Psychotherapy perspective of physicians and psychiatric patients
Memduha Aydin, Hulya Ertekin, Tahsin Etli, Hatice Yardim Ozayhan, Ibrahim Eren
Article No: 3   Article Type :  Research
Objective: In this study, we aimed to investigate the role of psychotherapy in healing and protection of mental health in integrated psychiatry and general medicine practice.

Method: This study is a cross-sectional study that was conducted in Konya Training and Research Hospital between dates May 2013 and July 2013. Data were collected by using 5-item questionnaires prepared separately for patients and doctors from internal medicine and surgical disciplines.

Results: The sample is consisting of 173 patients admitted to psychiatric outpatient clinic, 28 doctors from surgical and 89 doctors from internal medicine disciplines. Patients at psychiatric outpatient clinic believed that psychotherapy was an effective method for the treatment of psychiatric disorders, and knew that psychiatrists could apply psychotherapy, but thought that there was no sufficient time at outpatient clinics. No difference was determined between the doctors from internal medicine and surgical disciplines in tendency to ask support from psychiatrists for treatment of their patients (p=0.115). Doctors from internal medine disciplines had a higher proportion of belief that psychotherapy was as effective as medication treatments (p=0.038). No difference was determined between doctors from internal medicine and surgical disciplines in the belief that psychiatrists could provide psychotherapy service. Belief of applicability of psychotherapy at the outpatient clinic settings was higher among doctors from internal medicine than those from the surgical disciplines (p=0.038).

Conclusion: This study enabled us to assess the attitudes towards “psychotherapy” among patients and doctors from internal medicine and surgical disciplines.
Keywords : General practice, patients, physicians, psychiatry, psychotherapy
Dusunen Adam : The Journal of Psychiatry and Neurological Sciences : 2016;29:317-323
Full Text:

INTRODUCTION

Mental health does not just mean that there is no mental disease, but it is also the condition that an individual can cope well with normal life stresses with his/her individual resources; can provide balance, accordance, and satisfaction in his/her relationships networks; and it means to contribute to life productively (1). Psychotherapies which aim protection and development of health and treatment of mental problems, cause increased mental accordance by maturation of interpersonal relationships which will help individuals in solving emotional conflicts, and anxiety and tension arising from them (1-3).

When mental problems are mentioned, disorders which are observed biologically in brain neurochemistry and neuronal circuits are understood. In treatment of mental problems, these disorders are targeted, and changes occurred as a result of medical treatment can be shown by using cranial imaging examinations (3-5). It was reported that similar biological changes were determined in individuals who were treated by psychotherapy method without drug treatment as the ones treated by medications (6-9). Studies in this field indicated that psychotherapies were treatment methods affecting biological systems as drug treatment (10).

According to characteristics of mental state, psychotherapies may be with or without drug treatments. Currently, integrated model connecting pharmacotherapies with psychotherapies at the clinical practice is the most commonly used approach in treatment of mental diseases (11). Pharmacotherapy provides important benefits to patients, but high discontinuation rates of drugs, and low rates of drug compliance prevent to reach satisfactory treatment results (12,13). Recurrence rates are quite high after discontinuation of drug treatment. During chronic mental diseases in which patients should use preventive drug treatment, psychotherapy practices following acute period can help these individuals in continuing their well-being, and preventing from recurrences, as well as increasing treatment compliance (14-18).

Individual characteristics and cognition which deteriorate mental accordance may cause both mental and biological effects. Patients who apply to internal medicine and surgery clinics with complaints such as headache, dizziness, muscle skeletal system pains, dermatological problems, and gastrointestinal system disorders, and about whom no underlying reason has been determined, can be directed to psychiatry clinics, and they can receive necessary support (19-24).

Psychotherapeutic approaches have been more commonly used in recent years in other medical problems along with mental diseases. Psychotherapies in individuals with other medical diseases help them to accept the disease, manage the disease physically, and are evaluated as additional treatment option to decrease symptoms (25-27).

