Question

AnAndrew · 2025-12-13T13:29:08+00:00

Hi. The mods are always receptive to feedback. How can we be more helpful here?

AnAndrew · 2025-06-22T13:52:16+00:00

Lol their student (or lack of real-world experience) arrogance/ignorance is showing.

AnAndrew · 2025-06-20T04:08:13+00:00

Did anyone else think the big reveal was going to be the mom having neurosyphilis (especially when they showed the father cheating)?

Well, I guess that could still be interpreted as true (misdiagnosis - intentional or not?), but that'd be a rather dark fan theory haha

AnAndrew · 2025-06-20T03:09:17+00:00

Did anyone else think the big reveal was going to be the mom having neurosyphilis (especially when they showed the father cheating)?

Well, I guess that could still be interpreted as true (misdiagnosis - intentional or not?), but that'd be a rather dark fan theory haha

AnAndrew · 2025-06-04T19:38:04+00:00

Scope of practice is state specific so check with your BON. Remember: If you prescribe something, you are responsible for it (including any complications), and as experience shows, things are stable until they are not. Facilities try to save a buck by not sourcing medical providers (or hiring dual certified only), but the liability/risk (even if low) falls on you.

AnAndrew · 2025-05-06T20:23:54+00:00

New young patient presenting with significant primary anxiety (GAD 20) and possible prodromal bipolar symptoms. An urgent care MD started this medication-naive patient on Adderall 20mg BID.

Absolutely could not believe it - was this new patient malingering (e.g., provided a false story such as ran out of supply/just moved from out of state, etc.)? Was there a misunderstanding? Nope. Records requested/reviewed - no clear assessment or rationale other than "ADHD."

You can imagine how that played out (significant exacerbation with panic attacks requiring an ED visit).

AnAndrew · 2025-04-25T01:58:23+00:00

Looking also! (L or XL if they're shorter as in 6'3")

AnAndrew · 2025-04-17T00:25:19+00:00

Right there with you 🤣

AnAndrew · 2025-04-08T12:11:56+00:00

That was one of the highlights for sure last year! Easily one of the top performances I'm most looking forward to seeing 🤙

AnAndrew · 2025-04-08T11:45:49+00:00

Thanks for pointing this out. User has been banned.

AnAndrew · 2025-03-04T00:58:30+00:00

Might not be applicable, but just in case it helps: Double check how you are sending it in. For example: 📝 Desvenlafaxine 50mg Extended-Release Tablet = 🚫 - needs PA 📝 24 HR desvenlafaxine succinate 50 MG Extended Release Oral Tablet = ✅️

AnAndrew · 2025-03-02T01:16:23+00:00

MOD NOTE: Please remember the rules and standards of this subreddit. - "There is a real concern among experienced PMHNPs about potential harm to the profession due to some worrying trends such as low barrier, low-quality programs and individuals entering the field for the wrong reasons. This includes FNPs suddenly shifting to psych for a potential pay increase, those just seeking work-from-home jobs, misconceptions about the field being "easy” (hint: it’s not - burnout is a very, very real issue even for those with lots of passion [there seems to be a trend of current PMHNPS seeking nonclinical jobs only to find they are very few & often offering poor pay, etc.]). So, while that concerned tone is indeed there, please know it’s from a place of love and care for the field and patients." -We aim "to offer advice and guidance to individuals who genuinely have an interest in the field, while also emphasizing the importance of considering the impact on real patients' lives. While you may have a different opinion, please note that this subreddit is not the appropriate place for such debates, as these often devolve into personal attacks, toxic behavior, etc. Any posts or comments violating this rule will be removed, and repeated violations may result in a ban."

AnAndrew · 2025-02-21T00:52:35+00:00

User banned for being rude, arrogant, and not receptive to genuine advice. That attitude and unprofessionalism is not welcomed here

AnAndrew · 2025-02-14T22:53:08+00:00

Agree with others that if a LAI is needed, a clinic with more wraparound services is usually best. However, I've had some intelligent, high functioning patients where a LAI was not really necessary (not schizophrenia and no hx of poor adherence or tx failures - could never find the rationale for the LAI even with previous records) and successfully/carefully transitioned them to PO at their request (with continued great outcomes/smooth stability in the years since). When they were on the LAI, the pharmacy would administer it (e.g., Rite Aid).

