4th year psychiatry resident. AMA

That's as much as people are gonna get. I don't really care if people don't want to believe me.

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Sarcasm is the best honest reality check i could ask for i guess.

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Sound like you have a bad friend. Maybe not hang out with him for awhile till you get your head straight.

I can't tell you that people aren't out to get you. But if you arent in jail or dead on the side of the road yet then I think you will be okay

Oh, Manson for sure. Just for the laughs

Alright, I'll bite.

I've been practising counselling for a while now, but I've always wanted to advance to being a Psychologist (I know it's not the same as Psychiatry). I have the opportunity to do so now, and I've been short listed for a doctorate. How do you recommend I prepare for the interview and what would you say is the most difficult part about obtaining a doctorate?

Seemed like it was more of my own mind messing with me and took a little to shake off. Definitely not doing shrooms for a long while and shouldn't be mixed with ptsd for the time being. Thanks, Doc for the replies regardless!

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4th year medical student waiting to match into FM. I was hoping you could clear something up for me: as someone who wants to enter the primary care field, when should psychiatry be referred to? I've seen my FM mentor handle all of his psych patients on his own, but should they all be referred or say if they're treatment resistant/complicated?

That's always been something I've been a little confused about even though it seems so basic.

Also, do you still use lithium for your bipolar patients? I keep hearing docs say they refuse to prescribe it now because of sides and regular lab visits. It's cheap, effective and manageable in my eyes but I'd love your thoughts.

Congrats on finishing up your residency!

do you have any beef with psychiatrists? do y'all hate eachother?

This was retarded of me. I meant psychologists. Do you guys hate eachother. I imagien y'all like spit on eachother's style/practice.

do you see any correlation between early trauma and homosexuality?

Congrats on finishing the long haul, man! Match is coming up, bro! Good luck.

As for referrals, it really depends on what your comfort level is. I am doing integrated care right now, and we get consulted for refractory depression and the patient is on a starting dose of an SSRI. I would say that's unacceptable, but we get consulted all the fucking time for it. I would say, get yourself a copy of Stahls Prescribing Guide and learn to get comortable.

If the patient is bipolar or schizo, refer to us. If you have a weird clinical picture, refer. That stuff we are glad to help with.

Congrats on climbing the ladder. i would say start learning statistics, and start learning about the history of the different psychology models that are being used. That will help you with assessing the different programs strengths and weaknesses.

Honestly, the most difficult part is getting in. I've seen a lot of dunderhead psych PhDs

I mean, people have beefs across all disciplines. There are a ton of psychiatrists that I don't like personally, and do a substandard job, but I'm sure they think the same for me.

As for psychologists, oh man, that's tough. They seem to differ quite a bit. I have met some that totally disregard biology in their models. It's like, some have never been educated in cellular biology, and they think in purely psychological models. These people think that schizophrenia and OCD have no genetic factors. Some think that anti psychotics are placebos. It's bonkers how anti-science some of them can be.

OP what is the psychological factor behind you wanting to suck massive amounts of cocks, all day, every day?

Why are intelligent people so often socially rejected, misunderstood, and told that they’re “stupid”?

Also, are you excited for all the pharmaceutical benefits and perks once you land a F/T role?

Thanks man, gonna grab a copy of Stahls. We're both gonna make it my dude, you sound like a chill guy and I'm glad people like you are going into psych. Congrats!

yeah, for sure. It sucks that even admitting the facts makes me appear like a bigot, but the science is pretty sturdy that early trauma corresponds with higher rates of homosexuality.

I just ask my drug rep what I should prescribe.

This is why I want to get out of counselling.

Your first statement is false. There are different types of intelligence, including emotional and social intelligence. If you have a really high IQ, but you can't pick up emotional or social cues, you're gonna appear strange. And if you can't verbalize your intelligence, then you are going to look stupid. As a society, we value all forms of intelligence. Sorry if my response is a little tactless.

Also, the perks are pretty much nonexistent these days. We get taken out to a nice dinner every once in awhile, but long gone are the days of getting flown to the Caribbean for 3 days to have a two hour seminar.

>people have beefs across all disciplines.

Pretty much this. I'm in my local cabinet maker union and we can't STAND psychologists.

yeah man, I initially wanted to become an anesthesia intensivist. M3 psych rotation came and I was like 'fuck, I found my home". So glad I made the big switch.

it's crazy that drug reps have any impact. If anything, when I walk away from a dinner, it leaves a bad impression, and I am less likely to prescribe the drug.

