Management and multidisciplinary approach of psychiatric disease

Who defines psychological disorders?

The American Psychiatric Association's Diagnostic and Statis- tical Manual (DSM-5) describes some specific abnormal psy- chiatric conditions and defines these “mental disorders” as “… syndrome[s] characterized by clinically significant disturbance[s] in an individual's cognition, emotion regulation, or behavior that.

What causes mental health problems?

childhood abuse, trauma, or neglect.

social isolation or loneliness.

experiencing discrimination and stigma, including racism.

social disadvantage, poverty or debt.

bereavement (losing someone close to you)

severe or long-term stress.

having a long-term physical health condition.

significant trauma as an adult, such as military combat, being involved in a serious incident in which you feared for your life, or being the victim of a violent crime

physical causes – for example, a head injury or a neurological condition such as epilepsy can have an impact on your behaviour and mood. (It's important to rule out potential physical causes before seeking further treatment for a mental health problem).

so after your doctor takes medical History and do specific examination he/she may send you to some investigation if needed:

Investigations

1. Routine investigations in psychiatry: FBC, LFTs, U & Es or RFTs, TFTs, Urine drug screen and ECG (to look for prolonged QTc).

2. Further investigations will be required based on patient’s history and potential diagnosis, e.g. CT or MRI brain scan, EEG, VDRL, B12 and folate, HIV testing with patient’s consent..

3. With the patient’s permission, the psychiatrist may obtain collateral history from partner or spouse, friends, family, GPs and other professionals.

4. Investigations do not limit to the clinical setting. The treatment team may consider doing a home visit to understand the interaction between home environment and current psychiatrist illness. Occupational therapist can assess the activity of daily living of an individual while social worker can assess social support.

5. If the patient requires further psychological assessment, the psychiatrist needs to identify a clear goal. For example, a baseline neuropsychological assessment of a person with recent head injury and repeat the assessment after six months of cognitive rehabilitation.

Management and multidisciplinary approach :

1. Treatment can be divided as immediate, short term, medium term and long term.

2. Immediate treatment includes hospitalisation and close supervision to prevent suicide attempt or prescription of benzodiazepines to prevent alcohol withdrawals. Application of Mental Disorder and Treatment Act to admit the patients who are at risk but refuse admission to the Institute of Mental Health.

3. Short term treatment may include biological treatments, risk management and discharge planning.

a. Biological treatments: depending on the diagnosis, comorbidity and drug interactions, psychiatrists may

consider antipsychotics, antidepressants, mood stabilisers, benzodiazepine and anti-dementia medication.

b. Consulting other specialists: if necessary, the psychiatrists may obtain input from other experts in medicine, surgery, paediatrics, geriatrics, and obstetrics and gynaecology.

c. Risk management involves modifying and managing risk factors. (E.g. treat the underlying depressive disorder to prevent suicide and to advise caregivers to remove sharp items at home to prevent self-harm). It is important to prevent harm to other people (for example, inform the social agency to ensure the safety of the patient’s children).

d. Establish therapeutic alliance for future psychological therapy. Psychoeducation and supportive counselling can be offered while the patient stays in the ward. More sophisticated therapy e.g. cognitive behaviour therapy requires further work after discharge.

e. Discharge planning with active collaboration with patient’s relatives, outpatient psychiatrist, case manager (e.g. in Early psychosis programme), GP, and community psychiatric team. The relatives and mental health team can help to identify relapse and plays an active role in the contingency plan

4. Medium and long term treatment may include psychological and social treatments.

a. Psychological treatments may involve counselling, supportive psychotherapy, cognitive behaviour

therapy or interpersonal therapy. Individuals must explore patient’s motivation, preferences and previous response to psychological treatments.

b. Social treatments may involve monitoring by community psychiatric nurses, vocational assessment, supported work schemes, domiciliary self care training, supported accommodation and child protection.