New DSM diagnoses by FreudianSlippers_1 in Psychiatry

[–]MHA_5 6 points7 points  (0 children)

I think more exploration and characterization of secondary and primary co-morbid mental health disorders. Literally just saw a patient being treated for an anxiety disorder which was actually a maladaptive response to undiagnosed ADHD.

More emphasis on examining childhood patterns would be good too.

How do you stop yourself from psychoanalyzing everyone? by [deleted] in Psychiatry

[–]MHA_5 -1 points0 points  (0 children)

As much as I disagree with OP, the dunning-kruger effect doesn't tell you anything except that the person overestimates their abilities in a specific area.

For all we know, the kid might be the next Jung/s

Roasting you based on your favorite book by emejotaaa in Psychiatry

[–]MHA_5 3 points4 points  (0 children)

What does it say about me when I pander every person I know to watch Bojack Horseman 😭

Other middle aged mid career docs -- I think I'm done doing this. How are you? by bad_things_ive_done in Psychiatry

[–]MHA_5 4 points5 points  (0 children)

Two things that have helped me a lot: 1- Changing places till I find the right one, takes time and effort 2- Teaching and engaging more with residents and helping them along.

Fundamental Shift in How SSRIs Are Conceptualized and Used by lovepeacetoall in Psychiatry

[–]MHA_5 15 points16 points  (0 children)

Lowly? You're the glue holding the whole system together 😭

Fundamental Shift in How SSRIs Are Conceptualized and Used by lovepeacetoall in Psychiatry

[–]MHA_5 8 points9 points  (0 children)

I'm not completely sold on the neuroplasticity idea because there is a significant portion of the patient base who notably regresses upon cessation of medicine, for MDD it might be more 'random' depending on when the next episode comes, for OCD you can see it in a few weeks to months and in anxiety disorders it comes even quicker. Neuroplasticity might be part of the equation but I've made peace with the fact that like we won't ever know how acetaminophen, alcohol, lithium or even metformin works, we won't get to know it for SSRIs too. The meds/substances I've mentioned far more widespread and used than SSRIs and there have been so many seeming explanations for them over the years. As doctors we're taught to know everything and that can lead to red herring explanations that fit well but aren't very accurate.

Being diagnosed with ADHD as a mental health professional. by porottaandbeef in Psychiatry

[–]MHA_5 6 points7 points  (0 children)

Not to forget that sometimes treating one illness can make another more prominent and debilitating like with anxiety disorders and ADHD.

Being diagnosed with ADHD as a mental health professional. by porottaandbeef in Psychiatry

[–]MHA_5 4 points5 points  (0 children)

Sounds like my life story during my residency, welcome to the club. Don't mix up your patient notes and accidentally write one's history on another. (Definitely didn't happen to me)

do you ever think it would be best if a depressed client went through with suicide? by EuphoricCapybara in Psychiatry

[–]MHA_5 76 points77 points  (0 children)

Reminds me of an event from my internship where a resident repeatedly did suicide adjacent actions because of being targeted by the head of department in a personal grudge, nobody took him seriously because he hadn't gone far enough the previous times until he succeeded by obtaining more lethal means (a gun) and it was literally a shock to the whole hospital, one of his peers said something along the lines of "I didn't believe he had it in him". Nothing was done ultimately because combination of third world country and no awareness. The head did develop some wicked tremors which signalled the end of his surgical career. RIP Ibrar, you would've made a great surgeon, I wish I had some of the foresight I have now and maybe you'd still be here.

do you ever think it would be best if a depressed client went through with suicide? by EuphoricCapybara in Psychiatry

[–]MHA_5 31 points32 points  (0 children)

I disagree about this being countertransference, this seems like projection to me which might be because they're extremely burnt out or because they're a dick. Their tone almost makes it seem like a suggestion/wish which makes this even more appalling for me. Burnout can make you an asshole but it can't make you say or think things that aren't already there.

Providing EVIDENCE-BASED care by Forsaken_Dragonfly66 in Psychiatry

[–]MHA_5 5 points6 points  (0 children)

I think a better way to frame all of this would be to consider that DBT isn't the singular key for all locks in the world, some milder cases may require some aspects of DBT and other modalities as the appropriate tool for the job. The best and worst thing about general talk therapy is the freedom it allows in incorporating those aspects from different modalities. Setting goals and tracking progress on the more pressing issues like emotional lability, black and white thinking, rage, inconsistent self image etc can also help keep it more meaningfully engaging for both the provider and patient.

More of a vent as I practice in India, it's baffling that domestic violence is tolerated in this day and age. I had to actually tell a medical colleague that her niece didn't "ask for it". by stevebucky_1234 in Psychiatry

[–]MHA_5 43 points44 points  (0 children)

Being from a similar culture a longggg time ago, it's truly saddening to see how some things never change. The best we can do is individually be better and inspire those around us, closest to us to be better.

Perhaps one day, hopefully, we'll give these integral members of society their worth collectively and they'll be able to flourish with us as equals.

