FreePsychArticles#10  Once Medications Do Their Job

In the clinical practice of psychiatry there are basic phases that occur throughout treatment.   In the beginning of treatment these steps are initiated with a one, two, three sequence but as the process moves forward, these steps are revisited.

The first phase is the clinical evaluation in the initial consultation.   The emphasis is collecting relevant information about the past (history) and the present condition of the patient.     We look in the history for any clues that could be contributing to the formation of the patients current status.   These are the genetic or family traits, called the bio (biology) and any physical factors such as illnesses or physical trauma effecting the patients development.  Since it is often impossible to learn all there in the initial meetings we may return to this in the future to help explain new findings as they appear in the course of treatment.

The next phase is learning about the patients current condition.  This is referred to as the “mental status examination” and functional evaluation.    While observing the patients responses, questions are directed toward evaluation of thought, speech, behavior and emotion.    Included in this are symptoms and complaints or concerns expressed by the patient or collaterals (other’s involved in the patient’s life).   We also inquire into how the patient behaves and manages their life experiences.

From information gleaned from the first two phases we can begin to speculate and conceptualize diagnostic ideas.   This leads to decisions in treatment approaches including the use of medications, advise on activity, and other positive plans and suggestions.   Everything should be directed toward the improvement of basic health and vitality in harmony with the person’s world.

A major emphasis in modern psychiatry is the alteration of the microbiological behavior of the central nervous system.   This is the search for chemical balance or ‘enhanced connectivity of neuronal circuits.’   Counter to most peoples impressions, the conventional understanding of how the brain functions is extraordinarily limited!   This is especially true when it comes to designing and prescribing medications.   Nevertheless, the focus of most biological psychiatry is the ‘synapse’ where nerve cells connect with each other and the enhanced flow of neuronal circuits    This is, indeed, the main function of psychotropic medications.

Psychiatric symptoms tend to be excessive or distorted experiences that all people have at one time or another in their lives.    As I have mentioned in previous articles, the target of medications is the symptoms that grab on and tend to hold on or overwhelm the patient and reduce the ability to function normally.

But what happens once medications seem to do their job?   Sleep and appetite become regulated,  the mood stabilizes, depression lifts, anxiety or panic subsides, and the noisy or overactive mind quiets.  In many cases, the patient has fallen into different negative habits long before they came to the psychiatrist for treatment.    Maladaptive patterns of thought and behavior have become routine and often, become more conscious once the major symptoms have improved.   These people may feel better overall but the road to rehabilitation opens up in front of them with numerous obstacles along the way.

In some, after years of deterioration in function, they find their station in life is much lower than they could have expected to realize.   They have lost jobs, left school, lost family ties and are often financially struggling.    They have suffered under the stigma of mental illness and find themselves isolated with very few resources.   The medications may have reduced their symptoms and that is a good thing,  but to varying degrees they are at risk of relapse if they are ill equipped to revise or improve their outlook  and ability to function.

This is where psycho-therapeutic or psycho-educational interventions become the focus of the treatment.   Medication management is a parallel process that fades in and out of the overall clinical work as needed, to “tune up” the biological tools being used.   A new attention is given to the actual way the patient thinks and interacts with the world around him.

I have found the concept in connectivity or interconnectivity of neurons on the microbiological level a sound basis for all levels of the patient’s life and rehabilitation. Clinical studies have found certain non-medical activities, such as psychotherapy or exercise actually alter brain chemical balance.   Therefore, effective treatment must include helping the patient “get in touch with himself” on a personal level.    Further elements include improving relationships among family members, relating to friends, acquaintances and the public.   For those inclined, it would extend to the connection with soul, faith and G-d.    Connectivity can be enhanced on one level and improve the connectivity on all the other levels.   If the individual is viewed as part of a greater macrocosm, more harmony has a ripple effect both outward and inward.

With psychiatric and nervous disorders,  once medications provide the basic improvement of brain function through enhanced connectivity, there is still a lot to do.   The patient is well on the way or path toward rehabilitation by having participated in the initial steps of healing.   Now one must assume control and direction of self care through other activities to reinforce connectivity where able.   This is more than beneficial,  it’s an integral part of the rehabilitation.   The “other” activities are almost unlimited.  They include physical exercise, regulation of basic patterns of sleep and eating,  ongoing psycho-education, and creative pursuits.   Attention to integrating the parts of one’s life that have become unconnected with each other is another goal.   “Mending fences, patching up things, and sewing up deals” all echo this age old wisdom.   In the spiritual realm, connectivity can be represented by the Star of David, the upper triangle comes down to merge with the ascending lower triangle, as man reaches toward G-d and the Holy One reciprocates in kind.

This is the beginning and the middle, but by no means the end.  There’s a great deal more to be said about connectivity.

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Gershon Freedman, MD