Can psychiatrists do therapy

What is a Psychiatrist? What They Do & When To See One

Overview

What is a psychiatrist?

A psychiatrist is a medical doctor who’s an expert in the field of psychiatry — the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioral disorders.

Psychiatrists assess both the mental and physical aspects of psychological conditions. They can diagnose and treat these conditions.

What is the difference between a psychiatrist and a psychologist?

A psychiatrist is a medical doctor who can diagnose and treat mental health conditions. They can prescribe medications and other medical treatments.

A psychologist has a doctoral degree (PhD), typically in clinical psychology, and often has extensive training in research or clinical practice. Psychologists treat mental health conditions with psychotherapy (talk therapy). A psychologist can’t prescribe medication.

Psychiatrists typically treat more complex mental health conditions than psychologists, especially ones that require medication or medical treatments.

To give another perspective, psychology is the study of the mind, emotions and behavior; whereas psychiatry is the field of medicine focused on diagnosing and treating mental health conditions.

What is the difference between a psychiatrist and a therapist?

A therapist has a master’s degree in a mental health-related field such as psychology, counseling psychology or family therapy. They’re qualified to evaluate a person’s mental health and use therapeutic techniques, such as talk therapy. Examples of therapists include licensed social workers and licensed professional clinical counselors. A therapist can’t prescribe medication.

A psychiatrist is a medical doctor who can diagnose and prescribe medicine and medical treatment for mental health conditions.

What is the difference between a psychiatrist and a neurologist?

A neurologist is a medical doctor who diagnoses, treats and manages conditions of the brain and nervous system (brain, spinal cord and nerves). A neurologist knows the anatomy, function and conditions that affect your nerves and nervous system.

While neurologists and psychiatrists are both doctors that deal with conditions that affect your brain, a neurologist is more focused on the physical aspects and symptoms of the condition, and a psychiatrist is more focused on the cognitive and behavioral symptoms of the condition. Neurologists also diagnose and treat conditions that affect your nerves and spinal cord; a psychiatrist doesn’t work with these kinds of conditions.

Both doctors can prescribe medication, and both doctors may be involved with the management of certain conditions that affect your brain. For example, depression commonly occurs in people who have Parkinson’s disease or who’ve had a stroke.

What does a psychiatrist do?

A psychiatrist assesses, diagnoses and treats mental, emotional and behavioral disorders.

Psychiatrists are medical doctors and can order or perform a variety of medical and/or psychological tests. These tests, combined with conversations about symptoms and medical and family history, allow psychiatrists to diagnose mental health conditions.

Psychiatrists use criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM–5) to diagnose specific mental health conditions.

Psychiatrists also form individualized treatment plans, which can include psychotherapy (talk therapy), medication and other medical treatments.

What conditions do psychiatrists treat?

Psychiatrists can diagnose and treat several conditions, including:

Alcohol use disorder and other substance use disorders.
Alzheimer’s disease.
Anxiety disorders.
Attention-deficit/hyperactivity disorder (ADHD).
Autism spectrum disorder.
Bipolar disorder.
Body dysmorphic disorder.
Depression.
Dissociative disorders.
Eating disorders.
Gambling disorder.
Gender dysphoria.
Hoarding disorder.
Mood disorders.
Obsessive-compulsive disorder (OCD).
Panic disorder.
Personality disorders.
Post-traumatic stress disorder (PTSD).
Postpartum depression.
Schizoaffective disorder.
Schizophrenia.
Sleep disorders.

What treatments do psychiatrists use?

Psychiatrists use and prescribe a variety of treatments, including:

Psychotherapy (talk therapy).
Medications.
Other treatments, such as electric convulsive treatment (ECT) or transcranial magnetic stimulation (TMS).

Treatment for mental health conditions is very individualized and unique to each person. Treatment often involves a combination of therapies.

Psychotherapy

Psychotherapy, often called “talk therapy” or “therapy” for short, is a treatment that involves talking with a trained mental healthcare professional to help identify and work through the factors that are affecting your mental health or may be triggering your mental health condition.

The goal of psychotherapy is to eliminate or control disabling or troubling thought and behavioral patterns so you can function better. Psychotherapy can be short-term or long-term depending on your symptoms and condition.

