See link for a short animated film on the image of psychiatrists – written, directed and narrated by Dr Kamran Ahmed. In short, it also explains the work of a psychiatrist. Entertaining, and it captures most of what psychiatry in our modern days is.

Although both provide an evaluation of mental health issues and conduct psychotherapy, there is a significant difference between the two professions. Essentially this will be in their education and training background.

A psychiatrist is a medically qualified doctor who obtained MBBS degree over five years, then a year of rotating internship across various medical specialities. They then go on to specialize and get M.D or MRCPsych in psychiatry, which takes three years. In addition, many obtain other higher degrees or specialist training in neuropsychiatry, addiction or child psychiatry, alongside conduct psychotherapy sessions based on the cognitive, interpersonal or analytical school of thought. They usually study for 10 to 12 years before becoming a consultant or team lead. Psychiatrists are qualified to make a formal evaluation, diagnosis, treatment, and prevention of mental health problems. In addition, they are licensed to investigate medical ailments, analyze reports and prescribe medicine where required.

A psychiatrist might make an initial assessment and diagnosis, then either manage a patient with a combination of psychological therapies and medication or refer to a psychologist for ongoing psychological treatment.

It is a misconception that psychiatrists do not provide psychotherapy or counselling. On the contrary, most do, from primary health counselling to supportive therapy or more structured cognitive guidance/therapy to analysis.

On the other hand, Psychologists evaluate individuals through interviews or surveys. In addition, based on their training, they might conduct psychological testing, which is critical in assessing a person’s mental state and determining the most effective course of intervention.
They use this information to counsel and advise on behavioural problems, grief, trauma and mental health disorders. Some apply their findings to explain and predict group behaviour. Some psychologists study methods for improving an organization’s work performance or personal development.
In terms of education, psychologists typically obtain MSc or MPhil or a PhD, which can take up to three to five years.

Do read Dr Jain’s article, Mind Blog on emotional wellness and mental health awareness.

Subscribe to his YouTube channel Mindism

© Dr Roshan Jain 2016

Many people are (wrongly) apprehensive about meeting a psychiatrist! Perhaps this is due to misinformation and misperceptions about psychiatry, psychiatrist and the stigma of mental health problems.


A psychiatrist is a warm, caring and attentive clinician with a deep interest in human emotions and understanding suffering, which can be an inevitable part of our lives. A Psychiatrist treats all individuals with respect and compassion, irrespective of the nature of their problem. Therefore you should expect a non-judgmental clinician who will listen deeply and guide you with personalized and tailored solutions.

The first consultation may last for 30 minutes to an hour, and you are likely to be asked about your current problems, their impact on your life and relationship and work, and other relevant personal backgrounds. Typically, consultation and subsequent review or therapy sessions considers the “whole” person rather than just presenting the problem. Sometimes close family members and friends are involved in the assessment, of course with individuals consent.

Expect extensive education about the presenting problem, diagnosis, treatment and long-term outcome. Specialist outpatient-based one to one therapy or group treatment program and day hospital attendance is advised where appropriate. Most people can expect therapy on an outpatient basis. Where home treatment becomes unsuitable or deemed unsafe, then admission at a wellness facility will be discussed.

Do read Dr Jain’s article, Mind Blog on emotional wellness and mental health awareness.

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© Dr Roshan Jain 2017

Yes. All psychiatric consultations are confidential. Your records will never be shared with anyone at any time without your written directive.

As a qualified psychiatrist from the United Kingdom, I follow General Medical Council’s (UK) booklet Good Medical Practice (2006) that clarifies that patients have a right to expect their doctors to hold information about them in confidence. This guidance sets out the principles of confidentiality and respect for patient’s privacy that you are supposed to understand and follow.

Confidentiality is central to trust between doctors and patients. Without assurances about privacy, patients may be reluctant to seek medical attention or give doctors the information they need to provide proper care. But appropriate information sharing is essential to the efficient provision of safe and effective care, both for the individual and for the broader community of patients.

