ClinicalClinical PsychologistsPsychologists and Psychiatristsand Psychiatrists

How They Work Together to Produce Better How They Work Together to Produce Better OutcomesOutcomes

Simone PicaSimone PicaChief Psychologist –The Melbourne ClinicChief Psychologist –The Melbourne Clinic

Areas to be Covered:Areas to be Covered:

Clinical Psychologists and Psychiatrists - Clinical Psychologists and Psychiatrists - Health ProvidersHealth Providers

The Melbourne Clinic- The Treatment The Melbourne Clinic- The Treatment SettingSetting

Onset of Mental Disorders and typesOnset of Mental Disorders and types How we work together- Treatment How we work together- Treatment

Specialisations, Assessment,Treatment Specialisations, Assessment,Treatment Planning, Provision of Treatment and Planning, Provision of Treatment and Ongoing Challenges Ongoing Challenges

Clinical PsychologistsClinical Psychologists Psychologists are specialists in human Psychologists are specialists in human

behaviour, development and functioning. They behaviour, development and functioning. They have expertise in conducting research and have expertise in conducting research and applying research findings in order to reduce applying research findings in order to reduce distress, address behaviour and psychological distress, address behaviour and psychological problems, and to promote good mental health. problems, and to promote good mental health.

Today, most psychologists tend to specialise in Today, most psychologists tend to specialise in one or more areas. To date the APS has 9 one or more areas. To date the APS has 9 colleges including; Clinical Neuropsychology; colleges including; Clinical Neuropsychology; Clinical Psychology. Couselling Psychology, Clinical Psychology. Couselling Psychology, Educational Psychologists and Forensic Educational Psychologists and Forensic Psychologists Psychologists

Of these specialties, Clinical Psychologists are Of these specialties, Clinical Psychologists are trained to work with people with mental disorderstrained to work with people with mental disorders

IN brief, Clinical Psychologists are specialists in IN brief, Clinical Psychologists are specialists in the assessment, diagnosis and treatment of the assessment, diagnosis and treatment of psychological problems and mental illness.psychological problems and mental illness.

They work with children, adolescents, adults They work with children, adolescents, adults and the elderly in a range of agencies including and the elderly in a range of agencies including public and private hospitals, private practice andpublic and private hospitals, private practice and general medical servicesgeneral medical services

Skills and Competencies of Clinical Skills and Competencies of Clinical PsychologistsPsychologists

1. Psychological assessment and 1. Psychological assessment and diagnosisdiagnosis

Clinical psychologists have specialist Clinical psychologists have specialist training in the assessment and diagnosis training in the assessment and diagnosis of major mental illnesses and of major mental illnesses and psychological problems. Clinical psychological problems. Clinical psychologists are qualified to provide psychologists are qualified to provide expert opinion in clinical, compensation, expert opinion in clinical, compensation, educational and legal jurisdictions.educational and legal jurisdictions.

Clinical Psychologists cont.Clinical Psychologists cont.

2. Treatment2. Treatment Clinical psychologists are trained in the delivery Clinical psychologists are trained in the delivery

of a range of (non-drug) techniques, strategies of a range of (non-drug) techniques, strategies and therapies with demonstrated effectiveness and therapies with demonstrated effectiveness in treating mental health disorders. They are in treating mental health disorders. They are specialists in applying psychological theory and specialists in applying psychological theory and scientific research to solve complex clinical scientific research to solve complex clinical problems requiring individually tailored problems requiring individually tailored interventions.interventions.

3. Research, teaching and evaluation3. Research, teaching and evaluation

PsychiatristsPsychiatrists

Psychiatrists are specialist medical doctors who Psychiatrists are specialist medical doctors who diagnose and treat mental disorders. diagnose and treat mental disorders.

Qualifying as a psychiatrist involves first Qualifying as a psychiatrist involves first obtaining a medical degree and then obtaining a medical degree and then undertaking a minimum of 5 years’ undertaking a minimum of 5 years’ postgraduate specialisation in psychiatry. postgraduate specialisation in psychiatry.

The nature of their training means that The nature of their training means that psychiatrists have a strong grounding in psychiatrists have a strong grounding in both biological and psychological both biological and psychological frameworks for understanding mental frameworks for understanding mental disorders. They are trained both to disorders. They are trained both to recognise and treat the effects of recognise and treat the effects of emotional disturbances on the body as a emotional disturbances on the body as a whole, as well as the effects of physical whole, as well as the effects of physical conditions on the mind conditions on the mind

Differences between Clinical Differences between Clinical Psychologists and PsychiatristsPsychologists and Psychiatrists

A A Psychiatrist is required to complete a medical Psychiatrist is required to complete a medical degree prior to specialising in mental disorders degree prior to specialising in mental disorders including biological conditions (psychiatrists are including biological conditions (psychiatrists are physicians)physicians)

A Psychiatrist can prescribe medication; a A Psychiatrist can prescribe medication; a Clinical Psychologist cannot. Clinical Psychologist cannot.

