u/Big_Elephant_2331

Posting this because it's something I experience often (although a bit less as I get more experienced) but never really hear much about:

Decision fatigue in medicine/psychiatry & how it impacts clinicians + patient outcomes.

This includes making diagnoses, picking the right med in a field where the treatments are really based on a best guess & sometimes there are very marginal differences within a drug class, ordering tests (what's too much, whats not enough?), managing folks with personality disorders, or even cognitive biases.

Leaks out into delayed care for patients, broken therapeutic alliances when pts lose trust bc of decisions, etc. etc. etc.

Of course following guidelines and evidenced based care is the way to go - make the decision and trust it's the right one, but psychiatry can be a bit tricky here for varying reasons.

I don't think this is a me problem, although I do run a bit on the anxious side. Nonetheless certainly just part of the job, but curious what others do to help, be it through tools / resources / etc.

Came across research of a new class of drugs for ADHD being studied called COMT inhibiting drugs, which typically treat Parkinsons.

Made me wonder whether those with ADHD have higher risk of Parkinsons due to shared dopamine deficit and to my horror (I have ADHD) it seems there's an incredibly higher risk. Study below had an N of 13,098.

https://pubmed.ncbi.nlm.nih.gov/40419147/

Fortunately this can be modified, mostly by exercise. A meta-analysis of prospective studies found frequent moderate or vigorous physical activity is associated with a 34% reduction in Parkinsons risk.

If this isn't enough to scare your ADHD pts (or you) into getting to the gym, not sure what will.

Also as an aside, the hilarious part is that I'm pretty sure I came across this research years ago but my ADHD brain completely forgot. So lucky me, I got to be terrified twice for the same reason, years apart. Off to the gym I go.

This is for the folks in private practice. As someone in private practice, who has also been a patient seeking support with therapy and psychiatry on platforms like Alma, Headway, Psychology Today, etc, I wanted to share a few things that may or may not be helpful.

I looked at probably 100 profiles on psychology today and headway, and almost every single one of them said some combination of the following:

"I take a holistic whole person approach"

"I focus on more than just the medication"

"I don't think one size fits all"

"I take a collaborative approach to treatment"

"My orientation is compassionate, warm, nonjudgemental and empathetic"

Few notes:

Firstly, this is how at least one of my profiles look. So not knocking it. But It almost feels as if everyone went to ChatGPT (I did) to write out their profile and get a revision. So much so that every single profile looks exactly the same. But maybe they actually think they are differentiating themselves by writing these things?

It strikes me that the most commonly written things are simply part of being a psychiatric nurse practitioner.

So the question is what exactly would make you unique enough to get the attention of someone seeking care? So that the only way people judge a profile isn't just based on what they look like?

So...some things that at least stuck out to me:

1. vulnerability - people who included some of their lived experience in their profile

2. clinical niches - if i'm seeking someone for adhd i'm less confident that person is the right one when theyve listed everything under the sun in their profile. sure many of us do general psychiatry, but in the private practice context it probably makes sense to carve out some kind of niche. my guess is it means you can charge more. i've niched down a bit and bc of that i get tons of referrals from therapists who think of me first for particular pt profiles.

3. dual credentials - not everyone has this, but surely folks have some additional trainings or experiences that show a more expanded clinical perspective. even if its unrelated, like prior degrees or interest based trainings.

4. extra curriculars - i always felt more connected to the person who showed their world view in some way, particularly via what kinds of extracurriculars they do or have done, such as community service, mission trips, art, music etc.

5. non-professional interests. i used to do a lot of rock climbing till i got injured, but i've included that i like rock climbing on my profile, and bc of it i have a number of patients who decided to work with me JUST because of that. dont be shy about sharing what you like to do.

Hope this is helpful for someone out there either starting their practice or trying to do better with marketing.

New ADHD medication being fast tracked by the FDA:

https://www.otsuka-us.com/news/otsuka-announces-fda-acceptance-and-priority-review-new-drug-application-centanafadine

Drug is called Centanafadine. It's a norepinephrine dopamine serotinin reuptake inhibitor. Basically wellbutrin + an SSRI.

Many many many of my patients on either wellbutrin or stimulants are also on an SSRI. Always thought it'd be great to have the best of both worlds in one, especially with wellbutrin as the only NDRI, and while useful, often causes anxiety or irritability which makes it intolerable for many.

Adding an SSRI helps in those cases, and in fact i'll typically start one low dose before starting wellbutrin in those who lean towards anxiety with good success, so great that this new drug combines them all.

Bipolar patients were excluded from the study (far as I know). So curious whether it'll be useful for bipolar depression, in the way wellbutrin is. My guess is no. But well see.

I like to cook and enjoy watching cooking shows but half the time I don't know what in the hell they are talking about when they present their recipes.

I thought it'd be cool to actually learn, so sharing a resource for folks to learn. It includes 36 lessons in order of fine dining essential building blocks that cover theory, history and science.

Each lesson also has some demo videos and a real recipe you can use to practice the skill.

It includes a photo studio where if you make something, you can take a picture and edit to share on social media if you wanted.

All free! Would love to hear thoughts, criticisms, impressions. Esp if you work in fine dining. tear it apart, love to hear how bad it is coz surely there are a million areas for improvement

Check comments to see