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Posted by ed_uk2010 on November 17, 2011, at 11:59:19
In reply to Re: psychopharmacologist vs psychaitrist, posted by Phillipa on November 17, 2011, at 10:30:20
> I heard they delt more with things like neurological illnesses seizures as an example. Phillipa
Not really, neurologists deal with epilepsy, at least in difficult cases. Most routine cases of epilepsy might be managed predominantly by general physicians. Here in the UK we do not seem to have a lot of neurologists.
Posted by ed_uk2010 on November 17, 2011, at 12:06:32
In reply to Re: psychopharmacologist vs psychaitrist, posted by Christ_empowered on November 16, 2011, at 18:00:54
>Here where I live, all shrinks do is drugs. I mean, yes, they might talk to you briefly about your personal life, your past, etc. (more the older ones), but they're really about writing prescriptions.
Here, patients with severe psychiatric illness often see a team of workers. There may be a community psychiatric nurse (CPN), social worker, psychologist and a psychiatrist. The psychiatrist is in charge. Unfortunately, it doesn't always work very well because patients do not get to see these people very often. Psychiatry does not appear to receive a lot of funding. Patients will less severe psychiatric illness will not get to see all these different people. They will be treated by a psychiatrist and GP, or just their GP. In the UK, you cannot normally go straight to a specialist like in some countries, you have to go via your GP.
Posted by Christ_empowered on November 17, 2011, at 15:56:52
In reply to Re: psychopharmacologist vs psychaitrist » Christ_empowered, posted by ed_uk2010 on November 17, 2011, at 12:06:32
On the one hand, I think its unfortunate that psychiatrists don't get more funding in the UK. On the other hand, it sounds as if lower-cost, but probably very important, services are emphasized. Look at the US. Shrinks here have adopted the bio-bio-bio model of mental illness, although they often refer people for therapy (especially if there are some therapists/counselors in their practice). Is there any evidence that people with mental illness of any sort--especially the more severe disorders--do better over here than in the UK?
Given psychiatry's track record and the limited tools they bring to the table, maybe limited funding is appropriate.
Posted by gadchik on November 17, 2011, at 16:50:15
In reply to Re: psychopharmacologist vs psychaitrist, posted by Christ_empowered on November 17, 2011, at 15:56:52
My pdoc was originally to only prescribe the meds,and I had a therapist for talking.But now,Im out of therapy,and I talk more to the pdoc.She charges me more the longer i stay,which is understandable.Im private pay though and sometimes wish to get the rx and leave.When I visited my mom,she lives in bigger city,I noticed there were several psychopharmacologists listed in phone book,and I got curious about seeing one.
Posted by ed_uk2010 on November 17, 2011, at 17:19:26
In reply to Re: psychopharmacologist vs psychaitrist, posted by Christ_empowered on November 17, 2011, at 15:56:52
>On the one hand, I think its unfortunate that psychiatrists don't get more funding in the UK. On the other hand, it sounds as if lower-cost, but probably very important, services are emphasized.
There's been quite a bit of 'hot air' over here about how patients ought to be able to access 'talking treatments'. In practice, they aren't always available due to long waiting lists or lack of appropriate therapists. The result of this is that most people with moderate mental health problems get most of their treatment from the GP - which usually consists of occasional brief chats and repeat prescriptions for SSRIs or similar.
>Look at the US. Shrinks here have adopted the bio-bio-bio model of mental illness....
When it comes to moderate mental illness, I think there's much less of a bio emphasis here. There's still a strong bio emphasis for psychotic disorders, severe chronic depression and the more classic presentations of bipolar disorder (bipolar I).
>Is there any evidence that people with mental illness of any sort--especially the more severe disorders--do better over here than in the UK?
I don't know, but you guys certainly like prescribing the latest meds. I'm not saying that's a bad thing, but it's a major difference. When a new med gets launched here, it doesn't always get used much at first. Psychiatrists normally use the meds that they are familiar with and there is strong pressure from the NHS to avoid spending money on new products unless there is a clear advantage. This is not good for the pharma industry! It can sometimes be a good thing though... except when patients are denied access to new treatments even when the standard meds haven't helped.
