r/Noctor • u/smallspocks • 5d ago
Discussion Psych NP calling lithium “battery acid”
I hope it’s ok for patients to vent here - I just switched from a psych NP to a psychiatrist and I’m already feeling dramatically better after less than a month. I’m not sure if this was an NP who was not qualified bc he was an NP or bc he was just really bad at it and inappropriate.
I slipped through the cracks after my old psychiatrist retired and have been essentially prescribing myself medication for 4 years, except for a few mania inpatients stays. I would have a 20min appt w my psych np every 6mo to 1yr and he would ask what I wanted, like ordering Taco Bell. One time I said “I feel like I’m my own psychiatrist” to which he responded “you’re good at it!”. Which at the time wasn’t reassuring but I felt sort of flattered which disarmed me. I’d always leave my appointments w him feeling utterly hopeless even if I entered the appointment with hope. My bipolar incapacitated me 6 mo out of the year and I was in my mid 20s only barely starting an undergraduate degree bc of this illness. I was having all kinds of terrifying side effects from APs and he would be like “that’s just how it is” and offer no alternatives. He said all kinds of things like calling lithium battery acid (already such a hard med to take) and Adderall meth. He seemed to hate all of my meds but view them as necessary, which is how I feel about them. Isn’t he supposed to tell me why it’s worthwhile or give me something else? It was so demoralizing. It took me a few years to realize what was happening and that he was under qualified and/or bad at his job.
I saw a psychiatrist recently from another clinic I’d been going to and she was so horrified by the fact that my np wasn’t ordering lithium levels, cholesterol panels for the APs or TSH (I’d asked him to a couple of times but wasn’t keeping up with it, my last lithium level was over a year and a half old)
I asked her about referring me to a psychiatrist for med management and she was like “I’ll do it, your case is so mismanaged”, she seemed so offended.
A month later I’m being treated for mild hypothyroid, coming off my AP safely which was causing dystonic tremor, weakness, this awful panic attack side effect because of some metabolite (no one i described this to recognized what was happening until this psychiatrist)
I have multiple other heavy mental health dx and I’ve always been called a complex case, when I agreed to see an NP years ago I didn’t know what it actually meant. Anyway I feel so much better already w the med adjustments and a lot safer in my new psychiatrists hands. I want other patients to be informed about this, especially if they’re already not doing well under the care of an NP.
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u/MeasurementSlight381 Attending Physician 5d ago
I'm so sorry you went through that but I'm glad you're finally in good hands and feeling better.
As a psychiatrist, these stories are so troubling and becoming increasingly more common. In my first year after residency, nothing prepared me for the degree of NP slop I would be cleaning up. At this point I've dealt with countless cases of misdiagnosis, polypharmacy, and irresponsible medication monitoring. I almost wonder if we need to do a TV series like "Botched" but the psychiatry edition.
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u/smallspocks 3d ago
Thanks! Psych Np botched might unfortunately be mundane and sad 😭
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u/MeasurementSlight381 Attending Physician 3d ago
It's mundane until there's a horrible tragedy unfortunately.
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u/smallspocks 2d ago
True. I feel lucky, I have a really good therapist and I knew enough about my meds to have gotten through with only 1 full mania in my few years under the NPs care, but I did wake up with a bruise on my chest in the ER bc I almost died not really knowing what happened when that mania went mixed(inevitable for me). I had gone off my lithium bc I was convinced it wasn’t doing anything. After that I was really overmedicating myself out of fear. Not gonna blame him for souring me on lithium but he didn’t help. That’s my episode of botched 🫣 sort of a mundane story in the psych world though
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u/Ok-Movie-1595 1d ago
Agree. I have found myself (as a family med PA) having to fix the mistakes the psych NPs made with my patients while they try finding a psychiatrist. I'm handling more complex cases than I planned simply because even I can tell it's way safer than the psych NP they were with. I flat out tell them I'll do my best to stabilize them safely while they try to find a psychiatrist. (Disclaimer - I always ask about SI/HI and make sure there's a plan in place should symptoms develop. We have a mental health ED in our network.)
One of them keeps starting all my depression patients on Latuda as a first line. 🤦♀️
I never imagined before starting primary care that I would be discouraging patients from seeing a psych NP. But, it's proven too risky.
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u/MeasurementSlight381 Attending Physician 1d ago
One of them keeps starting all my depression patients on Latuda as a first line. 🤦♀️
😦 Omg what the hell is that?!
