FAQ (English)

(1) Introduction

Doctor, what is the difference between a Psychiatrist, a Psychologist, and a Counselor? There are so many experts that it is confusing?

A Psychiatrist is a medically qualified doctor with postgraduate training in Psychiatry. He / she can diagnose mental disorders and use both psychological and medical interventions to treat these.

A Psychologist is a nonmedical professional with postgraduate training in Psychology. They conduct psychological testing and can use psychotherapeutic techniques (excluding medicines) to help people.

A Psychiatric social worker is trained in evaluation and management of social aspects of mental health.

A Counsellor is a professional who gives focussed advice. Counselling can be done by all of the above mentioned professionals.

Other members of the team of Mental Health Professionals [MHP] are Psychiatric Nurse, Occupational Therapist and Special Educators.

A Neurologist (Neuro physician or Neurosurgeon) is a medical expert who deals with disorders of the brain due to physical causes (strokes, tumors, infections, etc.).

Mental illnesses are rare. How did I get such a rare illness?

It is estimated that 1 out of 4 person in population will require treatment for severe or common Mental disorder or stress related psychosomatic disorder during their life time.  of the population experiences some or the other form of psychological distress during their lifetime. World Health Organization (WHO) estimates that Depression will be the number one illness in terms of impact by 2030.

In spite of such a high prevalence, the number of people actually receiving proper care is very small due to various reasons. This creates a false impression in the public that mental illnesses are rare.

Why do people find it difficult to accept mental illnesses?

Ignorance, misconception, fear and social stigma are the main reasons. Strong visual images or personal experience with an occasional disturbed patient may leave a lasting impression on our minds.

At a personal level, we believe that we should be in total control of our mind all the time. A misconception that a mental illness always leads to loss of self-control because of a “weak mind” makes us take a “not me” stand.

Acceptance increases when we believe that mental disorders are like any other physical illness, and can happen to anybody.

I am not violent or behaving “crazy”. Why should I see a Psychiatrist?

Members of public have a common misperception that all mentally ill patients are violent or behave in a funny way. Exaggerated depiction of violence and comic behaviour by visual media adds to this misconception that all mental illnesses lead to total loss of self-control.

Of all the people suffering from mental disorders, a very small percentage exhibit disordered behaviour. The suffering of the majority is not visible to the outside world.

If I have to be seen by a Psychiatrist, does it mean I am “mad”?

A Psychiatrist deals with emotional disturbances, including disturbances in thought and behavior. Illness results in changes in these areas which are not necessarily features of “madness”. Madness is a loose term used by people and creates stigma for people with genuine emotional difficulties.

Why are mental illnesses considered medical when they are related to the “mind”?

The concept of health includes both physical and mental well-being. Mind and body are two sides of the same coin, and hence their disturbances are interrelated. The “Mind” is not purely a spiritual entity, but also forms part of the brain as a structure. So, like any body part it can have issues of illness. We always relate doctors, medicines and diseases with physical ailments. Unfortunately, mental disorders are visualised purely from non-medical and non-scientific aspects leading to misconceptions.

What are mental or psychological illnesses?

Mental illnesses are disorders of a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. There are various types of mental illnesses. These can be treated and recovery is possible. Medication and psychotherapy are examples of popular and effective modes of treatment. Treatment results are as good as any physical illness depending on the type of the illness.

(2) Psychiatric Assessment

When does one consider hospitalization for mental disorders?

Short term hospitalization is considered for any psychiatric emergency for rapid control of symptoms. At times it is impossible to treat the patient at home due to various reasons and hence supervised care by skilled staff in a hospital setup is necessary. Treatment like ECT/BPT / Detox/ Ketamine Infusion etc need medical facilities.

Long term hospitalization or institutional care is considered for severe, chronic, non remitting conditions, or in cases where adequate support system does not exist to manage the patient at home.

Doctor, how can an uncooperative person be brought to a Psychiatrist?

This is a challenge, and the best option is to discuss this with a Psychiatrist first who can guide you with respect to various options available in your setup.

This may involve help from a friend, family doctor, social agency, or some competent authority. Use of medication, home visit by a doctor, or direct hospitalization through emergency services are some options.

A severely depressed patient may be unmotivated to visit a Psychiatrist. Such patients will need to be handled tactfully. A recovered patient, or a neutral senior can help in this situation.

