Psychiatry threatened by Psychology?

[rotty1021]

I am interested in becoming a Psychiatrist, but have heard rumors that Psychiatrists will be obliterated by Psychologists. Is there any truth to this? I love Psychiatry, but certainly hope this is untrue. Any help would be appreciated.

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[md-student]

I don't know if I would say that "psychiatrists will be obliterated by psychologists." The nurse practitioners and physician assistants have not "obliterated" the GPs/FPs.

The issue at hand is what happened in New Mexico. As an attempt to provide some care for underserved areas, there was a push for psychologists to get the right to prescibes meds. They were successful this past summer. They must undergo additional training and need to be under the supervision of an MD/DO. With that said, it hasn't really changed much in New Mexico. The underserved are still.....well, underserved. I guess people were surprised that psychologists like to live and work in cities too.

Anyway, some people seem to shrug it off saying it isn't going to make a difference....that there are plenty of patients to go around....that people would prefer to go to a psychiatrist who has medical training. I've also been told that a lot of psychologist do not care to write meds. They prefer doing therapy and testing...the reason they went into psychology to begin with...not to mention not wanting to go through extra training (time and cost).

Currently there are many states pushing for the same laws that would allow psychologists to prescribe. But, at least from what I learned during interviews, in many of these states some psychiatrists are banding together to prevent this from happening. Who will win, it's hard to say. Guess we'll have to wait and see what happens in New Mexico. The fear that I hear is that psychologists will join a practice with a GP/FP. This way the generalists will not have to refer out for mental health.

Different people will give you different view points. But these are just some of the issues brought up to me. Anyway, I'm still doing psychiatry.

Good luck...

 

[medhopefully]

how could they ever allow psychologists to prescribe meds? They know nothing compared to psychiatrists who've spent ~10 years learning about brain and behaviour from a scientific standpoint, and psychologists are just PhDs in a pseudo-scientific field with practically no physiology awareness.

There is a huge difference between a damn psychologist who just takes your money for talk therapy (and knows nothing), compared to a psychiatrist who is an MEDICAL DOCTOR and moreover a SPECIALIST with 4-5 PGYs. There is a world of difference between the two (both in terms of knowledge and intelligence, since any ***** can stay in school and get their psychology PhD or the elusive "clinical" psychology PhD, but not everyone can be a MD).

 

[Sanman]

How closed minded and ignorant. And people wonder why doctors have a reputation for being full of themselves.

 

[Dmcpharmd2be]

Originally posted by Sanman
How closed minded and ignorant. And people wonder why doctors have a reputation for being full of themselves.

 

[cici]

Originally posted by Sanman
How closed minded and ignorant. And people wonder why doctors have a reputation for being full of themselves.

To medhopefully: You really don't know much about psychology do you? If you think it's easy to gain admission to, and graduate from, a clinical psychology PhD program, think again. Clinical psychology is one of the most competitive programs (some stats even show that it's even more difficult to get in than medical school -- THOUGH I DON'T NECESSARILY AGREE WITH IT BEING MORE DIFFICULT TO GET IN THAN MEDICINE EVEN THOUGH I'M A STUDENT IN A CLINICAL PSYCHOLOGY PROGRAM). If you think we don't know anything about the brain etc, or that psychology is a crappy "pseudo-science", you obvious don't know much about what we learn in our training, and what the scientific method is. Get a textbook on biopsychology / neuropsychology, or read a good experimental design book before you make such comments OK?

I doubt that you're a medical student right now, but don't forget we are considered part of the health care team. Hopefully you're not gonna bring this set of misconceptions and your ignorance to the ward when you realize there's something you need us to help you and wanna get a consultation. This will REALLY look bad on you.

Actually as a future clinical psychologist, I don't think we should be given the privilege to prescribe medication. I actually agree that we don't have the intensive training of physicians in terms of physiology and pharmacology, and I don't feel that just having several hundred of hours as extra training will make us competent. I'd rather stick to what we know best (and are trained best) e.g. assessment, therapy, working as a liaison between physicians and patients etc. So you see, some of us actually DO care about our competency and our ethical obligation to those we're serving .

 

[Big Lebowski]

Well said cici...

md-student provided a good elaboration on some of the arguments.

There are differences between the two professions. Some things I believe psychiatrists are better at and some things psychologists do better. Most psychology students/professionals I have met have no interest in prescribing meds. They tend to enjoy psychotherapy and testing....that's why they choose the Ph.D. route rather than an M.D. Both are essential to each other to optimize mental health....

 

[Dmcpharmd2be]

Originally posted by cici


To medhopefully: You really don't know much about psychology do you? If you think it's easy to gain admission to, and graduate from, a clinical psychology PhD program, think again. Clinical psychology is one of the most competitive programs (some stats even show that it's even more difficult to get in than medical school -- THOUGH I DON'T NECESSARILY AGREE WITH IT BEING MORE DIFFICULT TO GET IN THAN MEDICINE EVEN THOUGH I'M A STUDENT IN A CLINICAL PSYCHOLOGY PROGRAM). If you think we don't know anything about the brain etc, or that psychology is a crappy "pseudo-science", you obvious don't know much about what we learn in our training, and what the scientific method is. Get a textbook on biopsychology / neuropsychology, or read a good experimental design book before you make such comments OK?

