Psychiatrist vs. psychologist

Psychiatry is the branch of medicine that deals with the broad range of human mental disorders, their causes, circumstances, symptoms, course, and treatment.

Of course not. A psychiatrist is a doctor, or a person who has completed medical school and has a general medical knowledge. Psychiatry is a branch of medicine selected by a doctor in which he/she specializes.
A psychiatrist is a doctor whose interests focus on the diagnosis and treatment of disorders and mental illnesses. Only a physician can apply medication, i.e. prescribe medicines. It is not possible for a psychologist to do. A psychologist is not a physician. He/She is a specialist with university education dealing with human psychic phenomena, but from a slightly different point of view. Not all psychologists specialize in disorders and mental illness, or clinical psychology, but often deal with physiological phenomena, such as the psychology of work, social psychology, sports psychology, etc. Both the psychiatrist and the psychologist can deal with psychotherapy, and after passing the relevant training each of them can act as psychotherapist.
Despite the large differences between the two professions, it does not matter who we turn to for help in case of suspected mental disorders. A psychologist certainly suggests treatment with a psychiatrist if the patient requires it, and a psychiatrist will send the patient to a psychologist when necessary. A psychiatrist and a psychologist often work together.

An appointment with the psychiatrist

To answer this question you have to start with a general remark: an appointment with a psychiatrist is not a harrowing experience, it is not painful and it certainly neither causes nor worsens your mental ailments. If this statement reassures, what harm is there to visit a psychiatrist if you have any doubt as to your mental state or that of your loved ones ?
Some tips as to what you should worry about will be given later on in this guide.
Don’t underestimate the advice of your family or friends who suggest such a visit..
The diversity of our behaviour is easily noticed by others. To notice irregularities of one’s mental state, professionalism generally is not needed.

If you notice big changes around you whose cause cannot be explained, e.g. the environment well-known to you seems different, alien or even hostile, the people dear to you seem to have turned their back on you, and your life seems empty, unsatisfying and inert, you should certainly consult a psychiatrist. Generally, it is easier for other people to notice changes in your behaviour, so if one of our loved ones has become unjustifiably distrustful, suspicious, sad, thoughtful or absent-minded, and has changed or given up his interests, has sleep problems, has ceased to carry out his daily duties, has begun to reveal bizarre interests or has changed his preferences, then an appointment with a psychiatrist is absolutely necessary.

It can be stated that such a visit generally consists in talking. Of course, the psychiatrist is a medical doctor and can also perform a classic medical examination. Sometimes the doctor can ask you to fill in a questionnaire or perform a simple graphic task.

Certainly a person who, due to mental disorder, endangers themselves or others should undergo hospital treatment. It is best explained with an example: if the patient is convinced that he has become the target of a conspiracy, treats the people who surround him as his enemies who are trying to harm him in different ways, e.g. poison water and food, emit harmful radiation, lurk to kill him, you can expect the patient to take steps in order to defend himself. Not infrequently, convinced of defending his own life, the patient is so intimidated that he begins to attack his alleged persecutors. Obviously, hospitalization is inevitable in such a case.
The presence of suicidal tendencies is another example of the need for hospital treatment. A person overwhelmed by a thought of suicide should be under the strict supervision of the people that are able to prevent a possible suicide attempt. Not always the closest are able to provide the patient with proper care, and, then the hospital should take care of him.
The above example illustrates the situations of absolute necessity of hospitalization. Apart from these situations, there are much more where hospitalization is necessary as it can provide the best way of effective treatment.