In our study, we emphasized the importance and necessity of evaluation of mental problems and diseases with other environmental and biological processes; we also aimed to investigate attitudes of doctors and patients about places of psychotherapies in treatment and prevention of mental health in current psychiatric and general medicine practices.

The aims of the present study were:

1)Evaluation of knowledge, expectations, and requests of individuals who applied to psychiatry clinics with mental health problems, on the subject that they may have psychotherapy apart from drug treatment and also along with drug treatment, within the scope of psychiatric treatment.

2)Evaluation of attitudes of doctors in surgical and internal medicine diciplines about directing their patients to psychiatrists, and their interest and knowledge levels in treatment by using psychotherapy method.

METHOD

The present cross-sectional study was conducted in Konya Training and Research Hospital between dates May 2013 and July 2013. Approval of the Local Ethics Committee of Selcuk University Faculty of Medicine was provided before starting the study (approval no 2013/209).

Data collection of the study was performed by using 5-item questionnaires prepared for patients and doctors from both internal medicine and surgical disciplines. Verbal and written consents of participants were obtained before initiation of the study.

Involvement measurements and questionnaire studies present in the literature were also reviewed during the study. After measurements developed in the literature were reviewed, the final versions of questionnaires were prepared by the joint decision of authors. No pre-application was performed.

The study population was selected among female and male patients who applied consecutively to general psychiatry outpatient clinic, and were examined by a psychiatrist to ensure that they have no mental retardation, or psychiatric disease or cognitive disorder which may cause incapacity in answering the questionnaire, and have intact reality evaluation and rationalization. The study doctor groups were consisted of specialists and assistant doctors.

Statistical Analysis

Statistical analysis of the present study was performed using SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, USA). Descriptive statistics were presented by number and percentages. Chi-square test was used to compare categorical data between the groups, if any of boxes of expected frequency table were smaller than five, Fisher’s exact test was used. The level of statistical significance was accepted at p<0.05.

RESULTS

The sample size of our study was composed of 173 patients who applied to psychiatry outpatient clinic, 28 doctors from surgical disciplines, and 89 doctors from internal medicine disciplines. Questionnaire results are given in Table 1 and 2. The evaluation of 173 patients who attended the outpatient clinic was performed with their answers as “I agree” or “I disagree” or “No idea” for the following statements “medications are the main effective treatment method in psychiatric diseases”, “psychotherapy method is at least as effective as medications in psychiatric disease treatment”, “psychiatrists may treat concomitantly with medications and psychotherapy or alone with psychotherapy”, “psychotherapy can be applied at the outpatient settings”, “longer time period than normal outpatient clinic examination time is required to perform psychotherapy at the outpatient settings”.

Of 28 doctors in the surgical disciplines, 32.1% (n=9) responded as “I agree”, 46.4% (n=13) as “I disagree”, and 21.4% (n=6) as “No idea” to the statement of “the main effective treatment model in psychiatric treatment is medications”. Of 89 doctors in the internal medicine disciplines, 29.1% (n=26) marked as “I agree”, 65.2% (n=58) as “I disagree”, and 5.6% (n=5) as “No idea”. Statistically significant difference was determine between both groups (χ2=6.957, p=0.031).

The statement of “psychotherapy is at least as effective as medications in psychiatric disease treatment” was marked as “I agree” at 75.0% (n=21), 3.6% (n=1) as “I disagree”, and 21.4% (n=6) as “No idea” by doctors from the surgical disciplines; whereas at 92.1% (n=82) as “I agree”, 2.2% (n=2) as “I disagree”, and 5.6% (n=5) as “No idea” by doctors from the internal medicine disciplines. According to the responses, it was determined that doctors from the internal medicine disciplines were convinced at higher rates than the ones in the surgical disciplines that patients might benefit from psychotherapy as much as medications, and the statistical difference was determined significant (χ2=6.519, p=0.038).

