For a patient that can’t take clozapine anymore for various reasons, has anyone had experience with either olanzapine doses above 20mg vs. adding a second antipsychotic e.g. risperidone?
Genuine question. Interested in insights from forensics and lawyers. I can’t see anything objectively wrong in her clinical judgement and this being her first year as an attending, I could see it causing significant career damages…no?
Hi everyone, looking for some honest guidance because I feel a bit stuck on next steps.
I'm a US IMG. I'm legally blind with 20/400 visual acuity and cannot drive or commute on my own. I've passed Step 1 and scored 259 on Step 2 CK. I currently work as a USMLE tutor.
I'm trying to figure out realistically what my path forward looks like. A few questions I'd love input on:
Has anyone here gone through Match as a visually impaired or legally blind applicant? How did programs respond, and would Psychiatry realistically be a more accommodating specialty given the nature of the work?
If Match isn't realistic given my vision, what are other legitimate paths forward for someone with my scores and background? I don't want to waste years chasing something that isn't feasible, but I also don't want to give up on it without real input from people who've been through this or something similar.
Would it be worth speaking to a disability services counselor or advisor who specializes in medical licensure/Match, and if so, does anyone have suggestions on who that might be or where to start looking?
Any honest experiences, even if they're not what I want to hear, would genuinely help me make a clearer decision. Thank you.
I apologize that this is another trial related thread, if there is another better place to post I definitely apologize. But I would love to hear people’s thoughts on today’s testimony of Dr Condine and Dr Zeizel. I’m curious to people’s thoughts on the potential education learned from their testimony, the overall consideration of the accuracy of their statements. I was hoping for a chance to learn from everyone’s insights, thanks!
This is a sentiment I hear a lot from attendings in all fields; if this was true for you, what did you learn as an attending that you didn't learn as a resident besides the obvious stuff like billing?
So it has finally happened - family member of patients looking up my info online.
All my socials are private, minimal LinkedIn Info, but what can you do about those public databases that have massive info about you, your past addresses, family members, etc.
I’ve used Doc defender, but there are 2 websites of the same thing that list previous addresses (luckily not current), family members, telephone numbers, etc.
I reported the site to google but this is actually ridiculous
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For an ongoing murder trial in Idaho they have posted what appears to be the summary of a detailed comprehensive exam paid for by defense. The primary diagnosis is ASD level one. There are over 1k responses where people are debating what the findings mean. This is concerning as the clinical language of psychiatry/psychological assessment is going to continue to be misconstrued and dropped into the cultural lexicon of language on social media. The findings are also likely wrong and erroneous as the defendant allegedly was notorious for regularly verbalizing homicidal language directed at himself and to others in public which resulted in his banishment from multiple establishments. If I had to wager a guess (without having spoken to him or having any other data than interviews I have watched of people describing his alleged bizarre behavior) he was responding to internal stimuli. I hope to God people don't think this is ASD.
I added the link, it's on the court TV FB page, I'm not sure the link is allowed here.
Edit: I made an error in post title-the summary is edited.
The past couple of weeks a lot of the local psych hospitals have been full and EDs are overflowing with psych boarders in my geography.
I’m wondering if many people all at once have started to admit more “edge cases” as a result of the recent trial.
I’ve probably been a bit more cautious and I feel like I’ve seen colleagues being a bit more cautious too.
I might just be imagining things. But I wonder if just thinking about liability with such a public case has made everyone more cautious.
I wonder if there is risk of over correction the other direction too - not pushing as hard for using outpatient resources.
This is a general piece on uncertainty and thoughtful documentation in a pretty messed up healthcare system, not a comment on any specific case. Mostly pro tips and reminders for trainees on things to consider when documenting.
I’m curious about something that seems particularly relevant to psychiatry. Have you ever been close to someone who you knew was going through something psychologically, and your training made you feel like you could recognize what was happening and potentially help them?
But because you’re close to them, they might feel uncomfortable coming to you about it, and you also don’t feel like it’s your place to approach them and start acting like their psychiatrist.
How do you deal with that feeling of being able to see someone struggling but not really being able to step in? Do you learn to accept that you can only be there as a friend/family member, rather than trying to help professionally?
And has your perspective on this changed throughout your training and career?
ps: i’m a medical student, it’s been a lifelong dream of mine to become a psychiatrist but i’m not sure i’ll be able to just watch people close to me from the sidelines without actively trying to help
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Title: What would you say to a medical student who is afraid she has BPD?