One should act as soon as possible in case of an uncooperative person or a patient who is non adherent to treatment so as to avoid unpleasant steps subsequently. As per the provosiso of Mental Health Act02017 a patient who is Harmful to sel and others can only be admitted as supported admission for 72 hours with the consent of care givers all other admissions are under category of independent admissions in which the patient should have the capacity to take treatment decisions.

Doctor, this is very different from my impression of Psychiatry which is based on English fiction and Hollywood movies.

You are correct! Each culture has a different approach, and hence the style of functioning is not comparable.

Some people still associate a Psychiatrist with the use of a “Couch”. This used to be a practice for “Psychoanalysis” which was a form of therapy. Psychoanalysis has a limited role in modern Psychiatry.

Doctor, why do you prefer to involve a family member or a person close to the patient in the management of his problem?

Lot of relevant information can be obtained from people close to the patient. A highly distressed, confused, or violent patient is in no position to give accurate history. It is also important for family members to understand the illness, take appropriate decisions and supervise the treatment for best outcome.

Is it safe to share so much of personal information?

Confidentiality is a professional ethic followed by all Psychiatrists. So, one should share as much information as possible without hesitation. It may be necessary to share some information with other doctors or psychologists from the management perspective.

My friend, who visited a Psychiatrist recently, was asked for a lot of personal details. Why so?

It is necessary to evaluate the person in totality. Knowledge of the prior functioning of the individual, life history and the stresses contributing to the illness is vital. Family history is necessary to understand the social and inheritable aspects of the problem. Also important is the role of interpersonal conflicts and the personality structure of the individual.

Doctor, what are psychometric tests?

These are standardized tests consisting of questions, pictures, images, puzzles, and skill evaluation. These are conducted by a qualified clinical psychologist. These are helpful in certain conditions.

Is it not necessary to perform some tests, eg. Brain scan?

Physical health is evaluated by the doctor by a clinical history and examination. Investigations are asked for, if necessary.

In mental illnesses multiple internal and external factors have influence on brain chemistry resulting into imbalances in brain functioning. These are not visible on brain scans. However, if the cause for symptoms is suspected to be gross brain pathology (stroke or tumor), then a CT or MRI scan can be useful.

Doctor, how do we know that a person is suffering from a mental illness just by talking to him?

A clinical interview by a trained psychiatrist can yield valuable information about a problem. Information obtained from other sources like family members and friends also helps in reaching a diagnosis. The Psychiatrist evaluates parameters like mood, thought and behaviour. These are compared with standardized criteria to arrive at a diagnosis.

Is it not necessary to perform some tests, eg. Brain scan?

Physical health is evaluated by the doctor by a clinical history and examination. Investigations are asked for, if necessary.

In mental illnesses multiple internal and external factors have influence on brain chemistry resulting into imbalances in brain functioning. These are not visible on brain scans. However, if the cause for symptoms is suspected to be gross brain pathology (stroke or tumor), then a CT or MRI scan can be useful.

(3) Causes Of Psychiatric Illnesses

I have physical problems, so how can it be due to mental illness?

The mind and the body are intricately related. Unresolved conflicts and psychological distress can often lead to physical or somatic complaints. Common examples are a headache or frequent stomach upsets for which no cause can be found despite investigations. In addition, psychological factors are often known initiate,sustain and impact the course of illnesses such as Diabetes, Hypertension, and Bronchial Asthma etc.

He should not have taken that incident to heart, is it not his unwillingness to think positively that has led to the mental illness?

How each one of us responds to an incident depends on our mental makeup, coping skills & coping styles, past experiences, and our support system. When we are suffering from Depression there is an inability to think positively or think in a manner which would help us solve the issue. Negative thinking and thinking about the past is due to the ill state of mind as a result of neurochemical changes. One cannot simply wish it away.

When there were many setbacks & stressful events few years ago, I coped bravely & gave strength to others; how am I experiencing these symptoms now when there is no cause?

It is hypothesized that stress can produce long lasting changes in the biology of the brain, so that even when the problems are long gone, the changes persist. So, one may utilize all the resources & cope during the stressful period but experience symptoms later due to the effects of cumulative stress and exhausted reserves.

