Practical problems in treating psychiatric disorders

Now that so many of the most common psychiatric disorders are fairly well understood and have proven and effective treatments, you might think that treating them is fairly simple.

Unfortunately, even today there are a number of factors that tend to complicate things and present practical problems in the diagnosis and treatment of even the most common conditions.

A big obstacle in the treatment of psychiatric disorder is stigma. This affects things when people refuse to admit that they may be experiencing a psychiatric disorder. Perhaps they still don’t acknowledge that problems like depression or anxiety actually constitute medical illnesses or they might simply be too embarrassed to consider these possibilities in themselves.

Obviously, it is difficult to treat someone who doesn’t believe they have a problem.

Lack of information is also a very common issue in the treatment of psychiatric conditions. People often don’t recognize that they have a disorder – particularly if they experience something lifelong such as anxiety or depression. If the person has always felt the same, it is difficult to realize that there is any other way to feel.

Difficulty in accessing mental health resources is another problem faced by people attempting to get treatment for a psychiatric illness. I will discuss this further in next week’s column.

Of course, aside from these logistical factors complicating treatment, the very symptoms that need treatment can cause obstacles in themselves. For example, someone with social anxiety disorder is fearful of evaluation and authority figures and typically has a very difficult time going to a doctor and discussing the problem. Support and encouragement from a trusted family member or friend is often needed.

Individuals with generalized anxiety disorder worry about everything including medical treatments. Any side effect that has ever been recorded will likely loom large for these individuals and they often believe they will be the unlucky one in 50,000 to get the rare but serious adverse effects. These individuals may be unable to bring themselves to accept any risk at all and there is no treatment – psychological or pharmacological – with zero risk attached to it.

Aside from sadness and desperation, depressed people typically lack motivation and energy and often cannot get themselves to make an appointment or keep one once it is made. Feelings of hopelessness or worthlessness may also cause these individuals to believe they don’t deserve to be helped and they don’t want to waste the doctor’s time.

On the other end of the mood spectrum, individuals experiencing a manic episode of bipolar disorder don’t think they need any treatment. These people feel as though they’re on top of the world and believe everyone else has a problem.

Those with attention deficit disorder are forgetful and disorganized and even if an appointment is made, they often forget to keep it. After failing to show up for several appointments, doctors may refuse to see them.

Conditions that are very obvious to observers – such as those causing psychotic delusions and hallucinations are also difficult. Although everyone around them can see there is a mental health problem, the individuals experiencing the symptoms usually don’t have the insight to realize the psychosis is an illness. Many times these individuals are only brought in for treatment when their symptoms are causing a public disturbance or they have become a danger to themselves or others.

In many cases, the solution to these practical barriers is the help and support of a family member or friend. Of course, this can only occur with the patient’s agreement and in cases where the affected individual has someone they trust enough to include in treatment.

Young people wishing for independence sometimes resent family involvement and refuse to be assisted. Other times, families give up on the sick individual by taking the position that it is not their responsibility to deal with the problem, it is none of their business or they blame the patient for their lack of motivation and initiative.

In all cases, I encourage friends and family to be as supportive and encouraging as they can be and for the individuals experiencing the psychiatric condition to acknowledge their problem and be proactive in seeking help.

Barriers to treatment can be overcome and you can experience relief from symptoms that are disrupting your life. Don’t give up.


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