REMEMBER JOSH from chapter 2? In the course of his illness, Josh was treated with several psychiatric medications, so we're going to revisit him while we talk about how medications are used in psychiatry. In this chapter, we talk about how psychiatrists choose medications, and what they do when patients don't get better right away. We talk about the patient's right to know about the risks of medications and procedures, a process called informed consent. With some medications, for example, there is a risk of addiction, and this presents a particular challenge to psychiatrists. Finally, we talk about treatment-resistant conditions and a little about what the future might hold as we strive for better ways to help patients. \n
Josh first saw Dr. Smith because he was depressed, and Dr. Smith clarified that Josh was suffering from a mental illness. His symptoms were not simply manifestations of adolescent angst, trouble adjusting to college, or stress. Dr. Smith recommended both medication and psychotherapy for Josh's depression. \n
You'll remember that Josh had a rather complicated story. He became depressed and was treated with an antidepressant. This medication quickly caused him to become hypomanic, that is, his mood and energy level were elevated too far above the normal, a process known as switching. Josh was then taken off the antidepressant and given a mood stabilizer, and for quite some time, he did well, but then an unfortunate series of events transpired. Josh played soccer in the cold, got the flu, and went into a smoke-filled room, and all these things triggered a terrible asthma attack. Josh needed to take steroids for his asthma, and this medication induced a full-blown episode of mania during which Josh became psychotic and dangerous and was admitted to a psychiatric hospital, where he was treated with even more medications. \n
In this chapter, we borrow Josh to explain the issues a psychiatrist thinks about when prescribing psychotropic medications.
An edition of Shrink rap
(2011)
Shrink Rap
Three Psychiatrists Explain Their Work
by Dinah Miller, Steven Roy Daviss, and Annette Hanson
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What do psychiatrists think about when they approach a new patient? How do they decide what treatments to recommend?
In Shrink Rap, we aim to demystify psychiatry and make it transparent by describing, in plain English, what we think about. We strive to avoid medical jargon and to communicate in a straightforward way about what we see, how we formulate patients' difficulties, and what treatments we have to offer.
Psychiatry remains full of shortcomings. We don't know what causes some people to become mentally ill while others remain well. We don't know why certain treatments work for one person while they make another person with the same condition even worse. Scientific studies have only begun to touch on what we need to know, and as individual practitioners, we often still struggle to diagnose and treat psychiatric problems. Our understanding of psychotherapy is inexact. The medication strategies we use are sometimes motivated by a desperate desire to help a tormented patient after the tested treatments have failed. There are so many more questions to ask and so few for which we have answers.
The shortcomings of our field notwithstanding, we hope you'll enjoy reading about our work as much as we enjoy doing it. Psychiatry has evolved a great deal over the past few decades, and we hope you'll find this journey into today's world of psychiatry illuminating.
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Book Details
First Sentence
"MELISSA ADAMS is the nicest pediatrician a child could have. She softly sings the alphabet while examining a toddler and talks football draft picks with the teenage boys."
Table of Contents
What are the different types of mental health professionals?
What a is a psychiatrist?
What is a forensic psychiatrist?
When a patient should see a psychiatrist rather than a primary care doctor
What is split treatment?
When a patient should see a psychiatrist for psychotherapy
When is split treatment better than care with only a psychiatrist?
The psychiatric evaluation and the mental status exam
The importance of outside informants
What is a chemical imbalance?
How psychiatric diagnoses are determined
Involuntary commitment to a psychiatric unit
What are a patient's rights during hospitalization?
When life gets hard and stress causes symptoms
For psychiatric symptoms caused by medical illnesses
For maladaptive personality styles
For addictive or compulsive behaviors
For suicidal thoughts or behaviors
For insight and education
What is psychotherapy?
What are some different types of psychotherapy?
How psychiatrists learn to become psychotherapists
How are research studies conducted on psychotherapy as a treatment?
