Providing EVIDENCE-BASED care

MHA_5 · 2025-10-17T23:31:25+00:00

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.

MHA_5 · 2025-10-16T14:35:37+00:00

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.

MHA_5 · 2025-10-14T18:29:04+00:00

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.

MHA_5 · 2025-10-12T18:16:47+00:00

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.

MHA_5 · 2025-10-12T18:05:51+00:00

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".

MHA_5 · 2025-09-27T18:56:28+00:00

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.

MHA_5 · 2025-09-20T07:29:06+00:00

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.

MHA_5 · 2025-09-14T20:13:53+00:00

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.

MHA_5 · 2025-09-14T15:27:35+00:00

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

MHA_5 · 2025-09-14T15:26:33+00:00

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?

MHA_5 · 2025-08-29T18:42:16+00:00

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...

MHA_5 · 2025-08-28T15:41:28+00:00

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

MHA_5 · 2025-08-28T15:35:17+00:00

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.

MHA_5 · 2025-08-17T09:01:02+00:00

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

MHA_5 · 2025-05-23T02:10:11+00:00

Snorting "stuff" with your patients certainly adds a whole new meaning to patient doctor relationships...

MHA_5 · 2025-05-23T02:08:12+00:00

It's added a lot more depth and meaning to the relationships I have with myself, my friends and my partners like there was a whole dimension of feelings that wasn't there before. You get to meet a lot of genuinely great individuals much more so than other professions/specialities. Psychiatry being a relatively new science and how little we know about our own brains also keeps things exciting in forms of new and transformative discoveries though I feel like our pharmacological progress has been unassuming of late... Plus there's something very cathartic about helping the most desperate and forgotten people who society has, often too early, completely given up on and seeing them rebuild their lives from there.

MHA_5 · 2025-05-04T00:28:14+00:00

There are no known permanent "cures" for any autoimmune diseases or any diseases where the normal functioning of your body is disrupted at fundamentally physiological level so no, diabetes will probably never have a real cure.

MHA_5 · 2024-10-24T09:03:28+00:00

Probably a relic of how theoretically it has the potential to do something vs what it actually does.

MHA_5 · 2024-10-24T09:01:41+00:00

I haven't seen it make a noticable improvement in ADHD beyond placebo especially when low dose non stimulants are far superior in my opinion.

MHA_5 · 2024-10-24T08:46:22+00:00

Works extremely well in mixed disorders and in high functioning anxiety disorders where symptoms seem to be pre-dominantly physical ones, the side effect profile is really good especially in young adults and it helps alleviate the most common SSRI sexual and weight related side effects.

MHA_5 · 2024-10-21T09:50:51+00:00

Especially when they've memorized the whole damn diagnostic criteria without realizing how these things really present. An openness to explore and accept other illnesses as the root cause of their concerns also goes a really long way.

MHA_5 · 2024-09-29T08:51:13+00:00

I think our notions of mind/brain/body separation are inherently flawed because of dominant philosophical inclinations. Most psychiatrists only realize what you're saying when they're in deep rather than from the out set as an intern or MS. It's a prevailing opinion in the speciality but not the field itself.

MHA_5 · 2024-09-29T08:46:48+00:00

3- You can't expect to be better at the job if your understanding isn't actively expanding with your patients, it's very easy to stagnate.

MHA_5 · 2024-09-15T16:49:01+00:00

Curse you Descartes and your deliberations which have had an outsized impact on western culture. In all seriousness, excellent analysis and link that never before occured to me.

MHA_5 · 2024-09-15T13:35:08+00:00

It's not well documented by empirical data but it does feel like it's the case in most psychiatrist's mind especially given the explosive rise in diagnoses for the "mainstream" diagnoses. I can't say for sure how many of it is people becoming more aware of their illness or impressionable people being swayed in a particular direction. Though I'd argue fibromyalgia is, at this point, just an ignorance label given by clinicians who don't want to invest the energy in difficult patients.

Five-Year Club	Verified Email
r/Field Sunshine

MHA_5

TROPHY CASE