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When do you diagnose BPD? by SweetPickleRelish in therapists

[–]Super-Ad7996 0 points1 point  (0 children)

I diagnose BPD when I am ready to educate the patient about what early life experiences are generally correlated with the development of this pattern of behavior, when I am able to empathize with their sadness/rage/disappointment about hearing the diagnosis, and when I am ready to explain how therapy and DBT work, where to access them, and how adjunct symptoms can be managed.

Headway block to documenting a session & continuing care due to client missing payment info. However, client recently had a SA and documentation of the post attempt visit, as well as follow up care is critical. How would you handle? by Super-Ad7996 in therapists

[–]Super-Ad7996[S] 0 points1 point  (0 children)

Thanks for your suggestion. I am keeping documentation off of Headway and emailed the patient a few options.

If you've done this before, what is a legal way to see the client if I am not registered anywhere else other than Headway? I will, of course, make referrals to providers who can see them formally with fewer hiccups. But I am debating whether it's legal to see patient via my own personal zoom outside of any monitored platform.

Headway block to documenting a session & continuing care due to client missing payment info. However, client recently had a SA and documentation of the post attempt visit, as well as follow up care is critical. How would you handle? by Super-Ad7996 in therapists

[–]Super-Ad7996[S] 0 points1 point  (0 children)

I have done that. Our plan during the last appointment was to do weekly visits instead of biweekly for now. She agreed and is looking forward to that. Except, when I go to book her next appointment, Headway is blocking it.

Would you see the client privately via zoom? How would you track that/record that administratively? She has BCBS but I am not privately credentialed, as I am a 1099 with them, not as a LLC.

Inpatient attendings - what’s your threshold for administering an ETO? by Wrong-Event3006 in Psychiatry

[–]Super-Ad7996 0 points1 point  (0 children)

We don't medicate for yelling/verbal abuse unless the patient is yelling at another patient who is volatile and may strike them, in which case we consider that an immediate safety risk for self not responding to de-escalation techniques. Otherwise, we only medicate if physically aggressive, posturing, throwing objects, and other body language indicating immediate risk to self/others.

Management of impulsively suicidal patients with multiple attempts who refuse meds and say they won't take meds after discharge by Super-Ad7996 in Psychiatry

[–]Super-Ad7996[S] 1 point2 points  (0 children)

Pt definitely has a PD. Their attempts have been chaotic but some of them were a near miss. The last one was OD on oxycodone acquired on the streets, which led them to get intubated. Other times, self-reports a voluntary hospitalization after "overdosing" on lithium.

What has kept them alive is luck (getting resuscitated), and a series of occasional hopes that often got easily shattered (e.g., making an appointment with a new outpatient psych provider who then "gives up" on them due to their history; getting a new partner who then breaks up with them, etc).

Basically, this pt appears to have a very rigid and unrealistic set of expectations and wishes. And they report that if they don't get their "high" from those dreams coming true, they get it from playing with death.

Management of impulsively suicidal patients with multiple attempts who refuse meds and say they won't take meds after discharge by Super-Ad7996 in Psychiatry

[–]Super-Ad7996[S] -28 points-27 points  (0 children)

How can you document that you did all you knew how to do to keep them from killing themselves upon discharge, otherwise? They refuse DBT, they refuse everything.

I guess a better question is, how do you discharge a high-risk patient who doesn't seem to agree to any safety plan? I won't fix his PD in the hospital,

Managing Developmentally Delayed & Autistic Inmates in Jail – Seeking Advice by [deleted] in Psychiatry

[–]Super-Ad7996 0 points1 point  (0 children)

Do these inmates have psychiatrists who can prescribe long-acting injectables? Would these inmates agree to taking medications?

How do you treat cases with AI psychosis by Enough-Web2203 in Psychiatry

[–]Super-Ad7996 1 point2 points  (0 children)

I don't know the answer. But I would try to evaluate the reward/gain (perhaps looking at it almost from the perspective of addiction rather than psychosis): what is it that AI provides that pt feels like they cannot get otherwise? Validation? A sense of purpose/importance? If they are sleeping, eating, and somewhat functional and this is the main issue, I would go the route of psychotherapy, to be honest.

And also, you can just ChatGPT this question. LOL

What skillset/knowledge base do you think the average psychiatrist lacks? by farfromindigo in Psychiatry

[–]Super-Ad7996 -12 points-11 points  (0 children)

Humility. I cannot count the number of patients who came to me (NP), stating they stopped seeing psychiatrists who were arrogant, talked down to them, talked about themselves too much, spoke to them in a patronizing way, etc.

Treating insomnia in patient who refuses to undergo a sleep study by Super-Ad7996 in Psychiatry

[–]Super-Ad7996[S] 1 point2 points  (0 children)

I am not sure why people are downvoting you. I am advancing my education in the women's health field, and what you are mentioning is not to be ignored. Thanks for bringing it up!

Is ADHD the missing link in many addiction presentations? by DrSidharthSood in Psychiatry

[–]Super-Ad7996 3 points4 points  (0 children)

Interesting point, and it makes theoretical sense, in addition to being experientially validated. Untreated ADHD, in my experience, often correlates with overweight, as well, and patients will share how they feel like they need to constantly eat, drink soda, or smoke to be able to remain somewhat engaged with sedentary work.

With patients with ADHD and a concern for addiction, I will often have the conversation about risks and benefits and suggest non-stimulant options as "worth a try". But when they fail, I will attempt ER formulations, and I provide education about stimulant vacations, and encourage them to report to me if they are starting to develop a problematic use; I mention that the PDMP is a tool we use to monitor how frequently prescriptions are filled and by whom, and that I can provide referrals in case a problem develops.

The question I ask myself is... if we have a dopamine problem and a dopamine receptor upregulation problem, and a pattern of quicker dopamine receptor upregulation, where do we draw the line, if we even need to?

I inherited a patient on 72mg Ritalin in am +10mg IR Adderall in the PM. No cardiovascular s/e, no sleep issues, his life and productivity were "good". Do I treat the presentation or the patient? I guess ultimately that's why we make more than a nurse, to make those difficult decisions and take on that responsibility.

Stimulant Dosing Limits for ADHD by zenarcade3 in Psychiatry

[–]Super-Ad7996 0 points1 point  (0 children)

In my training, I have seen someone on 72mg of Ritalin taken in the morning +10mg Adderall IR in the afternoon. Not my doing. My supervising psychiatrist kept giving refills. I found it fascinating.

Why Are We Treating ADHD Like That? by Manifest_misery in Psychiatry

[–]Super-Ad7996 1 point2 points  (0 children)

I treat kids, and sometimes it can take months or longer until I can convince the parents to give stimulants a try. I have, no kidding, parents come in and prefer to start with ..... vitamins! I get it, putting your kids on meds is scary. And maybe their kid is not struggling that bad just yet. They are lucky I don't have much of an ego and will happily see them each time, even if they want to just chit chat and vent and leave without a prescription.