Psychopharmacology/Advanced Practice Psychology

[roubs]

I've posted multiple times about the numbers of hours of training and patient-hours in particular, and psychiatrists have many many more. So I haven't found anything to feel threatened about yet. Especially from Stigmata.

I hesitate to ask this because I don't really think the epeen comparison is useful but I'm actually curious, do you count in "patient hours" time spent on non-psychiatry clerkships in med school?

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[nitemagi]

Nope.

 

[Therapist4Chnge]

I've posted multiple times about the numbers of hours of training and patient-hours in particular, and psychiatrists have many many more. So I haven't found anything to feel threatened about yet. Especially from Stigmata.

Are you counting "on call" time when you aren't seeing patient, when you are studying for boards, etc.? The "80 hours a week" numbers get thrown around, but if you actually look at patient contact hours and actual psychiatric training and work.....the numbers are far far less.

 

[nitemagi]

Are you counting "on call" time when you aren't seeing patient, when you are studying for boards, etc.? The "80 hours a week" numbers get thrown around, but if you actually look at patient contact hours and actual psychiatric training and work.....the numbers are far far less.

Ahh, excellent point. 80 hours is pretty standard within the intern (first) year, but subsequent years probably are more like 60 hours on average.

At 50 weeks per year that comes out to (on average, of course some aspects will vary between programs):
Year 1: 4,000 hours
Year 2: 3,000 hours
Year 3: 3,000 hours
Year 4: 3,000 hours
Total (just in residency) = 13,000 hours

Boards studying time is not protected or separate time, and must be crammed in, usually in the minutes between patients or on your off time.

Medical school usually has a minimum of 1-2 months of psychiatry clinical rotation, plus an elective or three for anyone wanting to go into it. You can do the math on that. The harder to measure is all the direct clinical exposure occurring in non-psychiatric settings (primary care, surgery, internal medicine, etc.), where assessment and reassurance and actual clinical skills are being developed. Also the multiple classroom courses on neurophysiology, psychopathology, neurology.

Now T4C brings up interesting points, which really speaks to the variability amongst all clinical training -- how much of "clinical" time is actually spent in front of a patient? Of the 13,000 hours, you can probably eliminate 10-15% for didactics during residency. But what about all the other variation? Don't residents sleep on call? Depends on the hospital. I had maybe 1-2 nights during all of intern year that I got any sleep. Usually I was seeing multiple emergency room evaluations of suicidal, intoxicated, or acutely psychotic patients, or pure BS consults, while doing several admissions to an inpatient unit and fielding pages from multiple services for Floor consults and other ER consults. But what about all the other time? What qualifies as a "patient-hour?" Do you take out documentation time? No-show's? Does supervision count? This probably erodes Actual hours in all clinical training programs regardless of degree. What no one can say is if it erodes it proportionally between programs.

But I maintain that the total hours of patient exposure during training, on average, is far higher for a psychiatrist than for a psychologist. Psychologists of course can say they spend far more Classroom hours learning about mental illness. No one has ever shown that classroom hours maps out to better clinical outcome (and I'm not sure they have for patient-hours either). But to make a statement that psychologists are far better trained at diagnosis and treatment of mental illness is weighing classroom hours a lot, or that diagnostic instruments are far superior to a skilled clinical interview (which I would then ask to see data to support such a supposition).

But of course that then begs a good researcher to look beyond pure numbers. Jon Snow and I have discussed this several times on SDN, and the focus of training is quite different. Psychiatrists spent a lot of their training seeing the most severe aspects of mental illness -- when someone is severe enough to come into an emergency room or a be hospitalized. This means the most severely depressed, suicidal, psychotic, manic, anxious, somatic, and medically ill patients. They have far less training during residency in psychotherapy than psychologists. So I would make the argument that psychiatrists have superior training, again on average, in the breadth and extremes of all of mental illness, but may miss many subtleties in long-term management of the individual. Psychologists spend more hours per patient, likely giving them a better understanding into the depths of an individual. But they may have to extrapolate (after training) from the far fewer patients they've seen but understand quite well, to understand many clinical pictures they've never seen. This is the argument for how the fields should complement each other. To say one is superior is erroneous. To suppose that because of more classroom learning in mental illness without equivalent hours and supervision in the extreme presentations of mental illness (not to mention basically NO medical training that's so so necessary) that a psychologist would then be superior in use of medications to other medical professionals is again extrapolating from a narrow but well honed group of skills into areas that they just don't apply.

