The medication you should take for mental illness must be taken
In the case of major mental illnesses such as schizophrenia, bipolar disorder, paranoid psychosis and major depression, they usually need to receive systematic medication for a long enough period of time. In the case of mild mental illnesses such as anxiety, obsessive-compulsive disorder, hypochondria, dysthymia, anorexia nervosa, neurosis, somatoform disorders, and social phobia, medication is also usually necessary when symptoms are severe or in the early stages of treatment, not only to provide rapid pain relief and remission, but more importantly, to create conditions for psychological treatment, to provide an opportunity and platform for positive self-adjustment, and to time to accomplish some major things in their lives.
Case 1: Mom vetoed the doctor’s medication plan because she was worried about the side effects of the medication.
Three weeks ago, a junior high school girl came to see a doctor. Her main symptoms were nervousness during exams, rumination, inability to concentrate, and in severe cases, her brain went blank. She was diagnosed with “test anxiety”, and the following is a conversation I had with her mother about how to treat her.
Doctor: “It’s only 2 weeks before the midterm, I recommend medication because it works fast. It’s good that you came earlier. It’s only 2 weeks now and the medication may not be effective by then.”
Mother: “Professor He suggested us to come to you a long time ago, so we should have come earlier. We have some concerns about the side effects of the medication, are they serious?”
Doctor: “Not usually, but they vary from person to person.”
Mother: “Are there no side effects at all?”
Doctor: “I can’t guarantee that.”
Mother: “Then you decide, we come to see you, so we listen to you completely.”
Doctor: “Then let’s start with medication to control the symptoms as soon as possible, and then consider further treatment options after the midterm.”
Child’s mother: “But I’m still worried about the side effects of the medication, will it affect my child’s body?”
Doctor: “Usually not serious, we also have doctors and professors in our hospital whose children are treated with medication from me.”
The child’s mother: “And what is your opinion, doctor? I’ll listen to you.”
Doctor: “I still recommend medication first.”
Mother: “I’m still worried about the side effects of the medication, is there any other treatment?”
Doctor: “You can also consider psychotherapy, but psychotherapy is slow to work, and the child has only 2 weeks before the midterm, so the medication will work faster.”
Child’s mother: “Can we schedule psychotherapy today?”
Doctor: “After you pay the fee, discuss the time with our psychologist.”
The next day, the child’s mother came back to my office.
The child’s mother: “Professor He introduced me to you, she said you are good at treating children, so you should treat my child, we will listen to you completely, and treat him as you say.”
Doctor: “I still recommend medication first.”
The child’s mother: “Drugs really do not have a serious impact on the child’s body?”
The doctor I dizzy, now the doctor-patient relationship is so bad, the doctor must be very cautious in dealing with the side effects of drugs, especially for small children. Although the parents’ concern and nervousness is understandable, but in the face of such
The doctor is really afraid of what might happen to such parents, so he or she will usually choose the most conservative and safest treatment option, but the efficacy may not be the best, and it is often difficult to have the best of both worlds in the treatment of some mental illnesses.
By seeing a child of such a parent, the doctor takes on a lot of pressure and risk, and in case something goes wrong, she will say, “…….” The doctor can take it if she just says, but is afraid of the rest.
The first consultation for mental illness usually takes the doctor half an hour, but the doctor’s consultation fee plus registration fee is only $7. The doctor’s income and the responsibility and risk taken is really very unequal.
Difficult cases in psychiatry often require doctors to be liberal and bold with medication to get better. Without the active cooperation, support and trust of the family, the doctor will not dare, which will inevitably affect the effectiveness of treatment. Some cases, such as severe manic episodes, due to the extremely easy to tolerate drugs, it is best to be able to quickly control the condition before the patient’s tolerance to drugs, if the doctor is soft, a little slow to add drugs (Note: sometimes the patient’s family see the condition partially improved or drowsiness and other side effects and reduce the patient’s medication without permission), the condition fluctuates, the patient appears tolerance to drugs, the condition that could be controlled in a few weeks, may not be taken down for several months. The patient may not be able to take it down for several months. In this regard, please refer to the article: Treatment of schizophrenia and mania, what is the difference?
Case 2: Family members opposed the patient’s medication, and the condition was delayed for 10 years without improvement.
