Basic Tips of the Mental Health Guide


Basic tips on how to know if you have a psychiatric disorder that requires treatment?

It is necessary as one of the  basic tips,  go to a good experienced clinical specialist. Although self-diagnosis is helpful at first, it is limited by possible errors and requires verification; by the doctor to be sure.

The absence of precise delimitation between psychiatric disorders and reactions triggered by daily pain and suffering, makes it difficult to diagnose all those who have suffered a mild psychiatric symptom. This requires adjusting to the diagnostic criteria before treating the patient. One difficulty is the lack of diagnosis, since three quarters of people suffering from a psychiatric disorder that requires treatment never ask for help. The opposite case (of abuse of diagnosis or over diagnosis) is much less common, and mainly affects hypochondriacal people. All doubts about it can; clarify with a specialist consultation, without this implying the need for treatment.

What is the cause of the disorder?

Most psychiatric disorders appear to be based on an innate genetic vulnerability and a certain interaction with the environment, (as occurs with diseases such as diabetes , cancer , etc.) With advances in neurosciences, techniques of Neuroimaging and genetics, the next scientific challenge is to determine which genes are involved in the different disorders and know how they exert their influence. This search will allow finding more effective and specific treatments and prevention methods.

Who is “responsible” or “guilty” of psychiatric disorder?

You should never blame or stigmatize people for their illness ;; In addition to being unfounded, it is counterproductive for them. Only when the patient does not carry out the suggestions proposed below to improve, can he be held responsible for a bad evolution.

Do not confuse, however, the absence of guilt of the psychiatric patient with the lack of responsibility for criminal or immoral behavior. Sometimes patients with psychiatric problems have to make great efforts to control their impulses and avoid certain behaviors.

Basic advice on what can be done to improve the situation?

  • Acquire all possible information about the disease that is suffered and thus have as much control as possible about the situation.
  • Go to a psychiatrist to inform and instruct the patient about his illness and explain the different therapeutic options.
  • Improve self awareness, devoting the necessary time and efforts to this task.

Many of the disorders have a chronic course or recur frequently. It is necessary to have a long-term vision of the disease and not abruptly interrupt the treatment before a temporary improvement (which usually leads to recurrence in a few months). Improvements are usually achieved progressively. The desire to change and individual work in this regard are generally more important than mere attendance at therapeutic sessions.

Once the patient is well, he must continue with the medication for a variable time depending on the pathology he suffered (months, years or even for life); you will have to go to your therapist with a predetermined regularity to prevent relapses and control the medication; and both he and his relatives must be alert to the appearance of early signs of recurrence.

The duration and intensity of the treatment will depend on the type of disease , its duration, the previous frequency of episodes and the risk of recurrences, against the cost and; the difficulty to prevent them. The following general principles of mental hygiene improve the prognosis of any disorder:

  • Avoid the use of drugs (responsible for many relapses).
  • Have regular work, leisure and sleep schedules.
  • Do not undergo excessive stress.
  • Have time for yourself and loved ones.
  • Comply with the prescribed medication.

Should treatment be started now or can you wait?

Multiple studies have shown that early treatment (before symptoms profoundly change the way of life) obtains faster and more complete responses, reduces the risk of relapse, and improves the prognosis. It will only be expected in case of very mild, ambiguous or related symptoms of transient stress. It is necessary to consider that between the first visit and the results of the pharmacological treatment usually some weeks pass.

What should family, couple, friends or co-workers know?

It is a difficult question without universal answer. They always face at this point the need to be exact, sincere and honest with the need to protect privacy and the risk of encountering negative prejudices of the listener towards psychological problems. You must act according to personal context and criteria.

Another of the  basic tips is that you should almost always trust and ask the family for help, unless there is no relationship or it is a very trivial or transitory problem. Normally the most pleasant reactions and; cozy will be those of family members. As family support ends up being necessary, we must inform; Family members sooner or later.