 

[edieb]

Ahh, excellent point. 80 hours is pretty standard within the intern (first) year, but subsequent years probably are more like 60 hours on average.

At 50 weeks per year that comes out to (on average, of course some aspects will vary between programs):
Year 1: 4,000 hours
Year 2: 3,000 hours
Year 3: 3,000 hours
Year 4: 3,000 hours
Total (just in residency) = 13,000 hours

Boards studying time is not protected or separate time, and must be crammed in, usually in the minutes between patients or on your off time.

Medical school usually has a minimum of 1-2 months of psychiatry clinical rotation, plus an elective or three for anyone wanting to go into it. You can do the math on that. The harder to measure is all the direct clinical exposure occurring in non-psychiatric settings (primary care, surgery, internal medicine, etc.), where assessment and reassurance and actual clinical skills are being developed. Also the multiple classroom courses on neurophysiology, psychopathology, neurology.

Now T4C brings up interesting points, which really speaks to the variability amongst all clinical training -- how much of "clinical" time is actually spent in front of a patient? Of the 13,000 hours, you can probably eliminate 10-15% for didactics during residency. But what about all the other variation? Don't residents sleep on call? Depends on the hospital. I had maybe 1-2 nights during all of intern year that I got any sleep. Usually I was seeing multiple emergency room evaluations of suicidal, intoxicated, or acutely psychotic patients, or pure BS consults, while doing several admissions to an inpatient unit and fielding pages from multiple services for Floor consults and other ER consults. But what about all the other time? What qualifies as a "patient-hour?" Do you take out documentation time? No-show's? Does supervision count? This probably erodes Actual hours in all clinical training programs regardless of degree. What no one can say is if it erodes it proportionally between programs.

But I maintain that the total hours of patient exposure during training, on average, is far higher for a psychiatrist than for a psychologist. Psychologists of course can say they spend far more Classroom hours learning about mental illness. No one has ever shown that classroom hours maps out to better clinical outcome (and I'm not sure they have for patient-hours either). But to make a statement that psychologists are far better trained at diagnosis and treatment of mental illness is weighing classroom hours a lot, or that diagnostic instruments are far superior to a skilled clinical interview (which I would then ask to see data to support such a supposition).

But of course that then begs a good researcher to look beyond pure numbers. Jon Snow and I have discussed this several times on SDN, and the focus of training is quite different. Psychiatrists spent a lot of their training seeing the most severe aspects of mental illness -- when someone is severe enough to come into an emergency room or a be hospitalized. This means the most severely depressed, suicidal, psychotic, manic, anxious, somatic, and medically ill patients. They have far less training during residency in psychotherapy than psychologists. So I would make the argument that psychiatrists have superior training, again on average, in the breadth and extremes of all of mental illness, but may miss many subtleties in long-term management of the individual. Psychologists spend more hours per patient, likely giving them a better understanding into the depths of an individual. But they may have to extrapolate (after training) from the far fewer patients they've seen but understand quite well, to understand many clinical pictures they've never seen. This is the argument for how the fields should complement each other. To say one is superior is erroneous. To suppose that because of more classroom learning in mental illness without equivalent hours and supervision in the extreme presentations of mental illness (not to mention basically NO medical training that's so so necessary) that a psychologist would then be superior in use of medications to other medical professionals is again extrapolating from a narrow but well honed group of skills into areas that they just don't apply.

Nobody has shown that more classroom hours don't map to better clinical outcome because it hasn't been studied. I vehemently disagree that more classroom hours do not produce better clinicicans because it is illogical. I can see patients in the ER all day and, if I am just doing case management with them or treating them with some non evidence based treatment, there will be no improvement. In other words, I am doing the wrong thing over and over again...this is not making me a better clinician.

I would rather have someone trained with extensive coursework where they apply the e-b theories of mental illness with the patients they see and then come back and receive supervision and more classwork to help them fix the rough spots which they encounter when applying the e-b models.

When I was learning CBT, my professors would teach us the cognitive model behind each disorder, how to conceptualize co-morbid diagnoses along with these disorders, and what was driving and maintaining the dysfunction. I would then go to the therapy room and try to apply what I learned with the patient. I would then report back to my professor who would help me work out the parts that I would have trouble with. I would then go back to see the patient and start the process over again.

