Psych NP has been seeing my relative for 1.5 years now in a state that requires “supervision”. At first she was treating his ADHD with roughly 60-80 mg of Adderall daily but lately my relative has had suicidal ideations in a mixed bipolar episode. So naturally she discontinued the stimulant (thank God), but starts my relative on Abilify while bringing the other mood stabilizer on board. The principle of stabilizing with an atypical antipsychotic while bringing on a mood stabilizer is fine and is familiar to me. What follows is what is concerning.

Family member who is in touch with Psych NP tried to confirm whether this would be the final plan and asked if the supervising physician could be involved. (As my relative was currently being treated for a mixed episode outpatient with suicidal ideations). She says “I am positive that this is exactly what the doctor would want.” The family member tries to confirm whether the Psych NP will run anything by the physician, and she outright refuses to run the plan by the supervising physician.

My relative who is getting treatment is currently having some akathisia from Abilify and most likely some difficulty concentrating because they are having their mood stabilized. Psych NP hears “difficulty concentration”, in the setting of a mixed episode (I.e., both manic and depressive features). She starts Welbutrin, without his mood being stabilized for “ADHD” again while still having my relative on two drugs attempting to stabilize mood.

Beside a drug like Wellbutrin obviously making current episode harder to stabilize, it shows that Psych NPs don’t treat diagnoses. They treat symptoms. I have the spreadsheet that she has given my relatives and writes that Abilify is treating “anxiety and depression,” with the mood stabilizer for “irritability and anger.”

TL;DR: Psych NPs do NOT treat diagnoses. They treat symptoms. Unbelievable they would tell my family that it is the “final plan”, and NP refuses to talk with supervising physician. “Equivalence” is not an accurate description of Psych NPs relative to the average Psychiatrist.