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My Experience with Psychopharmacology Training |
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Early Career Professionals and Continuing Education |
Sally Horwatt |
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As I walked down the aisle to the strains of Pomp and Circumstance, I was surprised when tears started rolling down my cheeks. There, sitting in the bleachers at NOVA Southeastern University in Florida was Michael, my husband, smiling at me. Here, in line in front of and behind me were my classmates, by now very close friends. It was only then, suddenly, that the immensity of what I had achieved in two years became real to me. Running a full-time practice, learning vast quantities of material, and keeping good relationships with my friends and family seemed impossible....overwhelming at times. Truthfully, much of the time I was tired and wondered what I had got myself into. Now, all of a sudden, I was finished. And the subject-matter memorialized by the MS in Psychopharmacology degree had already truly had life-saving qualities. You see, even if we don’t get prescriptive authority (and we will) what I learned probably saved the life of a family member or two. Based on my study of pathophysiology and general pharmacology, and the symptoms exhibited by a family member, I realized that a cardiologist had prescribed an excess dose of a particular medicine. A trip to her office confirmed my suspicion, the dose was lowered, and my relative stopped collapsing and resumed his normal life. Another relative had had a spinal laminectomy. His anaphylactic reaction to the pain killer left this relative in terrible pain. Prednisone helped with the allergy, but the psychotropic side effects of that drug became intolerable, so the steroid was discontinued as soon as possible. The agent that made the difference, bringing his pain from about about a level 9 to 4, was Amitriptyline, a tricyclic antidepressant which is used for pain associated with injury to bone and soft tissue. However, soon this relative was experiencing very high blood pressure, sweating, headache and ringing in the ears. It appears that another drug was inhibiting an enzyme necessary to metabolize the Amtriptyline, so the plasma level of the Amitriptyline was rising. I figured this out. The solution? My relative was taking both drugs for a reason...which one do you get rid of? It is at this point, that you really need the patient to be informed and to help make the choice. We decided to lower the dose of the Amitriptyline, keep the other drug, and he’d put up with some pain. I’d just keep taking his blood pressure. In two situations, it was my training that enabled me to help the physicians treat my family members and keep them safe. I am not denigrating medical doctors, presuming that we can eliminate physicians altogether, or implying that psychologists don’t make mistakes. But, we are all guaranteed to have health problems as we age, and we all need to become informed partners in our own care with our physicians. I could go on about the ways in which this training has helped my patients. One man with mitral valve prolapse had such severe panic states that while driving with his wife, he nearly caused a collision with an oncoming car because he was pulling on her, demanding he be taken to an emergency room. Other than the prolapse, a cardiologist had already declared him to be in fine shape. He was unconvinced and made several trips to the ER, convinced he was having heart attacks. I referred him to the cardiologist for evaluation for a beta blocker – for anxiety. When the cardiologist independently recommended a beta blocker, my credibility went way up, and the patient’s panic states down-graded to generalized anxiety. My reputation with local physicians has sky-rocketed, resulting in more referrals. I am engaging in the holistic practice of psychology...one that embraces the whole, biological, psychological and social human being in my consulting room. I encourage everybody to begin the process of adding this training to their educational background. The Department of Defense psychologists are still prescribing (using far less medication, by the way, than the psychiatrists and far more psychotherapy). The psychologists in New Mexico and in Louisiana are preparing themselves to prescribe. I wish I could describe the satisfaction I felt Graduation day as I began the last third of my career. For all of you, I hope for the same satisfaction. The future of Psychology, with its expanded field of vision, expanding opportunities for biopsychosocial research, and its greater capacity to promote health and well-being is an exciting one. I look forward to seeing you there. |
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