He was a highly intelligent person, topper of his class; how could he get a mental illness?

Just as medical illnesses can afflict anybody, mental illnesses can affect any person irrespective of age, sex, education, financial status or social support. High intelligence does not confer protection against mental illnesses. Even a doctor who is knowledgeable about mental illnesses is not immune to them.

I know the stress/reason that caused my illness; therefore what is the point in seeking treatment?

Each one of us would respond differently to a given stressor. A mental disorder is defined by a cluster of symptoms lasting for a long duration of time (weeks) which incapacitates our ability to work and interact socially. Treatment attempts to restore normalcy which in turn helps to fight stress.Treatment gets priority irrespective of the cause. If a bone is broken, we don’t debate on the cause in order to fix it!

No one in my family has ever had a psychiatric illness, so how can I?

Mental illnesses develop due to multiple reasons. Hereditary factor is one of them. Genes confer a vulnerability to mental illness. The vulnerability may or may not result in illness depending on several other external factors. Thus, development of mental illness is not dependent only on family history.

My life is going smoothly; therefore how can I possibly suffer from any mental illness?

In some people, the biological and genetic factors predominate, leading to the occurrence of a mental illness even in the absence of identifiable stressors. Presence of a direct relation to stress is not necessary for illness to occur.

Doctor, my neighbor gets possessed every Navratri festival. She gets ok only after some “Tantrik” rituals.

These are likely to be symptoms of an unwell person. Some such episodes may be temporarily aborted by “Tantrik” rituals.
Usually, such symptoms are due to unresolved conflicts. Hence, these are repetitive unless treated with medicines and psychotherapy.

Doctor, my guru says that the solution to my problems is within me, and I have to work on my soul.

In major mental illnesses, the impairment is so severe that one cannot work objectively on such advice. One has to accept medical and psychological treatment with an open mind. You cannot exercise with a broken leg!

Last year the astrologer / priest had told us to perform a pooja which we could not; has God punished us for the sin we committed?

Last year the astrologer / priest had told us to perform a pooja which we could not; has God punished us for the sin we committed?

He belonged to a rich family and his success was envied by others. Is mental illness due to curses or black magic done on the person?

The person affected by mental illness may appear physically well but the symptoms change the person’s nature making him talk & behave differently. Due to the changes in a person’s identity, black magic/ possession by evil spirits became the belief of communities. Scientific advancements have helped us understand that mental illnesses are due to an interplay of biological (genes & brain),psychological and social factors and they affect the three realms of Emotion, Thinking & Behaviour.

I am not a weak person, then how did I get this psychological problem?

Psychological problem is not a sign of weakness. It occurs due to changes in the brain chemicals called neurotransmitters due to various influences. They can affect any person irrespective of age, sex, education, financial status or social support.

(4) Symptoms Of Psychiatric Illnesses

Doctor, my cousin has developed Depression for the second time in last 3 years and this time he also talks about ending his life from time to time. Should we take it seriously? He is too brave and strong willed person to carry out such a cowardly act.

A suicide attempt is not a cowardly act, but a manifestation of underlying Depression in this case. Being brave or strong willed does not make one immune to suicidal ideas or attempts. Any such idea expressed by the patient should always be reported to the Doctor so that appropriate measures can be taken.

My wife has become very suspicious after the birth of our daughter, she is irritable with her, not taking care, and has become very aggressive. Could she be having a mental illness?

Depression and Psychosis in women, after childbirth, is a common postpartum problem, known as Postpartum Psychosis. Stress associated with delivery and child care, and associated hormonal changes along with a genetic predisposition are responsible for this condition. Prior mental illness can also get precipitated in the postpartum period. Risk of suicide or harm to the baby are very high, and so it should be treated on an emergency basis.

Doctor, I have been told that sexual problems are psychological in nature. Is it so?

Sexual problems can result from psychological conflicts. They can also be symptoms of major psychiatric illnesses like Depression. Awareness about normal sexuality prevents many misconceptions and dysfunctions.

My neighbour keeps checking his lock again and again when he leaves his house. His wife also reports that he spends unnecessary time in the bathroom washing his hands. Do you think there is something wrong with him?