How do I stop fucking drinking? How do I do anything with my life at all?

what types of disorder do you consider the hardest to work with and which have usually better outcome?

Oh yeah, i totally understand.

In my opinion, the psychologists that I respect the most are the neuropsychologists. It kinda sucks, because all they do is a shit ton of testing, but they are the most scientific of the psychologists

When shit is barely more effective than placebo, does it matter? All I care is that they have more sides that require more treatment so the industry stays strong and active.

top zozzle. Thanks for the chuckle.

I'm addicted to porn. Not addicted to where it ruins my life. My wife knows about it and accepts it. I still do well at work, pay my bills and shit like that. It's just that I spend mad time browsing/hoarding porn.

What's wrong with me?

Alcohol use disorder is a disease. I hated to admit it when I started my training, because my dad drank and I hated him for it, but the evidence is pretty conclusive that a lot of people can't simply stop drinking, just as much as some people can't lower their high blood pressure.

The apathy and mood problems that come along with alcohol improves with sobriety.

Talk to a doctor about options. There are a few medications that seriously work well for most people.

Addicted via dopamine receptors. Replace it with something else. Preferably a variety of activities. Your brain is seeking stimulation.

personality disorders are almost always the most difficult to deal with. People with schizophrenia tend to be the easiest, which people find surprising.

As for best outcome, depression, partly because its a self remitting disease, and partly because our treatments tend to work if its severe enough.

hmmm, what should I replace it with? I don't get that kind kick from anything else?

How do i cure my ADHD, my depression and my anxiety
Don't wanna fry my brain on meds and fuck up my natural focus ability

You are gonna have to be more specific, fam, because lithium and clozapine work almost every goddamn time.

As for mild to moderate depression, yeah, our medications dont really work. There's a lot of possible reasons for this, including the fact that we are calling people who are angry and unhappy and misanthropic depressed when really there is something completely different going on.

I have met so many patients, that my gut just tells me that they aren't going to respond to antidepressants, and I have like a 70% success rate. Why do you think that is?

You won't at first. That is withdrawal. You have to let your receptors reset. Think of hobbies you've always wanted to try.

OP here. This guy is right. Addiction is pretty similar in the brain no matter the substance. Pornography is problematic for a lot of people, so is gaming, or just the internet in general.

If it's not causing problems, then its more of a hobby than a true addiction.

Still, you could try some things. I wouldn't recommend starting medications, but maybe some psychotherapy, or even, if you feel up for the novelty, trying some hypnotherapy. If it works, it works rather effectively and quickly.

>clozapine

Was referring to SSRIs. 90% of seratonin receptors exist in the gut so biome therapy will be the way forward.

That makes sense. Check this out. I was an alcoholic for like fifteen years. Since I started drinking when I was in the military until about a year and a half ago. Always wanted to stop, but never could. I always explained it like this. I can stop if I want, like just doni't go to the store. and buy beer. But my brain never made that choice. So anyways had a bad night where I got retarded when drunk (pretty common shit) and and the next day decided It was one of the worst episodes i ever had and didn't want to repeat it. Hadn't drank since. I don't drink at all now and even when people offer I don't take because I might start again and don't want to become an alcoholic again.

Exercise and psychotherapy if you want to stear away from meds. There is quite a bit of evidence that psychotherapy for ADHD is helpful, as well as for depression and anxiety.

Honesty, our medications for depression and anxiety are the safest medications in all of medicine, and if they work, you take them for a year or two and get some psychotherapy to strengthen those neural networks, and you will be good to go

TY I have my certification in Armchair Psychology from Brown I U

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Got kik ?
I go to a shrink but i don't really make progress i think. I realize stuff then either it depress me more or a bigger problem come and erase the previous shit

Got some medication name you like and are safe ?

did you watch Us and is that what Freud ment by id

Yeah, in life, fifty goddamn years. Until then, stay salty

I'm a medical doctor, faggot. Major academic centers utilize hypnotherapy for a variety of indications. Stay salty.

Honestly I don't even know what Kik is. I'm getting old.

I will always start with Zoloft or Lexapro, unless you have a family history of responding well to a different antidepressant. Honestly, Prozac is probably my favorite SSRI, it tends to be a bit more effective and almost as well tolerated

>biome therapy
what should i take to fix my shit

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How long until you become a real doctor?

I'm on a whole shitload or meds for bipolar and I just lost my health insurance so I guess it's back to crazy town. What can I realistically do to minimize the risks to myself and society without meds?