I'm curious how psychiatrists would counsel a medical student who is seriously afraid she may have borderline personality disorder—and worries that having BPD would mean she shouldn't become a psychiatrist.
A few years ago, her sister suggested she might have BPD. She became very worried about it and confided that fear to a psychiatrist. It was documented in her chart, although to her knowledge she was never diagnosed with BPD.
She has struggled with emotional regulation and interpersonal/professional boundaries, particularly during periods of significant stress. Since then, her father has died, she has experienced substantial family conflict, and she describes some experiences during M3 as traumatic.
There's another layer to the anxiety: someone in the medical community previously accessed her chart without permission and shared information with others. It is well known that that individual was punished for this. She now fears psychiatrists around her may know about it. At times, they seem to bring up very specific details that are listed in that note with her, from years ago.
I'm not asking anyone to diagnose her from this post. I'm more interested in the professional question: What would you say to a medical student who is terrified that she has undiagnosed BPD and that it makes her fundamentally unsuited for psychiatry from a mentor perspective? Is she allowed to share that with you? Is she allowed to question any of this?
And if she actually did meet criteria for BPD, would the diagnosis itself change how you viewed her potential to become a good psychiatrist?
I am a social worker on an ACT team in a large US city. Many of our patients have a primary psychotic disorder and a history of medication non-adherence, either by choice or due to their level of organization/functioning. As a result, most of them are on an LAI (mostly Invega, Uzedy, and Abilify with some Haldol and Prolixin mixed in) by the time they are enrolled with us.
There is an overlapping subset of patients (all of them currently on LAIs) we work with who have been on clozapine while hospitalized at one point in the course of their illness. These patients either a) have moderate to good insight but stop taking clozapine once they return to the community for any number of reasons or b) have little to no insight but receive court-mandated outpatient treatment that only requires adherence with an LAI as the standard for compliance.
For this subset of patients—those who can’t take clozapine due to their inability to consistently take oral meds and/or those who won’t take clozapine because of impaired judgement/insight—I can imagine that an LAI formulation would be incredibly beneficial. So many of them have cycled through multiple different antipsychotics and still experience a profound symptom burden.
So, why hasn’t a clozapine LAI been developed? Granted, I am not a psychiatrist and have a limited working knowledge of psychopharmacology, so there could be an obvious answer here that I am missing. But I am surprised that a medication viewed as the gold-standard for treatment-resistant schizophrenia is not available in an LAI form. Does anyone have insight into why this is?
Radiology residents have this moonlighting gig where they can do contrast coverage, where they cover allergic reactions to contrast during imaging. Most never get a call, or if they do it's once or twice in their whole career.
Have you done any similar gigs from the psych side, and how did you get into it?
We've been having recurring computer/system issues at our clinic and our current IT provider doesnt know what they're doing. Looking IT support that understands healthcare/HIPAA. Who are actually using and happy with?
Permission to post mods. Thank you
Long time follower, first time poster.
For the last 3 years I have run a digital mental health rotation for psychiatry residents. A lot of it has frankly involved getting residents to interact extensively with LLMs—understanding what they are good at, where they fail, developing the vocabulary needed to understand what is happening in the space, and becoming comfortable enough with the tools to actually use them well.
I generally wrap that education around a project the resident chooses at the beginning of the rotation. We have used LLMs to walk through setting up a private practice, help develop and submit early-career grants, build applications, think through how to market them, work through research ideas, etc. Basically, instead of teaching "prompting," I try to get them to use the tools to accomplish something they actually care about.
It has been interesting watching the baseline change over 3 years. Residents certainly come in more aware of these tools now than they did when I started, though their actual familiarity and understanding is still, in my opinion, woefully lacking. I don't particularly blame them for that. I think medicine generally has been very slow to figure out what exactly we should be teaching people about all of this.
My original goal with the rotation was pretty simple: I wanted residents leaving as comfortable with these tools as possible, with enough understanding that they could adapt as the technology changes. Hopefully that gives them some resilience through what I suspect will be a fairly destabilizing period for medicine.
Increasingly though, I realize the residents are only a small part of what I am actually worried about.
I feel the same obligation toward the psychiatrists who work in my practice, toward colleagues, and frankly toward myself.
I suspect that over the coming years we are going to see increasingly capable AI used for clinical decision support, followed eventually by systems capable of independently performing at least some diagnostic and treatment work. I don't know whether that happens in 2 years, 5 years, or 10 years. I don't know what the regulatory pathway will ultimately look like. And I certainly don't know how much of what psychiatrists currently do will actually be displaced.
