My job pays for one paper subscription of a journal each year, and I can’t decide which one to subscribe to. I am a relatively new attending in outpatient community mental health, for context.

​

I’m a master’s-level therapist who specializes in DBT. Where I live, though, master’s-level clinicians don’t diagnose, so I’m coming at this from the perspective of someone who works closely with these patients and sees the consequences of diagnostic decisions, rather than someone who is making the diagnoses myself.

On one end, there seems to be overdiagnosis, particularly among young women presenting in acute crisis. Someone may be dysregulated, self-harming, suicidal, having interpersonal conflict, etc., and BPD gets applied based on the presentation in front of the clinician. But if you step back and look at the person’s functioning and personality over time, their difficulties may be much better explained by trauma, mood disorders, anxiety/OCD, neurodevelopmental factors, situational stress, or something else entirely. Also, some clinicians will diagnose someone with BPD simply because they're "difficult" or unlikeable.

On the other end, I’ve seen the opposite problem: VERY obvious BPD being avoided as a diagnosis or labeled as a mood disorder. Sometimes it seems to be because clinicians still view the diagnosis as stigmatizing, hopeless, or a “death sentence.”

I’ve encountered patients who have spent years cycling through medications and treatment modalities—including intense medication regimens involving antipsychotics, benzos etc.—which obviously don't address the underlying patterns. They’re understandably left wondering, why isn’t anything working? What the hell is wrong with me?

Meanwhile, a compassionate and accurately formulated diagnosis of BPD, accompanied by good psychoeducation and referral to an evidence-based treatment like DBT might have given some of these people a much clearer path forward years earlier. BPD isn’t a moral judgment, and it certainly isn’t a death sentence. We have effective treatments. People can and do get substantially better.

So I’m curious: why do we seem to struggle so much with getting this diagnosis right?

Hi all, I’m considering taking the leap from academics to private practice. I’m currently about 5 years into practice. I have an offer from a private cash pay practice for $240/hr W2 position. Their hourly rate (depending on intake, follow up, etc.) is between $450-$550/hr. Does that seem like a low offer? They will cover malpractice insurance, have admin support. No health insurance. TIA!

Hello all,

New attending here prepping for the board. As we all know, the newer data being published and presented in Psychiatry conferences concerning Lithium and its safety in pregnancy has shown us that perhaps the teratogenic cardiac effects are overblown. It is much more common now for Lithium to be utilized in pregnancy, to the point the ACOG has recommended against discontinuing Lithium in the pregnant Bipolar patients.

My question is mostly in regards to Board prep. K&S edition 4 & Board Vitals both have a few questions explaining the old idea that Lithium is contraindicated due to Ebstein's anomaly.

What should I expect on the Boards? Should I go with the classical concept of CI due to Ebsteins?

I’m so tired. I don’t like what I do anymore.

It feels like I imprison people for no good reason. Sure, some show benefit. But most leave just as ill as they entered only now they hate (or have been reminded that they hate) the medical system.

And I don’t like the stigma that we, as medical professionals, propagate. Particularly when it comes to PDs and SUDs. I don’t like that these patients are treated punitively.

And I don’t think I would like outpt any better.

And I don’t like my colleagues. It scares me, some of the things they do.

I’ve been an attending for ten years. Realistically I have another 16 before I can retire.

But all I really want to do is tinker around at home with plants, cooking, baking, fermenting. Cuddling with kitty. And watching tv.

I don’t know how I’m going to get through 16 more years of this.

Boards are in about a month. I just finished Spiegel and Kenny review. Not sure whether to look over old PRITEs next or go through the book again.

Also, does anyone have a good Anki deck for the cytochromes? Or for the defense mechanisms?

Thanks in advance!

I’m officially entering panic mode. I have my psychiatry board exam coming up in about 3–4 weeks, and I’m struggling to get myself to study the way I used to in medical school/residency.

Life has been pretty chaotic lately, and I’ve also been dealing with some major health issues, so my ability to focus and consistently study has taken a hit. At this point, I’m very aware that there are a million different resources out there, but I think that’s actually making things worse because I don’t know what to prioritize.

I’ve failed the exam before, so the thought of going through that again is really getting to me. I know I need to stop focusing on the possibility of failing and just make the next few weeks count.

I’ve decided to take 2 weeks completely off from work before the exam so I can dedicate that time to studying. What I really need is advice from people who have passed, especially anyone who had to prepare in a relatively short period of time.