Yes, this could be a condition called Obsessive Compulsive Disorder (OCD). These patients can have repeated thoughts about getting infected, or contaminated. They often doubt everything that they do, and are unsure of themselves. Some patients can have irrational sexual or religious thoughts. Such patients require treatment in the form of medicines and psychotherapy.

Even at the age of 10 years, my daughter frequently bed wets. As a youngster, I had a similar problem. Is this a serious problem?

Bed wetting, or Nocturnal Enuresis, is diagnosed when a child continues to pass urine at night (occasionally in the daytime also) beyond the age at which he or she is expected to become continent. In Indian children, urinary incontinence beyond 5 years is a problem which needs to be addressed medically. Nocturnal Enuresis is called primary if a child has never achieved complete bladder control, and secondary if there has been a period of normalcy in between. This problem can be treated effectively with behaviour therapy & medicines.

My son is very smart, very active, but lacking in studies. The class teacher has referred him to the school counsellor. Is there something wrong with him?

Poor academic performance needs to be thoroughly evaluated. Commonest causes in cases like the one mentioned above will be:

Attention Deficit Hyperactivity Disorder – which is characterized by poor concentration, short attention span, easily forgetting things, incomplete work, poor understanding of rules & concepts, forgetfulness, etc. Such children are hyperactive, cannot sit at one place, are often clumsy, and impulsive.

Specific Learning Disabilities – characterized by poor performance (below the age & Standard requirement) in reading, writing & Mathematics.

Do patients who suffer from fits or seizures have low intelligence? Can they be completely normal?

Intelligence need not be impaired in person with epilepsy. When the seizures are well controlled they can lead almost completely normal life. However, they may need to follow certain restrictions so that further seizures do not occur.
Fit- or seizure-like episodes can occur as a reaction to stress. Psychotherapy & Stress management can help in long term relief from such episodes.

My father who is 75 years old has become very forgetful & is often confused about the time of the day. He sees imaginary people and objects. He seems to be losing control over his toilet habits. Is this age related? Should it be treated?

Some amount of forgetting is age related. When it is excessive and associated with impairment in daily routine activities, it is referred to as Dementia. Dementia is often associated with soiling or confused behaviour, aggression, depression or psychosis. Treatment is supportive, and aimed at controlling behaviour, improving mood and slowing the progression of the disorder.

I visited my Cardiologist because of repeated episodes of shortness of breath and fast heart beat. My Stress Test was normal. He has referred me to you. I don’t have any stress, so what do think is happening to me?

This is a commonly occurring problem called Panic Disorder.These are acute anxiety attacks with all sorts of bodily symptoms. The features mentioned above can easily be confused with a cardiac problem. Like other anxiety disorders mentioned above it requires medication & psychotherapy.

Why do I worry so much, and that too without reason? What is this problem? I also get irrational fears and I am not able to control them.

Excessive worrying without a reason is called anxiety. Repetitive anxiety causing thoughts about specific situations or objects which lead to avoidance behaviour are called as phobias. This problem requires a combination of medicines & psychotherapy.

My son is very aggressive, uses bad language, doesn’t go to work, mutters to self, and is suspicious about people in the house and the neighbourhood. We have taken him to our family doctor who gave him a sedative, but this is not working. What is the problem with him?

He will need to be assessed to rule out Schizophrenia. Schizophrenia is characterized by persistent false beliefs (Delusions), hearing voices or seeing images (hallucinations), odd behaviours, and social & occupational deterioration. It is a chronic problem and has to be regularly treated with medicines. This disorder is found in approximately 1 in every 100 persons.

My husband has become very irritable since the last few days. He sleeps very little, spends a lot, talks a lot, and is working excessively. Do you think this is a problem?

This seems to a psychiatric problem called Mania. The opposite of Depression, Mania is characterised by excessive cheerfulness, excessive activity & reckless behaviours. It can be treated with psychiatric interventions

What is Depression? What is the treatment for it? How does counselling help?

Depression is a common psychiatric disorder characterized by persistent low mood; reduction in confidence, interest & energy levels; negative thoughts about one’s self and her environment; and at times suicidal behaviour. It is found in all social classes and all age groups.
Depression can be effectively treated with antidepressant medication, psychotherapy, and Electroconvulsive therapy.
Counselling can address issues that may be responsible for Depression.

