And by “one thing” I mean prescribing medication.

Aside from the cost of mental health care, one of the biggest patient complaints I’ve heard since beginning Mental Health Notes and becoming involved with NAMI is the way in which appointments with psychiatrists seem to go these days.

It’s become the norm for a patient to take a half or whole day off work to sit in a waiting room for an hour or more only to see a psychiatrist for a few minutes in order to discuss whether or not a particular medication is working, grab a new or adjusted prescription, and leave in time for another patient to take the seat before the butt warmth has had time to cool.

When did psychiatrists decide it was okay to cut their services in half? Why are psychiatrists now merely tending to “medication management” (i.e. doling out drugs and monitoring their success) and leaving the “dirty work” to psychologists, social workers, and other non-doctor mental health professionals?

Read on.

From the Reuters article Move over Freud: Psychiatrists embrace pill power:

The shift to briefer visits for medication management, reported in the Archives of General Psychiatry, appears to be linked to better psychiatric drugs and pressure from managed care companies, which offer richer financial incentives for brief office visits.

“Psychiatrists get more for three, 15-minute medication management visits than for one 45 minute psychotherapy visit,” said Dr. Ramin Mojtabai of Johns Hopkins University in Baltimore and formerly of Beth Israel Medical Center in New York, where he did the research.

Up for a nice greedy round of money-grubbing, anyone?

Dr. Mojtabai also states that treatment from psychologists and social workers is most likely “short-term cognitive behavioral therapy” rather than the “analysis psychiatrists have traditionally offered.”

Of course, not everyone has dollar signs in their eyes.

While Dr. Mojtabai admits seeing a psychiatrist strictly for medication management and a psychologist or social worker for actual therapy “might not be as efficient” (as what? having a psychiatrist who actually knows more about you than what dosage of Zoloft you’re currently taking? and didn’t he just say the treatment from psychologists and social workers was different from what we can get from the analysis of a psychiatrist?), Dr. Eric Plakun, leader of an American Psychiatric Association committee on psychotherapy, notes that a shift in focus from psychotherapy to the biology of mental illness accounts for some of our psychiatrists’ current unwillingness to do more than drag out the prescription pad.

Plakun said in a telephone interview it is not clear if patients are getting therapy from other providers, or not at all.

“Either way, I’m worried about our patients,” he said. “Patients need the best help we can give them.”

For Plakun, that means offering a range of services, including psychotherapy, and not just medication. “If all you have is a hammer, everything looks like a nail,” he said.

Yes, everything does indeed start to look like a nail. If the only skills today’s psychiatrists are coming out of school with (or are willing to use) are the skills to properly medicate someone, does that mean more people than actually necessary are being medicated?

What about you? How would you describe your trips to the psychiatrist’s couch office? How happy are you with the various members of your mental illness management team?

Image: SXC

Post from: Blisstree

Is Your Psychiatrist Only Good For One Thing?

This week, which was also Children’s Mental Health Week, was fairly busy at Mental Health Notes. I talked about mental health situations in the news (some…bizarre, and some not so uncommon) as well as well as a few mental health studies such as increasing intelligence and how compliments affect the brain. I told you about NAMI and the DBSA participating in the online Women’s Health Expo, how my local NAMI’s cookout for Mental Health Month panned out, and even shared a few extreme ups and downs I experienced this week. Perhaps most noteworthy, however, is that Ken Jensen took over the This Is Why I ROCK! series slot for the next week!

My bookmarks are overflowing with mental health news-, research-, and government-related information. The Pentagon is working to reduce mental health counseling stigma (I wonder if this decision was made before or after VA mental health director Dr. Ira Katz sent around an internal email dealing with suicide data that had “Shh!” in the subject line?). Researchers in Canada believe celebrities are one reason the number of young people who visit mental health professionals has doubled in the last two years (well, that certainly adds to Tuesday’s conversation about celebrities and mental health), while researchers in Australia believe helping pregnant women cope with depression during pregnancy may lower the risk of being depressed after giving birth. And, sadly, another mental health care budget slash is in the works; this time, in California’s Santa Clara County.

