Dr. Lisa Durette
Child and Adolescent Psychiatrist
A graduate of the University of South Carolina who has practiced in the Valley since 2004, Dr. Durette teaches in the University of Nevada School of Medicine’s psychiatry residency program in Las Vegas and is responsible for the child and adolescent psychiatry curriculum. Three-fourths of her practice is children under 18, and she treats everything from schizophrenia to the effects of child abuse. Here are the highlights from her recent interview with Paul Szydelko.
About four or five years, ago I started really pushing to get a Child and Adolescent Psychiatry Fellowship going. Only about nine of us are certified and practicing here. We identified the agencies with which we would want to work, and they funded it—UMC, the Department of Family Services, the Department of Juvenile Justice, the Division of Child and Family Services, Desert Willow Hospital. Every two years, [pending accreditation],we’ll graduate two new child psychiatrists who will stay here.
Psychiatry was really never a primary interest. … In rotations, I really loved surgery and pediatrics, but there was the day in the psychiatry rotation when I remember saying this was going to be the field for me. This guy in his 40s was floridly manic. He was talking 10,000 miles a minute, obviously psychotic, having hallucinations, delusions—just really an unsettled gentleman. But he was fascinating to talk to. We treated him in the hospital, and over two weeks, we were able to get him to a place where he was better.
There was medicine involved [in that case]. The irony of that is in my current practice, I’m much more psyscho-therapeutically oriented than psycho-pharmacologically oriented. I try to go with everything other than medication first to treat my patients.
I don’t take insurance in my private practice. Insurance doesn’t reimburse enough per visit to allow you to practice in the best way possible. Also, psychiatric care is very private. When you are working with an insurance company, they will often ask for psychiatric records and for information that I would not be comfortable sharing with somebody who doesn’t have the appropriate training to know how to manage this information.
The satisfaction comes in watching kids get into normal developmental lines. A kid might have been seeing all sorts of treatment providers nearly every day after school and taking five or six different medications—one to sleep, one to get up in the morning. … Over time you can work toward getting them off medication, getting them to a point where they don’t need constant treatment providers, getting them to do things like take a gymnastics class or join a sport after school. It’s so enjoyable to just watch them come back and do normal kid stuff.
You have to be very careful not to over- or misdiagnose ADHD. Taking that larger bio-psycho-social picture is necessary. … So if you tell me the kid’s doing terribly at school but doing well at home, or vice versa, it’s hard to make that diagnosis. They have to have symptoms in multiple settings. This is the kid who is spacing out in the outfield in baseball, constantly struggling at school and can’t follow through with anything at home. Their friends are noticing they can’t even track a conversation or they’re butting in on every conversation; they’re intrusive. It’s happening everywhere.
It is shocking sometimes to see when parents are not involved and then some crisis occurs, and they say, “Oh, I wish I would have seen that.” For example, the kid who’s being cyberbullied. Why isn’t the parent aware of what they’re doing on Facebook, Instagram, Twitter? Know what’s going on socially; don’t be on your kid’s back 24/7, but have awareness. Know who their friends are, where they’re going. Be involved. … No one else is going to do it for you.
I can’t tell you how many times I’ve worked with families where they’ll come in, their kid’s been suffering with whatever it is for eight, nine, 10 months, a year. We address it. The kid starts to get better, and they say, “I wish we had done this sooner.” If there’s a way to just make that the billboard of psychiatry—Do it early, you’ll do better later—we’d be able to help a lot more people.
My first 10 years of practice, I didn’t have a kid, and here I am practicing child psychiatry, telling people the best way to do things and how to do this behavior plan. Then I have a kid, and it’s like, “Oh, wow, I’m really sorry I was so insistent that you be compliant 100 percent of the time.” That’s not realistic. …
You talk about the need for kids to have a good healthy breakfast and go off to school and they’re going to do so much better with a mix of proteins and vegetables and fruits and blah, blah, and just this morning my 4-year-old daughter ate an ice-cream sandwich for breakfast. I was just not going to fight the battle, and so I justified it to myself—yeah, there’s a little bit of calcium and protein in ice cream. It’s not the worst thing.