I doubt that you're a medical student right now, but don't forget we are considered part of the health care team. Hopefully you're not gonna bring this set of misconceptions and your ignorance to the ward when you realize there's something you need us to help you and wanna get a consultation. This will REALLY look bad on you.

Actually as a future clinical psychologist, I don't think we should be given the privilege to prescribe medication. I actually agree that we don't have the intensive training of physicians in terms of physiology and pharmacology, and I don't feel that just having several hundred of hours as extra training will make us competent. I'd rather stick to what we know best (and are trained best) e.g. assessment, therapy, working as a liaison between physicians and patients etc. So you see, some of us actually DO care about our competency and our ethical obligation to those we're serving .

Absolutely brilliant. I doubt that medhopefully will provide you with a rebuttal. Very well spoken!

 

[medhopefully]

ah yes, i do love stirring up controvery on these forums...it gives people a chance to be passionate and pig-headed!

I would agree that a CLINICAL psychology degree is more competative (and most likely more difficult) to gain acceptance to than medicine, but that's not what i'm referring to (and I give them a tremendous amount of credit).

I'm MedIV, and I've seen quite a bit of shady things with NON-clinical psychologists doing the job of clinical psychologists. These individuals often get into trouble with the insurance companies, because they did they PhD with a non-clinical focus, are not registered as clinical PhDs, and just like to do psychotherapy because it's great money or because that's really what they want to do, but lack the training. I know too many people who did their psychology PhD on absolutely *****ic topics, which indeed were bordering on pseudo-science, even though they think they use the scientific method. I'll quote my neuropharmacology prof, saying "now we're bording on psychology, the silly language of perception."

While i do have a bias against much of psychology, I do agree that are indeed part of the healthcare system, and they provide a much needed service. Just stay away from prescribing.

"I didn't spend 6 years in EVIL medical school to be called MISTER!" - Dr. Evil

 

[CPTAUSRET]

rotty:

Don't mean to butt in here but my best buddy, Nancy Andreasen M.D., Ph.D would tell you that there is NO truth to that:

She would tell you to be the best psychiatrist you can be:

Nancy attended Oxford on a Fulbright, Masters at 17 or 18, was an asst prof at 22 (English Lit), taught for five years, and then attended Med school:

If you aren't familiar with the name, just do a google, or Net Ferret search for Nancy Andreasen:

Terry

 

[cici]

medhopefully: You gave contradicting statements in your posts. In your first post, you said,

Originally posted by medhopefully
There is a world of difference between the two (both in terms of knowledge and intelligence, since any ***** can stay in school and get their psychology PhD or the elusive "clinical" psychology PhD, but not everyone can be a MD).

In your second post, you said,

Originally posted by medhopefully
I would agree that a CLINICAL psychology degree is more competative (and most likely more difficult) to gain acceptance to than medicine, but that's not what i'm referring to (and I give them a tremendous amount of credit).....I've seen quite a bit of shady things with NON-clinical psychologists doing the job of clinical psychologists.

Mind clarifying them for our *****ic PhD audience?

In any case, please put the blame on where it's due. Do you know that only the title "psychologist" is regulated, but anyone can do psychotherapy? Some people, with no training in clinical psyc (or even psychology) at all, can still call themselves "psychotherapists" and do clinical work. It's not illegal as long as they don't call themselves "psychologists". We think it's very unfortunate because it's these guys who give us a bad name, but honestly it's not our fault that something like this could happen. Don't form your bias and make generalized comments to the entire field of psychology (which actually encompasses a lot of disciplines -- neuropsychopharmacology being one by the way) just based on the behaviors of some quacks whom we don't even consider to be a member of our community. What you're doing is similar to people making comments about physicians and the field of medicine as a whole based on their experiences with chiropractors......

 

[PublicHealth]

A 45-year-old black male who was recently released from prison--where he tried killing two men and hanging himself--was admitted to the ER after flagging down a police officer and politely asking him, "Could you please shoot me, officer?" After numerous attempts to subdue him, he was eventually drugged up until morning, when he was evaluated by an inpatient attending psychiatrist. A 10-minute "med check" produced no new leads regarding his condition, and simply frustrated the man to the point where he exclaimed: "What the f**k do you know about me!?" When asked about why he was so violent with the ER staff, he replied: "I don't want your pills, I just want to be heard."

This is a true story that suggests that there is indeed a need for psychotherapy. Clinical psychiatry, clinical psychology, and social work are mutually dependent enterprises. Instead of competing for "turf," all of these groups need to work together in the interest of public mental health. Further fragmentation of the behavioral healthcare system will not yield solutions for patients who suffer from mental illnesses.