Confidentiality is an essential duty, but it is not absolute. A medical professional can disclose your personal information if:

    1. It is required by law.
    2. The patient consents – either implicitly for the sake of their care.
    3. Is justified in the public interest.

Reference: Confidentiality Guidance (2009), General Medical Council, United Kingdom

Do read Dr Jain’s article, Mind Blog on emotional wellness and mental health awareness.

Subscribe to his YouTube channel Mindism

© Dr Roshan Jain 2017

I see a broad range of emotional and psychological problems such as stress, depression, anxiety, panic disorder, etc. I also see prescribed & illicit drug-related problems as well as severe mental illness. See my areas of expertise. 

Further, I see many who come to me for a second opinion after having seen other specialists. Many who see me want to enhance self-awareness and how they relate to others and those who want to achieve greater satisfaction in their relationship or particular pursuits or life in general.

Remember, a psychiatrist is not just an “illness” doctor. They are champions of wellness and are qualified to offer integrated advice on brain, mind & body harmony.

I think many emotional and psychological difficulties are not due to the weakness of the mind or character but because one endures too much for too long without introspection or considering advice to cope better. In my experience, some of the problems emanate from Expectation, Experience and Evasion. Expecting too much from self, over and above what others expect from you. An experience of loss, abuse, harassment or unexpected change in life circumstances. And evading or avoiding things that need attention or effort.

In my opinion, it is better to consult and seek therapy for a problem before it significantly affects your health and wellness and ability to carry on with life as usual or enjoy its fullest potential.

Do read Dr Jain’s article, Mind Blog on emotional wellness and mental health awareness.

Subscribe to his YouTube channel Mindism

© Dr Roshan Jain 2016

All psychiatrists are qualified medical doctors with expertise in assessing, diagnosing, and treating mental health problems and illnesses. As medical professionals, they must first exclude any physical ailments, which may be the underlying cause of mental health deterioration. For example, underactive thyroid may present as general slowness or depressed mood, and low blood sugar can manifest as dizzy spells, anxiety or panic attack.
So during health evaluation, a specialist may examine apparent signs of a medical condition and investigate further with blood and other tests like ECG, CT brain etc., to rule out or confirm the suspected disease.

Don forget that psychiatrists are licensed to prescribe medication, which means they have to ensure that their patients are of good health while initiating medication or consider lower starting dose and careful increase in quantity where there are pre-existing ailments. For example, some drugs like Lithium or other mood stabilizers may require three to six monthly blood level monitoring. In contrast, antipsychotics may require an annual check of liver, kidney and cholesterol status.

Any initial and subsequent blood tests or investigations are for your safety and health monitoring.

Do read Dr Jain’s article, Mind Blog on emotional wellness and mental health awareness.

Subscribe to his YouTube channel Mindism

© Dr Roshan Jain 2016

 

Psychotherapy is a psychological method used to address and treat emotional and mental health problems and their impact on life, family and relationships. It’s also for awareness and self-improvement.

Psychotherapy is not a therapy ‘done to you’ by someone else but is ‘done by you’. You play an active part with the therapist as a facilitator. The process can be empowering.

It involves talking to a professional, either on a one-to-one basis or in groups, to get a deeper understanding of thoughts, feelings and problematic behaviour, raise awareness and bring about changes – from a less adaptive to a more adaptive state, as deemed desirable by the participant or client.

As per Carl Jung, “The principle aim of psychotherapy is not to transport one to an impossible state of happiness, but to help (the client) acquire steadfastness and patience in the face of suffering”.

I think psychotherapy is much more than just listening and guiding and change. It’s about building trust and rekindling hope that life is fluid (and ever-changing) and that problems are an opportunity for transformation and psychological growth rather than a hindrance.

Do read Dr Jain’s article, Mind Blog on emotional wellness and mental health awareness.