You have a greater range of psych meds in the US. We do not have Latuda, Geodon or Fanapt. Saphris is not widely available but I think it may be supplied to hospitals. I'm not sure how much we are missing. We do have a few meds that you don't have, after all.
Posted by ed_uk2010 on November 17, 2011, at 17:21:39
In reply to Re: psychopharmacologist vs psychaitrist, posted by gadchik on November 17, 2011, at 16:50:15
>I noticed there were several psychopharmacologists listed in phone book,and I got curious about seeing one.
I suppose I'd want to know, are they just pdocs who don't want to talk much or do they have special knowledge of meds? I'm sure they vary a lot.
Posted by emmanuel98 on November 17, 2011, at 18:04:27
In reply to Re: psychopharmacologist vs psychaitrist » gadchik, posted by ed_uk2010 on November 17, 2011, at 17:21:39
My p-doc (who is in his early 70s and does and likes to do therapy) says all psych residents learn today is meds. So I don't know what the difference is between a psychiatrist and a psychpharmacologist. There is no licensing exam in psycopharm. The licensing exams are still in psychiatry and neurology, which most psychiatrists take.
Posted by gadchik on November 17, 2011, at 18:38:43
In reply to Re: psychopharmacologist vs psychaitrist, posted by emmanuel98 on November 17, 2011, at 18:04:27
I remembered reading once that a pdoc may consult w/or send a pt to see a psychopharmacologist if the pt is not responding to any meds that have been prescribed,and they may need a more complicated regimen
Posted by Phillipa on November 17, 2011, at 21:12:02
In reply to Re: psychopharmacologist vs psychaitrist, posted by gadchik on November 17, 2011, at 18:38:43
Might google difference between them if I get done with ebay posting I will. Phillipa
Posted by Raisinb on November 17, 2011, at 21:20:14
In reply to Re: psychopharmacologist vs psychaitrist, posted by gadchik on November 17, 2011, at 18:38:43
My impression was always that a Psychopharmacologist knows more about neuroscience and medications than a pdoc--sort of a very expert pdoc
Posted by Solstice on November 17, 2011, at 22:31:12
In reply to Re: psychopharmacologist vs psychaitrist » Phillipa, posted by ed_uk2010 on November 17, 2011, at 11:59:19
> > I heard they delt more with things like neurological illnesses seizures as an example. Phillipa
>
> Not really, neurologists deal with epilepsy, at least in difficult cases. Most routine cases of epilepsy might be managed predominantly by general physicians. Here in the UK we do not seem to have a lot of neurologists.
>
>Really!? Wow. Here (the US), epilepsy is treated by neurologists, and more specifically by 'Epileptologists'(a sub-speciality of neurology.
Solstice
Posted by Phillipa on November 18, 2011, at 0:03:31
In reply to Re: psychopharmacologist vs psychaitrist, posted by Solstice on November 17, 2011, at 22:31:12
Google search. But first yes we have lots of neurologists here. Phillipa, now the google diffence between psychiatrist and psychopharmacologist.
http://www.wisegeek.com/what-is-clinical-psychopharmacology.htm
Posted by sigismund on November 18, 2011, at 1:04:15
In reply to Re: psychopharmacologist vs psychaitrist, posted by Solstice on November 17, 2011, at 22:31:12
>Really!? Wow. Here (the US), epilepsy is treated by neurologists, and more specifically by 'Epileptologists'(a sub-speciality of neurology.
If you can afford it (US) or socialised medicine (UK) , according to your preference.
Posted by jane d on November 18, 2011, at 4:44:18
In reply to Re: psychopharmacologist vs psychaitrist, posted by Phillipa on November 18, 2011, at 0:03:31
> Google search. But first yes we have lots of neurologists here. Phillipa, now the google diffence between psychiatrist and psychopharmacologist.
>
> http://www.wisegeek.com/what-is-clinical-psychopharmacology.htmThis is misleading if not actually wrong. Psychologists cannot prescribe in my state and and I believe there are only a few where they can. Further the word has been around long before they could prescribe in ANY state and it has always referred to psychiatrists. If psychologists really have appropriated this term I imagine the MDs are spitting nails.
