However, main problem is with “psychotropic mythologists;” those who take things to extreme. Members of this camp would have resident INITIALLY taking various medications possibly brimming with side effects that may interact with other meds that most residents take; this often makes clinical cause and effect issues very murky. Sometimes, you end up wasting time fussing with dosages, addition of other medications, titration of others, withdrawing of others, chasing down causes of additional symptoms and addressing frequent complaints of family members about over-medication. Phew!

The initial goal should be to quickly address relevant areas causing distress and to identify and “cue” overlooked strengths. The therapist should build rapport as quickly as possible and begin addressing problem areas and highlighting strengths. Thru this process resident gets to experience precious commodity of sharing his/her most private thoughts and feelings with therapist. This creates a feeling of being valued by resident which is ripped away with medication-only treatment. As resident begins to resolve issues through conversation, his/her learning accelerates and powerful self-esteem is acquired because of credit that s/he can take by contributing to successful process of “healing.” While medication is frequently helpful, none of these more personal and “substantive” benefits can accrue without use of psychotherapy and other behavioral techniques.

Their Prejudice Shows In most cases, writers of these articles betray their bio-medical prejudices within their own writings. They do this by advising professionals to INITIALLY use most inefficient side-effect prone methods for treating a psychiatric symptom. They do this WITHOUT EVEN ONCE MENTIONING time-tested relatively risk-free option of psychotherapy or other behavioral treatments. If they really knew what they were talking about, they'd mention all viable options, with least risky ones (which includes psychotherapy) mentioned first.…all while presenting medication strategy as a simple one with no problems attached other than just taking a pill or two every night.

Bull...deep substantive psychological recovery involves work, give-and-take, overcoming resistance, talking about unpleasant things and often pure exhaustion. To get deepest and best results, one must use methods and processes that are considerably more sophisticated than… JUST, “…here are your pills for tonight...”

Again, if they took time to see deeply into patients, rather than just prescribing something “off- -cuff,” they'd take time to consider and present all manner of treatment methods possible, suggest using safest methods first and convey that to their readers. Experience and open-mindedness makes a difference We can manage your mental health program properly. We know how to identify and treat troubled residents promptly and we maintain an attentive contact that will keep your potentially troublesome families at bay.

Triggers for referral for a psychological evaluation include symptoms that have continued for more than two weeks or significantly impair functioning, life quality or participation in prescribed treatment programs. The role of heart doctors in detecting psychological problems in their patients who are long term care residents is a big problem. They often don't have time because of new emphasis on quick turnaround and high productivity. That places onus squarely on long term care staff who see resident every day.

One remedial protocol to identify residents who really need help might be for nurses and other staff members to help screen residents before they meet with their cardiologists. Neglecting identification and treatment of psychological symptoms in residents with heart disease is very unfortunate because doctors now have effective tools to treat psychological problems, which might lead to a lessening of both psychological distress and cardiac dysfunction.

Copyright 2005, M. Shery http://www.nursinghomes.md/