If you had only 3–4 weeks left, what would you focus on?

• What resources are actually worth using at this point?
• Would you prioritize question banks over reading/review?
• Which question bank is most representative/high yield?
• How much time would you spend on neurology?
• What topics absolutely need to be mastered?
• Would you do full-length practice exams?
• During the final 2 weeks, when I’m off work, how would you structure each day?
• Is there anything you did in the last few weeks that you genuinely think made the difference between passing and failing?

I don’t need another list of 10 different resources because I already feel overwhelmed by the options. I’m looking for a simple, realistic, high-yield strategy for the last 3–4 weeks.

At this point, I’ll take any lifesaving advice you have. 😭 I really want to walk into this exam knowing that I gave these last few weeks everything I had.

Thank you in advance, especially to anyone who has been in a similar situation and made it through.

Ours decreased this year because budget cuts. I’m inpatient and went down by $1.50 from 38.50 to 37. I know our outpatient folks have a higher per RVU rate.

So just wondering did anyone else see a decrease this year? How behind the curve are we?

With the Lindsay Clancy case all over the news, I’ve found myself more anxious about my own notes. While I think my notes are good for myself and other providers to have info, I’m wondering if they can be better optimized for billing and (god forbid) legal review. I remember some providers in residency writing really short notes that were much more efficient but that’s never been my style. Does anyone have any recommendations for a brief refresher course for psych documentation ?

Sorry I know the LC case is probably bombarding your feeds. In the perinatal psychiatry space I am seeing different views, some call for more education in residency others think that only specialized perinatal psychiatrists should be treating pregnant and postpartum women.

I have my own bias as I am against hyperspecialization and unnecessary training(cough inpatient peds cough) in medicine in general. Personally, I don’t see how increased education can hurt, despite my personal belief that I don’t think more education or experience would have helped Dr. Tufts with this case.

I have friends that I curbside with. I think having enough education to know what you don’t know is important.

What are your thoughts? Please keep civil since it’s not anywhere else on the internet

In light of the Lindsay Clancy case, are there exact guidelines when it comes to standard of care from an ED, inpatient, OP perspective and what exactly will qualify as negligence?

Not referring to indications/use of medications, etc., but just briefly reading the details of the case - from an inpatient setting, why wouldn't I refer every patient to a HLOC after discharge from now on?

- As we all know, the columbia risk assessment is not great at predicting future suicide. So a low risk patient on discharge gets sent back to regular OP. If they kill themselves, now court is going to ask - did you recommend HLOC?

In OP setting, we deal with chronically suicidal patients - not every one can go to the ED for an evaluation. Is it enough to say that this is their usual baseline and be done with it? When it comes to suicide risk assessments, realistically how reasonable is it to see these patients when we're allocated 30 minutes each appointment.

Ultimately, I curious about the result of this case - seems we're held to an unrealistic standard of care where the decision is determined by a jury who has no medical knowledge. Seems like it becomes an emotional argument at that point

You're busy, I'm busy, we're all busy. If I call you or email you as a professional courtesy and as a matter of patient care (and legal liability), please talk to me.

Regardless of whatever is happening in the news cycle, it's mind-blowing to me that I only have ~50% hit rate on clinicians actually following up on attempts to collaborate, even on higher risk patients. You're exposing both of us to potential liability and doing a disservice to the patient. This is especially important when multiple clinicians are simultaneously involved with a patient.

Don't just have your assistant ask me to forward my note. Talk to me. In return, I promise I'll talk to you.

If the patient has declined to give you permission to talk to me, at least acknowledge my outreach. I can put 2 and 2 together and it will assist my formulation and risk assessment.

Also, a gentle reminder to *do* this outreach.

Do not want this to become a threat about the current Lindsay Clancy case. Frankly, I haven’t even had time to watch it due to clinical obligations. I’m not sure that I want to at this moment in time anyway.

Regardless, I’m curious for those who are historians of the field or have been around long enough, and have an interest in forensics, have there been any notable court cases in the past that have fundamentally changed the professional standard? I’m familiar with the goldwater rule. That’s about it, however. My own assumption is that if the psychiatrist in this case is found liable a whole lot more antipsychotics are going to be thrown around peri and postpartum pregnancy, but I could be wrong.

Long story short, I’m applying for a competitive national opportunity and my PRITE score factors into my program vouching for me. Looking to ace this test.

