Shirah Vollmer MD

The Musings of Dr. Vollmer

Machines For The Mind

Posted by Dr. Vollmer on July 30, 2019

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Transcranial Magnetic Stimulation….the neuromodulation device FDA approved treatment for depression. Trigeminal Nerve Stimulation..the neuromodulation device FDA approved treatment for ADHD in 7-12 year olds. Cervella, the neuromodulation device, FDA approved treatment for depression, anxiety and insomnia. All of these devices deliver electrical current to the brain/nerve endings via an external device. The mechanism of action, like antidepressants, is not known. The theory is that neural networks need a re-boot to treat psychic pain. These machines help us move away from the ā€œchemical imbalanceā€ theory to a ā€œneural network malfunctionā€ theory. Of course both mechanisms could be at play, but we do not know that yet. We know that FDA approval hinges on beating the placebo response, but we also know that all psychiatric illnesses have a high placebo response. My point is that we come from a place of humility, of not knowing how we help people, and yet, trying all of our tools, including psychodynamic tools, to help with suffering. The broader and deeper our toolbox the more likely we can help those in need and so I welcome these additions to our armamentarium.

 

 

Posted in Musings | 2 Comments »

Mental Illness vs. Mental Suffering

Posted by Dr. Vollmer on July 29, 2019

 

 

The human condition means that sadness, fear, depression, excitement, enthusiasm, low activity levels and high activity levels are all experiences we cycle through to a greater or lesser extent. Oftentimes, in an effort to help others, providers over-diagnose these mental states by telling the patient that he/she has a mental illness, when in fact, he/she is suffering. Why is this distinction so critical? Mental illness implies psychopathology, that something is terribly wrong with that person. Mental suffering implies a hard time, something we can all relate to. To include others in a shared humanity is the job of providers to help patients in need. To separate out patients with a diagnosis should be done cautiously and rarely, as mental illness, is indeed rare. However with the DSM 5 hitting our trails, and the abundance of medications available to help mental suffering, there has been an explosion of both diagnosis and treatment which I believe has distracted patients and their families from understanding the deep roots of mental awareness. I think we can help those with mental suffering without diagnosing them with a mental illness. I know insurance companies make this hard, but we, as providers, must push back and tell patients that our medications (and now our machines) can help mental suffering, but this by no means implies a mental illness. Putting the locus on the common humanity along with its shared ups and downs, allows us to provide compassion, while still having the goal of minimizing psychic pain. And so I begin to make this point. More to follow. Thanks for reading.

Posted in Musings | 2 Comments »

Checking In…

Posted by Dr. Vollmer on July 24, 2019

Hello Dear Readers,
I am checking in to see about suggestions for future blog topics.

I also want to mention that I have traveled the country giving talks about the evolution of psychiatry and one participant said ā€œI am going to remember that you said there was a difference between mental suffering and mental illness.ā€ I repeat that now in all of my lectures. We, as psychiatrists, have over-diagnosed children and adults with mental illness, thereby causing people to externalize rather than internalize their issues. They seek quick fixes as opposed to deep introspection and reflection. Our medications and our new neuromodulation devices have encouraged people to look for the next ā€œfixā€ and although I think our tools are very helpful, I also think there is tremendous value in psychological growth and development.

I consider myself an ambassador for the ā€œold schoolā€ of psychiatry where symptoms were put in historical context, while at the same time, being schooled in the new world of psychiatry which now includes Ketamine, intranasal, and machines including TMS, trans-cranial magnetic stimulation, and TNS-trigeminal nerve stimulation, and Cervella-a headset which is FDA approved for depression, insomnia and anxiety. Come hear me at Pri-Med, or come talk to me on my blog. Cheers!

Posted in Musings | 2 Comments »

What Am I Up To?

Posted by Dr. Vollmer on February 5, 2019

Faculty

Shirah Vollmer, MD

Clinical Professor of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA

Shirah Vollmer, MD is a Clinical Professor of Psychiatry at the David Geffen UCLA School of Medicine. She is a board certified child and adult psychiatrist and she is a psychoanalyst. She is on faculty at Loyola Marymount University, The New Center for Psychoanalysis, the Los Angeles Institute for Psychoanalytic Studies and UCLA Extension. Dr. Vollmer is a child, adolescent and adult psychiatrist and psychoanalyst in private practice in Westwood Village, California.


