Download Clinical Psychologists and Psychiatrists

Clinical Psychologists
and Psychiatrists
How They Work Together to Produce Better
Outcomes
Simone Pica
Chief Psychologist –The Melbourne Clinic
Areas to be Covered:
 Clinical
Psychologists and Psychiatrists Health Providers
 The Melbourne Clinic- The Treatment
Setting
 Onset of Mental Disorders and types
 How we work together- Treatment
Specialisations, Assessment,Treatment
Planning, Provision of Treatment and
Ongoing Challenges
Clinical Psychologists

Psychologists are specialists in human
behaviour, development and functioning. They
have expertise in conducting research and
applying research findings in order to reduce
distress, address behaviour and psychological
problems, and to promote good mental health.
 Today, most psychologists tend to specialise in
one or more areas. To date the APS has 9
colleges including; Clinical Neuropsychology;
Clinical Psychology. Couselling Psychology,
Educational Psychologists and Forensic
Psychologists

Of these specialties, Clinical Psychologists are
trained to work with people with mental
disorders
 IN brief, Clinical Psychologists are specialists in
the assessment, diagnosis and treatment of
psychological problems and mental illness.
 They work with children, adolescents, adults
and the elderly in a range of agencies including
public and private hospitals, private practice and
general medical services
Skills and Competencies of Clinical
Psychologists
 1.
Psychological assessment and
diagnosis
 Clinical psychologists have specialist
training in the assessment and diagnosis
of major mental illnesses and
psychological problems. Clinical
psychologists are qualified to provide
expert opinion in clinical, compensation,
educational and legal jurisdictions.
Clinical Psychologists cont.

2. Treatment
 Clinical psychologists are trained in the delivery
of a range of (non-drug) techniques, strategies
and therapies with demonstrated effectiveness
in treating mental health disorders. They are
specialists in applying psychological theory and
scientific research to solve complex clinical
problems requiring individually tailored
interventions.
 3. Research, teaching and evaluation
Psychiatrists
 Psychiatrists
are specialist medical doctors who
diagnose and treat mental disorders.
 Qualifying
as a psychiatrist involves first
obtaining a medical degree and then
undertaking a minimum of 5 years’
postgraduate specialisation in psychiatry.
 The
nature of their training means that
psychiatrists have a strong grounding in
both biological and psychological
frameworks for understanding mental
disorders. They are trained both to
recognise and treat the effects of
emotional disturbances on the body as a
whole, as well as the effects of physical
conditions on the mind
Differences between Clinical
Psychologists and Psychiatrists

A Psychiatrist is required to complete a medical
degree prior to specialising in mental disorders
including biological conditions (psychiatrists are
physicians)
 A Psychiatrist can prescribe medication; a
Clinical Psychologist cannot.
 Clinical Psychologists have specialist training in
non-medical interventions (psychological) and
work closely with Psychiatrists
 Psychiatrists should be able to provide
biological, psychological and social treatments
The Melbourne Clinic – The
Treatment Setting

The Melbourne Clinic (TMC) is a purpose built
psychiatric hospital established in the 1970’s
and was initially privately owned by a group of
psychiatrists. Since 1985 it has been managed
by Healthscope Limited
 TMC is the largest and longest established
private psychiatric hospital in Australia. It has
106 beds, well over 100 accredited psychiatrists
and employs a multi-disciplinary team including
psychiatrists, nurses, psychologists, social
workers, occupational therapists and dieticians
Inpatient Programs - TMC










TMC provides a comprehensive range of
inpatient and day programs as well as an
outreach program
The Inpatient Programs include:
General Psychiatry (Living Well Program group
interventions)
Intensive Psychiatric Care
Older Person’s Psychiatry Unit
Professorial Unit
Anxiety and Depression Program
Obsessive Compulsive Disorder Program
Eating Disorders Program
Substance Withdrawal Program
Day Programs - TMC










The Day Programs Include:
Life strategies program
Sills-based Psychosocial Program
Anxiety Day Treatment Program
Depression Management Program
Managing Bipolar Disorder Program
Mindfulness Based Cognitive Therapy
Dialectical Behaviour Therapy Program
Eating Disorders Program
Outreach Program -The outreach program provide
assessment, support, rehabilitation and treatment in their
own home and local community
Onset of Mental Disorders
One in 5 Australians will suffer from a mental
disorder at some point in their lives.
 A mental disorder is a health problem that
significantly affects how a person thinks,
behaves and interacts with other people and
functions in their daily life.
 Mental disorders are diagnosed according to
standardised criteria. One of the major wordwide
classificatory systems is the Diagnostic and
Statistical Manual of Mental Disorders (DSM
What causes Mental Disorders?