There are several different types of psychotherapy, including:

Cognitive behavioral therapy (CBT).
Interpersonal therapy (IPT).
Mindfulness-based cognitive therapy (MBCT).
Dialectical behavioral therapy (DBT).
Problem-solving therapy (PST).
Psychodynamic therapy.

Medications

Psychiatrists can prescribe medications to help treat mental health conditions. These medications work to alter chemical signaling and communication within your brain, which can minimize some symptoms of certain psychiatric conditions.

Psychiatrists often prescribe medications in combination with psychotherapy.

Classes of medications that psychiatrists typically prescribe include:

Antidepressants.
Antipsychotic medications.
Hypnotics.
Mood stabilizers.
Sedatives and anxiolytics.
Stimulants.
Ketamine.

Other treatments

Psychiatrists sometimes use other treatment therapies for certain psychiatric conditions, including:

Electroconvulsive therapy (ECT).
Transcranial magnetic stimulation (TMS).
Light therapy for seasonal depression (seasonal affective disorder [SAD]).

Much less common treatments include:

Vagus nerve stimulation (VNS).
Deep brain stimulation (DBS).

When should I see a psychiatrist?

Determining when to see a psychiatrist often requires a candid self-assessment of your symptoms and day-to-day experiences. While you shouldn’t try to self-diagnose any specific mental health conditions, you can become aware of and note behaviors, emotions and thought patterns that are unhealthy and disruptive to your everyday life.

While it can be difficult and overwhelming to seek help for mental health conditions, it’s essential to do so. Mental health conditions are very common, and your mental health is just as important as your physical health.

In some cases, your primary healthcare provider may refer you to a psychiatrist if you share your symptoms with them. But you can usually go directly to a psychiatrist for a diagnosis and treatment plan if you prefer.

Mental health episodes may happen randomly, infrequently or be constant. The important thing to remember is that if they’re negatively affecting your quality of life, it’s a clear sign you need to seek help.

If you have any of the following symptoms or experiences, you may want to consider seeing a psychiatrist or telling your primary healthcare provider:

Inability to manage or control your emotions.
Continuous or frequent episodes of anger or rage.
Excessive or irrational fears.
Engaging in risky behavior.
Excessive worrying and/or sadness.
Significant changes in sleep patterns.
Substance use.
Eating disorders.
Declining performance in school or work.
Withdrawal from social situations.
Thoughts of self-harm.

Remember, there’s no shame in having or seeking help for a mental health condition. The sooner you seek help and treatment, the sooner you’ll feel better.

What can I expect during an appointment with a psychiatrist?

To get the most out of your appointment with your psychiatrist, it’s helpful to be prepared. Ways to prepare include:

Bring a list of the most important issues you want to discuss with your psychiatrist.
Discuss new symptoms or changes in existing or prior symptoms. Consider keeping a day-to-day journal of your symptoms so it’s easier to keep track of how your symptoms change or affect your quality of life.
Discuss any changes in your overall physical health.
Discuss your family’s history of physical and mental health conditions.
Share with your psychiatrist how others see you doing, especially family, friends and co-workers who really care about you.
Bring a list of all the current medications and substances you take. Include prescription medications; over-the-counter medications; any vitamins, supplements and herbal products; and any recreational drugs.

What questions should I ask my psychiatrist?

It may be helpful to ask your psychiatrist the following questions during an appointment:

What’s my diagnosis and how did you arrive at it?
How much experience do you have in treating my condition?
What are my treatment options?
When can I expect to feel better?
How will I know I’m feeling better?
What should I do if I feel worse?
Who do I contact with an emergency related to my condition?
What are the side effects of my medication?
Will you work with my other healthcare providers?

Frequently Asked Questions

How does someone become a psychiatrist?

To become a psychiatrist, you must successfully complete:

Four years of undergrad education at a college or university, resulting in a bachelor’s degree.
Four years of medical school, resulting in a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.
Four-year residency program.

After completing residency, most psychiatrists take a voluntary written and oral examination given by the American Board of Psychiatry and Neurology to become a board-certified psychiatrist.

Some psychiatrists also complete fellowship programs to specialize in a particular area of psychiatry, such as child and adolescent psychiatry, which focuses on the mental health in the pediatric population, or consultation liaison psychiatry, which studies the interface of physical and mental health in the medical population.