Clinical Psychologists have specialist training in Clinical Psychologists have specialist training in non-medical interventions (psychological) and non-medical interventions (psychological) and work closely with Psychiatristswork closely with Psychiatrists

Psychiatrists should be able to provide Psychiatrists should be able to provide biological, psychological and social treatmentsbiological, psychological and social treatments

The Melbourne Clinic – The The Melbourne Clinic – The Treatment SettingTreatment Setting

The Melbourne Clinic (TMC) is a purpose built The Melbourne Clinic (TMC) is a purpose built psychiatric hospital established in the 1970’s psychiatric hospital established in the 1970’s and was initially privately owned by a group of and was initially privately owned by a group of psychiatrists. Since 1985 it has been managed psychiatrists. Since 1985 it has been managed by Healthscope Limitedby Healthscope Limited

TMC is the largest and longest established TMC is the largest and longest established private psychiatric hospital in Australia. It has private psychiatric hospital in Australia. It has 106 beds, well over 100 accredited psychiatrists 106 beds, well over 100 accredited psychiatrists and employs a multi-disciplinary team including and employs a multi-disciplinary team including psychiatrists, nurses, psychologists, social psychiatrists, nurses, psychologists, social workers, occupational therapists and dieticiansworkers, occupational therapists and dieticians

Inpatient Programs - TMCInpatient Programs - TMC TMC provides a comprehensive range of inpatient TMC provides a comprehensive range of inpatient

and day programs as well as an outreach programand day programs as well as an outreach program The Inpatient Programs include:The Inpatient Programs include: General Psychiatry (Living Well Program group General Psychiatry (Living Well Program group

interventions)interventions) Intensive Psychiatric CareIntensive Psychiatric Care Older Person’s Psychiatry UnitOlder Person’s Psychiatry Unit Professorial UnitProfessorial Unit Anxiety and Depression ProgramAnxiety and Depression Program Obsessive Compulsive Disorder ProgramObsessive Compulsive Disorder Program Eating Disorders ProgramEating Disorders Program Substance Withdrawal ProgramSubstance Withdrawal Program

Day Programs - TMCDay Programs - TMC

The Day Programs Include:The Day Programs Include: Life strategies programLife strategies program Sills-based Psychosocial ProgramSills-based Psychosocial Program Anxiety Day Treatment Program Anxiety Day Treatment Program Depression Management ProgramDepression Management Program Managing Bipolar Disorder ProgramManaging Bipolar Disorder Program Mindfulness Based Cognitive TherapyMindfulness Based Cognitive Therapy Dialectical Behaviour Therapy ProgramDialectical Behaviour Therapy Program Eating Disorders ProgramEating Disorders Program Outreach Program -The outreach program provide Outreach Program -The outreach program provide

assessment, support, rehabilitation and treatment in their assessment, support, rehabilitation and treatment in their own home and local communityown home and local community

Onset of Mental DisordersOnset of Mental Disorders

One in 5 Australians will suffer from a mental One in 5 Australians will suffer from a mental disorder at some point in their lives. disorder at some point in their lives. 

A mental disorder is a health problem that A mental disorder is a health problem that significantly affects how a person thinks, significantly affects how a person thinks, behaves and interacts with other people and behaves and interacts with other people and functions in their daily life. functions in their daily life.

Mental disorders are diagnosed according to Mental disorders are diagnosed according to standardised criteria. One of the major wordwide standardised criteria. One of the major wordwide classificatory systems is the Diagnostic and classificatory systems is the Diagnostic and Statistical Manual of Mental Disorders (DSM Statistical Manual of Mental Disorders (DSM

What causes Mental Disorders?What causes Mental Disorders?

Mental illness results from complex interactions between Mental illness results from complex interactions between the mind, body and environment.the mind, body and environment.

Factors which can contribute to mental disorders are:Factors which can contribute to mental disorders are: Biological factorsBiological factors Including genetics, neurochemistry, diseases of the Including genetics, neurochemistry, diseases of the

brain, physical illness drugs affecting the brain (use of brain, physical illness drugs affecting the brain (use of alcohol, drugs and other substances ), alcohol, drugs and other substances ),

Psychological factorsPsychological factors Including cognitive styles such as constant negative Including cognitive styles such as constant negative

thoughts about the self and the world, personality styles thoughts about the self and the world, personality styles including avoidance, low self esteem and confidence, including avoidance, low self esteem and confidence, poor coping styles and poor problem solving approaches poor coping styles and poor problem solving approaches

What Causes Mental Disorders What Causes Mental Disorders cont.cont.