Telling friends depends on intimacy, duration and type of relationship. Social isolation is an unpleasant consequence of psychiatric problems , avoidable with understanding friends and collaborators.

The couple (especially the new couple) must be informed progressively in a manner according to the degree of intimacy developed (as would be done with any other illness ). The reaction of the couple is crucial to move forward with the relationship.

At work, the decision to communicate it or not depends primarily on the patient. You can avoid possible future problems and feelings of dishonesty. If the psychiatric problem affects work and the company does not have an employee assistance program, the attitude will be clearly influenced by the relationship with the boss. It is usually better to publicize the problem and not risk giving the image of lazy and irresponsible. In any case, you can use the basic advice of the therapist and his experience in similar cases.

How to decide the most appropriate treatment?

For most psychiatric disorders there are several effective treatments and the one that (most reasonably) can be chosen that best fits the needs, requirements, preferences, and economy of each patient. In the event that a treatment is ineffective there is always one or several treatment alternatives, which allow finding the ideal and effective treatment for each patient. This great diversity, sometimes involves a difficult choice between different options:

Psychotherapy versus medical treatment

When both options are effective, it is advisable to choose according to the severity and urgency of the problem:

In mild to moderate symptoms and when the situation is not urgent, it is convenient to start with psychotherapy. If there is no improvement in one or several months, medication will be added.

In moderate to severe symptoms or in urgent situations, the medication will start immediately, usually with psychotherapy.

What kind of psychotherapy to choose?

It is better for the therapist to be flexible and use all available techniques (cognitive, behavioral, psychodynamic and interpersonal) and not follow; strictly one of them. For many problems cognitive behavioral therapy is useful, but it is more effective if the therapist is aware of the psychological conflicts, personal relationships and the environment surrounding the patient.

What medication to choose?

The great diversity of existing drugs for each disorder, and the misleading classification of drugs for laymen (for example, so-called “antidepressants” are also used in panic attacks, obsessive compulsive disorders, bedwetting, insomnia and eating disorders) , can make your choice seem disconcerting. Although they should always be prescribed by a doctor, it is essential that the patient knows how they act and what are the most common side effects. If the first therapeutic choice has not been effective ,; We will have to try other alternatives until we find the right answer.

The choice is influenced by possible side effects, but these should not be a reason to stop taking the medication (since lower doses or with other guidelines can be reduced) without consulting your doctor.

How to connect with the right clinician?

In the event that the patient can choose the clinician who will take care of their case, the professional competence of the clinician and the empathy (the “good chemistry”) that generates their relationship with him should be considered. Empathy of the relationship between doctor and patient is usually a predictor of good results, so in some cases, it may be advisable to meet with more than one clinician before choosing the one that finally treats you; Professional competence is more difficult to determine by the user. There is a growing number of professional disciplines that offer treatment for psychiatric problems, with a very variable competence among them. They can help in this regard, for example:

  • Ask for recommendations or  basic advice from  the attending physician or other doctors, professional associations and patient support groups or patients treated with similar pathologies.
  • Express doubts or questions that are had in the first interview and judge their skill by the precision, clarity and simplicity of the answers contrasted with other sources of information available (opinion of other clinicians, scientific literature, quality literature on the Internet, etc. …)
  • The medication must always be prescribed by a doctor usually a psychiatristor primary care. Most primary care physicians have some practice in some minor mental illnesses, although, given their training, a lot of variation can be found from one professional to another. Today all psychiatrists (except perhaps some isolated case that is dedicated exclusively to the practice of psychotherapy) are sufficiently familiar with the use of psychotropic drugs; and they are able to individualize each treatment (both in the choice of psychoactive drugs and in the dosage) to better adapt it to the needs of the patient. In this way, the initial appearance of side effects or the possibility of receiving an insufficient dose can be minimized, as is the case when using standardized doses. Psychiatrists also have more experience in enhancing the effects of one drug by adding another and are able to incorporate psychotherapeutic strategies into treatment. For all the above it is advisable that, except in very simple cases, it is a psychiatrist who is responsible for the prescription and control of psychotropic drugs inpsychiatric disorders .

