Dr. Siddiqui's Online Psychiatry Clinic

An outline of available treatment facilities:

With the advent of specific treatments for psychiatric disorders the emphasis shifted from asylums and prolonged stays to smaller Psychiatry Hospitals with modern facilities. Subsequently the General Hospitals started to offer both inpatient as well as outpatient care. The added advantage of full time complete medical specialties and well trained staff with better care and less stigma.

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Mild to moderate cases are very well managed in outpatient clinics with emphasis on psychotherapy and medications and social skills rehabilitation.

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Severe cases need inpatient care due to the nature of their uncontrollable symptoms of violence,potential harm to self or others,hallucinations,delusions,refusal of food and medications with deterioration in physical health.Admissions in such cases is either voluntary or involuntary.Post discharge further management continues on an OPD basis.

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Outpatient & Inpatient Psychiatric Services in a General Hospital or a Psychiatric Hospital.

Private Psychiatry Clinics.

Residential long term care.

Online Psychiatry Consultation.

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Private clinics:

These generally have one or more Consultants and psychotherapists.A one to one therapeutic relationship is the core benefit as compared to a General Hospital where the same doctor may not be always available.

 

The Treatment Team:

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• Family or primary care doctor

• Physician assistant

• Psychiatrist, a medical doctor who diagnoses and treats mental illnesses

• Psychotherapist, such as a psychologist or a licensed counselor

• Pharmacist

• Social worker

• Family members

Types of treatments available:

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• Psychotherapy

• Cognitive Behavior Therapy

• Individual

• Group

• Family

• Interpersonal Therapy

• Dialectical Behavior Therapy

 

Psychotherapy:

Psychotherapy is a type of therapy used to treat emotional problems and mental health conditions.It involves talking to a trained therapist, either one-to-one, in a group or with your wife, husband or partner.The therapeutic process helps and guides the client to look deeper into his/her problems and worries, and deal with troublesome habits and a wide range of mental disorders,such as anxieties,depression,obsessive compulsive disorders etc. Psychotherapy usually involves talking, but sometimes other methods may be used – for example, art, music,drama in special circumstances.Psychotherapy can help you discuss feelings you have about yourself and other people, particularly family and those close to you.In some cases, couples or families are offered joint therapy sessions together.You will meet your therapist regularly, usually once a week, for several months.Individual sessions last about 50 minutes, but group sessions are often a bit longer. Psychotherapy usually involves talking, but sometimes other methods may be used – for example, art, music, drama and movement where free communication may be not free flowing depending on underlying conditions.

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So how does it work ?

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Just talking by itself with a close trusted friend can work wonders. But, there may be issues that are very personal, sensitive, painful one needs an experienced trained person who will be able to guide in a non judgmental manner with full confidentiality, one has to look for professional help. One of the key objectives of psychotherapy is to help you gain a better understanding of the issues that are troubling you.It can help you work out new ways of approaching situations that you find difficult, as well as suggesting new methods to help you cope.Developing a trusting relationship with your psychotherapist is very important and will help you be able to talk about long-standing problems.

Cognitive behavioral therapy (CBT):

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Cognitive behavioral therapy is the most common psychotherapeutic approach.It can be used on the individual, group, or family level.If one wants the key concept of CBT it is very simple.Our thoughts affect our emotions. They on their affect our behaviors. Now, imagine a person burdened with negative thoughts like he is useless,he can’t achieve anything!If he starts believing in these thoughts he will stop doing anything. He will simply withdraw believing he cannot achieve anything.
Well,he will likely end up feeling more worse.The less he does the worse he feels and more the worse he feels the less he does. A vicious cycle sets in brought by his negative thoughts.But, if he is helped to re-frame his thoughts in a more positive way, it can lead to more positive feelings and helpful behaviors.

In CBT, problems are broken down into 5 main areas:

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• situations

• thoughts

• emotions

• physical feelings

• actions

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CBT is based on the concept of these 5 areas being interconnected and affecting each other.
For example, your thoughts about a certain situation can often affect how you feel both physically and emotionally, as well as how you act in response.

How CBT is different?

CBT differs from many other therapies because it's:
pragmatic – it helps identify specific problems and tries to solve them
highly structured – rather than talking freely about your life, you and your therapist discuss specific problems and set goals for you to achieve
focused on current problems – it's mainly concerned with how you think and act now rather than attempting to resolve past issues
collaborative – your therapist will not tell you what to do; they'll work with you to find solutions to your current difficulties.

