i. Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioral disorders.
A psychiatrist is a medical doctor (an M.D.) who specializes in mental health. Psychiatrists are qualified to assess both the mental and physical aspects of psychological problems.
People seek psychiatric help for many reasons. The problems can be sudden, such as a panic attack, frightening hallucinations, thoughts of suicide, or hearing "voices." Or they may be more long-term, such as feelings of sadness, hopelessness, or anxiousness that never seem to lift or problems functioning, causing everyday life to feel distorted or out of control.
Diagnosing Patients
Because they are physicians, psychiatrists can order or perform a full range of medical laboratory and psychological tests which, combined with discussions with patients, help provide a picture of a patient's physical and mental state.
Specific diagnoses are based on criteria established in Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and/or the International Classification of Diseases Manual (ICD – 10), which contains descriptions, symptoms and other criteria for diagnosing mental disorders.
What Treatments Do Psychiatrists Use?
Psychiatrists use a variety of treatments – including various forms of talk therapy, medications, psychosocial interventions and other treatments (such as electroconvulsive therapy or ECT), depending on the needs of each patient.
Psychotherapy, sometimes called talk therapy, is a treatment that involves a talking relationship between a therapist and patient. It can be used to treat a broad variety of mental disorders and emotional difficulties. In Albania, due to the lack of training during their residential program, psychiatrists are not equipped with the knowledge and skills to provide psychotherapy.
Most medications are used by psychiatrists in much the same way that medications are used to treat high blood pressure or diabetes. After completing thorough evaluations, psychiatrists can prescribe medications to help treat mental disorders. While the precise mechanism of action of psychiatric medications is not fully understood, they may change chemical signaling and communication within the brain, which may reduce some symptoms of psychiatric disorders. Patients on long-term medication treatment will need to meet with their psychiatrist periodically to monitor the effectiveness of the medication and any potential side effects.
Types of Medications
· Antidepressants – used to treat depression, panic disorder, PTSD, anxiety, obsessive-compulsive disorder, borderline personality disorder and eating disorders.
· Antipsychotic medications – used to treat psychotic symptoms (delusions and hallucinations), schizophrenia, bipolar disorder.
· Sedatives and anxiolytics – used to treat anxiety and insomnia.
· Hypnotics – used to induce and maintain sleep.
· Mood stabilizers – used to treat bipolar disorder.
· Stimulants – used to treat ADHD.
Psychiatrists often prescribe medications in combination with psychotherapy.
ii. Psychotherapy is a type of treatment that can help individuals experiencing a wide array of mental health conditions and emotional challenges.
Psychotherapy can help not only alleviate symptoms, but also, certain types of psychotherapies can help identify the psychological root causes of one’s condition so a person can function better and have enhanced emotional well-being and healing.
Conditions that can be helped by psychotherapy include coping with stressful life events, the impact of trauma, medical illness or loss such as the death of a loved one; and specific mental health conditions such as depression or anxiety. There are several different types of psychotherapy and some types may work better with certain clinical situations. Psychotherapy may be used in combination with medication or other therapies.
Psychotherapy treatment
Therapy may be conducted in an individual, family, couple, or group setting, and can help both children and adults. Sessions are typically held once a week for about 45 to 50 minutes. Both patient and therapist need to be actively involved in psychotherapy. The trust and relationship between a person and his/her therapist is important for working together effectively and making gains from psychotherapy.
Psychotherapy can be short-term (a few weeks to months), dealing with more immediate challenges, or long-term (months to years), dealing with longstanding and complex issues. The goals of treatment and duration and frequency of treatment are discussed by the patient and therapist together.
Confidentiality is a basic requirement of psychotherapy. Also, although patients share personal feelings and thoughts, intimate physical contact with a therapist is never appropriate, acceptable
The most common types of therapy are as following:
Cognitive behavioral therapy (CBT) helps people identify and change thinking and behavior patterns that are unhealthy or ineffective, replacing them with more accurate thoughts and functional behaviors. It can help a person focus better on current problems and how to solve them. It often involves practicing new skills in the “real world.” CBT can be helpful in treating a variety of disorders, including depression, anxiety, trauma related disorders, and eating disorders. For example, CBT can help a person with depression recognize and change unhelpful or maladaptive thought patterns or behaviors that are contributing to the depression.
Interpersonal therapy (IPT) is a short-term form of treatment. It helps patients understand underlying interpersonal issues that are troublesome, like unresolved grief, changes in social or work roles, conflicts with significant others, and problems relating to others. It can help people learn healthy ways to express emotions and ways to improve communication and how they relate to others. It is most often used to treat depression.
Dialectical behavior therapy is a specific type of CBT that helps more effectively regulate emotions. It is often used to treat people with chronic suicidal thoughts and people with borderline personality disorder, eating disorders and PTSD. It teaches new skills to help people take personal responsibility to change unhealthy or disruptive behavior. It involves both individual and group therapy.
Psychodynamic therapy is based on the idea that behavior and mental well-being are rooted in childhood and past experiences and involves bringing to conscious awareness feelings that might be unconscious (outside a person's awareness). A person works with the therapist to improve self-awareness and to change deep-seated patterns so that they can more fully take charge of their life.
Psychoanalysis is a more intensive form of psychodynamic therapy. Sessions are typically conducted three or more times a week.
iii. Which of the interventions should you choose?
The key to any successful result out of medication or psychotherapeutic treatment are the following elements backed up by the scientific evidence:
1. A trusting and collaborative relationship – Both patient and practitioner (psychiatrist and psychotherapist) have to be open, congruent, respectful and actively engaged in the treatment process. Studies show that when both patient/client and treatment provider are equally on the same terms regarding the treatment process, including individual oriented approach, the treatment outcomes and also satisfaction to therapy are much higher and possible.
2. Treatment should be consistent to theory driven and practice and continuing, - meaning that both patient/client and therapist/psychiatrist should be actively engaged in and follow with the treatment process and regulations such as protocols, in a systematic way. Both psychiatrist and psychologist should support their client in applying all the knowledge, skills and medical interventions that benefit and help the patients, also they should follow up with their clients in order to evaluate the effectiveness of the intervention in place.
3. Treatment is structured, time – framed, patient and goal oriented – There are protocols and treatment processes that guide both patient/client and therapist to get the most out of the treatment procedures. Nevertheless, “a single shoe doesn’t fit all” meaning that it may require time before you see any improvement or benefit out of the treatment process or modality. In terms of time, it may require days or weeks before you see any improvements, while for the psychotherapy, it may take weeks, months or even years. That’s because in therapy you work on improving your behavior, thoughts and emotional reactions to internal and external stations or stimulus while in medication the improvement is on symptom relief only and the effectiveness of the treatment is usually short-lived. Or that you might need to try and undergo different type of treatment before you see stable and long-term effectiveness out of your intervention. Not all modalities of interventions are created to treat all those in need in the same way, some people may need medical intervention only some short-term psychotherapy with or without medication and some other long-term psychotherapy.
4. Combination of both treatments - in most mental health disorders or psychological ill conditions both interventions (medication in addition to psychotherapy, or psychotherapy in addition to medication) have proven to be more effective than either one of them standing alone.
In short, its up to you to decide what kind of treatment you need based on your needs, symptom’s severity and global level of function (the emotional, cognitive and behavioral impact symptoms have on your ability to function on a daily basis and have meaningful relationships) and your perceived life satisfaction. Both psychiatrist and psychotherapist can help you address these issues and have a meaningful and fulfilling life despite the mental and psychological challenges.
As psychotherapists at Bliss, we are here to help you through this journey. 😊
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