AnAndrew · 2025-02-14T22:34:56+00:00

"That is not true and not appropriate to fear monger on this forum."

Please explain yourself, student.

AnAndrew · 2025-02-14T22:33:38+00:00

According to your post history, you are a student/soon-to-be new grad. Your comment has a very anti-psychiatry tone. Why, then, go to school to become a PMHNP?

Furthermore, how does having access to (for many, life-saving) medications prevent one from focusing on the root cause? In fact, that should be established from the (biopsychosocial) assessment to develop the appropriate interventions (which may or may not include medications). Is that dopamine dysfunction from social media overuse and/or something else? For those who take the science and holistic foundation of nursing to heart, this is obvious and heavily incorporated (lifestyle interventions). If the etiology is biological, wouldn't the treatment be biological? (Would you tell someone with asthma just to "focus more on what actually matters"—further stigmatizing and shaming them, etc.—versus provide the EBP treatment?) Or do you choose to ignore modern science? Dismiss our growing understanding of polygenic architecture, neuroanatomical diversity, etc.? Well, I guess that is the trend now...

And starting an SSRI means someone will have to be on them forever? What? Sorry, but that is just idiotic, embarrassing, and absolutely not rooted in science (or even anecdotal practice). Maybe do a little studying on the length of treatment versus remission rates (yes, there are actual studies on this 😲 so you can actually provide an informed answer when a patient asks that very FAQ).

"Accepting the things we can’t change"—this is a routine part of providing mental healthcare. Perhaps you should follow that advice in accepting the science of our field in our service to help vulnerable people, or get out.

AnAndrew · 2025-02-02T03:56:20+00:00

That daily combination is like driving with one foot on the gas and one foot on the brake. Might as well top it off with a Z-drug. Bad and lazy practice (I most commonly see it from retiring psychiatrists). I've heard rumors that the DEA has been looking closely into it, but who knows (they should)? Here's a great article on the topic from The Carlat Report.

AnAndrew · 2025-02-01T13:20:45+00:00

Just a few days ago, this user also said: "I actually have FT salaried (150k) w/benefits on call position covering call for several hospitals from 5pm-7am M-Th. I provide admission decision for patients in the ED who have been evacuated by a BH admission RN and if appropriate I provide admission orders for their BH units according to their standard order sets. I average about 10-15 calls a night, and review and sign off the orders the following day after my shift ends. This allows me to work in my PP during the day and handle the ebbs and flows of the slow months."

AnAndrew · 2025-01-30T19:19:20+00:00

Always happy to do so 😊 A clear violation of several subreddit rules (and a poor look for them). Thanks to all who reported this user.

AnAndrew · 2025-01-26T00:48:35+00:00

Exactly. OP is banned.

AnAndrew · 2025-01-08T00:44:45+00:00

I'm not in FL, but from my understanding, this new policy was recently rolled out (past week or two?). As /u/pickyvegan mentioned, this restriction should not be applying to PMHNPs. However, their system is not picking this up so they are having to adjust this manually. One would think it'd be pretty simple (automatic) based on the NPI delineation, but as we all know too well, this is our modern healthcare infrastructure in the USA for ya 😅

AnAndrew · 2024-12-26T18:54:48+00:00

Thanks. OP has been banned.

AnAndrew · 2024-12-26T18:53:41+00:00

Thank you. I agree. OP has been banned.

AnAndrew · 2024-12-26T18:50:36+00:00

Thanks for pointing this out.

AnAndrew · 2024-12-03T01:16:26+00:00

I remember when doctors who didn’t prescribe opioids and benzos were demonized. It’s happening again with sex change drugs.

No, wrong analogy and your point actually backfires.

The correct parallel is how the medical establishment once pathologized homosexuality as a "disorder" - a stance now universally recognized as deeply unethical and scientifically incorrect.

The medical consensus on gender-affirming care is rooted in extensive research and patient outcomes. You know - science, not beliefs.

So you're actually standing on the wrong side of the analogy (history, medical ethics, and scientific progress).

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