ALAN D.
KOENIGSBERG, M.D.
PRIVATE
PRACTICE OF ADULT PSYCHIATRY
1.
How do I know if I need Psychiatric Treatment?
Use
the same criteria as for any other general medical or surgical
concern:
If you're not feeling well, and the problem has lasted for
several
days or weeks and not gotten better, call for an appointment.
2. What are common symptoms of “Everyday
Psychiatric Conditions?”
Typical
symptoms are anxiety, excessive worrying, obsessional thoughts
that
won’t go away and interfere with functioning, compulsive behaviors
that
interfere with daily functioning, depressive mood that lingers, too
much
or too little sleep, excessive fatigue, change in appetite, lack of
motivation,
crying that won’t stop, decreased sexual drive, thoughts of
suicide,
lack of concentration, inability to make decisions.
3.
What are these symptoms typical of?
The
Anxiety disorders include Panic Disorder, Agoraphobia,
Post-Traumatic
Stress Disorder, and Obsessive-Compulsive Disorder.
Depressive
symptoms may be a result of normal grieving, Major
Depression,
Dysthymia (a more moderate form of Clinical Depression),
Bipolar
Disorder (BPD, formerly known as Manic Depressive Disorder).
Chronic
or long standing difficulties with attention, more problematic
than
anxiety or mood swings can be a result of Attention Deficit
Hyperactivity
Disorder, or ADHD.
It’s
also important to remember that many of these symptoms can result
from
other general medical conditions, such as fatigue from low thyroid
or
diabetes, depressed mood from prescription medications, and poor
attention
due to external stressors. That’s why
Psychiatrists do a
comprehensive
initial consultation—to clearly determine the causes of a
particular
set of symptoms before recommending a treatment plan.
4.
What kinds of treatments are available?
Treatment
always results from a rational understanding of the causes of
the
symptoms and the individual patient’s preferences. If a general
medical
condition is at cause, referral to a Family Physician or
Internist
is often recommended. If Biofeedback or
similar treatment is
best,
usually a referral to a Psychologist specializing in that
treatment
is made. Sometimes, Physical Therapy
may be recommended for
various
muscle pains.
Most
treatments can be considered either some form of medication
treatment
or some form of psychological treatment:
Medications used in Psychiatry are quite
similar to those used in other
fields
of medicine and surgery. Some are used
primarily for symptom
treatment,
as with a sleeping pill for occasional insomnia. Others are
used
for a specific event, such as a medication for anxiety when an
individual
has an intense fear of public speaking or flying.
Often, medications used to treat depression
and anxiety are taken once
or
twice daily for three to six months, and then re-evaluated. Some may
be
tapered and stopped, others continue to be taken regularly, much as
with
diabetes, thyroid disorders or high blood pressure.
The medications are remarkably safe and well
tolerated. The ones
available
now are much safer, have fewer side effects, and are more
specific
than have been available in the past.
The goal of treatment is to achieve a state
of being well. With time,
judicious
adjustments of the medications, and open communication between
the
patient and psychiatrist, most patients achieve this.
Psychotherapy is a form of treatment
where unresolved conflicts are
brought
to a person’s awareness. Weekly therapy
sessions are set at the
same
time every week, and a routine is established.
The patient comes
in
each week and brings up what comes to mind, and the Psychiatrist
helps
the patient become aware of his or her blind spots. This enables
the
patient to work through difficulties in dealing with current day
life. Often, repetitive troubles that one
encounters as an adult are
the
result of not being aware of what is buried beneath the surface.
This
does not imply that one had bad parenting.
What is does mean is
that
we may be unconsciously or unintentionally re-enacting patterns we
learned
as children in our everyday life with other adults. Sometimes
these
patterns help us be successful, and sometimes these patterns are
self
sabotaging.
Psychotherapy is usually once or twice
weekly and generally lasts
between
six months and one year. Some people
may finish sooner, others
may
want more time. It’s like taking piano
lessons or learning a
foreign
language; it takes a while to become proficient, and is well
worth
the time and effort.
5. How do I make an appointment?
Call and leave your name, telephone number
and a very brief idea
of
what you need help with (if you can) and a good time to have your
call
returned. The actual initial
consultation lasts about an hour and
a
half (90 minutes).
6.
What actually happens during that first appointment?
Dr. Koenigsberg will come out into the
waiting room to greet you,
and
ask you to fill out a face sheet with some basic information. When
you're
done, you go into his office and the hour and a half goes by very
quickly. You'll be asked to tell him what brings you
in, what kinds of
symptoms
are troubling you. After a while, he’ll
begin to ask specific
questions
about your medical history, current medications, a detailed
family
history, and so on.
When he’s asked all his questions, he’ll
ask you add anything else
that
might be helpful. He’ll then pull all
the information together and
offer
a diagnosis, explanation of causes, and treatment options. Both
you
and he will work out a plan to get you well.
Almost everyone
comments
on how it was much less stressful than they had expected.
7.
How do follow-up appointments work?
If
medication treatment alone is the preferred option, generally
follow-up
is in four weeks. Once a person is
well, appointments may be every three
months
for as long as treatment is necessary.
If psychotherapy is indicated, an appointment
schedule is discussed to
meet
weekly. If both medications and
psychotherapy are indicated,
regular
appointments are made for therapy, and medications are discussed
as
needed.
8.
What about confidentiality?
All
notes are kept in a binder, nothing is done electronically. All
communications
are personal and confidential, which means Dr.
Koenigsberg
will not discuss any aspect of your treatment without your
request
and permission. You are welcome to
email him, and many patients
find
this very useful between visits. Keep
in mind, though, if this is
done
in a work place, the employer may have access to those emails.
Last revised: Saturday, November 6, 1999