And, as usual, the rest of the b5 Health & Wellness Channel has a slue of stuff going on. In addition to Mental Health Notes’s birthday giveaway, Grace at Kids Health Notes currently has five giveaways going on (some end tonight, so hurry on over!) while Gloria at Cancer Commentary is running an HPV Awareness contest. In addition to the upcoming Living with Pain blog carnival, Help My Hurt’s Marijke has interviewed the author of How-To Marijuana, A Step-by-Step Guide to Medical Marijuana and is hosting a contest to win a free copy of the book. And, for you poets out there, Angelique at Breaking the Mirror is hosting a contest for a free copy of For Keeps: Women Tell the Truth about Their Bodies, Growing Older, and Acceptance. Of course, just when you thought we b5 bloggers didn’t know how to do anything but give stuff away, Gabrielle at Fertility Notes gets serious with tips for coping with fertility problems while Elaine at Genetics & Health the connections between child abuse, genetic changes, and suicide.

That’s all the sanity I can stand this Saturday! Remember, if you have any Saturday Sanity-worthy stories, send ‘em my way for next week.

Top image courtesy of morgueFile.
Middle and bottom images courtesy of Newscom.

Post from: Blisstree

Saturday Sanity: Ain’t The A Kick In The Brain?

Back in September I posted I’m Firing My Psychiatrist. In short, the post explained the reasons I had for firing my psychiatrist. Actually, the post explained the one main reason I had for firing my psychiatrist: He assured me that I could stop taking Lamictal cold turkey without even glossing over the potential risks for seizures that accompany quitting Lamictal cold turkey.

Yesterday, reader Patrick left the following comment under that post:

This discussion of lamictal is quite educational for me. I really don’t like the person I’ve become, the edginess, being short tempered and irritable all the time but my shrink won’t even consider changing it. To get past the racing thoughts and to get some rest they have me on trazadone and xanax at bedtime. It makes for good sleep but that seems to be the only peace I get in a 24-hour period. Just changed to a new therapist (5 sessions) and am ready to give up on him. Any advice?

Yes, Patrick, I do have some advice. Read on.

When it comes to seeing a therapist, psychologist, psychiatrist, or any other mental health professional, five sessions may seem like a short period of time for some people, while five sessions may feel like an eternity for other people.

Several factors go into determining how long a “time period” five sessions actually feels to you, such as:

• The therapist himself and how the two of you connect. Does your therapist listen to you and consider the things you say? Or does it feel like he ignores you and follows a course of action he’s developed without your input?
• How far apart the sessions are spread out. How often do you see your therapist? Once or twice a week? Once or twice a month? If you see your therapist once or twice a week, you may feel that the two of you should be making progress after a month or two. However, if you only see your therapist once or twice a month, it may take several months before the two of you start to connect and make progress.
• How in depth the sessions go. This includes how long the sessions last and what’s covered during the sessions. For example, I find that a five- or 10-minute session is unacceptable. That’s barely enough time to get comfortable. If all five of your sessions have been short, you may not have had enough time with your therapist. (You may also want to suggest longer sessions to your therapist.) However, if all of your sessions have lasted an hour or so and you still don’t feel as if the two of you are on the same page, it may be time to speak up.

Given those factors, it’s really impossible for me to say, “Oh, five sessions, that’s long enough, if you don’t like the therapist you should fire him/her,” just as it’s impossible for me to say, “Five sessions isn’t very long at all. Stick it out.”

So, what I will say is this: If you’re truly ready to give up on your therapist, tell him. Flat out. Tell your therapist you’re ready to give up, and then explain why. This gives him an opening to fix whatever it is you feel isn’t working. Maybe your therapist doesn’t fully understand that you’re not happy with your medications. Maybe your therapist didn’t realize that the sessions were too short and not frequent enough for you.