What are some subspecialties of psychiatry?

Some subspecialties of psychiatry include:

Addiction psychiatry.
Emergency psychiatry.
Forensic (legal) psychiatry.
Geriatric psychiatry.
Pain medicine.
Child and adolescent psychiatry.
Consultation-liaison psychiatry.
Sleep medicine.

A note from Cleveland Clinic

While it can be overwhelming to acknowledge and seek help for a mental health condition, it’s essential you do. A psychiatrist can provide an accurate diagnosis and suggest treatment plans. They’re experts in their field and have up-to-date knowledge on research, medications and other treatment therapies that can help you. Your psychiatrist will work with you to determine a treatment plan that’s best for you.

Psychiatry Doesn't Do Psychotherapy Anymore

Despite a trend that started as early as the late 1980s, Gardiner Harris writing in The New York Times yesterday seems to bemoan the fact that most psychiatrists don’t practice psychotherapy any longer.

Perhaps Harris should have interviewed Dr. Danny Carlat, who nearly a year ago wrote about his experiences as a modern psychiatrist (in the The New York Times Magazine, no less). Psychiatrists nowadays are generally poorly trained in psychotherapy, so they spend most of their time prescribing psychiatric medications. (Dr. Carlat’s book, Unhinged is well worth the read for further background about modern psychiatry.)

So I wasn’t sure why I was reading this in the “Money and Policy” section of the Times. Surely it’s not news that psychiatry is no longer practicing much psychotherapy — and hasn’t been doing so for decades. What’s the story here?

It appears to really just be a lifestyle piece about Dr. Levin, a practicing psychiatrist who has had to switch gears mid-career from a psychiatrist who was doing a fair amount of psychotherapy earlier in his career, to one who does nothing but medication prescriptions.

Dr. Levin no longer sees patients for 45-minute sessions to do psychotherapy:

Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart. Then, he knew his patients’ inner lives better than he knew his wife’s; now, he often cannot remember their names. Then, his goal was to help his patients become happy and fulfilled; now, it is just to keep them functional.

I think this is a perfect example of a false dichotomy on the part of the writer. Of course a person who is “functional” because he or she is stable on their medications can also be “happy and fulfilled.” The role of the psychiatrist has not been diminished — it has simply changed. Do we look down upon a family doctor because all they do is pretty much the same thing — try and address the person’s presenting complaints, usually with a prescription? Why the negative take on this important job?

The switch from talk therapy to medications has swept psychiatric practices and hospitals, leaving many older psychiatrists feeling unhappy and inadequate. A 2005 government survey found that just 11 percent of psychiatrists provided talk therapy to all patients, a share that had been falling for years and has most likely fallen more since. Psychiatric hospitals that once offered patients months of talk therapy now discharge them within days with only pills.

I guess it’s just a lament for “the good ‘ole days,” when psychiatry was the primary clinical mental health profession and didn’t have to share its professional space with clinical psychologists (or clinical social workers). Nowadays, of course, most psychotherapy is performed by either clinical psychologists — who get far more training and practical experience in psychotherapy than medical doctors do — marriage and family therapists or clinical social workers.

There is a tiny discussion of the economics of psychiatry and mental health care in general, buried in the middle of the article. Here’s a snippet of it:

Competition from psychologists and social workers — who unlike psychiatrists do not attend medical school, so they can often afford to charge less — is the reason that talk therapy is priced at a lower rate.

Wow, great research there. In fact, many psychologists nowadays come out of their graduate school training in as much debt as psychiatrists — as much as $150,000. While those are the extreme outliers, many psychologists are graduating with 6-digit debt figures, and will be hard pressed to repay that debt making $110 – $120/hour (the typical psychotherapy session fee charged by a psychologist).

A great deal of the article is focused on how over-worked and underpaid (for their training) psychiatrists can be — even when they switch to an all-meds practice.

I have news for Harris — that’s all of mental health care. I suspect most professionals today who practice psychotherapy don’t feel like they’re “doing well.” Sure, there are exceptions; for instance, anyone who can afford to move exclusively to an all-cash business are usually doing quite well (e.g., they accept no insurance). And once therapists figure out their business model (few psychology graduate programs offer any courses in business or marketing still!), 10 or 20 years down the road after graduating, they can begin to breathe a little easier.