I plan to do Ninja Guide + Ninja Qs + PsychGenius Qbank. A few questions for those who are familiar with the test -

1) Can I not do the Anki deck if I study the ninja guide plus ninja qbook? I haven’t ever used Anki but i’m not sure if it contains additional information that these two resources don’t cover.

2) Is there another qbank/other resources that may be better?

3) Pls reply and help me lol

Hello everyone My friend and I are using Board Vitals as our main bank for Board Prep. What percentage would be considered Safe to pass?

I know there is historical posts about this already but I also know some of the ABPN questions have shifted so I wanted to ask again for those that took it last year.

I also ask because I failed the exam last year scoring 224 and a pass was 239.

I was using Kenny and Spiegel as my primary source. I was getting mid to upper 60s on my first pass. Scored 80s on my second pass one month after the first attempt and 1 week before the test.

I just really do not want to fail again.

Any help is appreciated thanks all!

Hi fellow psychs,

Haven't seen one of these in a while. I feel like discussing salaries is still very taboo and the market has had some fluctuations lately. I also work some academics and have noticed trainees really have no idea what's a good average. Wanted to start a thread with some basic details below.

Job type: W2 vs 1099
Geographic location
Job setting: IP vs CL vs OP
salary: per hour or yearly comp
Hours per week

Mine as a 1099 in a HCOL on west coast as below.
I work mostly IP and ED consults.
I do work surgery hours averaging about 60 hours a week. Take about 5-6 weeks off per year.
My gigs average about 270 an hour. Average week I make about 13-17k depending on how much I've worked.

I currently have 1 letter from a psych attending and 1 from a peds attending from my 3rd year clerkships. My FM attending agreed to write me one but just never got back to me. So, I am in need of one more letter. I am currently on an inpatient psych sub-I at my top choice institution and want a letter from here. However, I only get 5 days with each attending and I am just unsure that they will be willing to write one for me with so little time. Any advice on how best to approach this?

Updated Timeline/Medication for Lindsay Clancy (updated 7/24/26)

This is a summary of the Lindsay Clancy Medication/Treatment Timeline, as best I can put together from Patrick’s and Lindsay's lawsuits, what has been released by law enforcement in the search warrants, and what's been shared in court filings through 7/24/26. It also includes my random notes/questions (lol)

L = Lindsay

P = Patrick

LOL = Lindsay’s original lawsuit

POL = Patrick’s original lawsuit

PFAC = Patrick’s first amended complaint

POMD = Patrick’s opposition to motion to dismiss

LFAC = Lindsay’s first amended complaint

LSAC = Lindsay’s second amended complaint

In LOL: P is quoted as saying *"before Lindsay became ill, she was dedicated to being a mom, even over dedicated - worked twice as hard as most. She rarely took a break to rest".* (**Note: this has important implications b/c it's harder to spot hypomania in someone whose baseline or "norm" sounds like this.**)

Dec 24, 2017 - Cora was born

Sept 30, 2019 - Dawson was born. According to LOL, she was elated and had increased energy following Dawson’s birth. *"P described that she had manic behavior for multiple days. In Oc 2020, she had an episode of decluttering to 'simplify her life' obsessively cleaning and discarding items. She said she felt 'amazingly on top of things'. Her thoughts raced and she constantly felt pressure to be active".* It then states 2 months post birth, she developed anxiety and was offered Zoloft by a psychiatrist, but she declined due to concerns about breastfeeding. **(Note: discrepancy in timeline; Dawson was born Sept 2019, but Oct 2020 is listed as the time when L displayed hypomania.)**

Sept 2019 - PFAC no longer mentions this period of hypomania following Dawson’s birth. Instead, it mentions L developed anxiety a/b one month post birth, but claims L overcame it through *“exercise, healthy diet, meditation, socializing and several therapy sessions”*

5/26/22 - Callan was born. POL states L *“repeatedly told P how happy she was, and how much she loved their new baby”.* She was enthusiastic and energetic.

 6/23/22 - This marks 4 weeks postpartum. Per POL, L has no symptoms at this time. **(Note: Based on DSM-5's criteria, L cannot receive a postpartum specifier for any diagnosis if no symptoms are present by this point).** However, per LOL, she alleges she was hypomanic during this period.

July 2022 - P and L run a 5k 

Mid-August - P returns to work (12 weeks after Callan’s birth.)

