Karissa Mishler
PMHNP-BC

Psychiatric Mental health Nurse Practitioner

Welcome! My name is Karissa Mishler (she/ her/ hers). I am a Psychiatric Mental Health Nurse Practitioner.I want to jump right into the information you want to know:I have a lifelong passion for mental health and wellness. My goal is to help you find your inner healing and growth. My role is not just to prescribe medications. Medication can be a part of your journey, but I believe it is only one piece of the pie. Nutrition, movement, and physical wellness are integral slices to the pie. We will work together to set goals or find resources for all these moving parts.I believe it is important to meet my clients where they are. I want this to be a safe place. I am not here to judge you or tell you what choices to make. I am here to support you on this journey of life. There are so many factors that bring each unique person to our practice, and each of those factors should be taken into consideration when you and I formulate your treatment plan together. If there is ever a medication or goal you want to change, just tell me and we can discuss it! I am all ears.
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One area that many clients benefit from is a deeper education about what they are being treated for. I find that many people have been prescribed medication without a thorough explanation of what their intended benefit is. This can also carry over into education about what your diagnosis is and how it can impact multiple facets of life. This deeper education can play a role in your ability to be your own best advocate. 

Sometimes our experiences with healthcare in the past might not have been what they should have been. It is ok to acknowledge that. I have also had these experiences for myself, my family members, and my patients. I want to play a role in continuing to change the landscape of healthcare for everyone.

Here is some of the more technical information about me:

I obtained my Master’s in Nursing from Texas State University and my Bachelor’s in Nursing from Sam Houston University. Prior to joining the wonderful humans at Forest Path Psychiatry and Healing, I worked in a community mental health clinic with clients across the lifespan. I treated a wide array of conditions. I was a founding member of the Assertive Community Treatment team there, which served adults that experienced treatment resistant psychosis.

Prior to Graduate School, as an RN I worked on inpatient psychiatric units for ages 4 and up. I additionally had the unique experience of working with hospice patients and families, which gave me a deeper understanding of how all forms of illness impact the entire family unit.

Karissa Mishler, PMHNP-BC

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Healing Support: Karissa Mishler's Specialties

(DMDD) in Youth

A childhood condition characterized by extreme irritability, anger, and frequent, intense temper outbursts. Children with DMDD experience severe impairment that requires clinical attention. This diagnosis is designed to better capture children who may have been previously diagnosed with pediatric bipolar disorder.

PDIBPD

Peripartum Depression/Anxiety & Borderline Personality Disorder (PDIBPD): Complex conditions involving emotional dysregulation during pregnancy and postpartum periods, particularly challenging when combined with borderline personality traits. Features intense mood swings, relationship difficulties, impulsivity, and anxiety about parenting. Requires specialized treatment addressing both emotional regulation and parenting challenges.

Somatoform Disorders

Somatoform Disorders: Psychological conditions where individuals experience physical symptoms that cannot be fully explained by medical conditions. Symptoms can include pain, fatigue, gastrointestinal problems, and neurological symptoms, causing significant distress and functional impairment. These symptoms are real and not under conscious control, often leading to frequent medical visits and tests. Treatment typically involves a combination of psychological and medical approaches.

Bipolar Disorders

A mood disorder involving alternating episodes of mania (elevated mood, increased energy) and depression. It can significantly impact a person's energy, activity levels, and ability to carry out day-to-day tasks.

Adolescent & Adult Mood Disorders

Adolescent & Adult Mood Disorders: A range of conditions affecting emotional regulation and mood stability across age groups. Includes major depressive disorder, persistent depressive disorder, and seasonal affective disorder. Symptoms vary but often include changes in sleep, appetite, energy, concentration, and interest in activities. Presentation may differ between adolescents (more irritability, social withdrawal) and adults (more pronounced sadness, cognitive symptoms). Treatment typically involves therapy, medication, or a combination.

