What do psychiatrists think of psychologists

The path to diagnosis in psychiatry

The diagnosis of mental illness is based primarily on conversations that explore the patient's experience and feelings (the doctor says to explore). In addition, the therapist uses observations from the patient, questionnaires and psychological tests.

The experienced doctor, psychiatrist or psychotherapist can make an initial suspected diagnosis by the way in which the patient speaks, how lively or inhibited his language, facial expressions and gestures are. However, in order to come to an exact diagnosis, he must question the patient specifically. He is particularly dependent on the patient describing his problems openly and that the conversation is not under time pressure.

Clarification of physical causes. Since almost all psychiatric symptoms can also be physical or organic, the doctor or psychiatrist will carry out or order specific internal and neurological examinations in order to identify or rule out organic causes:

  • Laboratory tests for the detection of z. B. Metabolism or hormonal disorders
  • An EEG to rule out other neurological causes of the disease
  • Magnetic resonance imaging or CT scan of the head to rule out brain tumors or inflammation.

Psychopathological findings and diagnosis. The anamnesis, the medical history of the patient, is of particular importance in psychiatry. This allows the psychiatrist to get to know the personal history of the person concerned from their point of view, which is an essential component for a correct diagnosis.

The following case illustrates this: Ms. Schumann, 27, was brought to the acute psychiatric clinic with the emergency doctor after attempting suicide. Because she was heavily drunk, a proper conversation with the therapist was not possible. She was admitted to the addiction center and given medication for sedation and alcohol withdrawal. The second attempt at anamnesis took place 24 hours later; The attending doctor learned in a conversation with the woman that her fiancé had a serious accident five days ago, had been admitted to a hospital 300 km away, and the patient had no money for the train ticket to visit her fiancé. A year earlier, her mother had died of a tumor. Based on these findings from the anamnesis, the doctor stopped the drug therapy with psychotropic drugs and carried out four one-hour therapy sessions. After ten days she was able to discharge the patient and refer her to a resident psychotherapist for further outpatient treatment.

The conversation with the relatives

The doctor or psychotherapist often asks relatives to speak to them or telephones them. If possible, he will obtain the patient's consent beforehand.

On the one hand, the therapist would like to find out how emotional complaints affect everyday life and in the family; on the other hand, he needs information that the patient may not remember or that he himself cannot assess easily. However, since relatives often need advice and help themselves, it may also be necessary to offer them a confidential "one-on-one" meeting.

Discussions with relatives also serve to prepare for discharge in the event of inpatient treatment. The relatives can also be taught the necessary knowledge about how to deal with the disease (psychoeducation). This is particularly important in the case of addictions, but also in the case of eating disorders such as anorexia, so that the relatives stop supporting unintentional pathological behavior.

Tests and questionnaires

There are quite a number of so-called standardized ones psychological tests and questionnaires that the therapist can use to make a diagnosis. Some questionnaires capture more general symptoms such as anxiety, depressed mood, psychotic symptoms, and aggression. Others are more specific, such as questionnaires about alcohol use or eating disorders. The questionnaires are often used again at the end of the treatment to check the success of the therapy and to document changes.

Authors

Dr. med. Arne Schäffler, Gisela Finke in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 15:06