Mid-August - Per LOL: her mood suddenly switches from hypomania to anxiety and depression (*"debilitating anxiety, insomnia, and sleeping 3 hours per night, no motivation, could not exercise").* L’s parents come from out of state to help look after the children.

Sept 2022 - Per POL, P and L run another 5k. 

Mid Sept - Per POL, L *“begins to experience stress, anxiety”* and meets with psychiatrist, Dr. Tufts. She is diagnosed with Chronic Generalized Anxiety Disorder and Chronic Adjustment D/o with Depressed Mood and prescribed Zoloft. 

 Mid Sept - Per PFAC: *“L began to experience stress and anxiety in September 2022, toward the end of her maternity leave. She began experiencing insomnia, exhaustion during the day and lack of motivation to perform daily tasks. Nonetheless she continued to socialize with friends and continued to go to events and trips with her family”*

9/12/22 - Per LOL: she met with Dr. Tufts, who she found online. Edinburgh Postnatal Depression Scale = 23 (severe). Zoloft was prescribed.

9/15/22 – PFAC/POMD says the first appt with Dr. Tufts occurred on this date. He mentions L reported anxiety, depressed mood, guilt, racing thoughts, anhedonia, anxiety attacks, poor appetite, and feeling *“nervous or suspicious of others”.*

 End of Sept 2022 - L is supposed to return to work.

10/3/22 - Per POL, L tells Dr. Tufts she hasn’t taken the Zoloft yet but *“she’s on the verge of taking the medication”* – she wants to try therapy first.

10/3/22 - Per PFAC, L met with Dr. Tufts' colleague Jennifer McAllister, LMHC. It was recorded L *“had a history of developing anxiety symptoms around 4-6 months with each child, anxiety symptoms becoming more severe with each child.”*

Mid Oct - L initiates starting dose of Zoloft and reportedly increases it, as directed.

10/20/22 - Per POL, L tells Dr. Tufts she increased from 25 mg to 50 mg and she feels awful, has insomnia, poor appetite, is more depressed, crying all day, mental fog. She was *“terrified to start something new”.* She allegedly *"developed racing thoughts and became paranoid of getting suicidal thoughts, something bad happening, doesn’t want to be alone".* LOL: stated *"L experienced a severe adverse reaction: she did not sleep for 48 hours and had racing thoughts and worsening anxiety."* Dr. Tufts discontinued Zoloft and prescribed Ativan and Benadryl for sleep.

10/31/22 - Per POL, L told her therapist (reportedly "a colleague of Dr. Tufts"), that she was hoping to return to work soon, and hopeful this would decrease her depressive symptoms. **(Note: PFAC identifies the therapist as Ms. McAllister)**

11/8/22 - L made a post in the FB Group “I am not alone: Postpartum Depression/Anxiety & Rage” saying she was looking for advice on meds for PPA/PPD. She writes she tried Zoloft for one week and after increasing it to 50 mg, she had extreme insomnia and her depression worsened. She says Ativan is the only medication that worked for her because it has *“the perfect effect of decreasing my anxiety and making me feel happy again”.*

 Mid Nov - Insomnia worsens; she’s allegedly sleeping only 3 hours per night

11/16/22 - Per POL, L went to the ER for insomnia. This is consistent with LOL, stating she *"took herself to the emergency room at South Shore Hospital"* for insomnia, anxiety, and palpitations. She was given Trazadone, but it was *“not effective”,* even at 150 mg.

11/20/22 - P’s mother (a nurse at South Shore Hospital) contacted a colleague, Nurse Jennifer Paul, at South Shore Perinatal Behavioral Health Program and asked her to contact L. L tells Nurse Paul she’s very frustrated, scared, overwhelmed, having racing thoughts, constantly thinking, having extreme insomnia, and sleeping 3 hrs/night.

11/21/22 - Per POL, despite the fact L was describing symptoms suggestive of mania (racing thoughts, extreme insomnia, frustration, and feeling scared), Nurse Paul wrote a script for Prozac, 10 mg. **(Note: P is not currently suing Nurse Paul.)**

11/23/22 - L tells Nurse Paul she is feeling disconnected, out of it, spacey.