In other words, whatever your problem is, maybe your therapist doesn’t yet realize it’s a problem.

If your therapist doesn’t work with you to try to correct the problems, or doesn’t feel that your problems are important and relevant, I’d start shopping around for a new therapist.

Think about this scenario: While walking down a flight of stairs you lose your balance, fall to the bottom of the stairs, and break your leg. You can clearly see that you’ve broken your leg. It’s a nasty break – the bone is sticking out of your skin! A friend rushes you to the hospital where a doctor tells you your leg isn’t broken. Maybe he gives you some pain medicine, but he sticks to his claim that your leg isn’t broken. Naturally, you say, “Hello?! My bone is sticking out of my leg! I can see that it’s broken!” If the doctor doesn’t look a bit closer and agree that your leg is broken, you’re going to find a new doctor, aren’t you?

Of course you are. And it’s the same with your therapist. Something was wrong, something was “broken.” You felt it. The edginess, the irritability, the short-temper – you felt it all. So, you went to a therapist. It seems as if your therapist keeps offering you a quick fix – the Trazodone and Xanax – just as the doctor in my example above offered pain medicine. While the Trazodone and Xanax may help you sleep (just as the pain medicine may help ease the pain of a broken leg), they aren’t “fixing” the problem. Your therapist needs to help you learn how to properly manage, treat, and maybe even heal whatever mental health condition you have. This may involve a different kind of medication and/or more intense therapy sessions. What it should not involve, however, is simply prescribing medication to knock you out.

The bottom line is this: You deserve a doctor who is going to listen to you and provide appropriate care. Explain to your therapist what you need – and what you’re not getting from him – and if he doesn’t take action to better help you, find someone who will.

I wish you the best of luck, Patrick!

Image source, used under this license agreement.

Post from: Blisstree

Before Calling It Quits With Your Therapist

We’ve hit the halfway point and it’s all downhill from here. Feeling any more educated about obsessive-compulsive disorder? Sure you are.

Now that you know the signs, symptoms, causes of, and risk factors for OCD, how do you know when it’s time to talk to a doctor? And on that note, how will a doctor even determine whether or not you have OCD?

Sometimes people mistake perfectionism for OCD, and vice-versa. Sometimes people mistake little quirks or odd habits for OCD, and vice-versa. However, if your “perfectionism” or “little quirks or odd habits” are taking over your life, i.e. interfering with your ability to function, work, sleep, have relationships, etc., it’s best to see a doctor.

Very simply put, and in my very unprofessional opinion, it’s time to see a doctor whenever the symptoms of any mental illness are affecting your life in a negative way. Given how much control OCD can claim over a person’s life, anyone who thinks s/he has OCD should schedule an appointment with a mental health professional. Period.

Doctors rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association when it comes to diagnosing mental illnesses. But let’s set the medical jargon aside and cut to the chase – your doctor will most likely diagnose you based on three main points:

1. You have either, or both, obsessions and compulsions that meet certain criteria (recurrent, persistent, intrusive, excessive, and, in the case of compulsions, being used as ways to alleviate stress and anxiety).
2. The obsessions and compulsions significantly interfere with your life.
3. You recognize that your obsessions and compulsions are unreasonable and excessive.

And how will your doctor come to these conclusions? By talking to you and asking questions about your obsessions and compulsions; looking for any physical symptoms/consequences of your compulsions (such as skin irritation from frequently washing your hands or bald spots from pulling your hair); and maybe even talking to your family members and friends about your behavior.

Stay tuned for information about OCD treatment and management options! And, in the meantime, feel free to share your own experiences with being diagnosed with obsessive-compulsive disorder, or even perhaps what you thought was obsessive-compulsive disorder.

Image credit.

Post from: Blisstree

How Will Your Doctor Diagnosis Obsessive-Compulsive Disorder?