Why Psychology and Psychiatry SHOULD NOT merge

[Poety]

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I give up - forget it

 

[Miklos]

Everything is biological.

Come again?

 

[Poety]

I'm just trying to make a positive post here - seems like its impossible, I give up, I see it starting already.

 

[Miklos]

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?

 

[Poety]

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.

 

[PublicHealth]

I'm at a loss for words.

So, in your view, environment determines behavior?

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

http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=14706942&query_hl=4

 

[Poety]

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.


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"

 

[Miklos]

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

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

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...

😕

 

[Poety]

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. . .

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.

 

[50960]

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.

🙂

 

[Miklos]

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.

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

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

 

[Miklos]

What are you getting at exactly? That going down to a certain level is an argument of infinite regress? In other words, not practical?

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

 

[Poety]

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....

 

[Miklos]

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

 

[Poety]

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.

 

[Poety]

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)

 

[mosche]

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....

 

[Poety]

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.

 

[mosche]

Jon <snaps fingers> you're NOT SINGING. 😉

 

[Poety]

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.

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)

 

[mosche]

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

 

[Poety]

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

I'm not ALWAYS nice Mosche 😛 That would be weird LOL

 

[mosche]

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! 😉

 

[Solideliquid]

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.

 

[PsychEval]

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.

 

[50960]

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.

 

[Solideliquid]

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....

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!

 

[Poety]

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.

 

[50960]

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

 

[Poety]

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!

Ok, now:

TSH: 9
t3: 100
T4: 4

CBC/LFT/Chem 7 - normal

UDS -

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 -

 

[Poety]

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

true, it can be scary in here can't it psici?

 

[OldPsychDoc]

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! 😉

"Hark the herald angels sing..."


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

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

 

[Poety]

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

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

 

[PsychEval]

Any polydipsia or polyuria?

 

[Poety]

Any polydipsia or polyuria?

no

 

[Anasazi23]

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).
😀

 

[Poety]

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).
😀

 

[50960]

Hypothyroidism...easy.

 

[Poety]

Hypothyroidism...easy.

Good job psisci, now treat - 😀

and for those that didn't already get it: When a woman presents with s/s of depression, after having a child - you must include in the differential subacute thyroiditis (an autoimmune response) this answer was evident by her experiencing palpatations shortly after the birth, that then went away (would be the hyperthyroid episode)

Now, what I fear, is that many psychologists don't have the background to do a full differntial on this patient - and as such, would throw some anti-depressant at her which coudl be catastrophic - does everyone now see why you need a medical background to manage meds? If not - I don't know what else to say, we've already had someone order a 1500. test for Petes sake 😱

 

[PsychEval]

Ok, now:

TSH: 9
t3: 100
T4: 4

CBC/LFT/Chem 7 - normal

UDS -

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 -

The main problem with the TSH test is that the reference range for it is too wide at most labs. The upper end of the range at some labs goes as high as 6, but according to the hundreds of references that we've compiled, symptoms of hypothyroidism accompanied by a TSH level over 2. Am I getting warm?

 

[Poety]

[/B]

The main problem with the TSH test is that the reference range for it is too wide at most labs. The upper end of the range at some labs goes as high as 6, but according to the hundreds of references that we've compiled, symptoms of hypothyroidism accompanied by a TSH level over 2. Am I getting warm?

One could infer that the TSH was elevated which is all that would be needed for correct guiding toward the diagnosis. I intentionally shot it up so people could recognize it readily.

 

[PsychEval]

Cool. I had fun playing doctor with you poety.

 

[Solideliquid]

Ok, now:

TSH: 9
t3: 100
T4: 4

CBC/LFT/Chem 7 - normal

UDS -

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 -

OK then seems like hypothyroidism. I would refer out to endocrinology at this point.

 

[Poety]

Cool. I had fun playing doctor with you poety.

🙂 😀 😛

 

[Poety]

That was the first hypothesis posed (thyroid). I confess I don't know the ranges for the thyroid tests. In RL, if I was presented with them with no physician interpretation, I'd look them up (as I've done with other relevant tests). Also, if this patient walked into my office, I would have referred out immediately for a medical workup including checking thyroid levels at which point hypothyroidism would have been diagnosed. What more would you want?


Just out of curiosity. Explain the catastrophe of prescribing an anti-depressant to someone with hypothyroidism?

Jon, your response would actually have been EXACTLY APPROPRIATE: If she walked into my office, I would have referred out for a medical workup.

But then my question is: (and this doesn't apply to you because you don't want to prescribe) This patient would get the treatment they need elsewhere, where does the need for a psychologist to prescribe come in? Anyone?

 

[Poety]

Just out of curiosity. Explain the catastrophe of prescribing an anti-depressant to someone with hypothyroidism?

I should have said, this patient would have continued to go untreated for her underlying medical condition, which to me IS catastrophic - thats what I meant to say - we're trained not to only treat symptoms but to find the cause- sorry I wasn't clear on that earlier.

 

[Poety]

Where does the need for the psychiatrist to prescribe come in this case?

the psychiatrist "prescibed" the appropriate tests -
which requires ---- a medical background ---- which led to ---- the patient getting treated appropriately.

As Solid eluded to, he got the tests, he did the work up, and sent her to endo- which is appropriate - psychologists aren't even able to do the workup - so why do they need to prescribe meds anyone?

Even in another scenario, I can't find the point of it ANYWHERE.

 

[PsychEval]

The patient may have also received 5 years of therapy from a psychologist with no benefit. That is another reason why it is important for psychologist to have medical training (for appropriate triage). Right?

 

[Poety]

The patient may have also received 5 years of therapy from a psychologist with no benefit. That is another reason why it is important for psychologist to have medical training (for appropriate triage). Right?

yes.

 

[Solideliquid]

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.

How is this a trap? This is a classic example of what you can see on the USMLE.