Services

Psychiatric Evaluation

Comprehensive biopsychosociocultural psychiatric evaluations are performed to assess your life currently and historically including assessment of relevant family history.

Psychiatric diagnosis(es), based on the DSM-5, are made at the conclusion of the visit though note that diagnosing personality disorders typically occurs over the course of 6 or more visits (no addition psychiatric evaluation visit required).

Finally, we will create a treatment plan based on a combination of symptomatology, diagnosis, your needs and preferences, my treatment experience, consultation (while keeping your privacy in accordance with HIPPA), established treatment guidelines, and other appropriate factors.

This and all other visits will include education on the diagnosis and prognosis, your presenting symptoms, and the recommended treatments especially those that will include psycho-pharmaceuticals and specialized therapies such as EMDR and DBT from outside clinicians.

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Note, neuropsychological testing can only be performed by clinical neuropsychologists.

Medication Management

After the psychiatric evaluation, follow up visits will involve medication management, if starting medications is a part of your treatment plan.

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Starting new medication(s)?

Typically when a medication naïve patient starts medication(s) for the first time, frequent monitoring is strongly suggested. This will typically come in the form of you calling the office within 2 weeks of starting a medication to ensure you're doing well with the current medication dosage. Follow up visits for patients starting new medications occur every 4 weeks until we have reached an effective dose with no to minimal side effects. Once the effective dose is reached follow up visit frequency extends. 

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My general practice philosophy, especially with medication naïve patients, is to start medication(s) at low doses while slowly titrating up the medication dosage.

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I do this to 1) minimize risk of medication side effect(s); 2) you should be on the minimum dose of medication effective for reducing your symptoms, if you are started at a moderate or higher dose of medication that could have given you the same effect at a lower dosage then you're having to metabolize and eliminate excess of the medication that your brain and body didn't need; 3) generally speaking, the less exogenous compounds introduced to the body the better. This is especially the case in the older adult population.

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Maintaining your medication(s), needing a medication review, or adjusting your medication(s)?

If you are visiting Spirit already on medication(s) then your medication management visit will entail a review of your psychiatric medication regime to ensure, 1) no medication redundancies are occurring in the regime this is intended to make certain you are on only what you need; 2) I will reiterate potential adverse effects, side effects, contraindications, and rare but potentially life threatening conditions associated with medication(s) you may be taking. Taking medications implies you are agreeing to the potential benefits and risks of said medication(s), therefore, I want to ensure you are educated on what you are agreeing to. Also, in order for your medications to be refilled you must sign an informed consent form. The education provided above, in this paragraph, is a part of your informed consent; 3) if you are presenting with a pre-existing medical-physical condition, I will go over the recommended dosages and/or medications according to the organ(s) most impacted by the medication (i.e., kidneys, liver, heart, lungs).

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If after the medication review, all is well with your regime you will follow up for medication monitoring every 3 months with some patients having the option of a biannual follow up based on the medication and dose, length of time on the medication(s), general mental and physical health, as well as other factors.

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Switching, removing, and/or adding medications may also be recommended based on your needs/preferences and thorough assessment.

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Decreasing or discontinuing your medication(s)?

Finally, some patients elect to taper medications with the intent to discontinue their medication. This is especially common when psychiatric medications are started following an event of crisis and emotional upheaval such as in the case of grief and loss. If your choice is to completely stop medications I will work with you to slowly taper doses, if necessary. Some, but certainly not all, medication can be stopped without a taper depending on the medication itself and your maintenance dose. I will go over your options with you and we will create a discontinuation plan.

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For patients who have been on their medications for an extended period of time and are looking to decrease medication doses or discontinue medications, this can cause a dichotomous reaction of both relief and anxiety. However, I will hear your concerns and hear out your desires. We will conduct an intensive review of your history focusing on the parts of your history that may have included missed doses and your response thereafter as well as the set of circumstances that lead to starting and remaining on medication(s) in the first place to ensure discontinuation is the safest and most appropriate decision. All patients have the right to trial stopping medication(s). I will be thorough in making sure this is a viable option for you. 

 Psychotherapy

Under my licensing, board certification, and training as a psychiatric-mental nurse practitioner I am able to perform individual psychotherapy. I am now offering psychotherapy in addition to medication management. Currently, I am under the supervision of Clinical Psychologist and Assistant Clinical Professor of Psychiatry at the Yale School of Medicine, Dr. Ellen Nasper.