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Your Mental Health

Get the most out of psychiatric care

It’s not easy to get an appointment to see a psychiatrist. With current shortages patients are often faced with a wait time of many months which can feel like a very long time when struggling with a mental health issue.

Here are a few simple tips that will help you get the most from your psychiatrist and will also make it easier for your psychiatrist to help you.

 

1. Be able and willing to talk openly about the problem or issue for which you’re seeking advice.

As you may have guessed, your doctor cannot be expected to read your mind. If you truly want help, you have to be willing to talk.

 

2. Bring a list with the names and doses of all current medications.

This information is very important to get an accurate picture of your medical history and is essential before your psychiatrist can recommend an action plan going forward.

 

3. Bring a list of medications and other therapies you have already tried.

For the same reasons as above, it is very helpful to know what treatments you may have tried and why they were discontinued.

 

4. Find out if anyone else among your biological relatives has a psychiatric condition including suicide and drug abuse.

Most psychiatric conditions do have a strong genetic component and it helps to know a family history.

 

5. Bring relevant past records if possible or know where these can be obtained.

Again, the more complete a picture you are able to provide, the more accurately your psychiatrist will be able to diagnose and recommend next steps. If you don’t have your medical records, it is still helpful to provide the names of previous doctors where information could be found.

 

6. If you have had lab work done (eg: blood, urine, brain scans etc.), bring the results or have your doctor forward them to the psychiatrist.

 

7. Complete any pre-interview questionnaires.

Some psychiatrists will ask you to complete detailed questionnaires prior to your first interview. Although they might seem lengthy, these provide important background information and help to give an idea of potential issues at the outset of a working relationship.

 

8. Be prepared to stop smoking cannabis, drinking excessively or using other non-prescription drugs.

If you are serious about receiving treatment for a mental health issue, drug and alcohol abuse are only going to be barriers for you. If you’re not willing to stop, it will be difficult for a psychiatrist to help you.

 

9. Be prepared to meet without children, spouses, friends, other counselors or lawyers in the room.

In order for an effective doctor/patient relationship to be built, there needs to be an atmosphere of calm and trust without interruptions. Psychiatric interviews often include discussion of topics that are very personal and can be inappropriate for children or friends.

If you are interested in family or couples therapy, this should be discussed with your psychiatrist ahead of time.

 

10. Be sure to arrive for your appointment on time.

Aside from being courteous, arriving on time will help ensure you receive your full interview in an unhurried manner.



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Postpartum obsessive thinking

Over the past few years public awareness has increased dramatically about the prevalence of postpartum depression. We now understand the postpartum period is a time of great transition and chemical upheaval that puts new mothers at highly increased risk for the development of psychiatric symptoms.

Today, every woman receiving perinatal care in Canada is screened for symptoms of depression and the stigma surrounding it has lessened significantly.

Less attention is paid to other psychiatric conditions commonly triggered during the postpartum period – particularly anxiety disorders such as obsessive compulsive disorder (OCD).

Research in recent years suggests postpartum OCD or obsessive-compulsive symptoms are more common than previously thought.

Obsessions are defined as ideas, thoughts, impulses or images that are intrusive and distressing to those experiencing them. In postpartum OCD, these are often thoughts or images of harming the infant. Postpartum obsessions are different from psychosis as the mother will recognize them as bizarre and distressing and understand that they are not rational. She will have fears of harming her baby but no intention to do it. Women experiencing these symptoms are very unlikely to ever harm their babies.

Compulsions can manifest as active rituals such as excessive checking to ensure the baby has not been harmed or avoidance of feared situations. These are different from healthy maternal behaviours because they often interfere with the ability to care for the infant.

Symptoms like the above are quite common – one study found 87 percent of women presenting to a perinatal mood disorders clinic had intrusive, obsessive-like thoughts with half of them being clinically significant.

Another study found 57 percent of women with postpartum depression experienced obsessional thoughts about harming their babies and most had some related checking compulsions.

Treatment for postpartum OCD typically involves a combination of SSRI medication and cognitive-behaviour therapy. Therapy focuses on exposure to feared situations with response prevention.

Education about the nature of obsessive thoughts is also very helpful. Mothers experiencing these symptoms are usually very relieved to learn they are not at elevated risk of aggressive harm to their babies.

