things being dire. I think psychiatry has some troubling issues going forward that I don't see easy fixes for. That doesn't mean the future is 'dire'.

That said, what is going on in the world of psych research, psychopharm, etc most definately does impact how the field is viewed by others because it directly leads to what we can do and how we can help(or fail to help) patients......

 

[JourneyAgent]

lol....I'm not particularly interested in such a thing.

If you were more advanced in your training than you were, it would be pretty easy to see I do work in psychiatry. I post fairly frequently on day to day matters that only someone who works in psychiatry would know and feel that comfortable talking about.

but honestly, apart from that, I'm just not real concerned about shaming you or proving anything to you.

If you are real. You're really strange. And I say that as someone comfortable with all manner of weirdness.

I couldn't eviscerate the potential for anything interesting about what I do with most of my waking hours and still do it.

It's not the details that are convincing. Anyone could learn shoptalk from reading here. It is, after attempting numerous times to interrogate your intentions the flippancy is what remains. The I'm just smarter than you thing.

If somebody had called me out like I did you after I worked so hard to be good at something I would be ready to fight them. But not you. You just want to continue your reptilian course. Smarter than everyone. Vile, humorless, and unmanly. The sort of company that makes the beer taste bad.

 

[billypilgrim37]

It's silly to question whether V is a psych resident or not. He is.

It is not silly to question other things he says, however.

 

[Atom bum]

With these drugs came a lot of excitement and it was anticipated that a second pharm revolution was about to take place, but it never really materialized. Atypicals really arent more effective than typicals in treating what we really want to treat and have no answer for. All the new antidepressants, although there side effect profiles are a little better(depending) aren't clinically better for the most part.

And now....there are no promising drugs on the horizon.

There are no new drugs on the horizon because there is no money in new drugs. Pharm companies stopped investing in psychopharm research because they have atypicals.

 

[Armadillos]

oh they aren't 'dire'.....I don't think I am implying such a thing. There is a big difference between having a somewhat pessimistic view and things being not ideal vs things being dire. I think psychiatry has some troubling issues going forward that I don't see easy fixes for. That doesn't mean the future is 'dire'.

That said, what is going on in the world of psych research, psychopharm, etc most definately does impact how the field is viewed by others because it directly leads to what we can do and how we can help(or fail to help) patients......

This is where I'm confused, your consistently laying out a grim picture, but then saying things aren't that bad.

Generally in your posts that I have seen you make it clear that psychotherapy is not the mainstay of psychiatry and that other fields are better positioned to do that.

From some of your other posts you have previously said things amounting to "the majority of psychiatric drugs basically don't work". Now your adding on that you believe there is no reason to expect any better psychiatric drugs will be available in the future.

You've also said that psychiatrists essentially have very little utility to offer people suffering from addictions.

You've said consult psychiatrist basically have no expertise an internist doesn't already have.

So if you believe all this stuff how would the outlook of psychiatry not be dire in your opinion?

 

[Atom bum]

This is where I'm confused, your consistently laying out a grim picture, but then saying things aren't that bad.

Generally in your posts that I have seen you make it clear that psychotherapy is not the mainstay of psychiatry and that other fields are better positioned to do that.

From some of your other posts you have previously said things amounting to "the majority of psychiatric drugs basically don't work". Now your adding on that you believe there is no reason to expect any better psychiatric drugs will be available in the future.

You've also said that psychiatrists essentially have very little utility to offer people suffering from addictions.

You've said consult psychiatrist basically have no expertise an internist doesn't already have.

So if you believe all this stuff how would the outlook of psychiatry not be dire in your opinion?

You know what is funny. I have thougt about going into several other specialties and every. single. one has had doomsayers just like vistaril.

FP: going to be taken over by NPs and PAs
Rads: Outsourced to india
Path: Computers will read slides better than any human, also, no jobs
Gas: Nurse Anesthetists
IM: Did you hear that mega computer Watson can take a history and come up with a better differential list than any human? Also Robot doctors

Also... OBAMACARE!!!!! is going to take all of our money and we will be forced to practice for chickens and moonshine!


Don't be a pessimist like vista. Things are going to be ok.

 

[vistaril]

There are no new drugs on the horizon because there is no money in new drugs. Pharm companies stopped investing in psychopharm research because they have atypicals.

this is nonsensical....of course there is money in new drugs. the amount of money which could be generated with an antidepressant that both works through a novel mechanism and has better efficacy is unlimited...literally into the tens of billions over time. Or an anxiolytic.