“In the depths of my heart I can’t help being convinced that my dear fellow-men, with a few exceptions, are worthless.”
Sigmund Freud
Do you agree with this?

It's a messaging app, like snapchat

Do you know seroplex ? a friend of mine took that for a few years i believe and said it was great

Do meds limit my thought speed and pattern ? i've got potential but shit stres managing and adhd. You know, dont wanna get screwed while trying to get better

Depends on what a real doctor is. I already have my medical license. I am done with residency in June, and then I do board exams, which aren't required to practice, and start a 1 year forensic psychiatry fellowship

One can prescribe, one can't. Of course they square up and squab nigga you stoopid

My wife has fucked loads of men and women before she met me.

I was virgin before her.

How do I stop being a fag about it?

Lithium costs like 4 dollars a month, and you can go into a free clinic.

Really, there is no excuse to not take any medications.

But, for non med treatment of bipolar disorder, the strongest evidence is for good sleep hygiene. Like, throw away all your lightbulbs, and don't use a television or computer past 4pm.

Yes, but probably for different reasons than Frued

That's just a weird name for Lexapro. I use it on the daily. My go-to starter med for anxiety with depression. Honestly, it changes so little that you won't even notice you are taking it. People expect huge changes with antidepressants. Its adorably naive

I'm not on lithium it doesn't work well for me. But it's not just the meds, it's the doctors appointments and everything else. My all in cost is like 1000 a month and I don't have it so I appreciate the advice on sleep.

Especially lately, various states are trying to pass bills allowing psychologists to prescribe medications. These are troubling times.

You should fuck a bunch of guys. Kidding. I would say talk about her with it, and even see a marriage counselor for a spell to address it. Being hung up on something like that is totally normal. If you let it interfere with your relationship instead of being a man and working on your problem, then you are a real fag

>there is no excuse to not take any medications

This, everyone should be on something. Why not take advantage of medical technology?

Good advice. Okay, I'll try that. Thanks

This would be great for the pharmaceutical industry. All that really matters is we generate revenue to compete with china.

Jesus fuck, these threads always bring out the salt.
If he has a medical condition there is no reason not to be on treatment.

How is high school going?

Even more salt. Damn.
The reasoning is that it takes a long time to see a doctor because of the huge shortage we have in our country.

How does one restores his dopamine receptor and all the stuff burnt during an addiction ?
a ketamine coma ?

what’s the worst way you think you can fuck up professionally and how are you going to avoid that?

Why has the medical field not figured out addiction yet? It seems that everything I touch I get addicted to to some varying degree. The times I swear off everything, I just feel busy and bored. And medication is just playing lab monkey where weird shit happens but it never solves anything.

So salty = wanting better profits?

Go to mexico and try ibogaine.

how do i stop being a coward ?
i get so anxious and became terrified when i face an unfamiliar situation for example : if a fucking 5yo kid ask me about time i start to stutter ,i can't even talk on the phone
how do i stop being such a wimp

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Your privilege request and renewals are less stringent with board certification but the moc can kill you

Just time. For chronic methamphetamine users, it takes about 9 months to 2 years for dopamine receptor density to reach pre-meth baseline.

Its a rough, depressing time. People get awfully dramatic, partly because of their depression and partly because the excitement of drama is a little bit of a high.

Oh, man, fuck a patient, That will get you fucked forever, especially in psychiatry. So the best way to avoid this is to not have a long treatment with a patient so there is no time to develop romantic attraction, so doing inpatient or consult work.

We have made a lot of progress in the past ten years, but the vast majority of doctors hold on to old dogma and prejudice. Our medications seriously do work. I've seen them work. I've seen a guy go from drinking a liter of vodka daily for thirteen years to drinking a pint of vodka every two days on his next visit. So enjoy that high chair of ignorance.

Salty = Thinking the spirit of any piece of legislation is for the corporate overlords

Thanks I didn't know that

Oh sweet summer child. How do you think those policy makers get rich? Off their 200k a year salaries? LOL

>People get awfully dramatic,
I've stopped cold turkey masturbating (a few times i've been on abstinence)
Do you think this + the college exam stress could have fucked me deeper and caused my dark period ?
also thanks for the answers !

what is more beneficial: being completely mentally healthy with no personal experiences in any of the fields you treat and therefore maintaining a professional distance only relying on proven facts OR actually going through some disorder related issues yourself, overcoming them and then making use of those experiences for the better of your craft?

thanks for all the answers btw, great thread.

