Conditions & Treatments

I have been practicing psychiatry in the community since 1981. In the near thirty years that I have been in practice, I have had the pleasure of treating many patients with many different diagnoses and problems.I wish to give some examples and concepts regarding some of the disorders that I have treated in the past. 

 

Anxiety Disorder and Panic Disorder have been frequent visitors to my office.  The way these disorders are treated has changed from the early 80's to today. Today we have more cutting edge treatment which involves newer forms of medicines and also there are newer forms of therapy to help with the panic disorder and anxiety spectrum disorder diagnoses. These therapies include cognitive behavioral therapy as well as analytic psychotherapy as well as hypnosis and stress management techniques. 

 

Depression has been one of the main problems that patients seek out treatment in psychiatry in the modern age. We have had a rapid change in the medications that we use from the older style medications into the newer era which was launched by Prozac.  However, we are now about to launch into an even newer arena where the selective seritonin re-uptake inhibitors will become the past as newer agents and newer modes of medication treatment are on the horizon in the next year. There is also newer forms of psychotherapy to deal with depression in the family using things such as family focus therapy which involves having family members or a family member as a co-therapist with the therapist to help with the basically cognitively oriented psychotherapy to deal with the beginnings of depression and later on there are more dynamically oriented psychotherapies to change things in a person’s life so that they do not get back into areas that got them into trouble in the first place. 

 

Attention Deficit Disorder with or without hyperactivity has become a very sensitive issue in our times.  The issues around medications to use or not to use are very critical as we have come to know that some of the medications we use can also be toxic in certain ways and especially for certain kinds of patients, for example those patients who might have issues with either substance abuse or with cardiac problems may have more difficulty with stimulant type medication.  We also know that these patients suffer from a lot of impulse control issues and need to at least have some attention at least one time per month where they talk to someone to review the areas in their lives where they have gotten into difficulty. This turns out to be a very important part of the relationship between the psychiatrist and the patient with attention deficit disorder.  
 

Obsessive Compulsive Disorder has been a rapidly rising diagnosis in America today. There are a number of patients where obsession and obsessive thinking are truly something that is counter-productive to a normal lifestyle.  These patients respond very well to cognitive behavioral therapy as well as to simple psychotherapy of a supportive nature.  They also respond very well to the medications that we have to offer them at this time.  Many of these patients also have other diagnoses which need to be figured out and treated at the same time.  And this concept of co-morbidity actually applies to all of the diagnoses that we’re talking about.

Substance Abuse Disorders are other areas that need twelve step type programs is another area of expertise that I have worked with over the past twenty-eight years or so.  These patients go to AA, some of them go to Gamblers’ Anonymous, and some of them go to Overeaters Anonymous, and so on.  There are approximately now 150 twelve step programs.  Working with these patients in terms of their twelve step program as well as their life and their co-morbid diagnoses where they may need medications and support is very critical.  Many of these patients as well as needing twelve step assistance and simple supportive psychotherapy, need family focus psychotherapy and analytic dynamic psychotherapy. 

 

Delusional Disorder is another rising form of diagnosis in our society today.  These patients suffer from having fixed false beliefs of various kinds whether it relates to their different kinds of somatic complaints that they may have thinking they may have illnesses they don’t have or thinking that someone or something is out to get them.  These patients often respond to a small amount of medication and respond very well to supportive and minor dynamic psychotherapy.

 

Eating Disorders - The most critical issues we face in our society today involve eating disorders, both anorexia and bulimia are the mainstay of what we consider eating disorders.  However compulsive overeating is not far behind and is a much bigger problem.  In America today, obesity is perhaps the single most epidemic disease our country faces.  The treatments that are being developed for these eating disorders are increasing besides medications and old forms of psychotherapy and dynamic psychotherapy we also have twelve step programs coming to be involved so that there is a multi-system approach to these diagnoses which needs to be applied. 