We must work together, people.

PH

 

[medcat3]

Let's get one thing straight...Psychiatry is not just about "pill pushing" as many Psychologist would lead you to believe. Psychiatrists are in the unique position of providing help to patients with both psychopharmacology and psychotherapy. The gentleman in the case study would likely benefit from both.

As a future Psychiatrist I have chosen a program where I will get strong training in both. I start my residency in July.

Psychiatrists will continue to run this country's Psychiatric wards because I believe that they are better trained to deal with the acute medical and psychiatric issues that arise all the time. Interpreting EKGs (from TCA intoxication or simple side effect), recognizing medical conditions disguised as psychiatric conditions, knowing when to refer out, acute psychosis & schizophrenia, severe treatment refractory depression, and medication management are just a few reasons why Psychiatry will remain a viable medical field. I have spoken to many Psychology interns at my school and all say they have no desire to write prescriptions (that's why they went into Psychology and not Medical school in the first place). One psychologist that I know was overwhelmed after he realized that Pscyhiatric patients don't just come in on Psychiatric meds (as he thought) but a multitude of prescription and non prescription non-Psych meds. I believe that it takes a well trained physician to realize potential side effects between these meds. I think that some Psychologists operate under the notion that only learning the psych meds will suffice. That is certainly not the case.

The New Mexico incident was a bit misleading because the government wanted to extend psychiatric care to the states underserved. While this is an admirable idea, granting psychologist prescription rights to solve this shortage is not. Studies have shown that psychologists are acutally less likely to work with underserved populations simply because the patients can't pay and reimbursements are so low for psychotherapy. The bottom line in New Mexico is that hiring psychologists to work with the underserved is a lot cheaper than hiring physicians. To make matters worse the New Mexico Psychologists would actually have to train under a Psychiatrist for a year and then get their prescriptions co-signed by the Psychiatrist as well. Hmmmmmm. A while back, the U.S. military tried to hire psychologist and the experiment wasn't too successful (to say the least).

Please, do not take my aforementioned statements as being 'anti-psychologist' because they are not. I have seen patients with mild-moderate depression and anxiety disorders do EXTREMELY well with psychologists and psychotherapy. Also, the amount and quality of psychotherapeutic training that some psychologists get is amazing!

Studies have repeatedly shown that a majority of patients get better with a combination of medications and therapy and I believe that psychiatrists are in the ideal position to deal with such cases. There has always been a way for Psychologists to prescribe medications: MEDICAL SCHOOL.

 

[El Duderino]

"What the f**k do you know about me!?" When asked about why he was so violent with the ER staff, he replied: "I don't want your pills, I just want to be heard."

This is a true story that suggests that there is indeed a need for psychotherapy.

Well, technically, it only suggests that there is someone out there who wants to be heard.

Pharmacological treatment does not preclude meaningful conversation.

 

[medcat3]

Well put Duderino I agree completely. It's not an 'either or' issue. Patients can and frequently DO receive BOTH Psychopharm AND Psychotherapeutic help from their Psychiatrist.

 

[PublicHealth]

Well put Duderino, but medcat 3, DOES THIS HAPPEN IN TODAY'S FRAGMENTED BEHAVIORAL HEALTHCARE SYSTEM? I completely agree with you that it's not an "either or" issue, but find the lack of integrated services to be a major problem in contemporary psychiatry. See J. Allan Hobson's "Out of Its Mind: Psychiatry in Crisis" for an extended review of what I'm talking about.

 

[medcat3]

I've read the book that you mentioned. It was interesting to say the least. I think that Psychopharm/Psychothearpy happends alot more frequently than many believe. I've worked with many Psychiatrists and I can honestly say that ALL have no problem doing both Pharm/Therapy with their patients if they think that a combination will benefit them. Many of the Psychiatrists that I have worked with are either in the University/Academic setting or in Private practice. I believe that these Psychiatrists are more apt to use both psychopharm and psychotherapy. I have seen very little Psychotherapy used in Acute Care/Crisis/Interventional Psychiatry,Consult Psych, and The Wards (besides group therapy). Truthfully, I have never worked with a Psychiatrist that only does med management...although I'm sure they exist.

When I was applying to different residencies, current residents would tell me about certain programs being only Psychopharm based with absolutely NO instruction in psychotherapy. That to me is a tragedy. Even if you don't think that you will do psychotherapy in your practce I think that you owe it to yourself to at least get some background in it. Just my 2 cents.

 

[PublicHealth]

Great post, medcat3. I guess the type of behavioral healthcare you receive depends largely on where you are, and who is treating you. Many "old-school" psychiatrists have abandoned modern psychiatry after witnessing a psychopharmacologic tide sweep over psychotherapy during the past few decades. (http://hem.fyristorg.com/mosher/resig.pdf). Yet others, including myself and many others who navigate this forum, wholeheartedly desire to pursue a career in this exciting area.