Yes. The Law on the Protection of Mental Health which regulates how to deal with mentally disturb persons provides for such situations . The first one is when a patient directly threatens his own life or the life or health of other persons as a result of mental illness . In such a case, every doctor (not necessarily a psychiatrist) may decide on the forced hospitalization of the patient. In practice, it is mostly the doctor of the Ambulance Service. If a patient, due to his evident mental illness, behaves in a manner endangering himself or others, e.g. in a state of extreme mobile agitation he violently destroys objects, beats or tries to hit other persons, sets fire, destroys installations, tries to hurt himself, e.g. he is going to jump out of the window, then such a behaviour qualifies him for immediate medical emergencies and hospitalization, even against the patient’s will.
The second way leading to hospitalization against the will of the patient is called the mode of a motion also provided by the Law on the Protection of Mental Health. This mode applies to people who need psychiatric treatment but do not want to take such treatment, which clearly leads to the deterioration of their health. Imagine a situation when a previously healthy persons stops going to work, is no longer interested in the basic activities of everyday life, ceases to take care of personal hygiene and only concentrates on thinking about bizarre topics that have never crossed his mind so far. It is hard to say that such a person is a threat to himself or others but in view of the symptoms of his illness he stops functioning normally and is sinking deeper and deeper into his illness..
Most likely, in this case, the treatment will improve his health, but the person does not see the need for such treatment. It is for such people that the mode of a motion is provided. The immediate family or social care proper to such a person’s place of residence may apply to the Family Court with a request for forced hospitalization. The opinion of a psychiatrist who has personally examined the patient is necessary for such a request to be accepted by the court..
Every psychiatrist has detailed knowledge on how to perform this procedure.

Every man can potentially be a threat to his environment. It also happens that the mentally ill are a danger. In the state of extreme agitation the mentally ill may commit violent acts which might result in hurting other people. It is also possible for a person under intense delusions to take action to eliminate the alleged threat or to retaliate against his oppressors. Keep in mind that it is fear which is the primary mechanism leading to the aggression of a mentally ill person. The majority of potentially dangerous situations can be appeased by full understanding and hostility-free attitude towards such a person.
Statistically, the aggression of the mentally ill is a small percentage of aggressive behaviour occurring in the entire population.

Symptoms of mental illness

It is just as important as in all other diseases. No one needs convincing that the treatment of the person in whom the disease is just beginning is simpler and brings better results. In the case of mental illnesses it is all the more important that the symptoms of the disorder not being treated are more and more acute and often lead to irreversible changes in the environment and the family of the patient such as loss of job, social stigmatization (being labelled as a sick person), breaking contact with loved ones which is actually not to rebuild.
In addition to losses in the sick person’s environment, the psychotic process itself not being treated gradually becomes fixed. Symptoms resistant to treatment frequently develop. Untreated mental illnesses in their acute phase of symptoms may progress to the chronic phase. Any chronic disease, including mental ones, is treated much worse than an acute disease.

There is no single pattern of behaviour ideal for all patients. You have to remember that a person betraying mental disorders is still the same person you knew before the disease. So you should continue to treat him or her in the same way. You should not dramatically change your behaviour – be yourself. Any unusual behaviour can then arouse suspicion and deepen the feeling of isolation and unreality.
It is natural that you try to learn as much as possible about the disorder the person close to you reveals. Such information will help you understand the person’s behaviour. This will make your contact with the sick person easier, e.g. you will not feel offended by his or her dislike or hostility towards you and will find it easier to overcome your own negative emotions towards the sick one. It is fully understandable that mental illness in your environment causes deep frustration of everyone involved. You cannot blame yourself for anger, hatred, resentment and other negative feelings towards a sick person. Talking with others can only help you to ease the tension.
You cannot doubt that you will not be able to help the patient. It is you, a healthy one, who must support the sick person in the decision about the necessity of treatment because the person himself has no sense of its own illness and does not see the point of treatment. You should not show impatience that the illness lasts too long and does not bring expected results. Belief in the success of treatment is important for both you and the patient.
Sometimes the patient will expect you to make the simplest life decisions for him. This does not mean that he is trying to make us responsible for everything. He is simply unable to think clearly about elementary things. When you are surprised by ever new and bizarre delusions in which the patient is involved, try to understand his point of view. Try to find as much as possible about the world the patient lives in. Try not to oppose him too violently because in this way you will be taken for someone who at least understands nothing or, at worst, becomes the patient’s enemy. That’s all you can discuss when emotions subside. You can then explain your point of view to the patient trying to correct his attitude.
In any case, when the patient is in an acute psychosis, you should not pretend that you think and feel in the same way as he does. You must remember that the patient is completely lost in the world around him and has difficulty in distinguishing real things from those resulting from his disease. Sometimes you are the only safe ground for the patient, but it can be cut from under his feet when even in good faith you do not behave honestly.

