Indian Write-Ups

Worldwide at least 10-15% of indoor admissions are of psychiatric patients. Of all the long-term expenses of a hospital, nearly 30% is spent on psychiatric patients.

One of the most important factors which can really influence the success of treatment of psychiatric disorders is the ‘attitude’ of various people involved in patient care.

Attitude by definition is ‘like or dislike towards an object or person’. This includes how one feels towards a certain thing. In this context the feeling can be discussed in few parts, the sum of which may provide a better control of the world’s expenditure on psychological illnesses.

Attitude in this context is:

• Attitude towards psychiatric illness by
  • The patient and
  • His/her relative
• Attitude towards the treating doctor
• Attitude towards the treatment.
• Attitude of doctor towards :
  • Patient
  • Illness

Attitude of The Patient

Towards the psychiatric illness has a great significance.

• Some times the patients does not feel that this type of illness requires treatment
• Patient feels that it can be cured by faith healers.
• Some patients do not feel it necessary to take medicines for a long duration inspite of the advice of doctor.
• Often patient feels that psychiatric illness is caused by sin which causes guilt and thereby results in a lot of mortality.

Attitude of the Family Members

The attitude of the family members & especially the primary caretaker towards the illness also has great impact on the outcome treatment.

For example, relatives may believe that psychiatric illnesses are due to some curse. So, instead of taking medical help they opt for faith healers totally ignore the illness and begin to consider the patient a burden. This complicates the course of the illness and hampers treatment.

Attitude towards the treating Doctor

Lack of understanding between the doctor and patients or relatives often complicates the disease. This may happen due to lack of interpersonal communication between the patients and his relatives. Even a total dependence on the doctor can worsen the disease. Therefore the patient does not feel the need to change his behaviour and thinking pattern, believing that every thing will be taken care of by the doctor and medicines. Such attitude ultimately decreases the patients own effort in getting cured. So the long term effect is a decreased psychological and physical performance.

The attitude of the patient and 'relatives' towards treatment creates dilemmas as to whether the patients needs-

• Medicinal treatment, or
• Electrical treatment, or
• Psychotherapy.

Another question is how long the patient should get treatment. People have a rather adverse opinion about psychotherapy, not appreciating the fact that psychotherapy is major part of psychiatric treatment. Some illness like personality disorders, minor depressive illness, grief reaction, conversion disorders. Conversion disorders do not require any medicine if effectively managed psychotherapeutically.

At times the patient is reluctant to continue therapy, especially if medicines are required to be taken for a long time. This also generates negative feeling from the relatives about the disease which could further lead to deterioration of the condition. Another factor which complicates the disease process is poor results with medicines which can create negative feeling in patient and his relatives.

Suggestions

One of the major issues here is that the treating doctor should explain everything about the disease and the relatives and should always try to generate a positive attitude among people towards the illness.

Attitude of The Doctor

It has often been noted that even doctor have a very unrealistic attitude towards the treatment. This can create a hurdle in the treatment of the patients.

Lastly considering that a substantial proportion of patients (ranging from 15-50%) attending various medical and surgical setting have been reported to suffer from different psychiatric disorders, it is necessary for the patient to get psychiatric referral. However, such referrals are much lesser in number which in turn can significantly increase psychiatric morbidity. Based on a survey of published literature, both national and international in this field and also a study conducted by us in Delhi we find that the reasons for low psychiatric referral rates includes – missed diagnosis, confidence to treat psychiatric disorder among non psychiatric practitioner, doubts about efficacy of psychiatric treatment and an anticipated negative feeling from a patient, on being advised psychiatric consultation. If these factors are taken care of, psychiatric care will see newer milestones in the country.