Hopefully the future will see more of an intermixing between psychopharmacology and psychotherapy, which will hopefully make way for better psychiatric care and patient outcomes.

Cheers,

PH

 

[CJLaw]

As a mental health professional, I see no difference in the diagnostic abilities of psychologists v. psychiatrists. Now when it comes to medications, i believe that it takes more than a few seminars to qualify someone for the power of prescription.

 

[Allred]

just erased a long post so this one will be short.

I am a psychologist, Ph. D in California.

I do assessments at about $1500 per report.

All. yes that's right all residents, are opting for PsychPharm, not TX.
See USC. They will not do Tx because no one has trained them
them.
Don't be afraid of any psychologist taking $ from you. I had no office, was on staff of 9 hospitals and now am retired.

In La for a 30 min med check the MD receives 44 bucks from Medicare.

Medicare will pay psychologists for tx or assassment.
Compare $ 1500 to 44 dollars. See why we are happy.

In my first post I listed the Brain Illnesses that respond to either meds or tx. I would be glad to answer any question. I am not arrogrant, just PO'ed that a lot of work could not be posted.

My best to you. A. www.sads.org


Your real threat is coming from Fam Practice and GP's. They give out SSRI's like peanuts.

 

[MacGyver]

Originally posted by md-student
The nurse practitioners and physician assistants have not "obliterated" the GPs/FPs.

well, honestly you have to admit that NP/PA scope is constantly expanding every year. You are right that as of RIGHT NOW, they have not obliterated FPs, but in 20 years who can say? PAs are already doing close to 90% of what FPs do in rural areas with almost no supervision (chart review once per month at the most, with no MD on site).

If the PA scope continues to widen and increase at the same rate as it has over the past 10 years, then in 20 years FPs will be obsolete and totally replicable by a PA.

With that said, it hasn't really changed much in New Mexico. The underserved are still.....well, underserved. I guess people were surprised that psychologists like to live and work in cities too.

True, but the disturbing thing is that the law wont be changed. Once you expand scope, it almost NEVER gets taken away, regardless of whether or not it achieved its stated purpose.

Thats the real problem here. There has never been any state law to reverse the expansion of scope of practice of a non-doctor provider. Once you grant them access, the genie is out of the bottle so to speak. So psychologists win in New Mexico, because the state obviously doesnt care if they practice in rural areas or not. They will not revoke the expanded practice scope and the psychologists know this.

Anyway, some people seem to shrug it off saying it isn't going to make a difference....that there are plenty of patients to go around....that people would prefer to go to a psychiatrist who has medical training. I've also been told that a lot of psychologist do not care to write meds. They prefer doing therapy and testing...the reason they went into psychology to begin with...not to mention not wanting to go through extra training (time and cost).

Thats shortsighted. Yes its true that RIGHT NOW there are probably enough patients to go around and it doesnt really matter that much. But what about 10 years from now? What about 20 years from now? Who knows what the healthcare environment will be like by then. By expanding psychologists' scope, you make it an irreversible change in delivery that will most likely never be revoked.

Its naive to assume that the healthcare market will look exactly the same 20 years from now as it does right now. Its very conceivable that if the certain federal/state laws were changed and/or new healthcare plans get introduced that you would have direct competition between psychologists and psychiatrists for patients.

For far too long, doctors have allowed expanded scopes of other providers with the naive and selfish attitude that it wont affect them in their lifetime, so you might as well allow it. For example, anesthesiologists were greedy and shortsighted in their allowing CRNAs to invade their scope of practice and in future anesthesiologists will pay for their sins.

Guess we'll have to wait and see what happens in New Mexico

Thats the whole problem though. New Mexico is a genie out of the bottle situation. Once psychologists have their expanded scope, its not going to be taken away. Its pretty much permanent. Thats why docs need to be more proactive BEFORE this crap gets written into state law, because once it goes that far, theres no going back

 

[Allred]

There is so much misinformation here. It's late so this is short.

Psychiatry is dying.

I have been a psychologist for 30 years who made friends with maybe 100 psych MD's

I had no interest in meds.

Psych meds are now given by GP's and FP MDs. They are safe, often unnecessary and have about 3% gain, SSRIs over placebo.

Psychiatry residents chose psych pharm over psychotherapy at a high rate. I can't find any MD Psychiatrists that do both meds and psychtx. in La. I need one.

The squeeze now is from:

1. GP and FP MD's They birth babies, do surgery and hand out Paxil

2. Medicare with their 50% discount. See a pt for 30 minutes, 99214 and Medicare will pay 43.44 bucks. Again you bill Medicare $100 for a 30 minute med session and they pay you 43 bucks.

3.Managed care--forget about that

4. Psychologists. They are in training all over the USA. I get stuff wanting to know if I want to get into a med registry.

To those who feel the new psych meds represent a challenge--see the GP and FP statement.

The tricyclics were dangerious as hell. Taking Paxil, Zolif, Prozax etc are a no brainor.