My office colleagues have been telling me, of late, that my work quality & efficiency are going downhill, and that my alcohol consumption might have something to do with that. Do you think alcohol intake can cause such problems? What about smoking and tobacco?

Alcohol consumption over a period of time can lead to social, financial & occupational problems.People often continue alcohol for the fear of sleeplessness and tremors on stopping. It is a diagnosable psychiatric problem for which effective treatment is available.

Tobacco in any form is, also, a substance use disorder associated with psychological & physical health issues.

All my investigations are normal and my physician tells me that most of my physical complaints are all “in my mind”? How is this possible when I am experiencing so much suffering?

Stress, anxiety & depression can cause disorders that have physical complaints or difficulties. On investigating these disorders, no physical cause is found. These disorders can be effectively managed by a psychiatrist.

What is Stress? How does stress affect me?

Any situation that is perceived to be overwhelming produces stress. The causes of stress vary from person to person. It can affect a person in many ways – psychological, physical, social & occupational. It can precipitate psychological & physical illnesses.

(5) Treatment Of Psychiatric Disorders

Doctor, I was reading on internet about the medicine that you have prescribed to me. I do not think I need that medicine.

The Internet has made a lot of information available to people at the click of a button. However, it is a mix of reliable and unreliable data. The information can often be misleading. It cannot determine one’s treatment. The treatment is best left to the psychiatrist.

Why can we not use Hypnosis to remove the illness from within the mind?

Hypnosis is a therapeutic technique that has applications in certain types of psychiatric problems. It is a common misperception that it can remove all deep seated conflicts.

What is Psychotherapy? What is Cognitive Behavior Therapy?

Psychotherapy is commonly known as “Talk Therapy”. In this, psychological principles are used to manage some psychiatric disorders. Psychotherapies are done by skilled professionals.
Cognitive Behaviour Therapy (CBT) is a widely used form of psychotherapy. It is based on the principles of thinking and behaviour.

What is Repetitive Transcranial Magnetic Stimulation (rTMS)?

rTMS is a non invasive technique for stimulating brain cells by applying a localised magnetic field over the surface of the head. It is helpful in patients with Depression, and is under evaluation for use in other disorders.

Is there any surgery available to treat mental illnesses?

Yes, some surgical procedures are available for treatment of Major Depression and OCD (Psychosurgery), for cases which are chronic, severe and debilitating; have already undergone an exhaustive array of available established treatments, and still have severe illness.
Deep Brain Stimulation (DBS), which is a new procedure and under evaluation, may be helpful in certain psychiatric conditions.

Once we give ECT will we have to continue giving it for life?

Usually a course of ECT is planned depending on the patients’ illness and response. The course may involve about 6-10 ECTs. Some patients may be put on a maintenance ECT regimen. There is no need to presume that it is always necessary.

What are the side effects of ECT? Does it not cause memory loss, and brain damage, as shown in movies?

Patient may experience headache and muscle pains which respond well to pain killers. Some disorientation and memory problems may be seen immediately after treatment, these effects diminish quickly after the course ends.

Dramatized depiction of ECT has done immense harm to public perception. Research has shown that there is no damage to the brain in scientifically conducted ECT.

Is the patient that mentally sick to warrant ECT treatment?

ECT is a safe treatment modality. It should not be considered a last resort. It is extremely effective when patient has active suicidal thoughts, or is extremely aggressive and violent. It also helps in resistant cases.

Isn’t ECT dangerous and inhuman as portrayed in movies? Is it painful?

No, ECT is a relatively safe method of treatment. ECT portrayed in movies is just sensationalised. In real life the patient is given anaesthesia and muscle relaxation. So, the pain factor is minimized.

What is ECT? Is it shock treatment? I thought it is not used anymore.

Electroconvulsive therapy (ECT) involves passage of small current through a device which induces seizure like activity in the brain. This seizure like activity brings about changes in the brain cells and neurotransmitters which help in improvement of symptoms in psychiatric patients.
Electric current is used for treatment of many diseases in body, hence shock is a misnomer.
ECT is still a very scientific treatment option for many psychiatric conditions, and is used all over the world. Due to various reasons, including stigma and fear attached to it, the use in day-day clinical practice may have gone down; but it is one of the best options in some of the psychiatric emergencies.

Is it not better to use herbal remedies or naturopathy compared to allopathy medicines which are “Chemicals”?