Most commonly this is seen in social anxiety disorder, a fairly common type of anxiety disorder, that responds very well to medications and psychotherapy. Going untreated for a long duration tends to lead to a worsening of symptoms and is more resistant to treatment.

Oh yes, everything is a vast conspiracy. I get it, I am so naive. Your black and white thinking and over-generalizations are a form of cognitive bias that allows you to navigate a complicated world. Your brain allows you to love in a simple world, because you are a simple man.

Have you had people try and self diagnose their own personality disorder? If so, were they right?

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Oh, that is a neat question! The college stress leading to depression, for sure, that is genetically ingrained in us. Depression is a survival mechanism during times of stress.

As for not getting that orgasm and having it lead to a decrease in your dopamanergic system, that is pretty damn tricky. I don't think there would be a consensus in the field. My gut would tell me that it is not a factor.

This is a pretty common question. I think you can be a great doctor either way, and you can be a terrible doctor either way. I myself had some PTSD from being a combat medic, in the shit in Iraq, and I think that it has really been a benefit in treating all patients, not just vets with PTSD. But a lot of people are attracted to psychiatry thinking it is going to somehow heal them as they heal others, which is, in my experience, never the case. i has my shit fixed for years before entering psychiatry.

Got tips to do something that stresses me out/depress me ? (like studying or filing administrative papers..)

Btw you gonna make more threads like this or it's a one time thing ?

Yes to self diagnosing. People love to figure out their issue, medical and psychiatric

For accuracy, borderline patients are almost always correct. Close to batting a thousand. For antisocial, very rarely is it correct. People often worry they are psychopaths. The real antisocial don't think anything is wrong with them.

Those are the only two often self diagnosed disorders. Lots of schizoid and schizotypal think they are autistic, like, half the motherfuckers on the chan

Are traps gay?

are there findings in your field which you consider obsolete but still remain standard for treating patients and, on the other hand, are there any standards that surprised you being more progressive than expected?

There are lots of pop articles about preventing procrastination. It really comes down to the reason you avoid and how to address that. The most universal advice is this: do a bad job now, and worry about doing it right later.

Sure, man, I do these threads when I have spare time, which should be more often in the near future. I always post the same pic, for fidelity

This is my last reply, I gotta go zap some brains.

Every trans person I have encountered has a reason for being trans, typically sexual trauma and/or autism. I'm talking 100%. And the treatment is to get comfortable in the body you hate, just like everyone else.

Nobody can change the core of their being, and that's what these people want. That, or simple perversion

i’m dealing with depression for decades and despite going through all sorts of treatments i always find myself coming back to being depressed. it’s a place that just feels like home and gives me a weird kind of peace. do i rightfully feel guilty about that, thinking that i’m not actually sick but just massively avoidant towards responsibilities or is that part of the sickness itself? i’m a male borderliner btw.

I know im crazy, but am i schizo?
So i used to fuck with the new age and spirit guides and shit, one day it went too far, “spirit guide” introduced me to my “new spirit guide” “Lucifer” and after that i stopped, But its been years and I still cant pray without having intrusive thoughts about Lucifer/Satan when i pray and when I try to end the prayer with “in Jesus Christ’s Name, Amen,” its a mental and physical strain to do so.

I could go into more detail, if needed, also my brother is definitely a schizo but that was from extreme drug abuse, so I doubt its genetic, but idk.

Here you go, for all the doubters

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Look up depressive personality disorder. I have found a handful of patients like you that seem to fit this diagnosis, although not in the DSM, but that's probably for political and monetary purposes rather than science

Google schizotypal personality and don't worry about it so much

What's up with Cingulotomies?

Honestly I've never seen one. Deep brain stimulators are now en vouge, and by the time a person gets DBS and we realize they have failed DBS, they are already dead, and therefore not a good candidate for cingulotomy

Hello Doctor, how am I?

You're a rascal, that's for sure. There is no cure, I'm afraid. You must learn to survive as you are.

Doc, what's the best SSRI for women with general anxiety about everything plus panic attacks here and there?

The best is the one that works. I typically start with Lexapro and the jack it up, past max recommended dose if necessary. I inherited a patient on 65mg that was tolerating well

Thanks man

good fuck you are a stupid quack

>I jacked off and my dopamine dripped out of my brain!

how the fuck can you actually believe this shit

OP is dyslexic

>psychiatry resident. AMA
I read an article some time ago, in the UK a man lost a court case trying to stop an ex-wife from chemically castrating his 7 yr old son. Do you have thoughts?
Your views on trans gender issues? Is gender dysphoria still recognized?