Recent & Upcoming Conference Sessions

Pri-MedĀ® Irving | Continuing Medical Education (CME/CE) | Irving, TX

Pri-Med Irving

Medicines for the Mind: An Overview of Psychopharmacology

Wednesday, June 26, 2019

1:45 PM – 2:45 PM

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Pri-MedĀ® Seattle | Continuing Medical Education (CME/CE) | Seattle, WA

Pri-Med Seattle

Medicines for the Mind: An Overview of Psychopharmacology

Thursday, June 20, 2019

7:30 AM – 8:30 AM

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Medicines for the Mind: An Overview of Psychopharmacology

Thursday, June 13, 2019

1:30 PM – 2:30 PM

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Pri-MedĀ® Phoenix | Continuing Medical Education (CME/CE) | Phoenix, AZ

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Medicines for the Mind: An Overview of Psychopharmacology

Tuesday, May 14, 2019

3:30 PM – 4:30 PM

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Pri-MedĀ® Washington, DC | Continuing Medical Education (CME/CE)

Pri-Med Washington, DC

Medicines for the Mind: An Overview of Psychopharmacology

Wednesday, April 17, 2019

1:30 PM – 2:30 PM

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Pri-Med South

Medicines for the Mind: An Overview of Psychopharmacology

Thursday, February 7, 2019

8:50 AM – 9:50 AM Hall A, Level 1

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Posted in About Me | 2 Comments »

The Making of a Professional Patient

Posted by Dr. Vollmer on February 5, 2019

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Fear motivates me to post today. I have come to realize that the ā€œdo no harmā€ approach to patient care is being violated without malicious intent, but still quite concerning. Newly trained psychiatrists are taught that a psychiatric diagnosis is definitive and as such, certain treatment protocols are indicated, and as such, if the patient ā€œfailsā€ the protocol, they are sent to a higher level of care, which in brief, means they could become, what I have termed, ā€œa professional patientā€. Kai, age twenty-one, comes to mind. She is a Caucasian young woman who was having trouble at home and at college, and so complained to her friends that she was suicidal and that she was thinking of jumping in front of traffic. This alarmed her friends, who in short order, called the police who then brought Kai to a psychiatric hospital on a 72 hour hold. This hold was quickly turned into a voluntary admission at which time she was diagnosed with ā€œborderline personality disorderā€ and she was told that as a result of this diagnosis, she needed to be on Latuda, an antipsychotic medication, and she needed to go to Dialectical Behavioral Therapy. She complied and she was discharged from the hospital and two months later the situation repeated itself. This time the hospital told her that she needed a higher level of care, since the DBT and the Latina did not seem to help her, and so she was sent to a residential facility for three months, on the recommendation of the psychiatrists at the hospital. Why does this story alarm me so much?

Reason 1. Kai is twenty-one years old. She needs to find autonomy from her parents, and she needs to continue on her train of maturity and psychosocial development. Hospitalizations, and residential treatment do not, by and large, promote development, but rather they promote dependency. Few decisions have to be made. By definition, institutional settings are regressive, and they create passivity as opposed to forward thinking life-planning skills.

Reason 2: The diagnosis of borderline personality disorder is often applied to women who create a lot of affect in others. That is to those who make their providers anxious because the treatment plan is unclear. This anxiety in the provider, used to be fodder as a way of understanding countertransference, but is now used as a way of pathologizing the patient, and thereby taking away any emotional work that needs to be done on the part of the provider to give deeper and more meaningful patient care.

Reason 3: Psychiatrists are being trained that diagnoses are definitive, and there is no thought that perhaps the diagnosis is given prematurely, and/or needs to be questioned for quite some time, before treatment is recommended. As such, this twenty minute diagnostic evaluation is nothing short of frightening, for both patient care and for physician training.