All the substances used for medical treatment are “chemicals” by nature. Only their source varies, i.e. herbal, animal or synthetic. From the psychiatric perspective what is important is concrete and quick recovery. Allopathic medicines are refined after years of research. All treatments have their share of adverse effects.

I often read advertisements about Homeopathy clinics, claiming that treatment offered by them is totally free from side effects. Is it not a better option?

One can always choose alternative therapies according to one’s preference and faith, but not on the basis of advertisement and hearsay. No treatment is free from side effects, efficacy is equally important. Once diagnosed, no delay is justified in controlling conditions like Depression, Mania and Schizophrenia; and hence, speed of recovery is equally important.

You need to inform doctors of either specialty about your decision to switch. Do not continue allopathic medication without supervision by the Psychiatrist.

I am told that these medicines can weaken my brain nerves when taken over a long period. Is it true?

This is a myth propagated all the time without any basis. Many people have taken them life long, for 30 – 40 years without any adverse consequence to their brain. These medicines are marketed after years of research and study. Like any other treatment, medicines should be taken under proper supervision for the best outcome. Similarly, there are medicines designed specially for children to help with their problems.

Everyone keeps talking about side effects. Will medicines damage my kidneys & other organs when taken for a long time?

Psychiatry medicines are like any other group of medicines (eg. medicines for heart or stomach). Any treatment which offers significant relief is acceptable even if minor temporary side effects occur. The same is true for psychiatric medicines if you look at harm:benefit ratio. Psychiatric medicines are just one of the scapegoats for the stigma associated with Psychiatry in general. Medicines, when taken under supervision, do not affect the kidneys, the liver or heart, as is believed. Discuss with your doctor if any periodic monitoring is needed for the drugs you are on.

Do these medications always give excessive sleep? Are they sleeping pills?

All medications do not necessarily cause sleepiness. Most of the newer medicines are designed to adapt to the active lifestyle of the patient by minimally interfering with day-to-day activities. Few patients may experience sedation in the beginning, but that effect wears out soon. In case, you still find it a problem, please discuss it with your psychiatrist.
‘Sleeping pills’ is a loose term and a misnomer for psychiatric medicines used by chemists and patients. The purpose of medication is not necessarily to induce sleep, but to correct the underlying chemical imbalance.

What are the common side effects of antidepressants, antipsychotics, and anxiolytic pills?

Each group of medication has few peculiar side effects and some side effects pertain to an individual drug. It is best to discuss this with your psychiatrist. The psychiatrist will inform you about important side effects at the time of starting medications.

How long should we continue medication?

It varies for each psychiatric disorder. It should be continued under strict supervision and guidance of a qualified Psychiatrist. Any problem in continuation of medication should be discussed with the Psychiatrist as she will offer you a solution to your problem. Medications should not be altered or stopped on your own.

Last time, she got better on her own with sleeping pills for 3-4 days, why can’t the same improvement be seen now?

Probably, last time she was suffering from acute but minor episode of psychological ill health but it may not be of the same intensity this time. In fact, research shows that with each new episode, the illness may aggravate in severity and duration.

My friends advise me to join Yoga, Gym, or dance or music class, which will rejuvenate me & get rid of my problems. Can problems of mind be solved with some hobbies or alteration in life style?

Many techniques mentioned above, especially Yoga & exercise promote health in general for all, and are more of healthy life style patterns. These are not treatments for specific problems. Medications & psychotherapy of different types are needed for specific illnesses.

What is the need for medication?

Medication is essential part of treatment of many psychiatric disorders. Medications restore the balance of chemicals present in the brain and help to achieve normalcy (eg. Antidiabetic medications help control sugar levels in Diabetes Mellitus). These are symptoms beyond the control of the patient and hence medication gets priority.

Can problems of mind be simply solved only with some advice / counselling?

When a cluster of symptoms leads to a decline in work & social functioning, medications play an important role in treatment. These complaints are neither imaginary, nor fabricated, and hence cannot be wished away. In spite of severe emotional turmoil a person can maintain composure or appear normal physically, and hence often does not receive any sympathy. When he / she complains, common sense advice is given which can be damaging (eg. “Think positive”, “Don’t take tension”, “Make your mind strong”, etc.).