Because you never master the theory behind the psychiatric disorder, seeing patient after patient without A LOT of training just teaches one to be a technician. For training to be good you need: 1) immense classroom work, 2) on the job exposure applying the learning, 3.) Constant feedback and correction till you can apply what you learn in the classroom in a coherent, logical manner

 

[nitemagi]

Nobody has shown that more classroom hours don't map to better clinical outcome because it hasn't been studied.

Exactly my point.

I vehemently disagree that more classroom hours do not produce better clinicicans because it is illogical.

Disagree as vehemently as you want. Disagreement doesn't make data to support your point. I didn't say more classroom hours don't produce better clinicians. I said more classroom hours haven't been proven to produce better clinicians than those with fewer classroom hours and 2-3x the amount of patient exposure hours. Is it impossible to imagine a point of diminishing returns in classroom time and that PhD could exceed that excessively? I'm not saying they do.

I can see patients in the ER all day and, if I am just doing case management with them or treating them with some non evidence based treatment, there will be no improvement. In other words, I am doing the wrong thing over and over again...this is not making me a better clinician.

Ah well that's the presumption that non-evidence based treatment has evidence to prove it is ineffective. Which it usually doesn't. So therefore it isn't "the wrong thing," just something that doesn't fit into the narrow EBT dogma that is ingrained in current PhD programs.

But besides that, there is still teaching going on in the clinical setting, but it is via real-time and other supervision. Didactics are a foundation, but the rubber meets the road in supervision.

I would rather have someone trained with extensive coursework where they apply the e-b theories of mental illness with the patients they see and then come back and receive supervision and more classwork to help them fix the rough spots which they encounter when applying the e-b models.

Which is also occurring in residencies, just with a lot more direct patient time and less front loaded classroom time on the theory behind it. And while you would prefer those with more classroom time, that doesn't speak to the original point that there isn't data to show that more classroom hours leads to superior (or inferior) clinical outcomes.

When I was learning CBT, my professors would teach us the cognitive model behind each disorder, how to conceptualize co-morbid diagnoses along with these disorders, and what was driving and maintaining the dysfunction. I would then go to the therapy room and try to apply what I learned with the patient. I would then report back to my professor who would help me work out the parts that I would have trouble with. I would then go back to see the patient and start the process over again.

Because you never master the theory behind the psychiatric disorder, seeing patient after patient without A LOT of training just teaches one to be a technician. For training to be good you need: 1) immense classroom work, 2) on the job exposure applying the learning, 3.) Constant feedback and correction till you can apply what you learn in the classroom in a coherent, logical manner

Again, your statements assume that physicians don't know quite a lot, and that we're rolling right in off of our surgery rotations, prescribe meds, and never learn anything about theory (which we do throughout medical school and throughout residency). We get quite a bit of classroom teaching (admittedly less mental health specific classroom hours than PhD's, and it ISN'T all frontloaded -- which makes for better integration and retention), but MORE on the job exposure while learning, and MORE feedback and correction. Therefore you cannot make the statement that PhD's are superior to a psychiatrist since we exceed 2 out of 3 of your criteria for good training.

We each are acculturated to the philosophy of training which aims to justify itself. Unfortunately there isn't data to support one leading to better clinical outcomes. There IS data that less medical training in those administering meds leads to more medical errors, though that hasn't been studies in PhD's. I would love to see data that could argue that PhD's would make less medical errors because they have more classroom theory training but less medical training than even a mid-level medical provider.

 

[stigmata]

Pay no mind to Nitemagi, Stigmata. If you look at the numbers, you have much more training in the diagnosis and treatment of mental illness than a psychiatrist and I am sure he feels threatened.

Well of course he does and that is why he feels the need to check our forum so much. I really couldn't be bothered. The rest of world goes by while psychiatrists like nitemagi are digging their own grave...professionally speaking.

 

[Therapist4Chnge]

But I maintain that the total hours of patient exposure during training, on average, is far higher for a psychiatrist than for a psychologist. Psychologists of course can say they spend far more Classroom hours learning about mental illness. No one has ever shown that classroom hours maps out to better clinical outcome (and I'm not sure they have for patient-hours either). But to make a statement that psychologists are far better trained at diagnosis and treatment of mental illness is weighing classroom hours a lot, or that diagnostic instruments are far superior to a skilled clinical interview (which I would then ask to see data to support such a supposition).

