Psych

[eellen3]

Hi,

I just wanted to get your thought on psychiatry. It's something I'm interested in but I don't see too many people mention on here.

Thanks!

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[Just Joshin]

That's because this is the pre-med board. You want the psych board:

http://forums.studentdoctor.net/forumdisplay.php?f=44

 

[eellen3]

Isn't psych part of pre-med?
Don't you have to go to med school to become one?

 

[Visionaire]

Psychiatry is one of the many well-established disciplines of medicine. Yes, psychiatrists are physicians.

 

[Geekchick921]

Hi,

I just wanted to get your thought on psychiatry. It's something I'm interested in but I don't see too many people mention on here.

Thanks!

Psych... eh. I think Neurology would interest me more, but I personally want to deal with the other end of the body (Ob/Gyn).

I have to agree with my abnormal psychology professor (who is also a practicing therapist) on this one. When it comes to disorders, lots of psychiatrists like to just throw medications at problems that would be better treated with therapy, or a combination of the two. Granted, there are psychiatrists that have advanced degrees in psychology and actually treat with psychotherapy as well, and there are some disorders like schizophrenia where you need drugs to reorient the patient to reality enough to even start therapy, but it's a matter of just treating the symptoms and not the underlying problem.

Also, just to clarify:
Psychiatrist = MD or DO that has specialized in psychiatry, the treatment of mental illnesses. They can prescribe medications.
(Clinical) Psychologist = PhD or PsyD (usually) that is licensed to diagnose and treat mental illnesses with psychotherapy. They cannot prescribe medication.

 

[Just Joshin]

Isn't psych part of pre-med?
Don't you have to go to med school to become one?

Yes, but you're dealing with PRE-meds. We're not even in med school yet and most of us have no idea which field we're going into. Choosing a field is a LONGGGGG way away. Some of the people on this board are college freshman. Their main concern, at the moment, is acing the pre-requisites, studying for the MCAT, writing a personal statement, graduating college, and getting INTO a med school. Most aren't thinking that far ahead to what specialty they're going into.

That's why I directed you to the psych board. If you want to learn more about the specialty, that's where you should go.

 

[TRAMD]

Psych is a great field. Find out more about it in the psychiatry forum.

 

[pingouin]

I have to agree with my abnormal psychology professor (who is also a practicing therapist) on this one. When it comes to disorders, lots of psychiatrists like to just throw medications at problems that would be better treated with therapy, or a combination of the two. Granted, there are psychiatrists that have advanced degrees in psychology and actually treat with psychotherapy as well, and there are some disorders like schizophrenia where you need drugs to reorient the patient to reality enough to even start therapy, but it's a matter of just treating the symptoms and not the underlying problem.

Psychotherapy training is a mandatory part of psychiatry residencies. Most psychiatrists who have an advanced psychology degree probably had that first and then went to medical school.

Also, just to clarify:
Psychiatrist = MD or DO that has specialized in psychiatry, the treatment of mental illnesses. They can prescribe medications.
(Clinical) Psychologist = PhD or PsyD (usually) that is licensed to diagnose and treat mental illnesses with psychotherapy. They cannot prescribe medication.

True in most states. A few states (NM, LA) have passed laws allowing properly trained clinical psychologists prescription rights. Other states have pending legislation. The SDN psychology forum has lots more info on this. And in most states, licensed clinical social workers and licensed professional counselors are also qualified as independent practitioners who can do psychotherapy. Apparently ability to diagnose varies by state for the masters-level practitioners, but I'm able to do so as a LCSW in my state.

 

[Snake Doctor]

Are Psychiatrists usually psychology majors (during undergrad)?

 

[pingouin]

Are Psychiatrists usually psychology majors (during undergrad)?

not necessarily, although like any specialty I'm sure some are.

 

[Chuckwalla]

Once you start med school you have a clean slate in respect to what your major and past experiences were. You can go into any specialty you want to. You can be a biology major and go into psych, you can be an art history major and become a neurosurgeon.

 

[smq123]

I have to agree with my abnormal psychology professor (who is also a practicing therapist) on this one. When it comes to disorders, lots of psychiatrists like to just throw medications at problems that would be better treated with therapy, or a combination of the two. Granted, there are psychiatrists that have advanced degrees in psychology and actually treat with psychotherapy as well, and there are some disorders like schizophrenia where you need drugs to reorient the patient to reality enough to even start therapy, but it's a matter of just treating the symptoms and not the underlying problem.

