About Me
Thank you for taking an interest! I practice at Mindful Therapy Group via telehealth only out of Seattle. I'm a board-certified psychiatric mental health nurse practitioner. I earned my BSN and Master of Nursing in Occupational and Environmental Health and Psychiatric Mental Health Master of Nursing Practice Certificate at the University of Washington.
I strongly believe that interpersonal connection and trust between a patient and provider is key to providing quality medication management services. I focus on educating and empowering patients so they can make the best decisions for their recovery. The best way to do this is to take our time.
My focus is providing care for adults experiencing recovery from trauma, depression, bipolar disorder and anxiety disorders.
My preferred contact for intakes for psychiatric care is the Mindful Therapy Group Intake Specialist line at 206-453-5707x1.
I also provide consultation for private practice mental health workers of all types. I donate the proceeds to a non-profit that is helping the people of Ukraine. Email me at jschladweiler@gmail.com if you are interested in a consult appointment.
I provide psychiatric medication management for adults with a focus on the following symptoms:
Depression
"Depressive disorder, frequently referred to simply as depression, is more than just feeling sad or going through a rough patch. It’s a serious mental health condition that requires understanding and medical care. Left untreated, depression can be devastating for those who have it and their families. Fortunately, with early detection, diagnosis and a treatment plan consisting of medication, psychotherapy and healthy lifestyle choices, many people can and do get better.
Some will only experience one depressive episode in a lifetime, but for most, depressive disorder recurs. Without treatment, episodes may last a few months to several years.
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Symptoms
Depression can present different symptoms, depending on the person. But for most people, depressive disorder changes how they function day-to-day, and typically for more than two weeks. Common symptoms include:
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Changes in sleep
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Changes in appetite
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Lack of concentration
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Loss of energy
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Lack of interest in activities
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Hopelessness or guilty thoughts
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Changes in movement (less activity or agitation)
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Physical aches and pains
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Suicidal thoughts
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Diagnosis
To be diagnosed with depressive disorder, a person must have experienced a depressive episode lasting longer than two weeks. The symptoms of a depressive episode include:
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Loss of interest or loss of pleasure in all activities
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Change in appetite or weight
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Sleep disturbances
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Feeling agitated or feeling slowed down
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Fatigue
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Feelings of low self-worth, guilt or shortcomings
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Difficulty concentrating or making decisions
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Suicidal thoughts or intentions
Treatments
Although depressive disorder can be a devastating illness, it often responds to treatment. The key is to get a specific evaluation and treatment plan. Safety planning is important for individuals who have suicidal thoughts. After an assessment rules out medical and other possible causes, a patient-centered treatment plans can include any or a combination of the following:
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Psychotherapy including cognitive behavioral therapy, family-focused therapy and interpersonal therapy.
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Medications including antidepressants, mood stabilizers and antipsychotic medications.
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Exercise can help with prevention and mild-to-moderate symptoms.
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Brain stimulation therapies can be tried if psychotherapy and/or medication are not effective. These include electroconvulsive therapy (ECT) for depressive disorder with psychosis or repetitive transcranial magnetic stimulation (rTMS) for severe depression.
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Light therapy, which uses a light box to expose a person to full spectrum light in an effort to regulate the hormone melatonin.
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Alternative approaches including acupuncture, meditation, faith and nutrition can be part of a comprehensive treatment plan, but do not have strong scientific backing."
(From NAMI Online)
Anxiety
"Anxiety disorders involve a state of distressing chronic but fluctuating nervousness that is inappropriately severe for the person's circumstances.
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Anxiety disorders can make people sweat, feel short of breath or dizzy, have a rapid heartbeat, tremble, and avoid certain situations.
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These disorders are usually diagnosed using specific established criteria.
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Drugs, psychotherapy, or both can substantially help most people.
Anxiety is a normal response to a threat or to psychologic stress and is experienced occasionally by everyone. Normal anxiety has its root in fear and serves an important survival function. When someone is faced with a dangerous situation, anxiety triggers the fight-or-flight response. With this response, a variety of physical changes, such as increased blood flow to the heart and muscles, provide the body with the necessary energy and strength to deal with life-threatening situations, such as running from an aggressive animal or fighting off an attacker. However, when anxiety occurs at inappropriate times, occurs frequently, or is so intense and long-lasting that it interferes with a person's normal activities, it is considered a disorder.
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Anxiety disorders include
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Specific phobic disorders"(From Merck Manual Online)
Bipolar Disorder
"Bipolar disorder is a mental illness that causes dramatic shifts in a person’s mood, energy and ability to think clearly. People with bipolar experience high and low moods—known as mania and depression—which differ from the typical ups-and-downs most people experience.
The average age-of-onset is about 25, but it can occur in the teens, or more uncommonly, in childhood. The condition affects men and women equally, with about 2.6% of the U.S. population diagnosed with bipolar disorder and nearly 83% of cases classified as severe.
If left untreated, bipolar disorder usually worsens. However, with a good treatment plan including psychotherapy, medications, a healthy lifestyle, a regular schedule and early identification of symptoms, many people live well with the condition.
Symptoms
Symptoms and their severity can vary. A person with bipolar disorder may have distinct manic or depressed states but may also have extended periods—sometimes years—without symptoms. A person can also experience both extremes simultaneously or in rapid sequence.