A psychiatrist is important in treating Schizophrenia M_D illness and other Organic states-- i will put a post on that one.

Please don't all go into psychpharm. Try both psychotherapy and meds.

The next generation of meds looks even less of a challenge. The challenge is not in giving meds but not giving them.

I had a good career. I admire the early psychiatrists and they needed someone to trust. It is a lonely profession.
A.

 

[El Duderino]

1. GP and FP MD's They birth babies, do surgery and hand out Paxil

Er... So logically, OB/GYN and surgery are also dying specialties?

While it is true that other physicians than psychiatrists prescribe psychopharmaca, this holds true for every other specialty as well. The only reason FPs are doing more psychiatric prescribing now than 20 years ago is that there is safe, effective treatment, which has led to an increase in the number of patients taking it.

2. Medicare with their 50% discount. See a pt for 30 minutes, 99214 and Medicare will pay 43.44 bucks. Again you bill Medicare $100 for a 30 minute med session and they pay you 43 bucks.

By no means am I an expert in reimbursement rates, but I imagine they are somewhat flexible (see Medicaid vis-a-vis OB/GYN for an example).

3.Managed care--forget about that

For a moment, think about why. Then ask yourself if more effective treatments and scientific progress will change things.

4. Psychologists. They are in training all over the USA.

Good for them, they are needed. Let's just hope the future generation has a better grasp on their role.

Taking Paxil, Zolif, Prozax etc are a no brainor

Nuff said...

 

[Allred]

Before you cut and paste, learn your medicare codes. Also,
why does Medicare cut mental health workers 50% on bill?--even MDs.

Psychologists first gained the right to be on hospital staffs. A state law.

Psychologists then gained right to co- Admit with any MD--really pissing off psychiatrists. This came about because the med staff has had it with psychiatrists, see New Mexico. GP refers a pt to a psychiatrist and that is the last time the GP sees that pt.

At my main hospital, there were about 25 psychiatrists--one half from foreign schools Mostly American. I admit that the foreign MD trained in their home School were tops. Most dress like clowns and showed disrespect to the other staff. Thus the full medical staff threw in the towel allowed for co-admit so they could follow their pts medically.

I am no threat, as I am retired. A smart psychologist can get the psychiatrist mad as hell, blowing up all that narcisism.

Show respect for youself by not quoting or pasting as I can read what I wrote.

Oh, as to your OB question. Don't know much about that one. Where I live the birth rate is almost zero. I have a question to all, what is it about Family Practice that makes the students think they can do anything. I have talked to residents and that appears to be the case. The OB MD have left this area long ago.
Have a good one.

 

[Allred]

Forget to say , we are told that Seroquel will be the first neuroleptic to go over the counter. This is a newer antipsychotic that has a wide range of benefits.

Be glad to expand what "dress like a clown" means.

BTW, I have seen the Federal guidlines to train Psychologists and they are long and hard as hell. I never had any interest in medicine.

Psychologists have 5 or so years training in psychotx.

Newer psychiartists have none. If the Ph.D er's gain med rights, it will be helpful for the community.

There is a need for MD's in this field. ECT, Schizophrenia, Manic Depressive illness, etc

I think you all know Kay Jamison. She founded the Affective disorders program at UCLA, now is at Johns Hopkins and is a Psychologist. THe Quiet Mind--really good book.

 

[hurt]

Allred,

Who pays you $1500 for a psych assessment, which type of assessment are you referring to, which Medicare code to you use to bill for this assessment?
Most of the psychologist in California that I know, make about $65k per year and do not get paid $1500 per assessment or even in the ballpark.

 

[Allred]

Hurt. Thank you for the question

If I do a court evaluation, or a referral from a lawyer, that's how. I also get 500 per am and 500 per pm, low figures for depositions.

Neuropsychological assessments are a flat 1500.

Ur question on Medicare I have answered. One can use the Psych Tx codes ie 90801 or as the MD's use 99214 which is an 30 min med evaluation.

I would recommend to all to call Medicare, toll free, and they will send to you the schedule in your area.

Los Angeles has 18 Medicare areas. One MD I know opened a POBox in the highest paying area where he received his checks. Medicare is smart, never cross their path, and he was convicted of fraud and moved out of state.

School Psychologists, those with a MS degree get 80+K in this area.

My post is not about money. Before chosing any field, check with Medicare re payment. Those guys, for unknown reasons, pay only 50% on what you are entitled. Other MD's get 80%.

Psych meds are now simple, non lethal--not like the damn tricyclics

Aspirin is more trouble than Paxil.

Do you think that a Ph.D should by fiat make less than a MD? I view them as seperate but equal. I would like to share why psychiatry has found it's in disfavor with the general public and other MDs. Thus opening up this issue of meds.

Any more? Have a good one.

 

[Allred]

Positive Post.

Go to an American school. I saw the saddness of those who didn't know what they were doing."Is it an anxiety disorder or a depression?