This isn't an accurate picture of what psychiatrists do. Despite what your abnormal psych professor (who has no medical training) wants to tell you.

 

[pingouin]

This isn't an accurate picture of what psychiatrists do. Despite what your abnormal psych professor (who has no medical training) wants to tell you.

 

[Begaster]

I have to agree with my abnormal psychology professor (who is also a practicing therapist) on this one. When it comes to disorders, lots of psychiatrists like to just throw medications at problems that would be better treated with therapy, or a combination of the two.

Hah, I'd never take the word of clinical psychologists on this issue - they're generally just bitter that they can't prescribe.

 

[eellen3]

Yes, but you're dealing with PRE-meds. We're not even in med school yet and most of us have no idea which field we're going into. Choosing a field is a LONGGGGG way away. Some of the people on this board are college freshman. Their main concern, at the moment, is acing the pre-requisites, studying for the MCAT, writing a personal statement, graduating college, and getting INTO a med school. Most aren't thinking that far ahead to what specialty they're going into.

That's why I directed you to the psych board. If you want to learn more about the specialty, that's where you should go.

Well, thanks for your help. That was nice of you.

 

[Aspen D]

I think also, I would recommend exploring in medical school through the rotations offered in your clinical years. It is very difficult to make a decision so early on about your prospective field when there are so many sides of medicine you have yet to experience.

 

[Geekchick921]

This isn't an accurate picture of what psychiatrists do. Despite what your abnormal psych professor (who has no medical training) wants to tell you.

That would be why I qualified it with "a lot of" and not "most of" or "all". While it's true she has no medical training, she's still a doctor of Psychology and very knowledgable on the subject of treating mental illness, and the fact that she's not an MD or DO doesn't discredit her. That said, I will admit she seemed bitter about the entire situation, but I do not think it was just because she couldn't prescribe meds. It was that she'd seen many psychiatrists do so too readily, which I think is an opinion a lot of psychotherapists share. I've personally seen it happen to people I know (they were just written a prescription instead of/and not also being referred to a therapist), so I think we'll just have to agree to disagree here.

 

[Geekchick921]

Psychotherapy training is a mandatory part of psychiatry residencies. Most psychiatrists who have an advanced psychology degree probably had that first and then went to medical school.

I have seen that, and I wonder if there are psych residency programs that also offer a degree in psychology. I've seen some that offer masters in public health and other things, so I think there would be some out there. I think that would be a great idea, personally.

True in most states. A few states (NM, LA) have passed laws allowing properly trained clinical psychologists prescription rights. Other states have pending legislation. The SDN psychology forum has lots more info on this. And in most states, licensed clinical social workers and licensed professional counselors are also qualified as independent practitioners who can do psychotherapy. Apparently ability to diagnose varies by state for the masters-level practitioners, but I'm able to do so as a LCSW in my state.

Wow, I didn't know that was changing. Nifty. Thank you for the information.

 

[searun]

My favorite author, Dr. Richard Selzer, the great professor of surgery and writing at Yale (yes, surgery AND writing) referred to psychiatrists as the "nuns of the medical profession." Apparently surgeons do not have much respect for psychiatrists. I recommend "Confessions of a Knife" to all premeds.

 

[smq123]

That would be why I qualified it with "a lot of" and not "most of" or "all". While it's true she has no medical training, she's still a doctor of Psychology and very knowledgable on the subject of treating mental illness, and the fact that she's not an MD or DO doesn't discredit her. That said, I will admit she seemed bitter about the entire situation, but I do not think it was just because she couldn't prescribe meds. It was that she'd seen many psychiatrists do so too readily, which I think is an opinion a lot of psychotherapists share. I've personally seen it happen to people I know (they were just written a prescription instead of/and not also being referred to a therapist), so I think we'll just have to agree to disagree here.

The problem with psychotherapists who like to say what psychiatrists do "correctly or incorrectly" is that they've only studied one side of the picture. They've only studied the psychotherapy treatments - so, of course, they think that everything can be cured with psychotherapy. (Sort of like - if you're born with a hammer in your hand, everything starts to look like a nail to you.)

Psychiatrist have studied both the psychotherapy and pharmacological treatments of mental disorders. I think this is crucial because they can tell which treatment is better than others in a particular instance.