Subscribe to his YouTube channel Mindism

© Dr Roshan Jain 2016

There is a large range of talking therapies (psychotherapy) such as cognitive behaviour therapy (CBT), cognitive analytical therapy (CAT), interpersonal therapy (IPT), mindfulness based cognitive therapy (MBCT), behavioural therapy, motivational enhancement therapy (MET) or motivational interviewing (MI), dynamic therapy (psychoanalysis – of which there are a number of varieties such as Freudian, Kleinian, Jungian etc), couple therapy, family therapy, and so on. This range has been developed to address a huge number of problems such as low self-esteem and confidence issues, to illnesses such as schizophrenia, obsessive-compulsive disorder and depression, through to personality problems including anger management and impulse control issues.

Choosing a particular therapy depends on the clinician/therapist’s skills, your preferences, and research evidence on the effectiveness of a particular therapy for a specific problem. A review of the current scientific evidence for the effectiveness of various psychotherapies for different conditions can be found on the resources page.

Not always. For example, mild depressive illness tends to resolve spontaneously over 6-8 months, but medication may be indicated to facilitate recovery and reduce suffering, especially in individuals where other supportive and pragmatic advice have been unsuccessful.

Extensive research evidence suggests that medication can be very useful in particular mental health problems. These include conditions such as depression, anxiety, schizophrenia, bipolar affective disorder (manic depression) and obsessive-compulsive disorder.

Unfortunately, there is lots of public and media misunderstanding surrounding medication, so it is important to receive specialist and honest information regarding proper medicinal prescription and its use. All medication has side effects (even antibiotic taken for infection), and knowing about them is essential for you to decide on whether to try any particular treatment. The final decision on any treatment option must be guided by an accurate understanding of the risks and benefits. Careful drug selection, close monitoring and optimisation of necessary dose have been shown to minimise the possibility of side effects and increase compliance as well as the likelihood of a beneficial effect.

NO.  Unlike tranquilizers (Diazepam, Alprazolam, Lorazepam), alcohol and nicotine (cigarette and chewing tobacco), antidepressants are not addictive. Therefore, individuals taking antidepressant medication do not develop tolerance (needing to keep increasing the dose to get the same effect) or suffer physical withdrawal state after reducing the dose or stopping intake. 

However, it’s worth clarifying that the withdrawal effects reported in 1/3 who abruptly stop taking antidepressants (like paroxetine, sertraline and citalopram and venlafaxine), are not addictive withdrawal state.  These withdrawal effects may include flu like symptoms – aches and pain, stomach upset, anxiety, dizziness, insomnia, vivid dreams, electric shock sensation in the body

In most people these withdrawal effects are mild, but for a small number of people they can be quite severe. Where indicated it is advisable to taper down the dose of an antidepressant slowly rather than stopping it abruptly.  Ideally this is done under professional supervision.

Some people have reported that, after taking an antidepressant for several months, they have had difficulty managing without it, so feel they are addicted to it.  Most doctors would say that it is more likely that the original condition has returned.

The Committee of Safety of Medicines in the UK reviewed the evidence in 2004 and concluded that “There is no clear evidence that the SSRIs and related antidepressants have a significant dependence liability or show development of a dependence syndrome according to internationally accepted criteria.’

Ref: Antidepressant discontinuation reactions. British Medical Journal (1998) 316: 1105-1106 (11 April).

Duration of antidepressant course depends on the nature and degree of a depressive episode. Usually for the first episode, one would need to take an antidepressant for up to 5-6 months after clinical response to treatment. If they have remained symptoms free for the duration mentioned above, then an attempt can be made to taper down the dose and stop where appropriate.

For those who have experienced 2 or more episodes of depression, it is advisable to take medicine between 12 – 24 months.  Any further recurrence may warrant medication for five years or even indefinitely.

In all cases, individual should receive minimal required dose during the maintenance phase, and the clinician must regularly review the need for ongoing drug treatment.  Effort must be made to wean off medication following risk-benefit analysis at clinical consultation.

Some people experience recurrent episodes of depression despite treatment with an antidepressant. It is important to evaluate and work on the trigger/cause of depression with general counselling or specialised psychotherapy (talking therapy) like Cognitive Behavioural Therapy, Interpersonal Therapy or Mindfulness-based cognitive therapy.  Research has established that psychotherapy along with medication is more effective than either one alone.

