The Differences between Psychology and Psychiatry

Basic & General

It’s ridiculous, because I’ve been asked by a psychology graduate about how to become a psychiatrist after completing her psychology undergraduate degree, from a top local university.

What?? Are you sure that you completed a psychology degree without even knowing that though both are in mental health field and both can provide therapy services, but psychologists and psychiatrists follow completely different routes?

The most distinctive difference lies in our educational backgrounds. The psychiatrists have a degree in medicine (and after becoming a so-called GP/doctor they further on become specialized in psychiatry) whereas the psychologists receive postgraduate or doctorate training in psychology after their undergraduate (usually) psychology degree.

The second most obvious difference especially in our day-to-day practice is that the psychologists do not (and are not allowed, unless received certain training) prescribe medicine whereas the psychiatrists do.

N.B. In fact there could still be a lot of differences in things that they do and don’t, clients they see and don’t etc, but I’m only pointing out the most distinctive ones here.

 

精神科医生 (psychiatrists)念完了医科 (medical degree) 再去攻读精神专科 (psychiatry) 或心理医科 (psychological medicine), 所以他们可以用药配药, 而心理学家 (psychologists) 则没有医药背景, 所以不能配药. 普遍两者都常被称为心理医生, 但是其实心理学家不具医学资格, 所以不能被称为医生 (doctor), 一般可以直接以先生 (Mr.), 女士 (Ms./ Mdm)或小姐 (Miss) 称呼.

心理治疗师 (psychotherapist) 一般是指进行心理治疗 (psychotherapy) 的心理学家 (psychologists),但是也有些精神科医生 (psychiatrists) 也受训进行心理治疗.

所以如果你问, 刚念完了心理学学士 (psychology degree), 要如何成为精神科医生 (psychiatrist) 呢? 两者走的是完全不同的训练路线. 唯一的答案, 就是去念医学学士(medical degree), 在专攻精神 专科, 虽然心理学的知识不会作废, 但其实成为精神专科医生, 与你的心理学学士没有直接关系.

A supposed-to-be successful and inspiring insurance agent

Clinical Case Studies, Depression

He became a millionaire in his early 30s, although primarily an insurance agent, he was known with his skills in investing. He had a wife and a daughter. They went on holidays all over the world every year.

In his mid thirties, he got depressed and suicidal, due to stress of work and some other problems. He attempted suicide several times, buying ropes to hang himself, overdosing himself on drugs but was always found early enough to save his life. Perhaps this wasn’t how his life meant to be.

His family took him to temples, hoping that the power of religion could help him to recover. They were told that the money he’d earned was “dirty money” (money obtained unlawfully or immorally). So by instructions, he went to China and donated almost all his money to the temples. At this point, the wife left him. He got even more depressed, he didn’t recover donating his money away.

Recommended by friends, he seek professional help and came to see psychiatrists. After weeks of medications and a course of ECTs, he got better. On the following years, his condition was maintained with medication. He would come to see doctor once he felt unwell. He rebuilt his career and became wealthy again. He even supported his ex-wife financially, although he also soon got married with another woman. Over the years he had had another 2 courses of ECT at times of difficulty.

He even went on press to talk about mental illness. He shared his stories including his suicidal attempts and helped raising the mental health awareness in the public, telling others not to discriminate them, but also encouraging those with mental illness not to give up, motivating them to seek help actively, telling them it’s recoverable, and they have the opportunities to lead a normal and fulfilling life just like him and anyone else!

He wasn’t just a normal successful insurance agent, but also one of the most motivating and inspiring speakers in the town.

Years later, in his mid 40s, he got into some troubles. This time he didn’t come back to see doctor, he checked himself in a hotel, jumped off from the window of the washroom in his hotel room. There ended his colourful short life.

People may think someone as motivating as him couldn’t and shouldn’t end his life that way, but it’s based on a true story. When the illness hits, it really hits, no matter who you are and what you are. Perhaps for cases like this, maintaining on medication and education on relapses are utmost important, including educating patient’s immediate family.

Tips for Succeeding in Your OCD Treatment

Basic & General, Obsession & Compulsion, Treatment Approaches

Adapted from Fred Penzel, PhD “25 Tips for Succeeding in Your OCD Treatment” (to make it more suitable and applicable to Asian culture)