But most clinical mental health professionals are living a very middle-class, middle-of-the-road lifestyle. The first decade after school is often the most difficult — debts are due, but salaries start out too low to even keep one’s head above water.

So while I do indeed feel for psychiatrists who have had to make these kinds of mid-career changes in how they practice their profession, they are not alone. The healthcare system in the U.S. remains broken, and every mental health profession — not just psychiatry — is feeling the pain.

Read the full article: Talk Doesn’t Pay, So Psychiatry Turns to Drug Therapy – NYTimes.com.

Psychiatrist - who is it and what does it treat? When to contact a psychiatrist? How to prepare for a visit to a doctor at the MEDSI Clinic

A psychiatrist is a specialist with a medical background who deals with the treatment of mental disorders (a group of symptoms and behavioral changes that cause mental suffering and are caused by a violation of the psyche). Such professionals are approached by people who are either aware of their condition as a violation, or feel completely healthy. Psychiatrists are also involved in the treatment of severe pathologies that are dangerous not only for the patient himself, but also for those around him. Therapy is carried out with the use of drugs. An appointment with a psychiatrist should be made when the first signs of pathology are detected. The effectiveness of therapy in this case will be as high as possible.

Types of doctors

There are the following specializations of psychiatrists:

Narcologists. Such doctors treat patients with substance abuse, drug addiction and alcoholism
Epileptologists. Such psychiatrists treat epilepsy
Gerontologists. These specialists deal with all mental disorders of elderly patients
Children and teenagers. Such doctors deal with disorders (autism, etc.) in children and adolescents
Criminologists. These doctors are studying the mental state of criminals
Somnologists. These specialists deal with the treatment of disorders manifested in sleep disorders
Suicidologists. These specialists work with patients suffering from suicidal thoughts and suicidal tendencies

What organs does a psychiatrist deal with?

Psychiatrists study the psyche, identify its disorders and prevent pathologies.

The doctor's duties include:

Identification of persons with mental disabilities
Accurate diagnosis of disorder
Determination of the causes that provoked deviations
Prescribing necessary treatment
Case management and rehabilitation
Conducting medical examinations
Carrying out preventive examinations
Hospitalization (including involuntary) of patients with severe disorders
Identification of healthy individuals (including those imitating the presence of various mental pathologies in them)

What does a doctor treat?

Psychiatrists treat psychiatric disorders such as:

Epilepsy
Dementia
Psychosis
Neuroses
Personality disorders
Schizophrenia
Parkinson's and Alzheimer's diseases
Autism
Sleep disorders
Cyclotomy
Manic-depressive syndrome, etc.

Doctors treat both independent pathologies and those that occur against the background of the following diseases:

Drug and substance abuse
Alcoholism
Infectious diseases
Vascular pathologies of the brain
Somatic diseases
Brain tumors
Traumatic brain injury
Intoxication with industrial poisons and drugs

When should I see a doctor?

Individuals who suffer from:

Drowsiness during the day and/or disturbed sleep at night
Constant feeling of anxiety without objective reasons
Complete lack of appetite or persistent hunger
Inability to concentrate on even simple tasks
Memory disorders (up to its complete loss)
Complete apathy
Attacks of aggression
Panic states
Unreasonable resentment
Fear and other uncontrollable conditions

Unfortunately, some mental disorders do not allow the patient to objectively assess the situation. The person does not want to see a doctor. In this case, close people should persuade the patient, convince him of the need to receive medical care.

It is important to make an appointment with a psychiatrist if a person is found to have:

Delusional ideas
Hallucinations
Suicide attempts
Frequent attacks of aggression
Disorientation in space
Missing memory, etc.

You should take your child to a specialist if:

Rough behavior
Difficulty in remembering information and concentrating
Thoughts of suicide
Complete lack of appetite or constant overeating
Addictions of any kind
Excessive focus on appearance (weight, figure, claims to structural features of the nose, ears, etc.)

