The aim of the treatment in psychiatry means to improve the quality and lengthening of life, so it must be oriented towards healing and secondary prevention: the reduction of socially unacceptable behaviors or the disappearance of symptoms do not constitute “healing.”
Moreover, with this approach the knowledge and techniques of psychiatry can be applied to the improvement of performance (sports, study, learning new subjects).
What are examples of inappropriate use of psychiatric care in which the goals of treatment have not been identified and shared?
1. Sedation, reduction of vigilance
Recent studies have highlighted that the patient must try to maintain the best possible contact with his or her environment to develop the best collaboration and the most accurate monitoring of subjective conditions.
Still, the patients who come to the first visits often complain of feeling sedated. This happens, unfortunately, because the treatments were prescribed at a time when the primary concern of the doctor was to mitigate the state of agitation of the patient. So, the doctor used medicines to achieve a sedative effect.
Sedation is never recommended, even when psychotic disorders present themselves: the goal should be the reduction of psychotic symptoms and not the reduction of vigilance or motor slowdown.
The use of medicines deliberately directed to obtain these soporific, sedative effects belong to the past.
Even today, unfortunately, sleep treatment or narcotherapy, the so-called rapid tranquilization with sedation, continues to be practiced on psychiatric patients. We know perfectly well that these practices have no scientific basis.
2. Untimely termination of treatment
Unfortunately, after the first improvement of the condition, many patients discontinue a therapy without agreeing to the ways and times with the professional who prescribed it. That the old symptoms reappear - in a more severe form – often happens in these cases; or new symptoms arise which are more difficult to treat: the dreaded relapse.
Behind every disorder there exists a vulnerability of the system that physicians may control or perhaps cancel only by maintaining adequate protection over time.
It would take much more time and effort to restore the dysfunction after relapse.
Treating oneself and overcoming the acute phase of the disease are the first goals to be achieved, but these effects are not sufficient to define a “cure.”
Often the patient's request is to return to his healthy state, the way it was before the disease. The disease leaves a painful mark that many would like to erase.
But going back to the way it was before can also mean reverting to the condition of previous fragility, the same state that led to the disorder.
Following the suggestions of the World Health Organization (WHO), the goal becomes more important, and the critical moment of the disorder must become an opportunity to know oneself, to learn more about the pitfalls of the disease, so as to commit oneself to changing one's vulnerable behavior.
It becomes essential to build, together with the doctor, a new awareness, a new style, a new balance that protects the individual as much as possible from relapse.
Healing as an objective. Is it possible?
Healing, for a large percentage of patients, posits a certain goal; thus, the WHO indicates healing as the real goal of treatment. The treatment should not only let one out of the acute phase of the emergency but start the patient again towards a new life.
How to achieve healing?
First, let us define “recovery.” The American Psychiatric Association defines “recovery” this way:
Being cured, therefore, does not mean that one should no longer take medication or cease Psychotherapy or Neuromodulation Therapies. It is not merely a point of arrival, but a process of change aimed at improving the quality of life.
Many people feel confused about this “cure” aspect, and already in the acute phase of the disorder would like to aim, as a primary goal, to stop the treatment with medicines or to stop the therapies. In other cases, they may approach the specialist with the illusion that everything can be solved after a single medical visit.
The ”single visit” scenario does not work because the disappearance of the symptom alone does not coincide with the disappearance of the disease.
Effective therapies rebalance the functioning of brain circuits that are malfunctioning; but, even after the remission of the symptom - even partial – the patient and consulting physician must continue for the necessary control and maintenance of what has been restored.
Why we cannot continue with the same therapy for a long time?
Under the surface of every disorder there lies a vulnerability of the system that, only by maintaining adequate protection over time and regularly scheduling visits, re-evaluation sessions and booster treatment, can be controlled and even eliminated.
The brain exists as a plastic, adaptive organ: medicine, or Neuromodulation Therapies will allow it to make the best use of its plasticity: but for this to happen without symptoms’ returning, therapy must be continued and balanced according to circumstances and environment over time. This therapeutic protocol becomes even more relevant because each therapy, pharmacological or neuromodulation, can have a sequential adaptation, or have different objectives or even different diagnoses.
To give an example: the patient arrives in a severe state of depression, which immediately becomes the main objective of the beginning of the treatment. This is followed by the emergence of a background of anxiety disorders or obsessive preoccupations that led to the onset of depression, and the treatment is then adapted. When the anxious and depressive symptoms will be eliminated, then problems of attention and concentration will emerge that have influenced a drop in self-esteem: here, again, the treatment will change its target and at the same time improve one’s response to stress: Resilience.
This is also why individuals cannot continue with the same pharmacological therapy for a long time without monitoring its effects.
What is the best defense against relapse?
Healing is not a grace that we derive from outside but a process of change - a new learning - in which you activate, with constancy, all the positive, personal resources of which you have become aware.
Healing demands a constant commitment, which becomes a new way of life, even while maintaining the necessary care: working for your well-being in a conscious way remains the best defense against the dreaded relapse, and it ensures the best road to recovery.
The evolution of science and medicine clearly demonstrates that it is possible to prevent relapses, the appearance of a psychiatric disorder, and the worsening of diseases.
What can be prevented:
Violence, including domestic violence;
Improper eating behaviors;
Addictions to substances, internet, gambling, and pornography;
Worsening of neurodegenerative diseases (such as Parkinson's, Alzheimer's and Huntington's disease);
Anxiety disorders, post-traumatic stress disorder (PTSD);
Loneliness: statistically correlated with most psychiatric disorders because the brain circuits that elaborate social processes correlate with the immune response. Therefore, psychological science should address behavioral health.
Psychiatry is a science that concerns itself with all of us because it addresses behavioral health and not just individual disorders.
To make prevention programs widespread and affordable, today's society must give new attention to psychiatry and overcome any self-fulfilling fatalism or social stigma.
Biennial course on Anxiety Disorders organized by the European College of Neuropsychopharmacology
A unique opportunity to expand your knowledge and experience in the field of Anxiety Disorders.
Dr. Stefano Pallanti will lecture on Neuromodulation Therapies during the 4th module of the course.