Child and Adolescent Trauma

Child and Adolescent Trauma: Traumatic experiences during developmental years can have profound effects on mental health and development. Sources may include abuse, neglect, witnessing violence, accidents, or natural disasters. Reactions can include regression in behavior, school difficulties, attachment problems, and risk-taking behaviors. Age-appropriate trauma-focused therapies and family involvement are crucial for recovery. Early intervention helps prevent long-term psychological impact.

Adults with Comorbid Medical Complexities

Comorbid Medical Complexities: Mental health conditions occurring alongside significant medical conditions, creating intricate treatment needs. These interactions can complicate both mental and physical health management. May include depression with chronic pain, anxiety with cardiovascular disease, or mood disorders with autoimmune conditions. Requires coordinated care between mental health and medical providers.

Additional Specialties

  • Anxiety
  • LGBTQAI2+ Concerns
  • Post Traumatic Stress Disorder (PTSD)
  • Perinatal Psychiatry
  • Psychotic Disorders
  • Addiction Psychiatry
  • Substance Abuse
  • Self Injury/Suicide
  • Adjustment Disorder
  • Serious Mental Illness
  • Adolescent Psychiatry
  • Sexual Abuse/Incest/Rape
  • Gender Identity/Sexuality
  • Alcohol/Chemical Dependency
  • Sleep Disorders
  • Somatoform Disorders
  • Stress Management
  • Attention Deficit Disorder
  • Autism Spectrum Disorders
  • Women’s Issues
  • Child Abuse/Neglect
  • Child Psychiatry
  • Mood Disorders
  • Chronic Medical Illness/Disability/Pain
  • Motivational Interviewing
  • Obsessive Compulsive Disorder
  • Conduct/Disruptive Disorder
  • Panic Disorders
  • Domestic Violence
  • Postpartum Depression

Karissa Mishler's Patient Care Mix:

Children (5-11), Adolescents (12-17), Adults (18-64), Seniors (65+)

Karissa Mishler's Care Philosophy: From Application to Psychiatric Practice

What inspires you to want to work for Forest Path Psychiatry & Healing? What did you like (or not like!) about the job description?

Your permission and expectation that the PMHNP treat the whole person and their journey of life inspire me. I am currently in a role that only allows medication management without holistic care, and it hurts my soul to see patients struggling in areas where I could support them. I dream of treating a patient's entire being (within scope, of course) for optimal mental wellness.

How do you define diversity, and why do you think it's important in your practice and team dynamics?

Diversity is the intentional blending of human experiences. These experiences could arise from gender, sexuality, disability, religion, race, age, etc. Diversity allows multiple perspectives to exist in a safe space. When there is a lack of diversity, there is an overabundance of shared ideas. This creates a lack of creativity in solving complex problems.

Please describe a time when you worked with someone of a different race, gender, sexual orientation, age, and/or cultural background, and how you worked together for the betterment of your patient(s).

I currently work with a woman who has been a nurse practitioner for many years. She has a great deal of experience and connects well with many patients. She does not believe in gender dysphoria or that any sexuality other than heterosexual or homosexual exists. She is very conservative, grew up in a rural area, and has strong religious beliefs that do not align with mine. However, we respect each other's differences. Her belief systems do not impact how I treat her. We regularly share casual conversation but simply do not discuss topics that we do not have in common. I will offer clients to transfer to her when they express they would prefer an older provider or a provider that can pray with them, etc. She will offer clients to transfer to me when they feel they cannot connect with her. We are able to acknowledge that differences are not wrong or bad; they just simply are.

What strategies do you use to ensure that all clients, regardless of their backgrounds, feel valued and respected in your clinical process?

From the first evaluation, I ensure to ask all clients what name they would like me to use and what their pronouns are. I explain there is never a right or wrong answer, particularly regarding substances or non-preferred behaviors. I am simply asking questions so I can best tailor the treatment plan to improve their safety and quality of life. When assessing for or discussing new trauma, I allow the client to lead the discussion. I give them permission to share as much or as little as they feel safe doing so. I ask if there have been any life experiences that continue to impact them today or any history of abuse. The details are not the most important; I mostly need to know if there are symptoms that could be related to these experiences that clinically I define as "trauma." I am always mindful when discussing trauma-related symptoms, to do so with caution to avoid triggering a flashback or dissociative experience during a session. In closing evaluations, I always offer an opportunity for new patients to discuss any fun facts about themselves, their hobbies, or any random facts in general. I try to make sure clients know I am a caring human that recognizes their need to be seen and heard.