The statement of “psychotherapies are treatment methods that can be applied at the outpatient clinic settings” was marked at 17.9% (n=5) as “I agree”, 53.6% (n=15) as “I disagree”, and 28.6% (n=8) as “No idea” by doctors from the surgical disciplines; whereas at 43.8 (n=39) as “I agree”, 40.4% (n=36) as “I disagree”, and 15.7% (n=14) as “No idea” by doctors from the internal medicine disciplines. According to the responses, it was determined that doctors from the internal medicine disciplines were convinced at higher rates than the ones in the surgical disciplines that psychotherapies can be applied at outpatient clinic settings, and the statistical difference was determined significant (χ2=6.527, p=0.038).

DISCUSSION

The present study investigated semantic and expectation projections of “psychiatry and psychotherapy” concepts for patients and doctors from surgical and internal medicine disciplines.

As the result of our study, it was determined that more than half of patients with psychiatric diseases evaluated medications as the effective factor in psychiatric treatments. As majority of patients supported medications predominantly, it indicated that they did not have enough information in psychotherapies. On one hand, while patients prioritized medications, they indicated that psychotherapies were at least as effective as medications. These findings may indicate that patients have inadequate information about the issue leading to their unfavorable attitudes to psychotherapy, whereas they may sometimes lead to the perceptional tendency that psychotherapy is ideal method in all patients and diseases with rapid treatment response.

It was determined that patients knew psychiatrists might do psychotherapy concomitantly with medications or alone. However, patients have not frequently requested that they would like to get psychotherapy support during their examinations at the general psychiatry outpatient clinics. Patients might not tell their requests of psychotherapy, because they did not know psychotherapy, and they believed that they needed longer time periods for psychotherapy. Currently, the serious obstacles in front of psychotherapies are time pressure on clinicians, shorter time periods spared for patients and thus obligations of rapid treatment planning for doctors, as well as patient’s desire to receive a quick treatment plan. Supportive psychotherapy practices and short-term sessions for cognitive behavioral therapies, which could be applied in suitable conditions, at suitable time periods, and by competent therapists even for short-term might partially remove the obstacles in front of psychotherapies (28,29).

It was determined in our study that doctors from internal medicine and surgical disciplines had tendencies to request help in treatment of their patients from psychiatrists. Although number of patients directed from internal medicine and surgery clinics to psychiatry outpatient clinics have been increasing over time (25), it has not been observed at reported rates of questionnaires, yet. It was also decided that thoughts and concerns of patients directed to psychiatry outpatient clinics might be a preventive factor for majority of those patients to reach a psychiatrist. Besides, it was thought that doctors working in surgical and inter medicine disciplines suggested sometimes psychiatric treatments to their patients, and this might be a postponing factor for their applications at psychiatry outpatient clinics.

Doctors from internal medicine disciplines had higher comment rates that psychiatric support was not only medication, than doctors from surgical disciplines. Although doctors in both disciplines believed that psychotherapy was an effective treatment method, this belief was determined at higher rates among doctors from internal medicine discipline. It was decided that doctors from both disciplines had the knowledge that psychiatrists could do psychotherapy practices. However, the belief of performing psychotherapy at the outpatient clinic settings was lower among doctors from surgical disciplines than the ones from the internal medicine disciplines. Responses of both doctor groups to questionnaire questions indicated that they believed that psychotherapy was an ideal method. This was supported by the finding that half of doctors believed that psychotherapies could not be performed at the outpatient clinical settings. It is believed that both doctor groups’ tendency to perceive psychotherapy as a rapidly responding treatment method which can be performed in all patients and diseases when other treatments are unsuccessful, has a negative effect on the multidisciplinary approach.

Number of patients who are redirected to psychiatry from non-psychiatry disciplines are increasing because of inefficiency of other medical treatments (25). Providing psychotherapy support can have improving effects on quality of life of patients who have other medical conditions which are not classified in any classical diagnosis and classification systems or named by any psychiatric diagnosis (30). Many mental signs may be the clue of cause for diseases of the body, whereas many body signs may be the clue or cause for mental diseases. This circular relationship emphasizes the importance of collaboration of healthcare professionals from all disciplines.