How to choose a psychotherapist?

First of all, the psychotherapist’s degree must be taken into account. Normally, psychiatristsand psychologists have more experience than other professionals but some specific psychotherapeutic treatments can be carried out by professionals with other qualifications duly qualified for the referred treatments (some psychoanalysts, for example, may not be doctors or psychologists; some social workers are effective family therapists , etc.). Before embarking on a defined psychotherapy, the opinion of a general clinical psychiatrist about the usefulness of that technique in your specific case and the suitability of a given psychotherapist (if you know it) can help a lot to make the decision right. Then, the rule of empathy between patient and therapist is also valid for choosing a therapist. Each psychotherapy has a predictable temporal process that is very variable depending on the technique; Any doubt in this regard should be raised to the professional who attends the case. The opinion of a second independent professional may be indicated if there are doubts about the progress of a treatment.

Should the family participate or stay out of the problem?

The psychiatric symptoms create stress and lack of understanding in the family. As another of the  basic tips it is essential not to blame the patient for his illnessIn spite of the difficulty of living with a person suffering from a psychiatric problem. To cope with the disease in the family, information and education are essential; about the problem. In this way many misunderstandings are avoided and; reproaches and family attitudes that can complicate evolution are corrected. Ideally, each family member participates and offers support under the direction of the professional attending the case and with the patient’s consent. For this, it is advisable that the family participate in some sessions with the therapist and receive information about the treatment and how they can contribute to its good results. On the contrary, some individual psychotherapies (especially those of a psychoanalytic type) require that relatives and relatives stay out of the process.

How can the patient cope with his symptoms and the behaviors and feelings that cause him?

Once a diagnosis has been received in a valid and reliable manner, the best attitude is to accept the existence of a disorder or disease. The next step is to know the prognosis and treatment of the same and start with direction the tasks capable of limiting complications and minimizing the impact of the disease on the biography and facilitating adaptation to the sequelae that, where appropriate, occur .

Attending a self-help group can be very useful to the patient and his family: it is a way of seeing that there are more people with the same problem and of not feeling alone when facing it.

The first self-help group was Alcoholics Anonymous, followed by others for other addictions to substances of abuse, for sexual problems, problems with gambling and others. Today there are many self-help associations for psychiatric patients in general and for pathology in particular. Support organizations have made tremendous progress in helping, for example, patients with mental retardation, schizophrenia, affective disorders; addictions, eating disorders, etc .; Many of these groups have acquired a growing influence in the political scene in which they get benefits and resources, try to reduce discrimination and stimulate the search for effective treatments with other professional organizations.

What to do when a patient refuses the care or treatment he needs in all probability?

When the mental disorder suffered by the person is dangerous for himself (suicides or severely disabled people) or for others, the law allows involuntary treatment. Each district has a special court in which family members can raise the case. Since involuntary treatment restricts the freedom of hospitalized patients, patients undergoing this regimen must be approved by an “ad hoc” judicial commission and patients have the right to appeal between her or other appropriate legal instances. At the moment the hospitalization cannot be indefinite, having to be manifest the benefits of the treatment within a defined period of time. In some serious chronic and unmanageable cases, family members and the administration may request incapacitation and guardianship procedures.

When and how should involuntary treatment of a family member be requested?

When the sick person cannot recognize their need for treatment due to the loss of contact with reality due to their illness , the request for admission must be made by a family member or relative. In Spain, once the request has been accepted by the corresponding court, the patient must be examined by a doctor appointed by said court who must confirm the need for hospitalization before the patient is admitted. In case of urgency the process can be reversed and the doctor attending the psychiatric guard of the referral hospital is empowered to enter a patient against his will provided he sends notification to the court in 24 hours. The court will confirm or not the legality of the admission in 72 hours more.


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