What happens during CBT sessions ?

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The course of treatment usually lasts for between 5 and 20 sessions, with each session lasting 30 to 60 minutes once or twice a week.During the sessions, your problems are broken down into their separate parts, such as your thoughts, physical feelings and actions.You along with your therapist will analyse these areas to work out if they're unrealistic or unhelpful, and to determine the effect they have on each other and on you.Your therapist will then be able to help you work out how to change unhelpful thoughts and behaviors. After working out what you can change, you will practice these changes in your daily life and you'll discuss how you got on during the next session.

The eventual aim of therapy is to teach you to apply the skills to your daily life.

This should help you manage your problems and stop them having a negative impact on your life.

Some of the advantages of CBT:

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• It may be helpful in cases where medicine alone has not worked.

• It takes less time compared to other talk therapies.

• The highly structured nature of CBT means it can be provided in different formats, including in groups, self-help books and apps.

• It teaches useful and practical strategies that can be used in everyday life.

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Some of the disadvantages of CBT:

 

• You need to commit yourself to the process to get the most from it

• Regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time.

• It may not be suitable for people with more complex mental health needs or learning difficulties, as it requires structured sessions.

• It involves confronting your emotions and anxieties may make you emotionally uncomfortable.

• it focuses on the person's capacity to change themselves (their thoughts, feelings and behaviors) – this does not address any wider problems in systems or families that often have a significant impact on someone's health and well being

• Another valid criticism is that CBT only addresses current problems and it does not address the possible underlying causes of mental health conditions, such as an unhappy childhood, a broken family, stress related disorders. This may lead to lingering unresolved issues.

 

Individual therapy:

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It is the most popular and common.It is conducted in an emotionally safe setting where the patient can feel accepted.
It allows for one to one sessions.The individual is comfortable as his privacy , confidentiality is ensured and in the absence of family members and strangers he / she can focus on personal matters without embarrassment and censorship.

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Group Therapy:

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Group therapy helps individuals develop communication skills and socialization skills, and allows clients to learn how to express their issues and accept criticism from others. Group therapy allows individuals to develop self-awareness by listening to others with similar issues , sharing experiences under the guidance of the therapist.
Group therapy is usually focused on specific topics that everyone in the group is working on. For example, a therapist may lead a group therapy session on anger management,postpartum depression, suicide etc.

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The benefits of group therapy:

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• Helps you realize you’re not alone.

• Facilitates giving and receiving support.

• Helps you find your “voice.”

• Helps you relate to others (and yourself) in healthier ways.

• Provides a safety net.

Family Therapy:

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Therapy with other members of your family that aims to help you work out problems together.
Difficult times can come unannounced. Family therapy aims at improving communication skills, resolving family conflicts and leading to a healthy functional family.

Examples in which Family therapy can help:

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• A major unexpected serious medical or mental illness.

• Domestic violence.

• Substance abuse.

• Sudden transition from job, marital status,bereavement.

• Emotional problems in children or adolescents.

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Interpersonal Therapy(IPT):

IPT is based on the principle that relationships and life events impact mood and that the reverse is also true. IPT was developed in the 1970s for the treatment of depression and has since been adapted for other psychiatric conditions too. The main goal of IPT is to improve the quality of a client’s interpersonal relationships and social functioning to help reduce their distress.

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The four key areas in which it is used are :

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• It addresses interpersonal deficits, including social isolation or involvement in unfulfilling relationships.

• It can help patients manage unresolved grief—

• It can help with difficult life transitions like retirement, divorce, or moving to another city.

• It is recommended for dealing with interpersonal disputes that emerge from conflicting expectations between partners, family members, close friends, or coworkers.

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The practice differs from cognitive and behavioral therapy approaches. It deals with maladaptive thoughts and actions only in context to interpersonal relationships.

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Dialectical Behavior Therapy(DBT):

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Marsha Linehan, the creator of DBT, defines dialectical as a synthesis or integration of opposites. Some people are prone to react in an unexpectedly intense manner in certain emotional situations, primarily those found in one’s families, friends and romantic relationships. DBT theory suggests that some people’s arousal levels in such situations can increase far more quickly than the average person’s, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels. People who are sometimes diagnosed with borderline personality disorder experience extreme swings in their emotions, see the world in black-and-white shades, and seem to always be jumping from one crisis to another.

They may be very caring, extremely well to get along with and all of a sudden quite unpredictably angry, rejecting, demanding total attention and insulting. Because few people understand such reactions — they don’t have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.

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