Have I said all of this before? Of course. Do I feel I need to say it again? Of course. The fictional Kai is going down the rabbit hole of passive treatment, thereby preventing her maturation. That is a tragedy. The fictional physicians are poorly trained to do assessments, and as such, treatment recommendations do not fit the patientā€™s issues. The fictional physicians will come to understand that their certainty is questionable, and as such, burn-out and dismay are likely to follow as their career progresses. Do I want to sound the alarm bell? Absolutely. Anyone listening?

Posted in Psychiatry in Transition | 2 Comments »

New Office

Posted by Dr. Vollmer on July 25, 2018

Image result for home office

 

I am proud to announce that as of September 1, 2018, I will be in my new office. This new space gives extra privacy for patients, as there are no offices nearby. Email me or text me at 3107804992 for more information.

Posted in About Me | 4 Comments »

Adding On….And Movin’ Around…

Posted by Dr. Vollmer on July 6, 2018

http://www.pri-med.com/globals/Faculty/V/vollmer-shirah.aspx#sm.0001dcru4j43kf0pyjx2qs3r1e3hx

 

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Regional Conference Los Angeles

The Worried Well: Anxiety Disorders in Primary Care

Thursday, November 1, 2018

7:30 AM – 8:30 AM

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The Worried Well: Anxiety Disorders in Primary Care

Monday, October 29, 2018

7:30 AM – 8:30 AM

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Regional Conference Philadelphia

The Worried Well: Anxiety Disorders in Primary Care

Tuesday, October 2, 2018

7:30 AM – 8:30 AM

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The Worried Well: Anxiety Disorders in Primary Care

Friday, September 21, 2018

4:00 PM – 4:45 PM

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The Worried Well: Anxiety Disorders in Primary Care

Tuesday, September 18, 2018

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The Worried Well: Anxiety Disorders in Primary Care

Friday, August 24, 2018

2:15 PM – 3:00 PM

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Pri-MedĀ® Washington, DC | Continuing Medical Education (CME/CE)

Regional Conference Washington, DC

The Worried Well: Anxiety Disorders in Primary Care

Tuesday, August 21, 2018

7:30 AM – 8:30 AM

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Pri-MedĀ® Phoenix | Continuing Medical Education (CME/CE) | Phoenix, AZ

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The Worried Well: Anxiety Disorders in Primary Care

Thursday, August 16, 2018

2:15 PM – 3:00 PM

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Pri-MedĀ® Santa Clara | Continuing Medical Education (CME/CE) in Santa Clara, CA

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The Worried Well: Anxiety Disorders in Primary Care

Tuesday, July 17, 2018

2:15 PM – 3:00 PM

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Pri-MedĀ® Irving | Continuing Medical Education (CME/CE) | Irving, TX

Regional Conference Irving

The Worried Well: Anxiety Disorders in Primary Care

Tuesday, June 26, 2018

7:30 AM – 8:30 AM

Pri-MedĀ® Seattle | Continuing Medical Education (CME/CE) | Seattle, WA

Regional Conference Seattle

The Worried Well: Anxiety Disorders in Primary Care

Monday, June 18, 2018

2:15 PM – 3:00 PM

Pri-MedĀ® Chicago | Continuing Medical Education (CME/CE) | Chicago, IL

Regional Conference Chicago

The Worried Well: Anxiety Disorders in Primary Care

Thursday, June 7, 2018

7:30 AM – 8:30 AM

Pri-MedĀ® West |Continuing Medical Education (CME) | Anaheim, CA

West Annual Conference

The Old and The Restless: Adult ADHD

Friday, June 1, 2018

5:00 PM – 5:45 PM

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South Annual Conference

The Worried Well: Anxiety Disorders in Primary Care

Sunday, February 11, 2018

2:20 PM – 3:00 PM

Posted in Anxiety, Primary Care | 1 Comment »

Mental Health Specialists

Posted by Dr. Vollmer on June 4, 2018

https://study.com/articles/Mental_Health_Specialist_Job_Description_Duties_and_Requirements.html

 

Image result for mental health specialist

 

