PhD/PsyD Health psychologist assessments?

[Healthmed101]

Can a clinical health psychologist help differentiate and recognize when a patient has a diffential health diagnosis that might be presenting as a mental illness with psychiatric symptoms?

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[erg923]

Can a clinical health psychologist help differentiate and recognize when a patient has a diffential health diagnosis that might be presenting as a mental illness with psychiatric symptoms?

Any properly trained psychologist should be familiar with the medical/medication/organic factors that can produce psychiatric symptoms (eg., hypothyroidism, NPH, poorly controlled blood glucose, drug induced psychosis).

 

[Healthmed101]

Any properly trained psychologist should be familiar with the medical/medication/organic factors that can produce psychiatric symptoms (eg., hypothyroidism, NPH, poorly controlled blood glucose, drug induced psychosis).

But they don't include this is standard phd/ psyd education? It's only if they do a postdoctoral fellowship or whatever.

 

[erg923]

But they don't include this is standard phd/ psyd education? It's only if they do a postdoctoral fellowship or whatever.

Whos "they?" I certainly learned about this via my curriculum and clinical training in grad school.

 

[PsyDr]

Covered in my program, before any speciality track coursework.

 

[Healthmed101]

Whos "they?" I certainly learned about this via my curriculum and clinical training in grad school.

I've heard that clinical psychology programs don't teach any medical/medication/organic factors that can produce psychiatric symptoms (eg., hypothyroidism, NPH, poorly controlled blood glucose, drug induced psychosis).. It isn't until you specialize in like neuro or medical psychology that they teach that stuff... Or so I've heard.

 

[erg923]

I've heard that clinical psychology programs don't teach any medical/medication/organic factors that can produce psychiatric symptoms (eg., hypothyroidism, NPH, poorly controlled blood glucose, drug induced psychosis).. It isn't until you specialize in like neuro or medical psychology that they teach that stuff... Or so I've heard.

I think you heard wrong.

 

[Healthmed101]

I think you heard wrong.

Oh wow, I was told by many in the field clinical psychologists learn minimal biological information regarding or relating to mental health.

 

[Justanothergrad]

Oh wow, I was told by many in the field clinical psychologists learn minimal biological information regarding or relating to mental health.

I would say that is generally true. Coverage in Health psychology is not required by APA (foolishly Imho given the direction of the field) and the number of programs with faculty who have specialized training to effectively train is far from comprehensive of all programs. Psychologists are aware of interplay with medical issues and may have knowledge of some issues. they may do some cursory reading but I doubt most have a strong working knowledge based on core class exposure.

 

[vitaminsea]

Can a clinical health psychologist help differentiate and recognize when a patient has a diffential health diagnosis that might be presenting as a mental illness with psychiatric symptoms?

Yes, it is our responsibility to do a complete differential diagnosis. We need to have an intermediate knowledge of the other potential (non-MH) factors that may be contributing to the symptom constellation. If I am treating someone for depression and they have an imbalanced metabolic profile then I am not providing them with the best care I can if I don't help that individual seek treatment to balance that profile. As that is being addressed, we continue to work on what is related to MH functioning. Good graduate programs will teach the basics of this differential diagnosis. Your responsibility for continuing education is to then move on to an intermediate knowledge. Advanced knowledge may be required in your specialty area.

 

[Healthmed101]

Yes, it is our responsibility to do a complete differential diagnosis. We need to have an intermediate knowledge of the other potential (non-MH) factors that may be contributing to the symptom constellation. If I am treating someone for depression and they have an imbalanced metabolic profile then I am not providing them with the best care I can if I don't help that individual seek treatment to balance that profile. As that is being addressed, we continue to work on what is related to MH functioning. Good graduate programs will teach the basics of this differential diagnosis. Your responsibility for continuing education is to then move on to an intermediate knowledge. Advanced knowledge may be required in your specialty area.

So then why do they say specially trained medical psychologists dont have enough medical knowledge or understanding of differential diagnosis to prescribe

 

[erg923]

So then why do they say specially trained medical psychologists dont have enough medical knowledge or understanding of differential diagnosis to prescribe

I think you are confusing many things here.

 

[deleted343839]

So then why do they say specially trained medical psychologists dont have enough medical knowledge or understanding of differential diagnosis to prescribe

After working with a specific population for a while, you do learn a lot about how certain diseases present, but that's not a substitute for medical training. Diagnosing medical conditions is not in our scope of practice. We can diagnose mental disorders and rule out psychological factors contributing to illness, but if we suspect an underlying medical etiology then we refer to a qualified physician for further workup, which, for what it's worth, usually includes procedures outside our scope of practice (physical examination, ordering lab tests/imaging, etc.).

