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Psychiatric Treatment

Psychiatric Treatment

Christopher Reist (Academic Psychiatrist, Co-Author of “Psychiatry”) gives expert video advice on: How do I know if I should go to see a psychiatrist?; How does a psychiatrist diagnose a patient?; Is a psychiatrist allowed to tell others about me? and more...

When should I seek psychiatric treatment for a friend or family member?

In many cases, individuals who are developing mental disorders sometimes don't have the insight that they are becoming ill. A friend can serve an important role in pointing out the changes that they have observed in their friend and suggest that treatment and help is available - especially with a <a href="http://www.videojug.com/interview/bipolar-disorder">bipolar disease</a>. Another important time when a friend should intervene on behalf of an individual who is depressed is when they are concerned over suicide. Fifteen percent of patients with depression commit suicide. In the United States it amounts to over 30,000 people each year. When this happens it can be a medical emergency and you should do whatever you can to get that person into the treatment.

What happens during a typical session with a psychiatrist?

A typical first visit to a psychiatrist would begin with questions about why you are there. That's obviously the most important point to understand. What is it that's bothering you? Following that, there's going to be a more comprehensive assessment of your current social and occupational situation, your relationships, how well you're working; trying to understand how much this complaint that you have is interfering with those important things in your life. The interview will then also include your medical history, to understand what kind of medical disorders you have that might be important, as well as what kinds of medications you're on and what kind of past treatment you've had for your psychiatric illness. It'll also include information gathering about your family; what kinds of diseases have been present in your immediate family, and what kinds of illnesses have been in your aunts, uncles, and other blood relatives, because this can be very important in making a diagnosis. Another part of the initial exam would be a mental status exam, in which the psychiatrist would systematically go through a number of symptoms to really complete his picture of what is going on with you. The final part would be an initial diagnosis and plan for therapy. Having said that, it's important to realise that sometimes you can't get to the final diagnosis in one session. Sometimes it may require more time. It may require review of past records. Sometimes it's important to interview the significant others or family members to help differentiate possible disorders.

How does a psychiatrist diagnose a patient?

Psychiatric diagnosis stands primarily from the interview with the patient. However, that's only one part of the puzzle. It's important also to gather information on family history, it's important if possible to gather information from significant others and in the case of some disorders. It's important to have a good sense of their medical condition. In medicine we have a term called “Differential Diagnosis”. So what a good psychiatrist would do after collecting the initial information is really come up with initial possibilities. You want that list to be as broad as possible. The process then is in eliminating those different possibilities one by one until you really come down to the disorder that is likely to be accurate.

What does a psychiatrist need to know about my life?

It's really very important to share with your psychiatrist things that you think are important in your personal life. I realize that some of those things might be uncomfortable, but you need to understand that the psychiatrist's goal is to understand you as best as he or she can. The more information that you can provide, the better. It's important to talk to your psychiatrist about substance abuse, your relationships, your sexual interests and other issues that are important.

Is a psychiatrist allowed to tell others about me?

When you see a psychiatrist, you should understand that that is strictly, by law, a confidential interaction and your psychiatrist cannot tell others about your personal condition. You have legal protection regarding what about you is discussed with other people but you can give authorization should you want your condition discussed with others. There is an exception to the confidentiality rule. If you express to the psychiatrist an intent to harm yourself or to harm others. In those cases, the law requires the psychiatrist to take action.

What does my psychiatrist test during a "physical exam"?

It's important for the psychiatrist to have a good sense of your physical condition and do various tests during a physical exam. Some psychiatrists may conduct a physical exam themselves but it's more common that they would ask you about recent medical check ups. If indicated your psychiatrist might ask you to allow your records from your Internist, Family Doctor or Obstetrician to be forwarded for his or her review rather than conduct a physical exam.

What is a "mental status exam"?

A mental status exam is a systematic evaluation of a number of qualities that are important in completing the assessment. It starts out with making notes about a person's appearance and behavior. There's an assessment of speech, both the speed of speech as well as the content. A psychiatrist will pay particular attention to how thoughts are connected together to see if there is disorganization. There'll also be inquiry into specific symptoms of mental disorder, such as sleep disturbance, problems with appetite, weight loss. Another category would include asking about hallucinations, paranoid ideas, and other symptoms that are seen as psychosis. The final part would be doing a screening of cognitive functions. And that would include testing of memory, testing of basic knowledge -- for example current social events -- and then finally trying to get an idea of a person's insight into their condition and their ability to make judgment decisions.

What is a "functional assessment"?

A functional assessment would be examining how a person is able to function in the important domains of life, and that would be primarily in the social situation or in the work situation. Socially, you'd want to be inquiring about significant relationships; do they have a significant other? What's the status or quality of that relationship? What kind of social network do they have, what kind of support? When evaluating job function, we're interested in what the highest level of job is that they've been able to attain; what's their work history? Do they stay in one job, or are there frequent changes that might be a consequence of mental illness? Another functional assessment for more severely ill individuals might be actually examining how they're able to make certain kinds of decisions that are important in everyday life. For example, can they figure out a bus route, or can they make simple financial calculations? This can be very important in making decisions about, for example, where a person might best reside when leaving the hospital.

What are most common types of therapy used to treat mental disorders?

We have a lot of approaches to treating mental disorders. Certainly in psychiatry one of the mainstays is the use of pharmacotherapy or medications. We find that this is often essential for certain of the serious mental disorders such as schizophrenia and bipolar disorder. In the case of depression and anxiety disorder they are also very effective but we know that certain psychotherapies can also bring relief. I think most psychiatrists would agree that the best kind of treatment would be combined pharmacotherapy and some form of psychotherapy.

What is "psychotherapy"?

Pyschotherapy refers to a collection of techniques that are used to promote well being, help people recover from mental illness.

What is "pharmacotherapy"?

Pharmacotherapy refers to the use of various medications to treat mental illness. Pharmacotherapy could include using drugs to treat an active problem, as well as medications to prevent or stabilize a person from developing future episodes.

What psychiatric therapies are no longer in use?

Prior to the introduction of psychiatric medications in the 1950s, we really had very few tools to treat the immense suffering that is associated with mental diseases. Because of that, people sometimes went to very desperate means to try to come up with therapies that help people with mental disorders. These included insulin shock, the use of cold sheets and the use of frontal lobotomies for treating severe aggression. Fortunately, now we're in the new age. We've abandoned those kinds of psychiatric therapies.

What does a psychiatrist assess during each subsequent visit?

At subsequent visits, if it's primarily a medication treatment, the psychiatrist will be interested in a person's side effects to medications. They'll be interested in how their disorder is responding to treatment. To do this, there would be a collection of questions that would very likely be asked by the psychiatrist at each subsequent visit. If the treatment includes psychotherapy, then medication issues may be covered at the beginning or end of the session, but the bulk of the treatment period would be subsumed with dealing with the psychotherapy issues.