Undoubtedly, you should be alarmed by any radical change in your behaviour or in the behaviour of the person you know well.
To understand better what you should pay attention to, you’d better get to know some basic symptoms of mental illness. They are as follows:

  • Disorders of thinking – disorganization of thinking caused by distraction or complete disruption of threads of thought.
  • Delusions – false beliefs that cannot be corrected by any persuasion, even by quoting irresistible, from the point of view of logic, arguments in their senselessness..
  • Hallucinations – false visual, auditory, gustatory, olfactory or sensory perceptions. A patient experiencing hallucinations hears, sees or senses things that are not real. Hallucinations often coexist with delusions providing the patient evidence of the truth of delusions.
  • Changing feelings – irrational feelings happen to the patient in a given situation, e.g. agitation, anger or anxiety caused by impaired thinking and perception. In another situation impoverishment of feelings may occur and the person feels indifferent to what is happening around him. Not infrequently, these two states are intertwined.
  • Changing behaviour – dissimilarity of behaviour resulting from a change in feelings in comparison with the behaviour known before the disease. Behaviours are the consequence of other productive symptoms and external manifestation of feelings, including irrational agitation or apathy, gestures bizarre for the environment or entire sequences of behavior resulting from disorders of thinking or perceiving experienced by the sick person. For example, a person experiencing gustatory and olfactory hallucinations, and convinced that he is poisoned, will change his behaviour according to this situation. He will refuse to take food, avoid being in polluted areas, show suspicion or outright hostility and aggression in his contacts with alleged persecutors.
  • Withdrawal from family and social life (isolation from the environment and lack of interest in things that used to be important).
  • Loss of initiative – closely related to withdrawal, causing depletion of active behaviour previously typical of the person. Patients need to be urged and guided often in basic activities of life.
  • Poverty of thought and expression – patients often complain of emptiness in the head and reducing thinking to a few permanently returning identical thoughts. This often illustrates the poverty of speech in people previously eloquent.
  • Emotional pallor – patients, who have shown emotional reactions so far, now become callous and not interested in their own affairs and those of others, and give the impression of people devoid of feeling

These symptoms do not exhaust the wealth of symptoms of mental disorders. Each patient is affected differently and the symptoms presented by patients sometimes surprise with their diversity.

Mental disorders

You cannot give a precise answer to this question because not all mental disorders are diagnosed. It is estimated that the phenomenon of „tip of the iceberg” occurs , for example, in the case of depressive disorders. It consists in the fact that only about 20 to 30% of cases are detected by health care so that the great majority is never diagnosed or treated.
In the case of schizophrenia the percentage of people affected by it is quite constant and estimated at 1% of the population and thus it is easy to calculate that about 400 000 people suffer from this disease in Poland .

Among patients calling at psychiatric surgeries those with problems of anxiety and depression, commonly referred to as neurotic, are the majority. .
Among the mental illnesses covered by this guide, the largest group are patients suffering from schizophrenia (approx.. 1% of the population suffers from this type of psychosis). More and more patients suffer from mental illnesses caused by degenerative changes of the brain such as dementia characteristic of Alzheimer’s disease and disorders conditioned by addictions.

Causes of mental illnesses

Mental illnesses are not inherited, although many people fear that. We do not have a comprehensive knowledge of the genetics of all mental illnesses. Some inherited predisposition to react to stress in a certain definite way has only been reported. In the case of schizophrenia, there is a greater risk in a family where the disease already exists. The risk is assessed on a 5 – 15 times higher than in the general population. . Similarly, the risk of falling ill for the monozygotic twin of the sick person is 48%. A similar risk exists in the case of a child of both ill parents – 46%, but when one of the parents is ill, it is only 17%.