Mental illness results from complex interactions between
the mind, body and environment.
Factors which can contribute to mental disorders are:
Biological factors
Including genetics, neurochemistry, diseases of the
brain, physical illness drugs affecting the brain (use of
alcohol, drugs and other substances ),
Psychological factors
Including cognitive styles such as constant negative
thoughts about the self and the world, personality styles
including avoidance, low self esteem and confidence,
poor coping styles and poor problem solving approaches
What Causes Mental Disorders
cont.




Social factors
Including life events, long-term and acute stress in all
areas of one’s life (e.g. personal. family, work,
relationships, financial), trauma, violence
Work stress is categorized under social factors. Apart
from major physical injuries and exposure to or
involvement in a traumatic event, patients often report
work stress as the significant contributing factor which
was an ongoing event which wasn’t addressed nor
resolved.
Common examples include harassment, bullying, little or
no supervision or training, work overload, poor
communication/support or difficulties with
managers/supervisors.
Types of Mental Disorders
 Mental
disorders are of different types and
degrees of severity. Some of the major
types of mental disorders include:
 Depression
 Bipolar Disorder
 Anxiety Disorders
 Schizophrenia
 Drug and Alcohol Disorders
Mood Disorders
Depression

The term depression is used to describe feelings
of sadness and grief, which many people
experience at some stage.

Reactive Depression - depression in response to
a distressing event, such as bereavement,
relationship breakdown or loss of a job. The
feelings are more severe or persistent than
normal unhappiness and symptoms often
include anxiety, sleep problems and changes in
eating habits.
Mood Disorders cont.

Endogenous or Major Depression - more severe
than in reactive depression and there may or
may not be a triggering event.
 Symptoms include sleep disturbance, appetite or
weight changes, sadness or irritability, loss of
interest in work or hobbies, loss of sexual
interest, fatigue, poor concentration, difficulty
making decisions, guilt and poor self-esteem or
suicidal thoughts. Symptoms are persistent and
severe and may leave the person unable to
function or care for themselves.
Mood Disorders cont.
 Bipolar
Mood Disorder (previously called
Manic Depression) - extremes in mood,
with periods of depressed mood
alternating with periods of mania. The
manic phase may involve extreme
happiness, overactivity, rapid speech,
reduced need for sleep, a lack of
inhibition, irritability with those who
question them, and grandiose plans and
beliefs
Anxiety Disorders

Anxiety refers to the physical, mental and
behavioural changes we feel in response to a
threat.
 These changes are sometimes referred to as the
'fight or flight' response, because they prepare
us to respond to danger.
 Some anxiety is inevitable in today's society and
in many situations it is an appropriate and
reasonable response. Anxiety disorders are
different from 'everyday' anxiety in being more
intense and persistent, to a degree which
interferes with a person's life.
Anxiety Disorders cont.
•
Panic attack - a sudden feeling of panic
associated with physical symptoms like:
shortness of breath, dizziness, chest pain,
an urge to flee, difficulty gathering
thoughts, fear of dying or losing control
 Some anxiety disorders include panic
disorder, agoraphobia, phobias
Anxiety Disorders cont.

