Hi, I'm a mid-level provider who sees a lot of patients with depression and anxiety, but some patients present with just some form of anxiety (GAD, panic, social anxiety, etc) without depression. For those patients, my first-line treatment is an SSRI, usually Sertraline, switching to Duloxetine if somnolence becomes an issue. For patients with strong physical symptoms of anxiety/tachycardia, I add Propanalol. I avoid BZDs except to take as-needed in the case of severe panic disorder. However, I was talking to a psychiatrist who said that her first-line treatment for pure GAD without depressiv ..read more

Hi, all. New attending in the first year out of residency working on an inpatient unit. I think we've all likely encountered the patient's who are high-utilizers and likely fall under the umbrella of malingering. Or the patient with borderline who gets too comfortable on the unit. As I've started to become more and more familiar with the patients in my area, it's sticking out to me. It burns out my nursing staff, and I'm running out of steam trying to positively reframe with them all the time (the staff). What ethical strategies exist to help mitigate this and help facilitate discharge when a ..read more

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I was recently informed by another psychiatrist that in regards to the Clozapine/Luvox combo, the strength of Luvox doesn't matter much. That if the Luvox dose is decreased it won't affect the Clozapine level much because Luvox's enzyme interactions with Clozapine's reaches a point of saturation. So as far as Luvox dose, it wouldn't matter if the person was on Luvox 100 mg or 25 mg (but the Luvox also addresses depressive symptoms so in that regard it does matter). I'm unable to find any studies confirming this and was hoping someone could guide me to where I can find some. submitted by /u/O ..read more

specific examples would be great submitted by /u/helpadhd04 [visit reddit] [comments ..read more

So I am a medical doctor finishing my residency in psychiatry in a small wealthy country in Europe. After 5 first years of residency that was honnestly traumatic-- I started off in the field passionated about mental health, psychology and neuroscience and I ended up being disgruntled but the reality or I saw In my daily practice. I guess I had an idealized view of psychiatry. Anyways; now finishing my residency I received so many offers it's not decent. Out of all these offers, I retained mostly two of them claiming to not be as a shit environment as I and most resident are used to: shit ..read more

Dear all I have recently received the wonderful assignment of individual supervision of some new psychologist. I have offered supervision before to experienced therapists, and thought this wouldn't be much different. However after a couple of sessions I feel like I am missing the mark - I haven't been able to offer them the right level of supervision that they need as completely new to psychotherapy. Also, the patients they see are quite difficult. All the new psychologist seem really talented, and I have no doubt that they will become excellent therapists in time. I am looking for advice, su ..read more

Curious to see what others are seeing for moonlighting rates locally for weekend inpatient coverage. Adult or child-adolescent. Anyone willing to share how much and what the coverage situation looks like? submitted by /u/Livid_Pear6135 [visit reddit] [comments ..read more

I treat a lot of ADHD. For the majority of my ADHD intakes, I actually do agree they have ADHD. In fact, it’s possible that I over-diagnose in favor of avoiding missed diagnoses. But if I disagree that ADHD seems likely, I have never seen people who distrust my professional judgment more than people who have convinced themselves that they have ADHD based on something they researched online. And I have never gotten more severely negative online reviews than from patients for whom I did not agree to prescribe (what I consider to be) abuse-level doses of Adderall, or Adderall to treat (what they ..read more

Enrollment: Use the following link: Enrollment link Deadline is 3pm PT on 4/18 Troubleshooting: Make sure you choose the year you are taking your test. If you do not see the correct rate (50% off), remove the full-priced course from the shopping cart and re-add the correct course using the group link above. BTB Representative: If you have any questions or concerns, please contact our group's representative Lynne at [lynne@americanphysician.com](mailto:lynne@americanphysician.com). submitted by /u/MusicianNo7717 [visit reddit] [comments ..read more