Covert administration of medication is a practice of concealing or disguising a person’s medication such that he or she is unaware of its administration. Such practice on an autonomous individual against his/her will is, both legally and ethically unacceptable.

There is a fundamental ethical and legal obligation in medicine to respect autonomous decision-making. Essentially, all individuals have a right to know what their problem is and must have the option of accepting or refusing treatment. In the eyes of the law, every person is presumed to retain the capacity to make a decision unless proven otherwise.

It is not right to assume that individuals with mental illness necessarily lose their ability to make a decision. However, some with severe mental illness like schizophrenia, (during active phase or in the later year of the disease) may develop cognitive & intellectual difficulties and require assistance in making decision.  In those cases, additional effort will be necessary to engage them and their family in decisions about treatment & intervention.

Doubts may exist in a situation relating to non-autonomous persons who are incapable (e.g. due to severe enduring brain condition like dementia or severe mental retardation) of giving informed consent to receive or refuse medication per se. Legally, treatment without permission is allowed only where common law or other legal statute provide such authority for detention and treatment. Such statutes have conditions that there is an immediate risk to self or others due to a known or suspected illness. Herein, medication may be prescribed and administered in person’s best interest or clinical necessity for a limited period, until he/she can make a decision. Nevertheless, medicine in not concealed in food but given orally or through injection, with families being fully engaged and informed.

Read more on http://pb.rcpsych.org/content/26/4/123.full

Mindfulness emphasises the importance of emotional awareness without evaluation or judging yourself. I like Jon Kabat-Zinn’s (a famous teacher of mindfulness meditation and the founder of the Mindfulness-Based Stress Reduction program at the University of Massachusetts Medical Center) definition – “Mindfulness means paying attention in a particular way; On purpose, in the present moment, and 
nonjudgmentally.”

See link: http://www.mindfullivingprograms.com/whatMBSR.php
http://mbct.co.uk/thembct-programme/

© Dr Roshan Jain 2016

Addiction is a complex problem, perhaps a disorder or even a disease that affects the structure and function of the brain and individual’s behaviour. It is characterised by intense and, at times, uncontrollable craving for the drug or activity, along with the compulsive behaviour of seeking and use that persist despite devastating consequences for health, functioning, work and social life including relationship.

Drug and alcohol addiction is treatable, often with medications (for some addictions) combined with behavioural and motivational therapies. Highly structured and empathic approach is required when dealing with individuals presenting with drug or behavioural dependency, as it is likely that they will be plagued with guilt and shame, and be suffering from ambivalence or scepticism about change.

Relapse is common and can happen even after long periods of abstinence, underscoring the need for long-term support and care. It is important to recognise that motivation fluctuates, and to err is human! Remember, relapse is an opportunity to gain awareness and prompt further effort with treatment engagement rather than individual or treatment failure. 

For more information see link: “Drugs, Brains, and Behavior – The Science of Addiction.”

There is no simple answer to this. Historically those with addiction were thought to be morally flawed and lacking in willpower. Those views shaped society’s responses to alcoholism and drug abuse, treating it as a moral failing rather than a health problem. This led to an emphasis on punitive rather than preventative and therapeutic actions. Scientific advances and discoveries about the functioning of the brain altered views toward addiction and enabled us to respond effectively to the problem.

Addiction is a complex issue, perhaps a disorder or even a disease that affects the structure and function of the brain and individual’s behaviour. Scientific research has argued that addiction is a brain disease. While the path to addiction begins with the act of taking drugs or indulging in the activity, but over time a person’s ability to choose not to do so, is compromised, and seeking and consuming the drug /activity becomes compulsive. This behaviour results largely from the effects of prolonged exposure (to drug or activity) on brain functioning. Initial pleasure and enjoyment from the said activity may become compulsive with habitual involvement, even required to feel normal, or reduce unpleasant feelings or emotions.  

