If you have mental health concerns, you should seek help. But where do you go? How do you know what type of doctor you should talk to? Do you look for a psychiatrist or a psychologist?
If you’re unsure what the difference is, you’re not alone. What you see on TV is not reality. There are similarities, but there are important differences, too. Here’s what you need to know to decide which is right for you.
How They’re Alike: Psychiatrists and psychologists are different types of professionals trained to help you deal with mental health issues. Both are there to get you through problems. Both Psychiatrists and Psychologists look closely at your behaviour such as not getting out of bed, your sleep patterns, eating habits, and negative thoughts that might be causing or contributing to depression for example.They aim to provide you with the means to manage the issues in your everyday life.
How They’re Different:
Education: Psychiatrists are medical doctors who graduate from 4-6 years of medical school, and then go through anywhere from 4-8 years of post graduate training in the assessment and treatment of mental health disorders depending on where they train (US = 4 years, UK = 8 years, so a total of up to 14 years of training). A doctor who graduated in the British system like we have in the Caribbean has the letters MB BS, or MB BCh or MB ChB after their name. A doctor who graduated from the American system has the letters MD after their name. They all mean the same thing: a basic medical degree. Then there may be other letters after that, for e.g. in the UK the letters MRCPsych mean that the person is a qualified Psychiatrist and CCT means they have completed their training. West Indian Psychiatrists may have the letters DM after their name, which is the local equivalent of MRCPsych.
On the other hand, psychologists have a doctorate degree in an area of psychology, which is the study of the mind and human behaviour. They are not medical doctors and so can’t prescribe medication. A psychologist can have a PhD or a PsyD in clinical or counselling psychology, for example. Typically, they have gone through 7-9 years of training in total. Unlike psychiatrists, psychologists are also trained in giving psychological tests (like IQ tests or personality tests). In most countries, only a person who has a doctorate degree can call themselves a psychologist.
The Approach: Psychiatrists are medical doctors and have studied the workings of the body (physiology, biochemistry) and mind (psychology) and how medications work (pharmacology). They focus on the medical side of things. They might ask you to do blood tests, or get a brain scan or to get an ECG to check your heart. For instance, before a psychiatrist calls someone depressed, they will make sure they don’t instead have a vitamin deficiency or a thyroid problem. Once they’ve excluded physical illness and they make a mental health diagnosis, psychiatrists often prescribe you medicine. People are often afraid of medications like antidepressants, However they have been proven to work and can improve your quality of life significantly. They will also advise you to make lifestyle changes to help you to help yourself (exercise, eat healthy, get good rest, don't drink too much alcohol, don't smoke etc.). Sadly most people do not listen to this advice as they don't want to take responsibility for their health!
Psychologists on the other hand are trained to practice different forms of psychotherapy (talking therapy) -- i.e. talking with their patients about their problems and using highly specialised ways to treat their problems and to give the person the tools to manage their daily problems. It is not just talking or getting advice as you would from a friend or family member, but it is a form of treatment that is equal to medication and it takes years of training to be competent. Only some psychiatrists are trained to do this in addition to their medical treatment, but not all. It depends on their training. It is important to know whether the person you are seeing is actually trained in psychotherapy before you do talking therapy. Don't be afraid to ask!
Both are highly important professionals in treating mental illness and both medication and talking therapy have been proven to work, and to work even better when combined!
For more info on this topic, check out this interview I did with a local podcast on mental health issues in T&T:
There are many different healthcare professionals available to Caribbean people that we may not have known about 20 years ago. Sometimes older people are uncertain of how different therapies or treatments can really help them. Below is a list of some common healthcare professions and how they can work for you. Many times, using one of these other professionals (besides your regular doctor) and can save you money in the long run and improve your quality of life. Here's how:
Psychiatrists- Psychiatrists are doctors who have specialised in the treatment of mental illness. First, we go to medical school. This is why we can prescribe medications- we are trained firstly as doctors. Then we spend some time specialising and training in psychiatry. Some psychiatrists like myself decide to spend even more time training, so we sub-specialise in a certain kind of psychiatry, like addiction or geriatric psychiatry.