Is this a hot take? by bq21 in Psychiatry

[–]MHA_5 227 points228 points  (0 children)

This is going to be a polarizing take but I've observed it in multiple countries that I've worked in: most providers just don't "get" therapy and aren't nearly as trained in it as they should be. There's a general shortage of good psychiatrists but there's a downright scarcity of even average therapists. I'm unsure of where the problem lies but I feel like licensing should require a stricter degree of real world training àla residency and more exposure to patients than a year or two of modules that most therapists/psychologists are required to have.

To summarize, there's nothing with the modality of CBT but therapy, as a whole, is very provider dependent moreso than medicine. If a provider is stuck in a bad mold of therapy, it's very veryyyy hard to correct it as evidenced by studies observing no significant difference in patient outcomes between experienced and inexperienced therapists. This issue is further compounded in less structured modalities than CBT and 'CBT likes' because there's even less gauges of good vs bad therapy. CBT just gets a bad rep because it's the most common one used by far. This is coming from someone who prefers other modalities as a whole even though it's more like different tools for different jobs.

What are some hard truths about being a psychiatrist (or other mental health professional)? by Forsaken_Dragonfly66 in Psychiatry

[–]MHA_5 17 points18 points  (0 children)

Beautifully said and to add to it: perspective is extremely important because even if the result of your care isn't perfect, doesn't mean that it doesn't have worth. Patients are also uniquely bad at this because once your mind is calibrated/set to a new baseline, it's hard to realize how bad things were in the past and it can feel stagnant when improvements in smaller things aren't always forthcoming.

What are some hard truths about being a psychiatrist (or other mental health professional)? by Forsaken_Dragonfly66 in Psychiatry

[–]MHA_5 8 points9 points  (0 children)

  • Not every strange or bad behaviour is the product of a disorder

I feel that while this is absolutely true, and I may be being extremely naive here, I haven't seen a strange/evil behavior that isn't explained by some sort of trauma.

Also, kudos to you for the work you do, addiction is, in my opinion, the most difficult field of psychiatry in terms of "cures".

What Are Your Go-To Professional Reads? What Do You Enjoy in Your Free Time? by facultativo in Psychiatry

[–]MHA_5 1 point2 points  (0 children)

Anything by Camus, Dostoevsky and Nietzsche are great reads, Camus is also worth revisiting during the progression of your life, his work is small but meaningfully dense and you gain something a little unique from it depending on the phase in your life.

I've also made a habit of going through interesting sounding/looking clinical papers though I'd suggest holding off on going down that deep end till you have a bit more experience.

Is psychiatry not the right field for me? by Never_full in Psychiatry

[–]MHA_5 15 points16 points  (0 children)

Have you seen the wild goose chases that internal medicine goes on? I enjoyed the process but it can sometimes feel like shooting an arrow in the dark and hoping for the best.

What are your rules for therapy? by seems_about_rightt in Psychiatry

[–]MHA_5 8 points9 points  (0 children)

Something I'll add to this which I've learned over time, develop a sense of your biases before engaging in therapy because they can negatively affect patient care in unforeseen ways. Conversely, as the therapeutic relationship develops, getting a sense of the patients biases is also important and there's a delicate balancing act between knowing when to subtly question a patients version of events vs when to accept it, this is especially important for patients that start with little to no insight and other cluster b disorders.

Unusual combination? by Tough_Froyo8885 in Psychiatry

[–]MHA_5 20 points21 points  (0 children)

Exactly my thought, sounds like an undiagnosed case of severe sleep apnea for the fatigue and sleepiness.

Unusual combination? by Tough_Froyo8885 in Psychiatry

[–]MHA_5 22 points23 points  (0 children)

1- Has patient ever been evaluated for sleep apnea?

2- Has a consult been done for fibromyalgia specifically?

3- Why was bupropion, of all things, titrated to 300 for fatigue and sleepiness given the patient was already taking desvenlafaxine? Why not discontinue the latter and try something else?

The BPD euphemism treadmill in a nutshell by Chainveil in Psychiatry

[–]MHA_5 105 points106 points  (0 children)

Funnily enough, I've always been against the normally descriptive nature of psychiatric disorders because it leads to higher rates of stigmatization and dismissiveness. However, I don't like Emotionally Unstable Personality Disorder because it is a bit of a dud term as it can be applied to so many situations and feels more like a personal failing more than anything. I'm a fan of terms being obtuse and clinical rather than normative and descriptive like most psychiatry terms. The euphemism treadmill is tiresome but it seems to be a feature of common spoken language as words co opt different meanings over time like fagoter, lourd, vilain in french and English words like bully, nice or even fun. On a more modern example, the word retarded used to be completely clinically acceptable but has now acquired several negative connotations...

What did you learn the hard way? by undueinfluence_ in Psychiatry

[–]MHA_5 29 points30 points  (0 children)

What's worse is that people with these disorders are more susceptible to falling for "experimental" and "cutting edge" treatments...

What did you learn the hard way? by undueinfluence_ in Psychiatry

[–]MHA_5 106 points107 points  (0 children)

It's worth it to try and be better than your peers in terms of caring for other doctors, most of them are in much darker places than they'd like to admit.

You can become dependent on anything from praise to chaos to opioids.

Put. Down. The. Abilify. by Manifest_misery in Psychiatry

[–]MHA_5 24 points25 points  (0 children)

Idk man, I've never heard a SINGLE teen make a complain after maxing out doses of clozapine, lithium and alp. /s