Psychiatric medication management services in New Jersey (PA and WA coming soon!)

At this time, see adults ages 18 and older, as well as teens ages 13 to 17.

I'm pretty good at helping:

• health care professionals and students
• people using substances in a way that might cause them (or people around them) concern
• nerdy, geeky, gamer types (I'm into Stephen Universe and TNG, have made a periodic table from cupcakes, can solder blinky lights into clothes, tried to have a vegan Minecraft game until I accidentally bludgeoned a digital sheep to death)
• LGBTQ+ folx, including young people and their families
• people living with chronic illness
• punks, anti-authoritarians, and contrarians

I really love to support people who have had a hard time:

• finding a psych med provider who will slow down and really listen
• getting explanations you can understand about how and why things work (as far as we understand them, anyway... the brain is still kind of a mystery sometimes)
• managing the impact of poor communication or therapeutic ruptures with previous providers, medical trauma, involuntary hospitalization or forced medication experiences
• being afraid of judgment for less-healthy coping strategies like self harm or substance use
• worrying about being dismissed because of your weight or history/current sex work
• experiencing existential angst or lack of meaning/purpose

Problems I am NOT the best at and will likely refer you to someone who can help you better:

• disordered eating with active restricting, purging, or compulsive exercising; or that needs support/supervision for meals
• using sex or pornography in a way that causes problems for you or people around you
• gambling or gaming in a way that causes problems for you or people around you
• evaluations for criminal or civil legal proceedings (court-mandated treatment, divorce and child custody issues, parental fitness assessments, etc.)
• active problematic sexual behavior that violates other people's boundaries
• creation and/or distribution of sexual images of children, non-consenting adults, or animals
• repetitive violence toward humans or non-human animals, including intimate partner violence and child maltreatment

As a Psychiatric Mental Health Nurse Practitioner with board certification (PMHNP-BC), I have been trained to work with a broad spectrum of presenting and co-occurring issues.

Some of the mental health issues I'm particularly helpful with include:

• low mood or depression
• too much energy or manic episodes, bipolar disorder
• excessive worries or generalized anxiety
• difficulty sleeping or insomnia
• intrusive thoughts and repetitive behaviors or obsessive compulsive disorder
• attention and concentration problems or ADHD
• Autism, particularly when diagnosed in adulthood
• rejection sensitive dysphoria (RSD)
• suicidal thoughts, plans, or behaviors (may need higher level of care to stabilize first)
• post traumatic stress disorder (PTSD) and complex PTSD
• borderline personality disorder
• drinking more than you want to or in a way that causes problems for you (or people around you)
• using pain pills or other opiates in ways that cause problems for you (or people around you)
• other use of substances in ways that cause problems for you (or people around you)

Med management is the careful selection, monitoring, and adjustment of medications or other physical treatments for mental health conditions. Med management is often one part of a holistic* and collaborative† care plan to help you feel and function your best.

*-holistic means we consider physical, mental, emotional, social, cultural, and phenomenological (how you make sense or meaning of your experiences)

†- collaborative means we work together to decide what seems like useful and reasonable goals, and what resources or steps we will take to help you get there. If you have a primary care provider, other therapist, or specialist you want involved, we can reach out to them to help coordinate care. You can also include supportive people like family members or friends as part of your care team if you wish.

This answer varies depending on your situation.

If you are starting new medication or changing medications, we will probably meet at least once every week or two weeks until we know how those changes are impacting you.

If you have been stable on your medication(s) for a while and things seem to be going well, we will probably meet every three to six months. These appointments do not need to be as long, provided everything is working how you want it to.

If you have a prescription for controlled substances (like stimulants for ADHD or benzodiazepines for anxiety or sleep), we need to meet a minimum of every three months. New Jersey law will only allow me to write for a 30 day supply of controlled substances at one time. The law in NJ does not allow me to write "pre-dated" prescriptions to be filled in the future (i.e., I cannot write you a prescription to fill in February if we meet in January).

Usually, all new patients start with an in-depth interview to discuss your concerns and needs as well as  your physical and mental health. This appointment usually lasts 45 to 60 minutes.

I will ask about your overall physical health, any new or ongoing physical health concerns you manage (like diabetes, heart problems, asthma, difficulties with movement, or nervous system issues like POTS).

I'll ask you about any medical and mental health concerns in your family, if you're aware of them. This is helpful because your risk for certain medical or mental health issues or promlems from some medications can be higher if someone in your family has that problem. Your mental health can also be influenced by growing up or living in a family where someone has a serious medical or mental health issue.

I will ask about any previous psychiatric care including inpatient treatment, partial hospitalizations, intensive outpatient treatment, residential programs, and other medications or treatments--including talk therapy--you may have tried before. I'm really interested in what you found helpful and what you'd like to never experience again so we can create a better interaction for you.

I will ask about suicidal thoughts, plans, and actions you may be having right now or have had in the past. This does not mean you I will make you go to the hospital. It means we might need to carefully consider what resources will help you stay alive long enough to get help.

I will also ask about your use of legal and illegal substances, thoughts of wanting to hurt or kill someone else, and if you are safe from harm caused by other people.

I'll also ask you about things like sleeping, eating, showering/bathing, taking care of responsibilities in and outside where you live, and how you're getting along with other people. If you work or go to school, I'll also ask you about that... and probably some other things too.

Near the end of this appointment, I'll summarize what I've heard to make sure I've got it right and I didn't miss anything important.

Some people prefer or need to start more slowly or get to know me a little more first. That's totally ok! 

This "assessment" appointment can sometimes feel overwhelming or intrusive because it asks for a lot of highly personal and sensitive information. 

There are some questions I have to ask, but you never have to answer. You can always say, "I don't want to talk about that." The reason why I have to ask these questions is to help create a plan of care with you that is safe and effective.

If you're anxious or scared about saying things out loud to a stranger, you are welcome to bring notes, a written list that I can read, or another person to help you.

We don't have to do all of my questions in one appointment. Maybe you have questions you want to talk about before I ask you some of my questions. We can make an agenda together to make sure we both are getting what we need from the appointment.

Depending on the medications we decide are appropriate for you, I may ask you to go to a lab to give blood or urine samples for testing. This is a standard of care for some medications that treat bipolar disorder, schizophrenia, ADHD, or substance use disorders. Some of these types of medications include (but are not limited to):

• atypical antipsychotics agents like quetiapine/Seroquel or cariprazine/Vraylar
• first generation antipsychotic clozapine/Clozaril
• mood stabilizers like lithium/Eskalith or valproate/Depakote
• stimulants like methylphenidate/Ritalin or amphetamine salts/Adderall
• buprenorphine/Subutex or buprenorphine-naloxone/Suboxone

Some of these medications can cause changes in metabolism, cholesterol, liver function, or kidney function while others have the potential for abuse/misuse. Because we want to help you feel better overall, we also want to minimize the risk of medications causing other problems.

This largely depends on your preference and needs.

• simple med check with or without a shorter therapy appointment is about 20 minutes. This is good for basic refills when everything is going ok, for a quick follow up about a medication change, or therapy +/- meds for people with shorter attention spans or ability to stay present with an appointment.

• a more complex med management appointment with or without longer therapy is about 45 minutes. This is good for people returning from a higher level of care (IOP, PHP, inpatient, etc.), who have complex medication management needs, or who want more therapy time.

When appropriate, I am willing to prescribe controlled substances including, but not limited to stimulants, benzodiazepines, and medications for opioid use disorder.