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questions about diagnosing mental disorders


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I tend to agree but I've seen a lot of variability in this area. And the reality of emergency psychiatric care may not meet anything approaching helpful. Depends on the hospital and who is on duty.

 

It really depends on the PCP. Some have additional training in and experience with mental health issues. Others are clueless. Without knowing the history, the severity of the existing dx, the dose, the med (I missed which specific one it was, I assumed it was a second gen anti-psychotic of some sort) and the plan for follow up, it's hard to say. I'd be pretty outraged if this were the first conversation about this class of meds, if there wasn't a follow up in the works and if the doctor is a-ok with meds only. I just didn't get the impression that the prescription necessarily meant any new dx, much less a dx of bipolar.

 

What I can say definitively is that this meds only desire/thinking/approach preferred by the patient/husband is unwise.

 

I think we are on the same page, especially with the bolded.

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I can only imagine how a phone call to the PCP went down.

 

"Good afternoon, Dr. Smith.You know how you've been treating me for depression? Well, I think I may be bipolar. You know I have a busy schedule and don't have time to wait for an appt. Can you help me out?"

"Well, are you still depressed"

"Yes"

"Are you experiencing any new symptoms? Like mania? Periods when you feel really good, excited, full of life? Like nothing can stop you or slow you down"

"Yes, exactly."

"Do you feel like your life is being negatively effected by these mood swings?"

"Yes"

"There's a new med I would like to try. I'll call in a script. Do you still use the Pharmacy on Main street?"

 

 

Pretty much. Only it wasn't the Doctor. I found out it was the PA. 

 

He didn't pick up the meds yet and scheduled an appointment with the Doctor for friday.  

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Pretty much. Only it wasn't the Doctor. I found out it was the PA. 

 

He didn't pick up the meds yet and scheduled an appointment with the Doctor for friday.  

 

a PA . . . :svengo:  though even in the psych unit of a hospital (re: emergency admission for my mother) they had "mental health specialists" who were maybe (maybe) equivalent to a pa - they weren't drs.

 

glad he has an appointment with the doctor.

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I shall add my own voice to the choir even though I normally find myself holding an unpopular opinion on mental illness threads.

 

Psych meds are serious business, more analagous to chemotherapy than aspirin.

 

We can all agree on that.

 

:grouphug: OP, and I am so sorry that you are going through this.

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I shall add my own voice to the choir even though I normally find myself holding an unpopular opinion on mental illness threads.

 

Psych meds are serious business, more analagous to chemotherapy than aspirin.

 

We can all agree on that.

 

:grouphug: OP, and I am so sorry that you are going through this.

Medically speaking, it is chemotherapy. In its most basic definition - chemotherapy means the treatment of disease using chemicals. There is a psychiatric billing code for "chemotherapy management"
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a PA . . . :svengo: though even in the psych unit of a hospital (re: emergency admission for my mother) they had "mental health specialists" who were maybe (maybe) equivalent to a pa - they weren't drs.

 

glad he has an appointment with the doctor.

There are mid level psychiatric specialists for sure. Both PAs and ARNPs. I have been pretty pleased using a psychiatric NP myself.

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There are mid level psychiatric specialists for sure. Both PAs and ARNPs. I have been pretty pleased using a psychiatric NP myself.

 

PA's and NP's do a lot of psychiatric care - there aren't enough MD's to go around. They are very qualified. 

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There are mid level psychiatric specialists for sure. Both PAs and ARNPs. I have been pretty pleased using a psychiatric NP myself.

 

A pa who only does psych isn't the same as one working in a regular Dr's office.

 

How are you liking the weather?

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A pa who only does psych isn't the same as one working in a regular Dr's office.

 

How are you liking the weather?

Was driving to my first PTA meeting when the sky was going off like crazy. :P

 

I'm also wondering if raingutter regatta got rained out at scouts tonight.

Edited by LucyStoner
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There are mid level psychiatric specialists for sure. Both PAs and ARNPs. I have been pretty pleased using a psychiatric NP myself.

We have also had a better experience with a psychiatric nurse practitioner than with the psychiatrists we have tried. The psychiatrists are just too busy--hard to get appointments, and when you do they are in-and-out. The NP actually takes the time to sit down and really talk through symptoms and medication options and side effects, and to talk about lifestyle factors such as exercise and diet and sleep as well.

Edited by maize
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A pa who only does psych isn't the same as one working in a regular Dr's office.

 

 

This is true!

 

And I seriously question the judgment of a general practice PA who would prescribe a new psych medication over the phone.

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Well crud. Appointment was rescheduled to two weeks from now.

Ugh.

 

Have you looked into psychiatric providers in your area? If you have ongoing mental health issues to deal with it really is worth getting in with someone who specializes in those. Wait times can be long and you may have to try more than one to find a good fit, so I would call today to get the ball rolling. Maybe try to get appointments with a couple of different practitioners.

 

Also, if your husband is open to it, I strongly recommend going with him to his psychiatric appointments. You have a perspective on his illness and the ways it affects him that can be very valuable to a doctor in making assessments and treatment decisions.

Edited by maize
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a PA . . . :svengo: though even in the psych unit of a hospital (re: emergency admission for my mother) they had "mental health specialists" who were maybe (maybe) equivalent to a pa - they weren't drs.

 

glad he has an appointment with the doctor.

Our local psych hospital ONLY uses PAs and social workers. They have one psychiatrist that overseas the psych ER and the unit, but as he doesn't have any real patient contact I don't know that he's useful in prescribing.

 

I think this scenario is much much more common than people realize. There are not enough psychiatrists, psychologists, or mental health beds available.

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I am fully qualified and licensed to diagnose and treat bipolar (and other mental illness). Never over the phone, and usually not in one session. In the overwhelming majority of cases, I recommend a full panel at a PCP, and, if that doesn't turn up something like thyroid, etc, I recommend a Psychiatrist because mental illness is a specialty. If substance abuse is involved, I am even MORE selective about the Psych Dr.

 

I am perfectly able to assist treating bipolar, or anxiety, or depression (I would refer out schizophrenia and OCD) as a part of a team of professionals. The Dr. does their thing, and I do mine. 

 

 

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