All this information, collected in the anamnesis and examination of the first and subsequent consultations, is key to being able to propose an intervention plan (treatment plan) to the patient that fits both their clinical needs and their personal situation and that, as a result, counts with a high probability of being well tolerated and effective.
In this regard, it is essential to have enough time and calm in each consultation to be able to collect all the relevant information and, at the same time, be able to convey the indications and therapeutic proposals to the patients. Time is also required for the patients to be able to assimilate, retain and, if necessary, comment on or clarify whatever is needed.
Interventions must be based on efficacy and safety studies, on clinical guidelines whose recommendations are consolidated. This is what we called “evidence-based medicine“
Likewise, the psychiatrist must be honest with the patient as to what personal (direct) experience he/she has acquired with the specific drugs or treatments that he/she proposes. Because it is the frequent use of them that makes it possible to acquire a fine management of the necessary doses, the required time to be effective, the most frequent adverse effects, how to avoid or counteract them, etc.
Psychiatric treatment: The key to success
Thus, the therapeutic compliance is directly related to the correct participation and agreement of the patient in their treatment.
Agreeing treatment plans with the patient is therefore an act of good practice. When appropriate, accompanying family members should be involved, and the response and progress should be regularly reviewed.
"It is important that the psychiatrist is available to review and readjust the treatment in the event of any difficulties that arise"
Adapted psychiatric treatments
Among the treatments to be prescribed, psychiatrists with psychotherapeutic training can perform psychotherapy in consultations with their patients. This type of treatment may or may not be combined with the prescription of drugs or may even form part of comprehensive and combined treatments such as those prescribed, for example, in Day Hospitals or in a Psychiatric Inpatient Units.
Psychiatrists may prescribe a combination of interventions, as I point out, depending on the needs and the complexity of the disorders, the symptoms, and the dysfunction that exists.
These interventions can be broadly categorized into the following blocks:
- Psychoactive drugs.
- Psychotherapy (individual, family or group).
- Nursing care, assessments and support.
- Occupational Therapy.
- Psycho-education.
- Social interventions (Social work).
- Non-pharmacological biological treatments such as phototherapy, ECT (electroconvulsive therapy) or TMS (transcranial magnetic stimulation).
The more complex the combination of treatments, the more important it is their coordination and their integration into a treatment plan that unifies them.
The most common treatment plan, however, is the prescription of drugs jointly with the possibility of referral to psychology for psychotherapy. It is also very common to combine psychotherapy with the prescription of medications by the same professional, in this case the psychiatrist.
We should not forget the indication of no treatment as one more option among the possible treatments. In a high percentage of consultations no pathology is found and the indication of no treatment itself, well explained to the patient, solves the reason why the patient consulted. It is an intervention in itself and requires time and dedication to be carried out correctly.
Possible contraindications
At this point, it is relevant to highlight that all treatments have their indications, as well as their possible contra-indications and their potential iatrogenic action.
Psychotherapy, occupational therapy or psycho-education, activities that the majority of the population conceives as innocuous can be harmful too. If they are poorly indicated or performed incorrectly, can have a negative impact on the patients, not only by diverting them from the correct treatment that should receive but also through their direct actions.
Therefore, it is very important that these treatments are indicated by a trained physician, competent and responsible for their indications. For milder and more common disorders, a consultation to your primary care physician may suffice. For the most serious cases, in which there are more disruptive symptoms or with greater impairment on functionality, a psychiatrist should be consulted. In any case, it is appropriate to ensure collaboration and coordination between both physicians in the treatment.
In these three articles I have summarized the general principles, or fundamental basis, of the good practice of psychiatry, particularly in reference to the first consultation.
I hope it has been of interest to you, we will address some of the elements that constitutes psychiatric practice in greater detail in subsequent articles.