Speech & Language Pathologists- These professionals are very useful for stroke and dementia patients. They are trained in helping people with communication issues or swallowing problems.
Physical Therapists (also known as Physiotherapists) Physiotherapists are specially trained to help persons recover from muscle injuries and strengthen their body. They can assist with mobility and balance issues. They are useful for persons who have had a fall or who have had a stroke.
Occupational Therapists- Occupational Therapy is very important for persons who have fallen ill and can no longer go about their daily tasks the way they used to. This includes dementia patients, stroke patients, or people with mobility challenges like Parkinson’s disease. Occupational Therapists assist with increasing a person’s independence and confidence by helping them to adapt and learn how to do day to day tasks such as bathing, dressing and hobbies even though they are ill or injured.
Cognitive Stimulation Therapy- In the UK, this is the only other approved treatment for dementia patients, in addition to medication. This therapy is like ‘exercises for the brain’ that can take place within a group session. It can help persons with orientation, confidence and socialisation.
Psychologists – sometimes people become depressed or anxious after they have retired from a job they loved, or received a scary health diagnosis. Very often, family members who are looking after an older, ill person can become depressed as well! Psychology is a very healthy way of addressing these issues and uses talking therapy to help persons cope with difficulties. Psychologists are not doctors and cannot prescribe medications, but they often work with doctors and psychiatrists to help a person get through a difficult time.
Dieticians – A dietician is different from a nutritionist. They have had specialist training in what kind of nutrition persons need to maintain a healthy weight, or to manage illness like diabetes or high blood pressure. Sometimes eating is a huge problem in Dementia patients and family members become concerned that their loved one is not getting their nutritional needs. A Dietician is an expert in this area and can help.
Social workers – Social workers can be extremely helpful in situations where there are serious social issues that a family needs help with. Some social workers might assist with government financial aid, or refer a family to government counselling or legal aid. Many social workers in the public sector are stretched thin because there are not too many of them. So it may take some time before you receive assistance.
Neurologists- Both Geriatric Psychiatrists and Neurologists can treat Dementia. A Neurologist treats disorders affecting the brain, spinal cord and nerves. For example, they are the specialist you will go to if you have had a stroke or to get tested for dementia.
Your GP- A general practitioner is probably your family doctor and is a good first stop if you suspect anything is wrong. Your GP will then refer you to a specialist depending on the circumstances. Your GP should say why you are going to a specialist if you are referred so you can fully understand your situation.
Learn more about finding these resources on our 50+ Resources page.
If you are confused or uncomfortable, ask whoever you go to about their training and qualifications. Many of the professionals listed are available both publicly and privately, so you may have options once you do your research. When you choose to see a professional, try to listen and follow their instructions as closely as possible. Remember, they have likely trained for many years in their field. If you are still uncertain, you are free to ask questions or get a second opinion.
Caregivers are often concerned that their loved ones don't get enough sleep. If you have noticed a change in sleeping patterns of an older person, do not panic. As we get older, we tend to sleep less. We may get up during the night more frequently due to aches or because we need to use the washroom.
Some older persons find that instead of getting 8 or 10 hours of sleep each night, they are only getting 4 or 6 hours of sleep. This is a common change and is nothing to be alarmed about. Do not turn to sleeping tablets right away. They can be addictive, and many more people (in T&T for example) end up taking sleeping pills for several decades, which is not healthy.
"As we get older, we tend to sleep less."