A preventive appointment with a psychiatrist is mandatory for:

Registration of a child in kindergarten and school
Passing the military medical board
Obtaining driving licenses/permits, carrying weapons, etc.
Hazardous Workplace

Stages of consultation

The psychiatric appointment is carried out in stages.

The consultation includes:

Poll. It is carried out in order to clarify the patient's complaints and the symptoms that concern him. If it is impossible to interview the patient himself, the doctor talks with his relatives
Testing
Additional diagnostics (if required)
Choice of therapy strategy and conditions (inpatient or outpatient treatment)

Examination and treatment are carried out, if necessary, on conditions of absolute anonymity and confidentiality.

Important! Only those patients who are socially dangerous are forcibly placed for treatment in a hospital. An examination is required beforehand.

Diagnostics

All diagnoses by psychiatrists are based on the overall clinical picture and test results.

Additionally, the thyroid gland, pituitary gland and adrenal glands are examined.

Neurophysiological diagnostics includes:

EEG (electroencephalography)
MRI (magnetic resonance imaging of the brain)
Duplex scanning of head vessels

Also, the doctor may prescribe a study of the work of the autonomic nervous system.

The complex of surveys is determined only by a psychotherapist on an individual basis.

Treatment

Therapy of any mental illness is carried out taking into account the patient's condition, the presence of concomitant diseases and individual characteristics.

In the treatment use:

Drug therapy
Psychotherapeutic methods of various types (art therapy, music therapy, hypnosis, etc.)
Autotraining

Treatment is carried out both individually and in groups.

Important! If the disorder is a symptom of an underlying disease (pathology of the internal organs or brain), therapy is carried out in conjunction with a general practitioner, neurologist, cardiologist and other specialists. In any case, treatment is aimed at eliminating not only the symptoms, but also the cause that provoked their appearance.

Benefits of treatment by a psychiatrist at MEDSI

Experience of psychiatrists. Our specialists have the necessary knowledge and skills to treat all mental pathologies known to medicine today
Rapid assistance. Elimination of symptoms is possible literally within a few days. Thanks to this, doctors can improve the quality of life of the patient in the shortest possible time
Modern techniques. They have proven their effectiveness and have already been introduced into the daily practice of doctors around the world
Prescribing effective and safe drugs
Combining different treatments to achieve desired results
Opportunities to work not only with the patient himself, but also with his relatives
An integrated approach to treatment. If necessary, not only a psychiatrist, but also a neurologist, psychologist and other specialists will work with the patient
Capabilities for comprehensive diagnosis and detection of all comorbidities

If you want to make an appointment with a psychiatrist yourself or visit a consultation with a loved one, call us at +7 (495) 7-800-500.

12 important questions for a psychiatrist

Ekaterina Kushnir

talked about mental health

Author profile

Kirill Sychev

psychiatrist

We talked with a psychiatrist and practicing psychiatrist Kirill Sychev.

You will learn how diagnoses are made in psychiatry, whether mental disorders can be treated without medication, and how to understand when it is time to change a psychiatrist.

What will you learn

What are the most common mental disorders?
What are the risk factors for mental disorders, why do they occur?
Does the risk of developing a mental disorder increase with age?
When should I see a psychiatrist?
Can a psychiatrist misdiagnose?
Can a psychiatrist make a diagnosis online?
Is there a problem in psychiatry of underdiagnosis or overdiagnosis of mental disorders?
Can mental disorders be treated without medication?
If you start taking medicine, will you have to take it for the rest of your life?
Is it true that all psychiatric drugs are addictive and have severe side effects?
In what cases is hospitalization in a psychiatric hospital required?
How can a patient assess the competence of a psychiatrist, when is the best time to see another doctor?

Go see a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you.

What are the most common mental disorders?

In the first place, anxiety disorders are various phobias, panic disorder, generalized anxiety disorder.

Statistics of mental disorders on the site Our World in Data

In second place is a depressive disorder. In third place, I would put bipolar affective disorder. It is common, in addition, now is a turning point: so many people who were previously observed with a diagnosis of "schizophrenia" have been replaced with "bipolar affective disorder." This is due to the diagnostic problems that exist in our country.

True schizophrenia is less common, less than 1% of the population. At the same time, severe psychosis with hallucinations and delusional thoughts can occur not only with schizophrenia, but also with bipolar disorder, sometimes with depression - in almost all mental illnesses, except for anxiety disorders.

