Can psychiatrists read your mind?

Elderly lady in training posted a comment on 2009/04/09 at 3:41am.

A question for you as a psychiatrist.    To my complete surprise my brother suffered an acute episode of paranoia recently and is currently an inpatient in a psychiatric hospital. His wife has left him with the children – which was possibly what brought on the attack. So with his wife out of the picture it falls to me to help him continue his recovery when he leaves hospital. Yesterday my brother and I had a meeting with his treating psychiatrist.

As well as talking about my brother’s future, I couldn’t help thinking – good heavens – this man is a psychiatrist – what is he going to make of *me* – will he some me up in a flash and spot all my oddities and see me as a patient about to happen? Even – how do I portray myself as “normal”?

I guess I am not alone in wondering this sort of thing about psychiatrists. Are you as a group all-seeing, all-knowing? What quirks do we “normal” people give away without realizing it? What do you see as we fumble over our words, wriggle in the chairs, hesitate, avoid eye contact or whatever? Is this the kind of thing that trainee psychiatrists take about at dinner parties? i.e. what people give away about themselves? I’d love to hear your views as a person – a friend even – who happens to be a psychiatrist.

Part of doing a psychiatric evaluation is the same as what any observant individual would do. A professional detective can detect most of the listed items below as well as many observant individuals. Many people pick up on these clues and aren’t even aware that they are doing it. Probably the main difference is that a psychiatrist is more keenly aware of what some of these cues mean.

We do not read minds, feelings and others’ thoughts. This takes training and work and are elicited during a psychiatric interview and may take many sessions with an individual to clearly obtain from the individual.

I’ve always been amused whenever I’ve attended a social function or a party. When speaking with someone, it is common to discuss what we all do for a living. I’ve tried to just say that I’m a physician in order to not ‘scare’ someone away. Many people settle for this, but there are others who enquire about “what specialty do you practice?” OK, you’ve asked for it. When told, the typical and usual response is, “Oh. I better watch what I say. Are you analyzing me? Are you reading my mind? Am I crazy, etc?” My usual response is, “Oh, just relax. Analyzing takes work and I’m not at work now. I’m just relaxing and enjoying myself, etc.” They usually don’t linger with me very long.

However, since we, like all other observant people, do read and pick up on the following very easily just because we do it all day long. So it becomes 2nd nature to do it. After a period of time, I’ve just done it so routinely that I’m not even aware that I’m doing it. I make no attempts to read anything into it though.

Here are some of the clues and cues we all show to others:

Does the person seem to know where he/she is?

What the general time of day it is as well as knowing who they are. Those with dementia often fall short on these as well as anyone ‘stoned or high’ on drugs/alcohol.

What kind of movements do they show?

gestures Restless, agitated, slow, pacing, immobile, hyperactive, gestures, mannerisms, posture, tics, gait, paralysis, tremors, gait, limp, shuffle, twitches, compulsive movements and rigidity

What is their attitude and behaviors?

sad face Cooperative, resistive, sociable, reserved, seclusive, belligerent, negativistic, suspicious, apathetic, fearful, confident, over-confident, sarcastic, act superior, depression, elation, euphoria, anger, anxiety, fear, composed, complacent, irritable, happy, elated, exalted, boastful, self-satisfied, distant, aloof,  indifferent, apathetic, dissociated, perplexed, anxious or tense, calm, panicked, seductive, playful, ingratiating, friendly, interested, attentive, frank, indifferent, evasive, defensive, hostile, Alert, dull, stuporous, smiling, crying, blank, mask-like facial expression

How do they dress? Their personal hygiene? Overall appearance?

face Obese, over-weight, under-weight, emaciated, hair — bizarre style, unnatural, color, unshaven, wounds, scars, tattoos, jewelry, glasses, dental braces, disheveled, soiled, body odor, halitosis, dress, overdressed, bizarre dress, neatness and the appropriateness of his appearance; his apparent and real age. Clothes —  tidy, slovenly, neat, careless, dirty, decorative, mourning. Do they appear sex appropriate — androgynous, masculine, feminine

What is their speech like?

Rapid, slow, hesitant, whispering, shy, humorous, screaming, mumbling, loud, soft, whisper, overly talkative, intelligibility, slurred, stutters, accented, hesitant, emotional, monotonous, unspontaneous

speech

 

Remember, we all show some of these general behaviors, attitudes, movements and speech patterns to the world. So, not to worry. However, it might explain why we tend to gravitate to some people and others we want to avoid. Psychiatrists are trained, however, not to allow his/her feelings interfere with helping someone seeking professional help.

I hope this helps!       Bottom line. Just be yourself.

 

Warmly………David

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Part 1 — Why do psychiatrists need to study other aspects of medicine – anatomy, the digestive system, the urinary system, etc?

human-anatomy

I don’t remember who made this comment but I thought it would make for a good post topic. I won’t give an in depth medical school explanation of what the various disease and conditions are. What I’m listing is by no means complete. They are just some of the reasons why psychiatrists need to have a medical background.

“By the way – there’s absolutely no need to respond to my 1-31-2009 comment. I do have another question though – why do psychiatrists need to study other aspects of medicine – anatomy, the digestive system, the urinary system etc? Does a knowledge of how the body works – and malfunctions – physically, have much bearing on the work of a psychiatrist? I’m just curious – please don’t bother to reply unless you feel like it. Other readers of your blog might enlighten me.”