Here is one often cited study from Meyer et al. (2001):

CONCLUSIONS
"....We have also demonstrated that distinct assessment methods provide unique sources of data and have documented how sole reliance on a clinical interview often leads to an incomplete understanding of patients. On the basis of a large array of evidence, we have argued that optimal knowledge in clinical practice (as in research) is obtained from the sophisticated integration of information derived from a multimethod assessment battery."

Meyer, G.J., Finn, S.E., Eyde, L.D., Kay, G.G., Moreland, K.L., Dies, R.R., Eisman, E.J., Kubiszyn, T.W., Reed, G.M. (2001). Psychological Testing and Psychological Assessment: A Review of Evidence and Issues. American Psychologist. 56, (2): 128-165.

 

[loveoforganic]

Is passive aggressiveness part of clinical psychology training? I know it's a big part of training in medicine, but it looks like this may be one area where you have us beat. Then again, your PA didactic hours may just be superior to the more directly clinical PA hours in medicine.

DO WE HAVE ANY STUDIES ON THIS???

 

[nitemagi]

Well of course he does and that is why he feels the need to check our forum so much. I really couldn't be bothered. The rest of world goes by while psychiatrists like nitemagi are digging their own grave...professionally speaking.

Yeah yeah Stig. We've been down this road before. In your eyes everything I do is an indication I feel inferior to you and insecure

I mean why even have a dialogue on Sdn with other clinicians if it wasn't to compensate for something like a lack of training and attempt to sound competent in areas one clearly doesn't have adequate training in? Right Stig?

 

[nitemagi]

Here is one often cited study from Meyer et al. (2001):

Interesting paper T4C, though if you read it (especially page 150 on, which is where they put forth the data to draw their conclusions, all they're really comparing is studies that compared the semistructured interview alone to the semistructured interview plus other data (usually identified as collateral sources from family and significant others).

"Clinical diagnoses were then compared with diagnoses derived from a comprehensive multimethod assessment that consisted of a semistructured patient interview, a review of the patient's medical record, a semistructured interview with the treating clinician, and an interview with the patient's significant other, all of which were then reviewed and synthesized by two clinicians to derive final diagnoses from the multimethod assessment."

Really they were comparing standard hospital diagnoses with a good assessment which takes into account collaterals, and doesn't weigh psychological assessment instruments into the mix at all.

I would absolutely agree that a thorough assessment takes into account collaterals. But the data they present actually doesn't support their conclusion that psychological assessments make a diagnostic evaluation superior to a skilled clinical interview that uses collateral. Next paper?

 

[stigmata]

Yeah yeah Stig. We've been down this road before. In your eyes everything I do is an indication I feel inferior to you and insecure

I mean why even have a dialogue on Sdn with other clinicians if it wasn't to compensate for something like a lack of training and attempt to sound competent in areas one clearly doesn't have adequate training in? Right Stig?

3rd grade english...don't end a sentence in a preposition.

 

[nitemagi]

3rd grade english...don't end a sentence in a preposition.

Stig, it seems that as expected your information is outdated. It may be due to inadequate education.

http://grammar.quickanddirtytips.com/top-ten-grammar-myths.aspx
http://www.legalwritingpro.com/articles/F49-five-grammar-myths.php

 

[roubs]

Anyone watch this week's Modern Family?

Claire gets security footage to prove her husband bumped into her, causing her to fall:

Claire: Okay look I fell yesterday and the market and Phil and I are having a little disagreement as to what happened, just watch here..I stopped to fix my shoe and then Phil..right there okay, he makes way for this very attractive woman whom he convienantly leaves out of his retelling of the story, now right here he backs up, pushes his butt into the cart, which pushes me into the cans. Do you see that? It's all his fault! Just like I said, I was right. Suck it!

Haley: You went to all that trouble just to prove you were right?

Claire: It really wasn't that much trouble, I just went to the store, found your friend Jordan the bag boy who got me the manager. He gave me the address of the off-site security office. I filled out some paperwork, Sally faxed it to corporate...three minutes later I'm buying a pack of DVDs and burning a copy. Cake.

Luke: It's like a sickness.

Claire: What? None of you believed me so I got proof.

 

[edieb]

Wow, I never said physician training was inferior or superior in my post. I was just saying which type of training I believe is optimal with no insinuation of whether this type of training occurs more frequently in PhD or MD programs...

Exactly my point.


Disagree as vehemently as you want. Disagreement doesn't make data to support your point. I didn't say more classroom hours don't produce better clinicians. I said more classroom hours haven't been proven to produce better clinicians than those with fewer classroom hours and 2-3x the amount of patient exposure hours. Is it impossible to imagine a point of diminishing returns in classroom time and that PhD could exceed that excessively? I'm not saying they do.