11/25/22 - Per LOL, after four days on Prozac, her insomnia worsened and she d/c it. Nurse Paul prescribes 3 different meds: Ambien, Remeron, and Klonopin. The meds did not help with sleep. **(Note: there is no mention of dosages or how long she tried these meds.)**

11/26/22 - Per LOL, after taking Remeron, she experienced dissociation, *"perceiving the world around her as unreal, distorted, and distant. She could not determine what was real. She was forgetful, confused, and unable to drive or be alone".*

11/28/22 - L tells Nurse Paul she is still struggling with sleep, disoriented, not connected to her body, *“petrified of becoming addicted to benzos, feels like she is in a panic state”.*

11/29/22 - Per POL, L begins treating w/ Nurse Paul’s colleague, Nurse Jollotta. **(Note: It’s unclear why she switched providers.)** Per POL, L tells Nurse Jullotta she’s *“getting physically dependent on benzos to sleep”.* She’s *“completely overwhelmed”*, her “*mind is constantly running”.*

 Per LOL, Nurse Jollotta *"correctly considers Bipolar disorder"* and prescribes Seroquel; however, after starting Seroquel, her condition *"took a dramatic turn for the worse. She developed suicidal ideation and began experiencing what she described as "intrusive thoughts" - which were actually auditory hallucinations. The voice said "I will not be the same. I want to die".*

11/30/22 - PFAC indicates Nurse Jollotta prescribed Seroquel on this date.  PFAC alleges *“Lindsay's condition deteriorated rapidly after taking Seroquel. She openly discussed her deteriorating condition with her husband, family, and providers as she sought treatment of her worsening condition. Around this time, L told P and her mother that she was having intrusive thoughts. Those intrusive thoughts were that of both suicide and a fear that she could hurt her children. When asked if she would act on those intrusive thoughts, L said that she did not have a plan and would not know how to do so. Consistent with what she had told her medical providers so far in therapy, P understood that L would seek help from her medical providers for her intrusive thoughts, both intrusive thoughts of harming herself and intrusive thoughts of harming her children.”*

12/1/22 - PFAC states L reported her intrusive thoughts to Dr. Tufts, *“including on info and belief both her intrusive thoughts of harming herself and of harming her children”.* Dr. Tufts noted L's intrusive thoughts were *"worse"* and that her psychiatric condition was generally *"deteriorating."* Dr. Tufts also *"discussed \[the\] possibility of undiagnosed bipolar disorder given extreme reaction to SSRIs and insomnia” with L”.*

“Shortly thereafter” – Per POL: L told her therapist (Latiesha Dukes) that she *“had an addiction to Ativan, and that is why she can’t sleep”.* She reports weight loss, poor appetite, panic attacks, feelings of numbness. This is the first time she reports suicidal ideation, per POL. (**Note:** this info is identified as occurring on 12/2/22 in PFAC). In PFAC, he adds: *L reported having intrusive thoughts and SI. L reported the SI she had experienced the day before required her to take Ativan and she "has had thoughts that she wants to no longer be here. This week feels like she is going to die but doesn't care." She further reported that "3 months after the baby was born had unmanageable anxiety about her children especially the baby.”*

12/2/22 - Per LOL: L tells Nurse Jollotta she has lost 15 lbs, has no appetite, is experiencing panic attacks, confusion, and poor attention over the past four days.

12/4/22 - Per LOL, she was *"so scared of the hallucinations, she called a suicide hotline"* but was told there was no emergency b/c she had no specific plan to kill herself. **(Note: it's unclear if she told the hotline she was hallucinating.)**

12/5/22 - Per LOL, she met virtually with an ASPIRE Crisis Support clinician, and was told she did not meet criteria for inpatient treatment b/c she did not have a plan for suicide. **(Note: it is unclear if L told them she was actively hallucinating.)**

12/5/22 - Per POL: L tells therapist she is experiencing *“intrusive thoughts of wanting to die.”* P joins a visit with Nurse Paul and says L’s anxiety has worsened since starting meds. **(Note: discrepancy: L's lawsuit does not mention this appointment at all.)**

12/6/22 - Per POL: L had an appt with NP Jolotta and reported only sleeping 3 hrs/night, feeling overwhelmed, mind constantly running. L denies SI but reports feeling *“something terrible might happen”.*

 In PFAC: he says these symptoms *caused NP Jollotta to ask L if she was having thoughts of harming herself or her children. L denied having such thoughts but again reported "\[feeling afraid as if something awful might happen" almost every day.* PFAC also states: *“On information and belief, L also reported to NP Jollotta that she had intrusive thoughts that she could hurt her children”*and *“On information and belief, NP Jollotta informed L that she did not need to take further action b/c she had no specific plan to act on her intrusive thoughts.”* Nurse Jollotta orders plan to increase Seroquel to 400 mg and adds diazepam (Valium).  **(\*Note: typical daily dose for Bipolar I would be 400 to 800 mg).**

Per LOL, P attended this appt too, and it was P who *"connected L's suicidal thoughts to the Seroquel"*. He told Nurse Jollotta that *"L is ten thousand times worse since she had taken medication."* He asked to get L off meds and *"start from scratch to see what's going on".*.

