Psychologist vs. Psychiatrist

[Redrum16]

This discussion was a subtopic of another thread but I think it deserves its own thread. Obviously, the best approach to mental health varies from patient to patient. However, we have minimal understanding of many major mental diseases and the underlying physiological mechanisms. I can't even begin to list the number of mental diseases I've studied where the literature is far from complete and research continues to meet a dead end. A psychiatrist tends to attack mental disorders from the physiological level and a psychologist tends to attack disorders from the behavioral level. Many times, where medication has failed, behavior modification has succeeded. Look at the breakthroughs Lovaas had with autistic children through behavioral modification and a reduction in medication. It's far too easy to rely on a magic pill to solve a multi-faceted problem. The psychiatrist has a strong medical background to diagnose but unfortunately diagnosing the brain is more complicated than diagnosing a heart murmur or a kidney stone.

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[PublicHealth]

Similarities:

(1) Both deal with mental health

(2) Both may be found working in Depts. of Psychiatry


Differences:

(1) Salary

(2) Biomedical orientation of psychiatrists/behavioral orientation of psychologists

(3) Reimbursements

There are more, but it's early and my brain hasn't started working yet.

 

[MacGyver]

Why are you trying to spin this into a "psychologists are more valuable/useful than psychiatrists" thread?

Cant we just say that that each is needed, valuable, and useful in their own expertise?

Why does this always have to degrade into a "my profession is better than yours" argument?

 

[PublicHealth]

Originally posted by MacGyver
Why are you trying to spin this into a "psychologists are more valuable/useful than psychiatrists" thread?

Cant we just say that that each is needed, valuable, and useful in their own expertise?

Why does this always have to degrade into a "my profession is better than yours" argument?

These kinds of threads are useful for those of us who can't decide if they want to pursue clinical psychology or psychiatry. There are many similarities and differences between the two fields, so it's useful to have an objective understanding of both before pursuing one route or another. While we may be comparing apples and oranges, I think this type of thread serves more of a purpose than MD vs. DO threads.

Cheers,

PH

 

[Redrum16]

I'm not trying to put down a particular field. I've just read too many posts about people entering medical school because they want to treat the mentally ill. I think it's important that they're aware of the different philosphies underlying the two fields. Psychiatry pays more and tends to carry more social prestige yet is not necessarily the better treatment. To be honest, this isn't even my field. I've just studied a lot about psych treatments in my psychobiology major at UCLA. I'm actually a future pharmacist who happens to be arguing against medication. ha! Go figure!

 

[Sanman]

Personally, I think that a good psychiatrist/psychologist should know a good deal about both the biological and behavioral aspects of the profession. As far as compensation goes, both make a decent buck. Public, are reimbursement rates different for the same treatment?

 

[PublicHealth]

Originally posted by Sanman
Personally, I think that a good psychiatrist/psychologist should know a good deal about both the biological and behavioral aspects of the profession. As far as compensation goes, both make a decent buck. Public, are reimbursement rates different for the same treatment?

Great question, Sanman. Unfortunately, I don't know the answer. Anyone?

 

[PublicHealth]

If you were referring to my earlier post about differences between psychiatrists and psychologists, I meant that reimbursements for clinical psychological services are rapidly decreasing, and this may push clinical psychologists to supplement their income by doing research, teaching, etc. The same is true for clinical neuropsychologists. In sum, psychiatrists can diagnose a wider variety of mental illness, and are likely to be better reimbursed for their services, especially since they can prescribe meds.