As your last comment('because they have atypicals'), this doesn't make any sense. There is research on glutamine right now(in both AD and antipsychotics)....it just isn't super promising. Atypicals aren't very good...why in the world would pharmaceutical companies say "well there is no market for better antipsychotics since Seroquel is so amazingly good"....do you know of a single community psychiatry provider who wouldn't love an antipsychotic that blunts the cognitive deficits in schizophrenia for example?

 

[vistaril]

This is where I'm confused, your consistently laying out a grim picture, but then saying things aren't that bad.

Generally in your posts that I have seen you make it clear that psychotherapy is not the mainstay of psychiatry and that other fields are better positioned to do that.

From some of your other posts you have previously said things amounting to "the majority of psychiatric drugs basically don't work". Now your adding on that you believe there is no reason to expect any better psychiatric drugs will be available in the future.

You've also said that psychiatrists essentially have very little utility to offer people suffering from addictions.

You've said consult psychiatrist basically have no expertise an internist doesn't already have.

So if you believe all this stuff how would the outlook of psychiatry not be dire in your opinion?

well I think I basically said most internists get little utility out of consulting psychiatry for delirium. Thats a lot different than what you wrote.

Also, the 'most psych drugs don't work' bit came with more explanation. That doesn't mean they have no use whatsoever, and it doesn't mean they can't work acutely in some situations. And there are plenty of examples where drugs do have some proven efficacy above placebo longterm(for ex Lithium in bipolar d/o).

The assessment and care of the smi population is always going to be there as well.

 

[vistaril]

If you are real. You're really strange. And I say that as someone comfortable with all manner of weirdness.

I couldn't eviscerate the potential for anything interesting about what I do with most of my waking hours and still do it.

It's not the details that are convincing. Anyone could learn shoptalk from reading here. It is, after attempting numerous times to interrogate your intentions the flippancy is what remains. The I'm just smarter than you thing.

If somebody had called me out like I did you after I worked so hard to be good at something I would be ready to fight them. But not you. You just want to continue your reptilian course. Smarter than everyone. Vile, humorless, and unmanly. The sort of company that makes the beer taste bad.

lol....you'll have to cite this post you supposedly 'called me out on' because it sure as heck didn't happen in this thread.

But again, the central disconnect on your part(and several others) is that just because there are problems and issues in a field doesn't mean it is being torn down. This forum in general is just very sensitive to any criticism of psychiatry or the future of the field.

 

[Atom bum]

this is nonsensical....of course there is money in new drugs. the amount of money which could be generated with an antidepressant that both works through a novel mechanism and has better efficacy is unlimited...literally into the tens of billions over time. Or an anxiolytic.

As your last comment('because they have atypicals'), this doesn't make any sense. There is research on glutamine right now(in both AD and antipsychotics)....it just isn't super promising. Atypicals aren't very good...why in the world would pharmaceutical companies say "well there is no market for better antipsychotics since Seroquel is so amazingly good"....do you know of a single community psychiatry provider who wouldn't love an antipsychotic that blunts the cognitive deficits in schizophrenia for example?

That isn't how drug research works. They spent billions developing atypicals and they didn't turn out as hoped so they aren't chomping at the bit to do it again. The side effect profile is "better" than the classic anti-psychotics, with the addition of "decreasing" the negative symptoms so they will just leave it at that.
Of course there are billions of potential dollars in an anti depressant, anxiolytic or antipsychotic. I could also make tens of billions of dollars with my new time machine, if only I could get the damn thing to travel back in time.

Pretty sure our only hope for novel drugs is through academic research. Maybe something existing like MDMA or a certain seratonergic agonist will prove useful based on academic research. Don't hold your breath for Pfizer to release anything soon. Maybe some new racemic derivative, but not anything novel.

 

[vistaril]

That isn't how drug research works. They spent billions developing atypicals and they didn't turn out as hoped so they aren't chomping at the bit to do it again. The side effect profile is "better" than the classic anti-psychotics, with the addition of "decreasing" the negative symptoms so they will just leave it at that.
Of course there are billions of potential dollars in an anti depressant, anxiolytic or antipsychotic. I could also make tens of billions of dollars with my new time machine, if only I could get the damn thing to travel back in time.

