About Psychiatry

ABOUT PSYCHIATRY: WHAT IS A PSYCHIATRIST?

A psychiatrist is a physician who specializes in the diagnosis, treatment, and prevention of mental illnesses and substance use disorders. It takes many years of education and training to become a psychiatrist. He or she must graduate from college and then medical school, and go on to complete four years of residency training in the field of psychiatry. (Many psychiatrists undergo additional training so that they can further specialize in such areas as child and adolescent psychiatry, geriatric psychiatry, forensic psychiatry, psychopharmacology, and/or psychoanalysis.) This extensive medical training enables the psychiatrist to understand the body’s functions and the complex relationship between emotional illness and other medical illnesses. The psychiatrist is thus the mental health professional and physician best qualified to distinguish between physical and psychological causes of both mental and physical distress.

ABOUT PSYCHIATRY: DIFFERENCES BETWEEN PROFESSIONALS

Only the Psychiatrist is a medical doctor who can order medical tests and prescribe medication. It takes many years of education and training to become a psychiatrist. After earning a bachelor’s degree, he or she must graduate from medical school and go on to complete four years of residency training in the field of psychiatry.

Other professionals who care for people with mental illness or provide mental health services undergo different types of training whose length and core emphases differ according to the field of study. Here is a brief summary:

Psychologist: Most clinical psychologists have a master’s or doctoral degree; on the doctoral level, the degree is usually a Ph.D. (doctor of philosophy) or Psy.D. (doctor of psychology, which is not a medical doctor). A psychologist applies psychological principles to the treatment of mental, emotional, and behavioral disorders and developmental disabilities through a broad range of psychotherapies. A psychologist is commonly trained in advanced psychology, abnormal psychology, statistics, testing theory, psychological testing, psychological theory, research methods, psychotherapeutic techniques, and psychosocial evaluation.

Licensed clinical social worker: A licensed clinical social worker (LCSW) is also trained in psychotherapy and helps individuals deal effectively with a variety of mental health and daily living problems to improve overall functioning. A social worker usually has a master’s degree in social work (MSW) and has studied, among others, sociology, growth and development, mental health theory and practice, human behavior/social environment, psychology, research methods.

Psychiatric nurse: A psychiatric nurse may have an associate arts, bachelor’s, or master’s degree in nursing. Much of the psychiatric nurse’s specialty training takes place in a hospital inpatient service. Among the services the psychiatric nurse is trained to provide (at the order of a medical doctor) are various patient care services, administration of medication, and other duties commonly performed by nurses, such as immunizations and skin tests.

ABOUT PSYCHIATRY: MOST COMMON TREATMENTS

Psychiatrists use a wide range of treatments–including various forms of psychotherapy, medications, and hospitalization–according to the needs of each patient.

Psychotherapy is a systematic treatment method in which, during regularly scheduled meetings, the psychiatrist and patient discuss troubling problems and feelings. The psychiatrist helps patients understand the basis of these problems and find solutions. Depending on the extent of the problem, treatment may take just a few sessions over one or two weeks, or many sessions over several years.

Psychiatrists use many forms of psychotherapy. There are psychotherapies that help patients change behaviors or thought patterns, psychotherapies that help patients explore the effect of past relationships and experiences on present behaviors, psychotherapies that treat troubled couples or families together, and more treatments that are tailored to help solve other problems in specific ways.

Psychoanalysis is an intensive form of individual psychotherapy that requires frequent sessions over several years. Psychiatrists who are also psychoanalysts have had additional years of training in psychoanalysis. They help the patient to recall and examine events, memories, and feelings from the past as a means of helping the patient understand present feelings and behavior and make changes as necessary.

Psychiatrists may also prescribe medications when a thorough evaluation of the patient suggests that medication may correct imbalances in brain chemistry involved in some mental disorders. Most medication is used in combination with psychotherapy. Just like a diabetic patient who needs insulin or a heart patient nitroglycerin, a patient suffering from a severe mental illness may need a specific type of psychiatric medication.

The usefulness of electroconvulsive therapy (ECT) in certain cases is indisputable. ECT has repeatedly been shown to be effective for patients who cannot take medications due to heart conditions, old age, or severe malnourishment and for patients who are suicidal or who do not respond to antidepressants. Before ECT is administered, patients receive anesthesia and a muscle relaxant to protect them from physical harm and pain. Its effects are largely transitory.

ABOUT PSYCHIATRY: WHY CHOOSE A PSYCHIATRIST?

Of all the mental health providers in the United States, only psychiatrists are fully licensed medical doctors. Because they are physicians, psychiatrists can order or perform a full range of medical laboratory and psychological tests that provide a complete picture of a patient’s physical and mental state. Their education and years of clinical experience equip them to understand the complex relationship between emotional and other medical illness, evaluate all the medical and psychological data, make a diagnosis, and develop a treatment plan. Also, as physicians, they are the only mental health providers who can prescribe medication and order medical tests.