Social factorsSocial factors Including life events, long-term and acute stress in all Including life events, long-term and acute stress in all

areas of one’s life (e.g. personal. family, work, areas of one’s life (e.g. personal. family, work, relationships, financial), trauma, violencerelationships, financial), trauma, violence

Work stress is categorized under social factors. Apart Work stress is categorized under social factors. Apart from major physical injuries and exposure to or from major physical injuries and exposure to or involvement in a traumatic event, patients often report involvement in a traumatic event, patients often report work stress as the significant contributing factor which work stress as the significant contributing factor which was an ongoing event which wasn’t addressed nor was an ongoing event which wasn’t addressed nor resolved. resolved.

Common examples include harassment, bullying, little or Common examples include harassment, bullying, little or no supervision or training, work overload, poor no supervision or training, work overload, poor communication/support or difficulties with communication/support or difficulties with managers/supervisors. managers/supervisors.

Types of Mental DisordersTypes of Mental Disorders

Mental disorders are of different types and Mental disorders are of different types and degrees of severity. Some of the major degrees of severity. Some of the major types of mental disorders include:types of mental disorders include:

DepressionDepression Bipolar DisorderBipolar Disorder Anxiety DisordersAnxiety Disorders Schizophrenia Schizophrenia Drug and Alcohol DisordersDrug and Alcohol Disorders

Mood DisordersMood DisordersDepressionDepression

The term depression is used to describe feelings The term depression is used to describe feelings of sadness and grief, which many people of sadness and grief, which many people experience at some stage. experience at some stage.

Reactive Depression - depression in response to Reactive Depression - depression in response to a distressing event, such as bereavement, a distressing event, such as bereavement, relationship breakdown or loss of a job. The relationship breakdown or loss of a job. The feelings are more severe or persistent than feelings are more severe or persistent than normal unhappiness and symptoms often normal unhappiness and symptoms often include anxiety, sleep problems and changes in include anxiety, sleep problems and changes in eating habits. eating habits.

Mood Disorders cont.Mood Disorders cont. Endogenous or Major Depression - more severe Endogenous or Major Depression - more severe

than in reactive depression and than in reactive depression and there may or may there may or may not be a triggering event.not be a triggering event.

Symptoms include sleep disturbance, appetite or Symptoms include sleep disturbance, appetite or weight changes, sadness or irritability, loss of weight changes, sadness or irritability, loss of interest in work or hobbies, loss of sexual interest, interest in work or hobbies, loss of sexual interest, fatigue, poor concentration, difficulty making fatigue, poor concentration, difficulty making decisions, guilt and poor self-esteem or suicidal decisions, guilt and poor self-esteem or suicidal thoughts. Symptoms are persistent and severe thoughts. Symptoms are persistent and severe and may leave the person unable to function or and may leave the person unable to function or care for themselvescare for themselves. .

Mood Disorders cont.Mood Disorders cont.

Bipolar Mood DisorderBipolar Mood Disorder (previously called (previously called Manic Depression) - extremes in mood, Manic Depression) - extremes in mood, with periods of depressed mood with periods of depressed mood alternating with periods of mania. The alternating with periods of mania. The manic phase may involve extreme manic phase may involve extreme happiness, overactivity, rapid speech, happiness, overactivity, rapid speech, reduced need for sleep, a lack of reduced need for sleep, a lack of inhibition, irritability with those who inhibition, irritability with those who question them, and grandiose plans and question them, and grandiose plans and beliefsbeliefs

Anxiety DisordersAnxiety Disorders Anxiety refers to the physical, mental and Anxiety refers to the physical, mental and

behavioural changes we feel in response to a behavioural changes we feel in response to a threat. threat.

These changes are sometimes referred to as the These changes are sometimes referred to as the 'fight or flight' response, because they prepare 'fight or flight' response, because they prepare us to respond to danger. us to respond to danger.

Some anxiety is inevitable in today's society and Some anxiety is inevitable in today's society and in many situations it is an appropriate and in many situations it is an appropriate and reasonable response. Anxiety disorders are reasonable response. Anxiety disorders are different from 'everyday' anxiety in being more different from 'everyday' anxiety in being more intense and persistent, to a degree which intense and persistent, to a degree which interferes with a person's life. interferes with a person's life.

Anxiety Disorders cont.Anxiety Disorders cont.