Obsessive-Compulsive Disorder - a person
experiences obsessions (persistent, unwanted
thoughts) and compulsions (being driven to
perform a ritual or behaviour) and causes
disruption to their everyday life.
 • Generalised Anxiety Disorder - excessive
general worry and anxiety and is very difficult for
the person to control.
 • Post-traumatic Stress Disorder (PTSD) recurrent feelings of terror, frightening dreams or
relived memories which result from a previous
traumatic event memories or flashbacks may be
triggered by a particular event and are intrusive,
interfering with everyday life.
Schizophrenia

Schizophrenia is characterised by unusual or
bizarre thoughts and emotions that others
consider inappropriate. Schizophrenia is not a
'split personality‘. The term refers to changes in
the person's mental and social functioning, when
their thoughts and perceptions become
disordered.
 Symptoms of schizophrenia include
hallucinations, delusions and problems with
feelings, behaviour, motivation and speech.
People may have disorganised thoughts and
difficulty concentrating. A collection of such
symptoms is sometimes termed psychosis, and
can occur in other disorders as well, for example
in severe depressive illnesses
Substance Use Disorders

People with substance use disorders have
generally taken one or more drugs of abuse over
an extended period, and are showing various
behavioural, physical and psychological
symptoms.
 People may develop substance use disorders
for a number of reasons, such as anxiety or
depressive disorders, a family history of
substance abuse, being prone to the effects of
stress and tension, or experiencing psychosocial
problems (e.g. work stress, family problems, and
relationship breakdown). Addiction may have
both physiological and psychological
components
Overview of Psychological and
Medical Treatments


Psychological Treatments
Psychotherapy is a useful treatment for may
mental disorders including depression and
anxiety disorders
 There are many types of psychotherapies
including Cognitive Behavioural Therapy (CBT)
which is an evidence based treatment that has
been evaluated and proven to be effective.
 Historically, this treatment was viewed as two
separate therapies which today are used in
combination to treat mental disorders
Psychological Treatments cont.

Cognitive Therapy- the aim of cognitive therapy
is to help individuals realise that they can
influence their emotions by identifying and
changing their thoughts and beliefs.
 when people are depressed, for example, they
often think very negative thoughts about
themselves, their lives and the future. This in
turn further worsens their mood.
 Cognitive Therapy focuses on discovering and
challenging unhelpful assumptions and beliefs
and developing balanced thoughts, more
realistic, rational ones
Psychological Treatments cont.

Behaviour Therapy focuses often maladaptive
behaviours that occur during an episode of
mental disorder.
 Behaviour therapy aims to identify and change
aspects of behaviour that may perpetuate or
worsen a person’s mental disorder.
 Some behavioural strategies include skills
training, goal setting, activity scheduling and
structured problem solving
 These 2 therapies, more commonly known as
CBT, have been found to be effective either on
their own for certain disorders or in combination
with psychiatric medications
Psychiatric Medications

Psychiatrists are experts in prescribing and
monitoring psychiatric medications.
 Medications are the cornerstone of treatment for
most mental disorders. Medications will alleviate
or ease symptoms for most people. The ongoing
use of medications will assist in stabilising
symptoms and preventing relapse.
 Medications have both desired effects (e.g.
reducing symptoms) and undesired effects
commonly called side effects (e.g. drowsiness).
 The aim is to find medications that are tolerable
and have the least number of side effects as well
as effectively reducing symptoms. Adherence to
medications is much more likely when it is clear
that the benefits of taking the medication
outweigh the costs.
Psychiatric Medications cont.






A feature of most psychiatric medications is that
they may only begin to have a beneficial effect
over several weeks. It is useful for the
psychiatrist to provide information about
• The name of the medication, what it is
supposed to do, and when it should begin to
take effect;
• How it is taken and for how long this might be
necessary;
• Any food, drinks, other medicines the person
should avoid while taking this medication;
• Possible side effects and what should be done
if they occur;
• Sources of information about this medication
(e.g. pamphlets).
Medications for Depression

These are used for treating symptoms of depression,
such as persistent sadness, hopelessness, poor
appetite, insomnia, lack of energy, difficulty in
concentrating and diminished interest in usually
pleasurable activities.
 Selective serotonin reuptake inhibitors are most
commonly prescribed because of their safety and
tolerability.
 Selective serotonin re-uptake inhibitors (SSRIs)
 Generic name
Common brand names
 citalopram
Cipramil, Celapram, Talam, Talohexal
 escitalopram
Lexapro
 fluoxetine
Genrix, Fluohexal, Lovan,
Prozac, Zactin
 Fluvoxamine
Faverin, Luvox, Movox
 paroxetine
Aropax, Oxetine, Paxetine
 sertraline
Xydep, Zoloft
Mood Stabilisers