 

Bipolar Disorder is one of the older mainstream diagnoses in psychiatry that needs to be made and these patients need to be treated as quickly as possible. These are people who have a mood problem. They have ups and downs.  Their ups may have only been for a short period of time but they are different than patients with other disorders we have mentioned.  People with bipolar disorder need to be on medications for their mood instability.  They need to have special attention paid to their medical condition as well as supportive issues in their psychotherapy and their psychotherapy needs to be tailor- made to issues in family work and relationships.

 

Post Traumatic Stress - Another mainstay in psychiatry today has to do with post traumatic stress disorder, grief reactions, and stress in general.  In these areas for the most part are psychotherapy arenas but they also require medications at times for shorter periods of time.  It is very important that these areas get treated as untreated they can lead to both substance abuse problems, medical problems, as well as more serious psychiatric problems.

 

Movement Disorders are a smaller area of concern that I have had to deal with in my practice. Most recently we have started treating more people with periodic limb movement disorder or restless leg syndrome.  These are also sleep disorders for the most part and interfere with people trying to get the right amount of rest so that they can function well during the day.  These fall in kind of the  broad arena of disorders that are between neurology and psychiatry and need very careful attention to the behavioral concepts that become involved in people’s needs during their ability to function on a daily basis as well as careful attention needs to be paid to the diagnostic issues in any sleep disorder.  We are developing new medications for these problems and it is good that we will be able to treat these problems in a better fashion very shortly.


Marriage & Family - I have spent a lot of time in my practice treating people with marriage and family problems.  These problems relate to discord between partners as well as issues of families where there are step-children or there is a second or third marriage and problems relate to the different families trying to organize themselves together into a new family.  I have dealt with this in terms of doing family therapy with these families and we have worked with everybody in the family in the room at the same time.  There has been a lot of success by being as open and as honest as we can with the problems and then finding solutions to the problems.


Sexuality and Relationships
between partners has been a major concern in my practice.  I have dealt with the sexuality of partners of the same sex as well as opposite sex in terms of finding solutions to the difficulties that people face with their sexuality and with their ability to be intimate with one another.  These areas of concern primarily consist of dynamic psychotherapy between the members of the relationship. 
 

Sleep Disorders have become more prevalent in our society today, the most common being obstructive sleep apnea.   While we have ways of increasing the amount of oxygen a person may receive even though they are using a C-PAP machine, they may continue to have problems with being sleepy during the day.  We have medications that have been significant in changing those problems as well as helping people through educating them about their problems so that they can function better during the day.  

 

Pain Management Pain Management - One of the other major areas where I have written a couple of chapters on, as can be seen in my CV, has to do with pain.  Pain is a very interesting phenomenon in our society today in that we face many issues regarding pain.  We have the diagnoses that cause the pain that need to be treated. We have diagnoses that are mostly psychiatric that the pain can cause.  We have information that pain
medications, and the reactions to them and, the diagnoses that are being treated by these pain medications may lead to addiction issues that need to be treated.  There is also the secondary gain involved in all of these areas that patients may face and may interfere with their normal lifestyle.  I have dealt with all of these areas and we have had good success. 

 

There have been a vast number of neurological and medical conditions where there are behavioral overlay that have occurred in my practice whether the patients had diagnosis of aids, myasthenia gravis, multiple sclerosis or muscular dystrophy.  We have dealt with both the behavioral overlay that occurs with any medical diagnosis and we have dealt with the specific psychological and psychiatric syndromes that have occurred because of these diagnoses.  This is especially true when there are unanswered questions between internal medicine, neurology, and psychiatry and it is up to the psychiatrist to play the one who gets all the communications between all these fields done as quickly and as easily as possible.  A major problem where this occurs is when patients have heart problems and they feel quite afraid and alone.  It is the psychiatrist who can play the most important role for them getting over the issues they face as well as dealing with their cardiologist and internist to bring them back into a level of high function.   

 

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