• • Panic attack - a sudden feeling of panic Panic attack - a sudden feeling of panic associated with physical symptoms like: associated with physical symptoms like: shortness of breath, dizziness, chest pain, shortness of breath, dizziness, chest pain, an urge to flee, difficulty gathering an urge to flee, difficulty gathering thoughts, fear of dying or losing control thoughts, fear of dying or losing control

Some anxiety disorders include panic Some anxiety disorders include panic disorder, agoraphobia, phobiasdisorder, agoraphobia, phobias

Anxiety Disorders cont.Anxiety Disorders cont. Obsessive-Compulsive Disorder - a person Obsessive-Compulsive Disorder - a person

experiences obsessions (persistent, unwanted experiences obsessions (persistent, unwanted thoughts) and compulsions (being driven to thoughts) and compulsions (being driven to perform a ritual or behaviour) and causes perform a ritual or behaviour) and causes disruption to their everyday life. disruption to their everyday life.

• • Generalised Anxiety Disorder - excessive Generalised Anxiety Disorder - excessive general worry and anxiety and is very difficult for general worry and anxiety and is very difficult for the person to control. the person to control.

• • Post-traumatic Stress Disorder (PTSD) - Post-traumatic Stress Disorder (PTSD) - recurrent feelings of terror, frightening dreams or recurrent feelings of terror, frightening dreams or relived memories which result from a previous relived memories which result from a previous traumatic event memories or flashbacks may be traumatic event memories or flashbacks may be triggered by a particular event and are intrusive, triggered by a particular event and are intrusive, interfering with everyday life. interfering with everyday life.

SchizophreniaSchizophrenia Schizophrenia is characterised by unusual or bizarre Schizophrenia is characterised by unusual or bizarre

thoughts and emotions that others consider thoughts and emotions that others consider inappropriate. Schizophrenia is not a 'split inappropriate. Schizophrenia is not a 'split personality‘. The term refers to changes in the personality‘. The term refers to changes in the person's mental and social functioning, when their person's mental and social functioning, when their thoughts and perceptions become disordered. thoughts and perceptions become disordered.

Symptoms of schizophrenia include hallucinations, Symptoms of schizophrenia include hallucinations, delusions and problems with feelings, behaviour, delusions and problems with feelings, behaviour, motivation and speech. People may have motivation and speech. People may have disorganised thoughts and difficulty concentrating. A disorganised thoughts and difficulty concentrating. A collection of such symptoms is sometimes termed collection of such symptoms is sometimes termed psychosis, and can occur in other disorders as well, psychosis, and can occur in other disorders as well, for example in severe depressive illnessesfor example in severe depressive illnesses

Substance Use DisordersSubstance Use Disorders People with substance use disorders have People with substance use disorders have

generally taken one or more drugs of abuse over generally taken one or more drugs of abuse over an extended period, and are showing various an extended period, and are showing various behavioural, physical and psychological behavioural, physical and psychological symptoms. symptoms.

People may develop substance use disorders for People may develop substance use disorders for a number of reasons, such as anxiety or a number of reasons, such as anxiety or depressive disorders, a family history of depressive disorders, a family history of substance abuse, being prone to the effects of substance abuse, being prone to the effects of stress and tension, or experiencing psychosocial stress and tension, or experiencing psychosocial problems (e.g. work stress, family problems, and problems (e.g. work stress, family problems, and relationship breakdown). Addiction may have relationship breakdown). Addiction may have both physiological and psychologicalboth physiological and psychological componentscomponents

Overview of Psychological and Overview of Psychological and Medical TreatmentsMedical Treatments

Psychological TreatmentsPsychological Treatments Psychotherapy is a useful treatment for may Psychotherapy is a useful treatment for may

mental disorders including depression and mental disorders including depression and anxiety disorders anxiety disorders

There are many types of psychotherapies There are many types of psychotherapies including Cognitive Behavioural Therapy (CBT) including Cognitive Behavioural Therapy (CBT) which is an evidence based treatment that has which is an evidence based treatment that has been evaluated and proven to be effective. been evaluated and proven to be effective.

Historically, this treatment was viewed as two Historically, this treatment was viewed as two separate therapies which today are used in separate therapies which today are used in combination to treat mental disorders combination to treat mental disorders

Psychological Treatments cont.Psychological Treatments cont. Cognitive Therapy- the aim of cognitive therapy Cognitive Therapy- the aim of cognitive therapy

is to help individuals realise that they can is to help individuals realise that they can influence their emotions by identifying and influence their emotions by identifying and changing their thoughts and beliefs.changing their thoughts and beliefs.

when people are depressed, for example, they when people are depressed, for example, they often think very negative thoughts about often think very negative thoughts about themselves, their lives and the future. This in themselves, their lives and the future. This in turn further worsens their mood. turn further worsens their mood.

