Insight into Psychiatry

Dr Spurrell came in this Thursday to give The Medical Society a talk about what it is like to work as a psychiatrist, and in particular what it is like to work with a particular form of psychosis- schizophrenia.

So first of all, what exactly does a psychiatrist do? As some of you asked during the meeting, the perceptions of a psychiatrist and a psychologist are often blurred. Dr Spurrell explained it most clearly by likening the relationship between psychiatrists and psychologist to that between rheumatologists and physiotherapies. A psychiatrist is fundamentally a doctor who treats illness related to the brain, administering drugs and considering aspects of the whole case in order to cure the patient. It is the psychiatrist who decides which course of action is best for the patient, whether be it referral to a clinical psychologist or a course of medication.

Psychiatry is a very broad term used to describe studies and treatments of mental and emotional disorders. It is further divided into areas such as psychosis, depression, anxiety, and personality disorders.

Psychosis is a condition in which a person isn't in contact with reality. There are usually four aspects, hallucination, delusions, thought disorder and lack of insight, all of which contribute to a unusual or bizarre nature of such behaviour, difficulties with social interaction and impairments in carrying out the activities of daily living. It should be noted that psychosis can occur in persons without chronic mental illness, as a result of an adverse drug reaction or extreme stress

About 1 in 100 of the population develop Schizophrenia, a disease that translates from Greek into “shattered mind”. This statistic is consistent in most populations, and surprisingly the disease usually presents in adolescence or early adulthood, with males tending to show symptoms earlier than females. Symptoms of schizophrenia may include; include delusions, auditory hallucinations and thought disorder, constricted affect and emotion, poverty of speech and lack of motivation, reduced or impaired psychological functions.

The causes of Schizophrenia are still unclear, although scientists believe that it is related to dopamine levels within the brain. There is definite evidence for the importance of genetic, neurobiological and environmental factors. If you have a close relative with schizophrenia, then your chances of developing the disease goes up to 1 in 10. The use of cannabis increases your chance of developing psychosis, which can lead into schizophrenia, and so does stressful or traumatic experiences in early childhood.

As Dr Spurrell outlined treatment for Schizophrenia is incredibly difficult, especially if the case is advanced or has been allowed to relapse. With milder cases it may be possible to treat a patient at home by examining and alter environmental factors such as stress and deciding on a course of medication. However for sever cases in which the hallucinations are acute, and perhaps dangerous to the individual, it is assumed that the best course of action is to admit them into hospital were they can be best cared for.

The pathology of a typical case is 18 months at least. And most of the time the disease is extremely damaging to the patient as it may cause the loss of family, friends and jobs.

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I found Dr Spurrell’s session both mentally and emotionally draining. My knowledge was certainly expanded, and in a way it my perception of the whole field has shifted slightly. I realise now the breadth of qualities required in a psychiatrist and how important they are to a healthy society.

Feel free to add your impressions in the comments below.