A lot of psychiatrists DO opt for drugs first. This is for a variety of reasons, that your abnormal psychology professor is NOT in a position to understand.
1) Many insurance carriers WILL pay for Prozac. But many insurance carriers do NOT pay for long term psychotherapy or talk therapy. Do you think that it would be responsible for a psychiatrist to insist that their patients get talk therapy, even if that patient couldn't afford it?

When you're faced with the option of offering your patient a sub-optimal treatment that they can afford, or offering your patient a better treatment that they can't pay for, what do you think a good physician should do?

2) Talk therapy is great, but it takes a lot of time and patient dedication. Sometimes drugs offer faster relief, but a good psychiatrist knows that it's not a long-term solution. But if prescribing a pill will make a person's life better, enough so that he/she doesn't commit suicide and can actually function normally, then I think that a pill is a perfectly reasonable option.

I think your professor is oversimplifying the picture way too much.

there are some disorders like schizophrenia where you need drugs to reorient the patient to reality enough to even start therapy, but it's a matter of just treating the symptoms and not the underlying problem.

Christ. Did your abnormal psych professor actually TEACH you guys that "psychotherapy" could "treat the underlying problem behind schizophrenia"? Because that's egregiously wrong. And it's irresponsible to teach something so incorrect.

Psychotherapy is not needed for schizophrenics. People don't have schizophrenia because they had bad childhoods, or they're repressing unhappy memories. No one knows what causes schizophrenia, but it doesn't have a psychological basis. That's like trying to use CBT to "cure" Lewy Body disease or Alzheimer's.

Good Lord.

My favorite author, Dr. Richard Selzer, the great professor of surgery and writing at Yale (yes, surgery AND writing) referred to psychiatrists as the "nuns of the medical profession." Apparently surgeons do not have much respect for psychiatrists. I recommend "Confessions of a Knife" to all premeds.

That's absolutely an understatement!

I would actually say that most surgeons don't have respect for most types of doctors...except other surgeons.

 

[MrBurns10]

Christ. Did your abnormal psych professor actually TEACH you guys that "psychotherapy" could "treat the underlying problem behind schizophrenia"? Because that's egregiously wrong. And it's irresponsible to teach something so incorrect.

Psychotherapy is not needed for schizophrenics. People don't have schizophrenia because they had bad childhoods, or they're repressing unhappy memories. No one knows what causes schizophrenia, but it doesn't have a psychological basis. That's like trying to use CBT to "cure" Lewy Body disease or Alzheimer's.

Completely agree with this. Psychotherapy is actually only recommended for a small population of individuals with mental illness. People with schizophrenia, bipolar, most anxiety disorders, etc. would NOT benefit from psychotherapy. Besides, schizophrenics will often have delusions regardless if they're taking meds or not...try sitting one down and discussing how their delusions aren't based in reality. It's damn near impossible.

 

[Geekchick921]

The problem with psychotherapists who like to say what psychiatrists do "correctly or incorrectly" is that they've only studied one side of the picture. They've only studied the psychotherapy treatments - so, of course, they think that everything can be cured with psychotherapy. (Sort of like - if you're born with a hammer in your hand, everything starts to look like a nail to you.)

Psychiatrist have studied both the psychotherapy and pharmacological treatments of mental disorders. I think this is crucial because they can tell which treatment is better than others in a particular instance.

True, but on the other hand, psychiatrists do not get nearly the amount of experience in methods of therapy as a PhD or PsyD gets. It's not very fair to say that psychiatrists are just as skilled in that area.

A lot of psychiatrists DO opt for drugs first. This is for a variety of reasons, that your abnormal psychology professor is NOT in a position to understand.
1) Many insurance carriers WILL pay for Prozac. But many insurance carriers do NOT pay for long term psychotherapy or talk therapy. Do you think that it would be responsible for a psychiatrist to insist that their patients get talk therapy, even if that patient couldn't afford it?

When you're faced with the option of offering your patient a sub-optimal treatment that they can afford, or offering your patient a better treatment that they can't pay for, what do you think a good physician should do?

I've got nothing to say to that, because it's true, but it's still a problem. I'm glad it looks like we agree that just throwing drugs at many mental problems is sub-optimal. However, this will lead to a discussion about all the adminstrative problems in US medicine, so I think we can just drop that here.

