Unfortunate stigma of psychiatrists

I find over and over again how helpful a good psychiatrist can be when trying to manage some of the negative behaviors that can show up when someone develops dementia.  I worked in geriatric mental health for 7 years and found that all these years later, there continues to be the stigma attached to anything mental health.  So many still believe anything mental health related is a matter of will power, especially those of the older generation who are now the prime age for developing dementia.

One of my residents with early dementia has been plagued by an underlying low level of agitation all the time.  Not only does this disrupt his relationships with residents and staff at the assisted living and his family members, but it has got to be distressing for him as well.  Fortunately, he has a wonderful family who is willing to seek out whatever help they can find.  Their situation reminds me how important personal choice and relationship is in any physician relationship.  They did not click with my favorite geriatric psychiatrist.  But they did try a couple and find one that both the resident and family members feel a better connection with.  I know with my mother, she was okay with the psychiatrist, although he made what she felt like was a criticizing comment.  My dad, on the other hand, felt like he was arrogant.  In my parents case, the psychiatrist made medication recommendations which the primary care physician not prescribes and follows.  Given their feelings about him and their positive relationship with the primary care physician, this is probably the best case scenario for them.  On the other hand, I have seen first hand a number of primary care physicians who are not specialists with psychiatric medications, much less the issues that effect the elderly, who really just blunder about with medications.  A specialist would be much more effective.

Not that I advocate "drugging" people up.  The most recent research verifies that the best approaches to manage typical dementia behaviors are lifestyle  and environmental changes.  I think anyone would agree that non medication changes are always the best first course.  However, I have also seen how effective a simple mood stabilizing medication can be in giving people a better quality of life.

One of the very positive outcomes I have seen with the Caregiver Support Group is the advocacy by family members for seeking out a psychiatrist for the treatment team.  A big thank you for the psychiatrists out there who seek to stay at the forefront of research on medications for seniors and seniors with Alzheimer's and dementia.  Even after all these years of trying to destigmatize mental health, I guess family members with positive experiences are still the best support for other caregivers struggling to find the best quality of life for their loved ones.