 

[Sanman]

thanx for the answer public, but your post just brought an old question to mind, since I was reading the mft thread and the link there quoted different hourly rates for therapists w/ different degrees. As far as the fact that psychiatrists can diagnose the widest variety of diseases I'd probably have to agree ( can they diagnose more than clinical psych PhDs?). However, I think that thats a double-edged sword because, as a psychiatrist, I would be afraid that psychologists would take the bread and butter cases - ADD, LD, anxiety, mild depression, etc. at a slightly lower rate and leave psychiatrists w/ more serious diseases - i.e. schizophrenia, violent psychotics, etc. This may be more a plus for some psychs because of the challenge, but would probably kill the lifestyle now enjoyed by many psychiatrists. This is kind of already happening in child psych because of the shortage of child psychiatrists. They are so bogged down w/ serious mental illness - i.e. childhood schizophrenia, suicidal adolescents, etc - in some areas that psyhologists and neurologists are taking the more popular ADD/LD and anxiety along w/ pediatricians. On a related note, I've seen compensation quotes that say that couseling PhD's make more than clinical PhDs and I figured that was for the same reason.

 

[PublicHealth]

Health insurers tend to cover services of healthcare professionals -- including clinical psychologists -- when the services provided are considered reasonable and necessary for diagnosis and treatment. In clinical psychology, the trend seems to be for insurance companies to limit coverage of psychological services, which has in turn decreased the number of patients who would otherwise seek such services. This is partly due to different reimbursement stuctures and inurance companies' deeming psychological services "not reasonable or necessary for diagnosis and treatment" -- or whatever legal definition they use. In addition, many insurers are probably influenced by the "biological revolution" in psychiatry, and therefore believe that psychopharmacologic interventions are best for the patient, and that only evaluations by psychiatrists trained to administer drugs are necessary and therefore reimburseable. Take a look at pretty much any psychiatry journal nowadays and you'll see drug therapies pitted against psychotherapy in clinical trials. Clinical psychologists are trying to hold their ground. Unfortunately, the insurance companies who make reimbursement decisions probably don't read these articles, and are instead influenced by the pundits -- psychiatrists, pharm reps, etc. -- who fill their boards. Politics, my dear Sanman, not science rules in this court.

Here's an article on Medicare coverage of mental health services: http://www.medicareed.org/content/CMEPubDocs/ACF525D.pdf

Here's a great article on clinical psychology by Bob Sternberg:
http://www.yale.edu/rjsternberg/position.html

 

[Ms. Madison]

Psychologists usually work in conjunction with psychiatrists. Since psychologists obviously can't prescribe psych. meds, many patients have two doctors. The fact that psychologists focus on treating the person rather than medicating is what is appealing to me.

 

[Sanman]

Public, I have no doubt that politics is the game being played. I'm sure that President Bush is trying to help lower malpractice rates out of the goodness of his heart and not the fact that the AMA is one of the most powerful private interest groups on capitol hill and an especially huge contributor to the republican party. However, I find the insurance companies very slippery and seem to turn on health care professionals at the drop of a dime. Today more psychiatric pharmalogic therapy, tomorrow who knows. They really are getting on my nerves, but lets not turn this into a political discussion.

 

[Sanman]

I'm aware that psychologists do the severely mentally ill. However,since they are usually in need of meds and therapy, they may be treated more so by psychiatrists who can treat w/ both meds and therapy. Then, psychologists would take more minor cases that don't need to be monitored like the seriously mentally ill and pediatricians or neurologists could prescribe any routine meds like ritalin. Just taking a stab at what the future could hold.

 

[Kimya]

Sanman,

I work in mental health and that's not how it works for severe mental illness like sz. The psychiatrist usually does primarily med checks. The psychologist, as well as others on the treatment team, does the bulk of the psychotherapy, as well as voc. rehab training, working on social skills, etc. Which can take up a lot of hours in the week for illnesses like sz- it's not a one hour a week therapy kind of thing for a lot of people. I don't see this changing in the future because of the discrepancies in salary. It is not cost effective for the psychiatirst to be taking on the bulk of the therapy as well.

 

[Big Lebowski]

This is a really sad thread....