  1. Always expect the unexpected. You can have an obsessive thought at any time or any place. Don’t be surprised when old or even new ones occur. Be prepared to use your therapy tools at any time, and in any place. Also, if new thoughts appear, be sure to tell your therapist so you can keep them informed.
  2. Be willing to accept risk. Risk is an integral part of life, and as such it cannot be completely gotten rid of. Remember that not recovering is the biggest risk of all.
  3. Never seek reassurance from yourself or others. Instead, tell yourself the worst will happen, is happening, or has already happened. Reassurance will cancel out the effects of any therapy homework you use it on and prevent you from improving. Reassurance-seeking is a compulsion, no matter how you may try to justify it.
  4. Never analyze, question, or argue with obsessional thoughts. The questions they raise are not real questions, and there are no real answers to them.
  5. Try to not be a black-and-white, all-or-nothing thinker — don’t tell yourself that one slip up means you are now a total failure. The good news is that you are in this for the long haul, and you always get another chance. It is normal to make mistakes when learning new skills, especially in therapy. It happens to everyone now and then. Accept it. Even if you have a big setback, don’t let it throw you. Remember the saying, “A lapse is not a relapse.” This means that you never really go back to square one. To do that, you would have to forget everything you have learned up to that point, and that really isn’t possible. Also remember the sayings, “Never confuse a single defeat with a final defeat,” (F. Scott Fitzgerald).
  6. Remember that dealing with your symptoms is your responsibility alone. Don’t involve others in your therapy homework (unless your therapist tells you to) or expect them to push you or motivate you. They won’t always be there when you need them, but YOU are always there for YOU.
  7. Don’t get too impatient with your progress, or compare yourself to someone else. Everyone goes at their own pace. Instead, try to simply focus on carrying out each day’s therapy homework, one day at a time.
  8. When you have a choice, always go toward the anxiety, never away from it. The only way to overcome a fear is to face it. You can’t run away from your own thoughts, so you really have no choice but to face them. If you want to recover, you will have to do this.
  9. When faced with two possible choices of what to confront, choose the more difficult of the two whenever possible.
  10. If your therapist gives you an assignment you don’t feel ready to do, you can speak up and tell them so. As half of the therapist–patient team, you should be able to have a say in your own therapy. The goal is for the homework to produce some anxiety for you to get used to tolerating — not to overwhelm you with it and cause you a setback. On the other hand, don’t be afraid to stretch yourself a bit whenever you can.
  11. Don’t wait for the “perfect moment” to start your therapy homework assignments. Procrastination is a feature of many people’s OCD, so start your therapy homework assignments the day you get them. The perfect moment is whenever you begin doing them. When starting the homework immediately isn’t applicable or possible, at least plan an exact date and time to start it.
  12. Don’t be side-tracked by perfectionism. Perfectionism can be another feature of OCD. You may find your OCD telling you that if you don’t do your homework perfectly, you won’t recover. If you do find yourself obsessing about having to do your homework perfectly, you risk turning it into another compulsion. Watch out for having to do your homework according to the same rigid rules each time you do it. Also, don’t do your homework so excessively that it takes up your whole day. Remember that you still have a life to live.
  13. Don’t forget to go back to the old homework assignments you have done and materials you’ve read before. Don’t assume that you know them all and will not forget them.
  14. Give your homework your full attention, focus on what you are doing, and let yourself feel the anxiety. Try to not let yourself tune out when doing certain assignments, so that you don’t have to feel the anxiety. People sometimes let the homework become routine and do it in a very automatic way as a kind of avoidance. Also, don’t do homework while carrying out other distracting activities. You are building tolerance to what you fear, and for that to happen you have to be in the moment with it.
  15. When faced with a challenging assignment or an unexpected challenging situation, try to look at it as a positive. View it as another opportunity to get better instead of saying, “Oh, no. Why do I have to do this?” Instead tell yourself, “This will be good for me — another chance to practice and get stronger.”
  16. Try to not rush through your therapy homework so that you don’t have to feel as much anxiety. Take your time, and see if you can view it in terms of all the good it will do you. Getting it over with as quickly as possible is not the goal — raising a moderate level of anxiety and staying with it is the goal.
  17. If your homework doesn’t really give you any anxiety, tell your therapist about it. If your exposure homework doesn’t cause at least some anxiety, it isn’t going to help you that much. On the other hand, try doing all new assignments for at least a week before deciding that they don’t make you anxious. Some assignments can cause reactions later on, and it may take doing them a few times before the anxiety occurs.
  18. It is sometimes possible for OCD to try to make you doubtful about your homework. It may tell you that you are not in the right treatment, that your assignments cannot possibly make you better, or that you really don’t understand what you are doing and won’t be able to make it work. Remember that OCD was known as the Doubting Disease, and it will try to cast doubt on anything that is important to you. Don’t try to argue, analyze or question it, just continue what you have to do and over time you’ll find the answers.
  19. Never forget that you have OCD. This means that you will not always be able to trust your own reactions or the things you think and feel, especially if they seem to be telling you very negative and extreme things. If you are unsure if something is really a symptom, treat it as a symptom. Better to do a bit more exposure than not enough.
  20. Remember that in OCD, the problem is not the anxiety — the problem is the compulsions. If you think the anxiety is the problem, you will only do more compulsions to get rid of it (which will only create more anxiety). If you recognize that the compulsions are the problem, stop doing them, and stay with the fearful situation, then the anxiety will eventually go away as you build up tolerance.
  21. Always take a moment to be proud of your own efforts and recognize your successes. It’s a good way to help keep up your motivation. Look back at earlier assignments that are no longer challenging if you believe you aren’t making progress.
  22. Overall, never forget that OCD is very paradoxical and rarely makes much sense. The things that you thought would make you better only make you worse, and the things you thought would make you worse are the very things that will make you better.