Back when psychiatrists were shifting from therapy to meds it distinguished those who used meds. Now they are all trained with an emphasis in medication. I'm fairly sure any psychiatrist can choose to use the term for themself and it doesn't guarantee any special expertise.
Posted by Emme-V2 on November 18, 2011, at 6:05:34
In reply to psychopharmacologist vs psychaitrist, posted by gadchik on November 16, 2011, at 12:28:17
> Just curious, has anyone been to a psychopharmacologist? There are none where I live.What was your experience?Do they have more understanding of psych meds than pdocs? Are their fees similar?
The psychopharmacologists I've seen are very sophisticated in their understanding of psych meds and are comfortable with both old and new meds, more comfortable with off-label prescribing when they feel it's appropriate for the patient, and remain very up to date on research. The one I saw for the longest time is also board certified in neurology. That doctor thought very holistically about checking for other medical conditions that can mimic depression (e.g., Lyme disease) and was also open to non-prescription options such as fish oil, Sam-E, etc. So yeah, I think it's ultra specialization in the pharmacopia. There is an American Society of Clinical Psychopharmacology.
Posted by 10derheart on November 18, 2011, at 12:03:02
In reply to Re: psychopharmacologist vs psychiatrist » Phillipa, posted by jane d on November 18, 2011, at 4:44:18
Great points, janed. I'd agree you have to take info on Wise Geek with a bit of a grain of salt....I'm unsure of its sources...?
In this case, though, it might be the difference between **clinical** psychopharmocology and use of the term without the clinical modifier. Maybe there are more psychologists doing this than we think....I dunno.
I just clicked over to the plain definition here:
http://topics.wisegeek.com/topics/psychopharmacology.htm#
...and it seems more like what I understood it to mean. If I had a psychiatrist, I'd ask how they understood its use....but I don't. My own therapist,(MA in counseling/social work) who chose not to get her doctorate, wants to go back to school to become a nurse practitioner so she can more comprehensively treat clients.
Posted by ed_uk2010 on November 18, 2011, at 12:32:04
In reply to Re: psychopharmacologist vs psychaitrist, posted by Solstice on November 17, 2011, at 22:31:12
>Really!? Wow. Here (the US), epilepsy is treated by neurologists, and more specifically by 'Epileptologists'(a sub-speciality of neurology.)
I don't think I explained it well at all. A specialist will be involved with the initial diagnosis but the specialist might not be a neurologist. For example, children may be referred to a hospital paediatrician. The specialist will decide on the treatment and titrate the dose but the medication will then be continued by the GP. They call this 'shared care', and it happens with most long term conditions here. Do your GPs only treat minor conditions?
A large proportion of epilepsy cases are not severe. Patients may have occasional seizures which are well controlled by a single medication. In these cases, there is not much for the specialist to do. Less often, epilepsy is extremely difficult to control and patients have multiple problems. A specialist will then be involved over a long period.
I didn't mean to give the impression that GPs diagnose and treat epilepsy without hospital intervention. It's just that mild/routine cases do not always need a great deal of specialist intervention beyond the initial diagnosis. That's not to say they won't have occasional follow ups at the hospital.
Posted by jane d on November 18, 2011, at 18:41:51
In reply to Re: psychopharmacologist vs psychiatrist » jane d, posted by 10derheart on November 18, 2011, at 12:03:02
> Great points, janed. I'd agree you have to take info on Wise Geek with a bit of a grain of salt....I'm unsure of its sources...?
>
> In this case, though, it might be the difference between **clinical** psychopharmocology and use of the term without the clinical modifier. Maybe there are more psychologists doing this than we think....I dunno.According to this AMA article it was still just New Mexico, Louisiana and the military as of last March with legislation introduced in New Jersey, Tennesee, Arizona, Hawaii, Montana and Oregon.
http://www.ama-assn.org/amednews/2011/03/07/prl20307.htmI couldn't find any evidence that it had yet passed in any of those places. So not that common yet. But comimg soon it seems.