Causes of mental illnesses are not fully explained. Their prospecting and exploration are still the subject of scientific interest. Undoubtedly, you must take many factors into account. Biological and environmental ones are among them.

  • Biological factors – include differences in the construction and operation of the brain of patients. These differences can be congenital , but the disturbances in the functioning of the brain caused by viruses are to be noted.Difference may involve the abnormal anatomy of the brain or biochemical disorders – improper transmission of signals between brain cells.
  • Environmental factors – include all the impacts of man from the environment in which he lives. In the search for the causes of mental illnesses negative life events, pathological family relationships, abnormal social situations in the environment wider than the family, the impact of psychoactive substances and consequences of acquired injuries are taken into account.

There are signs that stress may play a role in causing a mental illness. Apart from reactive psychoses which are, by definition, diseases emerging in response to the active stress, stress is considered to be a factor for the manifestation of a mental illness. In schizophrenia, stress is considered to be one of the factors likely to cause symptoms of psychosis, for example, in the case of a person with genetically inherited psychosis.

Methods of treatment

Of course, they are, but the results of treatment are dependent to a large extent on the type of disease, on the time when its treatment is administered as well as on the consequences of the conduct of its treatment. For example, in schizophrenia, when the treatment is properly conducted, about 60% of the patients achieve such improvement of their health that they can function both socially and professionally. For 20 – 30% schizophrenia ends at the first and the only episode.
The fact that in about 60 – 80% of cases the patients who have abandoned the continuation of treatment after the resolution of the acute psychotic episode relapse within a year shows how a consistent treatment is important.
It is to be noted that schizophrenia is a chronic disease and that the persons affected by it are susceptible to the occurrence of its symptoms throughout their lives. Long-term treatment reduces the risk of its relapse.
The prognosis for other mental illnesses is even harder; their courses are different in each case, and, in practice, it is difficult to determine whether the resulting health improvement is a permanent recovery or a periodic improvement only before the next episode of a given illness. In each case, it is necessary to work closely with a psychiatrist.

Pharmacological treatment, or drug therapy, is the most important method of treating mental illnesses.
Essential medications used in their treatment are called neuroleptics. Their function is to restore the proper chemical balance of the brain. The main task of neuroleptics consists in adjusting the biotransformation of the cerebral relay – dopamine. .
It is the irregularities in the economy of dopamine that are responsible for the occurrence of psychosis. There are many products used in the treatment of mental disorders, and their wealth results from very different reactions to these medications. The selection of the right medication for individual patients is the basis of success in the treatment of a given disease. The medication must often be selected by trial and error. You cannot get discouraged if a particular product does not prove to be effective or will have troublesome side effects. The doctor will certainly choose a medication that will cause the withdrawal of symptoms and along with good tolerance.
In addition to neuroleptics, antidepressants, sedatives and mood stabilizers are also used in the treatment of psychoses.

Failure to take medications is the primary cause why the treatment of mental disorders fails. There are several reasons why patients stop taking medications.
First, patients often have no sense of their disease and do not believe they need medical treatment . Second, if the patient under psychosis once felt subjectively bad, but now he feels better , he then comes to the conclusion that he has made a full recovery and there is no point in any further treatment. Third, patients give up taking medications because of their side effects which can be very unpleasant for them.