Why is there a constant need to demean other fields? Are we all that insecure? As a psychiatry resident, I see the psychologist and an essential part to treating both mood and psychotic disorders of varying severity. The same applies to the reverse. Both are necessary to effectively treat the mentally ill, regardless of what predominates treatment (meds vs therapy). We need each other. All good psychiatrists should be knowledgeable in psychotherapy and all good psychologists should know their psychopharmacology. It is that simple....no one profession is better than the other.

That's all I have to say...

 

[psyuk]

the medications work. even psychologist can't deny that. i feel that psychiatrists tend to be very aggressive with meds to treat patients' moods first, then use psychotherapy to modify their past erratic/abnormal behaviors.

let's have a psychiatrist and psychologist treat identical twins suffering from a same degree of clinical depression and see who could treat the twin faster and more efficiently. i give the edge to psychiatrists.

 

[Sanman]

Great idea, now does anybody know where we can find a pair of depressed twins??!!!!

 

[cici]

Originally posted by psyuk
the medications work. even psychologist can't deny that. i feel that psychiatrists tend to be very aggressive with meds to treat patients' moods first, then use psychotherapy to modify their past erratic/abnormal behaviors.

let's have a psychiatrist and psychologist treat identical twins suffering from a same degree of clinical depression and see who could treat the twin faster and more efficiently. i give the edge to psychiatrists.

I agree that medication leads to faster symptom relief, but don't forget that we also need to look at relapse rate. In this respect, psychotherapy (especially CBT) often does better than medication.

 

[Redrum16]

Well here's a case that I stated at the very beginning of this thread. Lovaas at UCLA has made several breakthroughs with Autistic children through behvioral learning (no meds). His patients have sometimes made full recoveries where they are indistinguishable from a non-autistic child. Lovaas is a strong advocate for psychotherapy over psychopharmacology.

 

[PublicHealth]

Originally posted by Sanman
Great idea, now does anybody know where we can find a pair of depressed twins??!!!!

Here's some:

Psychosom Med. 2003 May-Jun;65(3):490-7.

Depressive symptoms and metabolic risk in adult male twins enrolled in the national heart, lung, and blood institute twin study.

McCaffery JM, Niaura R, Todaro JF, Swan GE, Carmelli D.

Centers for Behavioral and Preventive Medicine (J.M.M., R.N., J.F.T.), Brown Medical School and The Miriam Hospital, Providence, Rhode Island.

OBJECTIVE: To determine the extent to which depressive symptoms are associated with metabolic risk factors and whether genetic or environmental factors account for this association. METHOD: Twin structural equation modeling was employed to estimate genetic and environmental contributions to the covariation of depressive symptoms, as indexed by the Centers for Epidemiological Studies-Depression Scale, and common variance among blood pressure, body mass index, waist-to-hip ratio, and serum triglycerides and glucose among 87 monozygotic and 86 dizygotic male twin pairs who participated in the NHLBI twin study. RESULTS: Depressive symptoms were associated with individual components of the metabolic syndrome and common variance among the risk factors. Twin structural equation modeling indicated that the associations were attributable to environmental (nongenetic) factors. CONCLUSIONS: These results support the hypothesis that depressive symptoms may increase risk for a pattern of physiological risk consistent with the metabolic syndrome.

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Psychol Med. 2003 Jul;33(5):793-801.

Genetic and environmental influences on psychological distress in the population: General Health Questionnaire analyses in UK twins.

Rijsdijk FV, Snieder H, Ormel J, Sham P, Goldberg DP, Spector TD.

Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry and Twin Research and Genetic Epidemiology Unit. St Thomas' Hospital, London.

