An approach to Psychological treatment

Enter your email address:

Get Goa News right in your mailbox!

Today people in India have begun to develop greater awareness about psychiatric problems and illnesses as against a decade ago and in turn seek assistance and treatment. Thanks to the efforts of mental health professional as well the media. But what exactly is psychiatric treatment?

Vast majority of people who seek psychiatric help take drug therapy. Hence it is popularly believed that psychiatric treatment constitutes taking medication that too for prolonged periods. This though not absolutely true, yet presently is not far from the practical situation in a lot of places in India .In more recent years people also seem to seek counseling which is in fact referred to as psychotherapy.

To understand what are the various forms of psychological therapies including psychotherapies and counselling one has to first be aware of how a psychological difficulty or problem is really diagnosed. In most fields of medicine one would diagnose a condition say diabetes and then advise treatment for it.

In psychological medicine however the process of diagnosis is quite different. According to the Diagnostic and Statistical Manual of American Psychiatric Association a psychiatric diagnoses is made on a multi-axial system consisting of 5 different axis. Each axis is designed to look at an important yet distinct facet of the individual or his problem .

On Axis I the doctor or therapist records the main psychological disorder eg depression or anxiety disorder, or substance dependence eg alcohol, heroin etc .If this was the only diagnosis, treatment options for it would be limited as the information obtained about the person too, is limited. Although the mainstay of therapy for a majority of conditions on this axis is drug therapy yet for conditions such Depression Cognitive behaviour therapy a form of short term psychotherapy, is found to be as useful as antidepressants and both taken together give better results than either of them alone. Some countries have special services for Dual Diagnoses wherein there are major psychological disorders such as psychoses along with Substance related disorders such as use of cannabis, amphetamine etc. which complicate the treatment of one another. Such specialized and exclusive facilities are presently not available in India.

Axis II is meant to record if the individual is also intellectually challenged and /or has any personality traits which are faulty or if a frank personality disorder exists.

Obviously presence of the first entity would certainly greatly influence the approach to be taken, in the treatment of the person, depending the degree of the intellectual disabilty. Now if the second factor i.e. any distinct personality traits, is present and the traits are considered maladaptive then it illustrates that the person is likely to have faulty or poor coping skills with problems he faces in day to day life. Now a mere prescription of a medicine such an antidepressant is not going to help such a person to overcome his psychological difficulties in their entirety .Such a person would certainly benefit from psychodynamic psychotherapy .

Axis III is meant to record the presence of any medical problems such as diabetes, high blood pressure , asthma etc. The doctor whether psychiatrist or any other can thus focus his attention to the adequate treatment of these conditions. He can also consider whether they are worsened by the psychological disturbance and stress and also whether the medical illness is contributing to psychological difficulties. To cite a few examples patients of hypothyroidism are more prone for Depression, a person diagnosed with cancer is likely to suffer from adjustment disorder and feel depressed, recent research shows that psychological difficulties are more in diabetics. Conversely psychological difficulties are likely to aggravate asthma or make control of blood sugar difficult in a diabetic.

A recent study by the WHO wherein 245,000 people were interviewed has revealed that Depression is a more disabling condition than angina, arthritis, asthma and diabetes. Researchers found that depression had the largest effect on worsening health. Dr Somnath Chatterjee of WHO said “The co-morbid state of depression incrementally worsens health compared with depression alone, with any of the chronic diseases alone, and with any combination of chronic diseases without depression.” “Better treatment for depression would improve people’s overall health” the researchers said in the Lancet. What is worse is that the main psychological disorder such as depression is very likely to be missed if it is not specifically looked for, thus making the outcome poorer for the patients with physical illnesses. To cite another example often ladies on treatment for polycystic ovarian diseases are referred for evaluation for depression . In such cases it would be worthwhile to screen them for depression prior to commencement of therapy as later the picture gets confounded whether the depression is related to the hormonal preparations they take or whether the distress is due to the disease itself or due to the knowledge of the diagnosis and its outcome.

Axis IV is used to report any psychosocial and environmental factors which may pose problems to the individual with regards to the diagnoses, treatment as well as the outcome. Factors under this category include a difficult life event, environmental deficiency or difficulty, educational problems, housing problems, economic problems, legal problems, a stressor in family or in other relationships, lack of social support, etc.

It is not uncommon that people come for evaluations complaining of stress or on requests of their physicians and on assessment one finds that there is no diagnosis on Axis I but yet they are distressed due to circumstances like unemployment , defiant adolescents, too strict parents, bullying in schools, unrealistic educational demands, death of family member, etc .In some of such cases counseling, family therapy, relationship and marital psychotherapy are useful while drug therapy may not be necessary. Further social work and assistance from welfare agencies if available are useful in cases where person is unemployed. When a person is unable to do activities such as budgeting , shopping, paying bills, etc services of a support worker, a social worker as well as occupational therapist who can provide regular visits at home to motivate and assist the person would help alleviate the persons distress significantly. Presently such facilities and therapies are difficult to find in India

Axis V is used to report the overall level of the individual’s functioning. This is useful in planning treatment, measuring its impact and also in predicting outcome. Eg if a person does not go out at all , or stops going to work and does not mix with any one it should be recorded as later an improvement can be easily noticed and conveyed to other therapists specially if more than one therapists or doctors are involved in his treatment.

Therapies which are useful in poor functioning persons are rehabilitation , social work, recreational therapy, and supportive psychotherapy. In patients who have very serious impairments such as not being able to wash ones clothes, have bath, speak and mix with others would require intensive rehabilitation imparted through supported accommodations and half way homes. Such facilities are currently not available in Goa

Following an assessment if the person has no problems then nothing is recorded on one or more axis. For example it may so happen that only on axis IV for there is problem such as conflict with office staff or school teacher but all the other axis are negative and the person is well balanced in which case the person or his parents would merely be counselled how to cope with that situation or remedy it if possible or avoid it. Thus psychological treatment is multifaceted and multimodal and the approach has to be tailor-made to suit the individual.


Dr. Ashutosh Prabhu Dessai
Dr. Ashutosh Prabhu Dessai MD (Website)
Consultant in Mental Health and Counselling
Former Consultant Psychiatrist Northland Health New Zealand
Taleigao Goa

contactus [AT] drashutoshprabhudessai.com
Mobile +91.9420162750

5 Trackbacks

  1. […] continues at Goa Blog brought to you by cancer.medtrials.info and […]

  2. […] Goa Blog added an interesting post today (An approach to Psychological treatment).Here’s a little bit of it:Axis III is meant to record the presence of any medical problems such as diabetes, high blood pressure , asthma etc. The doctor whether psychiatrist or any other can thus focus his attention to the adequate treatment of these conditions … […]

  3. […] approach to Psychological treatment December 31, 1969 4:00 pm ring worm medication diabetes Goa Blog put up a good read today.Here’s a quick excerpt:Axis III is meant to record the presence of […]

  4. […] rss@youtube.com (MedicalTourismCo) just wrote an article aboutHere’s a preview of it: […]

  5. By psychodynamic adjustment disorder on May 3, 2008 at 9:58 pm

    […] and illnesses as against a decade ago and in turn seek assistance and treatment. Thanks to thehttp://www.goablog.org/posts/an-approach-to-psychological-treatment/PEP Web – The Karolinska Psychodynamic Profile KAPP: Studies of …… and 2 had diagnoses of […]

Post a Comment

You must be logged in to post a comment.