Why is Psych not competitive?

[clausewitz2]

Who knows, almost all of the TMS studies are on people who have failed everything else multiple times. Studies that weren't started this way, failed because of lack of enrollment. It takes a lot to be ill and trust an unproven treatment.

I wonder if maybe we'll see the first good evidence of alleviation of mood symptoms with TMS emerge incidentally from the PM&R literature, as many of them are very keen on rTMS for recovery of motor function post stroke/ spinal cord injury. That patient population will generally try almost anything offering hope of improvement.

A bit how ketamine for depression came out of anesthesiology and antipsychotics came out of surgical literature.

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[MacDonaldTriad]

Lots of specialties have contributed more to psychiatry than any one psychiatrist. Maybe some day other specialties will stop being amazed when we have something to offer to them. A bit of an exaggeration, but I see a lot of evals that mention how well residents do despite being a psychiatrist. Maybe we should start rotating through radiology and upstage them.

 

[FlowRate]

Lots of specialties have contributed more to psychiatry than any one psychiatrist. Maybe some day other specialties will stop being amazed when we have something to offer to them. A bit of an exaggeration, but I see a lot of evals that mention how well residents do despite being a psychiatrist. Maybe we should start rotating through radiology and upstage them.

Honestly, I think a full medicine prelim year would be the only way to dispel the bias, even though many of us are just as medically adept as our IM-bound colleagues upon graduation from medical school.* I'm considering it a negative when programs have several months of outpatient primary care to fulfill the medicine training requirements--I think we should be as well-trained in medicine as our 4 months allow.

*To be clear, I don't think I'd prefer to actually do a medicine prelim, even though I know it is a somewhat risky option to anyone who really wants to do medicine then join psych as a PGY-2.

 

[MacDonaldTriad]

Yah, don't do TY. PGY-IIs are hard to find in psych. None the less, I hear you. Look at what Psych programs have real and not rented out medicine rotations.

 

[Shikima]

Why wouldn't psych want TY's prior to entry ... much like IM/TY prior to starting Neurology.

 

[MacDonaldTriad]

I think psych would like TYs, there just are very few PGY-II positions relative to demand.

 

[splik]

I wonder if maybe we'll see the first good evidence of alleviation of mood symptoms with TMS emerge incidentally from the PM&R literature, as many of them are very keen on rTMS for recovery of motor function post stroke/ spinal cord injury. That patient population will generally try almost anything offering hope of improvement.

A bit how ketamine for depression came out of anesthesiology and antipsychotics came out of surgical literature.

erm ketamine for depression didn't come out of anesthesiology (it is based on animal models of depression suggesting a role for glutamate in the pathogenesis) nor did antipsychotics come out of surgical literature, Delay and Deniker were well on their to studying the effects of chlorpromazine (RP4560) on their patients before Laborit published anything on it (though they were certainly familiar)

TMS is quackery. I like to keep an open mind so I am getting trained in this voodoo but it all feels a little silly. I'm wondering whether thinking about just how ridiculous one looks with this giant magnet overhead doesn't help even the most depressed person crack a smile. The idea is somewhat risible.

Also if you read the literature on ketamine you will see this evolution from it being used as a model to develop more rapidly acting antidepressants to being touted and studied as a treatment for treatment-resistant depression itself, quietly ignoring the earlier papers that noted the problems that would prevent widespread use of this as a practical treatment.

Delay J, Deniker P. Le traitments de psychoses par une méthode neurolytique dérivée de l’hibernothérapie; le 4560 RP utilisée seul en cure prolongée et continue. CR Congr Méd Alién Neurol (France) 1952a; 50: 497-502.
Laborit H, Huguenard P, Alluaume R. Un noveau stabilisateur végétatif (le 4560 RP). La Presse Médicale 1952; 60: 206-8.
Berman RM, Cappiello A, Anand A, Oren DA, Heninger GR, Charney DS. Antidepressant effects of ketamine in depressed patients. Biol Psychiatry. 2000;47:351–4

 

[clausewitz2]

erm ketamine for depression didn't come out of anesthesiology (it is based on animal models of depression suggesting a role for glutamate in the pathogenesis) nor did antipsychotics come out of surgical literature, Delay and Deniker were well on their to studying the effects of chlorpromazine (RP4560) on their patients before Laborit published anything on it (though they were certainly familiar)

TMS is quackery. I like to keep an open mind so I am getting trained in this voodoo but it all feels a little silly. I'm wondering whether thinking about just how ridiculous one looks with this giant magnet overhead doesn't help even the most depressed person crack a smile. The idea is somewhat risible.

Also if you read the literature on ketamine you will see this evolution from it being used as a model to develop more rapidly acting antidepressants to being touted and studied as a treatment for treatment-resistant depression itself, quietly ignoring the earlier papers that noted the problems that would prevent widespread use of this as a practical treatment.

Delay J, Deniker P. Le traitments de psychoses par une méthode neurolytique dérivée de l’hibernothérapie; le 4560 RP utilisée seul en cure prolongée et continue. CR Congr Méd Alién Neurol (France) 1952a; 50: 497-502.
Laborit H, Huguenard P, Alluaume R. Un noveau stabilisateur végétatif (le 4560 RP). La Presse Médicale 1952; 60: 206-8.
Berman RM, Cappiello A, Anand A, Oren DA, Heninger GR, Charney DS. Antidepressant effects of ketamine in depressed patients. Biol Psychiatry. 2000;47:351–4

Appreciate the proper historical perspective. Always such a useful corrective to the lore that circulates in any field.

I will say there is good data on rTMS in the stroke rehab literature, but obviously that in no way entails it will ever be useful in psychiatry per se.