Take a dual residency or speciality in both Psychopharm and Psychotherapy. Research says both have better utility than one alone.

Get some court experience and workers comp--if you can stand it.

Work in a clinic, at first. When you leave, the clients will follow.

If you are effective at your job, you will be happy and help many.

Don't worry about any psychologist. We like our job and 80% or more do not want to give meds. The rest may need them.

Get to know the General medical staff. They are your referral base. Cross them and you cut that supply.

Have fun. Man is that he might have joy.

 

[Big Lebowski]

Newer psychiartists have none (psycho-tx training).

I do not agree with this statement. Though most are not adequately trained...all psychiatry residency programs I am familiar with offer some therapy training. Some programs actually do an excellent job (ie. Duke, Cincinnati, Wisconsin) in training their psychiatrists to be good psychotherapists.

Psych meds are now simple, non lethal--not like the damn tricyclics

This is an oversimplification. I agree that SSRIs are simple, but would not imply that all psych meds (except tricyclics) are simple and non-lethal. There are plenty dangerous meds out there including mood stabilizers (ie. lithium, Depakote) and anti-psychotics (ie. Clozaril) that can have very dangerous (and lethal) side effects. Why do you think patients' taking Clozaril need frequent blood work? Anyone hear of agranulocytosis??? And let's not forget the sedatives (lorazepam, alprazolam, etc.) that many GPs/FPs are uncomfortable prescribing...I wouldn't necessarily call these "simple" meds.

 

[Allred]

Well I agree. Not as vocal.

I know LA, only. Check out UCLA faculity and see the speciality of each professor. Except for Parke Dietz--it all meds. USC has a 100 % psych pham speciality now.

Xanax and it's friends are real stupid meds, never given by psychiatrists but by GPer's Expept for Klonopin they produce one hellva of addiction and Boomerang.

Clozaril will be replaced and LI is safe. Unless one wants to OD.

Ur post shows the arrogarance that has put psychiatry in the corner. One doc here signs about 50 blank 5150's so he can stay home.

The public will not stand for this kind of slight of hand anymore.

Your post is simplistic as is mine. With all that anger, you might have trouble.

 

[Allred]

I was not hear to talk meds but to talk about the thread.

Clozril--the big hope of ther decade. A big flop. I had a pt male , 35, with minor delusions , who slept in his cloths and drank 5 liters of Coke a day. He changed smoked but appeared happy.

I asked the MD to do Clozril, he was indifferent. The man went on C. "woke up" no delusions, except all his behavior remanded the same. He had real life concers, job, wife, He became so anxious , he was hospitalized and the old meds were started.

The major problem with Clozril, if you use it, is the pts can't be trusted to follow directions. They say C. is given in the UK to higher functioning pts. Here I see it given to those most ill and they become confused as to blood level and appointment times. A possible dangerous situation. Resper, Zyprax. are the choice.

I hoped to point that to those who don't have training in psychotherapy or don't want such training, consider having a LCSW or MFCT or Psychologist in your office. Refer your Borderline pts to them and let them get the 4am telephone calls. You can rent office space.

Real training in psychotherapy takes many years. Our training might be as long as 6 years with personnal tx.

Good luck. I have left as this is for the future MD's and I don't argue.

 

[Clip]

I'm planning to become a psychiatrist and I'm not that worried about GP/FM taking over the field. It is great that there are relatively benign meds like the SSRIs that are effective for many people. There will still be plenty of opportunities for me to treat patients who have depressive symptoms resistant to single drug therapy and will need some one with more experience in psych meds to come up with a cocktail of meds that will work for them.

The reason I am opposed to psychologists having prescription privileges is that I think it is malpractice to look at the patient's mental illness as being separate from other physical diseases that they might have. It is important to have the training in physiology to understand how a patient's diabetes or other chronic problems will be affected by their medications. To me it just wouldn't be sufficient to have a list of contraindicated meds -- you should have the background necessary to understand the basic principles of why certain meds shouldn't be taken together.

On the other hand, as a psychiatrist I doubt that I will do much psychological testing as I would not have the training to perform these assessments competently.

 

[Big Lebowski]

Originally posted by Allred
With all that anger, you might have trouble.

Sorry if you misunderstood my post. I am not angry, nor did I come to argue with you. You expressed your opinions about psychotherapy and meds, and I mine. I appreciate the input, especially from a non-MD/DO since most people on this forum are MDs/DOs or soon-to-be MD/DO. Outside opinions are always welcome.

It is difficult to go into extreme detail...therefore people are going to disagree with some of your comments as they are a bit simplistic...but I will not deny that mine are as well. The goal to hope for is collectively, based on all posts, people seeking answers can come away with some information provided by everyone who posts here. Please continue to share your comments, as they are appreciated...

 

[Allred]

Thank You Big Man. Ok I'll visit but I am a visitor.

The future rests with the young bucks.

I am trying to bridge the gap between psychology and medicine.