> I just clicked over to the plain definition here:
>
> http://topics.wisegeek.com/topics/psychopharmacology.htm#
>
> ...and it seems more like what I understood it to mean. If I had a psychiatrist, I'd ask how they understood its use....but I don't. My own therapist,(MA in counseling/social work) who chose not to get her doctorate, wants to go back to school to become a nurse practitioner so she can more comprehensively treat clients.Ah. I'd missed that distinction when I read it the first time. Thanks for pointing it out. But I still think there's currently a distinction between psychopharmacology and psychopharmacologist in actual usage. But that may just be an accident of who can prescribe and may disappear. I've never heard of a psychiatric NP referred to that way even though that is in fact what they study and what they do. I'm a big fan of NPs.
I haven't used wisegeek before. Do you find it generally useful? There are so many phony "answer" sites around now that I tend to ignore any that I'm not familiar with. And there's a whole bunch I wish could block from all future search results.
Posted by Phillipa on November 18, 2011, at 19:05:14
In reply to Re: psychopharmacologist vs psychiatrist » jane d, posted by 10derheart on November 18, 2011, at 12:03:02
When my pdoc got in a really bad car accident she had a RN practioneer fill in for over a year. She prescribed all my meds for me including benzos. Then at some time the charts were sent to another psychiatrist to sign off on them. I think kind of like when RN if the Lpn (phasing out) gave a controlled med or did an admission the RN had to review material and sign her or his signature to indicate they agreed with what the LPN did. Phillipa
Posted by Phillipa on November 18, 2011, at 19:11:52
In reply to Re: psychopharmacologist vs psychaitrist » Solstice, posted by ed_uk2010 on November 18, 2011, at 12:32:04
Short and to the point I feel. 10der same place you got yours!!! Phillipa
http://www.wisegeek.com/what-is-clinical-psychopharmacology.htm
Posted by Solstice on November 18, 2011, at 22:09:36
In reply to Re: psychopharmacologist vs psychaitrist » Solstice, posted by ed_uk2010 on November 18, 2011, at 12:32:04
> I don't think I explained it well at all. A specialist will be involved with the initial diagnosis but the specialist might not be a neurologist. For example, children may be referred to a hospital paediatrician. The specialist will decide on the treatment and titrate the dose but the medication will then be continued by the GP. They call this 'shared care', and it happens with most long term conditions here. Do your GPs only treat minor conditions?Pretty much. I suppose there might be exceptions, but I can't imagine a GP here treating epilepsy. I am in electroneurodiagnostics, and I see a LOT of epilepsy, along with other disorders that result in seizures. I'm around neurologists all the time. The treatment of epilepsy here is highly specialized. Generally, a GP or pediatrician will refer a patient to a neurologist for any condition that causes seizures. A Neurophysiologist who specializes in seizure disorders would read the EEG and report to the Neurologist, who would treat the epilepsy. Depending on the type of epilepsy, etc., the patient would see the neurologist periodically - if mild maybe only if there is a breakthrough of seizures and medications need to be adjusted. Although there are indeed some 'mild' epilepsies, those often don't even require treatment. There are a couple of benign types that can appear in childhood which are often outgrown. In the neurophysiology field here, there has been a dramatic increase in understanding of patients, particularly the elderly, being in 'status epilepticus' (seizures that last more than 10 minutes), that are what we call 'non-convulsive.' Since the body is not actually seizing, no one is aware that the brain is seizing - and seizures that last more than 5 - 10 minutes can cause great harm to the brain. Anyway, people generally have a GP, but chronic conditions are treated by a specialist, and there are varying degrees of specialists. For example, a GP might treat high blood pressure, but if the patient develops thyroid problems, they will probably see an endocrinologist, who will closely monitor treatment of their thyroid problem, and that treatment will be communicated to the GP.
I went with my newly-became-an-adult son to see his new GP (after transfer from his pediatrician), about his sleep problems. The GP said "I want you to see a neurologist." So we saw the neurologist, who ordered a sleep study. After the sleep study, we go back to the neurologist.
No doubt about it, specialists are highly used in this country.
Solstice
Posted by ed_uk2010 on November 19, 2011, at 7:39:03
In reply to Re: psychopharmacologist vs psychaitrist, posted by Solstice on November 18, 2011, at 22:09:36
>I'm around neurologists all the time. The treatment of epilepsy here is highly specialized.