2) Talk therapy is great, but it takes a lot of time and patient dedication. Sometimes drugs offer faster relief, but a good psychiatrist knows that it's not a long-term solution. But if prescribing a pill will make a person's life better, enough so that he/she doesn't commit suicide and can actually function normally, then I think that a pill is a perfectly reasonable option.

I agree, and I think we can also agree that the ideal would be to supplement that with therapy. And I'm sure we've both heard of studies that say antidepressants can increase suicidal thoughts (but not actions, I know) in some people, especially younger people, and we both know they don't always work anyway. My little sister lost one of her best friends to suicide a few years ago, and we're pretty sure she was on antidepressants at the time.

Christ. Did your abnormal psych professor actually TEACH you guys that "psychotherapy" could "treat the underlying problem behind schizophrenia"? Because that's egregiously wrong. And it's irresponsible to teach something so incorrect.

Psychotherapy is not needed for schizophrenics. People don't have schizophrenia because they had bad childhoods, or they're repressing unhappy memories. No one knows what causes schizophrenia, but it doesn't have a psychotherapy basis. That's like trying to use CBT to "cure" Lewy Body disease or Alzheimer's.

Good Lord.

No, that's not what she taught. I actually still have the power points in my computer. In short, antipsychotics are necessary, but in some cases, where they are paired with certain forms of therapy (which, to be honest, is usually more to teach people to fuction with schizophrenia than to actually treat it) it can increase functionality and reduce the likelihood of rehospitalization. http://www.psychologyinfo.com/schizophrenia/cognitive.htm

Shall we end this conversation now? I think we both have valid points. To be honest, I have a lot of things I have to do today, and I like to argue too much to do any of them if this keeps going. I hope you have a good weekend.

 

[smq123]

And I'm sure we've both heard of studies that say antidepressants can increase suicidal thoughts (but not actions, I know) in some people, especially younger people, and we both know they don't always work anyway. My little sister lost one of her best friends to suicide a few years ago, and we're pretty sure she was on antidepressants at the time.

The theory behind this phenomenon is that many antidepressant clinical trials had study criteria that excluded openly suicidal people - it's not ethical to put suicidal people on experimental therapy, because you have to get them treated ASAP with a proven treatment. (It's like putting someone who is having an acute stroke on an "experimental" blood thinner. It's not ethical.) So the thinking is that a lot of people who signed up for these clinical trials lied and said that they were NOT depressed, in order to qualify for the study. Then, after they were in the study and the antidepressants started to work, the study participants would later admit that they did feel suicidal. So it skewed the results.

Unfortunately, many people who denigrate psychiatry don't think about this.

I've got nothing to say to that, because it's true, but it's still a problem. I'm glad it looks like we agree that just throwing drugs at many mental problems is sub-optimal. However, this will lead to a discussion about all the adminstrative problems in US medicine, so I think we can just drop that here.

I think that "just throwing drugs" at any problem (mental or otherwise) is sub-optimal. But what I was trying to say is that's not what psychiatrists do.

Dropping this discussion probably would be the mature thing to do. But it's unfortunate that many people have negative and damaging stereotypes about psychiatrists. I find it irritating that psychology professors are telling impressionable pre-meds (many of whom have had limited exposure to clinical psychiatry as it is practiced today) things that are a) only partially true or taken completely out of context, and b) put psychiatrists in an unfairly negative light. And it irritates me when people who don't have any basis for comparison like to pretend that they do - irritates me to the point that it's hard to stay quiet about it.

I have no intention of becoming a psychiatrist. But a lot of them do good work, and drugs have helped many people live with mental disorders. Psychotherapy would help some people, but far fewer people than we can help with drugs. And it's really a shame that people (not you, necessarily) seem so willing to believe that psychiatrists are lazily just prescribing drugs because they don't feel like doing "hard work" with psychotherapy, or that they're not capable of it.

 

[pingouin]

Addressing lots of issues..

1. Psychiatrists' training in psychotherapy is more than adequate, and many choose to incorporate that into their practice. A psychology degree (undergrad or grad) is not necessary. Many psychiatrists collaborate with therapists (doctoral- or masters-level) in their community to do the therapy end of treatment. The reasons are multi-fold: yes, part of it is an insurance reimbursement issue. However, due to the demand for psychiatric care, and the shortage of psychiatrists in many areas, it often just makes sense to refer out. Often therapists can see the patients more frequently than the doctor would be able to do, enabling the patient to access more care, rather than less.