Remember what Freud said.

Hope to learn about you

A.

 

[Allred]

There has been a request not to ban me.

Question. The laws of parsimony:

Big L. has pointed to the tough or more serious psych meds.

Question: say 80% of psych pts suffer an affective disorder. Should a MD GP prescribe medicine to them.

You should know 80% of anxiety disorders are secondary to Depression. If a pt goes to her GP and gets Celexia for "anxiety" as she says, what is wrong with this statement?

The GP knows she is depressed, gives her meds for depression and tells her the anxiety will go away. Strong plecebo effect here.

This is going on now --all over LA.

A lot of disinformation here, also. GP never told her her dx. Celexia is given for depression. She gets better and life goes on.

How is that any worse than having a good psychologist prescribe?
Are you all brothers? No.

Big L. or anyone , take a shot.

 

[hurt]

Allred,

Salaries for ALL psychologists employed by Los Angeles County top out at $79,800. Psychiatrist are paid $150,000 +. Why is that?
Do you believe that psychiatrists that perform forensic work are paid less than psychologists? Do you feel that the testimony of a psychologist is superior to a psychiatrist?

Additionally, anxiety can be secondary to many other physical conditions. Do you know the differential diagonosis for anxiety? Can you order the lab tests to confirm your findings? What is the pathophysiology for hyperthyroidism?

There are plenty of psychiatry programs that train students in psychotherapy and psychopharm. The real strength that I see with psychologists is psychological testing.

 

[Allred]

Hurt a lot there. La County is broke. Calif. state is flat broke.

School Districts are stiil well off due to the clause that they get first money in the State General Fund.

Iwould never work for anyone. I had a sole practice for 30 years. Those that can do, those who can't work for the county.My speciality was Neuropsychological Assessment and workers comp when wthat was alive.

When I began a company like Disney had 1/3 million insurance on their workers. Many were tapped out by physicians. One pt who had this type of policy, I was asked to assess and had an IQ of 78. Her MD DX was Psychoysis NOS. Hah hah

To your other question. Yes I know how to dx Anxiety but could you comment on my last post. It presents several problems.

a bit confusing , both psychologists and psychiatrist go to court. MD's made more money Most don't like this kind of work. You must have a strong ego.

No I do not feel a psychologist has superior talent in court, but they bring surplus value information if they bring in testing. The juries like to see stuff, they are tired of all the talking. I would never gone against Jolly West went was alive nor Parke Dietz. I can hold my own against the average psychiatrist. Some are good some stink--same as my profession.

You have not read my post, It is limited to UCLA and USC only.Which supplies the majority of psychiatrists in LA, with the foreign MD's

As I noted, training in psychotherapy takes many years ,6 on the
average. I have always been solo but invited to offices with psychiatrists. I work closely with other mD's.

I tested more than 20,000 clients. And can remember a few. I got a referral from a neurologist, the pt had many diffuse psych complaints. His MMPI was normal. I talked to the neurologist and his dx then became Huntingtons--sad but true. The man produced a clean MMPI, rarely seen. Oh I used to test police candidates and also take referrals from those who failed the examination.

1st generstions beside freud, Jung Adler Fromm Druckers.
2nd generation added much to the study of Borderline pd.

Ifyou become a psychiartist, are going to do you own H &P's? Psychiatrists don't. They call in a collague to do that--just like the psychologist would

Hurt Please comment on my post above on SSRI and GP's TNX

I agree with your last statment. If I wanted to be a MD, I would have gone to Mexico. The young psychologists scare me a bit. They have no training in psych testing. Here another problem. Testing is taught in the Mid West but for some rerason, UCLA and USC are "Biological psychology" UCLA kicked out all clinical students years ago. Some small schools like CSPP have taken over. The whole thing is a mess. No school in LA teaches the MMPI. etc.

 

[El Duderino]

Before you cut and paste, learn your medicare codes.

Err... No, if it's all the same to you, I think I'll just keep on quoting.

Psychologists then gained right to co- Admit with any MD--really pissing off psychiatrists. This came about because the med staff has had it with psychiatrists, see New Mexico. GP refers a pt to a psychiatrist and that is the last time the GP sees that pt.

I really don't see what you're getting at. Sure, psychologists do more now than ever, and in a few years they may even prescribe SSRIs or something. My point is, this may happen only when clinical experience tells us that this is safe. Decades ago, nurses were not allowed to take patients' blood pressure (at least in Sweden). This was considered far too complicated for them. Now they do, and noone thinks twice about it. On the other hand, there are now a wealth of procedures that weren't around in the first place. Once they are established and considered safe, nurses may or may not be allowed to do them.

The same thinking applies to psychologists and SSRIs. Not to equate what they do professionally, but they both have less medical training than MDs.

I am no threat, as I am retired. A smart psychologist can get the psychiatrist mad as hell, blowing up all that narcisism.

Well, I can tell you must have had a productive career.

