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Discussion in 'Psychiatry' started by Poety, Nov 30, 2005.
I give up - forget it
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.
I'm just trying to make a positive post here - seems like its impossible, I give up, I see it starting already.
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?
I'm not sure about this, but I think (from random conversations with psychologist investigators) that psychology has a big focus on environment dictating behavior. However, I'm not a psychologist so I don't know.
In regard to the other post: I know that from my limited experience I've tried really hard to be positive about both ends and to be honest, I always catch more hell from the psychologists saying how great they are, how superior they are in what they do, how they don't need psychiatrists for anything etc etc - its quite obnoxious, they act like they own the field of mental health and its very disturbing.
I dealt with this for 8 months during my research experience which made my time there miserable, and all it proved is that the people I worked with were fundamentally insecure about their positions. Its sad to see the same ideas being thrown around on this message board - no wonder psych gets the rap that it does - people can't even get along on an anonymous board - let alone in real life.
I'm finding that the posts have been most negative from psychologists coming in here to rebuttle what the psychs have been talking about, however I don't see the psychiatrists going over to the psychology board ranting and raving about how great we are - so I don't know.
I tried to make this a positive post but I can already see the arguments begin so I'm done with this -
Sazi, its going to be yet another one of those threads - my intention was good and I'm sorry for making it - you can lock it if you see fit.
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:
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.
You know Jon, I did not put you or your specialty down, in fact if you've read my other posts I've really tried to be supportive to ammend all these differences. However, YOUR REPLIES are the ones that imply that "we don't need psychs, we can do our own research" when that wasn't even along the lines of what my post was saying - in fact, had you read it more closely you would have seen it was COMPLIMENTING your profession but you took it as an insult - the same thing I experienced during my research.
So I'm not responding to your posts anymore - I'm done. You were inflammatory with Sazi, and you're being inflammatory with me in your own double talking way which from what I've seen is a manipulative - its like that side handed "let me insult you, but lets be friends, no need for hostility"
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...
First, it wasn't taken as good fun to me.
Second, it was not to say "oh to help MD's answer their questions" it was TO POINT OUT THAT PSYCHOLOGISTS HAVE THE TRAINING IN CLINICAL TRIALS AND COMPLIMENT PSYCHIATRISTS WHEN THEY WANT TO ANSWER QUESTIONS THEMSELVES i.e. most MD's have a psychologist on board to assist them in answering the QUESTION THEY CAME UP WITH - how thats insulting to your profession I'll never know. And I think I said in some other posts, that a tremendous amount of research is actually conducted by the psychologists themselves independent of MD"s with them there to oversee the medical aspect.
And my other response was to you and a couple of other posters that seem to get all enraged whenever someone says boo about a psychologist that shouldn't be prescribing - the fact of the matter is its true. And this debate is readily going on in research institutions and its quite disturbing since - as you have said in previous posts 'you have the pathophys to prescribe since you understand the basis of psychological disorders' well I hate to say it but, if you think prescribing meds is all about just understanding psychological disorders, than wherever you got your education is clearly lacking. Prescribing is not just about being able to diagnose - its about being able to factor in a mulitude of factors like normal physiology, pathophysiology, metabolism, this is not cookbook medicine like I'm sure they're teaching in these condensed courses.
And btw, I think that physicians that practice cookbook medicine are scary - and I personally wouldn't go to one myself.
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.
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.
Psici: How would you prescribe:
I'll give you an example:
28 y.o. F presents to your office with c/o depression lasting for 2+years. Has had no recent sig. life changing experience and reports that she is 'always tired", has increased appetite, has gained an enormous amount of weight over the past 1 year. She had a child 2.3 years ago - but doesn't equate her depression to the birth since she loves her baby and the baby was concieved via in vitro. Husband is supportive, no current conflicts, and reports no other symptoms.
Please tell me how you would approach this patient for prescribing....
Oh that's easy! I'd immediately prescribe 10,000 mg of Seroquel bid.
Make jokes, but I really want to see how a psychologist would handle this for prescribing - everyone says they are capable, so at least let me see a differential since "We are thoroughly trained in assessment and diagnosis"
so... show me.
Not enough information. For example, how's her thyroid?
are you ordering a thyroid test? and if so: which ones
just keep going over all the things you are going to ask, and what tests you are going to request (I don't know if you can order tests or not, I have no idea what the realm of psychologist RxP covers)
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"!?
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.
Mosche, I tried, but got NAILED saying that I was inferring how incompetent psychologists are which you KNOW ME - I wouldn't have said such a thing but my posts got twisted, and then I just got annoyed.
So now, the argument is that psychologists should prescribe, so I said fine - heres a NORMAL CASE SCENARIO - let me see and prove to all the psychiatrists that psychologists really can handle prescribing privelages.
Jon <snaps fingers> you're NOT SINGING.
If these patients have already had an extensive medical workup - they would already have been referred to a psychiatrist for management so where does a psychologists prescribing privelage come into play then?
And, for any (Jon Snow I know you are not for the RxP so it would be unfair of you to have to answer this) but for the psychologists that DO want to prescribe, please - tell me how you would approach adn treat this patient!
(I also edited my response to Jon about the tests)
Poety <disappointed> I really expected so much more from you.
I'm not ALWAYS nice Mosche That would be weird LOL
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 dont 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!
psisci im not trying to trap you, you konw thats not my style. I was honestly asking to see how you would go about it.
psycheval: pimping is part of practicing medicine. If you want to act like a doc, you should be able to perform like one too. students get pimped from DAY ONE, embarrassed, humiliated, and all for the sake of learning -
so I say, when in Rome
This is the psychiatry message board, not the psychology forum afterall.
I did not think you were, but it would open up the trap to all who are more critical.
CBC/LFT/Chem 7 - normal
She noticed her weight gain began about 6 mos. after having her baby- its been increasing since.
Shortly after birth she used to feel her heart racing excessively, she thought it was the "hormones", afterward she noticed feeling more sluggish and finally started feeling "depressed"
She had a couple episodes of feeling "back to her old self" but never for very long. Memory has been poor since the birth of her child although she tries to do memory games to no avail. No episodes of mania -
true, it can be scary in here can't it psici?
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!!!!!!!!!!
all benign, no masses/lesions
also: the usmle step 3 would fail a physician for ordering a 1500.00 test on this one- just so you can see what we are dealing with on the iatry/medicine end
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).