Some medical intervention as decided by the Psychiatrist becomes necessary for symptom relief.

Some problems like interpersonal conflicts, stress at workplace, marital disharmony, parenting attitudes, etc. can be helped with counselling.Counselling off late has become a hype and hence one should ensure that it is done by a qualified professional.

(6) Information For Patients On Treatment

What is a Rehabilitation Center?

A center, where efforts are made to help the patient organize his day, equip him with skills to interact with others, and trained to carry out some structured activity, in addition to medical treatment, can be called a Rehabilitation Center.

The set up is not like a conventional hospital, but more like a home.

My neighbour had an acute episode 10 years back, and was treated with ECT. His medications are still on, but nowadays I can see that he is not productive and confined to his home. Is it the effect of ECT and medicines?

Not motivated to work or socialize can be a part of the basic illness. This residual part of the illness may not show a good enough recovery compared to the initial symptom relief.

These symptoms are not related to medicines or ECT.

Can a recovered patient, under maintenance treatment, get married and have children?

Marriage adds to personal, social and financial responsibilities. Hence, the decision should be taken after discussion with the treating psychiatrist.

Several factors like symptoms, medication, level of functioning etc. need to be considered and discussed with the prospective spouse and the family. Such an important decision should not be taken under social pressure. The decision to plan for a family should, also, be taken after consulting the treating psychiatrist.

My son was recently put on treatment, and is better but keeps talking about marriage and girls. Should I get him married so that he can be cured?

It is a myth that marriage is a cure for any mental illness. Patients can talk inappropriately about love, marriage and sex, which can be a part of the underlying thought or mood disturbance. It is necessary to treat the mental illness adequately and not rush into marriage with an intent to cure.

Will a psychiatric disease or its treatment have an impact on one’s job or occupation?

Treatment is necessary to reduce the occupational dysfunction that results from a psychiatric disorder. Untreated disorders can lead to a number of work related issues like:

a. Absenteeism
b. Poor focus and poor work output
c. Impaired decision making ability
d. Failures
e. Loss of job
f. Financial problems, Interpersonal conflicts, Loss of respect and status

Overall outcome depends on the nature and severity of the illness. Some adjustments may, therefore, be needed at the workplace. Treatment related issues affecting the workplace are minor as compared to an untreated or a partly treated psychiatric disorder, and can be sorted out under the supervision of the psychiatrist.

Doctor, besides medication are there any other supportive measures which can help to sustain the improvement?

There are a number of important measures which help in sustaining the improvement. These can be integrated into a treatment program by the treating psychiatrist or another mental health professional. These measures help in reducing personal, interpersonal, social and workplace conflicts.

Support groups play an important role in managing many such issues. Alcoholics Anonymous (AA) is an example which works in the area of alcohol related problems.

Social and occupational rehabilitation is equally important in the recovery process.

Each time when the medicines have been stopped by my doctor, I develop the same illness within the next few months. Does it mean that I am addicted to medicines?

By the same logic, any long term treatment like that for Hypertension and Diabetes should be called an “addiction”.

It is not addiction but there is a need to continue medicines to maintain relief because:

a. All the symptoms cannot be cured, some of them can only be controlled.
b. Some illnesses have a strong genetic & physical component. So, other modalities of treatment [like psychotherapy] besides medicines have a limited value.
c. Having experienced relief from prolonged untreated illness, long term treatment may become necessary to prevent relapse.
d. Some conditions like Bipolar Mood Disorder are cyclical in nature, and hence are better prevented with mood stabilizers.

Can I continue taking medicines without following up with the psychiatrist?

Regular followup with your Psychiatrist is essential:

  1. Fine tuning of the dosage is necessary from time to time, depending on your response.
  2. Substitution, or reduction of medicines is often required.
  3. Some medicines require periodic laboratory monitoring.
  4. Prevent early side effects from being missed out.
  5. You may be deprived of the newest developments in the field of psychiatric medication.
  6. You may be at a risk for developing tolerance and habituation.
  7. You may miss out on counselling and psychotherapy.

It is necessary for the psychiatrist to screen you regularly, even if the doses are not changed. So, do not resort to the shortcut of self medication. You might end up paying more than you should have.

My son has received medication for 3 months and is perfectly fine, but his psychiatrist has advised him to continue medications. Is it necessary?