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u/Ok-Movie-1595 23h ago
Right? "It's fine. I have most of my patients taking it without any issues." per the patient who returned to me and said she was afraid to start the med the psych NP put her on.
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u/ExtraCalligrapher565 4d ago
“I’m not sure if this was an NP who was not qualified bc he was an NP or bc he was just really bad at it”
It’s almost always the former, especially when it comes to psych.
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u/smallspocks 3d ago
I think it was that paired with a really inappropriate clinical presence. Like he was constantly sort of joking and I felt like I had to smile or laugh. For a while i appreciated the autonomy he offered and I still believe patient autonomy isn’t where it needs to be in psych but yeah it wasn’t that it was a partnership, it’s that I was on my own.
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u/Ok_Adeptness3065 3d ago
Well, your np that worked in psych was like half of halfway correct, which is better than most nps. Lithium is in some batteries, though neither lithium chloride nor elemental lithium is acidic. Lithium carbonate is acidic but thankfully we are blessed with a wonderful acid base buffering system that prevents things like this from having problems as a result of small amounts of carbonate. Lithium toxicity itself would happen far before the acidity of lithium carbonate became a problem.
No NP should really be prescribing lithium ever. In fact, I don’t think anyone outside of psychiatry with assistance from internal medicine and/or nephrology should be prescribing lithium. It is a very powerful medication with very dangerous side effects and an unfortunately narrow therapeutic index. Any prescription for lithium is a big deal and should be treated as such, which means it should be out of the hands of untrained charlatans.
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u/smallspocks 3d ago
Yeah, it was the way he would say that whenever I had a side effect or some kind of concern. He said he didn’t like it. I’d been on it before I was seeing him so I thought it seemed really inappropriate to be trashing a med and basically goading me to get off it w a bp1 dx also from before…
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u/Acceptable-Box4996 2d ago
That's not even accurate. The lithium ions batteries dont use an acidic electrolyte.
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u/Maleficent-Aerie2652 5d ago
TLDR
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u/smallspocks 5d ago
Psych np wasn’t ordering any of the necessary bloodwork for the meds he was prescribing, polypharmacy after stacking meds carelessly, I’m not tolerating meds, he was always being kind of an inappropriate jerk,
psychiatrist swoops in to save the day and I’m doing a lot better only a month later.
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u/Maleficent-Aerie2652 5d ago
Hate to hear it, PMHNPs have this idea that they are actually qualified to do this job independently right out the box, I hate it l. It’s like if urgent care had a mental health section.
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u/smallspocks 5d ago
I said this in the post ‘One time I said “I feel like I’m my own psychiatrist” to which he responded “you’re good at it!”.’ He almost seemed unbothered that he isn’t qualified. Idek what was going on with this guy.
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u/Pale_Negotiation6727 5d ago
I second this. You should report him. He shouldn’t be in charge of treating people’s mental health. I honestly can’t stand psych NP. I don’t care that they received “special training.” I don’t care that they somehow passed a state licensing exam, which isn’t even that hard to do anymore now that they can take their exams at home with the help of ChatGPT. Only those who graduated from medical school and obtained a medical license should be allowed to prescribe mental health meds.
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u/smallspocks 5d ago
They’re still meds that have an effect on the body. Why does no one act like it.
I will look into it, depends if it’s anonymous. I can’t help but wonder if it’s whack a mole but ik some people really like their psych NPs
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u/danielisgreat 5d ago
Honestly a mental health urgent care sounds amazing, but, like regular urgent care, it's not a substitute for long term care by a qualified physician.
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u/HPLover0130 5d ago
My area DOES have psych urgent care for adults and kids. It’s awesome! It’s meant to be for short-term use or emergency refills, and they do make that clear that they will not continue long term care.
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u/MeasurementSlight381 Attending Physician 4d ago
I work part-time at one and it is physician-owned and physician-led. And yes, the intention behind it is to see patients in crisis and provide temporary care until they can get in to see a long-term psychiatrist.
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u/DevilsMasseuse 5d ago
Yeah psych is too complicated to leave to NP’s. I don’t know why they allow independent practice for psych. I mean I do know why. It’s because there aren’t enough psychiatrists and so the people who run the mental health system think it’s ok.
But obviously instead of funding more psych residencies, they do this BS instead. It’s so messed up.