The afternoon before yesterday, there was a patient who came from abroad and suffered from both anxiety and OCD. She had previously been treated in many large hospitals in Guangzhou and saw well-known specialists in Guangzhou, but her parents and family were opposed to her taking medication, and she had only been taking medication intermittently for 10 years, and the treatment effect was certainly not good.
She came to see me the day before yesterday, and it was only after the patient had fought for a long time that her family agreed. She also submitted her resignation letter to her supervisor last week, which I guess is one of the reasons why her family had to agree to her coming to see the doctor.
Case 3: The family is against the patient taking the medication, especially the girlfriend, or they will break up.
This male secondary school teacher in his 20s, suffering from severe somatoform disorder, mainly manifested by bugs crawling on his skin all over his body, which makes him very difficult and hard to work, has been treated with medication plus psychotherapy for more than 1 year, and now his condition has improved more significantly, but the symptoms are still there.
The day before yesterday he came to see the doctor and told me that his family was opposed to his medication, saying that he was too dependent on drugs, too dependent on psychiatrists, and his girlfriend was adamantly opposed, saying that if he did not stop taking his medication, he would break up with him, and last night he sent me a tweet asking what to do.
For this very excessive family members opposed to taking medication, in addition to the family’s concern about the side effects of drugs, there may be other reasons, some is the doctor did not explain the importance of drug treatment and side effects, some is the family witnessed around a colleague or neighbor to take psychotropic drugs after serious side effects, some may be too strong parents desire to control, some may be the patient is in a sick state to meet the family’s subconscious some need. Doctors need to carefully observe and deal with this, otherwise treatment cannot be carried out, or treatment is difficult to adhere to in the long run, resulting in a reasonable treatment plan being destroyed by the family’s intentional or unintentional “good intentions”.
Case 4: Family members opposed to western medicine and only allowed to take Chinese medicine.
The patient was a middle-aged male who had been suffering from anorexia for 5 years. His family refused to take western medicine and only allowed him to take traditional Chinese medicine.
Probably due to the special nature of our disease, the efficacy of Chinese herbal medicine in treating mental illness is usually not satisfactory. As patients or family members do not want to take western medicine and only agree to herbal treatment, which leads to aggravation or is often seen in our clinic, the lesson is too deep to be deeper, and here we also especially remind patients and family members suffering from mental illness to pay attention.
Case 5. In 2 years, the examination has never been so smooth and if cool.
One boy is a relative of a nurse in our department, suffering from obsessive-compulsive disorder, manifested by frequent thoughts in his mind of jumping or gouging his own eyes, listening carefully especially when the exam is obvious, due to the harassment of obsessive-compulsive symptoms, in recent years the important exam questions are basically incomplete, often only half of the topics to be turned in. When the patient came to see me 2 months ago, I suggested medication in the hope that the symptoms could be controlled before the midterm exams, and both the patient and his family agreed to medication first. When the patient came in for a follow-up 1 week before the midterm, the patient had improved significantly, but still had more obsessive-compulsive and anxiety symptoms, so the medication was increased to the upper limit of the maximum treatment dose.
After the midterm exam, the day before, the patient came to the follow-up appointment. The family came and I knew the results without asking, and happiness and satisfaction were written on their faces. The patient said, “In 2 years, I have never had such a good and smooth exam. I only had a couple of obsessive thoughts during the English exam, but I quickly adjusted myself, and there were no obsessive thoughts during the other exams. I didn’t have enough time to write my essay at the end of the language test, but I didn’t get nervous, and I read the material while I was thinking, and I finished the essay question in time.”
Since he had more than 2 months off after the midterm, I adjusted his treatment plan this time by reducing the dosage of medication appropriately, allowing his obsessive-compulsive symptoms to be partially exposed, and instructing the patient on how to face the symptoms through positive self-adjustment, to accept them, and to truly cure his OCD.
In the above five cases, the family members’ attitudes toward medication were absolutely different, and the treatment effects were different. In fact, these are not isolated phenomena, there are many family members like this, some family members can change their mindset after the doctor’s explanation and actively cooperate with the doctor’s treatment. Some family members can change their mindset after the doctor’s explanation and actively cooperate with the doctor’s treatment.
Today is the Dragon Boat Festival, I wonder if Qu Yuan also suffered from depression?