Sleeping tablets should be your last resort, after consulting with a trusted doctor. Some more creative, healthier ideas to improve sleep quality for older persons are suggested below, as adapted from Philip T. Hagen, M.D. of the Mayo Clinic, USA:
Memory loss is a common concern in persons over 50. If you are over 50 and find it harder to remember details, don't panic. Many factors may affect your memory, including stress, multi-tasking or a lack of interest in details. Here are 10 proven strategies you can try to help you recall information better:
1. Develop a routine and stick to it. Many persons have a morning routine, but what about an after work routine or weekend routine?
2. Advanced planning can help reduce the risk of forgetting. Keep a large, easy to read calendar nearby with important dates and events clearly marked.
3. Create a place for everything and store everything in its place. This is useful for smaller items like your phone, keys and wallet.
4. Use a back pack or handbag. Place things in the bag that you will need for the day ahead. Pack whatever you think you might need- better to be safe than sorry!
5. Use a to-do list and remember to take it with you when you leave the house! For your home, consider keeping a small blackboard or whiteboard in the house to list things as you remember them, which you can then go back to.
6. Use a Journal to keep track of important plans, impressions, ideas, and appointments. Keep it on you at all times.
7. Develop schedules for different time periods. Plan by the day, week and month, especially during hectic months like Christmas time and August vacation.
8. Use a network of reminders – it doesn't hurt to have several methods to remind you of one important event. Use post-its in easy to see places, or an alarm on your phone, or ask someone you trust to call you to remind you. Get a talking alarm clock to keep better track of the time or a talking pill box to remind you to take your medication.
9. Use tricks to help your memory like repetition or association. For example, associating your medication with your lunch might make it easier for you to remember to take it at lunch time.
10. Focus on one thing at a time. Paying attention to one thing at a time will help you to remember more details. Besides, trying to do too much at once might cause you to feel rushed and stressed out, which can then affect your memory.
The bottom line? Get organised! Your memory will work better if you give it some help by being proactive and making things as clear as possible.
Generic drugs have gotten a bad reputation in the Caribbean, perhaps because a lot of people are not convinced that the quality of these drugs is good, depending on the source.
First of all, what is a generic?
So this is what happens: A drug company, a multi-billion dollar organisation, conducts years of clinical trials before a medication receives approval for use by the general public. Because of the huge amount of money they invest, they are granted a patent (a license to produce the drug) which lasts for many years. This means that only that company has the right to make the drug during that time so they can make back their money.
After the patent expires, other drug companies are legally allowed to produce generics, or copies of the drug. This is good news for many older people who cannot afford expensive drugs and also for countries like the UK which provides free medication for people over 60.
So for example, Aricept is produced by a company called Pfizer and was the first medication approved to treat Alzheimer’s Dementia. The active ingredient in Aricept is Donepezil Hydrochloride. The patent that Pfizer had for Aricept is now expired, which is good news because now many companies around the world are producing generics such as Palixid (produced in Hungary) and Apo-Donepezil (produced in Canada) at a much cheaper price which is then passed onto the buyer who saves money..
So are the generics just as good as the branded drugs?
In my opinion, yes. But I would definitely choose generics from the US, Canada, the European Union or Australia/New Zealand because their quality standards are rigorous. There are many reports of medications produced in small, unsanitary factories in other countries around the world and even reports of fake medications packaged in fake boxes! So be careful of where the generic is produced and ask your doctor or pharmacist if you are not sure.
Why do all medications have two names?
One is the brand name (usually larger and in bold) that is used for marketing and the smaller name below is the active ingredient which is the important one. So always check the small writing below the brand name. For example it will look like this:
ARICEPT or PALIXID
Donepezil Hydrochloride Donepezil Hydrochloride
Another example is:
PANADOL or TYLENOL
As you can see Aricept and Palixid are the same drug, and Panadol and Tylenol are the same drug, just different brands! (NB: Paracetamol is called Acetaminophen in the US).
If I were you, I would go for the cheaper option, because in the long run you will save yourself a lot of money!
Dr James Bratt, Lead Consultant at Age Caribbean and Geriatric Psychicatrist.