Schizophrenia in Adults: Epidemiology and Pathogenesis - Uptodate

The increase in cases of specific mental illnesses may be due to various factors. Sometimes some kind of newsbreak happens - for example, someone very famous talks about his disease. Against this background, the number of people who come with similar symptoms may increase. There may be a false feeling that this disease has become more.

Such situations are good anyway. It is better if a person goes to the doctor in vain and they tell him that everything is in order than he will struggle with the symptoms on his own for years, being afraid to turn to a psychiatrist.

/shizofreniya/

How much does it cost to support a relative with a mental disorder

Source: Our World in Data Source: Our World in Data

What are the risk factors for mental disorders, why do they occur?

Traumatic situations increase the risk of developing a mental disorder. For example, the most difficult situations are when one of the parents dies in childhood or sexual or physical abuse occurs.

Risk factors for mental illness - WHO PDF, KB 800

There are also personality characteristics that can influence the development of mental illness. For example, when a person tends to sink into sadness, perceives the world in black and white, takes his failures too seriously, and so on.

In addition, there is a hereditary predisposition. How strong it is depends on the specific disease.

Does the risk of developing a mental disorder increase with age?

Quite the contrary: a person who has not developed a mental disorder before old age is unlikely to become ill, unless dementia is taken into account.

Age of onset of mental disorders worldwide: a large meta-analysis - Nature

For example, schizophrenia is primarily a disease of the young, it does not appear for the first time in old age. A person is most likely to experience depression for the first time between the ages of 20 and 30, often it first appears in women after childbirth. Bipolar affective disorder is more likely to manifest itself in childhood or adolescence.

Another thing is that often a person copes with symptoms on his own for a long time, and in old age mental disorders can be more severe. For example, a person with an anxiety disorder after the age of 60 will suffer more from it - there may no longer be the strength to fight it without help. Then for the first time he will be seen by a psychiatrist at a later age, although, most likely, he fell ill earlier.

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Coping with postpartum depression

It also happens like this: a psychosis happened, they waited it out, it went away, after a few years it happened again, but it was already harder - and by some age the person ended up in the hospital. It may seem that he fell ill with schizophrenia late, but in fact he had been ill for a long time, just no one noticed, did not want to notice, or hid it.

Source: Nature Source: Nature

When should I see a psychiatrist?

The first thing to start from is how much time a day a person spends experiencing the symptoms of a disorder. For example, if 30-40% of the time a person is in obsessive anxious thoughts or he is sad all the time, this prevents him from living, it’s definitely worth going.

The second option is when a person's condition changes dramatically. For example, a usually calm person, a homebody, suddenly woke up in the morning with a surge of strength and a desire to go on a trip around the world. Or, on the contrary, a person constantly traveled, talked a lot, but suddenly began to spend all the time at home, abruptly lost interest in old hobbies.

And, of course, if a person has suicidal intentions or even thoughts in the spirit of “it would be better if I didn’t exist, it would be good for me to die” - you definitely need to apply.

Of course, psychiatry is heavily stigmatized. It would probably be better if a person could turn to a psychologist, and then he would send him to a psychiatrist if necessary. However, we have a wide variation in the quality of psychological assistance. That is, a psychologist is not always competent enough to understand the situation and understand that a person needs psychiatric help.

/psychotherapy-search/

How to choose a psychotherapist

Can a psychiatrist misdiagnose?

Mistakes in psychiatry occur in most cases due to the fact that there are no other diagnostic methods other than communication with a doctor.

International Classification of Diseases, 11th Revision

In psychiatry, diagnosis is based on the criteria of the International Classification of Diseases. Diagnoses are made on the basis of a retrospective analysis of the anamnesis, that is, a doctor's assessment of the medical history according to the story of a person or his relatives.

There are no neurological tests, such as in neurology, examinations like MRI and tests that can reliably show mental illness. There are only questionnaires that increase the accuracy of the diagnosis, but do not give a 100% guarantee. In addition, all questionnaires are designed for specific diseases - the doctor still needs to understand what to look for first.