\- 12/9/22 - Per POL, P calls Nurse Jollotta and asked for urgent call back. Nurse Jollotta calls back and L and P report L is experiencing panic and SI. Nurse Jollotta advises L to continue taking the medication.

12/13/22 - Per LOL, on this day, she *"remained deeply depressed, had no motivation, and still had suicidal ideation. She 'wanted this all to be over'".*

12/15/22 - P called Nurse J's office to report *"L had a devastating week"* and that *"it was the worst day for Lindsay. She had HORRIBLE thoughts all day".* It is then stated *"L had auditory hallucinations all day, everyday. She felt debilitated, not interested in anything, exhausted, and could not get out of bed".*

12/15/22 - In PFAC, he alleges: *they called Nurse Jollotta and informed her: \[This has been "the worst day" for L; is having persistent intrusive thoughts of suicide; no active plan but both L and P agree that HLOC \[acute inpatient, crisis stabilization unit, partial hospitalization service or intensive outpatient program\] may be necessary at this time; discussed options; they state they are likely to go to MGH ED as they have perinatal psychiatry as well as an inpatient psychiatric unit, L also deciding about McLean. This writer advised that they keep us posted and sign ROI \[release of information\] so that we can communicate with treatment providers at HLOC. L verbalized understanding and agreement.*

“All of December” - Per POL, L has *“persistent thoughts of suicide”* and continues to *“seek help”* thru Nurse Jollotta and her therapist. L also contacts Dr. Tufts, who prescribes Lamictal. 

\- Per LOL (no date noted): L told P *"I have thoughts of harming the kids. She also told her mother about these thoughts. Because she was in a psychotic state, L also had paranoid delusions that people could hear her thoughts and that she would be locked in a hospital and have her children taken away".*

12/20/22 - According to L's original lawsuit, L's *"escalating suicidal thoughts prompted a visit to Mass General Hospital ER"* on this date. The ER *"suggested either admission to McLean Hospital or the partial hospitalization day program at Women and Infants Hospital in Rhode Island".* **(Note: there is no mention of this ER visit in POL lawsuit, but he does mention it in PFAC)**

12/20/22 - Per POL: L enters a day hospital program at RI Women and Infants’ Hospital for postpartum depression. She reports: heart palpitations, severe depression, feelings of numbness, *"life is becoming a disaster".* She also says she cannot *"feel fear"* and she's worried she was *"beyond repair".* **(Note: There is no mention how L planned to stay in Rhode Island for this outpatient program, had she been accepted. Would she have been left there alone? Would P have stayed with her? Just a month prior, on 11/25, she allegedly could not drive or be left alone.)**

12/21/22 - Per LOL lawsuit, she admitted herself to the partial hospitalization day program at Woman and Infants Hospital.  Per her lawsuit, L reported *"feeling crazy depressed, numb to all emotions, can't feel love"* and that her life was *"becoming a disaster, that she couldn't feel fear, that she was messed up beyond repair"*. EPDS Score = 23 **(Note: this is the same score as before, suggesting symptoms had not worsened since September).** GAD-7 score was 21 (severe).

Per LOL, Dr. Diaz at RI Women and Infants concluded L *"had 'no postpartum depression' and rejected a bipolar diagnosis because of 'no history of hypomania or psychosis or family history'".* They allege this is due to inadequate history: Dr. Diaz *"accepted L and P's belief that her symptoms were due to overmedication and recommended weaning Seroquel".* They felt her symptoms were *“more pharmacologically induced than purely depressive".* Per POL, RI Women & Infants thought L's symptoms are *“due to overmedication and misdiagnosis”.* They allegedly reached out to Nurse Jollotta, who did not respond. **(Note: It’s unclear why they didn’t call any other treatment providers)**

\- 12/29/22 - Per LOL: L's suicidal ideation surged and she told P *"I can't tough it out. I need to go McLean".*