Ah well that's the presumption that non-evidence based treatment has evidence to prove it is ineffective. Which it usually doesn't. So therefore it isn't "the wrong thing," just something that doesn't fit into the narrow EBT dogma that is ingrained in current PhD programs.

But besides that, there is still teaching going on in the clinical setting, but it is via real-time and other supervision. Didactics are a foundation, but the rubber meets the road in supervision.



Which is also occurring in residencies, just with a lot more direct patient time and less front loaded classroom time on the theory behind it. And while you would prefer those with more classroom time, that doesn't speak to the original point that there isn't data to show that more classroom hours leads to superior (or inferior) clinical outcomes.



Again, your statements assume that physicians don't know quite a lot, and that we're rolling right in off of our surgery rotations, prescribe meds, and never learn anything about theory (which we do throughout medical school and throughout residency). We get quite a bit of classroom teaching (admittedly less mental health specific classroom hours than PhD's, and it ISN'T all frontloaded -- which makes for better integration and retention), but MORE on the job exposure while learning, and MORE feedback and correction. Therefore you cannot make the statement that PhD's are superior to a psychiatrist since we exceed 2 out of 3 of your criteria for good training.

We each are acculturated to the philosophy of training which aims to justify itself. Unfortunately there isn't data to support one leading to better clinical outcomes. There IS data that less medical training in those administering meds leads to more medical errors, though that hasn't been studies in PhD's. I would love to see data that could argue that PhD's would make less medical errors because they have more classroom theory training but less medical training than even a mid-level medical provider.

 

[stigmata]

Anyone watch this week's Modern Family?

Claire gets security footage to prove her husband bumped into her, causing her to fall:

LOL! Saw it and was thinking the exact same thing...so true.

 

[stigmata]

Stig, it seems that as expected your information is outdated. It may be due to inadequate education.

http://grammar.quickanddirtytips.com/top-ten-grammar-myths.aspx
http://www.legalwritingpro.com/articles/F49-five-grammar-myths.php

LOL! You are true to form as common sense and practices continue to elude you. The part you missed is that doing so is usually colloquial and unprofessional, especially when there are many other ways to write the same sentence without sounding uneducated. The bill is in the mail.....

 

[Rivi]

can you two take this ridiculous squabble to pm? Quite frankly, it makes both of you look bad and it's not adding anything to the actual substance of the conversation.

+1

 

[nitemagi]

Sorry folks, not trying to perpetuate a debasement of the thread. As a dissenting voice here my opinion is often dismissed and my credentials derided (which I perceive as personal attacks), which any response on my part ultimately degenerates the thread to pettiness.

Apologies.

 

[stigmata]

+1

Then don't read it. I don't look bad, you don't know me. This is all just BS anonymous drivel, and taking it seriously is really weird.

 

[deleted106747]

I wish that this thread could dissolve less into the discussion of whether psychologists should prescribe, etc. and remain on the topic for those of us who are about to undergo additional training to discuss how to get that training, approaches, etc. That would be so much more useful. I tried to get them to pin the thread for those of us who are going back for our NP but it didn't go through.

 

[roubs]

I don't look bad, you don't know me.

This looks bad.

 

[stigmata]

You look bad. I could be your advisor, on your dissertation committee, your neighbor or on your APPIC match committee. You feel free to act like you are in a position of power because you are anonymous, even though you are a student. I feel free to call it like I see it because I am anonymous here. You think this is real life where you have to act like you really know what you are doing, and be the most mature, ethical and intelligent psychologist when in fact you will not actually feel that way, or be that person for a few more years at best. Enough with the holier-than-thou stuff...this is just an anonymous internet site.

 

[PETRAN]

PhD clinical psychology is FAR more superior in formulating, conceptualizing and interpreting mental health problems. The usual psychiatric procedure is some 10/15-minute interview followed by "diagnosis" according to DSM and many psychiatrists are interpreting these "different" diagnoses like they literally are different "diseases" in the strict medical sense. Patient has "anxiety co-morbid with depression and a bit of paranoid ideation/psychosis" and this ensures a 3/4-drug cocktail prescription with a bit of everything-benzo, SSRI and atypical.