But I think the possibility is substantial enough that simply teaching people how to use ChatGPT better feels inadequate.
So this is really what I am curious about from this group:
What should psychiatrists be doing now?
Not just residents. All of us.
If AI becomes extraordinarily good at diagnostic reasoning, medication selection, documentation, psychoeducation, measurement-based care, longitudinal monitoring, and eventually some amount of autonomous treatment, what skills become more valuable rather than less?
Should psychiatrists be deliberately moving toward more complex and treatment-resistant patients? Developing stronger psychotherapy and relationship-based skills? Interventional psychiatry? Leadership and supervision? Clinical informatics? Research? Building and owning the systems themselves? Entrepreneurship? Something else entirely?
And beyond individual psychiatrists, what should residency programs, practices, departments, health systems, and our professional organizations actually be building now?
I am particularly interested in the things that aren't obvious.
Three years ago I thought getting residents genuinely fluent with LLMs was probably ahead of the curve. Increasingly, that feels like table stakes. I am struggling with what the next layer of preparation should look like.
And if you think my premise is crazy, that's completely fair. But indulge my delusion for the sake of the exercise: assume for a moment that AI really does become capable of doing a meaningful percentage of the work psychiatrists currently do. What would you wish you had started doing 5 or 10 years beforehand?
A quick informal pulse check would also be interesting:
1. Over the next 10 years, how much do you think AI will change the actual work psychiatrists perform?
A. Mostly productivity gains; fundamentally the same job
B. Major workflow changes, but psychiatrists retain roughly the same clinical role
C. AI independently performs a meaningful portion of current diagnostic/treatment work
D. AI handles much of routine psychiatric care, with psychiatrists increasingly concentrated in complex, relational, procedural, or supervisory work
E. No idea / too early to tell
2. When do you think we first see AI routinely making at least some psychiatric diagnostic or treatment decisions without a psychiatrist individually approving each one?
A. Already / within 2 years
B. 3–5 years
C. 6–10 years
D. More than 10 years
E. Never, or effectively never
3. Perhaps the question I care about most: if C or D above turns out to be right, what would you personally start doing differently today?
I'm genuinely interested in both what people are already doing and what you think we are failing to think about.
Disclosure: I'm giving a talk on this topic in a few weeks and may reference some of the themes or ideas that come out of this discussion. Depending on where the thinking goes, it may eventually contribute to a more formal article or project, but this post is really me trying to hear how other psychiatrists are thinking about the problem.
And, in what I recognize is an amusing contradiction after spending several paragraphs arguing that psychiatrists should learn to use AI: yes, I did ultimately use AI to help me rewrite this post. The ideas and anxieties are mine; the model helped me organize them into something you might actually make it to the end of. Trust me, the original was painful to read.
For example, de-escalation, persuasion, maintaining strong boundaries, compartmentalization, etc
It’s been a month and a half since my last day of residency. Since then, I have mostly been a blob. I did move across the country and I have seen some friends and family. However, most of the time I have just been rotting and have no desire to do anything else. I have a couple weeks left before I start my first attending job. I want to make the most of it, but also maybe it’s okay to do nothing after an 8 year grind? I’m also trying to use my ADHD meds sparingly since I don’t know how long it will take to find a psychiatrist here, so that’s not helping…
Did anyone else experience this? Does anyone else struggle with constantly feeling like they should be productive?
I completed undergrad in 2022 and have been working in psychiatry for the last 4 years. I spent time as a technician in an inpatient drug rehab, worked with MAT patients at an FQHC, and spent 2 years doing psych clinical research.
My family background is closely tied to addiction med, both of my parents and countless friends/family members had SUDs. And before I get too many gunner accusations lmao, my heart is set on psychiatry. It’s genuinely my passion and I couldn’t imagine doing anything else.
I’m applying to medical schools currently and just started working at a psych private practice. It’s relatively new (~2 years) and it’s just me, another tech, and the psychiatrist.
I already have a lot of clinical experience as far as admissions go and have no real concern about acceptance. My real question is what can I gain from private practice that I won’t get anywhere else? How can I use this opportunity to learn more about the business side of medicine? If you previously worked in a hospital and started your own practice, what do you wish you would’ve learned beforehand?
I’m just trying to prepare myself for a future beyond clinical goals and the patient side of things. This is such a great opportunity to see essentially the start up phase of a private practice and I wanna gain as much as I can from this