How comfortable AND/OR experienced AND/OR jazzed are you about caring for diverse populations? We are specifically focused on supporting BIPOC and LGBTQAI+ Communities.

I am thrilled. I currently work with a low-resource population in a less diverse region than where I grew up and attended school. I am always tickled when I find a client who is feeling lost in this region due to feeling alone in their identity and without access to supportive care.

Growing up in Houston, TX and spending time in Austin, TX, I have seen things occur towards the BIPOC population that some people do not believe is reality. From witnessing aggressive law enforcement encounters, bullying of many forms, and simply offensive speech from others, their experiences are valid.

 In my current position, I often provide some of the first education parents receive on the statistics of suicide risk related to withholding gender-affirming care for LGBTQIA+ youth. Being in a semi-rural area with limited diversity, many of the individuals I work with are not familiar with these populations, and I am happy to provide a safe place to explore their thoughts and provide education.

Share a time when you advocated for your client even when the system around you was not supportive.

I am currently advocating for a young minor client who was mislabeled by the school system as attention-seeking. He had some significant disruptive behaviors in school previously. He was simply undiagnosed ADHD, hyperactive type. He was started on a non-stimulant and is no longer aggressive, and he can now sit for an age-appropriate amount of time. The school is providing online-only education in an isolated room with no access to recess or peers. The school has declined to attempt to re-integrate him into the general education classroom. They state he is being punished in this manner for the rest of the school year. I am attending IEP meetings with the parents to advocate for legal, evidence-based, safe education accommodations for their child. My current employer prefers case managers to attend IEP meetings. There is a 2-month wait for a case manager assignment, and I do not feel 2 more months of isolation is in the best interest of this child. The child's current therapist is hesitant to disagree with the school because the child did have a history of aggression. I feel strongly that a young child needs access to release physical energy in some form of recess, preferably more often than a child without ADHD. I also do not believe that punishment for an untreated mental health condition for a multi-month period is appropriate at his age. I have additionally supported the parents in contacting the state disability rights center.

What ages of patients are you most comfortable with working with (Tiny tots? Wise elders? All of the above?)? Choose as many as you wish!

Tiny Tots - Elementary School Kiddos (4 - 12yo), Young Adolescents (13-18yo), Older Adolescents to Adults (19 - 64yo)

What psychiatric population(s) have you worked with that have made you feel the most personally & professional fulfilled? Select as many as you wish!

Alcohol & Substance Abuse Disorders, Mood Disorders (Depression, Bipolar), Thought Disorders (Schizophrenia, Schizoaffective), Anxiety Disorders, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Disorders of Childhood, Adult Psychiatry, LGBTQAI+ Care, BIPOC Care, Religious Trauma, Medical Trauma, Personality Disorders, Polyamory/Nontraditional Relationship Members.

Outside of professional life, who or what do you find inspiring? (We're so excited to read your answer here!)

Horseback riding/training is the highlight of my week, every week. Horses are just magnificent creatures that have such strength but are so vulnerable at the same time. My backyard garden also brings me so much joy each year. The experiences and resources nature can provide bring me great joy outside of work. I am passionate about my work, but sometimes I enjoy the beauty of non-human interactions.

How do you feel about dark / silly humor amongst TEAMMATES?

Hysterical! You have to laugh at life; it's a good coping skill and it's tons of fun.

How do you feel about dark / silly humor with CLIENTS, when used in a trauma informed, ultimately respectful way?

Humor is an important part of my practice and the way I engage with clients.

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Working Hours

MONDAY - FRIDAY, see clinician hours
WEEKENDS, depending on clinician