A psychiatrist is a physician who specializes in the diagnosis, treatment, and prevention of mental illnesses and substance use disorders. He or she must graduate from college and then medical school, and go on to complete four years of residency training in the field of psychiatry. (Many psychiatrists undergo additional training so that they can further specialize in such areas as child and adolescent psychiatry, geriatric psychiatry, forensic psychiatry, psychopharmacology, and/or psychoanalysis.) This extensive medical training enables the psychiatrist to understand the body’s functions and the complex relationship between emotional illness and other medical illnesses. The psychiatrist is thus the mental health professional and physician best qualified to distinguish between physical and psychological causes of both mental and physical distress.” Psychiatrists’ medical background, training and experience allow them – under state licensing laws – to prescribe medication, and order and interpret medical tests. These procedures are essential for the appropriate diagnosis and treatment of mental disorders, just as they are for all other medical illnesses. Psychiatrists are also uniquely qualified to approach care and treatment from a therapeutic, as well as a medical, foundation.

  1. Many physical disorders can cause psychiatric symptoms similar to those characterizing mental disorders.
  2. There are exterior natural factors, like medication (therapeutic or illegal) and other chemical substances that can too cause psychiatric symptoms. (covered in Part 2)
  3. The physical diseases related to the manifestation of psychiatric symptoms can be separated in brain disorders and general or systematic disorders even though in reality these two categories overlap.

General diseases with psychiatric symptoms

  • Diseases from vitamins deficiency and excessive vitamin intake (pellagra, deficiency B1, deficiency B12, low vitamin A and D, along with many others)
  • Endocrine disorders (Cushing’s syndrome, hyperthyroidism, hypothyroïdism, Addison’s disease, pheochromocytoma , hyperparathyroidism, hypoparathyroidism, hypopituitarism)
  • Drugs and toxic substances
  • Infections (Syphilis, Malta fever, glandular fever, HIV infection and others)
  • Metabolism disorders (hepatic insufficiency, electrolyte disorders, uremia, acute intermittent porphyria, multiple sclerosis

psychiatric-symptomsIn Part 2, I will discuss in more detail several psychiatric symptoms of physical disorders such as brain disorders, schizophrenic symptoms, anxiety, depression, sexual dysfunction and mania. I’ll also give a list of some common prescription and over the counter medications which can cause or exaggerate psychiatric symptoms.


Warmly………David

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What is the difference between a Psychiatrist and a Psychologist?

“Elderly Lady in Training” commented that she had some difficulty rating the blog. She didn’t realize that the comment which you entered had to be verified vía your email. This prevents spammers going in and making false positive or negative ratings. I missed that part too. So I went back and checked. Sure enough, this is what it says:   Your e-mail address is used only for verification purposes only and will not be sold, or shown publicly.

The more I think about it, I like the idea of verification. You’d be surprised to know that since I started the blog, there have been 1752 spammers trying to make comments about the blog. 95% of them either take you to an XXX rated site using foul sexually explicit language or trying to sell things such as Viagra, etc. I almost approved one of the XXX comments last week. To think that you would have seen that on the blog………Lord have mercy!

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I started working on the Boys and Sports logic puzzle. So far, so good.

One of the most popular question I have received from people during my medical career is this.


What’s the Difference Between a Psychologist and a Psychiatrist?

By Kendra Van Wagner, About.com

It’s an important difference to understand, whether you are a student of psychology or a consumer searching for a mental health provider. The terms “psychologist” and “psychiatrist” are often used interchangeably to describe anyone who provides therapy services. While psychologists and psychiatrists both conduct psychotherapy and research, there are significant differences between the two professions.

Education, Training, and Credentials

The simple answer is that a psychiatrist is a medical doctor, while a psychologist is not. Educational background is the most obvious difference between psychiatrists and psychologists.

Psychologists receive graduate training in psychology and pursue either a Ph.D. or Psy.D. in clinical or counseling psychology. Doctorate programs typically take five to seven years to complete and most states require an additional one or two year long internship in order to gain licensure. Other states require an addition year or two of supervised practice before granting full licensure.

The title of “psychologist” can only be used by an individual who has completed the above education, training, and state licensure. Informal titles such as “counselor” or “therapist” are often used as well, but other mental health care professionals such as licensed social workers can also claim these titles.

Psychiatrists are physicians to have specific training in the assessment, diagnosis, treatment, and prevention of mental illnesses. Psychiatrists attend medical school and receive an M.D. After completing medical training, they complete an additional four years of residency training in mental health. In addition to this, some receive additional training in a specific area of interest such as geriatric psychiatry, child and adolescent psychiatry, addictions and other areas.

Prescribing Medications

A second important distinction between the two careers is that psychiatrists can prescribe medication, while psychologists cannot. There has been a recent push to grant prescribing powers to psychologists, with states such as New Mexico and Louisiana now allowing psychologists to write prescriptions after consulting with a psychiatrist.

Which is Better?

If you are considering a career as a therapist, you will need to determine which career path is best for you. Are you interested in conducting psychotherapy, administering psychological tests, and conducting research? If so, a career as a psychologist may be the best choice for you.

If you have an interest in medicine and want to be able to prescribe medications to your patients, a career in psychiatry might be your ideal choice. If you don’t want to invest five to eight years in graduate training, consider pursuing a career as a licensed social worker or counselor, which typically requires two or three years of graduate study. Psychiatric nursing is another great career option for students interested in medicine. Advanced Psychiatric Nurses hold a Master’s degree or higher in psychiatric-mental health nursing and are able to assess patients, diagnose disorders, provide psychotherapy and prescribe medications.


Fettucine Alfredo is macaroni and cheese for adults.

Warmly………David

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