Addiction affects multiple brain circuits, including those involved in reward and motivation, learning and memory, and inhibitory control over behaviour.  Simple biological or genetic basis cannot explain the heritability of addiction or addictive behaviour. It is well established that the vulnerability is multi-factorial with an interplay of genetic makeup, age of exposure to drugs (and activity), environmental influences (including stress from work, relationship and social milieu), and psychological status. Associated medical and psychiatric illnesses are common, and there has been an argument whether they are the cause or effect of particular addiction.

It’s a very broad concept but will try and simplify it.  Addiction can be categorised under chemical (or drug addiction) and behavioural addiction. This divide somewhat explains that behavioural element is essential for turning an infrequent habitual behaviour into compulsive/dependent one, and that particular chemical property is required for physiological withdrawal state. In behavioural addiction there can be withdrawal state but with prominent psychological component.

Common forms of drug addiction (especially in India) include alcohol and tobacco (cigarettes and gutka). Addiction to opium, stimulant drugs (like cocaine and amphetamines), glue and gum sniffing is less common but on the rise. Abuse of cannabis (weed, ganja, hash) is commoner than thought. Perhaps there is underestimation of the misuse of prescribed, and illegally available anti-anxiety and hypnotic medication (such as Anxit, Valium, Librium – containing Alprazolam, Diazepam, and Chlordiazepoxide, and sleeping pills – Zolpidem, Zopiclone).

Behavioural addiction is a growing epidemic. So far, diagnostic manuals (DSM-IV and ICD 10) have only recognised sexual disorders under the category of impulse control disorders and disorder of adult personality and behaviour such a pathological gambling and betting. This section includes a behavioural pattern of clinical significance, which tends to be persistent and appear to be the expression of the individual’s particular lifestyle and mode of relating to himself or herself and others.

With increasing recognition of other behavioural disorders, categorised by compulsions or repetitive, compulsive behaviour that are not substance (or drug)-related, subtypes such as Internet addiction is likely to be included in an upcoming version of DSM-V (Diagnostic and Statistical Manual, Version 5). This category includes addiction to chat rooms, online multiplayer gaming and gambling, compulsive surfing and online shopping and cyber sex and cyber pornography and social networking sites. Other types include sexual addiction, and addiction to video games, food, sex, work and television.

For more information see link: http://www.drugabuse.gov/drugs-abuse

Both drug and alcohol addiction can be effectively treated with behavioral therapies. For addiction to some drugs such as heroin, nicotine, or alcohol, medication will be required to reduce suffering and physical withdrawal complication. Treatment will vary for each person depending on the type of drug(s) being used. Multiple courses of treatment may be needed to achieve success. Relapse is common and does not signify individual or treatment failure, but rather should seen as an opportunity to learn and prompt treatment re-engagement or modification.

Detoxification is the process of allowing the body to rid itself of a drug while managing the withdrawal effects with our without medication. Detoxification from alcohol and tranquilizer is usually done with short-term or long-term reducing dose of medication, as there is risk of high level of anxiety, confusional state and convulsion (fits). ‘Detox’ is often the first step in a drug treatment program and should be followed by treatment with a behavioral-based therapy and/or a medication, if available. Detox alone with no follow-up is not treatment.

The word ‘Schizophrenia’ is over a century old, yet it makes many people uneasy.  Most do not understand it.  

Schizophrenia comes from the Greek roots schizo (split) and phrene (mind) to describe the ‘fragmented thinking’ of people with the disorder. However, a fundamental misunderstanding by the public is that it is an illness of split personality, demonstrating prejudice and misconceived notion that those with schizophrenia are unpredictable and dangerous. Unsurprisingly the word is stigmatising and acts a barrier for those needing or seeking treatment.

Schizophrenia is a disorder or illness of the mind that affects how you feel, think, behave and perceive the world. It is a form of psychotic disorder. “Psychotic” means out of touch with reality or unable to separate real from unreal experiences.  Remember the loss of touch with reality and fragmentation of thinking occurs during an active acute phase of illness or long-term untreated individuals.