The biggest challenge is distinguishing one illness from another, such as depressive disorder from bipolar affective disorder. It is important for a doctor to understand the diagnosis: if it is a common classic depression, antidepressants should be prescribed, and if it is a bipolar disorder, they may get worse - mania will begin. Another example is borderline personality disorder. It is also similar to bipolar affective disorder, but it cannot be corrected with drugs, psychotherapy is needed.

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How much does it cost to treat borderline personality disorder

Can a psychiatrist make a diagnosis online?

From a medical point of view, there is no difference between a face-to-face consultation with a psychiatrist and an online consultation. The main thing is that the doctor has the opportunity to talk in detail with the person.

The procedure for providing medical care using telemedicine technologies - Ministry of Health of the Russian Federation

If we take legal aspects, then an online consultation will not be considered a full-fledged medical consultation. This is just a doctor's opinion, not an appointment with a diagnosis and prescription.

Is there a problem of underdiagnosis or overdiagnosis of mental disorders in psychiatry now?

In Russia there is an overdiagnosis of schizophrenia - we have always had much more cases of this disease than in other countries. There is an interesting Russian study that studied the accuracy of diagnosis in a sample of patients. As a result, in more than 35% of cases it was more correct to diagnose "bipolar affective disorder" rather than "schizophrenia".

Typical medical errors in the differential diagnosis of endogenous psychosesPDF, 114 KB

To be fair, there is also the problem of overdiagnosis of schizophrenia abroad: not everyone wants to figure out why a person developed psychosis, writing “schizophrenia” is the easiest way.

There is also an anxiety-depressive disorder - such a diagnosis is in the International Classification of Diseases. It is given by many conventional doctors who need to establish a preliminary diagnosis in order to send a person to a psychiatrist, because they do not have to figure out what kind of anxiety disorder he has or whether he has depression.

As a result, anxiety-depressive disorder has become one of the most popular anxiety disorders. However, this condition is actually rare.

Can mental disorders be treated without medication?

Mental disorders can sometimes be treated without medication. For example, with a large part of anxiety disorders. Some people are surprised when I say that a phobia is a psychiatric disorder, because in most cases it is treated only with psychotherapy.

Generalized Anxiety Disorder in Adults: Management - Update

True, it must be borne in mind that phobias most often occur against a background of increased anxiety, and increased anxiety sometimes cannot be relieved without medication.

Cognitive Behavioral Therapy for Phobias in Adults - Uptodate

Mild depression should also be treated with psychotherapy. With an average degree, treatment is chosen taking into account the symptoms, depending on the suicidal risk and the characteristics of the person - whether he wants to engage in psychotherapy or not. If the suicide risk is low, only therapy can be tried. But a severe degree of depression is an indication for drug treatment.

Unipolar major depression in adults: choice of initial treatment - Uptodate

Bipolar affective disorder and schizophrenia spectrum disorders require medical treatment in 99% of cases. Personality disorders are the opposite: psychotherapy is needed here, and drugs are used only occasionally to relieve individual symptoms.

What are Personality Disorders - American Psychiatric Association

If you start taking medication, will you have to take it for the rest of your life?

How much medication you have to take depends on the disease. So, with a depressive disorder, in most cases, remission is achievable, which allows you to refuse medication with a minimal risk of getting sick again. However, one must understand that the drugs will still have to be taken for a long time - from a year.

What is depression - American Psychiatric Association

For anxiety disorders, lifelong pills are out of the question - such disorders are well treated. During the year, you can undergo a course of psychotherapy or medication and feel good.

Anxiety disorders - National Institute of Mental Health

Bipolar affective disorder - Mayo Clinic

Psychosis - NHS

Severe disorders that present with psychosis, such as schizophrenia, often require lifelong medication. And with bipolar affective disorder, everything depends on the situation: drugs are taken for a long time, in rare cases they can be canceled.

Is it true that all psychiatric drugs are addictive and have severe side effects?

Much depends on specific drugs, they cannot be combined into one group.

Antidepressants are practically the safest drugs, not only among psychiatric drugs, but among all drugs in general. They can be appointed for life. They do not cause addiction, and the risk of side effects is low.