 

[Allred]

Hey san

I lived in Sweden for a long time. But in English.

When someone quotes back what I said, you do a disservice to all. I know what I wrote.

I never pissed off any MD. To do that is dumb. One psychologist who is also JD like to wring necks.

MY point is forget all about us. We may never get script as most of us could care less.

Your real life worries come from your brothers. My wife had a depression and went to a psychiatrist for some effexor.
Her next pap done by her ob--she shared that fact. The ob jumped at the idea and wrote a script for her. She cancelled the psychiartist at 180 bucks and hasn't been back since.

Hey da.

 

[Allred]

To Big L

Wish you had returned. As I read your posts, my apologies.

That's a good strong ego you present. You made good points and I think you might be able to sum up this mess.

I suspect you are in your final days of training and wish you well.

Allred

 

[Big Lebowski]

I'm still around...was out of town for Memorial weekend, so I haven't had a chance to get onto these forums...

To your first question on whether a GP/FP should prescribe antidepressants for affective disorders...I would say yes in most cases. From what I've seen and been taught, it is probably a good idea if a patient gets their first trial of anti-depressant (SSRIs, Effexor, Wellbutrin,...of course not tricyclics) from their primary care. Talking with those in primary care, it seems that most feel comfortable with trying one and maybe another if the first fails...but after that they seem more comfortable referring to a psychiatrist. Many psychiatrists I know agree with this. This is not unlike a lot of primary care practice....ie. prescibing drugs to treat high bp, diabetes, etc. Once it gets complicated or requires special attention, the GP/FP should refer.

As for Anxiety Disorders...I would say most patients I've seen are on antidepressants and many of those are on antidepressants only. This is especially true for GAD. Again, I think GP/FPs can be very effective here...until treatment and response becomes complicated. In cases that require addition of anxiolytics...many GP/FPs I know get uncomfortable and would rather refer to a psychiatrist. Psychotherapy becomes very important here as well, ie. PTSD.

Of course I agree there is a strong placebo effect. And for many patients there is a fine line between anxiety and depression. And I've seen antidepressants given to patients without them being told they are antidepessants.

To answer your question, "how's this worse than having a good psychologist prescribe?"...I would say it doesn't for most cases. I think when people start getting uncomfortable is in cases of drug interactions (ie. thyroid meds)...pre-existing medical conditions (ie. high bp, CAD)....alternate medical diagnoses (ie. hypothyroidism)...and compounding medical diagnoses (alzheimer's and neurological d/o). I believe that many MDs/DOs feel that psychologists lack the well-rounded medical education to pick up on some of these things. Of course, I will not deny that MDs/DOs also do not like other professionals infringing on there turf....as is obvious throughout the history of medicine (ie. homeopaths, chiropractors, etc.)

Thanks for the well wishes...

 

[Allred]

Nice summary.

I would differ. The dx for GAD or Depression is not easy. Anxiety often is a symptom of depression. In my long experience, I found Depression to be a morning illness and GAD an afternoon one.
Simplistic, but true. I would refer those cases to a psychiatrist only.
Paxil is being sold as tx for both. Klonopin is better for anxiety. They are different illnesses but with common layers.

I am sure you know about the XYZ thing in phar. Studies by drug companies suggest that if a med has a XYorZ name, the MD will remember it first. Some damn psychologists at play here.

Of course it's anxiety over what. Or free floating anxiety. This is not easy stuff and required a detailed interview.Even psych testing has limited value in this dx. GAD should be medicated if pt wants for a very short time. Psychotherapy is hard as the pts verbalizes almost nothing. For example, "I don't feel well."
You need to R/o Etoh abuse, which is common, multiple MD at play and the pts life style. Good luck with this one. I disagree that OBs should give SSRI. I would restrict that to psychiatrists. Which SSRI, why? etc. I think some non psych MDs have a favorite they give to all. Do you think they tell their male pts of usual sexual side effects?

CU

 

[Allred]

The most important tool that a psychiatrist has in is his/her training in taking an interview. This is taught and often makes the use of psych testing unnecessary.

This interview is not the same as other MDs. You ask the same questions to every pt. When completed, you have your base for dictation of a Psych History and Mental Status Exam.

Where I worked American foreign school grads were lost. US and foreigned trained all did this well. You get to be able to do it in your sleep.

Re Anxietydx, I would always ask the pt if they felt better in the morning or afternoon. Then keep my mouth shut and listen.

I have some long stories here but will say BYE

 

[Anasazi23]

Allred....you have abolutely no frame of reference for your *****ic statements regarding medical school training and reimbursement, regardless of your mantra of $43.44.

It's late and I'm clearly tired and aggravated reading this drivel. Suffice it to say that the complexities of patients' polypharmacy issues is beyond your comprehension or understanding, and not, as you suggest, "a no brainer."

That said, I suggest you read-up on some real medical psychiatry journals and become informed before making insulting blanket statements based on one person's disgruntled misguided information.