Why Psychology and Psychiatry SHOULD NOT merge

Everything is biological.

Heh. I'd say that psychologists are quite active generating their own questions. Research is not a problem and really not relevant to the strife that seems to exists among trainees in psychiatry/psychology land. It's about scope of practice. Both psychology and psychiatry have their fair share of excellent researchers spanning an impressive breadth of subject matter. Psychology researchers are actually well versed in the physiology of that which they study (if that is their focus) and don't need medical consultation to generate relevant research questions.

Again, psychologists are perfectly capable of generating their own testing criteria for challenging patients. I'm not sure if you mean this as a research or clinical comment. I'm all for translational research. It's important stuff.

Also, a general point. There is no danger of psychiatry and psychology merging. They are different beasts.

Within the clinical arena, psychologists are best suited for assessment (across a range of disciplines: neuropsychology, forensic, educational, developmental, behavioral, health, etc. . ). This is a true strength. Also managing and directing psychotherapy treatments (including group and individual) is a strength. Clinical psychology is the gold standard of training in this area.

Psychiatrists are best suited for prescriping psychoactive medications across a range of applications: notably acute psychiatric care. They do an amazing job in that arena. Med management is also an important task with patients often needing trials of many different meds and med changes over time to strike an effective therapeutic balance. It's a truly difficult task.

 

Come again?

 

Hmm. My apologies, but it started in your post. I'm not insulted or miffed about it. The issue is perspective and fundamental attribution errors (in a sense).

I still think this can be a positive thread. There is confusion about what psychology does and what psychiatry does amongst ourselves and the medical community. Perhaps a way to handle this (in the spirit of your original post) is to have the various camps post what they're good at, rather than trying to define what the other is good at.

Environment affects the brain. Everything is biological. Example: You can treat a mood disorder like depression with drugs or therapy. Both affect the brain (e.g. relative activation states across brain regions inter and intrahemipherically and neurotransmitter levels).

 

I'm at a loss for words.

So, in your view, environment determines behavior?

 

Umm. . . no. Where did you get that idea from my posts?

Environment (i.e., womb, air quality, social interaction, food content, etc. . .) influences behavior.

 

I think this, at least in part, is what Jon Snow is referring to:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14706942&query_hl=4

 

If you're doing this on purpose. . bravo. If not, you seem to have a bit of a blind spot.


Since I'm the only psychologist posting in this thread, you have to be referring to me. I don't see where I was negative. Who said anything about not needing psychiatrists as a whole? Perhaps your negative interactions in your research rotation and your perception here is because of your insistence on placing psychiatry in a superior role even within the research environment (nutty concept). It appears you don't believe that psychologists are capable or trained in physiology as it relates to mental health issues and human behavior. Two of the biggest research areas in psychology are psychophysiology and cognitive neuroscience. Students often take medical school neuroanatomy and neuropathology (I did) in addition to experimental neuroscience coursework spanning neuroimaging (e.g., fMRI, diffusion tensor imaging, EEG, MEG, etc. . .) and electrophysiological measurements across a range of functional systems. So, in that sense, we don't need psychiatrists to generate hypotheses that involve physiology/behavior interactions. It's what we do. That's not to say that psychologists don't consult psychiatrists (and vice versa) on research hypotheses. It's a matter of individual expertise. If a psychiatrist is an expert in a particular system and I was putting together a study that involved that system, you bet your arse that I would be approaching them to get their input or involve them in the research.


There is no reason for hostility here.

 

Well, sure. But that's in good fun.

Just to refresh. . .

The inference I took from this was that the knowlege of the structure of how to do a clinical trial is valuable to assist MDs in persuing the questions they (MDs) want answered. True or no? If true, yes I see that as a helpful skill, though it's more in a technician like role. However, I felt it necessary to point out that the strength of psychology in research goes beyond that. Since this thread was supposed to be about postives that psychologists and psychiatrists bring to the field, I thought elaborating on the scope was important.

You then jumped to. . .

 

At what level exactly?

• Womb - Twin to twin transfusion syndrome, persistent and severe and/or well-timed insults to the embryo/fetus?
• Air quality - Like the rat in Skinner's box?
• Food content - Don't know the oral bioavailability of androgens present in bull's balls (does anyone?), but...

 

I didn't think it was insulting until your second post about your research experience. It's hard to catch nuance on a message board. I don't tend to get worked up about it.

Well, except that I agree with you, so I'm not sure why I'm included in that.

I agree.

 

How did I miss this whole diatribe until now??? Carry on. BTW, nobody wants psychology and psychiatry to merge......

My 2 cents is that psychiatrists are the best trained to treat serious mental illness, and mental illness with medical comorbidities. Psychologists are best trained to treat medium-minor (the majority) severity mental illnesses, but do not have the proper tools, and will not until some level of limited RxP is available.

