Hacker News Reader

Comment by briholt | Hacker News Reader

Let psychologists prescribe common, low-risk psych drugs (instead of scarcer psychiatrists), let optometrist prescribe glasses, etc.

View on HN

> Let psychologists prescribe common, low-risk psych drugs (instead of scarcer psychiatrists),

What the hell? No, there's no way you want a psychologist to be prescribing medication. They receive absolutely no medical training whatsoever.

If you want psychiatric drugs without going to a psychiatrist, find a GP or NP. They're at least trained to practice medicine, even if they're not specifically trained in psychiatry.

You probably should not get psychiatric drugs from a GP or NP without first being assessed by a psychologist. While GPs have meds training, they aren’t trained in how medication fits into a larger psychological treatment plan to actually address the underlying issue. This is equivalent to demanding OxyContin from your GP for a recurring knee problem, rather than seeing an orthopedist to find out what’s actually wrong.

> You probably should not get psychiatric drugs from a GP or NP without first being assessed by a psychologist. While GPs have meds training, they aren’t trained in how medication fits into a larger psychological treatment plan to actually address the underlying issue.

I'm not telling anyone to do anything, but the idea of going to a psychologist for prescription drugs is beyond ridiculous.

> This is equivalent to demanding OxyContin from your GP for a recurring knee problem

It's worse - it's like demanding Oxycontin from your personal trainer at the gym. At least your GP went to medical school and did residency training.

I think you missed my point. I’m not saying psychologists should prescribe meds. I’m saying that medicating psychological problems should not be done in the absence of an appropriate diagnosis of those problems. This can be done only by a psychiatrist or psychologist (edit: and most psychiatrists aren’t trained in testing either, and will generally refer you to a testing psychologist if they think your problems are complex in nature). GPs and NPs do not have appropriate training in diagnosis.

My wife is a psychiatrist. She doesn't prescribe drugs to people with psychological problems. She prescribes drugs to people with psychiatric problems. She's been trained to know the difference. The PA that works under her has been similarly trained. But he doesn't understand the non-psychiatric medicine part that patients often times have.

That’s a good way of putting it — “psychiatric” vs. “psychological”, being able to know the difference, and treat appropriately.

What is the difference between a psychological and psychiatric problem? I've never seen these terms used in the same context you used them anywhere in medicine.

Hallucinations are generally a pyschiatric problem. Being manic/depressive is a pyschiatric problem. Being a jerk isn't. Having a hard time saying saying no isn't. There are gray areas. As a rough approximation, where drugs can help it's psychiatric, where they can't it's psychological.

If they develop a drug that keeps you from being a jerk does it become a psychiatric problem?

If it the jerk state is the result of a chemical/biological problem in the brain then yes.

5-HT1A stimulation results in decreased aggression, increased sociability, and decreased impulsivity. Sounds like a lack of 5-ht1a activity might make you a jerk, and it's stimulation might cure it.

I’m not a psychiatrist, my wife is. I don’t know hat 5-HT1A is or what your point is. The brain is an organ. It’s the only organ that can be harmed by non-physical means. My understanding is that behavior problems resulting from lack of certain “chemicals” or over abundance of them are psychiatric problems. Problems that don’t arise from such brain defects aren’t. When other organs are defective and don’t produce the right stuff to function properly people take drugs in order to function properly. The brain is no different except there are times the damage is not medical. There are gray areas.

5HT1A is a serotonin receptor generally thought to be responsible for the majority of SSRI effects.

Sorry I guess I wasn't very clear. My point is that there are some conditions that are just "medical". Things like parkinsons or ms. You usually see a neurologist for these conditions.

I'm arguing that any behavior a psychiatrist treats, has some neurological component. And many can be treated with therapy or drugs. So seems weird to use two categories where almost everything is falls into both categories

Think "bottom-up/biological" (psychiatric) vs. "top-down/behavioral" (psychological). Many behavioral disorders have components of both, which means that you either need a psychiatrist doing both med management and behavioral work (e.g. therapy) OR a psychiatrist + psychologist working together to address the problem. The second option can be quite a bit cheaper, since the behavioral treatment is usually far more time-intensive, and psychologists' time is generally less expensive.

>"What is the difference between a psychological and psychiatric problem? I've never seen these terms used in the same context you used them anywhere in medicine"

You really ought to stop pushing your uneducated opinions and do more research.

One this is a completely unhelpful comment. Similar to name calling. A much more helpful one would be showing that medical researches clearly divide problems into psychological and psychiatric.

And no one I know in research, or the psychiatrists I know would say there are many problems that fall into one category or the other. The vast majority of problems you'd see a psychiatrist for fall into both camps.

Mood disorders, and anxiety. The two most common categories of disorders are at least partially treatable by both therapy, and medication.

Which part of this workflow does 4-6 years of schooling, and an internship not prepare you for?

Counselor: Here's a medical questionnaire used to assess depression.

Yep you sound depressed.

Here's a script for Celexa.

https://www.drugs.com/sfx/celexa-side-effects.html

Also,

https://www.drugs.com/dosage/celexa.html

Drug interactions and contra indications.

For you example:

> Counselor: Here's a medical questionnaire used to assess depression.

> Yep you sound depressed.

How do you know it's not bipolar? (Your medication choice just caused severe harm).

There are Mental Health Nurse Practitioners, who can and do prescribe psych meds.

I agree that letting psychologists prescribe meds is problematic due to lack of medical training, even though clinical psychologists have a PhDs or PsyD.

Please let me buy contact lenses or a CPAP without a prescription

You can get the same brands of contacts from UK websites shipped to the US very easily (and cheaply). I know a few people who do this and they haven't had any problems yet.

You need a prescription to buy contacts? Weird. In 3 European countries I’m familiar with they are a supermarket item (literally) or anyway simply an over the counter item from pharmacies and opticians’ shops

Optometrists can prescribe glasses...

This exactly highlights my point from above.

People who have no idea about an industry saying how that industry should be regulated.

The reason we have different professions withing the medical industry is because of the years of training it takes to specialise in that area and get to a level of competency in that field.

Optometrists in the UK already prescribe glasses and contact lenses, I'm not familiar with the US system for glasses prescriptions but having to see more than one person seems... Illogical and expensive.

Nurses already push meds. After a suitably qualified and experienced doctor has assessed the patients records, seen or read a history and decided on a course of treatment. A nurse is not capable and should not be expected to know that level of detail about drug interactions and treatment pathways, that is literally what the doctor is for. Not everyone has the capacity / interest to know all this stuff, but we still need staff to tend to and care for our patients. Hence we have nurses.

Not to be disrespectful to nurses because they do incredible work and are essential to the medical industry and patient care but I happen to know quite a few nurses and doctors through friends and what I've come to realise is that anyone who can follow an instruction can become a nurse. And there are a lot of bad nurses. Thankfully not just anyone can become a doctor in the western world, because we have stringent regulations and laws.

The major contributing factor that adds cost to medicine are patents. Companies artificially inflating the prices of drugs and medical devices, not wages on the front line.

Reply on news.ycombinator.com