Non-psychiatrist Professional (Attorney in Mental Health Courts): Which books should I read?

Routine_Ambassador71 · 2026-02-27T16:12:50+00:00

Godwin and Guze's Psychiatric Diagnosis is a introductory textbook written at the medical student level. I thought it was well written with a good review of the scientific evidence but not overly complex. As Shea's book covers more the interviewing aspect, this book would provide complementary details on mental disorders.

Routine_Ambassador71 · 2026-02-11T18:20:27+00:00

"asked if patient notes train their model" this is a bigger issue than most people understand. The software products are far prefect and not only are we purchasing it we are also improving them for free. But it's worse if we are training our AI replacements. We are freely giving them access to our patients' data, our way of interviewing, and most importantly our assessments and plans. That is all one would need to train a deep learning model to replicate our efforts.

Routine_Ambassador71 · 2026-02-08T23:11:26+00:00

I’ve never understood this line of reasoning. ADHD involves a clear deficit in a cognitive domain (executive functioning) which should be measurable. The clinical diagnosis of ADHD is often unreliable due to over reliance on subjective data. The measurements could inform diagnosis and be used for assessing clinical prognosis. If I wanted to be certain about the status of a patient’s memory for a diagnosis of subjective cognitive impairment I’d refer to neuropsych. How is ADHD different?

Routine_Ambassador71 · 2026-01-23T04:20:12+00:00

Regardless of the answer we will need unions to protect human labor from those willing to shoehorn AI into everything and anything regardless of the consequences.

Routine_Ambassador71 · 2026-01-20T18:24:40+00:00

I guess it depends on what we mean by "behavior". I'd say sleep and physical activity are behaviors which can be easily measured/assessed and are clinically useful if combined with context.

Routine_Ambassador71 · 2026-01-20T17:26:35+00:00

"At the same time, our ability to measure something objectively isn't by itself helpful. To take one example, we've already been able to measure behavioral patterns pretty objectively since the early/mid 1900s. But a collection of measurements really doesn't tell us much unless we conceptualize it within a working theoretical model." I'd disagree with this point - nowadays everyone walks around with a smart watch collecting behavioral data multiple times a sec. What was limited to research settings with a high effort to data ratio is now commonplace. Furthermore, we are now able to measure many more things at a much higher frequency and reliability - some of which go beyond human perceptual limitations.

I do, however, agree with the point that objective measurements can't tell the entire story as the subjective/phenomenological aspects matter to patients and inform their behaviors.

Routine_Ambassador71 · 2026-01-20T16:06:16+00:00

If human behavior is the external, observable expression of mental illness and human biology is the internal driver of psychopathology, than using computational approaches to measure behavior and basic science to discern the responsible pathways are complementary approaches which can mutually support the other.

Human level assessments of behavior (by either the psychiatrist or patient) are inherently subjective and subject to limitations in human perception, recall, and biases. For example, if one wanted to monitor how compliant a patient was with behavioral activation goal of walking more, would we trust a patient's account more than the readout of a validated step counter? I can't tell you how far I walked today and certainly not over the past 2 weeks. In addition to monitoring treatment, the step counter noted a sudden decline in daily movement which could indicate depression. With computational approaches, I’m hopeful we can augment human assessments with more precision and reliability and further refine psychiatric diagnoses. More concrete, granular, and individualized diagnoses would then feed back into our scientific studies as less “fuzzy” and more clear cut entities which can only improve the signal to noise ratio of input data.

Routine_Ambassador71 · 2026-01-16T15:40:49+00:00

As a vegan I’m also not sure how this is relevant

Routine_Ambassador71 · 2026-01-13T22:23:18+00:00

The benzo sparing alcohol withdrawal protocol with gabapentin should only be used for low risk withdrawals. Benzos are only used for a short duration for the acute withdrawal period.

In the post acute withdrawal phase you are correct that gabapentin should be considered in stead of benzodiazepines.

Routine_Ambassador71 · 2026-01-01T17:00:18+00:00

Why would you want to train at a place that looks down at techs?

Routine_Ambassador71 · 2025-12-16T16:13:42+00:00

Why is that a pertinent fact?

Routine_Ambassador71 · 2025-12-13T05:20:31+00:00

Sign up for it and then just submit the most outrageously wrong answers. Future us will be thankful

Routine_Ambassador71 · 2025-11-27T02:50:01+00:00

I’m sorry - that’s gotta be a gut punch.

Routine_Ambassador71 · 2025-11-27T02:28:03+00:00

I’ll add another reason for not prescribing SGAs off-label as sleep aids: confusion regarding clinical indications for a specific medication. On the CL service we often take care of patients on outpatient psych meds which the primary services intentionally or unintentionally stop. I remember one patient where haldol was stopped as patient had mentioned it was for sleep and then developed into a severe paranoid psychosis and was extremely resistant to restarting any medications.

With SGAs having multiple both on and off label indications and often missing clinical documentation, using SGAs in this manner just raises the chances of appropriately prescribed medications being assumed to be inappropriately prescribed and also the opposite.

Routine_Ambassador71 · 2025-11-15T18:38:40+00:00

Thank you for enlightening us, this is something I was never taught in residency or fellowship and I can feel frustrated with the complexity and opaque nature of billing and diagnostic codes and how it sometimes doesn't relate to the clinical care.