 

What are you getting at exactly? That going down to a certain level is an argument of infinite regress? In other words, not practical? If so, I both agree and disagree. Really, I'm not talking out of both sides of my mouth. I disagree because I think it's important to always keep in mind brain/body/behavior relationships (e.g., excercise influence cognitive and emotion functions, depression influences perception, etc. . .). It is important to understand research on psychophysiological relationships and how they might relate to treatment success (e.g., psychopathy, anxiety, etc. . .). The psychophysiological impact of treatments is important to be aware of as well (e.g. Topamax might cause/influence negatively altered cognition). I agree in that knowing that womb temperature at a certain time might relate to the development of say homosexuality (not a mental illness, just an example of how such things might influence future behavior) has little bearing on how you address someone that is experiencing adjustment issues with their sexuality.

 

Makes me wonder if these conditions are even mental illnesses...

Yeah, I bet you'd like a share of the worried well "mentally ill".

 

Really? What about autism?

 

That's precisely what I was getting at. There's plenty of plasticity built into (most) human beings.

 

Oh that's easy! I'd immediately prescribe 10,000 mg of Seroquel bid.

 

Not enough information. For example, how's her thyroid?

 

I think that I am going to come down on the side of the two professions mergeing. We can call it psychiatryology. I plan to write an NIH grant proposal that will focus on how the field of psychiatryology will force us all to get along. Poety, why don't you lead us all in a happy round of "Kum Ba Yah"!?

Everybody sing....

 

I can't order tests (at least not that I'm aware of). I would have to refer out for that. How it normally works is I would write an evaluation. As part of that evaluation, I would review medical records. If I saw something I felt needed to be ruled out, and, if not already done, I would recommend it/refer out (not that much different than an outpatient psychiatrist in that respect). With a referral like this patient, there would be a clinical interview. More extensive evaluation might include a SCID. If anything was medically amiss or not covered, I would refer out to treat it and see if it "fixed" the problem.

Most often, patients I see have already had extensive medical workups so I can look at the data. Sometimes I find something, sometimes not.

 

Jon <snaps fingers> you're NOT SINGING.

 

Poety <disappointed> I really expected so much more from you.

 

But it's Christmas < grimmaces because he knows that his mother would be so disappointed that he made the yuletide reference> think about the Christmas bunny hiding the Christmas eggs! That will make it all better!

 

You think so (the referral to a psychiatrist)? Probably not is the more likely situation. Most of the time you'd be dealing with a PCP.

 

I LOVE that Christmas bunny! So cute and cuddly....


P.S.> I want to practice medicine, so I went to medical school to learn how to do this. If psychologists want to practice medicine they should have gone to med school. Thats just the way I feel about these things. I'm not going to attempt a cholectomy if I didn't complete a surgery residency, and I'm not going to demand the right to cut someone open because I did a three month surgery 3rd year rotation.

 

Psychologists in LA, NM, Guam, and those who went through the DOD training are allowed to order tests. Various training programs have psychologists reading and being tested over books like Physicians guide to laboratory medicine. I don’t think this is the place to be pimping anyone.

 

Not even close to enough info, and I have no interest in walking into a trap. With what you told me I would check thyroid, CBC, maybe LFTs, get a good med hx as well as current meds, and consider effexor 37.5 qam to start.

 

I'd like to give this one a shot...kind of like Step 2 CS lol (which psychologists do NOT take, just thought I'd drop that in).

OK, first I'd ask if her depression seems to be the episodic kind, for example are there periods where you are not depressed? Then I would ask if she had ever had a manic episode (have you ever experienced thoughts racing through your head, felt like you could do anything, gone out and spend tons of money on just stuff?).
I would also need to assess her mood at the time, memory, libido, that sort of thing probably not go as far as doing a mini mental though. And ask if she has thought about hurting herself or others.

DDx: Major depression / Bipolar, Dysthymic disorder (this is what it sounds like), post partum depression

Labs: Check T3/T4, TSH, CBC, and toxic screen.
Rx: probably start her on a Zoloft starter pack.

Im applying for residency in psych in the upcoming match, would someone care to offer constructive criticism on the above? Thanks!

 

I did not think you were, but it would open up the trap to all who are more critical.

 

Hmm. How about an MRI and a cardiovascular eval? . . . and a neuropsych to quantify the cognitive complaint.

 

"Hark the herald angels sing..."


Hot cider and mulled wine at OPD's place after carolling!

No shop talk allowed!!!!!!!!!!

 

Any polydipsia or polyuria?

 

Guys, this is bad.

She basically told you the answer already.

I'll be back. I gotta run to Old Navy. I need some new boxers.
(I actually am going to Old Navy to get boxers, lest the more subtle amongst us think this is some sort of excrement-laden quip).