Cognitive Therapy focuses on discovering and Cognitive Therapy focuses on discovering and challenging unhelpful assumptions and beliefs challenging unhelpful assumptions and beliefs and developing balanced thoughts, more and developing balanced thoughts, more realistic, rational ones realistic, rational ones

Psychological Treatments cont.Psychological Treatments cont. Behaviour Therapy focuses often maladaptive Behaviour Therapy focuses often maladaptive

behaviours that occur during an episode of mental behaviours that occur during an episode of mental disorder. disorder.

BehaviourBehaviour therapy aims to identify and change therapy aims to identify and change aspects ofaspects of behaviour behaviour that may perpetuate or that may perpetuate or worsen a person’s mental disorder. worsen a person’s mental disorder.

Some behavioural strategies include skills Some behavioural strategies include skills training, goal setting, activity scheduling and training, goal setting, activity scheduling and structured problem solvingstructured problem solving

These 2 therapies, more commonly known as These 2 therapies, more commonly known as CBT, have been found to be effective either on CBT, have been found to be effective either on their own for certain disorders or in combination their own for certain disorders or in combination with psychiatric medicationswith psychiatric medications

Psychiatric MedicationsPsychiatric Medications Psychiatrists are experts in prescribing and Psychiatrists are experts in prescribing and

monitoring psychiatric medications. monitoring psychiatric medications. Medications are the cornerstone of treatment for Medications are the cornerstone of treatment for

most mental disorders. Medications will alleviate most mental disorders. Medications will alleviate or ease symptoms for most people. The ongoing or ease symptoms for most people. The ongoing use of medications will assist in stabilising use of medications will assist in stabilising symptoms and preventing relapse.symptoms and preventing relapse.

Medications have both desired effects (e.g. Medications have both desired effects (e.g. reducing symptoms) and undesired effects reducing symptoms) and undesired effects commonly called side effects (e.g. drowsiness). commonly called side effects (e.g. drowsiness).

The aim is to find medications that are tolerable The aim is to find medications that are tolerable and have the least number of side effects as well and have the least number of side effects as well as effectively reducing symptoms. Adherence to as effectively reducing symptoms. Adherence to medications is much more likely when it is clear medications is much more likely when it is clear that the benefits of taking the medication that the benefits of taking the medication outweigh the costs. outweigh the costs.

Psychiatric Medications cont.Psychiatric Medications cont. A feature of most psychiatric medications is that they A feature of most psychiatric medications is that they

may only begin to have a beneficial effect over several may only begin to have a beneficial effect over several weeks. It is useful for the psychiatrist to provide weeks. It is useful for the psychiatrist to provide information about information about

• • The name of the medication, what it is supposed to The name of the medication, what it is supposed to do, and when it should begin to take effect;do, and when it should begin to take effect;

• • How it is taken and for how long this might be How it is taken and for how long this might be necessary;necessary;

• • Any food, drinks, other medicines the person should Any food, drinks, other medicines the person should avoid while taking this medication;avoid while taking this medication;

• • Possible side effects and what should be done if they Possible side effects and what should be done if they occur;occur;

• • Sources of information about this medication (e.g. Sources of information about this medication (e.g. pamphlets).pamphlets).

Medications for DepressionMedications for Depression These are used for treating symptoms of depression, such These are used for treating symptoms of depression, such

as persistent sadness, hopelessness, poor appetite, as persistent sadness, hopelessness, poor appetite, insomnia, lack of energy, difficulty in concentrating and insomnia, lack of energy, difficulty in concentrating and diminished interest in usually pleasurable activities. diminished interest in usually pleasurable activities.

Selective serotonin reuptake inhibitors are most commonly Selective serotonin reuptake inhibitors are most commonly prescribed because of their safety and tolerability. prescribed because of their safety and tolerability.

Selective serotonin re-uptake inhibitors (SSRIs)Selective serotonin re-uptake inhibitors (SSRIs) Generic nameGeneric name Common brand names Common brand names citalopram citalopram Cipramil, Celapram, Talam, Talohexal Cipramil, Celapram, Talam, Talohexal escitalopram escitalopram Lexapro Lexapro fluoxetinefluoxetine Genrix, Fluohexal, Lovan,Genrix, Fluohexal, Lovan,

Prozac, ZactinProzac, Zactin FluvoxamineFluvoxamine Faverin, Luvox, Movox Faverin, Luvox, Movox paroxetine paroxetine Aropax, Oxetine, PaxetineAropax, Oxetine, Paxetine sertralinesertraline Xydep, Zoloft Xydep, Zoloft

Mood StabilisersMood Stabilisers Medications for mood disorderMedications for mood disorder Mood stabilizers are medicines that reduce the Mood stabilizers are medicines that reduce the

symptoms of acute manic and depressive symptoms of acute manic and depressive episodes. They also prevent the recurrence of episodes. They also prevent the recurrence of mania and depression in bipolar disordermania and depression in bipolar disorder

when taken regularly over an extended period of when taken regularly over an extended period of time. time.