 

[smalltownpsych]

So then why do they say specially trained medical psychologists dont have enough medical knowledge or understanding of differential diagnosis to prescribe

You would have to ask them. I have yet to see a psychologist say that we can't prescribe with adequate medical training and/or appropriate medical oversight. Also, psychiatrists won't see my patients until after a complete physical exam and labs so a medical psychologist would likely take the same stance. Usually psychologists who don't support RxP object for other reasons. I have posted some of my own objections in other threads, and remain firmly on the fence about the whole thing.

 

[Therapist4Chnge]

You would have to ask them. I have yet to see a psychologist say that we can't prescribe with adequate medical training and or appropriate medical oversight. Also, psychiatrists won't see my patients until after a complete physical exam and labs so a medical psychologist would likely take the same stance. Usually psychologists who don't support RxP object for other reasons. I have posted some of my own objections in other threads, and remain firmly on the fence about the whole thing.

100% agree.

 

[vitaminsea]

So then why do they say specially trained medical psychologists dont have enough medical knowledge or understanding of differential diagnosis to prescribe

Yes, there are several things going on here. An appropriately trained psychologist will be able to identify any potential biological contributions to the symptom constellation and follow up with a biological diagnostician and treatment provider to confirm and treat it. That does not mean our scope of practice is to use biological interventions for treatment without additional training beyond the PhD. Complete differential diagnosis (Biopsychosocial) and psychological principles for treatment = yes. Coordinating medical care for biological treatment = yes. Biological treatment for psychological or medical conditions = no (without appropriate training and even then the scope of practice should be very limited). Biological diagnosis or treatment for medical conditions = no.

 

[hamstergang]

psychiatrists won't see my patients until after a complete physical exam and labs

That may be where you work, but it certainly isn't a general rule. No outpatient site that I've worked at throughout my psychiatry residency, fellowship, or current job had patients get a physical exam and labs done by someone else prior to seeing the psychiatrist. I order labs when I feel they are warranted. I do parts of the physical exam when I feel they are warranted. I do, of course, refer to other medical specialties when more than that is warranted, but that's after not before I've seen them.

 

[Justanothergrad]

For those interested, Psychological Assessment has an upcoming issue devoted to health psychology assessments.

 

[bcliff]

3.) In achieving its objectives, the program has and implements a clear and coherent curriculum plan that provides the means whereby all students can acquire and demonstrate substantial understanding of and competence in the following areas:

(a) The breadth of scientific psychology, its history of thought and development, its research methods, and its applications. To achieve this end, the students shall be exposed to the current body of knowledge in at least the following areas: biological aspects of behavior; cognitive and affective aspects of behavior; social aspects of behavior; history and systems of psychology; psychological measurement; research methodology; and techniques of data analysis

(Guidelines and Principles for Accreditation of Programs in Professional Psychology, 2006, p. 7)

 

[smalltownpsych]

That may be where you work, but it certainly isn't a general rule. No outpatient site that I've worked at throughout my psychiatry residency, fellowship, or current job had patients get a physical exam and labs done by someone else prior to seeing the psychiatrist. I order labs when I feel they are warranted. I do parts of the physical exam when I feel they are warranted. I do, of course, refer to other medical specialties when more than that is warranted, but that's after not before I've seen them.

The only people I refer to a psychiatrist are kids and it's a two hour drive and appointments are 2 to 3 months out. I know that she requires a physical exam be done prior, not sure about labs. Our PMHNP requires labs and establishment with primary care done before they will see a patient. Also, when we admit a patient, they go through the ED and physical exam and labs are done there. What is also interesting is that every hospital where I have worked (which includes private inpatient psych, state hospital, private medical hospital with a psych unit, and a VA hospital) had another doc who would take care of the physical exam so much different from your experience. I guess the key difference is outpatient verses hospital. I don't have a lot of experience with outpatient psychiatry since its a rare thing in my neck of the woods.

 

[hamstergang]

The only people I refer to a psychiatrist are kids and it's a two hour drive and appointments are 2 to 3 months out. I know that she requires a physical exam be done prior, not sure about labs. Our PMHNP requires labs and establishment with primary care done before they will see a patient. Also, when we admit a patient, they go through the ED and physical exam and labs are done there. What is also interesting is that every hospital where I have worked (which includes private inpatient psych, state hospital, private medical hospital with a psych unit, and a VA hospital) had another doc who would take care of the physical exam so much different from your experience. I guess the key difference is outpatient verses hospital. I don't have a lot of experience with outpatient psychiatry since its a rare thing in my neck of the woods.

I only work with kids now. I was talking about outpatient, where I have never seen a requirement to have an exam done prior to being seen.

Inpatient is definitely different, and your experience there is not different than mine. There are reasons inpatient and outpatient are different in this regard but that's not so relevant to this thread.