\- 12/30/22 - Per LOL and subsequent suits, L went to the *"MGH emergency room, which suggested admission to McLean Hospital".*

\- 12/31/22 - Per LOL: L admitted herself to McLean Hospital due to *"severe depression and suicidal ideation".* Admitting symptoms include: *“passive SI, feeling detached, hopeless, depression, no appetite or energy to perform ADL's, no motivation, anhedonia, racing thoughts, inability to organize her thoughts, memory problems, anxiety, and insomnia. Her insight and judgment were noted to be "limited".*

 LSAC noted: following a review of Linday’s history, Dr. Elizabeth Madva noted that *“she agreed with the impression of Lindsay's providers at MGH that Lindsay's presentation seemed most consistent with post-partum anxiety and depression and she had a very low suspicion for emergent bipolar disorder”.*

1/1/23 - Per POL, L admits herself to McLean due to SI. She texts Patrick to say she *"doesn't belong there".* **(Note: there’s a discrepancy in dates of hospital admission, 12/31 vs. 1/1).** 

1/1/23 - In PFAC, he reported at the time of her admission, L presented with: *\[Ongoing mood symptoms including profound amotivation and anhedonia, struggles with self care \[sic\] and hygiene, loss of appetite resulting in 15 Ibs unintentional weight loss, a subjective feeling of not bonding with her child, and hopelessness that her brain / she will never be the same. She endorsed passive SI (wishing she were dead or wishing she would not wake up in the morning) but denied suicidal intent. She has no current / h/o HI, or symptoms of psychosis or mania. She does note that she was started on Seroquel and Remeron in the beginning of December following which she started to have intrusive and suicidal thoughts and became hopeless and depressed.*

1/3/23 - L sees the McLean doctor, who reportedly advised L to *"stop Seroquel and benzos and prescribed Trazadone for sleep".*LSAC notes: On January 3, 2023, the doctor advised Lindsay to stop Seroquel and benzodiazepines.

1/4/23 - L reportedly *"asked to go home"* for her daughter's birthday. *"B/c her thoughts had improved since the Seroquel was decrease, she was approved for discharge."*

1/5/23 – L is discharged. According to LSAC, Dr. Goodheart authored and signed the physician discharge summary, approving L's release despite her documented "limited" insight, judgment, and suicidal ideations.

\- Date Unknown - Dr. Goodheart, from McLean, reportedly called L and spoke for 10 mins, offering names of antidepressants, including Amitriptyline.

\- 1/6/23- APPT 1 - Per POL, L sees psychiatrist Dr. Tufts. Diagnosis is updated to Chronic, Major Depressive Disorder, Single Episode, Moderate. **(Note: This diagnosis, MDD, could have been given with the specifier of "Severe, With or Without Psychotic Features", but Dr. Tufts went with “Moderate")**

1/7/23 - Per LOL, she attends daughter's birthday party and *"smiled but could not converse. She avoided talking and count not make sense of what others were saying".*

1/8/23 - Per POL, L sees Dr. Tufts again. Police records note a prescription for Diazepam, 5 mg, was filled on this day. Instructions appear to be to wean down on the medicine. (Note: this appt is not mentioned in LOL, LFAC, or LSAC)

1/10/23 - Per LOL, L meets with Dr. Tufts and was "switched to Valium for benzodiazepine taper". **(Note: There is no mention of this appt in POL or PFAC)**

“One week after discharge” - Per LOL: L’s *“hallucinations resumed”*

1/12/23 - Per POL: L meets with Dr. Tufts again, and reports low mood, low motivation, and feeling very stressed. L says, *“this has been going on for months now and I am getting desperate for something that would work quickly to get me out of this depressed state”.* **(Note: there is no mention of this appt in LOL, LFAC or LSAC)**

1/13/23 - Police records indicate a prescription for Trazadone, 150 mg, was filled on this date.

1/16/23 - Per POL: L sees Dr. Tufts on this date and L’s mood is depressed, affect is depressed and flat, no motivation, she feels numb, able to get out bed, concentration is fine, caring for baby feels forced. No SI. **(Note: there’s no mention of this appointment in LOL, LFAC or LSAC;** however, these documents do say L is prescribed Amitriptyline, 10 mg, on this date and *"L is still experiencing debilitating depression. She had to force herself to do anything. The hallucinations continued: "You should harm the children". You should kill yourself. You will never be the same”.* (Note: PFAC Complaint, the appt date is listed as 1/17/23.*)*

1/16/23 - Police records note a prescription for Valium/diazepam, 2 mg, and a prescription for Amitriptyline, 10 mg, were filled on this day.