Generic name Generic name Common brand namesCommon brand names carbamazepine carbamazepine Tegretol, TerilTegretol, Teril lithium carbonatelithium carbonate Lithicarb, Quilonum SR Lithicarb, Quilonum SR sodium valproate sodium valproate Epilim, ValproEpilim, Valpro

Medications for Anxiety Medications for Anxiety DisordersDisorders-anxiolytic medications-anxiolytic medications

They are also useful in helping to manage They are also useful in helping to manage agitation. Some are used to help people to agitation. Some are used to help people to sleep.sleep.

Antidepressant medications, particularly the Antidepressant medications, particularly the SSRIs, are used to treat a range of anxiety SSRIs, are used to treat a range of anxiety disorders without the tolerance and dependence disorders without the tolerance and dependence problems associated with benzodiazepines problems associated with benzodiazepines (Valium and drugs like it). (Valium and drugs like it).

Benzodiazepine medicationsBenzodiazepine medications Generic name Generic name Common brand namesCommon brand names AlprazolamAlprazolam Kalma, Xanax AlpraxKalma, Xanax Alprax DiazepamDiazepam Atenex, Ducene, ValiumAtenex, Ducene, Valium lorazepam lorazepam AtivanAtivan oxazepam oxazepam Alepam, Murelax, SerapaxAlepam, Murelax, Serapax

Antipsychotic MedicationsAntipsychotic Medications

Medications for psychosisMedications for psychosis Antipsychotic medications are used for treating Antipsychotic medications are used for treating

schizophrenia,schizophrenia, schizophreniform psychosis, schizoaffective schizophreniform psychosis, schizoaffective

disorder, substance induced psychosis and disorder, substance induced psychosis and other conditions where psychotic symptomsother conditions where psychotic symptoms

(ie. hearing voices, hallucinations disorganised (ie. hearing voices, hallucinations disorganised thinking orthinking or

delusional ideas) are present.delusional ideas) are present.

Antipsychotic medications cont.Antipsychotic medications cont.

Atypical antipsychotic medicationsAtypical antipsychotic medications Generic name Common brand namesGeneric name Common brand names AmisulprideAmisulpride Solian Solian AripiprazoleAripiprazole Abilify Abilify clozapine clozapine Clozaril,ClopineClozaril,Clopine olanzapineolanzapine Zyprexa Zyprexa

Working Together –The Assessment and Working Together –The Assessment and Management of Mental DisordersManagement of Mental Disorders

1.To engage the patient in the treatment 1.To engage the patient in the treatment process from the initial stage, beginning with process from the initial stage, beginning with the initial interview. Failure to do so often the initial interview. Failure to do so often results in an incomplete assessment which will results in an incomplete assessment which will then limit how management should proceedthen limit how management should proceed

2.To conduct a thorough psychiatric, 2.To conduct a thorough psychiatric, psychological, social and medical assessment psychological, social and medical assessment (including a suicide assessment) (including a suicide assessment)

3. Decide where the patient should be treated, 3. Decide where the patient should be treated, in hospital or the community and give a in hospital or the community and give a thorough explanation to the patient if they need thorough explanation to the patient if they need to be hospitalisedto be hospitalised

4.To provide education and support for the 4.To provide education and support for the individual and family individual and family

5.To treat the mental disorder, e.g. depression 5.To treat the mental disorder, e.g. depression and associated depressive features with and associated depressive features with psychiatric medication and CBT psychiatric medication and CBT

6.To address and improve overall behavioural 6.To address and improve overall behavioural functioning and always aim to treat the person functioning and always aim to treat the person for return to their employment for return to their employment

7.To monitor the person’s condition and work 7.To monitor the person’s condition and work toward preventing relapse or recurrence of their toward preventing relapse or recurrence of their mental disordermental disorder

2. The Assessment2. The Assessment What are the sign and symptoms of the What are the sign and symptoms of the

illness?illness? What is the risk of self-harm, or harm to What is the risk of self-harm, or harm to

others?others? How disabling is the illness?How disabling is the illness? The individual’s general level coping and The individual’s general level coping and

functioningfunctioning Is their any evidence of a previous or Is their any evidence of a previous or

ongoing mental disorder?ongoing mental disorder? Whether there is any family history of Whether there is any family history of

mental disordersmental disorders

The Assessment cont.The Assessment cont. Whether there were any triggers to the disorder, and Whether there were any triggers to the disorder, and

if there were, what was their meaning to the individualif there were, what was their meaning to the individual If there were triggers, did they entirely cause the If there were triggers, did they entirely cause the

mental disorder, or did they trigger or worsen the mental disorder, or did they trigger or worsen the person’s exisiting conditionperson’s exisiting condition

The nature of family or friendship supportsThe nature of family or friendship supports Their personality style Their personality style Their drug and alcohol historyTheir drug and alcohol history Whether there are any relevant medical problemsWhether there are any relevant medical problems What is their understanding/explanation of their What is their understanding/explanation of their

current condition?current condition?