ABOUT PSYCHIATRY: HOW TO SELECT A PSYCHIATRIST

For a child:

The first line of defense when a child appears to be having problems is usually the family pediatrician. Since this physician has probably known the family for quite some time and is familiar with the family’s history, parents may find it easier to talk over their concerns with him or her. The pediatrician will be able to determine whether there is any physical cause associated with the problem. If the problem is not severe or debilitating, the pediatrician also should be able to give useful advice on how to deal with the situation or help the child resolve it. Examples of problems for which parents might want to get a pediatric consult are bedwetting, general complaints of not feeling well without any apparent physical symptoms, refusal to go school, withdrawal from friends and family, and excessive complaints of stomachaches and headaches.

If the problem has gone on for a long time or appears to interfere with the child’s ability to function or cope in general, a psychiatrist who specializes in the treatment of children or adolescents–depending on the child’s age–should be consulted. The child’s pediatrician should be able to refer parents to an appropriate specialist. Parents can also obtain referrals from the Texas Society of Psychiatric Physicians, community mental health centers, medical school, and the local medical society.

For an adult:
Adults who wish to obtain psychiatric help may want to start by conferring with his or her own physician. The physician will probably want to perform a thorough physical evaluation to check whether any physical problems may be the cause or a contributor to the mental or emotional problem. If the physician believes that psychiatric treatment is needed or could be helpful, he or she can recommend the names of psychiatrists appropriate to consult. Other sources of referrals are the Texas Society of Psychiatric Physicians, community mental health centers, medical school, and the local medical society.

ABOUT PSYCHIATRY: QUESTIONS TO ASK BEFORE CHOOSING A PSYCHIATRIST

Once you have the names of potential psychiatrists, you may want to talk to them or a staff member over the phone to choose the most appropriate one. Here are some questions you might want to ask:

  1. What is your location and appointment availability?
  2. Do you specialize in a particular treatment or therapy?
    Beware of any psychiatrist who or other therapist who espouses one brand of treatment as the only one that works. Psychiatrists have a multitude of ways to help you and will work with you to create a treatment program appropriate for you.
  3. What will psychiatric care cost?
    Psychiatrists charge by the session, typically 45 or 50 minutes once a week. The cost and time vary from one part of the country to another–generally it’s higher in urban areas and lower in rural areas. The initial evaluation, which may include psychological testing, costs extra.
    A psychiatrist cannot tell you in a phone interview how many sessions will be necessary for treatment, but he or she should be willing to discuss with you his or her fee policies. Any who refuses to do so should be crossed off your list.
  4. Are you willing to accept payment directly from the insurance company instead of from me?
    Many psychiatrists are willing to file the necessary paperwork if they are eligible to receive payment for their services directly from the insurer. Others expect payment in full from you for each session, and you can file the paperwork with the insurer to obtain reimbursement.
    If you or your child is covered under certain kinds of managed care plans (such as a health maintenance organization or preferred provider organization) and the psychiatrist is a recognized provider in that plan, the plan will pay the therapist directly. You may be responsible for a copayment. Before seeing the psychiatrist for the first time, it’s a good idea to check with your plan to be sure that the psychiatrist is a recognized provider.
  5. What if I don’t have insurance or mental health benefits under my health care plan?
    If you don’t have insurance and you can’t afford the fees quoted to you, ask whether the psychiatrist is willing to adjust his or her fees based on family income or can refer you to someone with such a policy.
    Also, you can check with your local government as well as your local medical or psychiatric societies about community mental health services for children or families. One drawback of community agencies, however, is that there is often a long wait because there are not enough mental health professionals to service all comers.
    These telephone interviews should help you select which psychiatrist is best for you and your family. Chances are good that the person you select will work out, but if the first time you meet with him or her is disappointing, don’t be discouraged. The first few appointments with any therapist are often upsetting, and it takes time to build up trust in someone with whom you are sharing highly personal information. If you continue to feel uneasy, however, you may need to try another therapist. Again, this is not uncommon. The more work you put into choosing a psychiatrist, the greater the probability that your choice will work out.

ABOUT PSYCHIATRY: QUESTIONS TO ASK AFTER CONSULTATION

  1. What is the diagnosis?
  2. What treatment plan do you recommend?
  3. How long will treatment take? When will we know it’s time to stop treatment?
  4. Will you or someone else conduct the treatment? If someone else, does that person work for you or would this be a referral? Will you supervise treatment?
  5. What are the alternative treatments?
  6. What are the benefits and the risks associated with the recommended treatment? with the alternative treatments?

If the patient is a child, you might also want to ask:

  1. What role will parents play in treatment? our other children? other people?
  2. What if the child doesn’t want to participate in therapy?
  3. What else can I do to help my child?
  4. How often will you talk to me about my child’s progress?