The significance and place of psychotherapy practices have been gradually increased in solution of mental problems and treatment of mental diseases by the help of studies performed in this field. It has been shown in conducted studies that medication treatments alone were insufficient in treating and recurrence of diseases. These insufficiencies are experienced in clinical practice, so they underline the belief that psychotherapy service should be provided with medication treatment or alone, in suitable cases, in psychiatric treatments.

Individualized psychotherapy approaches should take their places in the current psychiatric practices to help patients who apply to psychiatry outpatient clinics to reach their targets in the most effective way. Generalization of trainings in this field will facilitate presentation of a trusted method for mental health service.

The most important limitation of the study is that it has reached a few number of patients and doctors. Further large sized, multi-centered studies which can represent their disciplines will provide more reliable information for our aims. Studies which help us to define routes and aims of integrated approaches, and to reach successful treatment results are required.

Conflict of Interest: Authors declared no conflict of interest.

Financial Disclosure: Authors declared no financial support.

REFERENCES

1.Yorukoglu A. Cocuk Ruh Sagligi, 35th edition, Istanbul: Ozgur Yayinlari, 1998.

2.Ozturk O, Ulusahin A. Ruh Sagligi ve Bozuklukları 2 Cilt, 11th edition, Ankara: Tuna Matbaacilik, 2008, 955-957.

3.Oncu B. Psikoterapiler. Ruh Sagligi ve Hastaliklari. Ankara: Ankara Universitesi Basimevi, 2014, 331-342.

4.Brody AL, Saxena S, Stoessel P, Gillies LA, Fairbanks LA, Alborzian S, Phelps ME, Huang SC, Wu HM, Ho ML, Ho MK, Au SC, Maidment K, Baxter LR Jr. Regional brain metabolic changes in patients with major depression treated with either paroxetine or interpersonal therapy: preliminary findings. Arch Gen Psychiatry 2001; 58:631-640. [CrossRef]

5.Singh MK, Garrett AS, Chang KD. Using neuroimaging to evaluate and guide pharmacological and psychotherapeutic treatments for mood disorders in children. CNS Spectr 2015; 20:359-368. [CrossRef]

6.Baxter LR Jr, Schwartz JM, Bergman KS, Szuba MP, Guze BH, Mazziotta JC, Alazraki A, Selin CE, Ferng HK, Munford P, Phelps ME. Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry 1992; 49:681-689. [CrossRef]

7.Furmark T, Tillfors M, Marteinsdottir I, Fischer H, Pissiota A, Långström B, Fredrikson M. Common changes in cerebral blood flow in patients with social phobia treated with citalopram or cognitive-behavioral therapy. Arch Gen Psychiatry 2002; 59:425-433. [CrossRef]

8.Linden DE. How psychotherapy changes the brain? The contribution of functional neuroimaging. Mol Psychiatry 2006; 11:528-538. [CrossRef]

9.Linden DE. Brain imaging and psychotherapy: methodological considerations and practical implications. Eur Arch Psychiatry Clin Neurosci 2008; 258(Suppl.5):71-75. [CrossRef]

10.Etkin A, Pittenger C, Polan HJ, Kandel ER. Toward a neurobiology of psychotherapy: basic science and clinical applications. J Neuropsychiatry Clin Neurosci 2005; 17:145-158. [CrossRef]

11.Riba MB, Balon R. Farmakoterapi ile Psikoterapinin Birlestirilmesinde Yetkinlik: Birlesik ve Ayrısık Tedavi. Topcuoglu V (Translation Editor) 1st ed. Ankara: Tuna Matbaacilik San. ve Tic. A.S., 2011. (Turkish)

12.Cobanoglu ZSU, Aker T, Cobanoglu N. Treatment compliance problems in patients with schizophrenia and other psychotic disorders. Dusunen Adam: Journal of Psychiatry and Neurological Sciences 2003; 16:211-218. (Turkish)

13.Savas HA, Unal A, Virit O. Treatment adherence in bipolar disorder. Journal of Mood Disorders 2011; 1:95-102. (Turkish) [CrossRef]

