For new or prospective Psych NPs

I had been in practice as a Psych NP for several years when a 17 year old male was referred by his mother, also a patient. He had no previous known diagnoses of any kind, to include ADHD, but he was apparently making very poor progress in life.

His parents complained about him, because he was sassy and disrespectful. That part didn't concern me too much, as it seemed normal. But he also did not express interest in dating, driving a car, or getting a job. There was noevidence of substance abuse. However, his engagement with me with fair to poor, and most of the information was secondhand from his parents.

I didn't have much to offer, and over several months, I began to suspect borderline intellectual functioning, or pedophila, because he hung out with 13 year olds.

The parents kept complaining about him, but he was never arrested or anything along those lines. His mother claimed his IQ had been tested, and was quite high, ie 140, contrary to his grades, and my impression.

Finally, the situation came to a head, and I was pressured into offering depakote as a mood stabilizer. I emphasize the patient was never hospitalized, and was always calm, if somewhat sullen, in my office. The parents complained bitterly that he had "mood swings".

The patient started on the drug after I informed the mother that labs would be required. A co-pay was needed. This was somewhat of an issue, because they had a large family, and a limited income.

Several weeks went by, and no labs came in. I called to inform his mother that there would be no refills without lab work.

She called back to beg me for another chance. She said her son was a changed person on depakote, a night and day difference, and that she would somehow scrape up the funds for the labs.

She did, and the depakote level was zero.

I had several years of inpatient experience under my belt when this happened.

I offer this as an experience to people who think they can do online Psych NP without extensive inpatient experience.