Clinical Psychologists’ AssessmentsClinical Psychologists’ Assessments A well know test which is used worldwide is the A well know test which is used worldwide is the

MMPIMMPI The MMPI is composed of 567 true/false items. The MMPI is composed of 567 true/false items.

Personality inventories like the MMPI are Personality inventories like the MMPI are intended to discover what the individual is like as intended to discover what the individual is like as a person. A number of areas are assessed by a person. A number of areas are assessed by the MMPI to answer such questions as: "Who is the MMPI to answer such questions as: "Who is this person and what would they typically feel, this person and what would they typically feel, think and behave? What psychological problems think and behave? What psychological problems and disorders are relevant to this person right and disorders are relevant to this person right now?“ “What is the prognosis likely to be and now?“ “What is the prognosis likely to be and what difficulties will they experience in their what difficulties will they experience in their recovery” recovery”

Psychiatrists’ AssessmentsPsychiatrists’ Assessments

Psychiatrists must perform a medical Psychiatrists must perform a medical assessment in addition to the psychiatric assessment in addition to the psychiatric interview. Various test and investigations interview. Various test and investigations are used to determine if there is a medical are used to determine if there is a medical problem causing/contributing to the mental problem causing/contributing to the mental disorderdisorder

Some tests includeSome tests include relevant special relevant special investigations bloods, ECG, CT or MRI investigations bloods, ECG, CT or MRI scansscans

3. Where should the person be treated?3. Where should the person be treated?

Most people prefer not to go to hospital and the Most people prefer not to go to hospital and the majority of the time people can be treated in the majority of the time people can be treated in the community. community.

In some instances hospitalisation will be both In some instances hospitalisation will be both necessary and beneficial. Especially if the necessary and beneficial. Especially if the person cannot guarantee their safety of if they person cannot guarantee their safety of if they are seriously unwell and are unable to care for are seriously unwell and are unable to care for themselves without assistance. themselves without assistance.

People may also be admitted to hospital for People may also be admitted to hospital for specialised medical and psychological specialised medical and psychological treatments. treatments.

4. Psychoeducation and Support for the Family4. Psychoeducation and Support for the Family

The main goal of education is to facilitate The main goal of education is to facilitate understanding about the disorder and its understanding about the disorder and its management:management:

A mental disorder is an illness, not a sign of A mental disorder is an illness, not a sign of weakness. Recovery is the rule, not the weakness. Recovery is the rule, not the exception. exception.

Treatment is effective and there are many Treatment is effective and there are many treatment options available.treatment options available.

The goal of treatment is to get well and minimise The goal of treatment is to get well and minimise relapse. relapse.

4.Psychoeducation and Support for 4.Psychoeducation and Support for the Family cont.the Family cont.

Treatment options (i.e., psychotherapy, Treatment options (i.e., psychotherapy, medication) and relevant information about medication) and relevant information about each alternative (e.g., side effects, each alternative (e.g., side effects, duration, costs). duration, costs).

Recognising and acting upon early Recognising and acting upon early warning signswarning signs

Managing ongoing stressful problems that Managing ongoing stressful problems that directly impact on recovery directly impact on recovery

5. Medical and Psychological treatments in 5. Medical and Psychological treatments in combinationcombination

The essential features of the management of The essential features of the management of most mental disorders involve physical most mental disorders involve physical treatments and/or psychotherapy. Physical treatments and/or psychotherapy. Physical treatments involve the administration of treatments involve the administration of psychiatric medication. Psychotherapy includes psychiatric medication. Psychotherapy includes CBT.CBT.

The choice of psychiatric medication is based on The choice of psychiatric medication is based on a number of factors but is best made in a number of factors but is best made in consultation with specialist psychiatric opinion. consultation with specialist psychiatric opinion.

Individuals who are depressed or anxiously show a style Individuals who are depressed or anxiously show a style of thinking that focuses on negative views of the world, of thinking that focuses on negative views of the world, themselves as individuals, of their experiences, and of themselves as individuals, of their experiences, and of their future. They come to think of themselves as their future. They come to think of themselves as worthless and of the world as being a bad or unfair worthless and of the world as being a bad or unfair place, without hope of their lives improving in the future. place, without hope of their lives improving in the future.