Although we are doing a much better job these days in recognizing, treating and supporting mothers experiencing postpartum depression, we should also be screening for symptoms of anxiety and obsessive thinking as they are also quite common during this period. 



Treating tics

Roughly one percent of the population experiences Tourette Syndrome (TS), a distressing condition that begins in childhood and is characterized by motor and vocal tics.

Although first described in 1885, this neuropsychiatric condition is still not fully understood. We do know it typically begins between the ages of seven and 10, affects three to four times more boys than girls and often causes significant impairment in ability to function in both a school setting and at home.

Treatment options can be complicated due to a very high incidence of co-existing psychiatric conditions such as ADHD or obsessive compulsive disorder. Many treatments are available to assist those experiencing the symptoms of TS, but to date no one treatment has surfaced as the ideal.

Recently, a multidisciplinary team funded by the Canadian Institute for Health Research and the Tourette Syndrome Foundation of Canada has published much-needed Canadian treatment guidelines to assist physicians.

In order to make the new guidelines, the research team reviewed existing studies on this condition and evaluated the quality of the studies as well as their results. Weak or strong recommendations were given to each of the available evidence based treatments.

Essentially, intervention in Tourettes can involve education, psychotherapy or medication. Every situation is different and each case must be evaluated separately.

In all cases, patients and their families can benefit from receiving a full diagnosis and learning about the condition and its prognosis. For many mild cases, simply being educated about what to expect is enough to help individuals cope successfully with symptoms.

Practical strategies such as informing teachers and classmates about tics and teaching children with TS how to handle questions about their disorder can help to make things easier in school and social settings.

Tic symptoms usually subside on their own by the time the individual finishes adolescence and many people are encouraged when they learn this.

Still, for many, the tics are very distressing and more than education is needed to restore functioning and reduce physical and psychological pain. Behavioural therapy is shown to be supported by fairly strong evidence and can be helpful in these cases. Various medications are also available to help reduce tic symptoms and more are in the research stages.



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Time well spent

Maybe it sounds trite, but the way you spend the majority of your time is the best indicator both of what you are passionate about and what direction your life is heading.

A lot of lip service is paid to the notion of ‘following your dreams’ or ‘pursuing a passion’. We all have the idea that life would be great if we could make a living doing the thing we love most. Unfortunately, those who simply repeat these cliché phrases often do not emphasize the most important step in this journey – effort.

Many times, simply the idea of following a dream or passion can be the place where the journey stops.

Over the course of our lives, we may have many things or activities we feel passionate about. One of the great things about being human is our capacity for curiosity and interest in a variety of areas. Mostly, we become interested in something, dabble with it for a while and then move on to the next thing.

If you want to be successful at something, you must put in a lot of hard work. The more time you spend at it, the better you’ll become. When you are good at something, you are more likely to become increasingly passionate about it and the positive feedback loop continues. More effort equals more passion equals more effort. The two must go hand in hand if you expect to truly pursue your ‘passion’.

Of course, we often do spend a lot of time and effort on things we do not feel passionate about or even enjoy. Many people get into a job they are not suited for and work hard at it for years without increasing their enjoyment. Even with relative success, life can become pretty miserable when you spend the majority of your time doing something you don’t like.

In these instances, a little bit of career or life counselling can go a long way. When choosing what you will spend your time on, choose wisely. You’ll need to assess where you have strengths, what subjects interest you and how you might turn these strengths and interests into a viable career. Will it involve hard work every day? Yes – and if you’re working hard toward something you feel is worthwhile, you will look forward to the hard work rather than resenting it and simply wishing you were doing something else.

If you are in a job you truly don’t enjoy, maybe it’s time to do some serious research, education or professional career counselling and consider a switch. Then the cliché could become reality and with some focused and sustained effort, you could find yourself passionate about your work.



Read more Mental Health articles

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About the author...

Paul Latimer has over 25 years experience in clinical practice, research and administration. After obtaining his medical degree from Queen's University in Kingston, Ontario, he did psychiatric training at Queen's, Oxford and Temple Universities. After his residency he did a doctorate in medical science at McMaster University where he was also a Medical Research Council of Canada Scholar. Since 1983 he has been practicing psychiatry in Kelowna, BC where he has held many administrative positions and has done numerous clinical trials. He has published many scientific papers and one book on the psychophysiology of the functional bowel disorders. He is an avid photographer, skier and outdoorsman.

 

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The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet presents its columns "as is" and does not warrant the contents.


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