Mental Health: Truth-Telling VS Information Withholding

Basic & General, Issues & Debates

Should patients with mental health issues and their family members be noticed and explained about everything on their mental illness, diagnosis, treatments etc?

For Truth-Telling:

  • Most patients want to know. Studies found that most patients would want to know everything about their illness. Though not so sure what happens when they really discover “everything”.
  • Make informed decision and consent possible. Only when the patients know the full story that they can make a personally meaningful decision.
  • Building trust. If the doctor intendedly hides some information or lie to the patient and the patient finds out later, the patient will less likely to trust the doctor.
  • Lying is impractical. Chances are at some points patients are going to find out more through other people or means.
  • Avoid incorrect information found. When patients aren’t told enough about their illness or treatment, they may search for it themselves (e.g. google it) and find some information that may not be irrelevant or applicable to them.
  • Patients feel respected. Clinicians can always explicitly ask for patients’ preference.

 

For Information Withholding:

  • When everything was explained to patients/family, they may not accept the truth, lose hopes or become demoralised (e.g.” Chances are you may need to depend on medicine for the rest of your life”).
  • Some patients may deliberately state that they do not want to know more.
  • Patients become too mentally disturbed after knowing the truth that they harm themselves.
  • Patients/family feel stigmatized, being labelled as e.g. “schizophrenic”, “manic”, “mentally ill”
  • Family giving up their support to the patient knowing that it’s a long journey.

Brief Psychotic Disorder

Clinical Case Studies, Schizophrenia & Psychotic Disorder

It’s approaching Chinese New Year and it’s this time of the year where Chinese Restaurants are at their busiest period, whether it’s for reunion dinners, company year-end party, annual dinner or casual friends and relatives gathering dinners.

She’s in her 30s, a manager in one of a big Chinese Restaurants. Past few nights she hasn’t been sleeping well, under great stress and worrying about the bookings, menus, dishes, prices, ingredients, staff, part time staff etc. After few nights of poor sleep and poor performance at work in the day, one afternoon her family found her not gone to work but crying and laughing at the same time in her room, at times screaming, and at times talking about things that they can’t understand.

Her husband and mother admitted her into the general hospital, where she was put under anti-psychotic medication and injection. Though a lot more stable and spending more time in bed, she’s still screaming and at times talking nonsense. She then started to experience some side effects from the medication and injection, drooling, tremor, stiffness.

Upon discharge from the GH, the husband decided to bring her to see us. She has to come in in a wheelchair, still drooling and having stiffness, still screaming and non-responding.

She’s believed to have Brief Psychotic Disorder, triggered by great stress from work. There’s no history of mental illness running in her family. More about the illness on wikipedia here. It’s kind of difficult to believe that people actually get psychotic disorder just merely due to stress (oh well, what can stress not do!), it’s more usual depression or anxiety disorder.

So, well, guys and girls, do make sure you are aware of how much your body and mentality can take, not to put yourself under too great stress (hard!), and more importantly, always find healthy ways to de-stress yourself (e.g. exercise, hobbies, movies, outings with friends etc)!

A doctor who can’t doctor

Anxiety Disorder, Clinical Case Studies, Obsession & Compulsion

A doctor (noun, a person), who can’t doctor (verb, to treat).

She’s on her 4th year of medical degree when she first came to the clinic with her parents. Once treated for OCD many years ago, she had recovered from it with some medication and never had any problem causing much distress since then.

She is brilliant academically since young, doing so well on most of the papers in the uni now. Now it’s towards the end of her medical degree, the problem rises.

The parents found that she’s always studying, doing revisions – but she’s already done so well and that’s not even the most important things to do now, as they should start with practices, attending to patients on the wards. She slowly disclosed that she is very afraid of meeting people, especially seeing patients. Her mind is occupied with herself misdiagnosing patients and failing to treat patients. So she wants to revise more, learn more about the theories (a good example of safety seeking behaviours – doing something to relieve her fear in the short-term, but in long-term what she does further reinforce what she couldn’t do – seeing patients).

The parents aren’t quite sure what to do. They don’t care if their daughter can never become a doctor, it’s not important, as long as she’s happy. But now her fear is killing her confidence, and they’re still hoping that she can at least complete the degree (and plan what to do subsequently, e.g. teaching, doing research etc). She doesn’t seem to be able to cope to complete her degree.

The parents can give her a gap year, “but the more she rests, does it mean the harder she can ever practice again?”.

“We can push her. But we don’t want her to think we’re forcing her then start to avoid us or lose trust in us.”

The parents were advised that what’s most important now is not whether or not she can become a doctor, whether she can graduate, but whether she can conquer the fear, have the courage and go for her practices despite the obsessional thoughts that she may fail. (Something that Acceptance and Commitment therapy could do, I’m kind of interested to know whether ACT can do better than CBT in this case.)

It is definitely not going to be easy, in fact it could be a long journey till she can manage that, but everything that can make that possible should be done.