Medications for mood disorder
Mood stabilizers are medicines that reduce the
symptoms of acute manic and depressive
episodes. They also prevent the recurrence of
mania and depression in bipolar disorder
when taken regularly over an extended period of
time.
Generic name
Common brand names
carbamazepine
Tegretol, Teril
lithium carbonate
Lithicarb, Quilonum SR
sodium valproate
Epilim, Valpro
Medications for Anxiety
Disorders-anxiolytic medications

They are also useful in helping to manage
agitation. Some are used to help people to
sleep.
 Antidepressant medications, particularly the
SSRIs, are used to treat a range of anxiety
disorders without the tolerance and dependence
problems associated with benzodiazepines
(Valium and drugs like it).






Benzodiazepine medications
Generic name
Common brand names
Alprazolam
Kalma, Xanax Alprax
Diazepam
Atenex, Ducene, Valium
lorazepam
Ativan
oxazepam
Alepam, Murelax, Serapax
Antipsychotic Medications

Medications for psychosis
 Antipsychotic medications are used for treating
schizophrenia,
 schizophreniform psychosis, schizoaffective
disorder, substance induced psychosis and
other conditions where psychotic symptoms
(ie. hearing voices, hallucinations disorganised
thinking or
delusional ideas) are present.
Antipsychotic medications cont.
 Atypical
antipsychotic medications
 Generic name Common brand names
 Amisulpride Solian
 Aripiprazole Abilify
 clozapine
Clozaril,Clopine
 olanzapine
Zyprexa
Working Together –The Assessment and
Management of Mental Disorders



1.To engage the patient in the treatment
process from the initial stage, beginning with
the initial interview. Failure to do so often
results in an incomplete assessment which will
then limit how management should proceed
2.To conduct a thorough psychiatric,
psychological, social and medical assessment
(including a suicide assessment)
3. Decide where the patient should be treated,
in hospital or the community and give a
thorough explanation to the patient if they need
to be hospitalised

4.To provide education and support for the
individual and family
 5.To treat the mental disorder, e.g. depression
and associated depressive features with
psychiatric medication and CBT
 6.To address and improve overall behavioural
functioning and always aim to treat the person
for return to their employment
 7.To monitor the person’s condition and work
toward preventing relapse or recurrence of their
mental disorder
2. The Assessment
 What
are the sign and symptoms of the
illness?
 What is the risk of self-harm, or harm to
others?
 How disabling is the illness?
 The individual’s general level coping and
functioning
 Is their any evidence of a previous or
ongoing mental disorder?
 Whether there is any family history of
mental disorders
The Assessment cont.







Whether there were any triggers to the disorder,
and if there were, what was their meaning to the
individual
If there were triggers, did they entirely cause the
mental disorder, or did they trigger or worsen the
person’s exisiting condition
The nature of family or friendship supports
Their personality style
Their drug and alcohol history
Whether there are any relevant medical
problems
What is their understanding/explanation of their
current condition?
Clinical Psychologists’ Assessments

A well know test which is used worldwide is the
MMPI
 The MMPI is composed of 567 true/false items.
Personality inventories like the MMPI are
intended to discover what the individual is like as
a person. A number of areas are assessed by
the MMPI to answer such questions as: "Who is
this person and what would they typically feel,
think and behave? What psychological problems
and disorders are relevant to this person right
now?“ “What is the prognosis likely to be and
what difficulties will they experience in their
recovery”
Psychiatrists’ Assessments
 Psychiatrists
must perform a medical
assessment in addition to the psychiatric
interview. Various test and investigations
are used to determine if there is a medical
problem causing/contributing to the mental
disorder
 Some tests include relevant special
investigations bloods, ECG, CT or MRI
scans
3. Where should the person be treated?