2. "Throwing medications" at patients is a misperception about psychiatry. More accurate is to say that more than 70% of psychotropic medications in the US are prescribed by primary care physicians and their associated midlevel practitioners: pediatrics, family practice, OB/GYN, etc. There are many opportunities to educate these providers about referring to a mental health provider (therapist) first to see if CBT or another treatment modality may be helpful in addressing the issues at hand BEFORE going immediately to medication. On the other hand, if you're a pediatrician with an angry parent telling you that the school refuses to allow the child back until they're on medication (happens ALL THE TIME), then you don't have 6-8 weeks to wait and see if the child responds to a behavioral modification program...

3. Persons with schizophrenia and other serious mental disorders CAN respond to therapy if it's appropriate. I am not suggesting that these disorders themselves will be cured or the patient will become asymptomatic with therapy. However, there are often comorbid issues which compound these diagnoses which may be addressed. I'm thinking along the lines of a patient with schizophrenia who is stable on medication, and starts to have some depressive and/or anxious symptoms which start to emerge as she begins to recognize the devastating effect of her primary illness on her ability to live her life (ie, decreased cognitive functioning preventing her from achieving school/career-related goals). Similarly, the Alzheimer's patient who is still coherent enough to understand what this disease means and how it will progress.

4. Although conventional wisdom may hold that psychiatry is not respected, this is becoming outdated. Within hospitals, consult-liaison psychiatry is a well-entrenched part of the medical team. And they're incredibly well-respected when that surgeon's spouse, parent, or child (or surgeon him/herself) requires a psychiatrist.


To the OP:

Psychiatry's a great field, and there's a lot of exciting research going on right now. Definitely go read the psychiatry sub-forum on SDN to see what people are up to. And just keep your mind open as you get into medical school- you never know what's going to jump up and grab your interest.

 

[Quix]

Addressing lots of issues..

1. Psychiatrists' training in psychotherapy is more than adequate, and many choose to incorporate that into their practice. A psychology degree (undergrad or grad) is not necessary. Many psychiatrists collaborate with therapists (doctoral- or masters-level) in their community to do the therapy end of treatment. The reasons are multi-fold: yes, part of it is an insurance reimbursement issue. However, due to the demand for psychiatric care, and the shortage of psychiatrists in many areas, it often just makes sense to refer out. Often therapists can see the patients more frequently than the doctor would be able to do, enabling the patient to access more care, rather than less.

2. "Throwing medications" at patients is a misperception about psychiatry. More accurate is to say that more than 70% of psychotropic medications in the US are prescribed by primary care physicians and their associated midlevel practitioners: pediatrics, family practice, OB/GYN, etc. There are many opportunities to educate these providers about referring to a mental health provider (therapist) first to see if CBT or another treatment modality may be helpful in addressing the issues at hand BEFORE going immediately to medication. On the other hand, if you're a pediatrician with an angry parent telling you that the school refuses to allow the child back until they're on medication (happens ALL THE TIME), then you don't have 6-8 weeks to wait and see if the child responds to a behavioral modification program...

3. Persons with schizophrenia and other serious mental disorders CAN respond to therapy if it's appropriate. I am not suggesting that these disorders themselves will be cured or the patient will become asymptomatic with therapy. However, there are often comorbid issues which compound these diagnoses which may be addressed. I'm thinking along the lines of a patient with schizophrenia who is stable on medication, and starts to have some depressive and/or anxious symptoms which start to emerge as she begins to recognize the devastating effect of her primary illness on her ability to live her life (ie, decreased cognitive functioning preventing her from achieving school/career-related goals). Similarly, the Alzheimer's patient who is still coherent enough to understand what this disease means and how it will progress.

4. Although conventional wisdom may hold that psychiatry is not respected, this is becoming outdated. Within hospitals, consult-liaison psychiatry is a well-entrenched part of the medical team. And they're incredibly well-respected when that surgeon's spouse, parent, or child (or surgeon him/herself) requires a psychiatrist.


To the OP:

Psychiatry's a great field, and there's a lot of exciting research going on right now. Definitely go read the psychiatry sub-forum on SDN to see what people are up to. And just keep your mind open as you get into medical school- you never know what's going to jump up and grab your interest.

Listen to ping, for she speaks the truth.