We do not have enough neurologists here to provide a satisfactory service to patients with complex needs. I don't know why it is this way. We have plenty of experts in other fields eg. cardiology.
>a GP or pediatrician will refer a patient to a neurologist for any condition that causes seizures.
Here, paediatricians are hospital-based specialists. You cannot take your child straight to a paediatrician, you get referred by the GP. Our paediatricians treat a huge variety of acute and chronic diseases in children.
>For example, a GP might treat high blood pressure, but if the patient develops thyroid problems, they will probably see an endocrinologist, who will closely monitor treatment of their thyroid problem, and that treatment will be communicated to the GP.
I don't think we make much use of endocrinologists here. General physicians treat most common thyroid problems, especially hypothyroidism.
>No doubt about it, specialists are highly used in this country.
I suppose it is good if you can afford it, but I do get the impression that your GPs may have become de-skilled. If patients see a different specialist for each part of their body, who co-ordinates their care?
Posted by Solstice on November 19, 2011, at 9:12:28
In reply to Re: psychopharmacologist vs psychaitrist » Solstice, posted by ed_uk2010 on November 19, 2011, at 7:39:03
> >I'm around neurologists all the time. The treatment of epilepsy here is highly specialized.
>
> We do not have enough neurologists here to provide a satisfactory service to patients with complex needs. I don't know why it is this way. We have plenty of experts in other fields eg. cardiology.
>
> >a GP or pediatrician will refer a patient to a neurologist for any condition that causes seizures.
>
> Here, paediatricians are hospital-based specialists. You cannot take your child straight to a paediatrician, you get referred by the GP. Our paediatricians treat a huge variety of acute and chronic diseases in children.Wow. Here, pediatricians are considered GP's for children. For the insured, everybody gets one for their kid - usually interviews them while pregnant. Pediatricians see kids in an office setting. They are often grouped together - there will be two or three of them share a suite of office in a clinic setting, and share nursing and other staff. Pediatricians will ensure the kids get their vaccinations, check growth, remove warts, take care of broken bones, ear infections, etc. But, for example, if the ear infections are repeated, the pediatrician will refer the kid out to an ENT (EarNoseThroat) specialist, who will do an exam and may recommend tubes (as was the case with one of my kids). Here, physicians - including specialists - have offices outside the hospital where they see patients, and have 'privileges' at one or more hospitals in the area. Most hospitals will have a 'professional building' adjacent to it where the doctors' offices are. The majority of them don't work 'for' the hospital (like the nurses and other medical staff do). They are more like contract labor. They bill the patients separately for their services. Your system has made it more efficient - whereas ours has encouraged too many cumbersome layers. Anyway, physicians don't usually work 'for' a hospital, they work 'at' a hospital - and usually they work at several hospitals.
I have juvenile, type 1 diabetes. I have seen the same endocrinologist since I was 21. When I got pregnant, my gynecologist transferred me to a 'high risk' obstetrician. She took care of everything except she relied on my endocrinologist to handle the diabetes. They communicated information regarding my care. My endocrinologist was an arrogant and irritating man, and at one point I told my obstetrician that I wanted to change endocrinologists - and I hoped she knew of a decent one. She literally begged me to not switch. She said "After the baby's born, you can switch - but please stay with him until then. I know he's annoying, but he really is the best we've got around here." After my baby was born, he became much less irritating because I didn't have to see him very much anymore :-) Then, when my child was about 18 months old, I got the flu and a couple of weeks later I was still not fully recovered. My mom was over for a visit, and it was Friday morning. I was still somewhat weak, but nothing dramatic. Mom insisted that I call my endocrinologist. To humor her, I did. I called his office, asked for him, and since he happened to be available, he got on the phone right away. I told him I was fine, my mom was just being a worry wort because it was taking me so long to get over the flu. He asked me what my blood sugar was. "140" I responded. He said "Well, even though it's not high, I can tell by the way you are breathing that you are in ketoacidosis. He told me to meet him at the hospital. Had his staff cancel the rest of the day's appointments, and he came over as soon as I arrived. He sat with me in the ER for about six hours, ordering blood gasses constantly. He later told me that I was very, very close to my breathing shutting down. He was annoying as heck having to put up with him nonstop (he wouldn't stop talking - I think he was trying to prevent me from falling asleep). And he kept yelling at nurses and otherwise just acting like a jerk. I was later put in ICU for a few days while my metabolism was put back in balance. He later told me that he'd once had another patient with a rare case of ketoacidosis with normal blood sugar. He had sent her to the ER and faxed instructions to the ER doctor. The ER doctor thought he'd made a mistake, and did the opposite (because ketoacidosis is usally accompanied by very high blood sugar). Anyway that patient died.. so that's why he didn't leave my side. Anyway - after he saved my life like that, I decided I could accommodate the jerk in him after all and we developed a rather warm and funny relationship. I still see him.
