Lecture 1: Intro, Overview Flashcards
Prescribing Authority: Considerations
Will professional standards improve services provided?
Does an integrated approach lead to better outcome?
Does it increase cost-effectiveness?
The case FOR prescribing authority
Logical extension as a healthcare provider
Serves communities where psychiatrists aren’t available
Primary care physicians receive very limited training in psychopharmacology and mental health, yet they are the most common prescribers of psychotropic meds
Primary care physicians are only able to spend limited time with patients [Whereas a psychologist meets on a regular basis is likely to provide a higher quality of care]
Many GPs are already consulting psychologists
The case AGAINST prescribing authority
Main argument – negative effect on professional identity
It will “medicalize” the field
Psychologists lack formal medical training
*financially and politically motivated
- move away from psychotherapy
e. g. possible to triple daiily # of patients - make more money by just prescribing
Serper: prescribing authority should not be main focus
“Psychiatrists’ kingdom” = hospital and prescription privileges
Instead of prescribing authority, energy should be spent fighting for hospital privileges
Once someone is inpatient, it’s completely up to hospital staff to grant privileges to psychologists
Ethical obligation of all psychologists
Assessment and treatment services in a competent manner
This includes understanding of medication
Beneficence
We are obligated to provide the most effective treatment
Non-malfeasance
Fidelity
Autonomy
Collaborative Care [aka Integrated Approach]
Process and evolution of treatment of patient
e.g. medication in conjunction with psychotherapy
Biopsychosocial model:
*impact of medication on the patients, families, home, workplace
*collaborate with those who extend beyond your knowledge base to provide the best service possible
Each member of team does not need to know everything, since they are not the sole provider of treatment
*you don’t need to administer meds to engage in collaborative care
(though often pdoc don’t / won’t contact you)
**This is NOT consultation
APA 3 levels of training
*Important foror psychologists to have knowledge of pharmacology, regardless of whether or not we get prescription privileges
- Basic pharmacology education
- Psychodiagnosis
- Extensive clinical supervision
We are expected to know the conditions in which clients should be referred for psychiatric treatment
• Level 1 training is a minimal requirement to meet this standard level of care
Basic pharmacology education
To competently provide assessment and treatment services to the patient:
Basic pharmacology
Drug biodisposition
Therapeutic uses of psychopharmacological agents
Drug behavior interactions
Methods of clinical research
Psychodiagnosis
Medication selection and administration based on the diagnosis
Basically to know which meds would and would not be good for patients
Extensive supervised clinical supervision
Working with patients under supervision AND prescribing
Collaborative-Care vs Consultation Model
Collaborative-care model
- A process
- Addresses gaps in time
Consultation model
*Single event
Osheroff v Chestnut Lodge
Pharmacological treatment was not considered, even though ethically obligated
*Lawsuit conclusion: need to provide alternatives or options of treatment
If patient refuses phramacological treatment, doctor must discuss fears and concerns:
document patient’s refusal
During consent process, need to notify clients of medical options and that we cannot provide them with this option
MS: you have to bring it up within the first session:
“if you want to work with me, this is what I do”
“Never presume the presence or absence of anything”
*All medication will have side effects – many appear like psychiatric conditions
Other substances may cause symptoms that mimic disorders
o e.g. interactions, caffeine withdrawal, alcohol withdrawal, melatonin
Always ask o have you stopped anything recently? o substance use history o past medications *duration *frequency *amount *tx effects *side effects
Underlying causes: Too few neurotransmitters
Parkinson’s = decreased dopamine receptors due to cell death
Alzheimer’s = decreased acetylcholine