14.Soygur H, Celikel B, Aydemir C, Bozkurt S. The effect of psychodrama oriented supportive-training group psychotherapy with relatives of patients on progression of chronic schizophrenia. Dusunen Adam: Journal of Psychiatry and Neurological Sciences 1998; 11:5-11. (Turkish)

15.Cakir S, Ozerdem A. Psychotherapeutic and psychosocial approaches in bipolar disorder: a systematic literature review. Turk Psikiyatri Derg 2010; 21:143-154. (Turkish) [CrossRef]

16.Mackali Z, Tosun A. Cognitive behavioral therapy in bipolar disorder. Current Approaches in Psychiatry 2011; 3:571-594. (Turkish) [CrossRef]

17.Bilican FI, Ovul M. Integrative psychotherapy for a patient with delusional disorder persecutory type: a case study. Dusunen Adam: Journal of Psychiatry and Neurological Sciences 2012; 25:383-387. (Turkish)

18.Sungur MZ. The role of cognitive behavioral psychotherapy in treatment of bipolar disorder. Journal of Mood Disorders 2013; 3(Suppl.1):41-44. (Turkish)

19.Soykan A, Kumbasar H. Psychiatric interventions in chronic pain treatment. Klinik Psikiyatri Dergisi 1999; 2:109-116. (Turkish)

20.Kayacetin E, Uguz F. Psychiatric patients and irritable bowel syndrome. Turkish Journal of Academic Gastroenterology 2002; 1:74-76. (Turkish)

21.Yonal O, Sezgin U, Yucel B, Aktan M. Psychogenic purpura. Journal of Istanbul Faculty of Medicine 2008; 71:19-21. (Turkish)

22.Kröner-Herwig B. Chronic pain syndromes and their treatments by psychological interventions. Curr Opin Psychiatry 2009; 5:200-223. [CrossRef]

23.Balaban OD, Atagun MI, Ozguven HD, Ozsan HH. Psychiatric morbidity in patients with vitiligo. Dusunen Adam: Journal of Psychiatry and Neurological Sciences 2011; 24:306-313. [CrossRef]

24.Hubschmid M, Aybek S, Maccaferri GE, Chocron O, Gholamrezaee MM, Rossetti AO, Vingerhoets F, Berney A. Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks. Gen Hosp Psychiatry 2015; 37:448-455. [CrossRef]

25.Onur E, Yemez B, Polat S, Gurz NY, Cimilli C. Change in the preference of the psychotropic drugs and consultation liaison psychiatsu practice. Bulletin of Clinical Psychopharmacology 2007; 17:167-173. (Turkish)

26.Soylu C. Cognitive behavioral therapy in cancer patients. Current Approaches in Psychiatry 2014; 6:257-270. (Turkish) [CrossRef]

27.Anton S, Gugić D, Katinić K, Topić J. Efficacy of different psychiatric treatment methods of liaison psychiatrist in treatment of women with breast cancer. Coll Antropol 2015; 39:377-383.

28.Wright JH, Sudak DM, Turkington D, Thase ME. Kisa Sureli Seanslar icin Yuksek Verimli Bilissel Davranis Terapisi. Sungur MZ, Uguz S (Translation Editor) Ankara: Akademisyen Kitapevi, 2014. (Turkish)

29.Dewan MJ, Steenbarger BN, Greenberg RP. Bir Sanat ve Bilim Olarak Kisa Terapiler. Gokalp GP (Translation Editor) 1st ed., Ankara: Pelin Ofset Matbaacilik San. ve Tic. Ltd. Sti., 2012. (Turkish)

30.de Jonge P, Latour CH, Huyse FJ. Implementing psychiatric interventions on a medical ward: effects on patients’ quality of life and length of hospital stay. Psychosom Med 2003; 65:997-1002. [CrossRef]

SUBMIT AN ARTICLE
11th National Alcohol and Substance Abuse Congress
DUSUNEN ADAM BROCHURES
COVER
Creative Commons Lisansı

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Düşünen Adam - Psikiyatri ve Nörolojik Bilimler Dergisi
Bakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi
Yayıncı
Yerküre Tanıtım ve Yayıncılık Hizmetleri A.Ş.