Maybe not all psychiatry residencies are like this (well, maybe the top residencies offer more theoretical training) but i think that the majority are. In contrast to a much more complicated psychological formulation and conceptualization, with all the possible co-occuring factors and variables that interact in various feedblack loops and promote/sustain the mental health problem including, cognitive distortions, interpretations, psychosocial stressors etc. In that context, all major complaints could stem from common sub-processes rather than occur as three different "diseases". And don't tell me that a better theoretical and deeper understanding of the problem doesn't make for a better intervention, its common sense. Ofcourse extensive clinical experience based on deep psychological understanding is the factor that matters the most. Clinical experience on its own isn't. I haven't seen a single psychiatry residency which has advanced classes in cognitive theories, social-cognition, social psych etc. Most are stuck on traditional and ancient psychoanalytic concepts like it is some kind of dogmatic religion of some sorts and know nothing of recent advances in psychological science, psychometrics etc..



The majority of psychiatrists are good at "a-theoretical" psychopharmacological interventions and hence are better at managing severe and acute issues. As for prescribing psychologists, i never believed it, sorry to the prescribers here. If the psychologists with just two-three part-time years and some practica in psychopharmacology are able to prescribe all these psychotropic medications, then what really stops them to prescribe anything at all, anti-biotics or whatever? Where does the line stops exactly? Can a psychologist prescribe antiepileptic drugs? Why not prescribe for parkinson's, alzheimer's, or even spasticity in MS? It reallly sounds like an awful idea. If you want to prescribe drugs then go to medical school, period. It will never spread outside a few states of the American south and it will never-but-never- come to Europe or any other country outside the US for that matter (i mean in most European countries even the idea of prescribing nurses or optometrists is a joke and medicine has traditionally vast power and influence).


Lets stick on what we can do best...

 

[ForensicNeuro]

Prescription privilages for psychologists in the state of NJ is up for vote soon! If you vote in NJ, send your full name/email/possible school to [email protected] by OCTOBER 31 and also make your family members/peers in NJ do the same...you will get an email with one of those filled out letters to your governor.

 

[ForensicNeuro]

Sorry typo! that should be an "e" not an "a".

 

[Neuropsych2be]

Prescription privilages for psychologists in the state of NJ is up for vote soon! If you vote in NJ, send your full name/email/possible school to [email protected] by OCTOBER 31 and also make your family members/peers in NJ do the same...you will get an email with one of those filled out letters to your governor.

Wooo hoo!! I don't live anywhere near the Garden State but I hope this passes. Is this going before the full legislature or is the a committee vote??

 

[KillerDiller]

I'm sure there are lots of psychiatrists in NJ. What is the state's motivation for allowing psychologists to prescribe as well?

 

[Therapist4Chnge]

I'm sure there are lots of psychiatrists in NJ. What is the state's motivation for allowing psychologists to prescribe as well?

I'd still guess it has to do with access to prescribers. Many psychiatrists in the Tri-State area are cash-pay because of the supply/demand disparity. I'm not sure having psychologist prescribers will *fix* the problem, but I think it will improve access. If they could get something passed, I'd relocated back to Dirty Jersey and probably offer some part-time hours. It will be interesting to see how far this goes, as that would be a *significant* win for RxP Psychology if they do get something signed into law.

 

[edieb]

I'd still guess it has to do with access to prescribers. Many psychiatrists in the Tri-State area are cash-pay because of the supply/demand disparity. I'm not sure that will necessarily improve with psychologist prescribers, but I think it provides an opportunity for more access. If they could get something passed, I'd relocated back to Dirty Jersey and call it a day.

I see the same mentality at work here that is responsible for psychology's decline. We all just say "I hope it passes" instead of saying "What can I do to help?" We all need to put skin in the game. I sent $100 to their PAC today. Let's all pitch in

 

[Neuropsych2be]

I'd still guess it has to do with access to prescribers. Many psychiatrists in the Tri-State area are cash-pay because of the supply/demand disparity. I'm not sure having psychologist prescribers will *fix* the problem, but I think it will improve access. If they could get something passed, I'd relocated back to Dirty Jersey and probably offer some part-time hours. It will be interesting to see how far this goes, as that would be a *significant* win for RxP Psychology if they do get something signed into law.

I agree. Getting a "win" in New Mexico is one thing. New Mexico is a lovely state but it has a small population and its not a "playa" on the national stage. But getting a "win" in a major state in the Northeast is something else again. The same sex marriage win in New York has national significance because it is New York. An RXp victory in Jersey would be very very very significant.