The future of psychiatry involves less direct patient care, or so says James Phelps MD of the Samaritan Health System in Oregon. MHS, or mental health specialists, an un-licensed position takes the history, reports to the psychiatrist who then makes suggestions to the primary care physician. Am I missing something? The nuance of the narrative is lost without a skilled listener. Medicine, not just psychiatry, is losing this narrative and replacing it with symptom checklists which right now can be done by college graduates, but in the future, is likely to be done by computer. Large systems of care such as Kaiser or UCLA are going to absorb the liability making doctors less fearful about making recommendations without takingĀ  their own history. No license means no regulation, no specific training and no mandate for continuing education.Ā  I have said on this blog many times how appalled I am that the listening skills of a psychiatrist are no longer valued, but the creation of this new position is a new low for me.Ā  The listening bar has been lowered such that diagnosis and treatment is based solely on symptoms, without any room for, dare I say, intuition. Listening, I trust, will always be valued by patients, but clearly it is not valued by health care delivery systems. Medicine has gone corporate. I know this is not all bad, but for those who have mental suffering, it certainly is bad. Patients with difficult feelings need to be heard. They need to control their narrative. They need to understand themselves. Being evaluated by a mental health specialist will not accomplish that, and for that, I am very sad.

Posted in Psychiatry in Transition | 2 Comments »

Goin’ On The Road

Posted by Dr. Vollmer on June 4, 2018

http://www.pri-med.com/medical-conferences/2018/regional-conference-chicago/agenda/sessions/QMONYA0EDUEF.aspx#sm.0001dcru4j43kf0pyjx2qs3r1e3hx

 

Regional Conference Chicago

Chicago, IL | June 7-8, 2018

McCormick Placeā€“West

The Worried Well: Anxiety Disorders in Primary Care

Description

This talk will cover the assessment and treatment of anxiety disorders in a primary care setting, while incorporating new diagnostic issues incorporated in the DSM5. Signs and symptoms of generalized anxiety, panic and social anxiety disorders will be discussed, along with risk factors and available therapy options.

Learning Objectives

Classify anxiety disorders according to DSM5 guidelines

Choose a psychopharmacological agent to treat anxiety disorders

Manage patient anxiety in a busy clinical practice

Apply strategies to take patients off anti-anxiety medication


Speakers

Shirah Vollmer, MD

Shirah Vollmer, MD is a Clinical Professor of Psychiatry at the David Geffen UCLA School of Medicine. She is a board certified child and adult psychiatrist and she is a psychoanalyst. . Dr. Vollmer is a child, adolescent and adult psychiatrist and psychoanalyst in private practice in Westwood Village, California.

 

Posted in Musings | Leave a Comment »

Editor Job: Returns…

Posted by Dr. Vollmer on April 24, 2018

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Being on a board, often means being bored. Talking about budgets and money management and grant proposals can get dry and tedious. And so, I ask myself repeatedly, why I have stayed on this board, the Psychiatry Clinical Faculty at UCLA for over 15 years. You can read my editor’s note below to see the answer to that question, as I find our overall purpose both meaningful and essential to the next generation.

 

 

 

https://www.pcfala.net/

 

 

As Editor of this newsletter, I am so pleased to see how we, as psychiatry clinical faculty, have continued to pass the baton to our students to say that psychotherapy still matters, and it still matters that it is done by psychiatrists. Our board works tirelessly, now under the leadership of Dr. Sones, to give the adult residents from UCLA, from Harbor, and from Olive View/Sepulveda, along with the child fellows in these programs, the support they need to grow professionally into psychiatrists who are skilled with listening, thoughtfulness and deep caring of patients who need our help. We do this by offering them psychotherapy for a very reduced fee. We do this by offering as much supervision as they choose to partake, and we do this by giving them didactics which center around the doctor/patient relationship. We do this by having meetings and social gatherings throughout the year to remind them that they are part of a larger psychiatric community, and now we added on by offering mentorship to young trainees who want career guidance. This newsletter is a way of saying thank you for all you do and to remind you that your efforts are not just valuable, but essential, to our mission to promote the training and development of well-rounded psychiatrists. During the year, we soldier on, but as we review our work in this publication, we have a chance to reflect on our value as an organization. Indeed, we need to soldier on. The trainees need us. Thank you again for all you do.

Posted in Psychiatry in Transition | 2 Comments »

 
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