The clinical conclusion depends on the presence of a pattern of difficulties or symptoms such as seeing or hearing things that don’t exist (hallucinations) or believing that others are trying to harm you, or fear being always watched (delusions). Also, one experiences disorganised behaviour such as withdrawing from others and inability to care for one’s self, speaking in a strange or confusing way. Besides, lack of motivation, apathy and loss of interest may affect functioning. These experiences can be distressing consequently individual may become agitated or withdrawn. At times one may resort to alcohol or illicit drugs to dampen these experiences, which often contributes to worsening of illness.

Remember this is a treatable condition. With extensive treatment option including medicine and other emerging therapeutic and psychosocial intervention., the outcome continues to improve.  An Integrated medicinal and psychotherapy (talking therapy) intervention, besides empathic person-centered approach, will enable the sufferer with better control of their symptoms/difficulties, gain greater independence, and lead fulfilling lives.

Read more on http://www.mind.org.uk/mental_health_a-z/8032_schizophrenia

 

Read Dr Jain’s article on Schizophrenia published in B Postive Magazine. Do read his other articles on emotional wellness and mental health awareness

© Dr Roshan Jain 2016

www.roshanjain.com

Post- natal depression is depression experienced by mother within 6 months of delivery. It affects about 15 % of women having a baby. The symptoms or experiences are very similar to depressive illness at other times, and include continuous depressed mood with loss of interest, excessive tiredness, reduced sleep, early morning wakening (2 hours earlier than normal), loss of weight, poor concentration and negative thoughts including suicidal ideation in severe cases. These symptoms would be present for at least two continuous weeks.

One must differentiate it from Baby Blues – a state experienced 2-4 days after delivery, and seen in up to 40 to 85 % mothers. Being so common it’s regarded as normal! One reason may be that delivery is a time to rejoice and the focus in on the new baby.

Commonly reported experiences are emotional outbursts for no apparent reason, poor sleep (even when the baby lets you) and poor appetite. Some feel anxious, guilty, and inadequate. Experts have suggested that baby blues may be down to changes in hormone levels or is brought on by the experience of being in hospital. Blues resolve spontaneously usually in 3 days and only requires supportive intervention. Mother with Baby blues should be screened for depression.

It is important to recognise and treat PND as it can have negative effect on mother child bonding and emotional development of the child. Ideally treated under specialist psychiatric supervision with supportive and other form of talking therapy, and where required safe prescribing of medicines (especially if mother is breast feeding).

Read more on: http://www.rcpsych.ac.uk/expertadvice/problemsdisorders/postnataldepression.aspx

OCD is an abbreviation for obsessive-compulsive disorder, a form of anxiety disorder where in unwanted, unpleasant thought, image or urge (obsessions) repeatedly enters a person’s mind and cause him anxiety. These are followed by compulsion, where repetitive behaviors or mental acts one needs to carry out to try to prevent an obsession coming true.

Those with OCD recognize the irrational nature of their obsessions and compulsion but are unable to resist them. Consequently it can affect the quality of their life and those around them.

Most common obsessions involve fear of contamination/infection or causing harm, followed by ritualistic hand washing/cleaning or repeated checking behavior.

It is known that this condition may run in families, but certain environmental influences like upbringing in an overprotective and strict family could increase your chances of developing OCD. Equally life event such as a significant changes or bereavement or family break-up may trigger OCD in people who already have a tendency to develop the condition.

Treatment should primary entail cognitive behavioral therapy. Here is a therapist will teach effective ways of responding to obsessions. Additionally teach behavioral strategies thro exposure and response prevention (ERP) to change the way one behaves. Here in the therapist will help in identifying tasks that will expose the client to situations that cause anxiety, but at a level he/she can cope. Essentially carry out exposure tasks without engaging in anxiety-relieving compulsions (the actions usually taken to help cope with the situation). Additionally there is a role for reducing baseline anxiety with medication, in order to engage better with above therapy.

Remember OCD is a treatable condition. With professional input and self-help strategies, one can break free of the unwanted thoughts and irrational urges and take back control of their life.

Read more on: http://www.helpguide.org/mental/obsessive_compulsive_disorder_ocd.htm

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