BACKGROUND: The General Health Questionnaire (GHQ) is the most popular screening instrument for detecting psychiatric disorders in community samples. Using longitudinal data of a large sample of UK twin pairs, we explored (i) heritabilities of the four scales and the total score; (ii) the genetic stability over time; and (iii) the existence of differential heritable influences at the high (ill) and low (healthy) tail of the distribution. METHOD: At baseline we assessed the GHQ in 627 MZ and 1323 DZ female pairs and at a second occasion (3.5 years later) for a small subsample (90 MZ and 270 DZ pairs). Liability threshold models and raw ordinal maximum likelihood were used to estimate twin correlations and to fit longitudinal genetic models. We estimated extreme group heritabilities of the GHQ distribution by using a model-fitting implementation of the DeFries-Fulker regression method for selected twin data. RESULTS: Heritabilities for Somatic Symptoms, Anxiety, Social Dysfunction, Depression and total score were 0.37, 0.40, 0.20, 0.42 and 0.44, respectively. The contribution of shared genetic factors to the correlations between time points is substantial for the total score (73%). Group heritabilities of 0.48 and 0.43 were estimated for the top and bottom 10% of the total GHQ score distribution, respectively. CONCLUSION: The overall heritability of the GHQ as a measure of psychosocial distress was substantial (44%), with all scales having significant additive genetic influences that persisted across time periods. Extreme group analyses suggest that the genetic control of resilience is as important as the genetic control of vulnerability

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Nicotine Tob Res. 2003 Feb;5(1):77-83.

A study of depressive symptoms and smoking behavior in adult male twins from the NHLBI twin study.

McCaffery JM, Niaura R, Swan GE, Carmelli D.

Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island 02903, USA. [email protected]

Self-report measures of depressive symptoms, such as the Center for Epidemiological Studies-Depression Scale (CES-D), correlate with current and lifetime smoking status. In one previous study of adult female twins, genetic factors accounted for the covariation of liability to a diagnosis of major depressive disorder and liability to lifetime smoking (Kendler, Neale, MacLean, Heath, Eaves, & Kessler, 1993b, Archives of General Psychiatry, 50, 36-43); however, it remained unclear whether genetic effects also account for the covariation between subclinical depressive symptomology and smoking behavior. In this study, we use twin structural equation modeling to explore whether genetic and/or environmental influences contribute to the covariation between depressive symptoms, as measured by the CES-D, and current and lifetime smoking status among 120 monozygotic and 114 dizygotic Caucasian male twin pairs (aged 59-69). In this sample, depressive symptoms showed small but significant correlations with current and lifetime smoking status. Univariate twin analyses indicated that additive genetic and non-shared environmental factors contributed significantly to liability to current and lifetime smoking. However, the majority of variance in CES-D scores was attributable to non-shared (individual) environment. In bivariate analyses, non-shared environmental factors accounted for the majority of covariation between liability to depressive symptoms (CES-D scores > or = 8; above the 75th percentile) and liability to current and lifetime smoking status. Taken together with the previous literature, these results suggest that the etiology of covariation among depressive symptoms and smoking behavior may vary by measurement and severity of depressive symptomology.

 

[psyuk]

Originally posted by heelpain
Maybe the medication won't really help the twin. But, maybe biofeedback provided by a psychologist along with some EMDR and Cognitive-behavioral therapy sessions may help the individual sufferer. What do you say to that? CBT has been helpful for the tx of depression.

Another thing to keep in mind: not all psychiatrists have all patients taking meds. I met one that does not BELIEVE in meds.

I don't have anything to say to that. My mother is a psychologist, so I know depression can be treated effectively with CBT, but one also can't deny the fact that SSRIs do wonders for depression. What I am saying is my mother may be able to treat the twin faster, but I'd still bet on the psychistrist who can prescribe Paxil thereby getting a headstart. Sorry mom.

 

[cici]

Originally posted by psyuk
I don't have anything to say to that. My mother is a psychologist, so I know depression can be treated effectively with CBT, but one also can't deny the fact that SSRIs do wonders for depression. What I am saying is my mother may be able to treat the twin faster, but I'd still bet on the psychistrist who can prescribe Paxil thereby getting a headstart. Sorry mom.

Yes, but CBT leads to LOWER relapse rate than psychotropic medications. I always think whether something is effective depends not only on how fast it brings about symptom relief, but also on how long the results could last.