Severe bipolar episodes of mania or depression may include psychotic symptoms such as hallucinations or delusions. Usually, these psychotic symptoms mirror a person’s extreme mood.
Mania. To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania. Hypomania is a milder form of mania that doesn’t include psychotic episodes. People with hypomania can often function well in social situations or at work. Some people with bipolar disorder will have episodes of mania or hypomania many times throughout their life; others may experience them only rarely.
Although someone with bipolar may find an elevated mood of mania appealing—especially if it occurs after depression—the “high” does not stop at a comfortable or controllable level. Moods can rapidly become more irritable, behavior more unpredictable and judgment more impaired. During periods of mania, people frequently behave impulsively, make reckless decisions and take unusual risks.
Most of the time, people in manic states are unaware of the negative consequences of their actions. With bipolar disorder, suicide is an ever-present danger because some people become suicidal even in manic states. Learning from prior episodes what kinds of behavior signals “red flags” of manic behavior can help manage the symptoms of the illness.
Depression. The lows of bipolar depression are often so debilitating that people may be unable to get out of bed. Typically, people experiencing a depressive episode have difficulty falling and staying asleep, while others sleep far more than usual. When people are depressed, even minor decisions such as what to eat for dinner can be overwhelming. They may become obsessed with feelings of loss, personal failure, guilt or helplessness; this negative thinking can lead to thoughts of suicide.
The depressive symptoms that obstruct a person’s ability to function must be present nearly every day for a period of at least two weeks for a diagnosis. Depression associated with bipolar disorder may be more difficult to treat and require a customized treatment plan.
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Diagnosis
To diagnose bipolar disorder, a doctor may perform a physical examination, conduct an interview and order lab tests. While bipolar disorder cannot be seen on a blood test or body scan, these tests can help rule out other illnesses that can resemble the disorder, such as hyperthyroidism. If no other illnesses (or medicines such as steroids) are causing the symptoms, the doctor may recommend mental health care.
To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania.
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Treatment
Bipolar disorder is treated and managed in several ways:
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Psychotherapy, such as cognitive behavioral therapy and family-focused therapy.
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Medications, such as mood stabilizers, antipsychotic medications and, to a lesser extent, antidepressants.
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Self-management strategies, like education and recognition of an episode’s early symptoms.
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Complementary health approaches, such as aerobic exercise meditation, faith and prayer can support, but not replace, treatment."
(From NAMI Online)
Trauma
"Traumatic events—such as an accident, assault, military combat or natural disaster—can have lasting effects on a person’s mental health. While many people will have short term responses to life-threatening events, some will develop longer term symptoms that can lead to a diagnosis of Posttraumatic Stress Disorder (PTSD). PTSD symptoms often co-exist with other conditions such as substance use disorders, depression and anxiety.
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Symptoms
A diagnosis of PTSD requires a discussion with a trained professional. Symptoms of PTSD generally fall into these broad categories:
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Re-experiencing type symptoms, such as recurring, involuntary and intrusive distressing memories, which can include flashbacks of the trauma, bad dreams and intrusive thoughts.
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Avoidance, which can include staying away from certain places or objects that are reminders of the traumatic event. A person might actively avoid a place or person that might activate overwhelming symptoms.
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Cognitive and mood symptoms, which can include trouble recalling the event, negative thoughts about one’s self. A person may also feel numb, guilty, worried or depressed and have difficulty remembering the traumatic event. Cognitive symptoms can in some instances extend to include out-of-body experiences or feeling that the world is "not real" (derealization).
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Arousal symptoms, such as hypervigilance. Examples might include being intensely startled by stimuli that resembles the trauma, trouble sleeping or outbursts of anger.
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Diagnosis
Symptoms of PTSD usually begin within three months after experiencing or being exposed to a traumatic event. Occasionally, symptoms may emerge years afterward. For a diagnosis of PTSD, symptoms must last more than one month. Symptoms of depression, anxiety or substance abuse often accompany PTSD.
Treatment
Though PTSD cannot be cured, it can be treated and managed in several ways.
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Psychotherapy, such as cognitive processing therapy or group therapy
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Self-management strategies, such as self-soothing and mindfulness, are helpful to ground a person and bring her back to reality after a flashback
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Service animals, especially dogs, can help soothe some of the symptoms of PTSD"
(From NAMI Online)
A note about what I do not do:
I do not treat eating disorders, ADD/ADHD or pregnant or breastfeeding people. I do not provide medication for treatment for recovery or medical detoxification from addictions.
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I do not offer case management services, which include but are not limited to providing assessment and documentation for FMLA, short-term, long-term or permanent disability, L&I cases, letters for emotional support animals, service animals, unemployment, custody, adoption, foster care, car accidents or any other type of legal issues. I do not offer letters, medicolegal consults or testimony for people involved in criminal or civil court cases or provide any clinical attestations/letters for people who are court mandated for psychiatric treatment. Please note that the services listed above are often not covered by most commercial health insurance plans and the patient would be responsible for the clinical provider's fees.
If I am subpoenaed for a court case, I charge the patient a fee for time spent in court and preparing for court. I do not have any forensic training so am unlikely to provide any special insight on your case.
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The patient is responsible to pay all fees not covered by their insurance on the date of service.