Pretty sure our only hope for novel drugs is through academic research. Maybe something existing like MDMA or a certain seratonergic agonist will prove useful based on academic research. Don't hold your breath for Pfizer to release anything soon. Maybe some new racemic derivative, but not anything novel.

I don't know if we are disagreeing as much as you think here....though atypicals actually turned out pretty good for pharm(they did make money off them).....

my point was if there were some low hanging fruit for pharm to go after and make good drugs, they would.....the fact that there isn't just speaks to the fact that there isn't.

 

[someguy321]

Vis: this isnt sarcastic... Do you wish you would of chose a different specialty? or a different profession? You make psychiatrists seem like momo's. just curious

 

[Atom bum]

I don't know if we are disagreeing as much as you think here....though atypicals actually turned out pretty good for pharm(they did make money off them).....

my point was if there were some low hanging fruit for pharm to go after and make good drugs, they would.....the fact that there isn't just speaks to the fact that there isn't.

They spent a lot of money and effort to get atypicals out, and they are only marginally better if anything. They could have saved the money and just made some sort of mixture of chlorpromazine and tossed in some mirtazapine to help with the negative symptom. This is especially true when you consider they didn't even get rid of fu*king tardives with the atypicals.
I don't claim to be some pharmacy insider, but I have talked at great length with a guy that owned a pharm research company about this. Seems the drug companies don't see much point in psych pharm at the moment.

 

[xlithiumx]

this is nonsensical....of course there is money in new drugs. the amount of money which could be generated with an antidepressant that both works through a novel mechanism and has better efficacy is unlimited...literally into the tens of billions over time. Or an anxiolytic.

As your last comment('because they have atypicals'), this doesn't make any sense. There is research on glutamine right now(in both AD and antipsychotics)....it just isn't super promising. Atypicals aren't very good...why in the world would pharmaceutical companies say "well there is no market for better antipsychotics since Seroquel is so amazingly good"....do you know of a single community psychiatry provider who wouldn't love an antipsychotic that blunts the cognitive deficits in schizophrenia for example?

On the topic of glutamATE, what do you think of the research on ketamine? It's a striking, if short lived, anti depressant effect. I am inclined to believe that glutamate may be a useful pharmacological target during our careers.

 

[Atom bum]

On the topic of glutamATE, what do you think of the research on ketamine? It's a striking, if short lived, anti depressant effect. I am inclined to believe that glutamate may be a useful pharmacological target during our careers.

I'm right there with you man. NDMA receptor drugs have amazing effects in the brain. I'm excited to see what academic research can do with them.

 

[vistaril]

On the topic of glutamATE, what do you think of the research on ketamine? It's a striking, if short lived, anti depressant effect. I am inclined to believe that glutamate may be a useful pharmacological target during our careers.

oh yeah I think there is going to be a lot of money poured into that over the next two decades....not sure what will come of it(not a researcher...obviously I cant even get the names right), but in talking to researchers thats where they are saying some recources may move towards

 

[vistaril]

They spent a lot of money and effort to get atypicals out, and they are only marginally better if anything.

yes, we know all this of course....but the only thing that matters from the perspective of the pharm companies is that they sold a hell of a lot of the drugs.

 

[vistaril]

You've got to admit, although it doesn't specifically say psychiatrists, this is a pretty good shout-out to the mental health field:

(source: Obama's facebook page just now)

no, that's not a 'good' shout out....

it is vague, meaningless, unenforcable, and contains more questions than answers.

 

[hamstergang]

not really....I don't have to have a tremendous foundation in endocrine or DM to know be able to know how to monitor atypical use and when not to prescribe them.

Maybe if you were a doctor that went to medical school you would these things.

Now, with that known biological foundation still nowhere in sight(and in many ways less promising and uncertain than ever), medicine is starting to believe they aren't ever going to come.....

You don't think we will ever work out the biological foundation of schizophrenia? Do you not believe that this foundation exists?

 

[splik]

You don't think we will ever work out the biological foundation of schizophrenia? Do you not believe that this foundation exists?