What people talk about in psychotherapy
What the psychiatrist does in psychotherapy
Privacy and confidentiality in the therapeutic relationship: on keeping secrets and minding HIPAA
Special exceptions: child custody subpoenas and the Patriot Act
Self-disclosure by the therapist
How long should treatment last?
How psychiatric medications are (sort of) classified
How a doctor chooses a medication
Informed consent
Complementary and alternative treatments
How doctors dose medications
What happens when conventional treatments don't work?
Why psychiatrists don't like Xanax
Addictive medications in the treatment of the psychiatric patient
Difficulties with communication and poor patient-doctor fit
Recovered memory therapy
Disorders induced by the psychiatrist
When psychotherapy is inappropriately used as the only treatment
Side effects and adverse reactions from medications
Black box warnings
Antidepressants and suicide in young people and how the FDA decides on black box warnings
Boundary violations
Therapists who exploit patients
Healthcare proxies, advance directives, and medical decision making for the dying patient
Informed consent and medical decisions for minors
Juvenile delinquency and the legal system
Custody evaluations: who gets the child?
Specialty mental health courts and compelled treatment
Interrogation and why criminals confess
Psychopaths versus sociopaths and whether they can be treated
The insanity defense
What becomes of the insanity acquittee?
Psychiatric care in jail and in prison
Civil commitment of sex offenders
What happens in the Emergency Department?
Finding a hospital bed for a psychiatric patient: insurance approval and bed availability
What happens during psychiatric hospitalization?
Patient education, family involvement, and therapy
The agitated patient: restraint, seclusion, and forced medications
Shock treatments, or electroconvulsive therapy (ECT)
Bargaining for beds: insurance (again) and how psychiatric beds get allocated
Electronic health records
Day hospitals, or partial hospitalization programs
The consultation-liaison psychiatrist
Psychiatrists and insurance networks: how it all works
The missed appointment: no-shows and late cancellations
Preventing lawsuits
Providing safe environments for violent patients
When the patient assaults the psychiatrist
Changes in the patient's ability to pay for care
Influences of the pharmaceutical industry
Happy birthday! gifts from patients
Healthcare reform and how we allocate our treatments
What constitutes a psychiatric disorder: diagnostic criteria in the DSM age
Psychiatric disabilities and deciding who deserves special accommodation
Psychiatric disabilities in the workplace, from pilots to presidents
Medications with addictive potential
Medical marijuana for psychiatric disorders
Complementary and alternative treatments
The recovery movement
More than just medicines and psychotherapy: VNS, DBS, and rTMS
Just beginning: genetics, brain structure and function, and neuroplasticity
Psychopharmacogenetics: scientific gains that will lead to treatments based on each patient's biology
Edition Notes
Includes bibliographical references and extensive index.
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Work Description
[from front jacket:]
Three psychiatrists from different specialties provide frank answers to questions such as:
*- What is psychotherapy, how does it work, and why don't all psychiatrists do it?
- When are medications helpful?
- What happens on a psychiatric unit?
- Can Prozac make people suicidal?
- Why do many doctors not like Xanax?
- Why do we have an insanity defense?
- Why do people confess to crimes they didn't commit?*
Based on the authors' hugely popular blog and podcast series, this book is for everyone who is curious about how psychiatrists work. Using compelling patient vignettes, Shrink Rap explains how psychiatrists think about and address the problems they encounter, from the mundane (how much to charge) to the controversial (involuntary hospitalization). The authors face the field's shortcomings head-on, revealing what other doctors may not admit about practicing psychiatry.
Candid and humorous, Shrink Rap gives a closeup view of psychiatry, peering into technology, treatments, and the business of the field. If you've ever wondered how psychiatry really works, let the Shrink Rappers explain.
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Representative if writing (beginning of Chapter 5)
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| March 1, 2021 | Edited by drdaviss | added reviews |
| August 2, 2020 | Edited by ImportBot | import existing book |
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| July 29, 2011 | Created by LC Bot | import new book |