Some classic irrational beliefs which depressed or anxious people Some classic irrational beliefs which depressed or anxious people believe include: believe include: I will never get better, If I were a better/smarter I will never get better, If I were a better/smarter person this would never had happened to me, I won’t be able to person this would never had happened to me, I won’t be able to cope when I return to work, People don’t won’t to be with me cope when I return to work, People don’t won’t to be with me because I am crazy, nothing can help me, If I did things perfectly because I am crazy, nothing can help me, If I did things perfectly then everything would be OKthen everything would be OK

The aim of cognitive therapy is to help individuals The aim of cognitive therapy is to help individuals identify, challenge or test their belief and correct their identify, challenge or test their belief and correct their distorted and negatively-biased thoughts with a more distorted and negatively-biased thoughts with a more reasonable and realistic thought. reasonable and realistic thought.

Cognitive TherapyCognitive Therapy

6. 6. Improving Behavioural FunctioningImproving Behavioural Functioning

In addition to tackling the symptoms of mental disorders, In addition to tackling the symptoms of mental disorders, the challenge to a full recovery often relies on the person the challenge to a full recovery often relies on the person being able to pick up and carry on at the level they did being able to pick up and carry on at the level they did before becoming unwell.before becoming unwell.

Mental disorders lead to a decline in functioning where Mental disorders lead to a decline in functioning where the person may not be able to look after themselves as the person may not be able to look after themselves as well as they did before, stop them form returning to work, well as they did before, stop them form returning to work, a general slowing in their performance of activities and a general slowing in their performance of activities and avoidance of family and friends. avoidance of family and friends.

It is vital to monitor and tackle these problems from the It is vital to monitor and tackle these problems from the beginning which can get worse over time and the beginning which can get worse over time and the individual struggles enormously to overcome.individual struggles enormously to overcome.

Behavioral strategies are vitally important in addressing Behavioral strategies are vitally important in addressing these problems by addressing what problems the these problems by addressing what problems the individual is experiencing and planning how to tackle individual is experiencing and planning how to tackle them. them.

6. Improving Behavioural Functioning cont.6. Improving Behavioural Functioning cont. Patients will often show signs of getting worse when Patients will often show signs of getting worse when

faced with ongoing stressors such making claims for faced with ongoing stressors such making claims for their work injuries which is a painful and protracted their work injuries which is a painful and protracted process. process.

Ongoing therapy and skills training (e.g. dealing with Ongoing therapy and skills training (e.g. dealing with difficult situations, maintaining good physical health, difficult situations, maintaining good physical health, exercise, learning how to communicate and assert exercise, learning how to communicate and assert oneself more effectively, overcoming inactivity, planning oneself more effectively, overcoming inactivity, planning activities in advance, engaging in pleasant events with activities in advance, engaging in pleasant events with other people) are all important strategies. other people) are all important strategies.

Monitoring the use of poor coping strategies is also Monitoring the use of poor coping strategies is also important such as the use of drugs and alcohol, not important such as the use of drugs and alcohol, not taking medications regularly, missing appointments taking medications regularly, missing appointments

Improving the individual’s ability to function is important Improving the individual’s ability to function is important to avoid demoralization and the person giving up to avoid demoralization and the person giving up

7. Preventing Relapse 7. Preventing Relapse

Ongoing treatment involves the identification of Ongoing treatment involves the identification of conditions where the person may relapse or conditions where the person may relapse or have a set back. In general the following need have a set back. In general the following need to be monitored and addressed by the to be monitored and addressed by the patient’s Clinical Psychologist and Psychiatristpatient’s Clinical Psychologist and Psychiatrist

The first step is to The first step is to identifyidentify high risk situations. high risk situations. These situations may include :relationship These situations may include :relationship break-ups, moving house, illness, or financial break-ups, moving house, illness, or financial and status losses e.g.loss of a job, loss of a and status losses e.g.loss of a job, loss of a rolerole

7. Preventing Relapse cont.7. Preventing Relapse cont. It is vital to help the person plan how they can respond It is vital to help the person plan how they can respond

most effectively in these situations. One aim of planning most effectively in these situations. One aim of planning is to encourage individuals to realise that they can cope is to encourage individuals to realise that they can cope with these situations if they do indeed occurwith these situations if they do indeed occur

As with many mental disorders it is likely that some As with many mental disorders it is likely that some individuals will be able to identify changes in their individuals will be able to identify changes in their thoughts, feelings, or behaviours which may signify that thoughts, feelings, or behaviours which may signify that they are becoming unwell again. By being aware of early they are becoming unwell again. By being aware of early warning signs and acting immediately on these signs it warning signs and acting immediately on these signs it may be possible for the individual to decrease the may be possible for the individual to decrease the potential severity and duration of the episode.potential severity and duration of the episode.

Ongoing adherence to medication and psychological Ongoing adherence to medication and psychological treatment is likely to minimise relapse treatment is likely to minimise relapse