Given that 'schizophrenia' is a made up construct which not only eludes adequate definition, but whose definition has shifted considerably over time, it was pretty stupid to think that there would be a 'biological' foundation for it. if you talk to the geneticists in the field today, they will usually tell you that genetics explodes the myth that there is a biological foundation to schizophrenia, or that there is even a unitary schizophrenia with some unitary etiology. what you're looking at are lots of different diseases and non-diseases, all unhelpfully subsumed under the heading of 'schizophrenia'. The cause for some of these has already been described at the genetic level, but how that translates at the systems neuroscience level is still to be elucidated.

 

[kindasorta]

Given that 'schizophrenia' is a made up construct which not only eludes adequate definition, but whose definition has shifted considerably over time, it was pretty stupid to think that there would be a 'biological' foundation for it. if you talk to the geneticists in the field today, they will usually tell you that genetics explodes the myth that there is a biological foundation to schizophrenia, or that there is even a unitary schizophrenia with some unitary etiology. what you're looking at are lots of different diseases and non-diseases, all unhelpfully subsumed under the heading of 'schizophrenia'. The cause for some of these has already been described at the genetic level, but how that translates at the systems neuroscience level is still to be elucidated.

As an aspiring psychiatrist, should I just use my future board certification diploma as a foot mat for the taco truck I'll have to buy?

 

[vistaril]

Given that 'schizophrenia' is a made up construct which not only eludes adequate definition, but whose definition has shifted considerably over time, it was pretty stupid to think that there would be a 'biological' foundation for it. QUOTE

yep...which doesn't make us as psychiatrists look good.

 

[hamstergang]

The cause for some of these has already been described at the genetic level, but how that translates at the systems neuroscience level is still to be elucidated.

So you're saying there is a biological foundation?

I don't see how schizophrenia being a heterogeneous group of diseases makes the answer to my question "no, there is no biological foundation."

 

[hamstergang]

yep...which doesn't make us as psychiatrists look good.

How's that?

And how is it that you manage to screw up the simple act of quoting someone in what feels like more than half of your posts?

 

[vistaril]

How's that?

And how is it that you manage to screw up the simple act of quoting someone in what feels like more than half of your posts?

well, last i checked it was psychiatrists writing the dsm and not orthopods or whatever

 

[hamstergang]

well, last i checked it was psychiatrists writing the dsm and not orthopods or whatever

Go on...

 

[vistaril]

Go on...

schizophrenia as defined by the dsm is of limited usefulness, and since psychiatrists wrote that it doesn't make psychiatrists look good.

 

[kindasorta]

schizophrenia as defined by the dsm is of limited usefulness, and since psychiatrists wrote that it doesn't make psychiatrists look good.

Did you just pick this career because it was the path of least resistance and offered you an easy 6 figs, or is there some service to people you feel you are actually providing? I understand it either way, but if it's the latter, boy, you sure aren't revealing that hand.

 

[vistaril]

Did you just pick this career because it was the path of least resistance and offered you an easy 6 figs, or is there some service to people you feel you are actually providing? I understand it either way, but if it's the latter, boy, you sure aren't revealing that hand.

Im not sure how any of that is related to my statement on schizophrenia and the dsm(do you feel the dsm did a good job on that one?), but I'll answer anyways.....of course I am providing some service.

 

[kindasorta]

Im not sure how any of that is related to my statement on schizophrenia and the dsm(do you feel the dsm did a good job on that one?), but I'll answer anyways.....of course I am providing some service.

It's not related to that sole comment. No need to play coy. And it kinda sounds like you're building up for some big soliloquy on what "service" means in anticipation of my retort. I guess my question for you is which column do you think packs the heavier punch in the description of your career choice:

A) easy job
B) helping a sick person in need

Like I said before, I don't care what the answer is. I "get" both. But I think we all crave a bit of honesty. You're honest about everything else. I see no reason not to trust your answer to this question.

 

[hamstergang]

schizophrenia as defined by the dsm is of limited usefulness

That's not true, and that's not what splik said (and even if he intended it, it's not a necessary consequence of what he said). I'd say it's useful for helping us to discuss what it is we see in patients, deciding on treatment, and research.

 

[billypilgrim37]

Didn't you guys see Monsters Inc? Where Sully has to make the little kids scream in order to produce energy for Monster land?

Vistaril clearly fuels his super secret meth lab in Alabama with the gnashing of teeth of psychiatry residents and medical students.

This thread has become so disorganized that V and Grover are going to have to start passing out Adderall to all of us just to keep up.