>
> >For example, a GP might treat high blood pressure, but if the patient develops thyroid problems, they will probably see an endocrinologist, who will closely monitor treatment of their thyroid problem, and that treatment will be communicated to the GP.
>
> I don't think we make much use of endocrinologists here. General physicians treat most common thyroid problems, especially hypothyroidism.Endocrinologists here treat the awfully common conditions of diabetes, thyroid issues, anything relating to glands that secrete hormones. Internists (who are more specialized GP's) will treat milder cases of diabetes - but once a patient starts having complications, they would be referred to an endocrinologist.
I'm fortunate in that after having Type 1 for nearly 30 years, I don't have a single complication.
>
> >No doubt about it, specialists are highly used in this country.
>
> I suppose it is good if you can afford it, but I do get the impression that your GPs may have become de-skilled. If patients see a different specialist for each part of their body, who co-ordinates their care?You're very right. Our GP's have become de-skilled in a way. Of course, the human body is so complex, maybe it's more that they are the first line of defense (flu, simple broken bones, stitches, vaccinations, etc.), and competently hand their patients off to specialists when more complex body systems are involved. GP's are the coordinators of care. The first thing any specialist asks, is "Who's your PCP?" (Primary care physician/GP). They want to know who to send their reports to. As for affording it, that's what insurance is for. If you don't have insurance, you're definitely screwed here as far as health care.
Solstice
Posted by ed_uk2010 on November 19, 2011, at 13:00:21
In reply to Re: psychopharmacologist vs psychaitrist » ed_uk2010, posted by Solstice on November 19, 2011, at 9:12:28
>Here, pediatricians are considered GP's for children. For the insured, everybody gets one for their kid - usually interviews them while pregnant.
I think it's like that in Canada too. Here, paediatricians only see children who have been referred by a GP and children in hospital. Paediatricians have a very broad knowledge of childhood disease but they do of course refer to other specialists as well.
>Pediatricians see kids in an office setting. They are often grouped together - there will be two or three of them share a suite of office in a clinic setting, and share nursing and other staff. Pediatricians will ensure the kids get their vaccinations, check growth, remove warts, take care of broken bones, ear infections, etc.
Virtually all GPs in the UK see children every single day. Treating children for minor conditions doesn't normally require a paediatrician. The practice nurse does the vaccinations.
>Here, physicians - including specialists - have offices outside the hospital where they see patients
Our hospitals have 'out-patients' departments where physicians and surgeons see patients who are not in hospital.
>I still see him.
Interesting story. I think the greatest doctors do not always have the best bedside manner.
>Endocrinologists here treat the awfully common conditions of diabetes, thyroid issues, anything relating to glands that secrete hormones.
We do have diabetes physicians but GPs are normally very involved with diabetes. Many GPs have special interests so diabetic patients might tend to see one particular GP at the practice.
Posted by Phillipa on November 19, 2011, at 18:15:27
In reply to Re: psychopharmacologist vs psychaitrist » Solstice, posted by ed_uk2010 on November 19, 2011, at 13:00:21
Ed to take it further we have docs for foot problems, different ones for back problems, Hand doctors. Since I have medicaire and my Pcp will not do a thing but refer I refer myself without ever seeing the Pcp. I've referred myself to endos, Spinal neurologists, Dermatologists, Ent's. They then order MRI's etc. When I broke my wrist the ER wouldn't even cast had to see a orthopedist who did that who referred me to a nueurologist for breaks as wanted to be sure no nerve damage. Oh the docs offices have their own RN's here. PJx
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