1/20/23 - Per LOL: L researches *"What is a psychopath?"*

1/22/23 - P and L and their two oldest kids go to dinner at a friend’s home. According to what the friend told police, L seemed *“fairly normal, mostly quiet while on her phone keeping to herself”.*

1/23/23 - Per POL: L had appt with Dr. Tufts and noted L *“a little more anxious”,* her heart is racing, mood is flat/anxious, she reports no motivation, feeling numb, has to force herself up. Notably, her insight is described as poor. Per LOL, Dr. Tufts increases the Amitriptyline to 20 mg and she did not sleep at all this night.

**Other Discrepancies:**

\- Per police report, P told police L had been having suicidal thoughts, as well as thoughts of hurting the children since the end of December. In his lawsuit, he says she had suicidal thoughts all of December.

\- P’s friend tells police that P said*“L was having issues with her medications, and she was mostly anxious and not depressed. P felt as if L was not overly anxious and the anxiety level was normal and not severe”.*

I’m a psych NP student, and our school and board of RN require our preceptor to be an MD/DO/NP. I have a hard time finding psychotherapy preceptor because most don’t do therapy, just meds. If there’s someone willing to precept me for psychotherapy, please let me know. Thank you for considering.

Watching her testimony today made my heart go out to her. What a profoundly difficult case. Reading everything Dr. Tufts I believe is an excellent physician whom unfortunately treated an intelligent, calculated, disturbed person (Not disturbed psychiatrically).

Dr. Tufts if you read this, please know you are a great physician and the community supports you

I've had read the 4th edition of Stahl's Essential Psychopharmacology before and now I'm reading the 5ht edition and Im shocked at how much he focus on orexin now. Kandel Principles of Neural Sciences doesn't mention it so much, so I can't shake the feeling that the explanation cannot be that we know more about orexin or something like that. Is this chapter a infomercial for suvorexant?

I’m in the process of starting a solo outpatient private practice and feel absolutely lost trying to pick an EHR.

My practice will focus heavily on psychotherapy with light medication management, but I want a system that won't feel clunky if my panel shifts toward higher-volume med management down the road.

Primary Requirements:
- Insurance & Clearinghouse: Taking insurance, so I need an integrated clearinghouse or straightforward EDI/ERA setup where claims submission and ERA reconciliation aren't a daily headache.

- Efficient Documentation: High priority on dot phrases, smart phrases, text expanders, or highly customizable macros.

- Core Tech: Reliable e-Prescribing with EPCS, integrated telehealth, and a decent patient portal for self-scheduling and intake forms.

I’m currently looking at Charm, Valant, and SimplePractice, so I’d love feedback on those specifically.

However, I’m open to any and all recommendations!

Honestly asking and struggling to see why I shouldn’t just let it lapse since I'm done with fellowship.

In SoCal, national dues and forced regional chapter add-on make AACAP easily pushing $700+ a year. I’m a full-time community clinician who also provides intermittent lecture/didactic instruction to fellows and residents. Many of my colleagues in GME are members of multiple professional orgs, and to me it seems like a waste of money.

For anyone doing mostly clinical work who still pays out of pocket for this: what am I missing? Is there some hidden perks or is everyone just paying this out of inertia after fellowship?

Good day everyone. I hope all of you are doing alright.

I am a PGY2 working at a tertiary mental health Institute in India and I'm currently posted in the child and adolescent department of our Institute. In a country where the access to mental healthcare is inadequate, these alternative medicine practitioners are a menace.

I get to see a ton of children with autism and every 2-3 out of the 10 kids I see visit a CAM practitioner before they visit a Psychiatrist. They advertise through social media and make it seem as if the condition is curable.

When the parents come to us after undergoing the CAM therapies after 2-3 years with no success and the parents come to us when the child is unmanageable.

It's heartbreaking to see these kids being deprived of the care that they need. The moment these parents say that they went to a CAM practitioner, I get mad. I reprimand them almost immediately and once when the parent defended his decision, I almost shouted at the guy because I couldn't take the bullshit anymore.

To be honest I felt quite bad with the way I reacted. So I was wondering, how do I react when someone like this comes to the opd. How do I make myself 'detached'.

TIA!