 

[Neuropsych2be]

I see the same mentality at work here that is responsible for psychology's decline. We all just say "I hope it passes" instead of saying "What can I do to help?" We all need to put skin in the game. I sent $100 to their PAC today. Let's all pitch in

Here here. Who is their PAC and how does one donate??

 

[Therapist4Chnge]

I see the same mentality at work here that is responsible for psychology's decline. We all just say "I hope it passes" instead of saying "What can I do to help?" We all need to put skin in the game. I sent $100 to their PAC today. Let's all pitch in

I'm actually reading through the NJPA website right now to learn more about the proposed legislation. Here is a link to contribute to the NJPA PAC to help support the legislation: https://www.psychologynj.org/donate

Here is more specific information about the proposed legislation: http://njamp.net/interesting-links/

 

[Neuropsych2be]

I see the same mentality at work here that is responsible for psychology's decline. We all just say "I hope it passes" instead of saying "What can I do to help?" We all need to put skin in the game. I sent $100 to their PAC today. Let's all pitch in

Of course being New Jersey we could always pay my cousins Rocko and Tony to "convince" members of the legislature to vote for this. Rocko and Tony work for a certain organization that could be very helpful in advocating for our cause with the politicians in Trenton. It would be cheaper than donating to a PAC (disclaimer I am only joking .... ).

 

[OhHello]

lol wow, psychiatrists in NJ will sure be pissed if that goes through!

Do you really trust psychologists to be giving prescriptions for Xanax though?

 

[Jegg]

Prescription privilages for psychologists in the state of NJ is up for vote soon! If you vote in NJ, send your full name/email/possible school to [email protected] by OCTOBER 31 and also make your family members/peers in NJ do the same...you will get an email with one of those filled out letters to your governor.

Does this mean that psychologists will be able to prescribe marijuana?

Paging Dr. Landy...

 

[AcronymAllergy]

lol wow, psychiatrists in NJ will sure be pissed if that goes through!

Do you really trust psychologists to be giving prescriptions for Xanax though?

I haven't reviewed the NJ legislation itself, but I'm almost positive it requires that prescribing psychologists first receive the "standard" additional training in psychopharmacology that is undertaken by prescribing psychologists in NM and LA, pass the competency exam, and then practice under physician supervision for X years or XXX number of cases.

Whether or not the current psychopharm training is sufficient is of course another debate entirely, but I doubt NJ would allow psychologists to prescribe without first finishing this training.

 

[Therapist4Chnge]

Do you really trust psychologists to be giving prescriptions for Xanax though?

Absolutely.

The vast majority of benzo prescriptions come from GPs/FPs/PCPs, and not from psychiatrists or other prescribing providers. Prescribing practices of RxP psychologists, per the DOD study, have shown that they are less likely to prescribe a medication than their physician counterparts. Given this information, I'd hypothesize that a prescribing psychologist who is working with the PCP (the proposed setup in the NJ legislation) will be much less likely to prescribe a benzo like Xanax, and more likely to look for alternative pharmacological and non-pharmacological interventions.

As an aside, Xanax's ideal clinical use is very narrow, but it is often given out like candy. There are very specific instances where it would be the right choice, but most of the time there are better alternative options.

I haven't reviewed the NJ legislation itself, but I'm almost positive it requires that prescribing psychologists first receive the "standard" additional training in psychopharmacology that is undertaken by prescribing psychologists in NM and LA, pass the competency exam, and then practice under physician supervision for X years or XXX number of cases.

The actual language of the bill has not been released (it is probably still being developed by the supporting officials), though based on the document submitted back in May (?), this is the stated path towards psychologists prescribing.

 

[stigmata]

lol wow, psychiatrists in NJ will sure be pissed if that goes through!

Do you really trust psychologists to be giving prescriptions for Xanax though?

Ya Xanax is SOOO complex. It may be problematic, and I never give it, but it is quite simple kinetically and dynamically.

 

[Therapist4Chnge]

Ya Xanax is SOOO complex. It may be problematic, and I never give it, but it is quite simple kinetically and dynamically.

As my prof. was fond of saying, "A benzo is a benzo is a benzo....", with some slight variances. If people weren't so easily behaviorally-reinforced, they'd be a better option for short-term use.

 

[Quynh2007]

When I know several clients of mine being prescribed Celexa or another anti-depressant but is clearly bipolar, especially a child who is in a hypomanic phase, yes, I say, that psychologists can be just as competent if not more so than others at understanding and prescribing.