Most people prefer not to go to hospital and the
majority of the time people can be treated in the
community.
 In some instances hospitalisation will be both
necessary and beneficial. Especially if the
person cannot guarantee their safety of if they
are seriously unwell and are unable to care for
themselves without assistance.
 People may also be admitted to hospital for
specialised medical and psychological
treatments.
4. Psychoeducation and Support for the Family

The main goal of education is to facilitate
understanding about the disorder and its
management:
 A mental disorder is an illness, not a sign of
weakness. Recovery is the rule, not the
exception.
 Treatment is effective and there are many
treatment options available.
 The goal of treatment is to get well and minimise
relapse.
4.Psychoeducation and Support for
the Family cont.
 Treatment
options (i.e., psychotherapy,
medication) and relevant information about
each alternative (e.g., side effects,
duration, costs).
 Recognising and acting upon early
warning signs
 Managing ongoing stressful problems that
directly impact on recovery
5. Medical and Psychological treatments in
combination

The essential features of the management of
most mental disorders involve physical
treatments and/or psychotherapy. Physical
treatments involve the administration of
psychiatric medication. Psychotherapy includes
CBT.
 The choice of psychiatric medication is based on
a number of factors but is best made in
consultation with specialist psychiatric opinion.
Cognitive Therapy

Individuals who are depressed or anxiously show a style
of thinking that focuses on negative views of the world,
themselves as individuals, of their experiences, and of
their future. They come to think of themselves as
worthless and of the world as being a bad or unfair
place, without hope of their lives improving in the future.

Some classic irrational beliefs which depressed or anxious people
believe include: I will never get better, If I were a better/smarter
person this would never had happened to me, I won’t be able to
cope when I return to work, People don’t won’t to be with me
because I am crazy, nothing can help me, If I did things perfectly
then everything would be OK

The aim of cognitive therapy is to help individuals
identify, challenge or test their belief and correct their
distorted and negatively-biased thoughts with a more
reasonable and realistic thought.
6. Improving Behavioural Functioning




In addition to tackling the symptoms of mental disorders,
the challenge to a full recovery often relies on the person
being able to pick up and carry on at the level they did
before becoming unwell.
Mental disorders lead to a decline in functioning where
the person may not be able to look after themselves as
well as they did before, stop them form returning to work,
a general slowing in their performance of activities and
avoidance of family and friends.
It is vital to monitor and tackle these problems from the
beginning which can get worse over time and the
individual struggles enormously to overcome.
Behavioral strategies are vitally important in addressing
these problems by addressing what problems the
individual is experiencing and planning how to tackle
them.
6. Improving Behavioural Functioning cont.

Patients will often show signs of getting worse when
faced with ongoing stressors such making claims for
their work injuries which is a painful and protracted
process.
 Ongoing therapy and skills training (e.g. dealing with
difficult situations, maintaining good physical health,
exercise, learning how to communicate and assert
oneself more effectively, overcoming inactivity, planning
activities in advance, engaging in pleasant events with
other people) are all important strategies.
 Monitoring the use of poor coping strategies is also
important such as the use of drugs and alcohol, not
taking medications regularly, missing appointments
 Improving the individual’s ability to function is important
to avoid demoralization and the person giving up
7. Preventing Relapse
 Ongoing
treatment involves the identification of
conditions where the person may relapse or
have a set back. In general the following need
to be monitored and addressed by the
patient’s Clinical Psychologist and Psychiatrist
 The first step is to identify high risk situations.
These situations may include :relationship
break-ups, moving house, illness, or financial
and status losses e.g.loss of a job, loss of a
role
7. Preventing Relapse cont.



It is vital to help the person plan how they can respond
most effectively in these situations. One aim of planning
is to encourage individuals to realise that they can cope
with these situations if they do indeed occur
As with many mental disorders it is likely that some
individuals will be able to identify changes in their
thoughts, feelings, or behaviours which may signify that
they are becoming unwell again. By being aware of early
warning signs and acting immediately on these signs it
may be possible for the individual to decrease the
potential severity and duration of the episode.
Ongoing adherence to medication and psychological
treatment is likely to minimise relapse