Recent shootings...

[daru1]

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Given: http://www.cnn.com/2007/US/12/11/shooter.youth/index.html

News bias aside (I always err on the side of them not giving or covering the full story), how many times do you guys and gals in practice get referrals from psychologists that are trying to treat patients with - what I suspect here - schizophrenia?

I'm not really looking to start the psychologist vs. psychiatrist fight here, so I'll keep my opinions to myself, and would ask those that want to start that fight, do the same.

 

[PeeWee137]

funny, i was thinking of posting a thread on this topic as well.

i wonder if this is partly the result of a shortage of psychiatrists? from what i understand, most of the docs seem to be concentrated in the big coastal cities. i was always under the impression that the mid-west had a severe need for more psychiatrists. thankfully there are psychologists to fill some of that void.
these stories are just so sad.

 

[OldPsychDoc]

Regardless of degree, these are not people who are easy to treat, even if you are getting the bad vibes ahead of time. The paranoia can often be covered up and delusions "held together" for an while, so the "dark thoughts" get diagnosed as depression, and the kid gets started on an SSRI instead of an antipsychotic. The diagnosis is far from a "slam dunk" in the real world. The behaviors end up falling short of the threshold that puts them in a hospital or gets them committed. Families are notoriously invested in denial--even if there's a reasonably functional family, it's just hard to accept that something could be seriously wrong. Excuses get made, follow-up gets fragmented or neglected...I just see it happening all the time, and it's only the grace of God that more don't end up this way. 🙁

 

[MBK2003]

I saw two young adults who were referred for med management for their MDD by their therapists (credentials unimportant) and both had psychotic depressions lasting >2 months. To the credit of one of therapists, it was recognized by him and he leveraged the relationship with the patient to get him to come see me for meds despite my being a "pill pusher who was only trying to make him a slobbering mental patient."

I've seen a troubling trend in child psychiatry recently with 2 adolescent patients referred to me by PCPs with Bipolar disorder diagnosed by the PCP (no mental health professionals anywhere near the cases) and on mood stabilizers (VPA in one case, Zyprexa in another). I'm all for integration with primary care and management of ADHD and uncomplicated MDD by PCPs, but this was ridiculous. Don't get me started on what the "actual" diagnoses were. Our clinic's wait time for an outpatient C&A psychiatry consultation is 7-10 days, so it's not like there aren't available psychiatrists to accurately diagnose the kids. 😡