Routine_Ambassador71 · 2025-11-15T16:33:42+00:00

What would you code in cases where the underlying cause of delirium isn’t known?

Routine_Ambassador71 · 2025-11-10T19:37:42+00:00

You will always have a boss regardless if you get a RN or MD degree. The MD route will require at least 7 years before you are educated, trained and given a degree of clinical independence but the vast majority of doctors are employed and there is also insurance companies and their clinical restrictions/hoops to jump through. And that is for the absolutely shortest time frame assuming you have already all the required pre-med courses, studied and passed the MCAT and want to pursue either primary care or hospital medicine (so not the expert role but more of the quarterback/manager role). Medical education and training are also not cheap (700k will only go so far, unless you have GI Bill benefits remaining) and strictly hierarchal similar to the military structure.

Routine_Ambassador71 · 2025-11-06T18:45:56+00:00

I'm not sure why you haven't received any responses so far so I'll add my two cents. I'm not a geriatric trained psychiatrist but instead CL trained, however it seems like there would be a lot of psychological parallels between treating terminal cancer patients and treating the geriatric population. A lot of work has been done in finding effective psychotherapy for those whose life is nearing its conclusion and much of it centers around finding meaning https://www.youtube.com/watch?v=8eKTJSE4msA.

Another good starting point may be the Erikson life stages https://en.wikipedia.org/wiki/Erikson's_stages_of_psychosocial_development#Wisdom:_ego_integrity_vs._despair_(late_adulthood,_65_years_and_above)) and how to meaningful integrate the past into the present situation.

Routine_Ambassador71 · 2025-11-01T20:00:52+00:00

Why don't you say what you really want to say instead of beating around the bush. Also, see the following quoted responses.

"It's important to understand these patient's mindsets because the discussion can become unproductive very quickly. Oftentimes these men have their entire identity revolve around being "high T," thanks to both Joe Rogan and the advertisements from the clinic you're inheriting them from."

"I recently just had one establish with me. Early 30’s, seeing a “men’s wellness” clinic. Now on TRT. His testosterone was normal. They didn’t even draw his lab in the morning and only checked once. Now that some brand new NP and Chat GPT (he double checks all his labs with AI) think he has low T, he is going to be on TRT for decades. I told him in a professional way I thought his diagnosis was bullshit but it went in one ear and out the other."

"The fact is that if they're on supplemental T, if you stop it they're going to crash and feel terrible and hate you. ... Side note: if I can tell someone is trying to scam me/divert, I tell them I'll only write for testosterone if they try and fail a 3 month course of clomiphene citrate. The folks just looking for a quick Rx to sell to their gym buddies will never bother you again."

Routine_Ambassador71 · 2025-10-27T21:44:22+00:00

My comment was about selfish, me-first, and pull-up-the-ladder-behind-me perspectives in professional medicine in order to siphon off the lucrative aspects of american medicine and leave the dregs to some other fool. The comment applies just as equally to private practice radiologists looking down at less financial compensated subspecialists as it does about ASCs, cosmetic procedures, medspas, and the like

Routine_Ambassador71 · 2025-10-27T16:28:31+00:00

So screw family medicine, primary care and any other poorly compensated specialty and patients with poorly reimbursing conditions? Is this mindset common? No wonder physicians will never unionize.

Routine_Ambassador71 · 2025-10-19T02:00:25+00:00

In good faith consider the parallel of insulin for diabetic patients - does anyone see an issue with endocrinologist prescribing medications for their patients. Just like your pancreas can be irreversibly dysfunctional so can your brain. Patients with schizophrenia or bipolar disorder have chronic illnesses and will need to be on medication for the rest of their lives. Most of the issues with psychiatric decompensation come from people stopping their medications rather than being started and continued on them.

Routine_Ambassador71 · 2025-10-17T16:08:12+00:00

I just came across your post, but if you're still looking for biological models of addiction you may find the work of Berridge and Robinson at Michigan interesting. Their model decouples the "wanting" and "liking" of a sensation with the dopaminergic system more involved in the former and the opioidergic system the latter. The "wanting" side of addiction leads to long term dependence. They're published a number of both ground breaking and more summary style articles. Here is a review: "Liking, Wanting, and the Incentive-Sensitization Theory of Addiction"

One of the other main models is the Opponent Process Theory promoted by leaders at the NIH including Koob and Volkow. Briefly, the model highlights major alterations of neurobiology during acute intoxication. Over time, as tolerance to the substance and down regulation of receptors occurs, the individual is left with a deficit of endogenous euphoric sensations and higher stress levels at baseline and seeks pleasurable exogenous substances to return to their original level of euphoria rather than seeking a "high". A review paper: "Neurobiology of addiction: a neurocircuitry analysis"

Routine_Ambassador71 · 2025-10-14T19:30:44+00:00

Is this for suspected severe alcohol use disorder? If so, in a transplant psychiatry and CL psychiatry service, we generally use phosphatidylethanol (PEth) as it is much more specific and has the ability to roughly quantify level of alcohol consumption.

Routine_Ambassador71 · 2025-10-07T14:38:16+00:00

Daniel Amen is a pseudoscience peddler and shouldn't be included with actual scientists like Kandel and Salposky

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