Antidepressants - NHS

Tranquilizers - Drugs that may cause dependence. They can also cause tolerance - this is when after some time more medicine is needed to get the effect. They can only be taken in short courses, up to four weeks, after which it is better to cancel. Of course, they do not work like drugs, but there will be dependence on the physiological level and a noticeable withdrawal syndrome from these drugs.

Antipsychotics. There are first generation drugs here - they cause a lot of side effects that often look bad. For example, a person's movements are disturbed: he cannot open his jaw to eat, his hands or head are trembling. However, such drugs are best for relieving psychosis - if a person has acute psychosis, they are the first to be administered.

Antipsychotics - Drugs.com

Anxiolytics - Drugs.com

There are also second generation antipsychotics, they no longer have many side effects. They can cause drowsiness, decreased libido, mood deterioration, but if you choose the right dose, this can be avoided.

With long-term use, such drugs sometimes cause weight gain and pancreatic dysfunction, but the situation is the same here: if you choose correctly, you can take it for life.

Normotimics are drugs that are used to treat bipolar affective disorder. They also do not cause dependence and are intended for long-term use.

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How much does it cost to treat bipolar affective disorder

Normothymics can be toxic and are not recommended during pregnancy and breastfeeding. Here, too, a lot depends on the competent selection of the dosage: side effects can be avoided and the person can easily tolerate the treatment.

One cannot say that some drugs are better or worse, they are all used to treat various mental disorders.

When is it necessary to be admitted to a psychiatric hospital?

There is an opinion that in many cases it is absolutely necessary for a person to go to a hospital, without this he will not recover. But this is a myth.

Mental disorders - Mayo Clinic

The right psychiatrist just tries not to send him to the hospital. There is evidence that with outpatient treatment, patients begin to feel better much earlier. In the hospital, the quality of life deteriorates, this affects the well-being.

You need to go to a hospital in the following cases:

if a person is in a very serious condition, cannot take care of himself;
there is a risk of suicide or other life threat. For example, with anorexia, when the weight is very low, the functioning of the organs is disrupted - a person will simply die if he stays at home;
a person endangers the safety of others.

Mental Health - UK National Institute for Health and Care ExcellencePDF, 1.06 MB

Common psychiatric disorders, including non-psychotic schizophrenia and bipolar affective disorder, are best treated on an outpatient basis.

How can a patient assess the competence of a psychiatrist, when is the best time to see another doctor?

In my opinion, there are three fundamental things to worry about.

The doctor does not make an accurate diagnosis. A psychiatrist should make a diagnosis, not say "you have anxiety" or "you have depression" or "you have something else." There are no such diagnoses as anxiety or depression, these are conditions that can be associated with various disorders. Such terms can be used in normal conversation to simplify the conversation, but this is not the way to make a diagnosis.

Doctor prescribes strange medicines. Of course, the patient cannot always evaluate the prescriptions adequately, but if the doctor prescribes non-working drugs, such as nootropics, it is worth considering.

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The doctor does not answer questions. The psychiatrist must answer any questions the patient has. It's good if he tells everything in detail and clearly. It's bad if he says: "I'm a doctor, I know better." The first thing a good psychiatrist should worry about is whether the patient understands why he needs pills, whether he will take them.

All foreign textbooks explain in detail how to convince patients to drink medicines correctly at the right time. The big problem of psychiatry is not even that we cannot treat many diseases, but that patients refuse treatment on their own, because they do not understand why it works and how it works.

In addition, many personal factors influence the prescription of treatment. For example, you cannot prescribe a medicine for 6,000 R when he has a salary of 20,000 R, because he will not be able to buy it.

Another example: if a person is worried about their weight, they will stop taking pills that affect body weight. The doctor definitely needs to talk with the patient in order to understand which drugs are suitable, which may prevent him from being treated.

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In addition, in no case should there be any condemnation from the doctor and quick consultations with a diagnosis in ten minutes.

Remember

Anxiety and depression are the most common mental disorders.
The main risk factors for mental disorders are severe traumatic events in childhood, personality traits and heredity.
Most mental disorders first appear at a young age, apart from dementia.
A psychiatrist should be contacted when symptoms of a disorder interfere with life, a person's condition changes dramatically, or there are suicidal thoughts.
A psychiatrist can assess a person's condition online, since for this it is important to communicate with the patient in detail.
Learn more