Yes, this is called maintenance treatment. Supervised treatment is necessary to consolidate the improvement and prevent relapses. The duration of treatment will be decided by the treating doctor.

What precautions should I take while on medications?

All the medicines should be preserved in a safe and secure place so that they are not knowingly or unknowingly misused.

Check with your doctor whether you can drive. It is preferable to avoid driving when you start the medicines. Once you are sure that you are fine & alert on medications, you can resume. Sometimes you may be on certain group of medicines or high doses which can influence your reflexes.Doctor may advise you to avoid driving for some time.

Avoid alcohol. Take your doctor’s advice in case you plan to have a drink or two at any social function.Do not manipulate your dose for alcohol.

FOR WOMEN: You do expect alteration in your menstral cycles. It is often because of the illness or the treatment, and usually nothing to worry about.You should definitely inform your psychiatrist before rushing into any evaluation.

PREGNANCY: Inform your doctor if you are planning for a child so that you are on medications which are safe during pregnancy.Otherwise, in the childbearing age ensure that your contraceptive method is foolproof.
Other specific precautions will be told by your doctor.

Should I consult my Psychiatrist before starting other medications?

Discuss the psychiatric medication with the other doctor. If the doctor feels it’s important to seek opinion from your Psychiatrist, he will usually tell you so or do so. In the next scheduled visit to your psychiatrist, carry the notes & prescription of medicines and share all details.

Under no circumstances stop or alter psychiatric medicines just because there are too many medicines because of other additions.

If I have any other medical, surgical, or gynaecological problem, do I have to consult my Psychiatrist first before going to any other doctor?

Any other physical illness will require immediate attention most of the time. One can directly consult the related doctor without any hesitation. Whenever you consult any other doctor do remember to inform him about the medications you are on.

I’m having common cold

a) Can I take cough syrup along with my regular medication?
Sometimes, cough syrups & medicines for common cold (anti histaminic) may contain some ingredient which may cause excessive sleep. Otherwise, they are safe to be taken along with your ongoing psychiatry medicines.

b) Can I take painkillers and antibiotics along with my regular medication?
Most medications prescribed for common ailments like fever, cold, & most of the Over the Counter Drugs are well tolerated along with Psychiatric medication. Whenever you consult any other doctor do remember to inform him about the medications you are on.

My chemist stopped giving me medication without prescription, what should I do?

Psychotropic medications cannot be given as over the counter drug. It is prohibited by law to dispense these medications without valid prescription. Some of them are governed by rules which are more stringent and hence all chemists do not stock them. Please consult your Psychiatrist regarding your current status.

Do I have to live on these medications?

Some of the illnesses do need lifelong medication to keep the symptoms at bay and prevent relapse or recurrence. It is akin to taking medicines for hypertension & diabetes.

At the same time there are many psychiatric disorders which need treatment with medications for a short period ranging from few months to a couple of years.Medical treatment should be supported with other psychological interventions wherever necessary.

Last time I couldn’t take medication for 4-5 days and I had all these variety of symptoms like jitteriness, reduced sleep, irritability. Is it because of medication?

Abrupt stoppage of certain kinds of medication can cause such symptoms.These could also be early signs of relapse (return of original illness).Make sure that you do not miss out on regular doses because of:

  1. non availability,
  2. deliberate stopping medicines to experiment, and
  3. Poor supervision and follow up.

Termination of treatment should be decided by the treating psychiatrist only. Usually the medicines are gradually tapered down to avoid “withdrawal” symptoms.

What if I miss a dose or two of medication?

Do not double the next dose. Take your next dose at regular time and as prescribed. In the mean time, also keep a check on your symptoms like irritability, sleep disturbance or any of your previous symptoms. If any of the symptoms appear, please consult your Psychiatrist.

I am not comfortable when I take medication. Should I stop them, or can I reduce the dose on my own?

Stopping the medication abruptly or altering the doses on your own carries the risk of relapse of symptoms of illness. Sudden stoppage has the added problem of experiencing discomfort & symptoms caused by discontinuation of the medicines. If you have any problem with current medication, please discuss it in detail with your Psychiatrist. Today, there are many medications available to choose from to treat the same problem. The medicine that best suits you with least side effects can be prescribed or doses can be adjusted.