Maria Gianan’s PEER SUPERVISION
Link to join
2025 Schedule
- January 15, 2025
- April 16, 2025
- July 16, 2025
Many thanks to Maria Gianan, DNP for organizing an opportunity for MAAPPN members to participate in a free ongoing peer supervision group. Maria has scheduled quarterly meetings (virtual) in the tradition of peer supervision. Maria initiated a Peer Supervision Group in August of 2022 and opens it to all MAAPPN members, invited guests and students. The meetings are offered quarterly and use the following ZOOM LINK/ Maria’s Peer Supervision https://us02web.zoom.us/j/87153802935
Bonus!! NOTES from October 17, 2024 Peer Supervision Meeting
Attendees introduced themselves with a brief description of their private practice specialty areas and described practices that serve those with psychosis, depression, anxiety, PTSD/Trauma, ADHD, Autism, and Psychotherapy. Some providers are mid-credentialling and some providers are licensed to practice in both RI and MA.
Many had attended the MAAPPN “Pearls of Practice” Conference on 9/27/24 and expressed appreciation for the valuable information shared on that day. One provider has just started with the Functional & Integrative Psychiatry Fellowship!
Clinical issues were discussed:
Medication Indications
Vraylar verses Rexulti: Which did providers prefer? in what circumstances and for what indications? Both have different mechanism of action:
- Rexulti: A partial agonist at serotonin 5-HT1A receptors and dopamine D2 receptors, and an antagonist at serotonin 5-HT2A receptors. It helps modulate dopamine and serotonin levels, contributing to mood and thought regulation.
- Vraylar: Also, a partial agonist at dopamine D2/D3 receptors, but it has stronger affinity for D3 receptors, which may make it particularly beneficial in treating cognitive and negative symptoms of schizophrenia.
Psychotherapy: Discussion of transference and countertransference as extremely useful concepts to explore in Psych APRN practice. Here is a useful site for examples
Boundary Management: Discussion of how to therapeutically communicate boundaries with Axis II patients who idealize and devalue in the therapeutic relationship and how to transition patients to a new team when they repeatedly attempt to re-connect with providers
Insomnia:
- Encourage the CBT-I Coach app especially for college age students
- Unique uses for Provigil and stimulants
- Options: mirtazapine, eszopiclone, (Lunesta), Belsomra
Restless Legs Syndrome: Discussion of RLS and insomnia medication options such as Dopamine agonists: Mirapex (pramipexole); Requip (ropinirole), Neupro Patch (rotigotine); Dopamine mimics: gabapentin, pregabalin (Lyrica) and
Iron supplementation; benzodiazepines (clonazepam or diazepam) for short term use; review medical plan of care as medications can plateau in benefit, suggest lifestyle changes such as regular exercise, avoiding alcohol caffeine and nicotine
Integrative Psychiatry: Lots of interest in nutritional lithium (Lithium orotate)
Conferences: MGH – Psychopharmcology 2024; Psych Congress 2024
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BONUS!! NOTES from August, 2022 Peer Sup Meeting!
Book Recommendation:
- “CPTSD, from surviving to thriving” available on Libby as an audiobook too; Lamictal dosing schedule: https://online.epocrates.com/drugs/84901/Lamictal/Adult-Dosing
- “Desperate Remedies” from Tamara Hammer
Medication Interaction Checkers:
- https://www.drugs.com/
- https://online.epocrates.com/interaction-check
- https://www.dynamed.com/drug-interactions
Liability Pro Tip: Documentation of patient teaching: be sure to discuss RBA, side effects, indications for use, how to start, stop and take medications, how to contact the provider in the event of questions or concerns. Pt indicated understanding and agreement with the plan. (add special instructions as needed)
2022 – 2024 meeting dates
- November 10, 2022 at 7:00pm
- February 2, 2023 at 7:00pm
- April 27, 2023 at 7:00pm
- August 17, 2023 at 7:00pm
- November 9, 2023 at 7:00pm
- February 1, 2024 at 7:00pm