What is a Psychiatrist and what to expect from a psychiatric assessment

What is a Psychiatrist?

A Psychiatrist is a physician who took a degree in Medicine and Surgery, which usually lasts 6 years, and then did training in Psychiatry, which usually lasts for another 5-6 years. Psychiatry is a branch of medicine dedicated to the diagnosis, prevention, study, and treatment of mental disorders.

 

What is the difference between Psychiatrists and Psychologists?

I am aware that many people get Psychiatrists and Psychologists confused with each other. It is important to highlight that both Psychiatrists and Psychologists have knowledge of how the brain works, and have an understanding of our emotions, feelings and thoughts.

To summarise:

  • Psychiatrists attend medical school and become medical doctors before doing specialist training in mental health. They have a good understanding of the links between mental and physical health and, as doctors, can prescribe medications. Psychiatristscan provide a wide range of treatments, including psychotropic medications, general medical care, and brain stimulation therapies such as electroconvulsive therapy (ECT).
  • Psychologistsattend University where they study Psychology, which lasts for at least 5 years. During those years they also do some training and get supervised experience. They may also hold a Masters or Doctorate level qualification in Psychology. If they have a Doctorate (PhD), Psychologists can call themselves ‘Dr’, but they are not medical doctors.  Psychologists focus on providing psychological treatments, commonly called “talking therapy”, which can be of different types, such as counselling, CBT, CAT, psychodynamic therapy, etc.

 

What should I expect from my Psychiatric assessment?

A first psychiatric interview can probably generate some anxiety, especially if we do not know what it is all about. We probably imagine weird things happening in a psychiatric setting and this post has the aim of clarifying and explaining how a psychiatric assessment works.

Prior to attend the appointment, a discussion with the General Practitioner may be useful. GPs need to be involved in the treatment plan. If asked, they are usually willing to write a referral letter where they summarise the main symptoms that a person is experiencing. Having a referral would allow me to get a better and immediate understanding of the problems we want to deal with and would also facilitate regular correspondence between the General Practitioner and myself.

I commence the meeting by introducing myself, my role and explaining the nature of the interview. During the interview, I usually take some notes so that I can keep track of the topics discussed in the most faithful way possible.

It is utterly important to start building a therapeutic relationship since the very first beginning of the consultation. The person who takes part in the assessment needs to feel understood, valued and supported. At the same time, he/she needs to be able to understand each part of the meeting and to feel comfortable with participating fully in the process of the consultation.

I usually proceed by asking information about social circumstances, such as family, accommodation arrangements, personal relationships, work, hobbies and plans for the future.

We then discuss the concerns or the issues that brought the person to my attention. The symptoms that are most commonly discussed are related to anxiety, mood, thinking and behaviour, eating, sleeping, and drug and alcohol use. It is important to discuss if these symptoms have an impact on daily activities and if they affect the ability to function.

In many cases relatives, friends, and partners are able to help describing some symptoms from an external point of view. In other cases, they bring up symptoms that had not been previously identified. For these reasons, I strongly encourage inviting them to the interview whenever possible.

Once we have gone through the symptoms, we then discuss a bit of the personal history, such as childhood, education, previous jobs, and previous relationships. Often, more than one member of the family experiences psychiatric symptoms. Therefore, investigating on family history for mental disorders plays a crucial role in the assessment. I will be also asking about physical issues and concomitant medical treatments.

The following step will be to agree the appropriate diagnosis and make a treatment plan. Throughout the consultation I will be aiming to enable the person to understand the decision making process, and to get him/her involved in the decisions to the level they wish. I will explain my professional opinion in a simple and clear way and I will address doubts and concerns when expressed.

We will be exploring management options. If medical treatment is suggested, we will go through options available, we will discuss how medications work and possible side effects. I will be offering suggestions and choices, encouraging people to contribute with their own ideas so that a joint decision can be reached.

In light of the fact that physical health has a crucial role in the person’s wellbeing, it is likely I will suggest performing blood tests, and other investigations such as ECG and, occasionally, brain scans.

We will be finishing our meeting by agreeing whether and when we should meet up again.

After the appointment, I will write a letter that I will send to the person’s GP and I will send a copy of the letter to the person so that things can always be open and transparent and people are able to keep records of our meetings.

 

 

Image by Nicoletta Ceccoli