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Dr. Vijayakumar D.R MBBS, DPM, DNB (NIMHANS), CCST (UK)
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Frequently asked questions in psychiatry

1. Who treats psychological problems?

In India psychological problems are treated by the following mental health professional

Psychiatrist, psychologists, psychiatry social workers and councellors

A psychiatrist is a medical doctor who has done his MBBS training and then specialized in treating people with mental health problem. . Psychiatrists are uniquely qualified to assess both mental and physical aspects of psychological disturbances. Their medical education has given them a full working knowledge of both physical illness and psychological problems. They can treat patients with both medications and psychotherapy (talk therapy). They are able to interpret blood tests and other investigations done by medical doctors.

A psychologist  is a mental health professional who has done their graduation in psychology and specialization in clinical psychology ( MPHIL). They are not medical doctors and usually do their  graduation (BA) in  psychology. They are able to provide various therapies and they are trained to do Certain testing’s like Rorschach, IQ etc.   They are not able to prescribe medications and treat physical illnesses.

A psychiatry social  worker  is a mental health professional who has done her graduation and then specialized in the field of psychiatry social work ( MPhil). They can provide certain kind of talk therapies. They cannot prescribe medications or treat physical illnesses.

Counsellors are mental health professionals coming from various backgrounds and usually they do 6 months or more, courses in understanding psychological problems and they provide basic talk therapies depending on their training. They cannot prescribe medications.

It is to be noted that in India doctors from other specialties prescribe medications for certain psychiatry problem, at times. 

2. Consulting a psychiatrist means that I must be MAD?

A psychiatrist treats various psychological problems like anxiety disorders, depression, phobias, panic disorders, anger issues, alcohol and tobacco dependence, academic issues and various other issues. In fact majority of the problems treated by psychiatrists the patient is in complete control of himself/herself and are holding successful and responsible jobs.  The common stereotypical psychiatry patient depicted in movies and in the media form only a very minute percentage of patients seen by psychiatrists.  You can consult a psychiatrist for even minor issues which might be troubling you and get suitable advice.


3. Will other specialty doctors treat psychiatry problems?

In India other specialty doctors give medications for psychological problems but please remember that the exposure for psychiatry in MBBS and post graduation is very inadequate in India often the exposure is only 1-2 months during their whole period of specialization.  A psychiatrist has a minimum of 2-5 yrs training experience in handling psychological problems before he independently address the patient problems.

If you have a problem with your electrical issues you do not consult a plumber.

 

4. All medications given by psychiatrists are to be used lifelong and are addicting?

Psychiatrist is the only mental health professionals who can prescribe medications for psychological problems.  Not all medications given are life long, in fact majority of the patient treated for psychiatry problems get off their medications in due course of time or are off medications when they are fine. Some patients may have to take medications for considerable period of time and even lifelong but they form a smaller portion of the patients seen by psychiatrists.

Remember that many physical illnesses too need medication for lifelong like diabetes, hypertension.

 

5. All medications given by psychiatrists are addicting ?

Psychiatrists prescribe a whole range of medications to patients. Please remember majority of the medications given are not addicting and can easily be stopped without the patient feeling the craving for the medication or withdrawal symptoms.  The medications which cause addiction belong to a group of medications called benzodiazepine which are used by psychiatrists for treating anxiety problems, disturbed sleep, aggression etc.  They must be used continuously only for up to 4 weeks and then tapered off and stopped. Other medications which can cause dependence are certain stimulators used to treat attention deficit hyperactivity disorders like methyl phenidate etc.

Remember doctors of other specialty also use benzodiazepines for various conditions and psychological problems you might just not be aware of it.

Always ask your doctor if the medications you are receiving can cause dependence it your responsibility to ask as much as the doctors to tell you about dependence potential of medications.

 

6.  Mental illness cannot be cured?

To answer this commonly asked question we will first have to define what cure means.

If we use the strictest definition that cure means the patient will not get the illness again in life then most of the illnesses do not have a cure. Eg> diabetes, hypertension, numerous neurological conditions like multiple sclerosis, strokes, motor neuron disease, dementia, etc

This is the same with psychiatrist illness. 

Remember many patients can get an episode of a psychological illness and never get it again if treated promptly and correctly, it just very difficult to predict who would never get it again.

It is important to note that the quality of life for the patient and family members is much better when the psychological illness is treated rather than endured.

 

7. Medications given by psychiatrist have major side effects?

All medications given in allopathic medicine have side effects it is similar with psychiatry medication.  Psychiatry medication does have side effects but you need not get them.  Most of the side effects are minor and will go with time, some medications have more serious side effects like drop in the white cell count ( aganulocytosis), seizures, tardive dyskinesia etc. Your doctor will monitor for the side effects carefully when you are on such medications and will give you solutions if you suffer from the side effects.

The newer psychiatry medication have a very different side effect profile than the older ones and considered to be more safer than the older group.  The trick is to give the right medication to the right patient.

Remember  ask for the side effect profile of the medications being given by doctors and make an informed choice.         

 

8. How to get help for patients who do not want to seek help?

This is a common problem a lot of carers face. They are aware that the patient has a psychological problem but is refusing help. There is no particular way to address the issue and multiple approaches can be used . Some of the ways are

A) Get the patient to a doctor in context of the problem and defocus from the patients problem eg:  marital problem with one partner not seeing his part in the issue get the patient in context of the willing spouse.

B) Get a person who has some influence on the patient to speak to the patient

C) Tell patient to consider one appointment with the psychiatrist and then give him the option to decide if he wants to go again or not.

D) Focus on the issue the patient is willing to work and not on the issues he does not want to

Eg:  he might want to consult for his anger issues and not on his sexual problems.

E) Patient  feeling he has  no problem ,itself can be a symptom of the illness (no insight) so do not spend time trying to convince the patient he has an illness

F) If all methods fail  and the patient are seriously ill you can seek help from the Indian mental health act were a patient can be admitted against his will to the hospital.

Always use the least restrictive method first.

Remember there is no one method to seek help  but always focus on how to get the patient to the doctor and not on the problems you will face in the process. If you feel another method will work you can always try but consider  safety of the patient ,yourself and  the family.

G) Reasons for hospitalization?

Majority of the patients suffering from psychiatry problems can be treated on an outpatient basis if they have good family support. However there are times when hospitalization is warranted.  They are

  • If patient is suicidal and has active plans to do so
  • If patient has thoughts to harm others and has been violent
  • The symptoms of the illness are such that  it is difficult to contain the patient at home and he is wandering from place to place .
  • He continues in the same harmful behaviour  eg: taking alcohol and drugs in spite of having received treatment.
  • Patient  has a very poor support system 

 

9. Will the psychiatrist ask me about all my childhood issues in the first appointment?

The psychiatrist does not need to know about all your childhood  issues in the first appointment.  He will ask you only questions that are relevant to the current problem  in the first appointment. Childhood issues will be discussed only if therapy is adviced. The first appointment   will take about 25mins t0 half an hour in most cases.  He will speak to your family member if available, alone if needed. In case you would like to speak to the psychiatrist alone you can always  request for  the same. Confidentiality will be maintained.

 

10. Are talk therapy useful ?

There are many kinds of therapies  like brief dynamic therapy, cognitive behaviour therapy, marital therapy etc. All therapies are good when used by trained therapists.

Remember  for therapies to work the patient must be willing to work through the process and follow the instructions given by the therapist.