I have never taken a psychopharm class, but it is basic knowledge not to give someone with a bipolar an anti-depressant, yet, nurses, doctors, etc do it all the time for the depression and ignore the mania when they should in fact be getting a mood stabilizer.

 

[Neuropsych2be]

This is a great example of why I oppose prescription privileges. You're basically saying "I have no medical knowledge or even psychopharm training, but I certainly think I'm better qualified than those who do to make medical decisions". Sometimes you don't know what you don't know, I suppose, but this has reckless written all over it.

Well everyone in this field can point to bad medication management or psychiatrist horror stories. I think it can be very easy to think that we could do better. The big problem with psychiatry isn't their prescribing medications per se. Psychiatry today tends to attract some of the worst prepared physicians who graduate at the bottom 3rd of their medical school class. Compounding this are the enormous number of foreign medical school grads, some of whom can barely speak American English in a comprehensible way, entering psychiatry when they can't get boarded in their original specialty. These folks then operate in a milieu where culture and language is central.

 

[edieb]

This is a great example of why I oppose prescription privileges. You're basically saying "I have no medical knowledge or even psychopharm training, but I certainly think I'm better qualified than those who do to make medical decisions". Sometimes you don't know what you don't know, I suppose, but this has reckless written all over it.

In order to be trained to prescribe, a psychologist has to earn an additonal master's degree and pass a standardized exam called the PEP which assesses knowledge about a variety of domains relevant to prescribing:

http://www.rxpsychology.com/pep_knowledge_domains.pdf

 

[edieb]

Yes, I know. I was responding to the sentiment of the comment. I feel the actual training as it stands currently is not enough, but that's a whole other issue.

Yes, and being a licensed psychologist who has completed the psychopharm training, you are SO qualified to comment on the adequacy of the training

 

[cara susanna]

I dunno, the more I hear about how sketchy the chemical imbalance model of mental illness is, the happier I am that I can't prescribe psychotropic meds.

 

[OhHello]

Ya Xanax is SOOO complex. It may be problematic, and I never give it, but it is quite simple kinetically and dynamically.

No, I mean, cos the entire state of New Jersey will get hooked!

 

[OhHello]

I dunno, the more I hear about how sketchy the chemical imbalance model of mental illness is, the happier I am that I can't prescribe psychotropic meds.

Why do people in the psych field use the buzz phrase "chemical imbalance" anyway? (Not criticizing just asking)

I get that they mean they think it's all a neurotransmitter issue but I don't think that's the real dogma of somatic therapy. I don't think the school of thought that sees mental illness is mainly organic thinks it can be reduced to the neurotransmitters we know. The phrase "X is caused by a 'chemical imbalance'" is something people who haven't studied psych have picked up though pop psych and is repeated really matter-of-factly by people who have no idea of how much they're simplifying things. I think the psych field should make a point to stop using the phrase.

 

[stigmata]

I dunno, the more I hear about how sketchy the chemical imbalance model of mental illness is, the happier I am that I can't prescribe psychotropic meds.

Nobody believes this? I am not sure it was ever a model at all, but a lay-person interpretation of why more meds are being used. Every thought, feeling, impulse, symptom or cognition has a physio-chemical component.

 

[cara susanna]

Okay, fine, I mean the dopamine theory for schizophrenia and the serotonin (and NE) theory for depression.

Basically, anything that Stahl ever wrote.

 

[Neuropsych2be]

Okay, fine, I mean the dopamine theory for schizophrenia and the serotonin (and NE) theory for depression.

Basically, anything that Stahl ever wrote.

Cara

I agree but my view is more nuanced. Why should we psychologists give our clients all the benefits of a placebo and all the risks of a psychotropic?? Actually, while I support RXp for professional reasons, I am skeptical about much of the underlying "science" behind anti-depressants. If one examines the effect sizes of psychotherapy, you will find that psychotherapy is frequently more powerful than antidepressants and anxiolytics.

The interest I have in RXp is that it would give us the power un *unsubscribe* that most evil of all substances benzodiazapines. My own observation is that long term use of benzos increases general anxiety and panic across time much to the detriment of clients. The limbic system has a mind of its own and anxiety will not be banished by a pill. It finds a way to manifest itself.. My dream job would be getting RXp and running an anxiety treatment center whose focus is getting client off benzodiazapines forever while concurrently teaching coping skills. And yest Stahl is vastly over-rated.