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.
There are 3 licensed medications for the treatment of the above types of Dementia: (for more info on the different types of dementia, visit our dementia page)
1. Donepezil (brand names in T&T: Aricept, Palixid and Yasnal-Q)
2. Rivastigmine (brand name Exelon)
3. Galantamine (brand name Reminyl)
These medications have been proven to do several things:
They are not wonder drugs, but they are the best we have to treat these illnesses.
These medications, like all medications, have side effects. They can make people feel sick, nauseous, dizzy, vomit, have diarrhoea or they can interfere with sleep. However most of the time they do NOT cause any side effects at all. Also, if the side effects are mild they usually go away in 1-2 weeks and so it is best to persist and not give up too easily.
What to do if the side effects are intolerable?
If the person is on Donepezil 10mg daily here are some suggestions:
1. Ensure that the person is taking the medication after a full meal if they are having gastrointestinal side effects (stomach problems). This type of medication tends to be harsh on the stomach, so taking it after a meal is helpful.
2. Sometimes that's not enough and we have to add in a medication called a ‘proton pump inhibitor’ (e.g. Nexium, Prilosec, Omeprazole) to protect the stomach, and that can sometimes work very well to solve the problem. Omeprazole is available for free on CDAP.
3. Sometimes lowering the dose from 10mg to 5mg daily works, and so that is an option that you can try. If that works then we leave the person on 5mg daily indefinitely.
4. If the person is getting nightmares from taking the medication at night, then you can have them take the medication in the morning/lunchtime instead and that may get rid of the problem.
5. Sometimes none of this works and I have to change it to an alternative medication such as Reminyl or Exelon which are both available in T&T but are more expensive (over $1000 per month). Exelon also comes in patch form so the medication bypasses the stomach and goes directly into the bloodstream, therefore avoiding any side effects affecting the stomach. Exelon patches are applied to the person’s back and have to be changed every 24 hours.
6. Finally, sometimes some people do not tolerate any of these medications and we have to accept that. There is a second line treatment however, called Memantine (brand name Namenda or Ebixia), that is not available in T&T but is available in Barbados, the US, UK and Canada.
As a psychiatrist, I get questioned about the medications I prescribe all the time. People often Google and research the medication I give them. What they find might really worry them.
First of all, doing your research and asking questions about your medication is an excellent practice, once you use a reputable website such as www.mayoclinic.org or www.alzheimers.co.uk. It is important to know what a drug is being prescribed for, what the side effects are, if there are any risks, and how long you should take the medication for.
It's easy to think that drugs prescribed by a psychiatrist that effect your brain can be more dangerous than drugs perscribed by another specialist or GP. But this is not true. Some GP's prescribe psychiatric drugs. Other doctors might not properly explain what they are prescribing or why. It is up to you to make sure that you ask the right questions before you leave their office. Taking too many medications at the same time can be dangerous, unnecessary and expensive. So make sure that you and your doctor agree that each and every medication prescribed is absolutely necessary.
It is important to know what a drug is being prescribed for, what the side effects are, if there are any risks, and how long you should take the medication for.
But just because a medication is necesary does not mean that it will be perfect. So you need to look at the benefits over the risks and understand that it might be the best decision for you or your loved one, despite what you might find in your research,
For example, Antipsychotics have been shown to increase the risk of many things in people with Dementia including stroke, pneumonia, falls, sedation and death in extreme cases. Sounds terrifying, I know. But as a psychiatrist, it is my job to find the best and safest antipsychotic to treat extreme agitation and agression in persons with Dementia. In many cases I choose a drug named Risperdal because it works well and is specifically santctioned to help people with dementia.
Whenever I have Dementia patients with aggression or agitation, I recommend other tactics first, such as paying attention to any physical health problems that may be causing their agitation. Apart from this, the person's environment should be calm, peaceful, comfortable and cool. Most importantly, they should be receiving good nursing care. This is a real challenge in the Caribbean because many of the nurses or caregivers have very limited experience or training with Dementia patients. But in my opinion, when it comes to Dementia, having an excellent nurse is far better than any medication.
Whenever I have Dementia patients with aggression or agitation, I recommend other tactics first, such as paying attention to any physical health problems that may be causing their agitation...and the person's environment.
But the reality is that often I get calls from families saying that they simply cannot cope. Often times, local Nursing Homes threaten to throw Dementia patients out if their aggressive behaviour cannot be controlled. This is not pleasant, but this is what happens. So when the agitation is severe enough, I take on the risk of prescribing low doses of Risperdal (0.5mg to 1 mg daily) which in my experience helps with aggression and agitation, but are unlikely to cause harm at such a low dose. (The maximum dose of Risperdal is 16mg, or 32 times the dose I prescribe).
So in the end, sometimes antipsychotics, although dangerous in large doses, can be safely given to persons with Dementia who absolutely need it. But first, be sure to talk to your doctor, try to improve your loved one's behaviour by attending to their physical needs and environment and ask your doctor for the lowest possible dose to start off with in order to decrease the risks of the medication.
Remember- these guidelines apply to any medication for any condition- not just dementia. For our T&T clients, Age Caribbean will be hosting a seminar on Medication Management in January 2017. Check our Seminars page to learn more and keep educating yourself about elder care.
Dr James Bratt, Lead Consultant at Age Caribbean and Geriatric Psychicatrist.