The most commonly reported side-effects experienced by patients as extremely bothersome are symptoms of suppressing cognitive functions and the so-called “ extrapyramidal symptoms”. The first of them consist in the deterioration of memory, concentration, drowsiness and reflexes, the sense of suppressing and weakening intellect activities.
Extrapyramidal symptoms are muscle stiffness, depletion of facial expressions, slowness of movement, restlessness, involuntary muscle contractions and involuntary movements.
The occurrence or absence of symptoms of these two groups are usually decisive for interrupting or continuing medication by the patient, but these are not the only symptoms. Among other symptoms are constipation, decreased visual acuity, sensitivity to the sun, skin rashes, blood pressure drops, dry mouth or excessive salivation, sexual disorders and menstrual disorders, as well as increased body weight

Of course not. The vast majority of the side effects mentioned in the leaflet accompanying the medication occurs sporadically. Others may prove a little cumbersome for the patient.
Even in the event of certain side effects, the patient and his psychiatrist always decide whether the benefits of taking the medication outweigh the nuisance of its side effects. If this balance is unsuccessful, it is possible to change the medication.
Sometimes it is necessary to try several drugs before one of them turns out satisfactory for both parties. This requires a lot of patience and confidence to a psychiatrist. The role of the psychiatrist is also to alert the patient that some of the adverse psychological phenomena, taken by the patient for signs of side effects of the medication, are symptoms of his disease. This applies, for example, to weakness, lack of energy, depressed mood, poorer concentration and memory.

There are no ideal cures. In spite of the appearance of more and more new antipsychotic medications, which are often accompanied by the press comments on the permanent solution of the problem of mental illnesses, the same medications have been used for decades. This is because these disorders are diseases of very individual courses and each patient differently responds to medications. Both the antipsychotic effect and side effects caused by the same medication can be very different for different patients.
There are, of course, medications whose main side effects are definitely smaller – they are called. atypical neuroleptics. They differ from classical neuroleptics in having a minimal effect on the extrapyramidal system and thus do not produce the most troublesome side effects.
Another important characteristic of atypical neuroleptics is that they also affect the negative symptoms of mental illnesses. Patients taking these medications are more likely to get rid of symptoms of their illness (the so-called remission).
Thanks to the use of atypical neuroleptics, there are no negative symptoms of psychosis, and there is also some improvement in negative symptoms which have already had time to develop.
A growing group of patients are now treated with atypical neuroleptics. Owing to them patients can properly function socially, professionally and in their families.

The greatest chance for the patient creates a combination of medication with psychotherapy, in which the patient is given psychological support through a conversation. It helps not only patients but also their families who, because of illness, suffer deep psychological discomfort. This support includes education on the symptoms of the disease, the ways of dealing with them, and information about treatment options, etc..
A collective form of such support are made by psychoeducational groups in which patients, their families and all interested individuals can share their experiences in dealing with the disease. Apart from their own experiences, group members also receive comprehensive and clear information about the disease.
Most patients require rehabilitation to help them return to their social environment and families, decide on their further fate, e.g. their place of residence or a change of career. Patients often need apprenticeship to financial management, training social skills, such as e.g. how to behave in social and professional situations. Rehabilitation also includes workshops of occupational therapy meant to maintain their activity and initiative. Another useful form of therapy in mental illnesses is family therapy which involves the whole family- as a primary system in which the patient lives.

It is always an individual matter. For example, in schizophrenia and related psychoses it is a general principle to administer a medication for a year or two after the abatement of the first psychotic episode. After the second episode this period is five years long, and after the subsequent exacerbations of psychosis, treatment should be long-lasting, or even of unlimited duration.
Bipolar disorder requires an intensive treatment of antidepressing or antimaniacal nature depending on the phase, whereas between the exacerbations a treatment stabilizing the patient’s mood. After the expiry of their pathogens, reactive psychoses do not generally require maintenance therapy after the abatement of symptoms.

Of course, they can. Considering the prevalence of mental illnesses, we can be sure that a number of people we encounter in everyday life are being treated for mental disorders. Since we do not notice their difference, it means they do not differ from healthy people.
Most mental illnesses, not even treated ones, are characterized by exacerbations separated by periods of improvement, during which the functioning of these people is completely normal. Nowadays a psychiatric treatment allows for long-lasting abatement of symptoms – remission, or improvement in mental status, and the illness is often limited to a single psychotic episode. There is no reason whatsoever not to let a person whose therapy is successful play all the family and social roles.